Peer victimization and suicidality among LGBTQ youth: the roles of school belonging, self-compassion, and parental support - Hatchel, T.; Merrin, G.J.; Espelage, A.D. (Journal of LGBT Youth, 2019)
Research on lesbian, gay, bisexual, transgender and questioning (LGBTQ) youth’s experiences at school has largely focused on stigma, adversity, disparities, and peer victimization. Factors like school climate, individual differences, and social support have also garnered significant attention. However, there has been a dearth of research examining how they relate to both suicidal ideation and suicide attempts. Our goal was to bolster the extant literature by examining the protective role of parental support and psychological mechanisms like school belonging and self-compassion among LGBTQ youth struggling with peer victimization and suicidality. A cross-sectional study was completed with a sample of 934 LGBTQ high school students. Structural equation modeling was employed to analyze direct and indirect effects. Peer victimization was positively associated with both forms of suicidality and negatively associated with school belonging and self-compassion. Psychological processes varied in their in prediction of suicidal ideation and attempts. Parental support did not moderate pathways between victimization and processes, but was associated with diminished suicidality and improved school belonging. Our findings illustrate the critical nature of further developing our understanding of the complexities of suicidality. School programs and interventions that are designed to cultivate belonging, self-compassion, and parental support may prove to be especially beneficial for victimized LGBTQ youth who struggle with suicidality. © 2018, © 2018 Taylor & Francis Group, LLC.
Keywords: bullying; LGBTQ youth; mental health; school connectedness; social support; suicide

Coming out in Mainland China: A national survey of LGBTQ students - Wei, C.; Liu, W. (Journal of LGBT Youth, 2019)
This study examined the school experience and its association with the mental health of lesbian, gay, bisexual, transgender, and questioning (LGBTQ) students in Mainland China. From 29 Chinese provinces/municipalities, 732 LGBTQ students (Mage = 20.7 ± 2.5) completed an online survey based on the Supporting LGBT Lives study. The findings revealed that most Chinese schools were not inclusive for LGBTQ students. Despite the lack of support of very few LGBTQ-specific school policy, teacher training, and curriculum reported by students, the majority of LGBTQ youth felt safe living and learning at school. As well, most LGBTQ students felt comfortable about their sexual orientation and had come out to someone; however, the majority remained closeted with their siblings, parents, or teachers. Furthermore, Chinese LGBTQ students were at great risk for psychological distresses—about 85% of them felt depressed and around 40% had suicidal thoughts. Having a more inclusive school climate and more school resources, especially a positive LGBTQ role model, were significantly associated with the reduction of LGBTQ students’ suicidal ideation. Given these findings, the authors strongly recommend further research, development, and implementation of robust LGBTQ-specific policy, training, and counseling be implemented immediately to improve the lives of Chinese LGBTQ youth. © 2019, © 2019 Taylor & Francis Group, LLC.
Keywords: coming out; LGBTQ students; Mainland China; mental health; School climate

Risk and Protective Factors for Self-Harm in a Population-Based Sample of Transgender Youth - Taliaferro, L.A.; McMorris, B.J.; Rider, G.N.; Eisenberg, M.E. (Archives of Suicide Research, 2019)
This study sought to identify factors distinguishing transgender/gender non-conforming (GNC) adolescents across three groups: no self-harm, non-suicidal self-injury (NSSI) only, and NSSI and suicide attempt (NSSI + SA). Data were from the 2016 Minnesota Student Survey. The final analytic sample included 1,635 transgender/GNC students in grades 9 and 11. Logistic regression analyses determined factors that best distinguished transgender/GNC students who reported self-harm (NSSI only or NSSI + SA) from those who reported no self-harm, and transgender/GNC adolescents who reported NSSI + SA from those who reported NSSI only. Final models were developed over 3 stages of analysis that tested associations of variables within risk factor, protective factor, and health-risk behavior domains to self-harm. Over half (51.6%) of transgender/GNC adolescents reported past-year self-harm behavior. Factors that consistently distinguished transgender/GNC youth who reported self-harm from those who reported no self-harm included reports of a mental health problem, depression, running away from home, and substance use (alcohol or marijuana use). Factors that distinguished the NSSI + SA group from the NSSI only group were reports of a mental health problem, physical or sexual abuse, relationship violence, bullying victimization, less parent connectedness, lower grades, lower levels of perceived school safety, and running away from home. Clinicians and school personnel need to be prepared to address risk factors and enhance protective factors that may reduce the likelihood this population of vulnerable youth will engage in NSSI and/or attempt suicide. © 2018, Copyright © International Academy for Suicide Research.
Keywords: adolescent; self-harm; self-injury; suicide; transgender

Victimhood, truth and criminal justice failure in relation to anti-homosexual violence and killings in New South Wales - Tomsen, S.; Kirchengast, T. (Current Issues in Criminal Justice, 2019)
This paper discusses and analyses the consequences of the inadequate criminal justice response regarding victims of fatal anti-homosexual/transgender violence in New South Wales (NSW) in the late twentieth century, and subsequent developments and claims that have either continued or resisted this pattern. It outlines the complexities around key investigations into unsolved homicides dismissed as accidents, suicides, or low priority killings, with the possibility that these classifications are related to a view of homosexual/transgender victims as unworthy of full state attention. The next challenge is moving beyond the individualistic frame of understanding victimhood in crimes targeting members of these minority groups, and any naïve faith that existing pro-victim measures alone will result in systemic openness and equal treatment. The authors suggest that attempts to clarify victim’s legislative rights, enhanced opportunities to recount victim experience, a consolidation of the Coroner’s investigative role, and establishment of a related expert “death review” team, are all worthwhile goals. Finally, we stress that an open NSW Police apology over inadequate past investigations, as well as the promise to seriously re-investigate unsolved cases, are a fair expectation that could also serve to foster victim healing in relation to these crimes. © 2019, © 2019 Sydney Institute of Criminology.
Keywords: Hate Crime; Homicide; Victimhood; Victims; Violence

Stigma and suicide risk among the LGBTQ population: Are anxiety and depression to blame and can connectedness to the LGBTQ community help? - Kaniuka, A.; Pugh, K.C.; Jordan, M.; Brooks, B.; Dodd, J.; Mann, A.K.; Williams, S.L.; Hirsch, J.K. (Journal of Gay and Lesbian Mental Health, 2019)
LGBTQ individuals may be at risk for suicidal behavior due to perceived stigma and psychopathology. However, protective factors, such as community connectedness, may reduce risk. We examined depression and anxiety as mediators of the linkage between perceived stigma and suicidal behavior, and the moderating role of LGBTQ community connectedness. Among our sample of LGBTQ persons (N = 496), psychopathology mediated the association between perceived stigma and suicidal behavior. Connectedness moderated the relation between perceived stigma and depression, and between perceived stigma and suicidal behavior in the anxiety model. Therapeutically addressing stigma and promoting LGBTQ community connectedness may reduce risk for suicidal behavior. © 2019, © 2019 Taylor & Francis Group, LLC.
Keywords: Connectedness; LGBTQ; perceived stigma; psychopathology; suicide

Autoethnographic poetic inquiry: therapeutically engaging with violence toward queers - Teman, E.D. (Journal of Poetry Therapy, 2019)
Therapeutic applications of poetry provide a powerful means of exploring and portraying lived experiences of queer individuals. In this article, autoethnographic poetic inquiry is used to explore the author’s life. Bullying, suicide, moments of strength and weakness, othering, and stifling of voice are some of the issues explored through this poetic journey. The author reflects on each of the poems he has written and roots such explorations in methodological literature of arts-based qualitative research. The overall purpose of the article is to document parts of the author’s life as he demonstrates how poetry has begun to help him heal. Through the act of writing poetry and reflecting on the meanings of said poems, the author takes the reader on a journey through his therapeutic healing process. © 2019, © 2019 National Association for Poetry Therapy.
Keywords: Arts-based research; autoethnography; othering; poetic inquiry; queer

Suicides Among Lesbian and Gay Male Individuals: Findings From the National Violent Death Reporting System - Lyons, B.H.; Walters, M.L.; Jack, S.P.D.; Petrosky, E.; Blair, J.M.; Ivey-Stephenson, A.Z. (American Journal of Preventive Medicine, 2019)
Introduction: Information regarding the epidemiology of suicide among lesbian and gay male individuals is limited, and comprehensive information is needed. This study seeks to describe the characteristics and precipitating circumstances of suicide among lesbian and gay male decedents when compared with non-lesbian and non-gay male decedents. Methods: An analysis was conducted of National Violent Death Reporting System data from 18 U.S. states for the years 2003–2014. Sociodemographic characteristics and precipitating circumstances of suicide among lesbian and gay male decedents were compared with non-lesbian and non-gay male decedents. Logistic regression analysis was conducted to examine the association between precipitating circumstances and suicide by sexual orientation. The analysis was conducted in December 2017. Results: There were a total of 123,289 suicide decedents from 18 states participating in National Violent Death Reporting System during 2003–2014; of those, 621 (0.5%) were identified as lesbian, gay, bisexual, or transgender. The majority of lesbian, gay, bisexual, or transgender decedents were identified as gay male (53.9%), followed by lesbian (28.0%), transgender (10.4%), and bisexual (7.5%). The analysis revealed several differences by age, mechanism of injury, and precipitating circumstances, including intimate partner problems among lesbian decedents, suicide planning and intent for both lesbian and gay male decedents, and mental health problems among gay male decedents. Conclusions: Findings highlight differences in the characteristics of suicide among lesbian and gay male and non-lesbian and non-gay male decedents. It is important for suicide prevention efforts to be culturally sensitive and consider the needs of sexual minority populations. © 2018

Minority Stress and Relational Mechanisms of Suicide among Sexual Minorities: Subgroup Differences in the Associations Between Heterosexist Victimization, Shame, Rejection Sensitivity, and Suicide Risk - Mereish, E.H.; Peters, J.R.; Yen, S. (Suicide and Life-Threatening Behavior, 2019)
Despite sexual orientation disparities in suicide, there is limited research examining factors associated with suicide risk among sexual minorities while considering subgroup differences within this group. This study identified differences between sexual minorities at risk for suicide and those not at risk. The study also examined heterosexist victimization, as one form of minority stress, and two relational mechanisms (i.e., shame and rejection sensitivity) as risk factors for suicidality. We examined a moderated-mediation model, in which we tested gender and sexual orientation differences in the mediating effects of the relational mechanisms on the association between heterosexist victimization and suicide risk. Participants were recruited online and completed an online survey. The sample included 719 sexual minority adults. Of the sample, 27.7% were at risk for suicide. Suicide risk varied by age, gender, sexual orientation, income, education, and relationship status. Heterosexist victimization, shame, and rejection sensitivity were significant risk factors for suicide. Shame and rejection sensitivity were mediators of the association between heterosexist victimization and suicide risk for subgroups of sexual minorities, mostly lesbian and gay individuals and to some extent bisexual individuals. The findings underscore minority stress, shame, and rejection sensitivity as key intervention points. © 2018 The American Association of Suicidology

Suicidality Among Gay and Bisexual Men in Taiwan: Its Relationships with Sexuality and Gender Role Characteristics, Homophobic Bullying Victimization, and Social Support - Wang, P.-W.; Ko, N.-Y.; Hsiao, R.C.; Chen, M.-H.; Lin, H.-C.; Yen, C.-F. (Suicide and Life-Threatening Behavior, 2019)
This study aimed to examine the associations of suicidality in emerging adulthood with time of coming out, gender role nonconformity, sexual orientation, traditional and cyber homophobic bullying victimization, and family and peer support during childhood in gay and bisexual men in Taiwan. The frequency of “experiencing suicide ideation” and “attempting suicide” in the past year among 500 gay or bisexual men was examined. The participants’ time of coming out, level of subjective masculinity, sexual orientation, experiences of traditional and cyber homophobic bullying victimization, and levels of family and peer support during childhood were also evaluated. In total, 31% (n = 155) of participants reported experiencing suicide ideation (n = 82) or attempting suicide (n = 73). Early coming out, traditional homophobic bullying victimization, and low family support during childhood increased the risk of suicidality in emerging adulthood; by contrast, family support did not moderate the association of early coming out or traditional bullying victimization with current suicidality. A high proportion of participants reported experiencing suicide ideation and attempt in emerging adulthood. Hence, effective suicide prevention is required for gay and bisexual men. Suicide prevention programs should consider time of coming out, traditional homophobic bullying victimization, and level of family support. © 2018 The American Association of Suicidology

Are Developmental Assets Protective Against Suicidal Behavior? Differential Associations by Sexual Orientation - Toomey, R.B.; Syvertsen, A.K.; Flores, M. (Journal of Youth and Adolescence, 2019)
Sexual orientation disparities in suicide behavior are well-documented. Yet, few studies have examined how developmental assets – key values, self-perceptions, skills, relationships, and opportunities that have been identified as the building blocks of positive youth development – are associated with suicide behaviors, particularly among sexual minority youth. This study examined concurrent associations between young people’s developmental assets and suicidal behavior by sexual orientation using a large sample of 116,925 in-school U.S. adolescents (ages 11 to 19, M = 14.74, SD = 1.78). Most of the sample identified as only heterosexual (90.2%); 5% identified as mostly heterosexual, 3.5% as bisexual, 0.6% as mostly lesbian/gay, and 0.7% as only lesbian/gay. Most participants identified as White, non-Latina/o (62.6%) and as cisgender female (50.3%) or cisgender male (47.8%). Compared to only heterosexual adolescents, youth with all other sexual orientations reported lower levels of internal and external developmental assets except for non-sports extracurricular activity participation and social justice values. Identifying as a racial/ethnic minority, particularly for only heterosexual adolescents, and specifically as Latina/o for sexual minority adolescents was associated with greater risk for suicidal behavior. Further, identifying as a gender minority exacerbated risk for suicidal behavior. Relatedly, when youth reported feeling unsafe with their family, or in their school or neighborhood, they were at greater risk for suicidal behavior, regardless of sexual orientation. Feeling hopeful was associated with lower risk for suicidal behavior for all youth. Regardless of sexual orientation, planning and decision-making skills were associated with lower risk and social-emotional skills were associated with heightened risk for suicidal behavior. School boundaries and social justice values were associated with lower risk for suicidal behavior among bisexual adolescents; there were no additional protective assets for mostly/only lesbian/gay adolescents. In conclusion, sexual orientation disparities exist in the lives of adolescents for several internal and external developmental assets. Disparities in suicidal behavior by sexual orientation, however, were largely unexplained by differential associations between developmental assets and suicidal behavior. © 2018, Springer Science+Business Media, LLC, part of Springer Nature.
Keywords: Developmental assets; Positive youth development; Sexual orientation; Suicidal behavior

Disability, sexual orientation, and the mental health outcomes of intimate partner violence: A comparative study of women in the U.S. - Coston, B.M. (Disability and Health Journal, 2019)
Background: Research on disabled non-heterosexual women's post-intimate partner violence mental health outcomes—such as anxiety, depression, suicidal ideation, and alcohol use—is lacking. Objective: To examine the impact of the intersection of disability and sexual orientation on women's post-intimate partner violence mental health outcomes: including difficulty sleeping, missing school or work, or reporting some post-traumatic stress disorder symptomology and a self-reported subjective measure of overall wellbeing. Methods: Data come from the National Intimate Partner and Sexual Violence Survey (2010). A series of chi-square analyses were conducted (applying standardized sample weights and adjusting standard errors for both clustering and stratification for survey data). Results: Bisexual women are significantly more likely than straight women to report being disabled prior to victimization, but all disabled women—regardless of sexual orientation—are equivalently likely to rate their mental health as poor and/or actively experience difficulty sleeping, difficulty going to work or school, and/or PTSD. Conclusions: Aligned with previous work, this study finds that bisexual women are significantly more likely than straight women to be disabled prior to experiencing all forms of intimate partner violence; and that disabled women, generally, are significantly more likely than not-disabled women to experience the negative mental health consequences of that violence. However, contrary to previous work, there are no sexual orientation disparities in said mental health outcomes among disabled women. Clinically, it is important for health care providers to be aware of the significant impact of intimate partner violence on the disabled women they regularly provide care to. © 2018 Elsevier Inc.
Keywords: Bisexual; Domestic violence; Intimate partner violence; LGBT; Mental health

Prevalence of suicide ideation and its relationship with depression among transgender population - Azeem, R.; Zubair, U.B.; Jalil, A.; Kamal, A.; Nizami, A.; Minhas, F. (Journal of the College of Physicians and Surgeons Pakistan, 2019)
Objective: To record the prevalence of suicidal ideation in the transgender population and assess the relationship of depression with the suicidal ideation. Study Design: Cross-sectional study. Methodology: The study group comprised of 156 transgender people of Rawalpindi and Islamabad. Suicidal ideation was assessed by the scale for suicide ideation (SSI). Hamilton rating scale for depression (HAM-D) was used to look for the presence and severity of depression among the target population. Relationship of the age, smoking, family income, illicit substance use, and depression was studied with the presence of suicidal intent among these transgender population of twin cities. Results: One hundred and fifty-six transgender people were included in this study. Mean age of the study participants was 39.26 ±4.28 years. Out of them, 89 (57.1%) had no suicidal ideations, while 67 (42.9%) had suicidal ideation. Fifty-seven (36.5%) did not showed depression, while 99 (63.5%) had depression on HAM-D. With binary logistic regression, depression and illicit substance were found to be significantly related to the presence of suicidal ideations in the target population (p <0.05). Conclusion: A high prevalence of suicidal ideation among the transgender population of twin cities was found in this study. Depression, illicit substance use, and other mental health illnesses should be screened routinely on this high risk population for early recognition and treatment. © 2019 College of Physicians and Surgeons Pakistan. All rights reserved.
Keywords: Depression; Suicide intent; Transgenders.

Prevalence of Self-Injurious Thoughts and Behaviors in Transgender Individuals With Eating Disorders: A National Study - Duffy, M.E.; Henkel, K.E.; Joiner, T.E. (Journal of Adolescent Health, 2019)
Purpose: This study examined prevalence of self-injurious thoughts and behaviors (SITBs) in transgender individuals with eating disorders, as compared to cisgender individuals with eating disorders and transgender individuals without eating disorders. Methods: Data were analyzed from 365,749 individuals (median age 21 years, 71.8% White/Caucasian, 34.9% male, 64.9% female, and 0.2% transgender) who participated in American College Health Association-National College Health Assessment, an annual national assessment of college student health, from 2008 to 2011. Results: Rates of past-year nonsuicidal self-injury, suicidal ideation, and suicide attempts were elevated in transgender participants with eating disorders (74.8%, 75.2%, and 74.8%, respectively), as compared to cisgender participants with eating disorders and transgender participants without eating disorders. Follow-up logistic regression analyses indicated these differences were statistically significant above and beyond the effects of demographic variables and depression. Conclusions: Results found extremely high rates of SITBs in transgender individuals with eating disorders. This combination of identities, each associated with SITBs, may have a compounding effect. © 2018 Society for Adolescent Health and Medicine
Keywords: College student; Eating disorder; Gender identity; Non-suicidal self-injury; Suicidal ideation; Suicide; Suicide attempt; Transgender

The Preference for Strangulation in a Sexually Motivated Serial Killer - Pettigrew, M. (International Journal of Offender Therapy and Comparative Criminology, 2019)
The existing literature on the killing method of choice for sexually motivated serial killers suggests strangulation as the preferable means of homicide, when the victim is female. When homicide victims are male, however, existing research suggests that firearms and blades are preferable methods of causing death. A case is presented here of a sexually motivated male serial killer who exclusively targeted males and who chose strangulation as his means of killing. Analysis suggests that not only is the psychological constitution of the killer an important factor in understanding how they kill victims but, also, the nature of the sexual act is an important determinant in the method of killing in male on male sexually motivated killing. © The Author(s) 2018.
Keywords: homicide; killing method; male victims; serial killing; strangulation

Violence as Mediating Variable in Mental Health Disparities Associated to Sexual Orientation Among Mexican Youths - Mendoza-Pérez, J.C.; Ortiz-Hernández, L. (Journal of Homosexuality, 2019)
In this study, we explored the role of sex as an effect-modifying variable in the association between sexual orientation and mental health in Mexican youth. In addition, we tested if violent experiences in the family and the school and attitudes toward homosexuality could act as mediating variables in such association. Data from three representative surveys performed in 2007, 2009, and 2013 among Mexican high school students were analyzed. Two dimensions of sexual orientation were evaluated: romantic partnership and sexual behavior. The outcomes were negative and positive mood, suicidal ideation and intent, self-concept, and self-esteem. There were differences by gender because in males, there were more disparities in mental health associated with sexual orientation (suicidal ideation and attempt, negative and positive mood, negative self-concept, and family-related self-esteem) than in females (suicidal ideation and negative mood). Experiences of school violence were mediators in the relationship between sexual orientation and most health outcomes in males. © 2019, © 2019 Taylor & Francis Group, LLC.
Keywords: disparities; gender; mental health; mood; self-esteem; Sexual orientation; teenagers; violence sexual abuse

Epidemiology and outcome of HIV patients in Finland co-infected with tuberculosis 1998-2015 - Holmberg, V.; Soini, H.; Kivelä, P.; Ollgren, J.; Ristola, M. (BMC Infectious Diseases, 2019)
Background: Tuberculosis (TB) is a major cause of death in HIV patients worldwide. Here we describe the epidemiology and outcome of HIV-TB co-infections in a high-income country with low TB incidence and integrated HIV and TB therapy according to European guidelines. Methods: This study was based on the HIV cohort of the Helsinki University Hospital which includes all HIV patients in the Helsinki region with a population of 1.5 million. Totally, 1939 HIV-positives who have been under follow-up between 1998 and 2015 were included. Results: TB was diagnosed in 53 (2.7%) of the HIV-patients. The TB incidence rate was higher in injecting drug users (IRR 3.15; 95% CI 1.33-7.52) and heterosexuals (IRR 3.46; 95% CI 1.64-7.29) compared to men having sex with men. The incidence rate was also higher in those born in Sub-Saharan Africa (IRR 3.53; 95% CI 1.78-7.03) compared to those born in Finland. There was a significant reduction in the total TB incidence rate of 59% per 6-year period between 1998 and 2015 (p < 0.001). In injecting drug users there was a reduction in incidence rate from 1182 to 88 per 100,000 (p < 0.001) and in people born in Sub-Saharan Africa from 2017 to 195 per 100,000 (p < 0.001). Among the 53 HIV-TB co-infected cases, one female and 15 males died during follow up. HIV was the primary cause of death in five patients but none of the deaths were caused by TB. Conclusion: The incidence rate of tuberculosis among HIV-positives in Finland has been declining between 1998 and 2015. Among injecting drug users, the reduction is probably explained by harm reduction interventions and care in comprehensive care centers in Helsinki. The increased coverage of antiretroviral therapy is probably another main reason for the decline in TB incidence rates. Despite good treatment results for both HIV and TB, the all-cause mortality among Finnish males with HIV-TB was high, and common causes of death were intoxications and suicides. © 2019 The Author(s).
Keywords: Co-infection; Epidemiology; HIV; Outcome; Tuberculosis

Stigmatization and suicide vulnerability in LGBT students: Inquiry and recommendations - Hanimoǧlu, E. (Journal of Education and e-Learning Research, 2019)
In all countries, schools should be a safe environment for the students. Nonetheless, the LGBT students are too often faced with a schooling experience that is characterized by inadequate access to LGBT-related information, discrimination, harassment, cyber bullying, and, in worst cases, sexual and physical abuse. The different abusive experiences of these students cause great physical and emotional stress leading to poor performance, increased school dropout cases, and suicide among others despite the fact that the right to have education is being protected under the most countries' laws as well as the international law. The article reviews the existing research in regards to stigmatization and how it makes the students vulnerable to suicide, and it suggests recommendations for dealing with the existing knowledge and policy gaps. Studies indicate that LGBT students in schools which promote the formation of GSAs are less likely to attempt suicide, miss school, and suffer from bullying as compared to schools without the support groups. Moreover, parents with LGBT children should become more supportive, educative and monitor their children's behavior to ensure that they do not suffer from stigmatization which triggers suicidal behavior. © 2019 by the authors; licensee Asian Online Journal Publishing Group .
Keywords: LGBT members; LGBT students; Minority populations; Stigmatization; Suicide vulnerability

Minorities and foreign born are disproportionately affected by injuries due to violence: An analysis based on a National Trauma Registry 2008-2017 - Tiruneh, A.; Radomislensky, I.; Bahouth, H.; Becker, A.; Hadary, A.; Jeroukhimov, I.; Karawani, M.; Kessel, B.; Klein, Y.; Lin, G.; Merin, O.; Miklush, B.; et al. (Israel Journal of Health Policy Research, 2019)
Background: Populations of different ethnicity and country of origin living in the same country may possess particular features of violence-related injuries. This study aims to compare violence-related injury characteristics and circumstances, hospital resource utilization and in-hospital mortality among the major ethnic groups in Israel. Methods: A study based on the Israeli National Trauma Registry database of patients hospitalized due to violence-related injuries between 2008 and 2017. Data included demographic, injury and hospitalization characteristics and in-hospital mortality. Statistical analysis included χ 2-test and multiple logistic regression. Results: During the study period, 16,151 violence related-hospitalizations were reported, of which; 46.1% were Arab Israelis (AI), 3.2% were Israelis born in Ethiopia (IBE), 12.7% were Israelis born in the former Soviet Union (IBFSU) and 38.0% were all other Israelis (AOI). The proportion of violence-related hospitalizations among AI, IBE and IBFSU was greater than their respective proportion in the Israeli population. In comparison to the other groups, stab injuries were significantly greater among IBE (30% vs 39%); unarmed brawl-related injuries were greater among IBFSU (22-41% vs 49%) and firearm injuries were greatest among AI (2-8% vs 23%). These differences in violence mechanism persisted even after accounting for age, gender, injury place and time differences. The foreign born groups had higher rates for injuries sustained on the street/road (58% for IBE, 54% for IBFSU vs 46% for AI and AOI, each), with IBE also showing higher rates for weekend and weeknight injuries compared to the other groups (83% vs 71-75%). IBE were more likely to suffer from severe and critical injuries (19% vs 12-16%), to be admitted to the intensive care unit (17% vs 9-11%) and to have prolonged hospital stays of seven days or more (20% vs 16-17%), with no significant difference in in-hospital mortality between the comparison groups. Conclusions: Characteristics of violence-related casualties differed significantly among diverse ethnic populations living in the same country. Each population group showed specific attributes regarding injury mechanism, circumstances, severity and hospital utilization. Violence prevention programs should be culturally adapted and take into account ethnicity and country of origin of the target population. © 2019 The Author(s).
Keywords: Ethnicity; Foreign born; Hospitalization; Injury; Violence

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

Sexual minority children: Mood disorders and suicidality disparities - Blashill, A.J.; Calzo, J.P. (Journal of Affective Disorders, 2019)
Background: Sexual minority (gay, lesbian, and bisexual) individuals experience elevated mood disorders and suicidality compared to their heterosexual counterparts. However, to date, these sexual orientation disparities have yet to be examined among middle childhood-aged participants. Methods: Data were employed from the baseline wave of the Adolescent Brain Cognitive Development (ABCD) study, a U.S. representative sample. Population-level weighting was utilized, resulting in an analytic sample of N = 8,204,013 (n unweighted = 4519) children between the ages of 9 and 10 years: with 70,952 (n unweighted = 43) identifying as sexual minories (0.9% of the population). Structured clinical interviews were used to assess mood disorders (i.e., depressive and bipolar disorders) and suicidality. Sexual orientation (sexual minority vs. heterosexual) was examined as the focal independent variable. Results: The overall prevalence of mood disorders was 7.1%. Sexual minority children (22.5%) possessed a higher rate than heterosexual children (6.9%). The overall prevalence of suicidality was 4.8%; sexual minority children (19.1%) possessed a higher rate than heterosexual children (4.6%). Limitations: Sexual orientation assessment did not include attraction, and thus, results may represent a lower bound estimate of sexual minorities. Conclusions: Sexual orientation disparities in mood disorders and suicidality appear to develop as early as middle childhood. Clinicians are encouraged to assess sexual orientation among children as young as 9–10 years old, and provide appropriate normalization of sexual orientation, and referrals for mental health treatment, as indicated. © 2018 Elsevier B.V.
Keywords: Children; Mood disorders; Sexual minority; Sexual orientation; Suicide

Psychosocial Factors Associated with Suicide Attempts, Ideation, and Future Risk in Lesbian, Gay, and Bisexual Youth: The Youth Chances Study - Rimes, K.A.; Shivakumar, S.; Ussher, G.; Baker, D.; Rahman, Q.; West, E. (Crisis, 2019)
Background: Lesbian, gay, and bisexual (LGB) youth have elevated suicidality rates. Aims: To investigate LGB-related and other factors associated with suicide attempts, suicidal ideation, and future suicide risk in a large UK sample. Method: Logistic regression was used to investigate factors associated with suicidality in 3,275 LGB young adults from the Youth Chances project. Results: Suicide attempts (lifetime) were reported by 13.6% of participants; 45.2 % had suicidal ideation in the past year and 9.5% said future suicide attempts were likely. LGB stigma and discrimination experiences were significantly associated with all three aspects of suicidality. These included school stigma factors (e.g., teachers not speaking out against prejudice, lessons being negative about sexual minorities), negative reactions to coming out from family and friends, and LGB-related harassment or crime experiences. Bisexuality, not feeling accepted where one lives, younger sexual minority identification, and younger coming out were also associated with suicidality. Significant non-LGB factors included female gender, lower social support, anxiety/depression help-seeking, experiences of abuse/violence, and sexual abuse. Limitations: This study is cross-sectional and further research is needed to test out whether any of these factors have a causal relationship with suicidality. Conclusion: A wide range of LGB stigma and discrimination experiences are associated with increased suicidality in LGB youth. Health, social care, and education professionals supporting young people should address LGB-specific risk factors. © 2018 Hogrefe Publishing.
Keywords: discrimination; prejudice; sexual orientation; stigma; youth

Sexual orientation and mental health among adults in four U.S. cities - Nam, B.; Jun, H.-J.; Fedina, L.; Shah, R.; DeVylder, J.E. (Psychiatry Research, 2019)
Sexual minorities have higher risk for psychological distress than heterosexual populations. However, this disparity remains under-studied in urban settings, and there likewise has been minimal prior research of potential interactions with gender and race/ethnicity. The present study aimed to examine mental health correlates of sexual minority identification in conjunction with gender and race/ethnicity. A community sample of 1,615 adults from four eastern cities in the United States was used. A series of regression analyses were conducted to examine differences in psychological distress and suicidal ideation across different sexual orientation populations. The results showed that only bisexual individuals had significantly higher psychological distress and risk for suicidal ideation than heterosexual individuals even after adjusting for age and income. The associations were consistent across gender and race/ethnicity. No significant differences between homosexual and heterosexual individuals were found. Health professionals working with people of bisexual orientation in urban settings should attend to potential psychological distress and recent suicidal ideation. © 2018
Keywords: Bisexual; Mental health; Minority stress model; Race/ethnicity; Sexual minorities

Thwarted belongingness and perceived burdensomeness explain the relationship between sleep problems and suicide risk among adults identifying as sexual and/or gender minorities - Chu, C.; Hom, M.A.; Hirsch, J.K.; Joiner, T.E. (Psychology of Sexual Orientation and Gender Diversity, 2019)
Sleep problems are robust suicide risk correlates. According to the interpersonal theory of suicide, thwarted belongingness (TB) and perceived burdensomeness (PB) may explain the link between sleep problems and suicide risk. This study examined these relationships among 331 community-dwelling adults identifying as sexual and/or gender minorities. Self-report measures of sleep problems, TB, PB, suicide risk, and anxiety were completed. Bootstrap mediation analyses were conducted to test TB and PB as interacting, individual, and parallel explanatory factors linking sleep problems and suicide risk. Sleep problems were associated with greater TB, PB, and suicide risk. TB and PB, in parallel and individually, accounted for the relationship between sleep problems and suicide risk, beyond age and anxiety. In contrast to the interpersonal theory, the indirect effect of PB was stronger at lower levels of TB and the indirect effect of TB was stronger at lower levels of PB. Exploratory analyses indicated significant differences between sexual minorities, gender minorities, and individuals identifying as both sexual and gender minorities: the indirect effect of sleep problems on suicide risk through PB was descriptively strongest among sexual minorities, and the indirect effect through TB was descriptively stronger among gender minorities and individuals identifying with both minority groups. Findings suggest that intervening upon TB and PB may thwart the trajectory from sleep problems to suicide risk among sexual and gender minorities. Further work is needed to determine whether suicide risk pathways differ across minority groups. © 2019 American Psychological Association.
Keywords: Gender identity; Interpersonal theory of suicide; Sexual orientation; Sleep; Suicide

Anti-LGBT victimization, fear of violence at school, and suicide risk among adolescents - Barnett, A.P.; Molock, S.D.; Nieves-Lugo, K.; Zea, M.C. (Psychology of Sexual Orientation and Gender Diversity, 2019)
We investigated whether strengths of the relationships between anti-lesbian, gay, bisexual, and transgender (LGBT) victimization, fear of violence at school, and suicide risk differ by sexual orientation among a predominantly ethnic minority sample of adolescents. Using the 2012 District of Columbia Youth Risk Behavior Survey high school data set, we performed a 4-stage, stepwise logistic regression for suicide attempts, suicidal ideation, and suicide planning. First, we tested the independent variables, sexual orientation and anti-LGBT victimization. Second, we added an anti-LGBT victimization by sexual orientation interaction term. Third, we tested the independent variable, fear of violence at school, in an additive model. Fourth, we added a fear of violence at school by sexual orientation interaction term. In Model 1, sexual orientation and anti-LGBT victimization were both significantly associated with each suicide risk behavior. In Model 2, the anti-LGBT victimization by sexual orientation interaction term was not significant for any of the dependent variables. In Model 3, fear of violence at school was significantly associated with each suicide risk behavior. In Model 4, the fear of violence at school by sexual orientation interaction term was not significant for suicide attempts or suicidal ideation but was significant for suicide planning in the direction opposite to our hypotheses. Anti-LGBT victimization, sexual orientation, and fear of violence at school were associated with suicidal ideation, suicide planning, and suicide attempts. The strength of the association between fear of violence at school and suicide planning was weaker for sexual minority adolescents than for heterosexual adolescents. © 2019 American Psychological Association.
Keywords: Bullying; Sexual minorities; Suicide

Religion, psychiatry, and alternate sexuality - Darmansjah, D.; Kalra, G.; Ventriglio, A. (East Asian Archives of Psychiatry, 2019)
Religious institutions tend to display a conservative view towards individuals with alternate sexuality or identity. For managing patients with alternate sexuality, it is imperative that clinicians understand and take into account religious views and its effects on a person's mental health. We review the literature on religion, alternate sexuality, and psychiatry to ascertain their interaction and impact on the mental health of individuals with alternate sexuality or identity. Differing but overlapping perspectives on alternate sexuality persist across world religions. Individuals with conflict between religious and sexual identities are prone to have adverse mental health outcomes; adequate social supports result in more positive mental health outcomes. Education on lesbian, gay, bisexual, transgender, queer, and intersex-related topics in mental health professionals leads to better recognition of the issue and provision of respectful, effective mental health care within the context of socio-religious identity and background. 2019 Hong Kong Academy of Medicine Press. All Rights Reserved.
Keywords: Gender dysphoria; Religion and sex; Sexuality

LGBTQ youth in unstable housing and foster care - Baams, L.; Wilson, B.D.M.; Russell, S.T. (Pediatrics, 2019)
BACKGROUND AND OBJECTIVES: Lesbian, gay, bisexual, transgender, and questioning (LGBTQ) youth abstract are suggested to be overrepresented in unstable housing and foster care. In the current study, we assess whether LGBTQ youth are overrepresented in unstable housing and foster care and examine disparities in school functioning, substance use, and mental health for LGBTQ youth versus heterosexual youth in unstable housing and foster care. METHODS: A total of 895 218 students (10-18 years old) completed the cross-sectional California Healthy Kids Survey from 2013 to 2015. Surveys were administered in 2641 middle and high schools throughout California. Primary outcome measures included school functioning (eg, school climate, absenteeism), substance use, and mental health. RESULTS: More youth living in foster care (30.4%) and unstable housing (25.3%) self-identified as LGBTQ than youth in a nationally representative sample (11.2%). Compared with heterosexual youth and youth in stable housing, LGBTQ youth in unstable housing reported poorer school functioning (Bs = 20.10 to 0.40), higher substance use (Bs = 0.26-0.28), and poorer mental health (odds ratios = 0.73-0.80). LGBTQ youth in foster care reported more fights in school (B = 0.16), victimization (B = 0.10), and mental health problems (odds ratios = 0.82-0.73) compared with LGBTQ youth in stable housing and heterosexual youth in foster care. CONCLUSIONS: Disparities for LGBTQ youth are exacerbated when they live in foster care or unstable housing. This points to a need for protections for LGBTQ youth in care and care that is affirming of their sexual orientation and gender identity. Copyright © 2019 by the American Academy of Pediatrics.

Alcohol and marijuana use as daily predictors of suicide ideation and attempts among adolescents prior to psychiatric hospitalization - Sellers, C.M.; Diaz-Valdes Iriarte, A.; Wyman Battalen, A.; O'Brien, K.H.M. (Psychiatry Research, 2019)
Objective: Little research has been conducted on alcohol use, marijuana use, and suicide ideation and attempts on a daily level, and specifically among adolescents prior to inpatient hospitalization. The purpose of this study was to examine the within (over time) and between (between adolescents) effects of alcohol use and marijuana use on suicide ideation and attempts. Methods: Participants included 50 adolescents (80% female; M age = 15.8). All participants reported drinking alcohol in the prior three months and were receiving treatment in an inpatient psychiatric hospital. Random and mixed-effect models were used to test study hypotheses. Results: Results from the random effect model indicated that alcohol use, marijuana use, hospitalization and sexual orientation were significant predictors of suicide attempts. Results from the mixed-effect model indicated that marijuana use, hospitalization, and sexual orientation were significant predictors of suicide ideation. Conclusions: Study findings extend current knowledge about the longitudinal and day-to-day relationship between alcohol and marijuana use and suicide ideation and attempts. Results underscore the importance of addressing alcohol and marijuana use in interventions with suicidal adolescents, recognizing that sexual minority youth may be at elevated risk for suicide ideation. © 2019 Elsevier B.V.
Keywords: Substance use; Suicidal behaviors; Suicide ideation

A New Generation Speaks - Carroll, M. (Clinical Pediatric Emergency Medicine, 2019)
Keywords: adolescent; advocacy; cognitive bias; firearm violence; generation Z; pediatric emergency medicine; pregnancy prevention; sexually transmitted infections; suicide screening; synthetic drugs

The suicide of leelah alcorn: Whiteness in the cultural wake of dying queers - Schares, E.M. (QED, 2019)
In this article, I examine public discourse in the wake of transgender teenager Leelah Alcorn’s suicide. I argue that Alcorn’s politicized suicide beckoned a national tragedy whereas the slew of queer and transgender people of color murdered did not because of the repeated deployments of a whiteness-derived innocence. Performances of hegemonic grief evinced Alcorn’s posthumous rhetorical agency in ways that caused responsible adults to take action against the violence of conversion therapy on U.S. queer youth. In this article, I analyze how the rhetorics and performances of white grief functioned as an exigence for a queer of color critique that used the wake of Alcorn to unhinge logics of white supremacy and white grievability. As queers of color labored in Alcorn’s wake to grieve their own dead in more public ways, they demonstrated how queers of color shoulder the burden of evincing their own trauma more so than their white counterparts. The cultural wake of Alcorn suggests that hegemonic grief functions as a modality of white supremacy while determining whose life is worthy of remembrance and a place in the queer imaginary. © 2019 Michigan State University.

Between christmas day, 1895, and new year’s eve, 1922: Queer suicide and Brazil’s long Fin de Siècle - Braga-Pinto, C. (Journal of Lusophone Studies, 2019)
This essay considers a heterogeneous and often unreadable group of fin-de-siècle Brazilian writers that includes Parnassians, Symbolists, and Decadents. These artists imagined themselves part of a cosmopolitan, transnational movement that posed as extravagant or queer, turning their back on both emerging nationalist sentiments and urgent social issues of their time. This detachment, I argue, points to a queer mode of historicity. I further argue that an affirmative rhetoric of hope and community is insufficient to understand or cope with negative figures, that is, those who turn away from social life, communication, and, ultimately, from futurity. I first focus on two queer fin-de-siècle writers who committed suicide, Raul Pompeia (1863-95) and the playwright Roberto Gomes (1882-1922). I then propose that an archive of Brazilian “suicidals” may provide ways of reading these fin-de-siècle writers, as well as others who resist accommodation in the genealogy of national culture. © 2019, American Portuguese Studies Association. All rights reserved.
Keywords: Decadence; Modernism; Raul Pompeia; Roberto Gomes; Suicidals

'Meiotic genes' are constitutively expressed in an asexual amoeba and are not necessarily involved in sexual reproduction - Maciver, S.K.; Koutsogiannis, Z.; De Obeso Fernández Del Valle, A. (Biology Letters, 2019)
The amoebae (and many other protists) have traditionally been considered as asexual organisms, but suspicion has been growing that these organisms are cryptically sexual or are at least related to sexual lineages. This contention is mainly based on genome studies in which the presence of 'meiotic genes' has been discovered. Using RNA-seq (next-generation shotgun sequencing, identifying and quantifying the RNA species in a sample), we have found that the entire repertoire of meiotic genes is expressed in exponentially growing Acanthamoeba and we argue that these so-called meiotic genes are involved in the related process of homologous recombination in this amoeba. We contend that they are only involved in meiosis in other organisms that indulge in sexual reproduction and that homologous recombination is important in asexual protists as a guard against the accumulation of mutations. We also suggest that asexual reproduction is the ancestral state. © 2019 The Author(s) Published by the Royal Society. All rights reserved.
Keywords: Acanthamoeba; Asexual reproduction; Meiosis; Muller's ratchet; Polyploidy; RNA-seq

Emotional Distress, Bullying Victimization, and Protective Factors Among Transgender and Gender Diverse Adolescents in City, Suburban, Town, and Rural Locations - Eisenberg, M.E.; Gower, A.L.; McMorris, B.J.; Rider, G.N.; Coleman, E. (Journal of Rural Health, 2019)
Purpose: Understanding the root causes of the substantial disparities in risk and protective factors among transgender and gender diverse (TGD) adolescents is essential to the development and expansion of resources and supports for this vulnerable population. This study examines differences in emotional distress, bullying victimization, and protective factors among TGD high school students in city, suburban, town, and rural locations. Methods: Data come from a statewide school-based survey conducted in Minnesota in 2016 (n = 2,168 TGD youth). Analysis of covariance models were used to predict the prevalence of multiple indicators of emotional distress, bullying victimization, and protective factors across the 4 location categories, with multiple adjustments. Findings: Significant linear trends were observed for 2 emotional distress outcomes and 2 bullying victimization outcomes, with urban TGD students having the lowest rates and rural having the highest prevalences. Additional significant differences in emotional distress were noted, with unexpectedly high rates of depressive symptoms and suicidal ideation among suburban students. Conclusions: Helping TGD adolescents in all types of locations identify resources and supportive professionals is critical to supporting this population. © 2018 National Rural Health Association
Keywords: adolescence; bullying; mental health; social environment; transgender

Thinking Sexual Difference with (and against) Adriana Cavarero: On the Ethics and Politics of Care - Ryan, K. (Hypatia, 2019)
This article engages with Adriana Cavarero's framing of sexual difference, specifically in terms of how this displaces “bodies that queer” (Volcano 2013). For Cavarero, the narratable self is inescapably relational and characterized by vulnerability, which is how ethics arises in the form of a decision between caring and wounding. At the same time, Cavarero's deconstructive method of appropriating stereotypes restricts the scope of sexual difference to dimorphism. In examining the implications of this, I build on the work of Michel Foucault and Judith Butler by looking to the intersexed life of Adélaïde Herculine Barbin, whose suicide in 1868 at the age of twenty-nine was precipitated not through malice or cruelty, but through concerted care. This mode of care is anchored in the apparent self-evidence of how we see and how we think with and through narratives that sediment in orders of power/knowledge. While agreeing with Cavarero's critique of the autonomous “I,” the article nevertheless argues for authorial audacity—the courage to name oneself—as a way of subverting asymmetrical power relations, including those that make it possible to inadvertently generate suffering through care. © by Hypatia, Inc.

Intimate partner violence among postsecondary students with military experience - Albright, D.L.; Fletcher, K.L.; McDaniel, J.; Thomas, K.H.; Godfrey, K.; Grohowski, M.; Dane, J. (Traumatology, 2019)
The purpose of this study was to explore intimate partner violence (IPV) among student service members and veterans within postsecondary educational settings. Secondary data for the present cross-sectional study were retrieved from the 2011-2014 National College Health Assessment on a nationally representative sample of college students (n = 114,816). Fisher's exact test (Upton, 1992) was used to determine differences in 3 types of IPV (emotional abuse, physical abuse, and sexual violence) between students with and without military experience (ME). Logistic regression was conducted to determine (a) risk factors for IPV and (b) associations between IPV and certain mental, physical, and behavioral health outcomes among students with ME. Although-in terms of descriptive statistics-self-reported emotional abuse (10.700% vs. 9.000%) and physical abuse (23.200% vs. 20.500%) were higher among students with ME, self-reported sexual violence was more prevalent among students with no ME (8.300% vs. 10.200%). Risk factors for IPV among students with ME included identifying as transgender, identifying as heterosexual, being a graduate student, identifying as an "other" race, and being married. The odds of self-reported mental and physical health problems, as well as unhealthy behaviors (such as binge drinking and suicide attempts), were higher among students with ME who had experienced IPV. The emotional, behavioral, and psychological risks evident from our study substantiate the critical need for higher education professionals to place more emphasis on IPV and its consequences on students' success. © 2018 American Psychological Association.
Keywords: College; Intimate partner violence; Mental health; Student veteran

Pedophilia, substance-use disorder, and intellectual disability: A case report - Cassiani-Miranda, C.A.; Quintero-Gómez, T.C.; Burbano, A.L.; Eduard, A.-C. (Addictive Disorders and their Treatment, 2019)
Objective: To present a case of pedophilic disorder associated to intellectual disability and substance-use disorder (SUD). Background: Pedophilic disorders often appear in comorbidity with other mental disorders. Case description: A 21-year-old man is hospitalized in an addictive behavior unit, with a history of SUD, an exclusive sexual preference for boys aged 12 or under, associated to interpersonal problems with borderline Intelligence Quotient score, and failure in global functioning. Discussion: The article analyses the criteria related to pedophilic disorder, the difficulties in its diagnosis, the clinical implications of the comorbidity with intellectual disability and SUD. Conclusions: It is important to differentiate between pedophilic disorder, SUD, and intellectual disability. An active search for deviant sexual behavior is recommended in patients with dual diagnosis. © 2018 Wolters Kluwer Health, Inc.
Keywords: case studies; intellectual disability; pedophilia; substance-use disorders

Dolutegravir and lamivudine maintenance therapy in HIV-1 virologically suppressed patients: Results of the ANRS 167 trial (LAMIDOL) - Joly, V.; Burdet, C.; Landman, R.; Vigan, M.; Charpentier, C.; Katlama, C.; Cabié, A.; Benalycherif, A.; Peytavin, G.; Yeni, P.; Mentre, F.; Argoud, A.-L.; et al. (Journal of Antimicrobial Chemotherapy, 2019)
Objectives: To evaluate the dolutegravir+lamivudine combination in virologically suppressed patients living with HIV. Methods: The ANRS 167 LAMIDOL trial was an open-label, single arm, multicentre trial assessing once-daily dolutegravir (50 mg) + lamivudine (300 mg) in virologically suppressed HIV-1 patients on first-line triple-drug regimens. The main criteria for inclusion in the trial were plasma viral load (pVL) ≤50 copies/mL for ≥2 years, CD4 nadir >200 cells/mm3 and WT HIV prior to treatment initiation. From week-8 (W-8) to day 0 (D0) (Phase 1), the current third agent was switched to dolutegravir. From D0 to W48 (Phase 2), patients received once-daily dolutegravir+lamivudine, except if intolerant or if pVL >50 copies/mL during Phase 1. Virological failure was defined as pVL >50 copies/mL in two consecutive samples. The study was designed to show that the strategy had an efficacy of >80%, assuming a 90% success rate with a type I error of 5% and a power of 90%. Results: In total, 104 of 110 patients enrolled in Phase 1 were included in Phase 2. These 104 patients were 86% male, 72% MSM and 87% CDC stage A. Their characteristics were (median): age 45 years, CD4 nadir 339 cells/mm3, baseline CD4 743 cells/mm3 and duration of viral suppression 4.5 years. The overall success rate at W48 was 97% (95% CI: 94%-100%), meeting the design expectation/assumption. Three therapeutic failures occurred: one virological failure at W4, one lost to follow-up at W32 and one interruption of therapeutic strategy at W40 after a blip (pVL 59 copies/mL but control pVL <50 copies/mL). Three viral blips occurred in two additional patients. Neither M184V nor integrase resistance mutations were detected after failure or blips. Conclusions: Dolutegravir+lamivudine is a promising maintenance therapy in HIV-1-infected patients with controlled virological suppression. © The Author(s) 2018. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved.

Transgender college students: Academic resilience and striving to cope in the face of marginalized health - Messman, J.B.; Leslie, L.A. (Journal of American College Health, 2019)
Objective: To examine health behavior and outcome disparities between transgender, female, and male participants in a national sample of US college students. Participants and Method Summary: Analyses utilized secondary data from 32,964 undergraduate and graduate students responding to the Fall 2013 American College Health Association–National College Health Assessment; 65.8% were female, 0.4% were transgender, 67.9% were white, and 90.4% were heterosexual. Results: Transgender students reported more mental health diagnoses, trauma, and suicidality; experienced more violence and less safety, reported more sex partners and sexually transmitted infections (STIs); higher rates of illicit and nonprescription substance use and binge drinking use while engaging in less harm reduction behavior; and reported more barriers to academic success. Conclusions: There is an established need for college clinicians and health educators to reduce these disparate outcomes once students arrive on campus through professional training and culturally competent campus prevention and intervention efforts to promote health equity. © 2018, © 2018 Taylor & Francis Group, LLC.
Keywords: Alcohol; counseling; gender; health education; mental health; other drugs

LGBT-Specific Education in General Psychiatry Residency Programs: a Survey of Program Directors - Hirschtritt, M.E.; Noy, G.; Haller, E.; Forstein, M. (Academic Psychiatry, 2019)
Objective: Lesbian, gay, bisexual, transgender (LGBT) and other sexual minority individuals are at higher risk than non-LGBT individuals for multiple psychiatric conditions and suicide. However, little is known regarding LGBT-specific training among psychiatric residents. The authors sought to characterize LGBT-specific training among adult psychiatry residency programs. Methods: An anonymous, cross-sectional survey was electronically distributed to U.S.-based adult psychiatry program directors between February and April 2018. Survey topics included program demographics, characteristics of LGBT-specific training, perceived barriers to implementation, and anticipated needs. Results: Seventy-two program directors (30.8%) provided complete survey responses. Over half (55.6%) of these programs had ≤ 5 h of LGBT-specific training (“lower-hour programs”). Lower- and higher-hour (> 5 h of LGBT-specific education) programs were similar on measured demographic variables, but lower-hour programs covered fewer LGBT-specific topics and program directors were more likely to report lack of interested or topic-expert faculty as a barrier to enhancing LGBT-specific training. Conclusions: Results of this survey suggest a need for the development and implementation of LGBT-specific educational curricula for use in U.S.-based adult psychiatry programs. In addition, future research may explore effective ways for programs to recruit, retain, and support teaching faculty with LGBT-specific expertise. © 2018, Academic Psychiatry.
Keywords: Curriculum development; Faculty development; Minorities; Residents: sexuality/sexual orientation

Suicidal ideation and attempted suicide amongst Chinese transgender persons: National population study - Chen, R.; Zhu, X.; Wright, L.; Drescher, J.; Gao, Y.; Wu, L.; Chen, C.; Xi, Y.; Ji, L.; Zhao, H.; Ou, J.; Broome, M.R. (Journal of Affective Disorders, 2019)
Background: This study aims to understand suicidal ideation and suicide attempts among transgender individuals through an in-depth analysis of a nation-wide population general survey in China. Methods: Transgender Men (TM) and Women (TW) were investigated through a cross-sectional survey. A structured questionnaire was used to investigate participants’ demographic information, perceived sexuality conflicts, childhood adversity and mental health conditions. Logistic regression models were utilized to investigate risk factors associated with suicidal ideation and suicide attempts in these groups. We also conducted a quasi-meta-analysis in order to compare the prevalence of suicidal ideation and attempted suicide between general and transgender populations in China. Results: A total of 1309 participants across 32 provinces and municipalities in China took part in this survey, out of 2060 valid questionnaires. In this transgender population, the lifetime prevalence of suicidal ideation and an attempt at suicide were 56.4% and 16.1%, respectively. This estimated prevalence rate is far greater than in Chinese community samples. For all transgender people, disliking birth-assigned sex, seeking sex reassignment surgery, having intense conflicts with parents, lifetime history of suffering from major depressive disorder, a recent episode of depression, self-harm, and seeking mental health services were significantly associated with increased risk of suicidal ideation. An education level of high school or equivalent, being married and/or separated/divorced, having intense conflicts with parents, or self-harm and seeking mental health services were all significantly associated with increased risk of suicide attempt. Although most risk factors for TM and TW were equivalent across groups, differences were observed in both suicidal ideation and suicide attempt models. Limitations: The cross-sectional study design and lack of follow-up data are limitations of this study. Conclusions: This is the first study to examine suicide within a Chinese transgender population. The clinical implications of these findings for Chinese mental health professionals are discussed. Also, the evidence from this study can be used to inform the practices of suicide prevention workers, and policy makers working with the transgender population. © 2018 Elsevier B.V.
Keywords: Chinese; Mental health; Suicidal ideation; Suicide attempt; Transgender

Suicidality and clinical correlates in Chinese men who have sex with men (MSM) with HIV infection - Wang, Y.-Y.; Dong, M.; Zhang, Q.; Xu, D.-D.; Zhao, J.; Ng, C.H.; Ungvari, G.S.; Jia, F.-J.; Xiang, Y.-T. (Psychology, Health and Medicine, 2019)
Little is known about suicidality in Chinese men who has sex with men (MSM) infected with human immunodeficiency virus (HIV). This study investigated suicidality and its clinical correlates in Chinese MSM with HIV infection. Suicidality, demographic and clinical characteristics were assessed in 410 MSM with HIV infection consecutively recruited from a public HIV clinic in China. The prevalence of suicidality was 10.7% in Chinese HIV-infected MSM. Compared with those without suicidality, MSM with suicidality were more likely to be younger, unmarried and unemployed, and have more frequent insomnia, lower CD4 lymphocyte counts, and higher GAD-7 and CSE-D total scores. Multiple logistic regression analyses revealed that suicidality was independently associated with unemployment (p = 0.03, OR = 0.3, 95% CI = 0.1–0.9), age (p < 0.01, OR = 0.9, 95% CI = 0.8–0.9), CD4 lymphocyte counts (p = 0.02, OR = 0.9, 95% CI = 0.9–1.0), and the GAD-7 total score (p < 0.001, OR = 1.3, 95% CI = 1.1–1.5). Suicidality is common in Chinese MSM with HIV infection. There is an urgent need to develop comprehensive suicide prevention program and mental health services for this population. © 2018, © 2018 Informa UK Limited, trading as Taylor & Francis Group.
Keywords: China; human immunodeficiency virus; men who have sex with men; Suicidality

Depression and self-harm from adolescence to young adulthood in sexual minorities compared with heterosexuals in the UK: a population-based cohort study - Irish, M.; Solmi, F.; Mars, B.; King, M.; Lewis, G.; Pearson, R.M.; Pitman, A.; Rowe, S.; Srinivasan, R.; Lewis, G. (The Lancet Child and Adolescent Health, 2019)
Background: There are few population-based cohort studies of the emergence, development, and persistence of mental health problems in sexual minorities compared with heterosexuals. We compared trajectories of depressive symptoms in sexual-minority adolescents and heterosexual adolescents from when they were aged 10 years to 21 years, and examined self-harm at ages 16 years and 21 years. Methods: The study included 4828 adolescents born between April 1, 1991, and Dec 31, 1992, from the Avon Longitudinal Study of Parents and Children birth cohort (Bristol, UK) who reported their sexual orientation when aged 16 years. Depressive symptoms were assessed with the short Mood and Feelings Questionnaire (sMFQ) at seven timepoints between ages 10 years and 21 years. A self-harm questionnaire was completed at ages 16 years and 21 years. Analyses were linear multilevel models with growth curves (depressive symptoms), logistic multilevel models (self-harm in the previous year at ages 16 years and 21 years), and multinomial regression (lifetime self-harm with and without suicidal intent at age 21 years). Findings: At age 10 years, depressive symptoms were higher in sexual minorities (mean sMFQ 4·58 [SD 3·59]) than in heterosexuals (3·79 [3·36]) and increased with age to a larger extent. Depressive symptoms increased at each timepoint by 0·31 sMFQ points in hetereosexuals (95% CI 0·27–0·34), and by 0·49 sMFQ points in sexual minorities (0·40–0·59). Sexual-minority adolescents were more likely than heterosexual adolescents to report self-harm in the previous year at ages 16 years and 21 years (adjusted odds ratio 4·23, 95% CI 2·90–6·16), with no evidence that this estimate decreased with age (p=0·80). When aged 21 years, sexual minorities were 4·53 (95% CI 3·02 to 6·78) times more likely to report lifetime self-harm (ie, on at least one previous occasion) with suicidal intent than heterosexuals. Interpretation: Mental health disparities between heterosexuals and sexual minorities are present early in adolescence and increase throughout the school years, persisting to young adulthood. Prevention of these mental health problems and early intervention must be a priority. Funding: Medical Research Council, Wellcome Trust. © 2019 Elsevier Ltd

Current and Military-Specific Gender Minority Stress Factors and Their Relationship with Suicide Ideation in Transgender Veterans - Tucker, R.P.; Testa, R.J.; Reger, M.A.; Simpson, T.L.; Shipherd, J.C.; Lehavot, K. (Suicide and Life-Threatening Behavior, 2019)
Research suggests the prevalence of suicide ideation and suicide attempts in the transgender veteran community may be upwards of 20 times higher than nontransgender veterans, who are known to be at increased risk than the general US population. This study aimed to understand the potential influence of external and internal minority stress experienced during and after military service on past-year and recent suicide ideation in a sample of 201 transgender veterans. Nonparametric bootstrapping analyses indicated past-year transgender-specific discrimination and rejection (external minority stress) indirectly predicted frequency of both past-year and past 2-week suicide ideation through past-year shame related to gender identity (internal minority stress). This result was significant when controlling for symptoms of depression and demographics. Similar patterns emerged when examining relationships among military external and internal minority stress on suicide outcomes. These results suggest that attempts to reduce both the experience and impact of minority stressors related to gender identity during and after military service may be an important avenue for suicide prevention. © 2018 The American Association of Suicidology

The Cowboy Code - Teman, E.D.; Saldaña, J. (Cultural Studies - Critical Methodologies, 2019)
Issues of bullying, suicide, self-expression, self-acceptance, self-harm, among others, within the gay, lesbian, bisexual, transgender, queer, questioning, ally, and others (GLBTQQA+) culture are explored. We show the suffering, the silenced voices, and the pain endured by GLBTQQA+ college students in rural Wyoming. We act as storyretellers by creatively and strategically editing interview transcripts to transform the narratives into a screenplay. The issues within are viewed through a social justice framework rooted in queer theory. © 2018 SAGE Publications.
Keywords: arts-based research; fiction-based research; GLBTQQA+; screenplay; Wyoming

Psychiatric epidemiology of transgender and nonbinary adult patients at an urban health center - Beckwith, N.; McDowell, M.J.; Reisner, S.L.; Zaslow, S.; Weiss, R.D.; Mayer, K.H.; Keuroghlian, A.S. (LGBT Health, 2019)
Purpose: Transgender and nonbinary people have an increased burden of psychiatric problems compared with the general population. Data are needed to understand factors associated with psychiatric diagnoses, acuity in terms of suicide attempts and level-of-care escalation, and outpatient engagement among transgender and nonbinary adults. Methods: We conducted a retrospective review of records from 201 transgender and nonbinary adults who presented for primary care at a health center. Regression models were fit to examine factors associated with psychiatric diagnoses, substance use disorders (SUDs), acuity, and outpatient behavioral health engagement. Results: Male sex assignment at birth was associated with decreased odds of a psychiatric diagnosis (odds ratio [OR] 0.40, 95% confidence interval [CI]: 0.20-0.81). Increased odds of SUDs were associated with later hormone initiation (OR 1.04, 95% CI: 1.01-1.08) and suicide attempt (OR 5.79, 95% CI: 2.08-16.15). Increased odds of higher acuity were associated with alcohol use disorder (OR 31.54, 95% CI: 5.73-173.51), post-traumatic stress disorder (OR 18.14, 95% CI: 2.62-125.71), major depressive disorder (MDD) (OR 6.62, 95% CI: 1.72-25.44), and absence of psychiatrist integration into primary medical care (OR 4.52, 95% CI: 1.26-16.22). Increased odds of outpatient behavioral health engagement were associated with case management utilization (OR 10.73, 95% CI: 1.32-87.53), anxiety disorders (OR 15.84, 95% CI: 2.00-125.72), and MDD (OR 10.45, 95% CI: 2.28-47.98). Conclusion: Psychiatric disorders were highly prevalent among transgender and nonbinary adult patients. Novel findings include associations of lack of psychiatrist integration into primary care with acuity and of case management utilization with outpatient behavioral health engagement. © Mary Ann Liebert, Inc., publishers 2019.
Keywords: mental health; minority stress; nonbinary; substance use disorders; suicide; transgender

Discrimination and suicidal ideation among transgender veterans: The role of social support and connection - Carter, S.P.; Allred, K.M.; Tucker, R.P.; Simpson, T.L.; Shipherd, J.C.; Lehavot, K. (LGBT Health, 2019)
Purpose: The aim was to examine social support and community connection as moderators of the relationship between discrimination and suicidal ideation (SI) in transgender veterans. Methods: A national convenience sample of 298 transgender veterans completed an online cross-sectional survey from February to May 2014. Hierarchical regressions using nonparametric bootstrapping assessed associations among gender-related discrimination within the past year, two aspects of social support (social support, social connection) from four sources (family, friends, transgender/LGBT friends, and veterans), and SI in the past 2 weeks. Results: Discrimination was positively associated with SI. Social support from transgender friends and social connection with LGBT and veteran communities moderated the relationship between discrimination and SI. At high and average levels of social support and connection, discrimination was associated with greater SI, whereas at low levels of these variables, SI was consistently elevated and unrelated to discrimination. Conclusion: Given that SI was consistently elevated when discrimination was high, these findings emphasize the need for additional research on how to mitigate the detrimental effects of discrimination, with consideration given to interventions targeting discrimination or responses to discrimination. In addition, given that high and average transgender social support and LGBT social connection were associated with reduced SI when discrimination was low, research would benefit from continued exploration of the potential protective elements of social support from a shared stigmatized community. © Mary Ann Liebert, Inc., publishers 2019.
Keywords: discrimination; minority stress; social support; suicide ideation; transgender; veterans

Barriers and stigma experienced by gay fathers and their children - Perrin, E.C.; Hurley, S.M.; Mattern, K.; Flavin, L.; Pinderhughes, E.E. (Pediatrics, 2019)
BACKGROUND: Gay men have become fathers in the context of a heterosexual relationship, by adoption, by donating sperm to 1 or 2 lesbian women and subsequently sharing parenting responsibilities, and/or by engaging the services of a surrogate pregnancy carrier. Despite legal, medical, and social advances, gay fathers and their children continue to experience stigma and avoid situations because of fear of stigma. Increasing evidence reveals that stigma is associated with reduced well-being of children and adults, including psychiatric symptoms and suicidality. METHODS: Men throughout the United States who identified as gay and fathers completed an online survey. Dissemination of the survey was enhanced via a “snowball” method, yielding 732 complete responses from 47 states. The survey asked how the respondent had become a father, whether he had encountered barriers, and whether he and his child(ren) had experienced stigma in various social contexts. RESULTS: Gay men are increasingly becoming fathers via adoption and with assistance of an unrelated pregnancy carrier. Their pathways to fatherhood vary with socioeconomic class and the extent of legal protections in their state. Respondents reported barriers to becoming a father and stigma associated with fatherhood in multiple social contexts, most often in religious institutions. Fewer barriers and less stigma were experienced by fathers living in states with more legal protections. CONCLUSIONS: Despite growing acceptance of parenting by same-gender adults, barriers and stigma persist. States’ legal and social protections for lesbian and gay individuals and families appear to be effective in reducing experiences of stigma for gay fathers. Copyright © 2019 by the American Academy of Pediatrics.

Rethinking queer failure: Trans youth embodiments of distress - Roen, K. (Sexualities, 2019)
This article examines trans youth embodied distress in relation to the workings of normativity. I consider the normative cruelties that structure the embodied and gendered experiences of trans youth, and I locate trans youth embodied distress in relation to a notion of queer failure. Central to this analysis is the way emotion is implicated in normativity. I focus on the idea that happiness norms are implicated in keeping gendered subjects in line, and I consider the specific emotions that are bound up in queer failure and embodied distress, such as shame, hatred, and fear. Trans youth frequently respond to the challenges of embodied distress by embarking on a significant emotional, relational project that can involve reworking the relationship to the body and reworking the relationship to norms. In the context of this emotional, relational project, some trans youth self-harm and/or become suicidal. I work with empirical data from trans and gender questioning youth who write online about their self-harming and suicidal feelings, and I use this analysis to locate self-harm in relation to the ways in which some trans youth are crafting embodied and gendered ways of being that break with norms. © The Author(s) 2018.
Keywords: Emotion; gender queer; normativity; self-harm; transgender youth

Death wish: Suicide and stereotype in the gay discourses of imperial and weimar Germany - Huneke, S.C. (New German Critique, 2019)

13 Reasons Why: Viewing patterns and perceived impact among youths at risk of suicide - Hong, V.; Ewell Foster, C.J.; Magness, C.S.; McGuire, T.C.; Smith, P.K.; King, C.A. (Psychiatric Services, 2019)
Objective: The streaming series 13 Reasons Why generated controversy because of its depiction of teen suicide and concerns about its impact on vulnerable youths. This study examined exposure to and patterns of engagement with the show and the show’s perceived impact in a sample of youths presenting to a psychiatric emergency department (ED) with suicide-related concerns in the year after the series’ premiere. Methods: Participants were 87 parent-youth dyads (youths’ mean6SD age=14.661.8; 71% of youths were female, 26% male, and 2% gender nonconforming) who completed a battery of questionnaires during their ED visit. Results: Half (49%) of the sample viewed at least one episode of 13 Reasons Why, season 1. Most youths (84%) viewed the show alone and were more likely to discuss their reactions with peers (80%) than with a parent (34%). Over half of youth viewers (51%) believed the series increased their suicide risk to a nonzero degree; having a stronger identification with the lead female character was significantly related to this belief (r=.63, df=41, p,0.001). Youths with more depressive symptoms and suicidal ideation were more likely to identify with the lead characters and report negative affect while viewing. Conclusions: To date, this is the first published study examining viewing patterns and reactions to 13 Reasons Why in a high-risk sample. Although further research is needed, the findings suggest a particular vulnerability to the show’s themes among youths at risk of suicide and the importance of prevention strategies to ameliorate risk among these viewers. © 2019 American Psychiatric Association. All Rights Reserved.

Physician advocacy for public health - Gusmano, M.K. (Journal of Health Politics, Policy and Law, 2019)
This article documents the public positions taken by the American Academy of Pediatrics, the American College of Physicians, and the American Medical Association on five topics with implications for public health: access to care for undocumented patients, fracking, gun control, climate change, and same-sex marriage. There are stark divisions on each of these issues between political parties, and taking a strong public position on them runs the risk of alienating some members of Congress, but each of these associations has done so. At the same time, there is a clear distinction between the public positions of these organizations and the priority given to them by their offices in Washington, DC. Drawing on an organizational maintenance framework, the author argues that taking these public positions is explained, in part, by a growth in the number of women and the number of physicians that affiliate with the Democratic Party in the United States. © 2019 by Duke University Press.
Keywords: Interest groups; Organizational maintenance; Physician advocacy; Physician associations; Public health

Discussion of potentially sensitive topics with young people - Santelli, J.S.; Klein, J.D.; Song, X.; Heitel, J.; Grilo, S.; Wang, M.; Yan, H.; Kaseeska, K.; Gorzkowski, J.; Schneider, M.; Dereix, A.E.; Catallozzi, M. (Pediatrics, 2019)
OBJECTIVES: To identify modifiable factors that facilitate discussion of potentially sensitive topics between health care providers and young people at preventive service visits after Patient Protection and Affordable Care Act implementation. METHODS: We used data from a national internet survey of adolescents and young adults (13–26 years old) in the United States. Questionnaire construction was guided by formative research and Fisher’s Information-Motivation-Behavioral Skills model. Those who had seen a regular health care provider in the past 2 years were asked about 11 specific topics recommended by national medical guidelines. Four multivariable regression models were used to identify independent predictors of discussions of (1) tobacco use, (2) drug and/or alcohol use, (3) sexually transmitted infections or HIV, and (4) the number of topics discussed. RESULTS: Fewer than half of young people reported having discussed 10 of 11 topics at their last visit. Predictors were similar across all 4 models. Factors independently associated with health discussions included the following: ever talked with a provider about confidentiality (4/4 models; adjusted odds ratio [aOR] = 1.85–2.00), ever had private time with a provider (1 model; aOR = 1.50), use of health checklist and/or screening questionnaire at last visit (4 models; aOR = 1.78–1.96), and time spent with provider during last visit (4 models). Number of years that young men had seen their regular provider was significant in 1 model. Other independent factors were positive youth attitudes about discussing specific topics (3/3 models) and youth involvement in specific health risk behaviors (3/3 models). CONCLUSIONS: Discussions about potentially sensitive topics between health care providers and young people are associated with modifiable factors of health care delivery, particularly provider explanations of confidentiality, use of screening and/or trigger questionnaires, and amount of time spent with their provider. Copyright © 2019 by the American Academy of Pediatrics.

Safeguarding LGBT+ adolescents - Salkind, J.; Bevan, R.; Drage, G.; Samuels, D.; Hann, G. (BMJ (Online), 2019)

Transgender-inclusive care - Lam, J.S.H.; Abramovich, A. (CMAJ, 2019)

Risk and protective factors for mental health morbidity in a community sample of female-to-male trans-masculine adults - McDowell, M.J.; White Hughto, J.M.; Reisner, S.L. (BMC Psychiatry, 2019)
Background: Trans-masculine (TM) individuals, who are assigned female sex at birth and identify along the masculine gender spectrum, face mental health disparities relative to cisgender people. Limited research has sought to explore the multi-level risk and protective factors associated with mental health morbidity for TM populations. Methods: Between August 2015-September 2016, 150 TM adults were enrolled in a one-time biobehavioral health study. A survey assessed socio-demographics, past 12-month everyday discrimination, lifetime intimate partner violence (IPV), resilience (using the Brief Resilience Scale), and other factors. Bivariate and multivariable logistic regression analyses examined associations between participant characteristics and four mental health statuses: post-traumatic stress disorder (PTSD), depression, anxiety, and non-suicidal self-injury (NSSI). Results: In this sample (76.7% had a binary gender identity, i.e., man or transgender man; 74.7% were white, 70.0% were under age 30 years), 42.2% had PTSD based on past 30-day symptoms; 25.7% had depression based on past 7-day symptoms; 31.1% had anxiety based on past 7-day symptoms; and 31.3% had engaged in NSSI within the past 12-months. Results from multivariable models: 1) PTSD: unemployment, lifetime IPV and past 12-month discrimination were each associated with increased odds of PTSD, while having a partner was associated with the reduced odds of PTSD. 2) Depression: lower educational attainment and past 12-month discrimination were each associated with the increased odds of depression, while greater resilience was associated with the reduced odds of depression. 3) Anxiety: low annual household income and past 12-month discrimination were each associated with the increased odds of anxiety, while resilience was associated with the reduced odds of anxiety. 4) NSSI: past 12-month discrimination was associated with the increased odds of past 12-month NSSI, while higher age and greater resilience was associated with the reduced odds of NSSI (all p-values < 0.05). Conclusions: Unemployment, low income, limited education, everyday discrimination, and violence were risk factors for poor mental health, while being in a relationship, higher age, and personal resilience were protective against mental health morbidity. Findings highlight the need for interventions to address the individual, interpersonal, and societal factors that may be driving poor mental health in this population. © 2019 The Author(s).
Keywords: Discrimination; Mental health; Resilience; Transgender; Violence

Cultural versus classic risk and protective factors for suicide - Chu, J.; Robinett, E.N.; Ma, J.K.L.; Shadish, K.Y.; Goldblum, P.; Bongar, B. (Death Studies, 2019)
The current study examined the predictive value of cultural versus classic risk and protective factors for suicide in a community sample of 322 ethnic, sexual, and gender minority adults. Cultural factors played a significant and substantial role in predicting suicide attempts (explained 8% of variance in attempts and correctly classified 8.5% of attempters) over and above the classic factors of hopelessness, depression, and reason for living (which explained 17% of variance in attempts and correctly classified 14.1% of attempters). Findings suggest that cultural factors are important to include in standard suicide practice. © 2018, © 2018 Taylor & Francis.

“Extra marginalisation within the community”: queer individuals’ perspectives on suicidality, discrimination and gay pride events - Schimanski, I.D.; Treharne, G.J. (Psychology and Sexuality, 2019)
Suicidality is more common among queer individuals. Past research has overlooked queer individuals’ own understandings of suicidality in relation to discrimination and supportive processes potentially achieved through gay pride events. This study applied the decompensation model as a framework to explore queer individuals’ perceptions of suicide, discrimination and gay pride events. Seven focus groups were held with a total of 28 queer individuals aged 18–25 years old. Participants had a range of sexualities, genders and ethnicities. Qualitative data from the focus groups were interpreted using an inductive form of thematic analysis, resulting in three themes: the invisibility of suicide; compound discrimination; and processes of normalising queer identities. Participants suggested that greater awareness of suicide is needed and proposed a trajectory from discrimination to suicide, wherein both queer identities and suicidality are discriminated against. Discrimination from within queer communities was problematised and gay pride events were understood to normalise queer identities by providing opportunities for support and fostering activism against inequalities. The results underscore nuanced perspectives on suicidality, discrimination and gay pride events among young queer individuals in Aotearoa/New Zealand and have implications for suicide prevention efforts. These findings also demonstrate the value of applying an intersectional approach to identity, ideology and discrimination in research on suicidality among queer individuals. © 2018, © 2018 Informa UK Limited, trading as Taylor & Francis Group.
Keywords: decompensation; discrimination; gay pride events; LGBT; Queer; suicide

“Savoring” buffers the association between negative emotions and suicidal behaviors in the GSM community - Klibert, J.J.; Luna, A.; Miceli, M. (Journal of Gay and Lesbian Mental Health, 2019)
This study examined the effects of “savoring the moment” (the ability to generate, maintain, and extend positive emotions) on the relationship between negative emotions and suicidal behavior in a sample of gender and sexual minorities (GSM). Savoring the moment moderated the associated effects of negative emotions on suicidal behavior; the relationship between negative emotions and suicidal behaviors ceased at higher levels of savoring the moment. Our finding offers preliminary evidence for savoring as a buffer to suicide among subpopulations of GSM individuals. Our findings also provide some insights into the use of positive psychological interventions in GSM suicide prevention efforts. © 2018, © 2018 Taylor & Francis Group, LLC.
Keywords: Gender and sexual minorities; negative emotions; positive psychology; savoring; suicidal behavior

Background, experience of abuse, and mental health among adolescents in out-of-home care: a cross-sectional study of a Swedish high school national sample - Tordön, R.; Svedin, C.G.; Fredlund, C.; Jonsson, L.; Priebe, G.; Sydsjö, G. (Nordic Journal of Psychiatry, 2019)
Purpose: To compare experiences for adverse events, especially sexual abuse, and mental health in a group of high school students in out-of-home care with a representative sample of peers of the same age and similar educational attainment living with their parents. Materials and methods: A sample of 5839 students in the third year of Swedish high school, corresponding to a response rate of 59.7%, answered a study specific questionnaire. Data from 41 students living in out-of-home care were compared with data from peers not in out-of-home care in a cross-sectional analyze. Results: Students in out-of-home care had more often an immigrant background and a non-heterosexual orientation, had more often experienced physical and penetrative sexual abuse, and more often sought healthcare for mental problems. Disclosure of sexual abuse was less common, and acts of persuasion or adults' use of their social position was more common among students in out-of-home care. Conclusions: Even where the protective factor ‘senior educational attainment’ is present, risks for abuse and poor mental health are evident for adolescents in out-of-home care. Disclosure of adversity, when it has occurred, ought to be higher among these adolescents with regular contact with social services, but our findings indicate tendencies for the opposite. We therefore suggest routines to be established to screen for adverse life events and mental health actively, along with general and systematic assessments of adversity and mental health during care. © 2019, © 2019 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
Keywords: child sexual abuse; foster home care; mental health; Out-of-home care; residential care

Minority Stress and Suicidal Behavior: Investigating a Protective Model Through Resilience in a Bisexual Sample - Miceli, M.; Klibert, J.; Yancey, C.T. (Journal of Bisexuality, 2019)
Suicidal behaviors are a serious public health concern in the bisexual community. Protective models are needed to guide culturally informed methods of prevention. The current study evaluated the moderating effects of resilience and mental health status on the relationship between minority stress and suicidal behaviors. Data were collected from a convenience sample of bisexuals (N = 200). Results reveal a complex pattern of findings. Resilience moderates the relationship between minority stress and suicidal behaviors for bisexual community members with a reported mental health diagnosis; at moderate levels of resilience, a score of 15 on the Brief Resilience Scale, the relationship between minority stress and suicidal behaviors is nullified. Alternatively, resilience was not revealed as a significant moderator among bisexual community members without a mental health diagnosis. These findings provide preliminary evidence for resilience as a buffer against suicide for bisexual community members with mental health difficulties. © 2019, © 2019 Taylor & Francis Group, LLC.
Keywords: Bisexual; mental health status; minority stress; resilience; suicidal behavior

Effects of Multiple Forms of Information Bias on Estimated Prevalence of Suicide Attempts According to Sexual Orientation: An Application of a Bayesian Misclassification Correction Method to Data from a Systematic Review - Salway, T.; Plöderl, M.; Liu, J.; Gustafson, P. (American Journal of Epidemiology, 2019)
Multiple epidemiologic studies demonstrate a disparity in suicide risk between sexual minority (lesbian, gay, bisexual) and heterosexual populations; however, both "exposure" (sexual minority status) and outcome (suicide attempts) may be affected by information bias related to errors in self-reporting. We therefore applied a Bayesian misclassification correction method to account for possible information biases. A systematic literature search identified studies of lifetime suicide attempts in sexual minority and heterosexual adults, and frequentist meta-analysis was used to generate unadjusted estimates of relative risk. A Bayesian model accounting for prior information about sensitivity and specificity of exposure and outcome measures was used to adjust for misclassification biases. In unadjusted frequentist analysis, the relative risk of lifetime suicide attempt comparing sexual minority with heterosexual groups was 3.38 (95% confidence interval: 2.65, 4.32). In Bayesian reanalysis, the estimated prevalence was slightly reduced in heterosexual adults and increased in sexual minority adults, yielding a relative risk of 4.67 (95% credible interval: 3.94, 5.73). The disparity in lifetime suicide attempts between sexual minority and heterosexual adults is greater than previously estimated, when accounting for multiple forms of information bias. Additional research on the impact of information bias in studies of sexual minority health should be pursued. © The Author(s) 2018. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
Keywords: attempted suicide; bias; bisexual; gay; lesbian; sexual and gender minorities

Is There a Need for LGBT-Specific Suicide Crisis Services? - Goldbach, J.T.; Rhoades, H.; Green, D.; Fulginiti, A.; Marshal, M.P. (Crisis, 2019)
Background: Lesbian, gay, bisexual, and transgender (LGBT) youth are more than twice as likely to attempt suicide than their peers. Although LGBT-specific crisis services have been developed, little is known about the need for these services beyond that of general lifeline services. Aims: The present study sought to (a) describe the primary reasons for calling a specialized provider as opposed to another and (b) examine sociodemographic differences in the primary reason by race, ethnicity, gender, age, and sexual orientation. Method: Data from 657 youth who sought crisis services from an LGBT-specific national service provider in the United States were assessed. Logistic regression models assessed demographic differences. Thematic analysis of open-ended responses regarding reasons for choosing this LGBT-specific crisis service provider followed a consensus model. Results: Most respondents indicated they either would not have contacted another helpline (26%) or were not sure (48%). Nearly half (42%) indicated they called specifically because of LGBT-affirming counselors, a reason more commonly reported by gender minority (transgender and gender nonbinary) and queer or pansexual youth than cisgender, gay, or lesbian youth. Conclusion: LGBT-specific crisis services appear to play an important role in suicide prevention. Further research is needed to understand the use of culturally tailored suicide prevention approaches. © 2018 Hogrefe Publishing.
Keywords: crisis services; LGBT youth; suicide prevention

Sexual orientation and complete mental health - Gilmour, H. (Health Reports, 2019)
Background: Previous research indicates that lesbian, gay and bisexual individuals have poorer mental health than their heterosexual counterparts. The concept of complete mental health, which combines the presence of positive mental health and the absence of mental disorder, has not been thoroughly examined in this population. Data and methods: Data from the 2015 Canadian Community Health Survey (CCHS) were used to estimate the number and percentage of men and women aged 15 and older who self-identify as lesbian, gay, bisexual, or heterosexual. Complete mental health was defined as the presence of flourishing mental health together with the absence of any self-reported mood disorder, anxiety disorder or suicide ideation in the previous 12 months. Multivariate logistic regression models stratified by sex were used to identify differences in complete mental health among gay, lesbian, bisexual, and heterosexual individuals. Results: In 2015, an estimated 252,000 (1.9%) Canadian men identified as gay and 145,000 (1.1%) as bisexual, while 153,000 Canadian women (1.1%) identified as lesbian and 299,000 (2.2%) as bisexual. Gay men had significantly lower unadjusted odds of complete mental health, but this association was no longer significant when controlling for sociodemographic and health factors. The likelihood of complete mental health was not significantly different for lesbians than for heterosexual women. Both bisexual men and bisexual women had significantly lower odds of complete mental health in the fully adjusted models. Interpretation: Awareness of poorer mental health outcomes, particularly for bisexual individuals, can help guide specific interventions aimed at improving the mental health and well-being of sexual minority populations. © 2019 Statistics Canada.
Keywords: Anxiety disorders; Cross-sectional study; Flourishing; Health survey; Mood disorders; Positive mental health; Quality of life; Suicidal ideation

Sexual Orientation and the Integrated Motivational–Volitional Model of Suicidal Behavior: Results from a Cross-Sectional Study of Young Adults in the United Kingdom - Rasmussen, S.; Cramer, R.J.; McFadden, C.; Haile, C.R.; Sime, V.L.; Wilsey, C.N. (Archives of Suicide Research, 2019)
Sexual orientation minority (i.e., lesbian, gay, bisexual, queer, and other; LGBQ+) persons represent a vulnerable population with respect to suicide-related behavior. An emerging theory of suicide, the Integrated Motivational–Volitional Model of Suicide (IMV), is utilized in the present study to examine sexual orientation, as well as a number of other IMV-defined pre-motivational factors (i.e., demographics, psychological distress and personality), as they impact the IMV motivational factors of defeat, entrapment, and suicidal ideation/intent. The present investigation featured a cross-sectional online survey of young adults (ages 18–34 years; n=418; 27% identified as LGBTQ+) across the United Kingdom. The key findings included: (1) high rates of 12-month suicidal ideation prevalence (54.5%) and willingness to enact a future suicide attempt (60.8%); (2) bisexual and other (e.g., pansexual)-identifying sexual minority persons reported higher levels of IMV-related outcomes (e.g., internal entrapment, defeat); (3) sexual orientation accounted for significant variance in predicting motivational constructs controlling for a number of other pre-motivational factors; (4) other sexual minority status, compared to heterosexual identity, predic all motivational outcomes, and; (5) extraversion, agreeableness, and emotional stability emerged as pre-motivational protective factors for varying motivational outcomes. Findings are discussed with respect to the suicide and sexual minority theories, as well as tailored suicide prevention efforts and future research. © 2019, © 2019 International Academy for Suicide Research.
Keywords: defeat; entrapment; personality; sexual orientation; suicide

Sexual Orientation Enumeration in State Antibullying Statutes in the United States: Associations with Bullying, Suicidal Ideation, and Suicide Attempts among Youth - Meyer, I.H.; Luo, F.; Wilson, B.D.M.; Stone, D.M. (LGBT Health, 2019)
Purpose: The aim was to assess the associations of antibullying U.S. state statutes that enumerate sexual orientation with exposure to bullying and other stressors and with suicidal ideation and suicide attempts in sexual minority and non sexual minority youth. Methods: We analyzed data from the 2015 national school-based Youth Risk Behavior Survey, representative of 9th through 12th grade students attending public and private schools in the United States. We reviewed each state's antibullying statutes and classified them on enumeration. Results: Antibullying state laws that enumerate sexual orientation were associated with lower risk for suicide attempts and serious attempts requiring medical attention and lower risk for forced sexual intercourse. They were also associated with feeling safe at school or on the way to or from school. Results did not differ by sexual orientation. Conclusions: Enumeration of sexual orientation was associated with reduced stressors and suicide attempts, but it is insufficient to remove significant disparities based on sexual orientation. Additional policies and practices are required to address persistent sexual orientation disparities in exposure to bullying and suicidal behavior. © Copyright 2019, Mary Ann Liebert, Inc., publishers 2019.
Keywords: bullying; law and policy; schools; sexual minority youth; suicide attempts

Introduction to the Special Section on Bisexual Health: Can You See Us Now? - Bostwick, W.B.; Dodge, B. (Archives of Sexual Behavior, 2019)
Despite comprising the largest proportion of the “lesbian, gay, and bisexual” population, research focusing on the unique health concerns and needs of bisexual individuals is relatively scarce. While health disparities are increasingly well documented among lesbian, gay, bisexual, and transgender individuals relative to their heterosexual and cisgender counterparts, gaps remain in our basic understanding of how health status, behaviors, and outcomes vary within these groups, especially bisexual individuals. The lack of specified research on bisexual health is even more curious given that, when separated from both heterosexual and gay/lesbian individuals, bisexual individuals consistently report higher rates of a wide range of negative health outcomes, including mood and anxiety disorders, substance use, suicidality, as well as disparities related to healthcare access and utilization. Indeed, in scientific research, mass media, and in public health interventions, bisexual individuals remain relatively invisible. This Special Section represents an effort to shed light on a new generation of quantitative, qualitative, and mixed methods research studies that examine health-related concerns, outcomes, and intervention opportunities specifically among diverse samples of bisexual individuals from a variety of social and cultural contexts. The research herein focuses on intersections of multiple identities, the development of new measures, the use of large national data sets, and diverse groups of self-identified bisexual men (who tend to be least visible in health research). Findings from these studies will significantly advance our knowledge of factors associated with health disparities, as well as health and well-being more generally, among bisexual individuals and will help to inform directions for future health promotion research and intervention efforts. © 2018, Springer Science+Business Media, LLC, part of Springer Nature.
Keywords: Bisexual health; Bisexuality; LGBT; Sexual and gender minority (SGM); Sexual identity; Sexual orientation

Early roots of sexual-orientation health disparities: Associations between sexual attraction, health and well-being in a national sample of Australian adolescents - Perales, F.; Campbell, A. (Journal of Epidemiology and Community Health, 2019)
Background: Research documents substantial adolescent health disparities by sexual orientation, but studies are confined to a small number of countries - chiefly the USA. We provide first-time evidence of associations between sexual orientation and adolescent health/well-being in a new country - Australia. We also add to knowledge by examining health/well-being outcomes not previously analysed in national samples, considering adolescents reporting no sexual attractions, and rank-ordering sexual-orientation health disparities by magnitude. Methods: Data from an Australian national probability sample of 14/15 years old (Longitudinal Study of Australian Children, n=3318) and regression models adjusted for confounding and for multiple comparisons were used to examine the associations between sexual attraction and 30 outcomes spanning multiple domains of health/well-being - including socio-emotional functioning, health-related quality of life, depressive symptoms, health-related behaviours, social support, self-harm, suicidality, victimisation, self-concept, school belonging and global health/well-being assessments. Results: Lesbian, gay, bisexual and questioning adolescents displayed significantly worse health/well-being than their heterosexual peers in all outcomes (p<0.05). The magnitude of the disparities ranged between 0.13 and 0.75 SD, and was largest in the domains of self-harm, suicidality, peer problems and emotional problems. There were fewer differences between the heterosexual and no-attraction groups. Worse outcomes were observed among both-sex-attracted adolescents compared with same-sex-attracted adolescents, and sexual-minority girls compared with sexual-minority boys. Conclusions: Consistent with the minority stress model and recent international scholarship, sexual-minority status is an important risk factor for poor adolescent health/well-being across domains in Australia. Interventions aimed at addressing sexual-orientation health disparities within Australian adolescent populations are urgently required. © Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.
Keywords: adolescence; Australia; health disparities; sexual orientation; well-being

Suicidality among Gender Minority Youth: Analysis of 2017 Youth Risk Behavior Survey Data - Jackman, K.B.; Caceres, B.A.; Kreuze, E.J.; Bockting, W.O. (Archives of Suicide Research, 2019)
We examined differences in suicidality based on gender identity while adjusting for known suicide risk factors in a sample of United States adolescents. Using data from the 2017 Youth Risk Behavior Survey we used logistic regression models to examine three suicide-related outcomes. Youth were categorized as transgender (1.3%), gender-questioning (1.4%), or cisgender (97.3%). In fully adjusted models, compared to cisgender youth, transgender youth had 2.71 (95% CI 1.50–4.92) higher odds of past-year suicide attempts and 2.54 (95% CI 1.05–6.15) higher odds of past-year suicide attempts requiring treatment. Gender-questioning youth had 2.31 (95% CI 1.48–3.60) higher odds of past-year suicidal ideation compared to cisgender youth. Policies and interventions are needed to reduce suicidality among gender minority youth, improve access to mental healthcare, and reduce peer victimization and substance use. © 2019, © 2019 International Academy for Suicide Research.
Keywords: gender identity; mental health; suicide; transgender; adolescent

Gender Identity, Sexual Orientation, Mental Health, and Bullying as Predictors of Partner Violence in a Representative Sample of Youth - Walls, N.E.; Atteberry-Ash, B.; Kattari, S.K.; Peitzmeier, S.; Kattari, L.; Langenderfer-Magruder, L. (Journal of Adolescent Health, 2019)
Purpose: Partner violence (PV) is prevalent among US adolescents, though little is known about its prevalence and correlates across gender identities and sexual orientations. Existing research has frequently placed lesbian, gay, bisexual (LGB), questioning, and transgender adolescents in the same category, obscuring potential differences in risk of PV. Methods: This study (N = 9,352) uses the 2015 Healthy Kids Colorado Study, a statewide representative survey, to explore how sexual orientation and gender identity are associated with PV victimization among high-school youth, and whether there is a relationship between mental health and bullying victimization and PV. Results: Out of all youth who dated in the past year, 9.4% reported experiencing past-year PV. Compared to their cisgender heterosexual peers, cisgender LGB youth (AOR = 1.48 [1.17, 1.86]) and cisgender questioning youth (AOR = 1.68 [1.13, 2.48]) had elevated risk of experiencing PV. Transgender youth, particularly those who are both transgender and LGB (AOR = 3.25 [2.02, 5.22]) or transgender and questioning their sexual orientation (AOR = 8.57 [4.28, 17.16]), had the highest risk of PV. Depressive symptoms (AOR = 1.99 [1.67, 2.37]), suicidality (AOR = 1.83 [1.62, 2.06]), bullying victimization (AOR = 1.58 [1.31, 1.91]), and online bullying victimization (AOR = 1.98 [1.62, 2.06]) were associated with PV. Conclusions: LGB, questioning and transgender high school students are at elevated risk of PV, with the highest risk among those who are both LGB and transgender. Adolescents who report PV are also more likely to be struggling with bullying, depression, and suicidality. PV prevention and response interventions should use intersectional approaches responsive to the unique needs of LGBT youth. © 2018
Keywords: Bullying; Depression; Gender identity; Partner violence; Sexual orientation; Suicide

The prevalence and predictors of mental health diagnoses and suicide among U.S. college students: Implications for addressing disparities in service use - Liu, C.H.; Stevens, C.; Wong, S.H.M.; Yasui, M.; Chen, J.A. (Depression and Anxiety, 2019)
Background: The college years represent a period of increased vulnerability for a wide range of mental health (MH) challenges. The onset of common psychiatric conditions occurs during this period of development. Increases in depression, anxiety, and suicidality among U.S. college students have been observed. This study identified prevalence and correlates of MH diagnoses and suicidality in a recent sample of U.S. college students. Methods: The Spring 2015 American College Health Association-National College Health Assessment (ACHA-NCHA) survey assessed MH diagnoses and suicidality from U.S. undergraduate students (n = 67,308) across 108 institutions. Results: Stress was strongly associated with a greater likelihood of suicide attempts and MH diagnoses, even among students reporting 1–2 stressful events (OR [odds ratio] range 1.6–2.6, CI [confidence interval] = 1.2–3.2). Bisexual students were more likely to report MH diagnoses and suicidality, compared to heterosexual and gay/lesbian students (OR range 1.5–3.9, CI = 1.8–4.3), with over half engaging in suicidal ideation and self-harm, and over a quarter reporting suicide attempts. Transgender students reported a higher rate of MH diagnoses and suicidality relative to females (OR range 1.9–2.4, CI = 1.1–3.4). Racial/ethnic minority students were generally less likely to report MH diagnoses relative to Whites, although the likelihood for suicidality was mixed. Conclusions: The high rate of multiple stress exposures among the U.S. college population and the high impacts of stress on MH and suicidality point to an urgent need for service utilization strategies, especially among racial/ethnic, sexual, or gender minorities. Campuses must consider student experiences to mitigate stress during this developmental period. © 2018 Wiley Periodicals, Inc.
Keywords: attempted suicide; mental health; minority groups; sexual and gender minorities; suicidal ideation; universities

Risk Factors for Suicidal Ideation in a Sample of Colombian Adolescents and Young Adults who Self-identify as Homosexuals - Pineda-Roa, C.A. (Revista Colombiana de Psiquiatria, 2019)
Background: Research shows higher rates of ideation and attempted suicide in the homosexual population compared to their heterosexual counterparts. To date, there are no known studies in Colombia that investigate risk factors related to suicidal behavior in a male homosexual population. Objective: The objective of the present study is to investigate the risk factors for suicidal ideation in young men living in Bogota (Colombia) who self-identify as homosexuals. Methods: 175 males between 14 and 27 (19.02 ± 2.0) years completed two tests, one for suicidal thoughts and one for internalized homophobia (IH). The snowball non-probability sampling technique was used. Results: 18.4% reported low suicidal ideation, 24.6% a moderate level and 24% declared a high level of suicidal thoughts. IH scores ranged between the expected minimum and maximum (9-45) (21.54 ± 7). Being sexually abused was the main factor associated with suicidal ideation (OR = 4.02; 95%CI, 1.51-10.67; P = 0.005). Adolescents were 3 times more at risk of suicidal thoughts than young adults (OR = 3.63; 95%CI, 1.35-9.76; P = 0.010). High IH scores were twice as likely to experience suicidal thoughts as those with low IH (OR = 2.11; 95%CI, 1.22-3.67; P = 0.008). Conclusions: These findings are consistent with previous research and suggest the need for early preventive interventions in pursuit of non-coercive sexual health, seeking the re-examination of IH through affirmative sexual diversity therapies. © 2017 Asociación Colombiana de Psiquiatría
Keywords: Suicidal ideation; Teenagers; Young gays

(Ir)Reconcilable Identities: Stories of Religion and Faith for Sexual and Gender Minority Refugees Who Fled From the Middle East, North Africa, and Asia to the European Union - Alessi, E.J.; Greenfield, B.; Kahn, S.; Woolner, L. (Psychology of Religion and Spirituality, 2019)
Religion can be an important aspect of identity for refugees, yet may be a complex phenomenon for lesbian, gay, bisexual, transgender, and queer (LGBTQ) refugees, as it has often been used to oppress them in their countries of origin. This qualitative study sought to understand how 34 LGBTQ refugees who fled to Austria and the Netherlands from Islamic societies described and understood experiences arising from the their religious and sexual or gender identities. Semistructured interviews were conducted to examine participants' religious experiences before, during, and after migration. The researchers used thematic analysis to identify four themes: Internalizing religious messaging: shame, self-blame, and suicidality; rejecting organized religion; 'I only had God': drawing strength and solace from one's faith; and reclaiming Islam in one's own way. Participants grappled with conflict between their religious and LGBTQ identities in their countries of origin; however, their understandings of these identities in the host country differed. The majority out rightly rejected their religious backgrounds and identities. However, religion supported others through the difficulties of migration and resettlement, enabling them to reconcile their faith and sexual or gender identities by adapting their religious practices. Implications for clinical practice are discussed. © 2019 American Psychological Association.
Keywords: Identity; LGBTQ refugees; Religion; Thematic analysis

Clustering Help-Seeking Behaviors in LGBT Online Communities: A Prospective Trial - Liang, C.; Abbott, D.; Hong, Y.A.; Madadi, M.; White, A. (Lecture Notes in Computer Science (including subseries Lecture Notes in Artificial Intelligence and Lecture Notes in Bioinformatics), 2019)
Online Lesbian, Gay, Bisexual, and Transgender (LGBT) support communities have emerged as a major social media platform for sexual and gender minorities (SGM). These communities play a crucial role in providing LGBT individuals a private and safe space for networking because LGBT individuals are more likely to experience social isolation and family rejection. However, the emergence of these online communities introduced new public health concerns and challenges. Since LGBT individuals are vulnerable to mental illness and risk of suicide as compared to the heterosexual population, crisis prevention and intervention are important. Nevertheless, such a protection mechanism has not yet become a serious consideration when it comes to the design of LGBT online support communities partially because of the difficulties of identifying at-risk users effectively and timely. This pilot study aims to explore the potential of identifying LGBT user discussions related to help-seeking through natural language processing and topic model. The findings suggest the feasibility of the proposed approach by identifying topics and representative forum discussions that contain help-seeking information. This study provides important data to suggest the future direction of improving data analytics and computer-aided modules for LGBT online communities with the goal of enhancing crisis suicide prevention and intervention. © 2019, Springer Nature Switzerland AG.
Keywords: LGBT; Mental disorders; Natural language processing; Suicide; Topic model

Cultural Pathways for Suicidal Ideation and Behaviors - Chu, J.; Maruyama, B.; Batchelder, H.; Goldblum, P.; Bongar, B.; Wickham, R.E. (Cultural Diversity and Ethnic Minority Psychology, 2019)
Objective: Goals were to empirically examine cultural suicide pathways initially theorized by the cultural theory and model of suicide, by examining relationships between cultural (family conflict, minority stress, cultural suicide sanctions), general distress (depression, hopelessness), and cultural idioms of distress factors as predictors of suicidal ideation and attempts. Method: Path analysis examined a moderated mediation model with a community sample of 1,077 ethnic minority and/or LGBTQ adults (average age of 24.32 (SD = 10.23) ranging from 18 to 88, 299 LGBTQ, 447 Asian American, 196 Latino/a, 60 Black or African American, 8 Hawaiian or Pacific Islander, 6 Arab American, 2 Native American, 187 mixed race). Results: Multiple pathways of statistical significance emerged. First, cultural life events (family conflict and minority stress) showed direct paths to ideation and attempts and indirect paths through general (depression and hopelessness) and cultural idioms of distress to ideation and attempts. The path from minority stress to ideation was entirely explained by general/cultural distress. Second, cultural suicide sanctions moderated the relationship between family conflict and ideation. Third, cultural idioms of distress was an important component of overall distress, alongside depression and hopelessness, predicting attempts and ideation. Conclusions: Findings elucidated pathways involving both general distress and cultural factors, and pathways from cultural life events to suicide constructs independent of mental illness-related factors. Findings question utilizing mental illness as a primary suicide driver, make theoretical contributions in refining the cultural theory and model of suicide, and advance understandings of roles of cultural factors in suicide research and practice. © 2019 American Psychological Association.
Keywords: Culture; Ethnic minority; LGBTQ; Path analysis; Suicide

Sexual assault, sense of belonging, depression and suicidality among LGBQ and heterosexual college students - Backhaus, I.; Lipson, S.K.; Fisher, L.B.; Kawachi, I.; Pedrelli, P. (Journal of American College Health, 2019)
Objective: To compare the effect of sexual orientation, history of sexual assault and sense of belonging on depression and suicidality among lesbian, gay, bisexual, queer and questioning (LGBQ) and heterosexual students. Participants: A total of 60,194 students from 60 US campuses who participated in the 2017–2018 Healthy Minds Study. Methods: Three-way interaction effects were analyzed using PROCESS macro models in SPSS. Results: Significant three-way interaction effects were found for sexual orientation, sexual assault and sense of belonging predicting depressive symptoms (b = –0.06, p= 0.042, CI: –0.12 to –0.00), and suicidality (b = –0.10, p= 0.004, CI: –0.01 to –0.003). The effect of sexual assault on mental health differed depending on sexual orientation and sense of belonging. Particularly among LGBQ students, high sense of belonging was protective in the presence of sexual assault, and its absence had a deleterious effect on mental health. Conclusion: Enhancing sense of belonging may represent a strategy to mitigate depression and promote suicide prevention, particularly among LGBQ students. © 2019, © 2019 Taylor & Francis Group, LLC.
Keywords: College students; depression; LGBQ; sense of belonging; sexual assault; suicidality

Estimating the Magnitude of the Relation between Bullying, E-Bullying, and Suicidal Behaviors among United States Youth, 2015 - Kuehn, K.S.; Wagner, A.; Velloza, J. (Crisis, 2019)
Background: Suicide is the second leading cause of death among US adolescents aged 12-19 years. Researchers would benefit from a better understanding of the direct effects of bullying and e-bullying on adolescent suicide to inform intervention work. Aims: To explore the direct and indirect effects of bullying and e-bullying on adolescent suicide attempts (SAs) and to estimate the magnitude of these effects controlling for significant covariates. Method: This study uses data from the 2015 Youth Risk Behavior Surveillance Survey (YRBS), a nationally representative sample of US high school youth. We quantified the association between bullying and the likelihood of SA, after adjusting for covariates (i.e., sexual orientation, obesity, sleep, etc.) identified with the PC algorithm. Results: Bullying and e-bullying were significantly associated with SA in logistic regression analyses. Bullying had an estimated average causal effect (ACE) of 2.46%, while e-bullying had an ACE of 4.16%. Limitations: Data are cross-sectional and temporal precedence is not known. Conclusion: These findings highlight the strong association between bullying, e-bullying, and SA. © 2018 Hogrefe Publishing.
Keywords: bullying; electronic bullying; suicide; suicide prevention

Non-binary and binary transgender youth: Comparison of mental health, self-harm, suicidality, substance use and victimization experiences - Rimes, K.A.; Goodship, N.; Ussher, G.; Baker, D.; West, E. (International Journal of Transgenderism, 2019)
Background: Little research has compared the mental health and victimization experiences of non-binary youth depending on their sex assigned at birth (SAAB), or compared these two groups with binary transgender youth. Aims: To compare mental health, self-harm and suicidality, substance use and victimization experiences between non-binary and binary transgender young adults, both male assigned at birth (MAAB) and female assigned at birth (FAAB). Methods: Online survey data from 677 participants from the “Youth Chances” community study of 16 to 25 year olds in the United Kingdom was analyzed, comparing across binary participants (transgender females (n = 105) and transgender males (n = 210)) and non-binary participants (MAAB (n = 93) and FAAB (n = 269)). Results: Female SAAB participants (binary and non-binary) were more likely to report a current mental health condition and history of self-harm than male SAAB participants (binary and non-binary). Similarly, female SAAB participants (binary and non-binary) were more likely to report childhood sexual abuse than male SAAB participants (binary and non-binary); the reverse pattern was found for lifetime physical assault relating to being LGBTQ. Non-binary MAAB participants were less likely than the other groups to report past suicide attempts and previous help-seeking for depression/anxiety. Binary participants reported lower life satisfaction than non-binary participants. For all four groups, mental health problems, self-harm, suicidality, alcohol use and victimization experiences were generally higher than that of youth in general population studies. Conclusions: These findings highlight the importance of considering both non-binary versus binary gender identity and SAAB in relation to mental health problems, self-harm, suicidality and substance use in transgender youth. The roles of sexual abuse, other abuse and discrimination in contributing to increased rates of mental illness and self-harm in non-binary and binary transgender individuals, particularly those who were assigned female at birth, relative to those assigned male, require investigation. © 2017, © 2017 Taylor & Francis Group, LLC.
Keywords: Abuse; discrimination; gender identity; gender-nonconformity; genderqueer; mental illness

History of Physical Teen Dating Violence and Its Association With Suicidal Behaviors Among Adolescent High School Students: Results From the 2015 Youth Risk Behavior Survey - Baiden, P.; Mengo, C.; Small, E. (Journal of Interpersonal Violence, 2019)
Although studies have investigated and found physical teen dating violence (TDV) has a significant negative impact on mental health outcomes, few studies are yet to investigate the effect of physical TDV on suicidal behaviors among adolescents. The objectives of this study are to examine the prevalence of physical TDV, suicidal ideation, suicide plan, and suicide attempt among adolescents aged 14 to 18 years and the association between physical TDV and these suicidal behaviors. Data for this study were obtained from the 2015 Youth Risk Behavior Survey. A sample of 9,693 adolescents aged 14 to 18 years (50.4% males) was analyzed using logistic regression with suicidal ideation, suicide plan, and suicide attempt as outcome variables and physical TDV as the main explanatory variable. About 17% of the adolescent students experienced suicidal ideation, 13.7% made a suicide plan, and 7.6% attempted suicide during the past 12 months. Among those who were dating, 9.9% experienced physical TDV. In the multivariate logistic regression, adolescent students who experienced physical TDV were 1.92 times more likely to have experienced suicidal ideation, 1.67 times more likely to have made a suicide plan, and 2.42 times more likely to have attempted suicide during the past 12 months when compared with their counterparts who were dating but experienced no physical TDV. Other significant predictors of suicidal behaviors include being a sexual minority, experiencing forced sex, bullying, feeling sad or hopeless, and binge drinking. Having sufficient sleep lowered the odds of suicidal ideation and suicide plan. The topic of physical TDV and its association with suicidal behaviors among adolescents is such an important issue for researchers, policymakers, and practitioners in the United States and around the world. Prevention and intervention efforts should be culturally tailored to reflect the unique experiences with physical TDV and suicide among minority populations such as sexual minority adolescents. © The Author(s) 2019.
Keywords: adolescents; physical teen dating violence; suicidal ideation; suicide attempt; suicide plan

The gender affirmative lifespan approach (GALA): A framework for competent clinical care with nonbinary clients - Rider, G.N.; Vencill, J.A.; Berg, D.R.; Becker-Warner, R.; Candelario-Pérez, L.; Spencer, K.G. (International Journal of Transgenderism, 2019)
Background: The limited research on nonbinary individuals suggests that this community experiences significant health disparities. Compared to binary transgender individuals, research suggests that nonbinary individuals are at elevated risk for discrimination and negative mental health outcomes, including depression, anxiety, traumatic stress, and suicidality. Even mental health providers who work with binary transgender individuals often lack knowledge of and training to work competently with nonbinary individuals. Methods: The authors of this conceptual article present the Gender Affirmative Lifespan Approach (GALA), a psychotherapy framework based in health disparities theory and research, which asserts that therapeutic interventions combating internalized oppression have the potential to improve mental health symptomatology resulting in improved overall health and well-being for gender diverse clients. GALA’s therapeutic interventions are designed to promote positive gender identity development through five core components: (1) building resiliency; (2) developing gender literacy; (3) moving beyond the binary; 4) promoting positive sexuality; and (5) facilitating empowering connections to medical interventions (if desired). Results: The core components of the GALA model are individualized to each client’s unique needs, while taking into consideration age and acknowledging developmental shifts in, or fluidity of, gender across the lifespan. This model represents an inclusive, trans-affirmative approach to competent clinical care with nonbinary individuals. Discussion: Application of the GALA model with nonbinary clients is discussed, including one clinical case vignette. © 2018, © 2018 Taylor & Francis Group, LLC.
Keywords: gender affirming psychotherapy; Genderqueer; LGBT health; nonbinary; transgender; transgender health

Suicidal Ideation and Behavior among Youth Victims of Sex Trafficking in Kentuckiana - Frey, L.M.; Middleton, J.; Gattis, M.N.; Fulginiti, A. (Crisis, 2019)
Background: Youth experiencing homelessness are at risk for sex trafficking and mental health concerns. Aims: More information is needed to elucidate the prevalence and characteristics of suicidal ideation and behavior among youth experiencing sex trafficking. Method: The present study examined suicidal ideation and behavior in a convenience sample of 128 youths experiencing homelessness aged 12-25 years in metropolitan Louisville, Kentucky, and southern Indiana. Participants were asked seven questions regarding suicidal ideation and attempts as part of an enhanced version of the 60-item Youth Experiences Survey (YES). Results: Approximately 53% of the sample reported experiencing suicidal ideation at some point in their lifetime and the odds of a youth experiencing homelessness who had experienced sex trafficking reporting suicidal ideation was 3.87 times higher than the odds of a youth experiencing homelessness who had not experienced sex trafficking. Additionally, of those who reported experiencing suicidal ideation, the majority (84.4%) reported they had attempted suicide in their lifetime. Limitations: This study relied on a convenience sample of youth receiving services in the Kentuckiana region and brief, self-report measures yielding categorical data. Conclusion: Programs servicing youth experiencing homelessness should require additional training and resources regarding the identification, screening, and assessment of youth who are at risk of or who have experienced sex trafficking in order to more quickly connect youth with much-needed, trauma-informed services. © 2018 Hogrefe Publishing.
Keywords: homelessness; human trafficking; sex trafficking; suicidal disclosure; suicide; youth

The Queer Kairotic: Digital Transgender Suicide Memories and Ecological Rhetorical Agency - Hatfield, J.E. (Rhetoric Society Quarterly, 2019)
When two transgender teenagers posted eerily similar suicide letters to public Tumblr accounts in late 2014 and early 2015, they inspired a viral memorialization effort across the website. In this article, I argue the widespread circulation of transgender suicide rhetoric facilitates the possibility for queer rhetors to provoke collective enactments of rhetorical agency even after their deaths. I identify the suicide letters as an emergent rhetorical form, which on its dissemination and due to its intelligibility, incites a kairotic moment. The kairotic moment may be protracted by a network of bodies who feel and collectively reproduce its sensate exigence. As it becomes viral, the kairotic moment acts as the queer futurity of ecological rhetorical agency because it stretches the visceral pressure of exigence beyond its original spatiotemporal emergence, draws bodies into collaborative networks, and orients invention toward the dismantling of normative rhetorical constructs and the composition of alternative worlds. © 2019, © 2019 The Rhetoric Society of America.
Keywords: kairos; queer rhetoric; rhetorical agency; rhetorical ecology; transgender

Differences in Characteristics and Exposure to Stressors between Persons with and Without Diagnosed Mental Illness Who Died by Suicide in Victoria, Australia - Clapperton, A.; Newstead, S.; Bugeja, L.; Pirkis, J. (Crisis, 2019)
Background: Mental illness is an established risk factor for suicide. To develop effective prevention interventions and strategies, the demographic characteristics and stressors (other than, or in addition to, mental illness) that can influence a person's decision to die by suicide need to be identified. Aim: To examine cases of suicide by the presence or absence of a diagnosed mental illness (mental illness status) to identify differences in factors associated with suicide in the groups. Method: Logistic regression analyses were used to investigate mental illness status and exposure to stressors among 2,839 persons who died by suicide in Victoria, Australia (2009-2013), using the Victorian Suicide Register. Results: Females, metropolitan residents, persons treated for physical illness/injury, those exposed to stressors related to isolation, family, work, education, and substance use and those who had made a previous suicide attempt had increased odds of having a diagnosed mental illness. Employed persons had decreased odds of having a diagnosed mental illness. Limitations: The retrospectivity of data collection as well as the validity and reliability of some of the data may be questionable owing to the potential for recall bias. Conclusion: The point of intervention for suicide prevention cannot always be a mental health professional; some people who die by suicide either do not have a mental illness or have not sought help. © 2018 Hogrefe Publishing.
Keywords: mental illness; suicide; suicide epidemiology; suicide stressors

Non-suicidal self-injury among sexual minority youth: An etiological and treatment overview - Smithee, L.C.; Sumner, B.W.; Bean, R.A. (Children and Youth Services Review, 2019)
Non-suicidal self-injury (NSSI) among sexual minority youth (SMY) is a problem that is growing in attention yet is understudied and requires an informed response from therapists who engage in clinical work with youth. This paper proposes a unique model of treatment for working with SMY who engage in NSSI, accounting for proximal, distal, and systemic factors that influence the etiology of NSSI. This model is based on a review of two bodies of clinical literature: (a) treating adolescent NSSI and (b) working with SMY and their families. As an etiological theory of self-harm, Nock (2009) is applied to SMY, factoring in the unique stressors experienced by this group that affect intervention. Reviewed treatment approaches include Dialectical Behavioral Therapy for Adolescents (DBT-A) and narrative family therapy. Treatment guidelines are conceptualized and outlined to aid therapists in providing affirmative and informed therapeutic services. While few, if any articles have studied treatment for SMY who engage in NSSI, this article contributes to the literature by proposing culturally competent interventions. © 2018 Elsevier Ltd

Resilience and non-suicidal self-injury in LGBTQIA+ people: Targets for prevention and intervention - Watson, C.; Tatnell, R. (Current Psychology, 2019)
Identifying as LGBTQIA+ is associated with greater risk of non-suicidal self-injury (NSSI); understanding why may aid in decreasing NSSI and associated risks in this vulnerable population. We examined discrimination, psychological distress, ‘outness’, resilience, and NSSI in 330 young adults (18–30) from the Australian LGBTQIA+ community. Individuals reporting NSSI reported more depression, anxiety and stress, and less resilience than those who had not engaged in NSSI. Perceived discrimination was not associated with NSSI engagement, however people identifying as queer reported more discrimination than other LGBTQIA+ participants. Additionally, not being ‘out’ in the workplace was associated with NSSI. Building resilience and social support within and for the LGBTQIA+ community may be beneficial in addressing LGBTQIA+ mental health and NSSI. © 2019, Springer Science+Business Media, LLC, part of Springer Nature.
Keywords: LGBT; Non-suicidal self-injury; NSSI; Resilience; Sexual orientation

Suicide ideation, planning, and attempts: The case of the Latinx LGB youth - Boyas, J.F.; Villarreal-Otálora, T.; Alvarez-Hernandez, L.R.; Fatehi, M. (Health Promotion Perspectives, 2019)
Background: Guided by an ecological systems theory (EST) framework, the purpose of the present study was to investigate how multiple micro, mezzo, and macro factors influence the suicidality continuum from suicidal ideation to suicide attempt among Latinx LGB (lesbian, gay, and bisexual) youth living in the United States. Methods: Data for this cross sectional-study included 451 participants who self-identified as Latinx LGB on the 2017-National Youth Risk Behavioral Survey. The analysis explored micro, mezzo, and macro-level factors' association with three suicidality outcomes (ideation, planning, and attempt) at the bivariate and multivariate level. Since the outcome variables were dichotomized, univariate logistic regressions and backward elimination logistic regressions were used. Results: The most commonly reported suicidal behavior was ideation (n = 173; 40%), followed by planning (n = 150; 34%), and then attempt (n = 64; 21%). Findings from the backward elimination logistic regression on suicidal ideation suggest the best set of independent variables are being bullied at school (odds ratio [OR] = 2.81; CI: 1.61-4.89), experiencing sexual assault (OR = 2.32; CI: 1.32-4.07), experiencing depressive symptoms (OR = 1.99; CI: 1.07- 3.69), being cannabis use (OR = 1.76; CI: 1.08-2.89), and being female (OR = 1.72; CI: 1.01-2.93). For suicide planning the model suggested, experiencing depressive symptoms (OR = 3.21; CI: 1.74-5.91), cannabis use (OR = 2.46; CI: 1.49-4.07), being bullied at school (OR = 2.04; CI: 1.17-3.58), and experiencing sexual assault (OR = 1.88; CI: 1.07-3.31) exhibited the strongest relationships. Suicide attempt was significantly associated with cannabis use (OR = 3.12; CI: 1.60-6.08), experiencing depression (OR= 2.89; CI: 1.30-6.43), experiencing sexual assault (OR = 2.77; CI: 1.34-5.71), and being bullied at school (OR = 2.34; CI: 1.12-4.91). Conclusion: Given the findings of this study, it is essential that tailored suicide prevention efforts be established that uniquely address the intersections of race/ethnicity and sexual orientation and how this intersection influences micro, mezzo, and macro factors associated with suicide ideation, planning, and attempt among Latinx LGB adolescents. © 2019 The Author(s).
Keywords: Adolescence; Latinos; LGB Persons; Suicide

Does it get better? Exploring “it gets better” videos using visual sociology - Brandon-Friedman, R.A.; Kinney, M.M.K. (Journal of LGBT Youth, 2019)
In 2010, the It Gets Better (IGB) project website was launched to house videos containing messages of support for youth who identify as sexual and/or gender minorities (SGMs). Despite success as a virtual social movement, scholars have suggested that the imagery portrayed may unintentionally exclude those who are most marginalized and that the videos often implore individuals to endure suffering now to gain happiness later. Using visual sociology methodology, the visual messaging and demographics of IGB video producers were examined and compared against criticisms of the project. Imagery portrayed was consistent with common concerns about exclusions of minorities, those who do not fit social standards of physical attractiveness, and those who challenge heteronormativity and adherence to gender norms. Despite IGB videos’ intentions to promote hope, the tales of struggle and hardship relayed often resulted in the depiction of negative emotions. Expressions of confidence, defiance, and empathy were visible, but the most prevalent emotion was sadness. Negative visual presentations and exclusion of significant demographics within the SGM community suggest IGB videos project more complex visual signals and different messaging than would be expected from videos designed to be supportive. Professionals should be attuned to these concerns when working with SGM youth. © 2019, © 2019 Taylor & Francis Group, LLC.
Keywords: It Gets Better; LGBTQ Media; sexual orientation; Social support; suicide; visual sociology; youth lgbt < youth

Position statement on the hormonal management of adult transgender and gender diverse individuals - Cheung, A.S.; Wynne, K.; Erasmus, J.; Murray, S.; Zajac, J.D. (Medical Journal of Australia, 2019)
Introduction: Rising demand for gender-affirming hormone therapy mandates a need for more formalised care of transgender and gender diverse (TGD) individuals in Australia. Estimates suggest that 0.1–2.0% of the population are TGD, yet medical education in transgender health is lacking. We aim to provide general practitioners, physicians and other medical professionals with specific Australian recommendations for the hormonal and related management of adult TGD individuals. Main recommendations: Hormonal therapy is effective at aligning physical characteristics with gender identity and in addition to respectful care, may improve mental health symptoms. Masculinising hormone therapy options include transdermal or intramuscular testosterone at standard doses. Feminising hormone therapy options include transdermal or oral estradiol. Additional anti-androgen therapy with cyproterone acetate or spironolactone is typically required. Treatment should be adjusted to clinical response. For biochemical monitoring, target estradiol and testosterone levels in the reference range of the affirmed gender. Monitoring is suggested for adverse effects of hormone therapy. Preferred names in use and pronouns should be used during consultations and reflected in medical records. While being TGD is not a mental health disorder, individualised mental health support to monitor mood during medical transition is recommended. Changes in management as result of this position statement: Gender-affirming hormone therapy is effective and, in the short term, relatively safe with appropriate monitoring. Further research is needed to guide clinical care and understand long term effects of hormonal therapies. We provide the first guidelines for medical practitioners to aid the provision of gender-affirming care for Australian adult TGD individuals. © 2019 AMPCo Pty Ltd
Keywords: Endocrine system; Endocrinology

A comparison of mental health symptomatology and levels of social support in young treatment seeking transgender individuals who identify as binary and non-binary - Thorne, N.; Witcomb, G.L.; Nieder, T.; Nixon, E.; Yip, A.; Arcelus, J. (International Journal of Transgenderism, 2019)
Background: Previous research has consistently reported high rates of mental health symptomatology and lower social support in young treatment seeking transgender individuals. However, these studies have failed to distinguish between transgender people who identify within the gender binary and those who identify as non-binary. Aims: This study aimed to compare levels of mental health symptomatology (anxiety, depression, and non-suicidal self-injury behavior) and social support of treatment seeking non-binary transgender young individuals with those self-identified as binary transgender young individuals. All participants attended a national transgender health service in the UK during a 2-year period. Measures: Age and gender identity descriptors were collected, as well as clinical measures of anxiety and depression (Hospital Anxiety and Depression Scale), self-esteem (The Rosenberg Self-Esteem Scale), non-suicidal self-injury (Non-Suicidal Self-Injury: Treatment Related), and social support (Multidimensional Scale of Perceived Social Support). Results: A total of 388 young people, aged 16–25 years, agreed participation; 331 (85.3%) identified as binary and 57 (14.7%) as non-binary. Analysis of the data showed the non-binary group experienced significantly more anxiety and depression and had significantly lower self-esteem than the binary group. There were no significant differences between groups in the likelihood of engaging in non-suicidal self-injury behavior or levels of social support.Conclusions: Non-binary identifying treatment seeking transgender youth are at increased risk of developing anxiety, depression, and low self-esteem compared to binary transgender youth. This may reflect the even greater barriers and feelings of discrimination that may be faced by those whose identity does not fit the notion of binary gender that is pervasive in how society views both cis- and transgender populations. © 2018, © 2018 Taylor & Francis Group, LLC.
Keywords: Anxiety; depression; gender dysphoria; non-binary; non-suicidal self-injury; self-esteem; social support; trans; transgender; youth

A structural equation model for predicting depressive symptomatology in Black, Asian and Minority Ethnic gay, lesbian and bisexual people in the UK - Jaspal, R.; Lopes, B.; Rehman, Z. (Psychology and Sexuality, 2019)
This study identifies the predictors of depressive symptomatology in Black, Asian and Minority Ethnic (BAME) lesbian, gay and bisexual (LGB) people in the UK. 289 White and BAME LGB individuals participated in a cross-sectional survey. BAME participants exhibited significantly more discrimination, rejection from significant others, ethnic victimisation, internalised homophobia and concealment motivation than White participants. They manifested greater internalised homophobia, less outness and greater drug use than White participants. Outness was associated with less depressive symptomatology, and internalised homophobia and victimisation with more depressive symptomatology. The structural equation model showed a significant effect of ethnicity on depressive symptomatology. This relationship was mediated by the situational stressors, the psychological schemata and coping variables. Consistent with the cognitive-behavioural model, the results indicate that exposure to situational stressors can increase the risk of developing a self-hatred and depressive psychological self-schema, maladaptive coping strategies and depressive symptomatology in BAME LGB people in the UK. © 2019, © 2019 Informa UK Limited, trading as Taylor & Francis Group.
Keywords: BAME; depression; LGB; mental health; psychological distress; suicidal ideation; Symptomatology

Psychopathology and self-harm among incoming first-year students in six Mexican universities - Benjet, C.; Gutiérrez-García, R.A.; Abrego-Ramírez, A.; Borges, G.; Covarrubias-Díaz, A.; Durán, M.S.; González-González, R.; Hermosillo-de la Torre, A.E.; Martínez-Martínez, K.I.; Medina-Mora, M.E.; Mejía-Zarazúa, H.; Pérez-Tarango, G.; et al. (Salud Publica de Mexico, 2019)
Objective. To estimate psychopathology and self-harm behavior of incoming first-year college students, sociodemographic correlates, service use and willingness to seek treatment. Materials and methods. 4 189 male and female incoming first-year students of six universities in four different states of Mexico responded to an online survey with a 79.3% response rate. Results. Almost one in three incoming students has experienced some type of psychopathology; however, only one in five has received treatment. Female, students who are older, whose parents are not married or deceased, and who have a non-heterosexual orientation, no religion or a non-Catholic/Christian religion have greater odds (1.18 - 1.99), whereas those who attend a private university and have a parent with some college education have lower odds (0.68 - 0.75) of experiencing any probable disorder. Conclusions. Substantial unmet need for mental health services combined with reported willingness to use university services suggests an opportunity for the detection, referral, and treatment of incoming students to promote a successful transition. © 2019 Instituto Nacional de Salud Publica. Objetivo. Estimar psicopatologías y autolesiones en universitarios de nuevo ingreso, así como los correlatos sociodemográficos, el uso de servicios y la disposición para recibir tratamiento. Material y métodos. 4 189 estudiantes de nuevo ingreso de seis universidades en cuatro estados contestaron una encuesta en línea con una tasa de respuesta de 79.3%. Resultados. 32.5% han padecido psicopatologías en su vida, pero únicamente 19.5% han recibido tratamiento. Mujeres, estudiantes con una orientación no heterosexual, estudiantes de mayor edad, quienes tienen padres fallecidos o no casados, sin religión o con una religión no católica/cristiana tienen mayor probabilidad de presentar psicopatologías (RM= 1.18-1.99), mientras que aquellos de universidades privadas y cuyos padres tienen estudios universitarios tienen menor probabilidad (RM= 0.68-0.75). Conclusiones. La alta tasa de psicopatologías no tratadas combinada con la disposición reportada de recibir servicios a través de su universidad sugiere una oportunidad para la detección, canalización y tratamiento de alumnos de nuevo ingreso para promover una transición exitosa. © 2019 Instituto Nacional de Salud Publica.
Keywords: Estudiantes; Mental disorders; Mexico; México; Students; Substance-related disorders; Suicide; Suicidio; Trastornos mentales; Trastornos relacionados con sustancias

Exploring the Temporal Dynamics of the Interpersonal Theory of Suicide Constructs: A Dynamic Systems Modeling Approach - Rogers, M.L.; Joiner, T.E. (Journal of Consulting and Clinical Psychology, 2019)
Objective: The interpersonal theory of suicide has contributed to advances in the understanding and prevention of suicidal behavior, with over a decade of empirical examination. Few studies, however, have used a longitudinal design with repeated short-term follow-ups to examine the temporal trajectories of perceived burdensomeness, thwarted belongingness, and suicidal ideation, nor have any studies to our knowledge investigated the propositions of the interpersonal theory of suicide using a dynamic systems theory approach. The present study examined the temporal dynamics of perceived burdensomeness, thwarted belongingness, and suicidal ideation, as moderated by capability for suicide, using dynamic systems modeling analyses in a sample of 91 adults at high risk for suicide (Mage 27.03 years, SD 8.64; 53.8% female, 44.0% male, 1.1% nonbinary, 1.1% transgender female). Method: Participants completed brief online self-report measures at 6 timepoints, each 3 days apart. Results: Results were generally in support of the interpersonal theory of suicide: perceived burdensomeness, thwarted belongingness, and suicidal ideation exhibited patterns of temporal stability that were accentuated at high levels of capability for suicide; perceived burdensomeness and thwarted belongingness exhibited a reciprocal temporal pattern, as did perceived burdensomeness and suicidal ideation. However, thwarted belongingness did not have an incremental influence on suicidal ideation. Conclusions: Overall, these findings provide additional information about the nature of suicidal ideation and interpersonal risk factors over time and point to nonlinear dynamic systems modeling as an analytic technique that may prove useful in understanding trajectories of suicidal thoughts and behaviors. © 2018 American Psychological Association.
Keywords: capability for suicide; interpersonal theory of suicide; perceived burdensomeness; suicide; thwarted belongingness

Gender affirmation surgery from a public health perspective: Advances, challenges, and areas of opportunity - Williams, E.A.; Patete, C.L.; Thaller, S.R. (Journal of Craniofacial Surgery, 2019)
Gender affirmation surgery (GAS) is sought out by approximately 20 to 40% of transgender individuals. These patients possess unique mental and physical health needs. These are compounded by prejudices and lack of education about transgender individuals within the medical system and society at large. Societal and medical barriers are associated with increased risks of violence, suicide, and sexually transmitted infections. This combination of high medical needs and barriers to accessing appropriate care may give rise to a self-perpetuating cycle of risk exposure, stigmatization, prejudice, and eventually poor health outcomes. It is imperative that plastic and reconstructive surgeons understand GAS from a public health perspective, so that they may provide the highest quality of care and help alleviate these disparities. The authors describe unique public health topics in GAS. These are specifically related to healthcare access, surgical education, cultural sensitivity, as well as mental health outcomes for patients who undergo GAS. Copyright © 2019 by Mutaz B. Habal, MD.
Keywords: Craniofacial surgery; Gender affirmation surgery; Public health; Transgender

Using the PHQ-9 and GAD-7 to screen for acute distress in transgender youth: Findings from a pediatric endocrinology clinic - Moyer, D.N.; Connelly, K.J.; Holley, A.L. (Journal of Pediatric Endocrinology and Metabolism, 2019)
Transgender and gender nonconforming (TGNC) youth are at higher risk for anxiety and depression than their peers. The referral rate for those seeking specialty medical care has rapidly increased in recent years. This paper examines the use of brief screening tools with clear cutoffs to assist physicians in rapidly identifying TGNC youth in acute distress. A retrospective chart review was conducted for patients aged 11-18 years being treated in a pediatric endocrinology clinic for gender dysphoria. Patient Health Questionnaires for depression (PHQ-9) and Generalized Anxiety Disorder 7-item (GAD-7) were collected for patients attending an initial consultation (n=79) or follow-up appointment (n=115). Screener data identified high rates of acute distress, including depression (47%), anxiety (61%), and suicidal ideation (30%). Distress was not associated with age or gender identity. More youth endorsed clinically significant anxiety at initial consultation appointments versus follow-up appointments. The results support the use of the PHQ-9 and GAD-7 as brief, easy-to-use screening measures that can be administered by physicians to rapidly identify acute distress and inform treatment recommendations among TGNC youth seeking medical intervention. © 2019 Walter de Gruyter GmbH, Berlin/Boston.
Keywords: anxiety; depression; pediatric; screening; transgender

Correlates of Suicidality Among A Community-Based Cohort of Women Sex Workers: The Protective Effect of Social Cohesion - Argento, E.; Strathdee, S.A.; Shoveller, J.A.; Braschel, M.; Shannon, K. (Journal of Interpersonal Violence, 2019)
Suicide is a critical public health concern globally. Sex workers experience a disproportionate burden of social and health inequities driven by forms of violence, stigma, and criminalization, yet empirical research on suicidality is limited. This study longitudinally investigated the burden and socio-structural correlates of recent suicidality among women sex workers in Vancouver, Canada. Data (2010-2017) were drawn from a community-based, prospective cohort of cis and trans women sex workers across Metro Vancouver. Women completed biannual interviewer-administered questionnaires, and correlates of suicidality in the last 6 months were analyzed using bivariate and multivariable logistic regression with generalized estimating equations (GEE). Of 867 women at baseline, 48% (n = 413) reported lifetime suicidality, 16% (n = 141) reported suicidality in the last 6 months, and 29% reported suicidality at some point during the study. In multivariable analysis, factors independently associated with suicidality included physical/sexual childhood abuse (adjusted odds ratio [AOR]: 2.99; 95% confidence interval [CI] = [1.75, 5.10]), mental health issues (depression/anxiety/posttraumatic stress disorder; AOR = 2.19; 95% CI = [1.63, 2.95]), intimate partner violence (AOR: 2.11; 95% CI = [1.60, 2.80]), physical/sexual client violence (AOR: 1.82; 95% CI = [1.33, 2.50]), and homelessness (AOR: 1.44; 95% CI = [1.10, 1.89]). Older age (AOR: 0.97; 95% CI = [0.95, 0.99]) and higher social cohesion (AOR: 0.88; 95% CI = [0.78, 0.99]) were significantly associated with reduced odds of suicidality. Findings reveal key socio-structural correlates of suicidality among sex workers including experiences of historical and interpersonal violence, trauma/mental health issues, and homelessness. Strengthening social cohesion may have a protective effect on suicidality. Trauma-informed community-led structural interventions tailored to sex workers are urgently needed alongside a legal framework that enables collectivization and connectedness. © The Author(s) 2019.
Keywords: mental health; sex workers; suicidality; suicide prevention; violence; women

Healthcare chaplaincy and spiritual care for trans people: Envisaging the future - Cornwall, S. (Health and Social Care Chaplaincy, 2019)
Spiritual care has the potential to mitigate against "gaps" left when waiting lists (and times) for NHS gender identity clinics (GICs) spiral, and trans people awaiting medical interventions are at increased risk of suicide and self-harm. Healthcare chaplaincy has an explicit role to play, particularly for the sizeable number of trans people with religious faith or who struggle with finding support from faith communities. Spiritual care should be integrated within direct care provided by healthcare professionals, with additional care from specialist chaplains where desirable. Findings from the Modelling Transgender Spiritual Care project point to a need for additional training and resourcing in gender identity care for spiritual carers; a new prioritization of healthcare chaplaincy for gender identity services, which has implications for budgets and commissioning; and increased accountability for fulfilling the statutory requirement for spiritual care in the NHS. © Equinox Publishing Ltd 2019.
Keywords: Chaplaincy; Gender transition; Spiritual care; Transgender

Psychometric assessment of the Persian version of a dimensional instrument to measure gender identity disorder - Haghighat, F.; Shirazi, E.; Ardebili, M.E.; Alavi, K. (Revista Latinoamericana de Hipertension, 2019)
Suicide is a deliberate process of ending life and it is one of the ten leading causes of death in different countries around the world. Averagely, every forty seconds, one individual loses his life due to suicide in the world. Stigma, on the other hand, is a negative tag given by people to the groups and individuals who are different in terms of appearance, race, physical and mental health. Research has shown that Stigma is a barrier to care for those who attempt suicide. Since nurses play an important role in the care of patients with psychiatric disorders, their level of literacy and their attitude and behavior towards this group of patients have an impact on stigmatizing and non-stigmatizing behavior and the quality of nursing care. Therefore, the present study aimed to investigate the correlation be-tween suicidal literacy and stigmatizing attitude towards suicidal patients in nurses working in selected hospitals of Shahid Beheshti University of Medical Sciences in 2018. In this descriptive-correlational study, the samples were selected randomly among nurses working in psychiatric, poisoning, burn and emergency wards of selected hospitals. For data collection, besides questionnaire of demographic data collection, two questionnaires of suicide literacy and stigma questionnaires were used after determining the validity and reliability. Data analysis was performed using the latest version of SPSS software and descriptive and correlation statistics. The findings of the study showed that there is a positive correlation between the two variables of suicide literacy and stigma (p <0.05). It means that, with increasing literacy of nurses in the field of suicide, their attitude is also increased. In other words, increasing the literacy of nurses about suicide will improve their attitude in this regard. Regarding the fact that there is a significant relationship between suicidal literacy and stigma of nurses about the patients with suicide attempts, it can be hoped that increasing literacy of nurses will have a positive effect on their attitude and behavior with these patients and ultimately on the quality of care provided by them. © 2019 Revista Latinoamericana de Hipertension. All rights reserved.
Keywords: Attitude; Nurse; Stigma; Suicide; Suicide suicidal knowledge

Sexual and gender minoritized youth in christian home schools: Perceptions of climate and support - Anderson, S.O.; Lough, B.J. (Journal of LGBT Youth, 2019)
In 2014, Leelah Alcorn, a homeschooled transgender teenager in the United States, died by suicide after enduring months of social isolation and her parent’s repeated efforts to change her gender identity. Sexual and gender minoritized (SGM) youth who are, like Leelah, homeschooled in the U.S. do not have access to the institutional and relational supports afforded to SGM youth in public schools. This study examines how variations in educational setting, family support, internet access, and peer relationships influence mental health outcomes in a sample of 651 sexual and gender minoritized (SGM) young adults who were primarily homeschooled in Christian homes. Participants reported extremely high rates of mental illness (87%) suicidal ideation (72%), suicide attempts (22%) self-harm (66%), and substance abuse (29%). Regression analysis revealed that a positive family attitude toward SGM people (although rare) and access to the internet were the most significant protective factors against negative mental health outcomes in this sample. This study explores the unique vulnerabilities of SGM youth in Christian homeschool settings and has implications for educators, policy makers, health care providers, and mental health and social service professionals. To our knowledge, this is the first study to explore the experiences of homeschooled SGM youth. © 2019, © 2019 Taylor & Francis Group, LLC.
Keywords: adolescents; educational policy; family; homophobia; LGBT youth; mental health; religion; suicide

Que(E)rying youth suicide: Unpacking sexist and racist violence in skim and 13 reasons why - Froese, J.S.; Greensmith, C. (Cultural Studies Review, 2019)
This paper troubles positivist and pathological discourses surrounding youth suicide through critical engagement with young adult fiction: Skim and 13 Reasons Why. These texts offer opportunities for readers to dwell on and question youth suicide prevention and intervention through an engagement with affect, gender, queerness, and race. Skim (2008, Groundwood) and 13 Reasons Why (2017) counter ‘it gets better’ stories: they interrogate the inevitability of bullying, question the predictable approaches that schools take in their response to violence, and assert that the issue at hand is more systematic. Together, these analytics que(e) ry youth suicide by asking: how does the biopolitics (or necropolitics) of livability fit into popularized understandings of youth suicide? Read together, Skim and 13 Reasons Why provide opportunities to meaningfully question livability through the characters of Skim and Courtney—two Asian girls who bear the brunt of racist and sexist violence. Skim becomes a ‘project’ of white girls’ anti-suicide campaign and Courtney is barely living as she attempts to secure the plaform of ‘model minority.’ Both girls are queer, too. In its entirety, this paper arguse that popularized models of suicide intervention continue to ignore the pressing needs of queer Asian girls—such as Skim and Courtney. © UTS ePRESS. All rights reserved.
Keywords: 13 Reasons Why; Girlhood Studies; Queerness; Racial Violence; Sexism; Skim; Suicide; Youth Adult Texts

Clinical chemistry’s special issue on men’s health - Park, J.Y.; Deutsch, M.B.; Koenig, W.; Lilja, H.; Platz, E.A. (Clinical Chemistry, 2019)

Investigating the association between age at first alcohol use and suicidal ideation among high school students: Evidence from the youth risk behavior surveillance system - Baiden, P.; Mengo, C.; Boateng, G.O.; Small, E. (Journal of Affective Disorders, 2019)
Background: Although various studies have investigated and found a significant link between age at first alcohol use and health risk behaviors, few studies have investigated the effect of age at first alcohol use on suicidal ideation among adolescents. The objective of this study was to investigate the effect of age at first alcohol use on suicidal ideation. Methods: Data for this study were obtained from the 2015 Youth Risk Behavior Surveillance system. A sample of 10,745 adolescents aged 14–18 years (50.9% males) were analyzed using logistic regression with suicidal ideation as the outcome variable and age at first alcohol use as the main explanatory variable. Results: About 17% of adolescents experienced suicidal ideation during the past 12 months and 15.6% started having alcohol before age 13. Adolescents who started having alcohol before age 13 had 1.60 times higher odds of experiencing suicidal ideation and adolescents who started having alcohol by age 13 or over had 1.47 times higher odds of experiencing suicidal ideation. Other significant factors associated with suicidal ideation include experience of forced sex, physical teen dating violence, bullying, and feeling sad or hopeless. Having sufficient sleep lowered the odds of suicidal ideation. Limitations: The use of cross-sectional data limits the extent to which we can make causal claims regarding age at first alcohol use and suicidal ideation. Conclusions: Younger age at first alcohol use was associated with increased likelihood of suicidal ideation. Public health initiatives that seek to address the co-occurring problems of alcohol use and mental health illness, sexual violence, and victimization among sexual minority youth could help in reducing suicidal ideation. © 2018 Elsevier B.V.
Keywords: Adolescents; Age at first alcohol use; Suicidal ideation; Victimization

Transgender population's experiences with regard to accessing reproductive health care in Kwazulu-Natal, South Africa: A qualitative study - Luvuno, Z.P.B.; Ncama, B.; Mchunu, G. (African Journal of Primary Health Care and Family Medicine, 2019)
Background: The transgender population has unique health risks, including increased risk of mental illness, substance abuse, suicide and a high prevalence of human immunodeficiency virus (HIV). Worldwide studies indicate that this population is marginalised and faces barriers in accessing health care. In South Africa, there is limited information and research on the transgender population's interaction with health services. Aim: The purpose of this study was to examine the experiences of the transgender population in accessing health care facilities for sexual and reproductive needs. Setting: The study took place in KwaZulu-Natal province of South Africa. Methods: A qualitative study combining phenomenological and critical ethnographic approaches was conducted to explore the experiences of the transgender population in the health care setting. Critical ethnography was chosen because it is an emancipatory method that highlights the plight of disenfranchised groups, and phenomenology was used to illuminate experiences of the transgender population. Purposive snowball sampling was applied to select nine transgender participants who had experiences of contact with a health care setting. Data collection was performed through semi-structured interviews and a focus group discussion. Results: Participants provided details about the paucity of facilities, resources and targeted programmes to cater for the transgender populations' sexual and reproductive health needs. The participants engage in high-risk behaviour, comprising unprotected sex and use of cross-gender hormones without medical supervision. Furthermore, the participants reported experiences of hostile and discriminatory behaviour by healthcare workers. Conclusion: It emerged that there is a paucity of resources and knowledge to provide appropriate health care services to the transgender population, resulting in adverse experiences. Policies on transgender care and training of health workers will contribute towards improvement of health care access for the transgender population. © 2019. The Authors.
Keywords: Health care access; Health care accessibility; HIV; Transgender; Transgender health; Transgender population; Transphobia

Genetic associations with suicide attempt severity and genetic overlap with major depression - Levey, D.F.; Polimanti, R.; Cheng, Z.; Zhou, H.; Nuñez, Y.Z.; Jain, S.; He, F.; Sun, X.; Ursano, R.J.; Kessler, R.C.; Smoller, J.W.; Stein, M.B.; et al. (Translational Psychiatry, 2019)
In 2015, ~800,000 people died by suicide worldwide. For every death by suicide there are as many as 25 suicide attempts, which can result in serious injury even when not fatal. Despite this large impact on morbidity and mortality, the genetic influences on suicide attempt are poorly understood. We performed a genome-wide association study (GWAS) of severity of suicide attempts to investigate genetic influences. A discovery GWAS was performed in Yale-Penn sample cohorts of European Americans (EAs, n = 2,439) and African Americans (AAs, n = 3,881). We found one genome-wide significant (GWS) signal in EAs near the gene LDHB (rs1677091, p = 1.07 × 10 −8 ) and three GWS associations in AAs: ARNTL2 on chromosome 12 (rs683813, p = 2.07 × 10 −8 ), FAH on chromosome 15 (rs72740082, p = 2.36 × 10 −8 ), and on chromosome 18 (rs11876255, p = 4.61 × 10 −8 ) in the Yale-Penn discovery sample. We conducted a limited replication analysis in the completely independent Army-STARRS cohorts. rs1677091 replicated in Latinos (LAT, p = 6.52 × 10 −3 ). A variant in LD with FAH rs72740082 (rs72740088; r 2 = 0.68) was replicated in AAs (STARRS AA p = 5.23 × 10 −3 ; AA meta, 1.51 × 10 −9 ). When combined for a trans-population meta-analysis, the final sample size included n = 20,153 individuals. Finally, we found significant genetic overlap with major depressive disorder (MDD) using polygenic risk scores from a large GWAS (r 2 = 0.007, p = 6.42 × 10 −5 ). To our knowledge, this is the first GWAS of suicide attempt severity. We identified GWS associations near genes involved in anaerobic energy production (LDHB), circadian clock regulation (ARNTL2), and catabolism of tyrosine (FAH). These findings provide evidence of genetic risk factors for suicide attempt severity, providing new information regarding the molecular mechanisms involved. © 2019, The Author(s).

Transgender individuals in Mexico: exploring characteristics and experiences of discrimination and violence - Lozano-Verduzco, I.; Melendez, R. (Psychology and Sexuality, 2019)
There is limited research of transgender individuals in Mexico. Transgender individuals on a whole tend to have increased exposure to violence and discrimination which complicates access to health services, despite a great need for services relating to HIV, sexually transmitted infections, and gender confirmation processes. Questionnaires from 148 transgender-identified participants were completed using both online and face-to-face recruiting. Participants were asked about their backgrounds, health access, experiences with discrimination and violence. More than half reported being single and 23% reported being married or living with their partner. Five percent reported having children mostly through a previous sexual relationship. Violence was reported at higher frequencies than discrimination. More than 40% of participants had been sent to psychotherapy and more than 70% engaged suicidal ideation. Transgender communities endure frequent forms of discrimination and violence in their everyday lives. While transgender individuals in Mexico have unique characteristics that may make access to services distinct from other countries, they seem to face common problems, such as exposure to sexually transmitted infections and difficulties in access to gender confirmation processes and violence. © 2019, © 2019 Informa UK Limited, trading as Taylor & Francis Group.
Keywords: gender confirmation procedures; gender violence; Mexico; Transgender

Gender dysphoria in children: Puberty blockers study draws further criticism - Cohen, D.; Barnes, H. (The BMJ, 2019)

‘Make this adult mess make sense again’: the psychic lives of gentrification’s children - Seitz, D.K. (Social and Cultural Geography, 2019)
This paper advocates for increased scholarly curiosity about the painful and hopeful psychic agency of children and youth in critiquing neoliberal urban gentrification and imagining alternative forms of city life. It performs a geographically and theoretically informed reading of American director Ira Sachs’ 2016 film Little Men, a story about a brief but intense childhood friendship that is ended by an eviction. Drawing on the gentrification and psychoanalytic geography literatures, I turn to psychoanalyst D.W. Winnicott’s key clinical observations regarding ‘antisocial’ children and youth. Bringing these tools into dialogue with Little Men, I consider the revealing differences between the film’s shooting script and the final cut, as well as the film’s reception. Little Men and its child protagonists, I argue, should inspire more fine-grained attention to gentrification’s psychic dimensions, which both animate the process and open it to contestation. © 2019, © 2019 Informa UK Limited, trading as Taylor & Francis Group.
Keywords: children’s geographies; D.W. Winnicott; gentrification; Ira Sachs; psychoanalytic geographies; queer

Demographic and psychiatric correlates of compulsive sexual behaviors in gambling disorder - Cowie, M.E.; Kim, H.S.; Hodgins, D.C.; McGrath, D.S.; Scanavino, M.D.T.; Tavares, H. (Journal of Behavioral Addictions, 2019)
Background and aims: Gambling disorder (GD) and compulsive sexual behavior (CSB) may commonly co-occur. Yet, the psychiatric correlates of these co-occurring disorders are an untapped area of empirical scrutiny, limiting our understanding of appropriate treatment modalities for this dual-diagnosed population. This study examined the demographic and clinical correlates of CSB in a sample of treatment-seeking individuals with GD (N = 368) in São Paulo, Brazil. Methods: Psychiatrists and psychologists conducted semi-structured clinical interviews to identify rates of CSB and other comorbid psychiatric disorders. The Shorter PROMIS Questionnaire was administered to assess additional addictive behaviors. The TCI and BIS-11 were used to assess facets of personality. Demographic and gambling variables were also assessed. Results: Of the total sample, 24 (6.5%) met diagnostic criteria for comorbid CSB (GD + CSB). Compared to those without compulsive sexual behaviors (GD − CSB), individuals with GD + CSB were more likely to be younger and male. No differences in gambling involvement emerged. Individuals with GD + CSB tended to have higher rates of psychiatric disorders (depression, post-traumatic stress disorder, and bulimia nervosa) and engage in more addictive behaviors (problematic alcohol use, drug use, and exercise) compared to GD − CSB. Those with GD + CSB evidenced less self-directedness, cooperativeness, self-transcendence, and greater motor impulsivity. Logistic regression showed that the predictors of GD + CSB, which remained in the final model, were being male, a diagnosis of bulimia, greater gambling severity, and less self-transcendence. Discussion and conclusion: Given those with GD + CSB evidence greater psychopathology, greater attention should be allocated to this often under studied comorbid condition to ensure adequate treatment opportunities. © 2019 Akademiai Kiado Rt.. All rights reserved.
Keywords: Clinical correlates; Comorbidity; Compulsive sexual behaviors; Gambling disorder

Diminished fronto-limbic functional connectivity in child sexual offenders - Kneer, J.; Borchardt, V.; Kärgel, C.; Sinke, C.; Massau, C.; Tenbergen, G.; Ponseti, J.; Walter, H.; Beier, K.M.; Schiffer, B.; Schiltz, K.; Walter, M.; et al. (Journal of Psychiatric Research, 2019)
Background: Child sexual abuse and neglect have been related to an increased risk for the development of a wide range of behavioral, psychological, and sexual problems and increased rates of suicidal behavior. Contrary to the large amount of research focusing on the negative mental health consequences of child sexual abuse, very little is known about the characteristics of child sexual offenders and the neuronal underpinnings contributing to child sexual offending. Methods and sample: This study investigates differences in resting state functional connectivity (rs-FC) between non-pedophilic child sexual offenders (N = 20; CSO-P) and matched healthy controls (N = 20; HC) using a seed-based approach. The focus of this investigation of rs-FC in CSO-P was put on prefrontal and limbic regions highly relevant for emotional and behavioral processing. Results: Results revealed a significant reduction of rs-FC between the right centromedial amygdala and the left dorsolateral prefrontal cortex in child sexual offenders compared to controls. Conclusion & recommendations: Given that, in the healthy brain, there is a strong top-down inhibitory control of prefrontal over limbic structures, these results suggest that diminished rs-FC between the amygdala and the dorsolateral prefrontal cortex and may foster sexual deviance and sexual offending. A profound understanding of these concepts should contribute to a better understanding of the occurrence of child sexual offending, as well as further development of more differentiated and effective interventions. © 2018 Elsevier Ltd
Keywords: Child sexual abuse; Child sexual offending; Functional connectivity; Functional magnetic resonance imaging (fMRI); Resting state

Estimating the Risk of Attempted Suicide among Sexual Minority Youths - Di Giacomo, E.; Krausz, M.; Colmegna, F.; Aspesi, F.; Clerici, M. (JAMA Pediatrics, 2018)
Importance Suicide is the second-leading cause of death among adolescents. Sexual minority individuals are at a higher risk of suicide and attempted suicide, but a precise and systematic evaluation of this risk among sexual minority youths has not been documented to our knowledge. Objective To examine the risk of attempted suicide among sexual minority adolescents, differentiating for each sexual minority group. Data Sources Electronic databases (PubMed, Embase, and PsycINFO) were searched for articles published through April 30, 2017, with the following search terms: heterosexual, homosexual, bisexual, transgender, adolescents, teens, and attempted suicide. Study Selection Studies that reported attempted suicide in sexual minority adolescents compared with heterosexual peers were included. Thirty-five studies satisfied criteria for inclusion of 764 records identified. Data Extraction and Synthesis Pooled analyses were based on odds ratios (ORs), with relevant 95% CIs, weighting each study with inverse variance models with random effects. Risk of publication bias and analysis of heterogeneity through univariable and multivariable meta-regressions were also rated. Main Outcomes and Measures The evaluation of increased odds of attempted suicide among sexual minority youths compared with heterosexual peers. Results Thirty-five studies reported in 22 articles that involved a total of 2378987 heterosexual and 113468 sexual minority adolescents (age range, 12-20 years) were included in the analysis. Sexual minority youths were generally at higher risk of attempted suicide (OR, 3.50; 95% CI, 2.98-4.12; c 2 = 3074.01; P <.001; I 2 = 99%). If estimated in each sexual minority group, the OR was 3.71 in the homosexual group (95% CI, 3.15-4.37; c 2 = 825.20; P <.001; I 2 = 97%) and 4.87 in the bisexual group (95% CI, 4.76-4.98; c 2 = 980.02; P <.001; I 2 = 98%); transgender youths were described as an individual group in only 1 study, which reported an OR of 5.87 (95% CI, 3.51-9.82). Meta-regressions weighted for the study weight highlighted that the presence of young participants (12 years old) was associated with heterogeneity in the bisexual group, whereas the year of sampling was associated with heterogeneity in the whole group when combined with other covariates. Conclusions and Relevance Our findings suggest that youths with nonheterosexual identity have a significantly higher risk of life-threatening behavior compared with their heterosexual peers. Public awareness is important, and a careful evaluation of supportive strategies (eg, support programs, counseling, and destigmatizing efforts) should be part of education and public health planning. © 2018 American Medical Association. All Rights Reserved.

The world was not built for us: Improving access to care for transgender youth - Bernstein, S.M.; Lewis, H.C. (Pediatrics, 2018)

Corrigendum: The social determinants of lesbian, gay, bisexual and transgender youth suicidality in England: a mixed methods study - McDermott, E.; Hughes, E.; Rawlings, V. (Journal of public health (Oxford, England), 2018)

Supporting Transgender and Gender Diverse Youth: Protection Against Emotional Distress and Substance Use - Gower, A.L.; Rider, G.N.; Brown, C.; McMorris, B.J.; Coleman, E.; Taliaferro, L.A.; Eisenberg, M.E. (American Journal of Preventive Medicine, 2018)
Introduction: Important mental and physical health disparities exist for transgender and gender diverse youth compared with cisgender youth (i.e., those whose birth-assigned sex and gender identity align), yet little is known about factors that protect transgender and gender diverse youth from health problems. The objective of this paper is to identify modifiable protective factors in the lives of transgender and gender diverse adolescents, with the goal of informing efforts to eliminate disparities in depression, suicidality, and substance use in this population. Methods: Secondary data analysis of the 2016 Minnesota Student Survey examined associations between eight protective factors (connectedness to parents, adult relatives, friends, adults in the community, and teachers; youth development opportunities; and feeling safe in the community and at school) and depression, suicidality, and substance use (alcohol, binge drinking, marijuana, nicotine) among 2,168 adolescents who identified as transgender, genderqueer, genderfluid, or questioning their gender. Logistic regressions assessed the role of each protective factor separately and simultaneously. Results: Each protective factor was associated with lower odds of emotional distress and substance use. When protective factors were examined simultaneously, parent connectedness was protective for all measures. Feeling safe at school and connected to adults in one's community protected against depression and suicidality; teacher connectedness buffered risk of substance use. Conclusions: Given that transgender and gender diverse youth report lower levels of connectedness and safety, bolstering an explicitly transgender and gender diverse–friendly network of caring parents, safe and supportive schools, and connections to adults in the community may support efforts to eliminate disparities in depression, suicidality, and substance use. © 2018 American Journal of Preventive Medicine

Ethical issues in gender-affirming care for youth - Kimberly, L.L.; Folkers, K.M.; Friesen, P.; Sultan, D.; Quinn, G.P.; Bateman-House, A.; Parent, B.; Konnoth, C.; Janssen, A.; Shah, L.D.; Bluebond-Langner, R.; Salas-Humara, C. (Pediatrics, 2018)
Transgender and gender-nonconforming (TGNC) youth who suffer from gender dysphoria are at a substantially elevated risk of numerous adverse physical and psychosocial outcomes compared with their cisgender peers. Innovative treatment options used to support and affirm an individual's preferred gender identity can help resolve gender dysphoria and avoid many negative sequelae of nontreatment. Yet, despite advances in these relatively novel treatment options, which appear to be highly effective in addressing gender dysphoria and mitigating associated adverse outcomes, ethical challenges abound in ensuring that young patients receive appropriate, safe, affordable treatment and that access to this treatment is fair and equitable. Ethical considerations in gender-affirming care for TGNC youth span concerns about meeting the obligations to maximize treatment benefit to patients (beneficence), minimizing harm (nonmaleficence), supporting autonomy for pediatric patients during a time of rapid development, and addressing justice, including equitable access to care for TGNC youth. Moreover, although available data describing the use of gender-affirming treatment options are encouraging, and the risks of not treating TGNC youth with gender dysphoria are evident, little is known about the long-term effects of both hormonal and surgical interventions in this population. To support ethical decision-making about treatment options, we encourage the development of a comprehensive registry in the United States to track long-term patient outcomes. In the meantime, providers who work with TGNC youth and their families should endeavor to offer ethically sound, patient-centered, gender-affirming care based on the best currently available evidence. © 2018 by the American Academy of Pediatrics.

Examining characteristics of worry in relation to depression, anxiety, and suicidal ideation and attempts - Gorday, J.Y.; Rogers, M.L.; Joiner, T.E. (Journal of Psychiatric Research, 2018)
Background: Pathological worry is defined as worry that is excessive, pervasive, and uncontrollable. Although pathological worry is related to depression, anxiety, and suicidal ideation, less is understood about what specific features of worry confer risk for these mental health conditions. The current study examined associations between four characteristics of worry—frequency, duration, controllability, and content—and self-reported symptoms of depression, anxiety, suicidal ideation, and lifetime suicide attempts. Methods: A sample of 548 community participants (53.6% female, 45.4% male, 0.5% transgender male, 0.2% transgender female, and 0.2% gender non-binary), aged 19–98 years (M = 36.54, SD = 12.33), was recruited via Amazon's MTurk and completed a battery of self-report questionnaires online. Results: Results indicated that controllability of worry was uniquely associated with depression, anxiety, and suicidal ideation above and beyond other characteristics of worry, demographic variables, negative affect, and future-oriented repetitive thinking. Lifetime suicide attempts were found non-significant to these mental health outcomes. Frequency of worry was also positively related to depression. Limitations: This study utilized a cross-sectional design with exclusive self-report measures. Conclusions: Overall, these findings suggest that controllability of one's thoughts may be a key transdiagnostic factor that confers risk for a variety of psychopathology-related concerns. Clinical relevance includes identifying potential risk factors for varying psychopathology. Future research should examine relationships between worry controllability and anxiety, depression, suicidal ideation, and attempts, within clinical samples and utilizing a variety of methodologies. © 2018
Keywords: Anxiety; Depression; Perceived control; Repetitive thinking; Suicide; Worry

Transgender Women's Experiences with Stigma, Trauma, and Attempted Suicide in the Dominican Republic - Budhwani, H.; Hearld, K.R.; Milner, A.N.; Charow, R.; McGlaughlin, E.M.; Rodriguez-Lauzurique, M.; Rosario, S.; Paulino-Ramirez, R. (Suicide and Life-Threatening Behavior, 2018)
Studies on attempted suicide in transgender populations, particularly those in resource-limited settings, are scarce. We examined the relationships between stigma, trauma, and suicide attempts in a national sample of transgender women from the Dominican Republic. Bivariate analysis examined differences between suicide attempters and nonattempters (n = 298). Multivariate analysis reported odds ratios with attempted suicide as the outcome (n = 260). About a quarter of respondents (23.9%) experienced sexual abuse, 12.3% were tortured, and 20.3% experienced a murder attempt. More than a quarter reported using illegal drugs. Independent sample t tests found significant differences between suicide attempters and nonattempters. Attempters were more likely to have experienced sexual abuse, psychological abuse, torture, and a murder attempt (p <.001 for all). Respondents who experienced psychological abuse had over three times higher odds of attempting suicide, compared to respondents who had not (OR = 3.203, p <.01). Experience with torture and attempted murder were associated with higher odds of attempting suicide (OR = 2.967, p <.05 and OR = 2.894, p <.05, respectively). Although some nations have implemented antidiscrimination policies protecting transgender citizens, these policies are often not consistently enforced. Eliminating stigmatizing policies may reduce rates of negative health outcomes and subsequently improving population health. © 2017 The American Association of Suicidology

Childhood maltreatment and age effects on depression and suicide risk among Canadian men - Rice, S.M.; Kealy, D.; Oliffe, J.L.; Seidler, Z.E.; Ogrodniczuk, J.S. (Psychiatry Research, 2018)

Should Gender Reassignment Surgery be Publicly Funded? - Go, J.J. (Journal of Bioethical Inquiry, 2018)
Transgender people have among the highest rates of suicide attempts of any group in society, driven strongly by the perception that they do not belong in the sex of their physical body. Gender reassignment surgery (GRS) is a procedure that can change the transgender person’s physical body to accord with their gender identity. The procedure raises important ethical and distributive justice concerns, given the controversy of whether it is a cosmetic or medical procedure and the economic costs associated with performing the procedure. This paper argues that there is a strong case for funding GRS as a matter of clinical necessity and justice. This paper will be divided in four key sections: First, the state of transgender health will be outlined, including the role of GRS and common objections to it. Second, a number of common objections to GRS will be analysed at the outset and shown to be unconvincing. Third, a constructive argument will be advanced, arguing that publicly funded GRS is clinically necessary, cost-effective, and demanded by principles of justice. Fourth, the paper will briefly discuss moralistic biases and why we demand a higher burden of justification for funding GRS compared with other analogous procedures. © 2018, The Author(s).
Keywords: Distributive justice; Gender reassignment surgery; Health resource allocation; Transgender

Development and characterization of nine polymorphic microsatellite markers for the deep-sea scleractinian coral Deltocyathus magnificus using paired-end Illumina shotgun sequencing - Liu, S.-Y.V.; Cheng, Y.-R. (Molecular Biology Reports, 2018)
Deltocyathus magnificus is an azooxanthellae deep-sea scleractinian coral species that is distributed in the Indo-Pacific region. In order to investigate its genetic structure and connectivity, polymorphic microsatellite markers were isolated and tested on 37 individuals collected from the South China Sea. Twenty loci were selected and primers synthesized for further PCR testing. Nine of 20 were amplified successfully with polymorphism markers. The number of alleles detected in each locus ranged from 2 to 13. The expected and observed heterozygosities of these loci were 0.053–0.819 and 0.054–0.946, respectively. These nine novel polymorphic loci were used to reveal the genetic connectivity pattern among depths and geographic locations in the South China Sea. © 2018, Springer Nature B.V.
Keywords: Asexual reproduction; Connectivity; Genetic structure; Microsatellite; Shotgun sequencing

The risk of consuming “Bath Salts”. Exemplification through four forensic cases in Spain - Ballesteros, S.; Almarza, E.; Quintela, O.; Martínez, M.A. (Forensic Chemistry, 2018)
A significant rise in the abuse of a new group of synthetic cathinones was reported recently in Western Europe. We selected four documented cases that recently occurred in Spain to discuss the toxicological significance and the mechanisms that explain the legal facts. All drugs and metabolites were detected using gas chromatography-mass spectrometry (GC-MS) and liquid chromatography-mass spectrometry (LC-MS-MS). Case 1: A 19-year old male was arrested for assaulting his father. He drank a random glass in a discotheque. He described a feeling of elation, irritability and several episodes of amnesia. Methylone and its metabolites, and 11-nor-9-carboxy-delta9-tetrahydrocannabinol (THC-COOH) were detected in urine. Case 2: A 33-year-old gay male committed suicide by hanging. Alpha-pyrrolidinovalerophenone (alpha-PVP) and 4-methylethcathinone were found in blood and urine. Cocaine and its metabolites were detected in urine. Case 3: A 53-year-old male went to the hospital suffering palpitations and thoracic pain and explained that he had inhaled a “white substance” while taking money from a cashier. The case was defined as drug facilitated crime (robbery). Alpha-PVP was detected in blood (0.009 mg/L) and urine, along with nordiazepam and lorazepam and metabolites. Case 4: The police restrained a 39-year-old Colombian male with agitation, persecutory psychosis and irrational behavior. Autopsy samples showed alpha-PVP in blood (1.20 mg/L) and urine along with cocaine, amphetamine, 3,4-methylenedioxy-methamphetamine, lormetazepam and alprazolam. The four cases bring attention to the severe toxicity including behavioral abnormalities induced by easily accessible synthetic cathinones, all of which should be taken into consideration by authorities in order to adjust legislation with celerity to real life circumstances. © 2018 Elsevier B.V.
Keywords: 4-MEC; Alpha-PVP; Methylone; Synthetic cathinones

Migrating texts: The case of Ingmar Bergman's thirst - Lundén, R. (Adaptation, 2018)
The article follows the journey of one text, Thirst (1948), a modernist short story cycle by Birgit Tengroth, into Ingmar Bergman's 1949 film of the same title, and further into the novelization of the film's shooting script (1949-50). It studies the texts as independent items directed to three separate audiences. This kind of close analysis has not, so far, been devoted to the process of textual travel, of which a Bergman film was part. The investigation goes from a text of five loosely linked stories, characterized by interiority, competing points of view, expressions of female desire, to two film scripts, produced in collaboration between Bergman and Herbert Grevenius, trying to harmonize the episodic cycle through the narrative strategies of selection, integration, and addition, to, finally, the anonymous novelization leading to even further cohesion and exteri-ority. The process of migration is characterized by a gradual movement away from a modernist, disunified structure towards a realist form of expression. It is also noticeable that the eroticism and focus on lesbianism in the adapted text are possible to repeat and make even more explicit in the novelization of the film script, while the film does not allow for such openness. The article also emphasizes the reception of these texts by both contemporaneous and later critics. © The Author(s) 2018. Published by Oxford University Press. All rights reserved.
Keywords: Adaptation; Ingmar Bergman; Novelization; Text migration

Syndemic indicators predict poor medication adherence and increased healthcare utilization for urban HIV-positive men who have sex with men - Pantalone, D.W.; Valentine, S.E.; Woodward, E.N.; O’cleirigh, C. (Journal of Gay and Lesbian Mental Health, 2018)
Research on men who have sex with men (MSM) has uncovered psychosocial factors (syndemic indicators) that are associated additively with poor health. To test these relations in a sample of HIV-positive MSM, we enrolled 166 patients from two HIV clinics. We investigated relations between syndemic indicators and outcomes, including medication nonadherence, condomless anal sex (CAS), and healthcare utilization. A large proportion of participants reported each syndemic indicator: polysubstance use 43%, suicide attempt 28%, childhood sexual abuse 39%, partner abuse 64%. Analyses confirmed an additive effect, whereby endorsing 1+ indicator was associated with increased odds of medication nonadherence and medical hospitalization. © 2018 Taylor and Francis Group, LLC. All rights reserved.
Keywords: Healthcare utilization; HIV; Medication adherence; MSM; Syndemics

“Fear Runs Deep:” The Anticipated Needs of LGBT Older Adults in Long-Term Care - Putney, J.M.; Keary, S.; Hebert, N.; Krinsky, L.; Halmo, R. (Journal of Gerontological Social Work, 2018)
Objectives: Older lesbian, gay, bisexual, and transgender (LGBT) adults are a vulnerable yet resilient population who face unique stressors as they foresee health decline. This paper presents the results of a study about community-dwelling LGBT older adults’ anticipated needs and fears related to nursing homes and assisted living. Methods: This qualitative study collected data through seven focus groups. The sample (N = 50) consisted of LGBT-identified adults age 55 and over. We used an inductive, thematic analysis approach to data analysis. Results: Participants seek an inclusive environment where they will be safe and feel connected to a community. They fear dependence on healthcare providers, dementia, mistreatment, and isolation. Importantly, these fears can lead to identity concealment and psychological distress, including suicide ideation. Discussion: This study adds to the existing literature about the worries of older LGBT adults as they anticipate long-term care. The results suggest that older LGBT adults seek LGBT-inclusive residential care settings that encompass two distinct yet related aspects of LGBT-affirmative care: the procedural (e.g. culturally competent skills and knowledge of practitioners) and the implicit (e.g. the values and mission of the organization). This paper identifies implications for practice, policy, and training. © 2018, © 2018 Taylor & Francis Group, LLC.
Keywords: LGBT; long-term care; Qualitative; quality of life; skilled nursing

Chinese sexual minority male adolescents’ suicidality and body mass index - Huang, Y.; Li, P.; Lai, Z.; Jia, X.; Xiao, D.; Wang, T.; Guo, L.; Lu, C. (International Journal of Environmental Research and Public Health, 2018)
Excess weight status may increase the risk of suicidality among sexual minority females, but few studies have examined this suicidality disparity in sexual minority males. This study examined the association between sexual minority status and suicide attempts in Chinese male adolescents and tested whether body mass index (BMI) had a moderating effect on that association. Data were collected from 7th to 12th graders from seven randomly selected provinces of China in the 2015 School-Based Chinese Adolescents Health Survey. In total, 72,409 male students completed the questionnaires regarding sexual attraction, self-reported weight and height, and suicide attempts. After adjustment for covariates, sexual minority status was associated with suicide attempts among male students (AOR = 1.74, 95% CI = 1.57–1.93). Stratification analyses showed that BMI category moderated this association; compared with the results before stratification analyses, sexual minority males who were obese had increased risk of suicide attempts (AOR = 2.15, 95% CI = 1.09–4.24), sexual minority males who were overweight had reduced odds of suicide attempts (AOR = 1.40, 95% CI = 1.01–1.92), and no significant association change was found in sexual minority males who were underweight (AOR = 1.82, 95% CI = 1.43–2.33). Our study indicated that BMI moderated the risk of suicide attempts in sexual minority males. Suicide prevention targeting sexual minority males should be focused on weight status disparity and the creation of a positive climate to reduce minority stressors due to body image. © 2018, MDPI AG. All rights reserved.
Keywords: Adolescents; Body mass index; Moderating effect; Sexual minority; Suicide

Suicidal and Help-Seeking Behaviors Among Youth in an Online Lesbian, Gay, Bisexual, Transgender, Queer, and Questioning Social Network - Lytle, M.C.; Silenzio, V.M.B.; Homan, C.M.; Schneider, P.; Caine, E.D. (Journal of Homosexuality, 2018)
LGBTQ youth have a great burden for suicidal ideation/behavior compared to their non-LGBTQ peers. While scholars have explored risk factors for suicidal behaviors, little is known about protective factors among LGBTQ youth, let alone within group differences in terms of help-seeking. Data were collected from 203 TrevorSpace (e.g., a social network for LGBTQ youth) users via online survey to examine suicidal and help-seeking behaviors among LGBTQ individuals. Among participants who reported suicidal ideation/behavior, a large proportion did not seek help (73.1% of gay men, 33.3% of bisexual men, 42.9% of bisexual women, 14.3% of lesbian women, 41.2% of queer individuals) when they considered or attempted suicide. Among those who sought support, reaching out to a friend was most common. However, family support was associated with fewer suicidal behaviors. Our findings underscore the need to examine the effectiveness of specific sources of help and the impact of exposure to social connectedness. © 2018, © 2018 Taylor & Francis.
Keywords: LGBTQ youth; protective factors; Risk factors; suicidal ideation; suicide attempt

A media-based school intervention to reduce sexual orientation prejudice and its relationship to discrimination, bullying, and the mental health of lesbian, gay, and bisexual adolescents in western canada: A population-based evaluation - Burk, J.; Park, M.; Saewyc, E.M. (International Journal of Environmental Research and Public Health, 2018)
School interventions to address sexual orientation discrimination can be important tools for fostering inclusive school climate, and improving student wellbeing. In this study, we empirically evaluated a film-based intervention, Out in Schools, designed to reduce sexual orientation prejudice and foster inclusive school attitudes. Our evaluation mapped data about Out in Schools presentations onto student data from the random cluster-stratified, province-wide 2013 British Columbia Adolescent Health Survey (BCAHS) as well as potential confounding variables of Gay-Straight Alliance clubs (GSAs) and inclusive school policies. Outcome measures included past year sexual orientation discrimination, bullying, suicidal ideation, and school connectedness among lesbian, gay, and bisexual (LGB) and heterosexual (HET) students in grades 8 through 12 (ages 13 to 18; unweighted N = 21,075, weighted/scaled N = 184,821). Analyses used complex samples logistic regression, adjusted for sample design, conducted separately by gender and orientation. We found Out in Schools presentations were associated with reduced odds of LGB students experiencing discrimination, and both LGB and HET girl students being bullied or considering suicide, and increased levels of school connectedness, even after controlling for GSAs and policies. Out in Schools appears to have an additive contribution to reducing orientation prejudice and improving LGB and heterosexual student wellbeing within schools. © 2018, MDPI AG. All rights reserved.
Keywords: Adolescent; Bullying; LGBT youth; Mental health; School intervention

Providing Solutions to LGBT Homeless Youth: Lessons From Baltimore’s Youth Empowered Society - Dolamore, S.; Naylor, L.A. (Public Integrity, 2018)
In the United States, nearly 1.7 million youth under the age of 18 run away from home and often end up homeless each year. Reports estimate that between 20% and 40% of the runaway and homeless youth population identifies as lesbian, gay, bisexual, or transgender (LGBT) (Durso & Gates, 2012; Kaiser Family Foundation, 2014). This suggests that as many as 80,000 LGBT youth are homeless for over a week each year (National Alliance to End Homelessness, 2012). In addition, LGBT youth are more likely to suffer from poverty, substance abuse, violence, mental illness, and attempted suicide as a result of harassment and discrimination (Cray, Miller, & Durso, 2013; Kaiser Family Foundation, 2014; Swan, 2014). Grounded in social equity theory (Frederickson, 2010) and intersectionality (Crenshaw, 1991), this article argues that additional legal protections are necessary in order to ensure the constitutional rights of LGBT youth. A case study of the Youth Empowered Society (YES) in Baltimore City is provided as an example of a service-delivery model for this vulnerable population. Best practices are identified and anti-discrimination policies are recommended. © 2017, Copyright © American Society for Public Administration.
Keywords: anti-oppression; Baltimore; homelessness; LGBT; youth

Does self-compassion covary with minority stress? Examining group differences at the intersection of marginalized identities - Vigna, A.J.; Poehlmann-Tynan, J.; Koenig, B.W. (Self and Identity, 2018)
Informed by the minority-stress hypothesis and intersectionality theory, this study examines differences in dispositional self-compassion across diverse youth subject to varying levels of structural and interpersonal discrimination. A secondary analysis of survey data from two suburban high schools in a Midwestern state (n = 1872) found significant differences in rates of exposures to stigma processes in accordance to rates of marginalization as estimated by sexual and/or gender status and racial category (minority vs majority), with a large effect. Sexual and/or gender minority students of color (SGmin) reported the highest rates of stigma experiences including exposure to economic hardship, having an incarcerated parent, not trusting the police, assignment of an IEP and exclusionary discipline. However, white SGmin students reported the highest rates of mental health concerns. Sexual gender majority (SGmaj) students of color reported the highest rates of self-compassion while white SGmin students reported the lowest and the negative relation between bullying and self-compassion was stronger for white SGmin students than for SGmin students of color, suggesting that the latter may have developed ways of coping with multiple stigmatized identities that reflect kindness to the self. As scholars seek to understand the role of self-compassion in resilience processes, we suggest emphasizing the strengths of marginalized youth as well as protecting them from the ill effects of bullying. © 2018, © 2018 Informa UK Limited, trading as Taylor & Francis Group.
Keywords: depression and suicidality; peer victimization; self-compassion; Sexual and gender minorities

Association of Exposure to Police Violence With Prevalence of Mental Health Symptoms Among Urban Residents in the United States - DeVylder, J.E.; Jun, H.-J.; Fedina, L.; Coleman, D.; Anglin, D.; Cogburn, C.; Link, B.; Barth, R.P. (JAMA network open, 2018)
Importance: Police violence is reportedly widespread in the United States and may pose a significant risk to public mental health. Objective: To examine the association between 12-month exposure to police violence and concurrent mental health symptoms independent of trauma history, crime involvement, and other forms of interpersonal violence exposure. Design, Setting, and Participants: This cross-sectional, general population survey study of 1221 eligible adults was conducted in Baltimore, Maryland, and New York City, New York, from October through December 2017. Participants were identified through Qualtrics panels, an internet-based survey administration service using quota sampling. Exposures: Past 12-month exposure to police violence, assessed using the Police Practices Inventory. Subtypes of violence exposure were coded according to the World Health Organization domains of violence (ie, physical, sexual, psychological, and neglectful). Main Outcomes and Measures: Current Kessler Screening Scale for Psychological Distress (K6) score, past 12-month psychotic experiences (World Health Organization Composite International Diagnostic Interview), and past 12-month suicidal ideation and attempts. Results: Of 1221 eligible participants, there were 1000 respondents (81.9% participation rate). The sample matched the adult population of included cities on race/ethnicity (non-Hispanic white, 339 [33.9%]; non-Hispanic black/African American, 390 [39.0%]; Hispanic/Latino, 178 [17.8%]; other, 93 [9.3%]), age (mean [SD], 39.8 [15.2] years), and gender (women, 600 [60.0%]; men, 394 [39.4%]; transgender, 6 [0.6%]) within 10% above or beyond 2010 census distributions. Twelve-month prevalence of police violence was 3.2% for sexual violence, 7.5% for physical violence without a weapon, 4.6% for physical violence with a weapon, 13.2% for psychological violence, and 14.9% for neglect. Police violence exposures were higher among men, people of color, and those identified as homosexual or transgender. Respondents reported suicidal ideation (9.1%), suicide attempts (3.1%), and psychotic experiences (20.6%). The mean (SD) K6 score was 5.8 (6.1). All mental health outcomes were associated with police violence exposure in adjusted logistic regression analyses. Physical violence with a weapon and sexual violence were associated with greater odds of psychotic experiences (odds ratio [95% CI]: 4.34 [2.05-9.18] for physical violence with a weapon; 6.61 [2.52-17.36] for sexual violence), suicide attempts (odds ratio [95% CI]: 7.30 [2.94-18.14] for physical violence with a weapon; 6.63 [2.64-16.64] for sexual violence), and suicidal ideation (odds ratio [95% CI]: 2.72 [1.30-5.68] for physical violence with a weapon; 3.76 [1.72-8.20] for sexual violence). Conclusions and Relevance: Police violence was commonly reported, especially among racial/ethnic and sexual minorities. Associations between violence and mental health outcomes did not appear to be explained by confounding factors and appeared to be especially pronounced for assaultive forms of violence.

Disparities in Health Risk Behaviors and Health Conditions Among Rhode Island Sexual Minority and Unsure High School Students - Jiang, Y.; Reilly-Chammat, R.; Cooper, T.; Viner-Brown, S. (Journal of School Health, 2018)
BACKGROUND: Sexual minority students have higher risk for health-related behaviors. We examined 5 domains including 34 health risk behaviors and health conditions among sexual minorities and unsure students in Rhode Island. We also included sexual contact of heterosexually identified students to capture heterosexually identified students who may be considered sexual minorities by their behavior. METHODS: We used the 2007-2015 Rhode Island Youth Risk Behavior Survey data (N = 14,264). We categorized students into 4 groups: students self-identified as heterosexual and reported no sexual contact with same sex only or both sexes (group 1); self-identified as heterosexual and reported sexual contact with same sex only or both sexes (group 2); self-identified as lesbian, gay, bisexual (group 3); and responded as unsure (group 4). We used multivariable adjusted logistic regression analyses to evaluate associations of sexual minority and unsure students with 34 health risk behaviors and health conditions accounting for complex sampling design. RESULTS: Students in groups 2-4 were more likely to engage in health-risk behaviors including violent behaviors, attempted suicide, substance use, and no physical activity than their peers. CONCLUSIONS: As sexual minority youth continue to report higher rates of health-related risk behaviors, targeted evidence-based prevention approaches must focus on reducing these risk behaviors among those youth. © 2018, American School Health Association
Keywords: health risk behavior; high school students; sexual contact; sexual identity; sexual minority; Youth Risk Behavior Survey

Do Anti-Bullying Laws Reduce In-School Victimization, Fear-based Absenteeism, and Suicidality for Lesbian, Gay, Bisexual, and Questioning Youth? - Seelman, K.L.; Walker, M.B. (Journal of Youth and Adolescence, 2018)
Lesbian, gay, and bisexual youth are at heightened risk for bullying and other forms of in-school victimization. Anti-bullying laws are a potential policy mechanism for addressing this issue, yet there has been little investigation of the impact of such policies for this population using generalizable samples or quasi-experimental designs. The current study explores whether the presence of state anti-bullying laws predicts lower likelihood of bullying victimization, fear-based absenteeism, in-school threats or injury with a weapon, and suicidality for lesbian, gay, bisexual, and questioning high school students in the United States. Based on Youth Risk Behavior Survey data across 22 states from 2005–2015, coupled with data about the presence of general and enumerated anti-bullying laws that include sexual orientation as a protected class, this study analyzes this topic using a quasi-experimental design (linear difference-in-difference models). The results indicate that lesbian, gay, bisexual, and questioning youth (particularly boys aged 15 or younger) experienced less bullying victimization in states with general or enumerated anti-bullying laws. There was modest evidence of a reduction in fear-based absenteeism among boys in states with such laws. However, there was little evidence of a relationship between such policies and in-school threats or injuries or suicidality. Further, lesbian, bisexual, and questioning girls’ likelihood of victimization, absenteeism, or suicidality was generally not related to the presence of anti-bullying laws. The results suggest that general and enumerated anti-bullying laws may help reduce bullying victimization for gay, bisexual, and questioning boys. © 2018, Springer Science+Business Media, LLC, part of Springer Nature.
Keywords: Absenteeism; Anti-bullying laws; Bullying; High school; Sexual minorities; Victimization

Prevalence rates, reporting, and psychosocial correlates of stalking victimization: results from a three-sample cross-sectional study - Nobles, M.R.; Cramer, R.J.; Zottola, S.A.; Desmarais, S.L.; Gemberling, T.M.; Holley, S.R.; Wright, S. (Social Psychiatry and Psychiatric Epidemiology, 2018)
Purpose: Public health and criminal justice stalking victimization data collection efforts are plagued by subjective definitions and lack of known psychosocial correlates. The present study assesses the question of stalking victimization prevalence among three groups. Psychosocial risk and protective factors associated with stalking victimization experiences were assessed. Methods: Archival data (n = 2159) were drawn from a three-sample (i.e., U.S. nationwide sexual diversity special interest group, college student, and general population adult) cross-sectional survey of victimization, sexuality, and health. Results: The range of endorsement of stalking-related victimization experiences was 13.0–47.9%. Reported perpetrators were both commonly known and unknown persons to the victim. Participants disclosed the victimization primarily to nobody or a family member/friend. Bivariate correlates of stalking victimization were female gender, Associates/Bachelor-level education, bisexual or other sexual orientation minority status, hypertension, diabetes, older age, higher weekly drug use, elevated trait aggression, higher cognitive reappraisal skills, lower rape myth acceptance, and elevated psychiatric symptoms. Logistic regression results showed the strongest factors in identifying elevated stalking victimization risk were: older age, elevated aggression, higher cognitive reappraisal skills, lesser low self-control, increased symptoms of suicidality and PTSD re-experiencing, and female and other gender minority status. Conclusions: Behavioral approaches to epidemiological and criminal justice stalking victimization are recommended. Victimization under reporting to healthcare and legal professionals were observed. Further research and prevention programming is needed to capitalize on data concerning personality and coping skills, sexual diversity, and trauma-related psychiatric symptoms. © 2018, Springer-Verlag GmbH Germany, part of Springer Nature.
Keywords: BDSM; LGBTQ; Mental health; Personality; Stalking; Victimization

Bias from potentially mischievous responders on large-scale estimates of lesbian, gay, bisexual, or questioning (LGBQ)-heterosexual youth health disparities - Cimpian, J.R.; Timmer, J.D.; Birkett, M.A.; Marro, R.L.; Turner, B.C.; Phillips, G.L., II (American Journal of Public Health, 2018)
Objectives. To determine how sensitive estimates of lesbian, gay, bisexual, or questioning (LGBQ)-heterosexual youth health disparities are to the presence of potentially mischievous responders. Methods. We used US data from the 2015 Youth Risk Behavior Survey, pooled across jurisdictions that included a question about sexual identity for a total sample of 148 960 students. We used boosted regressions (a machine-learning technique) to identify unusual patterns of responses to 7 screener items presumably unrelated to LGBQ identification, which generated an index of suspected mischievousness. We estimated LGBQ-heterosexual youth disparities on 20 health outcomes; then we removed 1% of suspected mischievous responders at a time and re-estimated disparities to assess the robustness of original estimates. Results. Accounting for suspected mischievousness reduced estimates of the average LGBQ-heterosexual youth health disparity by up to 46% for boys and 23% for girls; however, screening did not affect all outcomes equally. Drug- and alcohol-related disparities were most affected, particularly among boys, but bullying and suicidal ideation were unaffected. Conclusions. Including screener items in public health data sets and performing rigorous sensitivity analyses can support the validity of youth health estimates. © 2017 American Public Health Association.

Nonconforming Gender Expression and Associated Mental Distress and Substance Use among High School Students - Lowry, R.; Johns, M.M.; Gordon, A.R.; Austin, S.B.; Robin, L.E.; Kann, L.K. (JAMA Pediatrics, 2018)
Importance: The cultural roles and expectations attributed to individuals based on their sex often shape health behaviors and outcomes. Gender nonconformity (GNC) (ie, gender expression that differs from societal expectations for feminine or masculine appearance and behavior) is an underresearched area of adolescent health that is often linked to negative health outcomes. Objective: To examine the associations of GNC with mental distress and substance use among high school students. Design, Setting, and Participants: Cross-sectional study based on data from the Youth Risk Behavior Survey (YRBS) conducted in 2015. The setting was 3 large urban US school districts (2 in California and 1 in Florida). Participants were a racially/ethnically diverse population-based sample of 6082 high school students representative of all public school students in grades 9 through 12 attending these 3 school districts. Main Outcomes and Measures: Sex-stratified adjusted prevalence ratios (APRs) (adjusted for race/ethnicity, grade, and sexual identity) for high gender-nonconforming students (very/mostly/somewhat feminine male students or very/mostly/somewhat masculine female students) and moderate gender-nonconforming students (equally feminine and masculine students) relative to a referent group of low gender-nonconforming students (very/mostly/somewhat masculine male students or very/mostly/somewhat feminine female students). Results: Among 6082 high school students, 881 (15.9%) were white, 891 (19.1%) black, 3163 (55.1%) Hispanic, and 1008 (9.9%) other race/ethnicity. Among female students (2919 [50.0% of the study population]), moderate GNC was significantly associated with feeling sad and hopeless (APR, 1.22; 95% CI, 1.05-1.41), seriously considering attempting suicide (APR, 1.41; 95% CI, 1.14-1.74), and making a suicide plan (APR, 1.52; 95% CI, 1.22-1.89); however, substance use was not associated with GNC. Among male students (3139 [50.0% of the study population]), moderate GNC was associated with feeling sad and hopeless (APR, 1.55; 95% CI, 1.25-1.92); high GNC was associated with seriously considering attempting suicide (APR, 1.72; 95% CI, 1.16-2.56), making a suicide plan (APR, 1.79; 95% CI, 1.17-2.73), and attempting suicide (APR, 2.78; 95% CI, 1.75-4.40), as well as nonmedical use of prescription drugs (APR, 1.81; 95% CI, 1.23-2.67), cocaine use (APR, 2.84; 95% CI, 1.80-4.47), methamphetamine use (APR, 4.52; 95% CI, 2.68-7.61), heroin use (APR, 4.59; 95% CI, 2.48-8.47), and injection drug use (APR, 8.05; 95% CI, 4.41-14.70). Conclusions and Relevance: This study suggests mental distress is associated with GNC among female and male students. Substance use also appeared to be strongly associated with GNC among male students. These findings underscore and suggest the importance of implementing school-based programs to prevent substance use and promote student mental health that are inclusive of gender diversity in students..

Examining Mechanisms and Moderators of the Relationship Between Discriminatory Health Care Encounters and Attempted Suicide Among U.S. Transgender Help-Seekers - Romanelli, M.; Lu, W.; Lindsey, M.A. (Administration and Policy in Mental Health and Mental Health Services Research, 2018)
This study examined how experiences of service denial and discrimination in three health care settings—doctors’ offices, emergency rooms, and mental health clinics—might contribute to attempted suicide among transgender adults. Mechanisms of this relationship were examined, including treatment receipt and the use of substances to cope with mistreatment. Perceived emotional social support was also tested as a potential protective factor against the deleterious effects of service denial and discrimination on treatment receipt, substance use, and attempted suicide. The analysis included 4190 respondents from the National Transgender Discrimination Survey. Structural equation modeling was employed to test hypothesized relationships. Being denied a greater number of services and discriminated against in more settings were associated with lower levels of treatment receipt. Service denial was also correlated with increased rates of coping-motivated substance use and elevated rates of attempted suicide. Treatment receipt mediated the relationships between service denial/discrimination and substance use. Substance use mediated the relationship between treatment receipt and attempted suicide. Higher levels of support were protective to treatment receipt when denied services in one setting, but no longer retained protective effects when denied in two or three settings. Results have critical implications for service access and delivery and policies that protect transgender help-seekers in the health care system. © 2018, Springer Science+Business Media, LLC, part of Springer Nature.
Keywords: Discrimination; Health care access; Social support; Suicide; Transgender

Military sexual trauma and suicidal behavior among National Guard personnel - White, K.L.; Harris, J.A.; Bryan, A.O.; Reynolds, M.; Fuessel-Herrmann, D.; Bryan, C.J. (Comprehensive Psychiatry, 2018)
Background: Preliminary evidence suggests military sexual trauma (MST) may be associated with increased risk for suicidal behaviors among active duty military personnel and veterans. Among National Guard personnel, a high-risk subgroup, MST and suicide risk have not received much empirical attention. Purpose: To examine the association of MST with suicide ideation and suicide attempts among National Guard personnel. Procedures: N = 997 National Guard personnel from Idaho and Utah participated in an anonymous online survey. Weighted analyses were conducted to minimize sampling bias. Main findings: 9% of participants had a history of MST (6% of men, 28% of women). Among participants reporting MST, 68% reported a service member perpetrator and 44% reported a civilian perpetrator (12% reported both). A history of MST was associated with significantly increased risk for lifetime suicide attempt. MST remained a significant predictor of lifetime suicide attempt even when restricting the sample to the subgroup with a history of suicidal thoughts (n = 257, 27% of full sample). When adjusting for premilitary sexual victimization, MST was no longer significantly associated with lifetime suicide attempts, but premilitary sexual victimization was. Conclusions: The rate of MST among National Guard personnel is comparable to rates among active duty military personnel, although the perpetrators of MST are less likely to be service members. MST is a risk factor for suicide attempts, but premilitary sexual victimization is a relatively stronger risk factor. © 2018 Elsevier Inc.

Trajectories of Suicidal Ideation from Adolescence to Adulthood: Does the History of Same-Sex Experience Matter? - Oi, K.; Wilkinson, L. (Archives of Sexual Behavior, 2018)
The fluidity of same-sex experience (SSE) can be conceptualized as both a risk and a resource that impacts suicidal ideation over time. Considering whether SSE occurs in adolescence, adulthood, or both, this study suggests that SSE in both adolescence and adulthood is associated with depression and low self-esteem throughout the life course, resulting in chronic susceptibility to suicidal ideation. Yet due to variation in both accumulation of risk and resources over time, trajectories of suicidal ideation during the transition to adulthood likely vary by timing of SSE. To test these hypotheses, we fit latent growth curve models to a gender-stratified sample taken from the National Longitudinal Study of Adolescent to Adult Health (7608 men, 8070 women). We created four groups of SSE: no SSE (6322 men, 5981 women), SSE in adolescence only (634 men, 480 women), SSE in adulthood only (372 men, 1081 women), and SSE in adolescence and adulthood (280 men, 528 women). Men and women with SSE in both life stages had the greatest risk of suicidal ideation in adolescence and in adulthood. Yet women with first SSE in adulthood had less of a decline in suicidal ideation over time, relative to those with no SSE and those with SSE in adolescence only, and this was partially due to higher depression and lower self-esteem. Results suggest greater support is needed for adolescents expressing non-normative sexualities and for those with first SSE in adulthood, a group that is more difficult to identify in schools. © 2018, Springer Science+Business Media, LLC, part of Springer Nature.
Keywords: Adolescence; Coping; Non-heterosexuality; Sexual orientation; Suicidality

A transgender woman with intellectual disability and borderline personality disorder - Newman, W.J.; Barnhorst, A.V.; Landess, J.S. (American Journal of Psychiatry, 2018)
What diagnostic criterion is noted to be a central feature for each of the diagnoses of intellectual disability, borderline personality disorder, and gender dysphoria? A. Functional impairment. B. Emotional instability. C. Cognitive dysfunction. D. Neurotic traits. "Ms. A" is a 23-year-old transgender woman (assigned male at birth) with a history of fetal alcohol syndrome, mild intellectual disability (a full-scale IQ of 60), and borderline personality disorder. She received primary care and support through a regional intellectual disability agency but was also well known to psychiatric services for frequent violent outbursts and recurrent self-harm gestures. Ms. A's interactions with the mental health system began before age 5. She was adopted at birth into a home with other special-needs siblings. Early records reflect her difficulty with impulse control and anger management. By age 8, she was frequently wearing makeup or girls' clothing. By age 16, she consistently identified as female, wearing articles of women's clothing at school and soliciting her sisters' boyfriends. She made frequent self-harm gestures, such as cutting herself in the school hallway as well as threatening suicide, and she occasionally responded with violence toward peers or siblings who taunted her. During adolescence, Ms. A used social networking sites to find potential dates, often meeting older men in dangerous situations. Her high-risk behaviors continued; she often threatened "to turn myself into a girl" with knives, and she asked a man to "rape and kill me." By age 23, she had more than 15 referrals to mental health crisis units for behavioral issues, typically leading to inpatient hospitalizations. Despite support in her gender identity by her adoptive mother, she was unable to find services that provided hormone or surgical transition services for transgender youths and therefore had not received either intervention. Her main social service provider for intellectual disability also did not provide resources for transgender youths. Police last brought Ms. A to our facility after she threatened herself with scissors when a peer referred to her as a boy. She appeared tall and thin, looked younger than her age, and had a speech impediment with a significant lisp. She also exhibited dysmorphic facial features consistent with fetal alcohol syndrome, shoulder-length blonde hair, and faint beard growth. She frequently hunched over, hiding her face in her hands or behind her hair. She moved awkwardly and frequently missed social cues, unintentionally provoking anger from peers on the inpatient unit. On admission, Ms. A wore pink pajama pants and a loose-fitting T-shirt. She commonly wore pink T-shirts with adolescent slogans during her stay. She usually engaged readily and eagerly with staff and peers, but she was often childish in her mannerisms, consistent with intellectual disability Throughout her stay, she displayed limited frustration tolerance and frequently responded to misidentification of her gender with dramatic displays of emotion. Staff was unsure how to address Ms. A. Some were outwardly hostile. On one occasion, a staff member was overheard saying, "I'm not going to call that a she." Documentation from Ms. A's previous contacts with service agencies revealed unfamiliarity with transgender terminology and frequent dismissal of her transgender status. Of 15 intake notes, only two referred to her gender with correct pronouns; others documented male pronouns; some used both male and female pronouns; one avoided mentioning gender altogether. One writer noted, "He is trying to be transgender." Others frequently put the transgender modifier in quotation marks. Ms. As treatment team made several attempts to change her recorded gender on her hospital identification to prevent misidentification on subsequent admissions. Although gender misidentification was a trigger for many of her admissions, this was rarely included as part of her treatment plan. Most inpatient treatment focused on bolstering coping mechanisms before discharging her to the care of her service agency. The issue of her transgender status was often unaddressed, sometimes even actively avoided. Ms. A was unable to be discharged back to her adoptive mother's house. She and her mother sought a group home placement through the intellectual disability regional services. However, the local group homes were gender segregated, and the homes for females would not accept Ms. A, who often looked like a young man. Meetings between the family, the mental health team, and intellectual disability regional services revealed no known housing resources in the area that would meet her gender, intellectual, and mental health needs. © 2018 American Journal of Psychiatry. All rights reserved.

Liberals Possess More National Consensus on Political Attitudes in the United States: An Examination Across 40 Years - Ondish, P.; Stern, C. (Social Psychological and Personality Science, 2018)
Do liberals or conservatives have more agreement in their political attitudes? Recent research indicates that conservatives may have more like-minded social groups than do liberals, but whether conservatives have more consensus on a broad, national level remains an open question. Using two nationally representative data sets (the General Social Survey and the American National Election Studies), we examined the attitudes of over 80,000 people on more than 400 political issues (e.g., attitudes toward welfare, gun control, same-sex marriage) across approximately 40 years. In both data sets, we found that liberals possessed a larger degree of agreement in their political attitudes than did conservatives. Additionally, both liberals and conservatives possessed more consensus than did political moderates. These results indicate that social–cognitive motivations for building similarity and consensus within one’s self-created social groups may also yield less consensus on a broad, national level. We discuss implications for effective political mobilization and social change. © The Author(s) 2017.
Keywords: consensus; political attitudes; political ideology

Combining intersectionality and syndemic theory to advance understandings of health inequities among Canadian gay, bisexual and other men who have sex with men - Ferlatte, O.; Salway, T.; Trussler, T.; Oliffe, J.L.; Gilbert, M. (Critical Public Health, 2018)
Syndemics (socially produced intertwined epidemics) of psychosocial issues have been shown empirically to increase the risk of HIV infection among gay, bisexual and other men who have sex with men (GBM). However, to intervene effectively identifying those who are most vulnerable is critically important. Using an intersectionality framework, this study analyzed data drawn from 8490 Canadian GBM respondents to an online survey to evaluate demographic factors associated with experiencing a syndemic. A multivariable regression model was used to identify demographic characteristics among those experiencing a syndemic of two or more issues. Then, applying an intersectionality framework, the sample was stratified by gay and bisexual men, and by men partnered with woman (whether they were gay, bisexual or other), and the multivariate analyses for demographic variables were repeated for each strata. Multivariate regression models found that men were more at risk of syndemics if they identified as gay, were single, young (< 30-years-old), did not have a university degree and were low-income earners (< $60,000 per year). On stratified analysis, variations were found between gay, bisexual and female-partnered men where gay men were at greater odds of reporting a syndemic. These results provide further evidence that syndemics of psychosocial issues increase the risk of HIV infection among GBM. More so, the occurrence of syndemics was dependent on every single variable investigated including ethnicity and income. As such, interventions to reduce the effects of syndemics should be targeted to those most at risk and address social and structural inequities. © 2017, © 2017 Informa UK Limited, trading as Taylor & Francis Group.
Keywords: bisexual men; gay men; intersectionality; quantitative methods; Syndemic

Association between sexual minority status and suicidal behavior among Chinese adolescents: A moderated mediation model - Huang, Y.; Li, P.; Lai, Z.; Jia, X.; Xiao, D.; Wang, T.; Guo, L.; Lu, C. (Journal of Affective Disorders, 2018)
Background: Evidence shows sexual minority adolescents have a higher risk of suicidality than their heterosexual peers due to minority stressors or lack of social support, but it remains unclear how the combined effects of these influence factors impact suicidality in this population. In this study, we examine whether school victimization mediates association between sexual minority status and suicidal behavior of adolescents and explore whether such mediation is moderated by interpersonal relationships. Methods: We sampled a large nationally representative dataset comprising data collected from 7th to 12th graders (the 2015 School-based Chinese Adolescents Health Survey) using a multistage, stratified-cluster, random-sampling method. Our sample consisted of 123,459 students who completed questionnaires regarding their sexual minority status, suicidal ideation, suicide attempts, school victimization, classmate relations, and teacher–classmate relations. Results: Using a moderated mediation model, we found that school victimization mediated the effects of sexual minority status on suicidal ideation (indirect effect = 0.0296, 95% confidence intervals (CI) = 0.0259–0.0333) and suicide attempts (indirect effect = 0.0086, 95% CI = 0.0074–0.0100). These indirect effects were moderated by interpersonal relationships, and a greater effect was seen among sexual minority students with poor classmate or teacher–classmate relations. Limitations: Our study sample included only students attending school, and interpretation of the direction of the observed associations is limited due to the cross-sectional design. Conclusions: Interpersonal relationships moderate the indirect effects of school victimization on association between sexual minority status and suicidal behavior. Early intervention addressing school violence combined with improving the quality of relationships with school peers would help prevent suicidality in sexual minority adolescents. © 2018
Keywords: Adolescents; Interpersonal relationships; School victimization; Sexual minority status; Suicidal behavior

Socio-demographic, mental health and childhood adversity risk factors for self-harm and suicidal behaviour in College students in Northern Ireland - O'Neill, S.; McLafferty, M.; Ennis, E.; Lapsley, C.; Bjourson, T.; Armour, C.; Murphy, S.; Bunting, B.; Murray, E. (Journal of Affective Disorders, 2018)
Background: Prevalence estimates of suicidal behaviour in the college student population are consistently higher than rates for the general adult population. This study examines mental health disorders and childhood adversities as predictors of self-harm and suicidal behaviours. Methods: The Ulster University Student Wellbeing study commenced in September 2015 as part of the WHO World Mental Health Surveys International College Student Project. In Northern Ireland (NI) 739 students participated (462 female, 274 male and 3 other specified), with the WMH-CIDI used to examine psychopathology. Mean age was 21 years old. Results: Thirty-one percent endorsed suicidal ideation (24.3% of males and 36.9% of females) with almost 1 in 5 students having made a plan for suicide in the 12 months prior to the survey. Latent profile analysis revealed three profiles of childhood adversity (high, moderate, and low risk). Logistic regression analyses showed that there was an increased likelihood of all queried self-harm and suicidal behaviours in those who were not heterosexual orientation, and among those with either moderate or high levels of childhood adversities. Probable alcohol dependence was associated with a significantly increased likelihood of suicide attempt or self-harm with either a suicide plan or a suicide attempt. Limitations: Influences of self-report measures and the generalizability of the sample are discussed. Conclusions: Policies and strategies for early identification of those with mental illnesses or adversities that increase their risk, should be prioritised. It would also be useful to identify individuals at risk in secondary schools to allow for additional support to be offered to them during the key time of transitioning into higher education. © 2018
Keywords: Childhood adversities; College students; LGBT; Mental health; Suicidal behaviour

Relationship between illness representations and mental health among HIV-positive men who have sex with men - Mo, P.K.-H.; Lau, J.T.-F.; Wu, X. (AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV, 2018)
Illness representations play a significant role on mental health across various health conditions. The present study explores the associations between illness representations of HIV and mental health (suicidal ideation and depression), and the mediation effects of emotional representations on the associations between cognitive representations and mental health among men who have sex with men who were newly diagnosed with HIV (ND-MSM) in China. A total of 225 ND-MSM were recruited from a non-governmental organisation and were invited to complete a cross-sectional survey. Results showed that 48.0% had suicidal ideation since HIV diagnosis and 48.4% scored higher than the cut-off for mild depression or above. Stepwise regression analyses showed that higher levels of emotional representations of HIV and lower levels of treatment control were associated with both suicidal ideation and depression. Emotional representations were shown to mediate the associations between some cognitive representations variables and mental health. Findings suggest that both cognitive and emotional representations of HIV were important factors of mental health among ND-MSM. Interventions to promote the mental health of ND-MSM are warranted and should seek to improve their cognitive and emotional representations of HIV. © 2018, © 2018 Informa UK Limited, trading as Taylor & Francis Group.
Keywords: depression; HIV; illness representations; men who have sex with men; suicidal ideation

Suicide and the Human Service Professions in the Twenty-First Century: Current Issues and Future Directions - Westefeld, J.S.; Rinaldi, A.P. (Journal of Loss and Trauma, 2018)
Five current issues of importance to human service professionals and the field of suicidology are examined, including Joiner’s theory of suicide, suicide in the LGBT population, bullying and suicide, the relationship between firearm availability and suicidal risk, and suicide in the military. Implications and recommendations for the human service professions are addressed. © 2018, © 2018 Taylor & Francis Group, LLC.
Keywords: psychology; suicide

Suicide Acceptability and Sexual Orientation: Results from the General Social Survey 2008–2014 - Blosnich, J.R.; Lytle, M.C.; Coulter, R.W.S.; Whitfield, D.L. (Archives of Suicide Research, 2018)
Lesbian, gay, and bisexual (LGB) individuals have higher prevalence of lifetime suicide ideation and attempt than their heterosexual peers, but less is known about differences in suicide acceptability (i.e., believing suicide is a viable answer to a problem). The purpose of this study was to examine if LGB adults had greater suicide acceptability than heterosexual adults. A total of 4 items in the General Social Surveys from 2008 to 2014 assessed whether a nationally representative sample of U.S. adult respondents (n = 5,037) thought it acceptable for individuals to kill themselves if one: goes bankrupt, dishonors their family, is tired of living, or has an incurable disease. Multiple logistic regression analyses were used to assess the association of sexual orientation with suicide acceptability items after adjusting for confounding factors. Compared with heterosexuals, lesbians/gays had higher odds of reporting suicide acceptability if one goes bankrupt (OR = 1.92; 95% CI: 1.06, 3.46), dishonors family (OR = 1.83; 95% CI: 1.01, 3.28), or is tired of living (OR = 2.25; 95% CI: 1.30, 3.90). Bisexual and heterosexual groups were largely similar across the 4 suicide acceptability items. No sexual orientation differences were observed for reporting acceptability of suicide in the instance of an incurable disease. Post hoc analyses revealed significant interactions between sex and sexual orientation, such that differences in suicide acceptability seemed to be driven by sexual minority women rather than by sexual minority men. Suicide acceptability differs by sexual orientation, and community-level interventions around changing norms about suicide may be a prevention strategy for sexual minority individuals. © 2017, Copyright © International Academy for Suicide Research.
Keywords: general social survey; sexual minority; sexual orientation; suicide acceptability

The autobiography of a Victorian pornographer: Edward Sellon’s The Ups and Downs of Life - Arcara, S. (Porn Studies, 2018)
Written by Edward Sellon just before his suicide, The Ups and Downs of Life (1867) is at once a book of pornography and a pornographer’s philosophical testament. This article analyzes the literary strategies, discursive practices and ideological implications that inform this ‘erotic autobiography’, a remarkable text so far neglected by scholarship. With the methodological tools of gender studies and feminist literary criticism, the article examines the porno/autobiographer’s efforts to construct a heroic, heterosexual masculine identity through the discourse of philosophical libertinism, and his tragic failure. The Ups and Downs expands our knowledge of the Victorian subculture of pornography and sheds further light on the relationship between libertinism and masculinity, as well as on the power of pornography to challenge dominant public and literary discourses. With his skilful manipulation of generic categories (the realist novel, the ‘men of letters’ autobiography) and the search for a metaphysics of the flesh, Sellon destabilizes the boundaries between high and low culture: by choosing to recount the ‘ups and downs’ of his life (and of his penis) as an experiment in pornographic writing, he invents a textual space for articulating counter-hegemonic discourses otherwise unspeakable in Victorian culture. © 2017, © 2017 Informa UK Limited, trading as Taylor & Francis Group.
Keywords: autobiography; feminist literary criticism; gender studies; queer theory; Victorian literature; Victorian pornography

Towards a greater understanding of anxiety sensitivity across groups: The construct validity of the Anxiety Sensitivity Index-3 - Jardin, C.; Paulus, D.J.; Garey, L.; Kauffman, B.; Bakhshaie, J.; Manning, K.; Mayorga, N.A.; Zvolensky, M.J. (Psychiatry Research, 2018)
The present study examined the factor structure, invariance properties, reliability, and validity of the Anxiety Sensitivity Index-3 (ASI-3, Taylor et al., 2007). Participants were recruited from a large, ethnically diverse southwestern university (n = 3651; 77.8% female; M age = 22.06 years; 28% non-Hispanic White). Findings supported a bifactor structure for the ASI-3, which demonstrated measurement invariance across sex, race/ethnicity, age, and sexual minority status. Furthermore, the ASI-3 demonstrated strong reliability and validity, with the anxiety sensitivity general and specific factors (physical, cognitive, and social concerns) evidencing unique patterns of relations with symptoms of depression, suicidality, anxious arousal, and social anxiety. Clinically, these findings generally support the validity of the ASI-3 in measuring anxiety sensitivity across sex, age, race/ethnicity, and sexual minority status. Future work is needed to better understand the role anxiety sensitivity plays within specific demographic subgroups, particularly African–Americans, Asian Americans, and sexual minorities. © 2018
Keywords: Anxiety sensitivity; Gender; Measurement invariance; Race/ethnicity; Sexual orientation

Exploring Cross-Sectional Predictors of Suicide Ideation, Attempt, and Risk in a Large Online Sample of Transgender and Gender Nonconforming Youth and Young Adults - Kuper, L.E.; Adams, N.; Mustanski, B.S. (LGBT Health, 2018)
Purpose: Rates of suicide ideation and attempt appear to be particularly high in the transgender and gender nonconforming (TGNC) population, yet little is known about which factors are the most salient contributors for TGNC young people and how these contributors vary across suicide-related outcomes. Methods: Within the largest sample of TGNC young people to date (N = 1896; ages 14-30), we examined the contribution of demographics (age, assigned sex, gender identity, sexual orientation identity, race/ethnicity, and socioeconomic status), minority stress (gender-related affirmation, gender-related self-concept, victimization, and gender-Affirming medical treatment desire/access), social support (from family and friends), and depressive symptoms in the cross-sectional prediction of three suicide-related outcomes: past-year attempt, past-year ideation, and a composite measure of suicide risk. Results: Each set of factors explained significant variance in each outcome; however, only several predictors remained significant in each of the full models. Gender-related victimization and depressive symptoms were independent predictors for all three outcomes. Additional predictors varied across outcome. Age, male identity, sexual orientation-based victimization, and friend support were associated with suicide attempt. Age, queer identity, gender-related self-concept negativity, and family support were associated with suicide ideation, and pansexual identity and gender-related self-concept negativity were associated with positive suicide risk screen. Conclusion: Prevention and intervention efforts aimed at building support and positive self-concept, decreasing victimization, and treating depression are likely to partially reduce suicide ideation and attempt in TGNC adolescents and young adults. Comprehensive interventions with younger adolescents are particularly critical. © Copyright 2018, Mary Ann Liebert, Inc., publishers 2018.
Keywords: gender nonconforming; minority stress; suicide; transgender

Transgender adolescent suicide behavior - Toomey, R.B.; Syvertsen, A.K.; Shramko, M. (Pediatrics, 2018)
OBJECTIVES: Our primary objective was to examine prevalence rates of suicide behavior across 6 gender identity groups: female; male; transgender, male to female; transgender, female to male; transgender, not exclusively male or female; and questioning. Our secondary objective was to examine variability in the associations between key sociodemographic characteristics and suicide behavior across gender identity groups. METHODS: Data from the Profiles of Student Life: Attitudes and Behaviors survey (N = 120 617 adolescents; ages 11-19 years) were used to achieve our objectives. Data were collected over a 36-month period: June 2012 to May 2015. A dichotomized self-reported lifetime suicide attempts (never versus ever) measure was used. Prevalence statistics were compared across gender identity groups, as were the associations between sociodemographic characteristics (ie, age, parents' highest level of education, urbanicity, sexual orientation, and race and/or ethnicity) and suicide behavior. RESULTS: Nearly 14% of adolescents reported a previous suicide attempt; disparities by gender identity in suicide attempts were found. Female to male adolescents reported the highest rate of attempted suicide (50.8%), followed by adolescents who identified as not exclusively male or female (41.8%), male to female adolescents (29.9%), questioning adolescents (27.9%), female adolescents (17.6%), and male adolescents (9.8%). Identifying as nonheterosexual exacerbated the risk for all adolescents except for those who did not exclusively identify as male or female (ie, nonbinary). For transgender adolescents, no other sociodemographic characteristic was associated with suicide attempts. CONCLUSIONS: Suicide prevention efforts can be enhanced by attending to variability within transgender populations, particularly the heightened risk for female to male and nonbinary transgender adolescents. Copyright © 2018 by the American Academy of Pediatrics.

Psychiatry’s ethical involvement in gender-affirming care - D’Angelo, R. (Australasian Psychiatry, 2018)
Objective: To reflect on the role of psychiatry in authorising physical treatments for Gender Dysphoria and to examine the quality of evidence for gender-reassignment. Method: A Medline search was performed with the subject term “transsexualism” or “gender dysphoria” and “outcome” or “follow-up” in the title. Studies published from 2005 onwards reporting psychosocial outcomes were selected for review. Results: Most available evidence indicating positive outcomes for gender reassignment is of poor quality. The few studies with robust methodology suggest that some patients have poor outcomes and may be at risk of suicide. Conclusion: The author raises questions about the implications for ethical treatment of transgender individuals. © The Royal Australian and New Zealand College of Psychiatrists 2018.
Keywords: ethics; gender dysphoria; gender-reassignment; transgender

Chosen Name Use Is Linked to Reduced Depressive Symptoms, Suicidal Ideation, and Suicidal Behavior Among Transgender Youth - Russell, S.T.; Pollitt, A.M.; Li, G.; Grossman, A.H. (Journal of Adolescent Health, 2018)
Purpose: This study aimed to examine the relation between chosen name use, as a proxy for youths' gender affirmation in various contexts, and mental health among transgender youth. Methods: Data come from a community cohort sample of 129 transgender and gender nonconforming youth from three U.S. cities. We assessed chosen name use across multiple contexts and examined its association with depression, suicidal ideation, and suicidal behavior. Results: After adjusting for personal characteristics and social support, chosen name use in more contexts was associated with lower depression, suicidal ideation, and suicidal behavior. Depression, suicidal ideation, and suicidal behavior were lowest when chosen names could be used in all four contexts. Conclusion: For transgender youth who choose a name different from the one given at birth, use of their chosen name in multiple contexts affirms their gender identity and reduces mental health risks known to be high in this group. © 2018 The Society for Adolescent Health and Medicine
Keywords: Depression; Suicidality; Transgender; Youth

Hormone therapy, gender affirmation surgery, and their association with recent suicidal ideation and depression symptoms in transgender veterans - Tucker, R.P.; Testa, R.J.; Simpson, T.L.; Shipherd, J.C.; Blosnich, J.R.; Lehavot, K. (Psychological Medicine, 2018)
Background Access to transition-related medical interventions (TRMIs) for transgender veterans has been the subject of substantial public interest and debate. To better inform these important conversations, the current study investigated whether undergoing hormone or surgical transition intervention(s) relates to the frequency of recent suicidal ideation (SI) and symptoms of depression in transgender veterans.Methods This study included a cross-sectional, national sample of 206 self-identified transgender veterans. They self-reported basic demographics, TRMI history, recent SI, and symptoms of depression through an online survey.Results Significantly lower levels of SI experienced in the past year and 2-weeks were seen in veterans with a history of both hormone intervention and surgery on both the chest and genitals in comparison with those who endorsed a history of no medical intervention, history of hormone therapy but no surgical intervention, and those with a history of hormone therapy and surgery on either (but not both) the chest or genitals when controlling for sample demographics (e.g., gender identity and annual income). Indirect effect analyses indicated that lower depressive symptoms experienced in the last 2-weeks mediated the relationship between the history of surgery on both chest and genitals and SI in the last 2-weeks.Conclusions Results indicate the potential protective effect that TRMI may have on symptoms of depression and SI in transgender veterans, particularly when both genitals and chest are affirmed with one's gender identity. Implications for policymakers, providers, and researchers are discussed. © Copyright Cambridge University Press 2018.
Keywords: Gender affirmation; hormone therapy; suicide; transgender; veteran

Connections that moderate risk of non-suicidal self-injury among transgender and gender non-conforming youth - Taliaferro, L.A.; McMorris, B.J.; Eisenberg, M.E. (Psychiatry Research, 2018)
We examined associations between social connections and non-suicidal self-injury (NSSI) among transgender/gender non-conforming (TGNC) youth. Data came from the 2016 Minnesota Student Survey (N = 2168). Logistic regression analyses determined connectedness factors associated with any past-year NSSI and repetitive NSSI, as well as moderating effects of significant connectedness factors on different risk factors. Almost 55% of TGNC students engaged in NSSI, and 40% of self-injurers reported repetitive self-injury. Parent connectedness, connections to non-parental adults, and school safety emerged as robust protective factors. Strategies to prevent/reduce NSSI should focus on fostering connections with prosocial adults, and ensuring schools represent safe places. © 2018 Elsevier B.V.
Keywords: Adolescent; Connectedness; Self-harm

Measuring the Health of an Invisible Population: Lessons from the Colorado Transgender Health Survey - Christian, R.; Mellies, A.A.; Bui, A.G.; Lee, R.; Kattari, L.; Gray, C. (Journal of general internal medicine, 2018)
BACKGROUND: Transgender people, those whose gender identity does not match their sex assigned at birth, face barriers to receiving health care. These include discrimination, prohibitive cost, and difficulty finding transgender-inclusive providers. As transgender identities are not typically recognized in public health research, the ability to compare the health of the transgender population to the overall population is limited. OBJECTIVE: The Colorado Transgender Health Survey sought to explore current disparities and their effects on the health of transgender people in Colorado. DESIGN AND PARTICIPANTS: The Colorado Transgender Health Survey, based on the Behavioral Risk Factor Surveillance System (BRFSS), was developed by the Colorado Department of Public Health and Environment, transgender advocates, and transgender community members. Outreach was targeted to transgender-inclusive events and organizations. MAIN MEASURES: Responses to the 2014 Colorado Transgender Health Survey were compared side by side to Colorado 2014 BRFSS data. RESULTS: Results from 406 transgender or gender-nonconforming adults who live in Colorado were included in the analysis. Forty percent of respondents report delaying medical care due to cost, inadequate insurance, and/or fear of discrimination. Respondents report significant mental health concerns, with 43% reporting depression, 36% reporting suicidal thoughts, and 10% attempting suicide in the past year. Respondents with a transgender-inclusive provider were more likely to receive wellness exams (76 versus 48%), less likely to delay care due to discrimination (24 versus 42%), less depressed (38 versus 54%), and less likely to attempt suicide (7 versus 15%) than those without. CONCLUSIONS: The transgender community in Colorado faces significant disparities, especially around mental health. However, a transgender-inclusive provider is associated with improved mental and physical health and health behaviors. Further population-level research and provider education on transgender health should to be incorporated into national efforts to eliminate health disparities.
Keywords: access to care; community health; cultural competency; disparities; health behavior; transgender; underserved populations

Transgender adolescents and legal reform: How improved access to healthcare was achieved through medical, legal and community collaboration - Telfer, M.; Kelly, F.; Feldman, D.; Stone, G.; Robertson, R.; Poulakis, Z. (Journal of Paediatrics and Child Health, 2018)
Transgender children and adolescents face hardships in all domains of their lives, with many experiencing family rejection, social exclusion, discrimination, bullying and assaults. The mental health implications of these experiences include high rates of depression, anxiety, self-harm and attempted suicide. Gender-affirming social support and medical treatment has been shown to ameliorate the poor mental health outcomes of transgender youth, with those who are supported in their social and medical transition reporting rates of depression and self-worth equivalent to general population levels. Advocacy efforts that improve access to support and medical treatment are therefore likely to produce significant positive health and well-being outcomes for this vulnerable population. The transgender community in Australia identified the legal restrictions placed on children and adolescents accessing medical treatment as a significant barrier to positive psychological well-being. Australian law, unique internationally, required the parents of transgender adolescents to apply for court authorisation prior to the commencement of their child's gender-affirming medical treatment. Concerned by the harm created by this process, a coalition of experts, including transgender children, adolescents and their parents, as well as academic and clinical experts in the fields of law and medicine, was created to advocate for reform. Over a period of approximately 4 years, a collaborative process was undertaken, which ultimately led to law reform and improved access to medical treatment for the transgender community. © 2018 Paediatrics and Child Health Division (The Royal Australasian College of Physicians)

Creative health promotion methods for young LGBTIQA+ people - Bellamy, R. (Health Education Journal, 2018)
This paper evaluates the potential efficacy of using life writing to address mental health disparities and to promote health and well-being among young LGBTIQA+ persons. It examines the potential benefits of young LGBTIQA+ people engaging with life writing including memoir, autobiography, creative nonfiction, journaling and digital storytelling. These benefits include exploring identity and making sense of one’s experiences, unifying and empowering marginalised communities, providing people with agency, illuminating common experiences, and facilitating the exchange of resources and support. It evaluates current developments in literacy and English education and identifies an increasing trend towards neo-liberalism and economic discourses, potentially at the expense of providing opportunities for young people to develop creativity and engage in self-exploration. It discusses the author’s experiences in running life writing workshops with groups of LGBTIQA+ young people and offers suggestions on how to run similar workshops in educational and wider community settings, including possible prompts, modes of working and debriefing the participants. Overall, the findings suggest that life writing can be used to improve the health and well-being of LGBTIQA+ young people; however, the paper concludes that this sort of intervention needs to be run respectfully, strategically and with full awareness of how sensitive and traumatic the content may be that can emerge for young people. For this reason, the paper presents guidelines and recommendations to provide structure and support. © The Author(s) 2018.
Keywords: Digital storytelling; LGBTQ; life writing; pedagogy; well-being; youth

Recent Suicide Attempts Across Multiple Social Identities Among Gay and Bisexual Men: An Intersectionality Analysis - Ferlatte, O.; Salway, T.; Hankivsky, O.; Trussler, T.; Oliffe, J.L.; Marchand, R. (Journal of Homosexuality, 2018)
This study draws from intersectionality to describe variations in recent suicide attempts (RSA) among gay and bisexual men (GBM) across sociodemographics. Using survey data, logistic regression modeling explored RSA in two analytical stages: (1) the individual effects of each sociodemographic were measured; (2) two-way interaction terms between sociodemographics were tested and added to the models created in stage A. In stage A, only education and income achieved significance. In stage B, the study found that (a) education and income interacted significantly such that the odds of RSA increased for those with a lower income and a lower education; (b) sexual orientation and partnership status interacted, resulting in decreased odds among bisexual men in heterosexual partnerships; and (c) income and education interacted with geography; the effects of these variables were significant only among urban men. These findings suggest that GBM are at unequal risk of RSA according to intersecting sociodemographics. © 2018, © 2018 Taylor & Francis.
Keywords: bisexuality; gay; homosexuality; intersectionality; risk factors; Suicide; suicide attempts

The social determinants of lesbian, gay, bisexual and transgender youth suicidality in England: a mixed methods study - McDermott, E.; Hughes, E.; Rawlings, V. (Journal of public health (Oxford, England), 2018)
Background: Lesbian, gay, bisexual and transgender (LGBT) youth have a higher risk of suicidality and self-harm than heterosexual youth populations but little is known about the underlying mechanisms. We aimed to investigate the social determinants of this mental health inequality. Methods: A two-stage sequential mixed method study was conducted. Firstly, 29 semi-structured interviews with LGBT youth (aged 13-25 years old) were completed. Data was analysed thematically. Stage 2 involved a self-completed questionnaire employing an online community-based sampling strategy (n = 789). Logistic regression analysis was performed to predict suicidality. Results: Five social determinants explained suicidal risk: (i) homophobia, biphobia or transphobia; (ii) sexual and gender norms; (iii) managing sexual and gender identities across multiple life domains; (iv) being unable to talk; (v) other life crises. Youth who were transgender (OR = 1.50, P < 0.022), disabled (OR = 2.23, P < 0.000), had self-harmed (OR = 7.45, P < 0.000), were affected by abuse (OR = 2.14, P < 0.000), and affected by not talking about their emotions (OR = 2.43, P < 0.044) were most likely to have planned or attempted suicide. Conclusions: Public health universal interventions that tackle bullying and discrimination in schools, and selected interventions that provide specific LGBT youth mental health support could reduce LGBT mental health inequalities in youth suicidality.

Self-Injurious Thoughts and Behaviors May Be More Common and Severe Among People Identifying as a Sexual Minority - Fox, K.R.; Hooley, J.M.; Smith, D.M.Y.; Ribeiro, J.D.; Huang, X.; Nock, M.K.; Franklin, J.C. (Behavior Therapy, 2018)
Research indicates that people who identify as a sexual minority are at higher risk of numerous negative outcomes, including self-injurious thoughts and behaviors (SITBs). The minority stress model proposes that people identifying as a sexual minority are at higher risk of these behaviors due to sexual orientation-specific stressors—however, it does not clarify whether SITBs will be more severe among these individuals. The present study tested whether SITBs are more common and more severe among people identifying as a sexual minority using several metrics, including frequency of SITB engagement, age of onset of SITB, desire to discontinue SITB engagement, and likelihood of future SITBs. Four independent research samples were used to test this model. Results were then combined and tested in an internal meta-analysis. Findings converge to indicate a longer and more severe course of SITB engagement among people identifying as a sexual minority. Future research is needed to replicate these findings and to advance the understanding of why this imbalance in risk and severity might exist, and how it can be prevented. © 2017
Keywords: NSSI; self-injury; sexual minority; suicide

Barriers to insurance coverage for transgender patients - Learmonth, C.; Viloria, R.; Lambert, C.; Goldhammer, H.; Keuroghlian, A.S. (American Journal of Obstetrics and Gynecology, 2018)
Transgender people report discrimination in access to health care that is associated with numerous poor health outcomes, including higher prevalence of HIV infection, substance use disorders, and suicide attempts. The field of obstetrics and gynecology is uniquely positioned to meet a wide range of health care needs for transgender people, and obstetrician-gynecologists can and ought to provide gender-affirming care for these patients. Despite growing evidence that gender-affirming care is both necessary and cost-effective, transgender patients continue to face barriers to securing insurance coverage, which prevents clinicians from practicing standards of care. The purpose of this article is to delineate the major barriers transgender patients face when seeking insurance reimbursement for services routinely available to cisgender (nontransgender) women. © 2018 Elsevier Inc.
Keywords: electronic health record; gender identity; gender queer; gender-affirming; insurance barriers; lesbian, gay, bisexual, and transgender; nonbinary; obstetrics and gynecology; third-party payer; transgender; transsexual

LGBT people and suicidality in youth: A qualitative study of perceptions of risk and protective circumstances - Rivers, I.; Gonzalez, C.; Nodin, N.; Peel, E.; Tyler, A. (Social Science and Medicine, 2018)
Evidence suggests that lesbian, gay, bisexual and trans (LGBT) people are more likely to attempt to take their own lives in their youth when compared to heterosexual and/or cisgender people. This study draws on in-depth interviews with 17 LGBT individuals living in England, and explores the narratives used by participants to better understand their perceptions of risk and protective circumstances to explain suicide attempts in youth. Using a Goffman-informed thematic analysis, results identified three key themes that were linked to attempts to end life in youth. The first theme considers the conflicts resulting from first disclosure of sexual orientation and/or gender identity/trans status and being ‘out’ to others. The second theme explores participants’ accounts of their concurrent mental health issues and how diagnoses of the mental health issues helped them make sense of their own experiences of attempted suicide. The final theme explores the experience of grieving over lost relationships and how that grief is received by others, including health professionals. Our results indicate that some LGBT individuals have effectively, although often arduously, navigated suicidal crises by utilising various approaches to coping. We provide a rich and layered picture of LGBT suicide risk in youth and potential resilience scenarios, although these are a reflection of our specific group of participants’ experiences and realities. We argue that it is important to understand how LGBT individuals with a history of suicide attempts narrate and make sense of their experiences in early life and we suggest that the early negative experiences continue to have an effect on LGBT adults today. © 2018 Elsevier Ltd
Keywords: England; LGBT; Perception; Protective; Qualitative; Risk; Suicide; Youth

Constructing and Expanding Suicide Narratives From Gay Men - Salway, T.; Gesink, D. (Qualitative Health Research, 2018)
In this study, we document life stories of gay men who attempted suicide as adults. Our goal is to expand the collection of narratives used to understand this persistent health inequity. We interviewed seven adult gay men, each of whom had attempted suicide two to four times, and identified five narratives. Pride narratives resist any connection between sexuality and suicide. Trauma-and-stress narratives enable coping through acknowledgment of sexual stigma as a fundamental trauma and cause of subsequent stress and suicidal thoughts. Memorial narratives prevent suicide by maintaining a strong sense of “permanent” identity. Outing narratives demand that the listener confronts the legacy of unjust practices of homosexual surveillance and “outing,” which historically resulted in gay suicides. Finally, postgay narratives warn of the risk of suicide among older generations of gay men who feel erased from the goals of modern gay movements. Sexual identity concealment or invisibility featured prominently in all five narratives. © The Author(s) 2018.
Keywords: Canada; gay; mental health; narrative research; qualitative; suicide

Factors associated with deaths from suicide in a French nationwide HIV-infected cohort - Hentzien, M.; Cabie, A.; Pugliese, P.; Billaud, É.; Poizot-Martin, I.; Duvivier, C.; Valantin, M.-A.; Kaladjian, A.; Dramé, M.; Bani-Sadr, F.; Dellamonica, P.; Cuzin, L.; et al. (HIV Medicine, 2018)
Objectives: People living with HIV (PLHIV) are at a higher risk of dying by suicide than the general population. Epidemiological data regarding determinants of suicide in PLHIV are scarce. The aim of this study was thus to study demographic, socio-economic, psychiatric history and immunovirological characteristics associated with death from suicide in the French multicenter Dat'AIDS cohort, from January 2000 to July 2013. Methods: This was a nested case–control study. All deceased PLHIV during the study period who died by suicide and whose medical files could be checked were included as cases. Controls were selected using incidence density sampling. For each case, up to four controls were selected among all actively followed PLHIV at the index date (date of death of cases). Controls were matched for time from HIV diagnosis (5-year periods) and clinical centre. Results: Seventy cases and 279 controls were included in the study. By multivariable analysis, the factors significantly associated with death from suicide were: not having children, active or substituted drug consumption, alcohol intake > 20 g/day or history of alcohol abuse, history of depressive disorder and/or of attempted suicide, and psychotropic drug intake. Conversely, age, gender, country of birth, positive HCV serology and HIV-related factors, such as AIDS status, use of combination antiretroviral therapy (cART), nadir and current CD4 counts and HIV viral load, were not significantly associated with the risk of death from suicide. Conclusions: In the cART era, HIV-related factors are not associated with a higher risk of suicide mortality. Suicide prevention measures should target PLHIV with the psychological morbidities observed in our cohort. © 2018 British HIV Association
Keywords: Dat'AIDS cohort; HIV; psychological morbidity; suicide; suicide mortality

Factors associated with discrimination in social-service settings among a sample of transgender and gender-nonconforming adults - Klein, A.; Mountz, S.; Bartle, E. (Journal of the Society for Social Work and Research, 2018)
Objective: Few studies have investigated discrimination in social-service or social work settings among transgender and gender-nonconforming (TGNC) individuals. This study aims to (a) examine the prevalence and magnitude of discrimination against TGNC individuals and (b) explore the factors associated with discrimination in social-service settings. Method: We examined sociodemographic factors and psychosocial and health-related indicators (suicide attempt ever, substance misuse to cope, HIV positive serostatus, transactional sex, and marginally housed) associated with reports of social-service discrimination in a national sample of transgender adults (age 18–98, M = 36.69, SD = 13.11) from the U.S. and its territories. Data were from the National Transgender Discrimination Survey (N = 6,456). Results: Approximately 16% (n = 952) of the total sample experienced some form of discrimination related to their gender identity/expression in a social-service setting. Participants reporting social-service discrimination were more likely to be non-White, under 45 years of age, lower income, and to report negative psychosocial and/or health-related outcomes. Conclusions: Findings highlight the need for future research to examine individual-, interpersonal-, and structural-level factors associated with access to and use of social services among the transgender and gender-nonconforming community. © 2018 by the Society for Social Work and Research. All rights reserved.
Keywords: Discrimination; Health disparities; Social service; Transgender

Developing Resilience: Gay Men’s Response to Systemic Discrimination - Handlovsky, I.; Bungay, V.; Oliffe, J.; Johnson, J. (American Journal of Men's Health, 2018)
Gay men experience marked health disparities compared to heterosexual men, associated with profound discrimination. Resilience as a concept has received growing attention to increase understanding about how gay men promote and protect their health in the presence of adversity. Missing in this literature are the perspectives and experiences of gay men over 40 years. This investigation, drawing on grounded theory methods, examined how gay men over 40 years of age develop resilience over the course of their lives to promote and protect their health. In-depth interviews were undertaken with 25 men ranging between 40 and 76 years of age who experienced an array of health concerns including depression, anxiety, suicidality, and HIV. Men actively resist discrimination via three interrelated protective processes that dynamically influence the development of resilience over their life course: (a) building and sustaining networks, (b) addressing mental health, and (c) advocating for respectful care encounters. Initiatives to promote and protect the health of gay men must be rooted in the recognition of the systemic role of discrimination, while supporting men’s resilience in actively resisting discrimination. © The Author(s) 2018.
Keywords: gay health issues; gender issues and sexual orientation; gender issues and sexual orientation; health promotion and disease prevention; health-care issues; homophobia; psychosocial and cultural issues; social determinants of health

“I should have …”:A Photovoice Study With Women Who Have Lost a Man to Suicide - Creighton, G.; Oliffe, J.L.; Bottorff, J.; Johnson, J. (American Journal of Men's Health, 2018)
While the gendered nature of suicide has received increased research attention, the experiences of women who have lost a man to suicide are poorly understood. Drawing on qualitative photovoice interviews with 29 women who lost a man to suicide, we completed a narrative analysis, focused on describing the ways that women constructed and accounted for their experiences. We found that women’s narratives drew upon feminine ideals of caring for men’s health, which in turn gave rise to feelings of guilt over the man’s suicide. The women resisted holding men responsible for the suicide and tended to blame themselves, especially when they perceived their efforts to support the man as inadequate. Even when women acknowledged their guilt as illogical, they were seemingly unable to entirely escape regret and self-blame. In order to reformulate and avoid reifying feminine ideals synonymous with selflessly caring for others regardless of the costs to their own well-being, women’s postsuicide bereavement support programs should integrate a critical gender approach. © The Author(s) 2018.
Keywords: behavioral issues; bereavement; caregiving; gender issues and sexual orientation; gender role; suicide; women’s health

Gender differences in demographic and clinical characteristics of patients with opioid use disorder entering a comparative effectiveness medication trial - Campbell, A.N.C.; Barbosa-Leiker, C.; Hatch-Maillette, M.; Mennenga, S.E.; Pavlicova, M.; Scodes, J.; Saraiya, T.; Mitchell, S.G.; Rotrosen, J.; Novo, P.; Nunes, E.V.; Greenfield, S.F. (American Journal on Addictions, 2018)
Background & Objectives: We investigated gender differences in individuals with opioid use disorder (OUD) receiving inpatient services and entering a randomized controlled trial comparing extended-release naltrexone to buprenorphine. Methods: Participants (N = 570) provided demographic, substance use, and psychiatric information. Results: Women were significantly younger, more likely to identify as bisexual, live with a sexual partner, be financially dependent, and less likely employed. Women reported significantly greater psychiatric comorbidity and risk behaviors, shorter duration but similar age of onset of opioid use. Discussion/Conclusions: Findings underscore economic, psychiatric, and infection vulnerability among women with OUD. Scientific Significance: Interventions targeting these disparities should be explored, as women may face complicated treatment initiation, retention, and recovery. (Am J Addict 2018;27:465–470). © 2018 American Academy of Addiction Psychiatry

Accidental death in autoerotic maneuvers: Case series - Focardi, M.; Bugelli, V.; Defraia, B.; Gualco, B.; Norelli, G.-A. (Romanian Journal of Legal Medicine, 2018)
Literature describe relatively few studies about accidental death in autoerotic maneuvers. Authors report three new cases on this topic that involved adult male individuals. The purpose of the paper is to increase the knowledge and the classification of the phenomenon and give a contribution for the forensic medicine and psychiatric implications. The dynamics of the investigation of the scene, the autopsy finding and the examination of the medical history are particularly important for forensic professionals that must classify the event as a suicide, homicide or as an accidental event. The Authors describe the phenomenon also from the epidemiological point of view that shows a high prevalence of men, even if in Italy there are not official estimates. Last but not least the Authors and take in consideration and discussed about the existence in the subject of a para-physiological habitude or a real type of pathology as paraphiliac disorders (masochism, fetishism, travestic fetishism). © 2018 Romanian Society of Legal Medicine.
Keywords: Accidental death; Autoerotic maneuvers; Cases; Difficulty investigation

Impacts of a Documentary about Masculinity and Men’s Health - King, K.; Schlichthorst, M.; Reifels, L.; Keogh, L.; Spittal, M.J.; Phelps, A.; Pirkis, J. (American Journal of Men's Health, 2018)
As part of a larger study, we developed a three-part documentary called Man Up that explored the relationship between masculinity, mental health, and suicide. In this study, we examine in detail the qualitative feedback provided by those who viewed Man Up, in order to gain a more in-depth understanding of its impact on them. A total of 169 participants provided qualitative feedback via an online survey 4 weeks after viewing Man Up. We examined their opinions about the show and whether they reported any changes in their attitudes and/or behaviors as a result of watching it. All the men who provided feedback on Man Up were overwhelmingly positive about it. The majority reported significant and profound impacts of viewing the documentary. They reported being more aware of others, more willing to help others, and more open about their emotions and problems, as well as demonstrating associated behavioral changes related to helping others and being more emotionally expressive. The data presented here demonstrate the potential for men’s health outcomes to be positively impacted by novel, media-based public health interventions. © The Author(s) 2018.
Keywords: behavioral issues; gender issues and sexual orientation; health-care issues; masculinity; mental health; public health; qualitative research; research; suicide

The effect of different acoustic noise on speech signal formant frequency location - Sadeghi, M.; Marvi, H.; Ali, M. (International Journal of Speech Technology, 2018)
The presence of noise is one of the major challenges and concerns in speech recognition systems. There are in particular different kinds of noises (pink, white and leopard) that can adversely affect a speech signal in various ways and degrees. In this study, the extent of resistance of a speech signal’s formants or in other words, the displacement of the formants have been measured against being subjected to different conventional noises. The methodology adopted was to apply different noises to the original voice signal, then to measure and to investigate the amount of formant location displacement. In this paper, the mean square movement (MSM) parameter has been introduced. This represents the deviation and displacement amount of the frequencies of the formants caused by applying the various noises. All of the investigations were conducted under three different SNR conditions (5, 10 and 15 dB). This allowed for the assessment of the influence of the signal-to-noise ratio (SNR) on the MSM parameter and the extent of the displacements of the formants. The results indicate that the frequency of the formants under these three SNR amounts was resistant against the machine gun type of noise, whilst white noise caused the most measureable effect and displacement in the frequencies of the formants. © 2018, Springer Science+Business Media, LLC, part of Springer Nature.
Keywords: Acoustic; Auto regressive (AR); Automatic speech recognition (ASR); Formant; Hidden Markov model; Linear predictive coding (LPC); Mean square movement (MSM); Vocal tract

First genome-wide analysis of the endangered, endemic lichen Cetradonia linearis reveals isolation by distance and strong population structure - Allen, J.L.; McKenzie, S.K.; Sleith, R.S.; Alter, S.E. (American Journal of Botany, 2018)
Premise of the Study: Lichenized fungi are evolutionarily diverse and ecologically important, but little is known about the processes that drive their diversification and genetic differentiation. Distributions are often assumed to be wholly shaped by ecological requirements rather than dispersal limitations. Furthermore, although asexual and sexual reproductive structures are observable, the lack of information about recombination rates makes inferences about reproductive strategies difficult. We investigated the population genomics of Cetradonia linearis, a federally endangered lichen in the southern Appalachians of eastern North America, to test the relative contributions of environmental and geographic distance in shaping genetic structure, and to characterize the mating system and genome-wide recombination. Methods: Whole-genome shotgun sequencing was conducted to generate data for 32 individuals of C. linearis. A reference genome was assembled, and reads from all samples were aligned to generate a set of single-nucleotide polymorphisms for further analyses. Key Results: We found evidence for low rates of recombination and for isolation by distance, but not for isolation by environment. The species is putatively unisexual, given that only one mating-type locus was found. Hindcast species distribution models and the distribution of genetic diversity support C. linearis having a larger range during the Last Glacial Maximum in the southern portion of its current extent. Conclusions: Our findings contribute to the understanding of factors that shape genetic diversity in C. linearis and in fungi more broadly. Because all populations are highly genetically differentiated, the extirpation of any population would mean the loss of unique genetic diversity; therefore, our results support the continued conservation of this species. © 2018 Botanical Society of America
Keywords: biogeography; Cladoniaceae; conservation genetics; endangered species; fungal biology; Gymnoderma lineare; population genetics; population genomics; rock gnome; symbiosis

Mindfulness and other psycho-social resources protective against mental illness and suicidality among gay men - Wang, J.; Häusermann, M.; Ambresin, A.-E. (Frontiers in Psychiatry, 2018)
Background: There is considerable evidence of health disparities among gay men characterized by higher levels of stress and distress. Psycho-social resources have been linked to numerous positive health outcomes and shown to act as buffers in the stress-distress pathway. Methods: With data from the 3rd Geneva Gay Men's Health Survey carried out in 2011 using time-space sampling (n = 428), a relatively elaborate profile of 14 psycho-social resources-including mindfulness-is presented. Using their original scores, latent class analysis created an index variable dividing the respondents into meaningful groups. Psycho-social resources-the index variable as well as each resource individually-were then compared to two recent outcomes-i.e., serious mental illness in the past 4 weeks and short-term disability in the past 2 weeks-using a series of logistic regression models, controlling for all other psycho-social resources and socio-demographic confounders. To assess their potential role as buffers, a similar series of logistic regression models were erected using victimization and three outcomes-i.e., major depression, suicidal ideation, and suicide attempt-in the past 12 months. Results: According to the latent class analyses, (1) 5.1% of this sample had a low level of psycho-social resources (i.e., one standard deviation (SD) below the group means), (2) 25.2% a medium-low level, (3) 47.4% a medium level (i.e., at the group means), and (4) 22.2% a high level of psycho-social resources (i.e., one SD above the group means). Psycho-social resources appeared to strongly protect against recent mental morbidity and buffer against the impact of victimization on major depression and suicidality in the past 12 months, reducing the adjusted odds ratios below statistical significance. The explained variance and the individual psycho-social resources which remained independent in the models differed for each outcome. Conclusions: There may be disparities in several psycho-social resources among gay men, and as strong compensatory and protective factors, they may explain in part the well-established disparities in stress and distress in this population. While multiple psycho-social resources should be promoted in this population, gay men under 25 years should receive particular attention as all three disparities are most pronounced in this age group. © 2018 Wang, Häusermann and Ambresin.
Keywords: Depression; Homosexuality; Mindfulness; Psycho-social resources; Suicidality; Victimization

On hate crime victimization: Rates, types, and links with suicide risk among sexual orientation minority special interest group members - Cramer, R.J.; Wright, S.; Long, M.M.; Kapusta, N.D.; Nobles, M.R.; Gemberling, T.M.; Wechsler, H.J. (Journal of Trauma and Dissociation, 2018)
Hate crimes remain pressing traumatic events for sexual orientation minority adults. Previous literature documents patterns in which hate crime victimization is associated with elevated risk for poor mental health. The present paper held 2 aims to advance literature. First, we investigated the rates and types of hate crime victimization among sexual orientation minority adults. Second, adopting a mental health amplification risk model, we evaluated whether symptoms of depression, impulsivity, or post-traumatic stress exacerbated the hate crime victimization–suicide risk link. Participants were 521 adult sexual orientation minority-identifying members of the National Coalition for Sexual Freedom (i.e., a bondage and discipline, and sadomasochism-identifying sexuality special interest group). Participants completed demographic and mental health inventories via online administration. Results showed: (1) low rates of total lifetime hate crime victimization and (2) higher rates of interpersonal violence compared to property crime victimization within the sample. Regression results showed: (1) independent positive main effects of all 3 mental health symptom categories with suicide risk; (2) an interaction pattern in which impulsivity was positively associated with suicide risk for non-victims; and (3) an interaction pattern in which post-traumatic stress was positively associated with suicide risk for hate crime victims and non-victims. Results are discussed concerning implications for trauma-informed mental healthcare, mental health amplification models, and hate crime and suicide prevention policies. © 2018 Taylor & Francis.
Keywords: depression; hate crimes; post-traumatic stress; Sexual orientation; suicide

Sexual minority status and suicidal behaviour among Chinese adolescents: A nationally representative cross-sectional study - Huang, Y.; Li, P.; Guo, L.; Gao, X.; Xu, Y.; Huang, G.; Deng, X.; Lu, C. (BMJ Open, 2018)
Objectives Suicidality among sexual minority adolescents has generated worldwide concern in recent decades, and previous Western studies have demonstrated that sexual minority status is associated with adolescent suicidality. However, whether this association exists in Chinese adolescents remains largely unknown. This study aimed to estimate the associations between sexual minority status and suicidal behaviour among Chinese adolescents. Design Cross-sectional survey. Setting A total of 506 high schools in 7 provinces of China. Participants A total of 150 822 students in grades 7-12 who completed the questionnaires (response rate of 95.9%) were included. Main outcome measures Suicidal ideation and suicide attempts were used to measure suicidal behaviour, and sexual attraction (opposite sex, same sex or both sex) was used as a measure for sexual minority status. Results Of the 150 822 adolescents analysed, 4.1% self-reported as sexual minorities and 17.3% were unsure. Compared with heterosexual and unsure adolescents, same-sex romantic attraction (SSA) and both-sex romantic attraction (BSA) adolescents reported a higher prevalence of past-year suicidal ideation (SSA: 21.6% for males and 30.4% for females; BSA: 34.7% for males and 42.3% for females) and suicide attempts (SSA: 6.9% for males and 8.9% for females; BSA: 12.2% for males and 10.9% for females). After adjustment for covariates, SSA and BSA adolescents were more likely to have past-year suicidal ideation and suicide attempts than their heterosexual and unsure peers. BSA adolescents reported the highest risk of suicidal ideation (males: adjusted OR (AOR) 2.42, 95% CI 2.03 to 2.88; females: AOR 2.61, 95% CI 2.41 to 2.82) and suicide attempts (males: AOR 3.83, 95% CI 2.85 to 5.14; females: AOR 2.59, 95% CI 2.19 to 3.06). Conclusions Our study suggested that Chinese sexual minority adolescents were at increased risk of suicidality, and those with BSA had an especially high risk in this population. These findings emphasised the urgent need to develop targeted interventions to effectively address suicide-related problems among Chinese sexual minority adolescents. © 2018 Author(s) (or their employer(s)).
Keywords: paediatrics; public health; sexual medicine

Trend Disparities in Emotional Distress and Suicidality Among Sexual Minority and Heterosexual Minnesota Adolescents From 1998 to 2010 - Porta, C.M.; Watson, R.J.; Doull, M.; Eisenberg, M.E.; Grumdahl, N.; Saewyc, E. (Journal of School Health, 2018)
BACKGROUND: Sexual minority young people have demonstrated higher rates of emotional distress and suicidality in comparison to heterosexual peers. Research to date has not examined trends in these disparities, specifically, whether there have been disparity reductions or increases and how outcomes have differed over time by sex and sexual orientation group. METHODS: Minnesota Student Survey data, collected from 9th and 12th graders in 3 cohorts (1998, 2004, 2010) were used to examine emotional distress and suicidality rates. Logistic regression analyses were completed to examine outcome changes over time within and across sexual orientation/sex groups. RESULTS: With few exceptions, sexual minority youth are at increased risk of endorsing emotional distress and suicidality indicators in each surveyed year between 1998 and 2010. Young people with both-sex partners reported more emotional distress across all health indicators compared to their opposite-sex partnered peers. With a few exceptions, gaps in disparities between heterosexual and sexual minority have not changed from 2004 to 2010. CONCLUSIONS: Disparities in emotional health persist among youth. Research is needed to advance understanding of mental health disparities, with consideration of sexual orientation differences and contextualized to sociocultural status and changes over time. Personalized prevention strategies are needed to promote adolescent mental health. © 2018, American School Health Association
Keywords: adolescent mental health; disparity; sexual minority; suicidality; trend

Relation between sexual and gender minority status and suicide attempts among veterans seeking treatment for military sexual trauma - Sexton, M.B.; Davis, M.T.; Anderson, R.E.; Bennett, D.C.; Sparapani, E.; Porter, K.E. (Psychological Services, 2018)
There is limited study of suicidal behaviors among veterans identifying as sexual and gender minorities (SGMs), despite previous research indicating rates of suicide attempts are high within civilian SGM populations. Further, some research incorporating military service members suggests those identifying as SGMs are disproportionately exposed to military sexual trauma (MST), an additional risk factor for negative psychiatric sequelae. To address health care research disparities among minority veterans (i.e., women, those endorsing MST, SGMs), we examined presentations of veterans (N = 277) who attended initial consultation appointments for MST-related treatment and completed a semistructured clinical interview including demographic characteristics, history of suicide attempts (HSA), and a diagnostic evaluation. Twenty-eight (10.1%) veterans identified as SGMs. SGM/non-SGM groups were contrasted on suicidal and psychiatric morbidity outcomes. Overall, endorsement of HSA was high (30.7%). Despite similar clinical profiles, 53.6% of veterans who identified as SGM endorsed HSA in contrast with 28.1% of peers identifying as heterosexual and nontransgender, a significant effect of small-to-moderate size. Findings suggest assessment and clinical management of suicidality is of critical importance for clinicians providing services to veterans pursuing recovery from MST, generally, and may be especially so when delivering care to SGM. Further, results underscore the need for culturally competent delivery of trauma-focused interventions. © 2018 American Psychological Association.
Keywords: Gender minorities; Military sexual trauma; Sexual minorities; Suicide attempts; Veterans

Co-occurring psychosocial problems predict HIV status and increased health care costs and utilization among sexual minority men - O’Cleirigh, C.; Pantalone, D.W.; Batchelder, A.W.; Hatzenbuehler, M.L.; Marquez, S.M.; Grasso, C.; Safren, S.A.; Mayer, K.H. (Journal of Behavioral Medicine, 2018)
Sexual orientation related health disparities are well documented. Sexual minority men appear to be at risk for mental health problems due to the stress they experience in establishing and maintaining a minority sexual identity. These mental health issues may combine synergistically and lead to higher medical costs to society. We examine whether sexual minority specific syndemic indicators were associated with higher health care costs, health care utilization, or the risk of being HIV-infected. Health care consumers at a community health center (N = 1211) completed a brief screening questionnaire collected over 12 months. Self-reported data were linked with participants’ clinical billing records. Adjusted logistic regression models identified that four syndemic indicators (suicidality, substance use, childhood sexual abuse, and intimate partner violence) were each significantly related to each other. Multiple syndemics significantly predicted higher medical care utilization and cost, and were associated with 2.5 times the risk of being HIV-infected (OR 2.49, 95% CI 1.45–4.25). Syndemic indicators did not significantly predict the number of mental health visits or costs per patient. These results confirm and extend earlier findings by relating syndemics to health services use and costs for sexual minority men. © 2018, Springer Science+Business Media, LLC, part of Springer Nature.
Keywords: Medical cost; Mental health; Sexual minority; Syndemic

Sexual orientation, gender, and attempted suicide among adolescent psychiatric inpatients - DeCou, C.R.; Lynch, S.M. (Psychological Services, 2018)
Lesbian, gay, bisexual, and queer (LGBQ) and female youth report disproportionately high rates of attempted suicide. Previous studies have not addressed the association between sexual orientation, gender, and attempted suicide among adolescent psychiatric inpatients. This study examined LGBQ orientation as a correlate of attempted suicide above and beyond other risk factors (e.g., age, rurality, trauma exposure, psychopathology), and also examined the interaction between gender and sexual orientation with regard to attempted suicide. We conducted a chart review study that included 550 adolescent psychiatric inpatients admitted to a public psychiatric hospital. Adolescents completed standardized intake assessments and self-report measures of sociodemographics, history of attempted suicide, psychopathology, and trauma history. Sexual orientation, gender, and their interaction were evaluated as predictors of attempted suicide using sequential logistic regression. LGBQ youth were more than 3 times more likely (odds ratio [OR] = 3.08) than non-LGBQ peers to have attempted suicide, and female youth were more than twice as likely to have attempted suicide compared with male patients (OR = 2.44). There was not a significant LGBQ orientation by gender interaction. These findings demonstrate the importance of LGBQ orientation and female gender as risk factors for suicidal behavior in a sample of adolescent psychiatric inpatients. Although limited by the self-report and retrospective nature of the data collected, these findings suggest the importance of initial and ongoing assessment of gender, sexual orientation, and suicidality in inpatient youth and the need for additional research to inform effective intervention efforts in this high-risk population. © 2018 American Psychological Association.
Keywords: Adolescents; Attempted suicide; Gender; LGBQ/sexual orientation; Psychiatric inpatients

Mind the gap: predicting the positive mental health of adult sexual minority Canadians - Peter, T. (Health promotion international, 2018)
The goal of the study is to investigate possible predictors of positive mental health, and whether they differ across sexual identity adult groups. Using data from the 2012 Canadian Community Health Survey on Mental Health, multivariate analyses were conducted, including interaction terms, to assess the effects of sexual orientation on various mental illness, health-risk behaviors, and sociological indicators and their correlations with positive mental health. Substantial effect sizes were observed across all sexual identity groups for psychological distress, social provisions and sense of belonging in terms of their influence on positive mental health. However, various mental health disorders, suicidality, and whether or not care needs were being met varied considerably in the disaggregated analysis, suggesting that there are key differences among sexual minority groups when it comes to predicting positive mental health. This study represents perhaps the largest population-based analysis of positive mental health, which is both theoretically informed and psychometrically verified, on sexual minority adults. Findings raise important concerns regarding the lower than average levels of positive mental health for all sexual minorities, which may be explained, at least in part, to the health care system's tendency to focus primarily on individual treatment needs rather than broader socio-structural aspects within a mental health promotion framework.

Homelessness, Mental Health and Suicidality Among LGBTQ Youth Accessing Crisis Services - Rhoades, H.; Rusow, J.A.; Bond, D.; Lanteigne, A.; Fulginiti, A.; Goldbach, J.T. (Child Psychiatry and Human Development, 2018)
LGBTQ youth experience increased risks of homelessness, mental health disorder symptoms, and suicidality. Utilizing data from LGBTQ youth contacting a suicide crisis services organization, this study examined: (a) rates of homelessness among crisis services users, (b) the relationship between disclosure of LGBTQ identity to parents and parental rejection and homelessness, and (c) the relationship between homelessness and mental health disorder outcomes and suicidality. A nationwide sample of LGBTQ youth was recruited for a confidential online survey from an LGBTQ-focused crisis services hotline. Overall, nearly one-third of youth contacting the crisis services hotline had experienced lifetime homelessness, and those who had disclosed their LGBTQ identity to parents or experienced parental rejection because of LGBTQ status experienced higher rates of homelessness. Youth with homelessness experiences reported more symptoms of several mental health disorders and higher rates of suicidality. Suggestions for service providers are discussed. © 2018, Springer Science+Business Media, LLC, part of Springer Nature.
Keywords: Crisis services; Homelessness; LGBTQ youth; Mental health; Suicidality

Counselling transgender individuals: Issues and considerations - Weir, C.; Piquette, N. (Canadian Psychology, 2018)
Les personnes transgenres représentent une population à part entière dont les voix sont souvent perdues parmi les communautés lesbiennes, gaies, bisexuelles et transgenres (LGBT). Le fait d'être transgenre remet en question les idées que peuvent se faire les gens à propos des sexes masculin et féminin puisque cette identité n'adhère pas aux modèles traditionnels féminin et masculin. Les personnes transgenres font face à des situations de vie difficiles, sont plus à risque de subir de la violence et des problèmes de santé mentale, y compris de commettre des tentatives de suicide. Avec l'augmentation de la sensibilisation par rapport aux personnes transgenres, il est important que les conseillers soient sensibilisés à cette population et aux défis auxquels ils font face. Les personnes transgenres sont souvent mises dans la même catégorie que d'autres minorités sexuelles; or, même si elles s'identifient comme étant homosexuelles et sont victimes d'homophobie, elles sont aussi victimes de transphobie à cause de leur identité sexuelle. Le potentiel de multiples formes de violence, combiné à un manque d'outils d'aide sécuritaires et appropriés peut entraîner de graves préjudices et dommages chez cette population. Pour cette raison, les conseillers devraient travailler de façon à développer des compétences et à augmenter la sensibilisation pour mieux desservir cette population. Cet article se penche sur un grand nombre des questions importantes et de recommandations en counseling. © 2018 Canadian Psychological Association. Transgender individuals represent a unique population whose voices are often lost within the Lesbian, Gay, Bisexual, and Transgender (LGBT) population. Being transgender challenges the assumptions that people may make regarding sex and gender as they do not adhere to a gender binary. Transgender individuals experience unique life challenges and are at risk for violence as well as mental health concerns, including suicide. With an increase in awareness regarding transgender individuals, as well as recent changes to policies and treatment, it is important that counsellors are aware of this population and the challenges they face. Transgender individuals are often combined with other sexual minorities; however, although they may identify as homosexual and experience homophobia, they also experience transphobia because of their gender identity. The potential for multiple forms of violence, combined with a lack of safe and appropriate supports, can lead to the potential for serious harm and damage among this population. Therefore, counsellors should work toward developing competencies and awareness in how to best serve this population. This article addresses many of the key issues and counselling recommendations. © 2018 Canadian Psychological Association.
Keywords: At risk; Compétences en counseling; Counseling; Counselling competencies; Counselling support; Transgender; Transgenre; Violence; Violence; À risque

Religion, Sexual Orientation, and Suicide Attempts Among a Sample of Suicidal Adolescents - Shearer, A.; Russon, J.; Herres, J.; Wong, A.; Jacobs, C.; Diamond, G.M.; Diamond, G.S. (Suicide and Life-Threatening Behavior, 2018)
Despite condemnation of same-sex attraction by certain religious groups, few studies have explored the relationship between religion, same-sex attraction, and suicidality. This study examined the moderating effect of same-sex attraction on the relationship between parent/adolescent religiosity and suicide ideation/attempts in a suicidal adolescent sample (N = 129). Linear and negative binomial regressions tested the effects of a two-way dichotomous (same-sex attraction, yes/no) by continuous (religiosity) interaction on ideation and attempts, respectively. The interaction was not significant for ideation. However, high religiosity was associated with more attempts in youth reporting same-sex attraction but fewer attempts in those reporting opposite-sex attraction only. © 2017 The American Association of Suicidology

A comparison of LGBTQ youth and heterosexual youth in the child welfare system: Mental health and substance abuse occurrence and outcomes - Scannapieco, M.; Painter, K.R.; Blau, G. (Children and Youth Services Review, 2018)
Purpose: LGBTQ youth enter the child welfare system often because they are at higher risk of experiencing child maltreatment compared to youth who are heterosexual (Friedman, Marshal, Guadamuz, Wei, Wong, Saewye, & Stall, 2011), and due to family rejection, which places them at higher risk of suicide, higher levels of depression and are more likely to use substances (Ryan, Huebner, Dias & Sanchez, 2009). Using national data from the Substance Abuse and Mental Health Services Administration (SAMHSA), this study had two purposes; first to examine mental health disparities among LGBTQ youth and their heterosexual peers who are involved in the child welfare system, and second to observe the effectiveness of systems of care with youth in child welfare and if any differences exist between LGBTQ youth and heterosexual youth. Methods: Chi-square and logistic regression were used to analyze differences at intake between youth who identified as LGBT or Q and their heterosexual counterparts. Repeated linear mixed modeling was used to evaluate the outcomes and to compare the groups at fixed time points (intake, 6-months, and 12-months). Findings: The study found LGBTQ youth had higher levels of suicidal ideation, suicide attempts, depression, and gender identity related problems compared to the heterosexual youth in child welfare. All youth in the study experienced significant improvement, further supporting the effectiveness of system of care approaches. Recommendations are also discussed. © 2018
Keywords: Child welfare; LGBTQ; Mental health disparities, mental health outcomes; System of care

Nonsuicidal self-Injury among a representative sample of US adolescents, 2015 - Monto, M.A.; McRee, N.; Deryck, F.S. (American Journal of Public Health, 2018)
Objectives. To provide prevalence estimates of adolescent nonsuicidal self-injury (NSSI) based on large, representative, nonclinical samples of high-school students, and to explore gender differences in health risks associated with NSSI. Methods. We used 2015 Centers for Disease Control and Prevention Youth Risk Behavior Surveillance System data to estimate the prevalence of self-injury and variables potentially associated with self-injury for high-school–age boys (n = 32 150) and girls (n = 32 521) in 11 US states. We used logistic regression analysis to consider associations between NSSI and other health risks. Results. Rates of boys reporting purposefully hurting themselves without wanting to die over the past 12 months ranged from 6.4% (Delaware) to 14.8% (Nevada). Rates for girls varied from 17.7% (Delaware) to 30.8% (Idaho). Rates declined with age and varied by race and ethnicity. Depression; suicidal thoughts, plans, and attempts; sexual minority status; being electronically bullied; smoking; and substance use were associated with NSSI. There were minor differences in associations between NSSI and health risk variables by gender. Conclusions. Nonclinical populations of adolescents are at high risk for self-injury. Nonsuicidal self-injury was higher among girls than among boys, but patterns of association with other health risks were similar. © 2018 American Public Health Association Inc. All rights reserved.

Retrospective Cyberbullying and Suicide Ideation: The Mediating Roles of Depressive Symptoms, Perceived Burdensomeness, and Thwarted Belongingness - Mitchell, S.M.; Seegan, P.L.; Roush, J.F.; Brown, S.L.; Sustaíta, M.A.; Cukrowicz, K.C. (Journal of Interpersonal Violence, 2018)
Research suggests that being cyberbullied is associated with increased risk for suicide ideation; however, few studies have examined the underlying mechanisms of this relation, and fewer have examined this relation within a theory of suicide. Specifically, the interpersonal theory of suicide posits that thwarted belongingness (indicated by loneliness and a lack of reciprocal caring relationships) and perceived burdensomeness (indicated by feelings of liability and self-hatred) increase risk for suicide ideation. The current study aimed to examine depressive symptoms, thwarted belongingness, and perceived burdensomeness as mediators between intensity of being cyberbullied and suicide ideation. Participants were college students (N = 348) who completed assessments of retrospective peer victimization, thwarted interpersonal needs (i.e., thwarted belongingness and perceived burdensomeness), and suicide ideation. The results indicated that after adjusting for sexual orientation, depressive symptoms significantly mediated the relation between intensity of being cyberbullied and suicide ideation. Furthermore, depressive symptoms and perceived burdensomeness serially mediated the relation between intensity of being cyberbullied and suicide ideation; however, thwarted belongingness was not a significant mediator. Clinical and research implications, limitations, and future directions are discussed. © 2016, The Author(s) 2016.
Keywords: cyberbullying; depressive symptoms; perceived burdensomeness; suicide ideation

Risk of suicidal behavior with use of efavirenz: Results from the strategic timing of antiretroviral treatment trial - Arenas-Pinto, A.; Grund, B.; Sharma, S.; Martinez, E.; Cummins, N.; Fox, J.; Klingman, K.L.; Sedlacek, D.; Collins, S.; Flynn, P.M.; Chasanov, W.M.; Kedem, E.; et al. (Clinical Infectious Diseases, 2018)
Background Randomized trials have shown increased risk of suicidality associated with efavirenz (EFV). The START (Strategic Timing of Antiretroviral Treatment) trial randomized treatment-naive human immunodeficiency virus (HIV)-positive adults with high CD4 cell counts to immediate vs deferred antiretroviral therapy (ART). Methods The initial ART regimen was selected prior to randomization (prespecified). We compared the incidence of suicidal and self-injurious behaviours (suicidal behavior) between the immediate vs deferred ART groups using proportional hazards models, separately for those with EFV and other prespecified regimens, by intention to treat, and after censoring participants in the deferred arm at ART initiation. Results Of 4684 participants, 271 (5.8%) had a prior psychiatric diagnosis. EFV was prespecified for 3515 participants (75%), less often in those with psychiatric diagnoses (40%) than without (77%). While the overall intention-to-treat comparison showed no difference in suicidal behavior between arms (hazard ratio [HR], 1.07, P =.81), subgroup analyses suggest that initiation of EFV, but not other ART, is associated with increased risk of suicidal behavior. When censoring follow-up at ART initiation in the deferred group, the immediate vs deferred HR among those who were prespecified EFV was 3.31 (P =.03) and 1.04 (P =.93) among those with other prespecified ART; (P =.07 for interaction). In the immediate group, the risk was higher among those with prior psychiatric diagnoses, regardless of prespecified treatment group. Conclusions Participants who used EFV in the immediate ART group had increased risk of suicidal behavior compared with ART-naive controls. Those with prior psychiatric diagnoses were at higher risk. © The Author(s) 2018. Published by Oxford University Press for the Infectious Diseases Society of America.
Keywords: efavirenz; HIV; suicidal behavior

Association of recent gay-related stressful events with depressive symptoms in Chinese men who have sex with men - Liu, Y.; Jiang, C.; Li, S.; Gu, Y.; Zhou, Y.; An, X.; Zhao, L.; Pan, G. (BMC Psychiatry, 2018)
Background: To assess the association of different gay-related stressful events (GRSEs) with depressive symptoms in Chinese men who have sex with men (MSM). Method: A total of 807 MSM were recruited using respondent-driven sampling from four cities in northeastern China. GRSEs were measured using the Gay Related Stressful Life Events Scale, and depressive symptoms were assessed using the Self-Rating Depression Scale (SDS). Results: A total of 26.0% of study participants experienced GRSEs in the past three months, and the average SDS score was lower than the previously reported national average for China. The study participants had significantly elevated risks of depression (SDS score ≥ 53) due to recent troubles with a boss (OR = 4.92, 95% CI = 1.87-12.97) or a workmate (OR = 3.68, 95% CI = 1.52-8.88), loss of a close friend (OR = 2.41, 95% CI = 1.39-4.18), argument with a close friend (OR = 2.07, 95% CI = 1.33-3.22), and being physically assaulted (OR = 2.08, 95% CI = 0.98-4.43). Arguments with family members or classmates had no significant effect on depression. Multiple logistic regression analysis showed that the number of GRSEs, a lower level of education, more advanced age, and HIV infection significantly increased the risk of depression. Conclusions: There are large differences in the associations of different types of GRSEs with depressive symptoms. Reducing the stigmatization and discrimination toward MSM in all social environments and improving the capability of MSM to cope with different types of GRSEs may improve their emotional wellbeing. © 2018 The Author(s).
Keywords: Depressive symptoms; Gay related stressful event; Men who have sex with men; Social support

In 8100 Again: The Sounds of Students Breaking - Wozolek, B. (Educational Studies - AESA, 2018)
In this article, the author uses the sounds of schooling to explore LGBTQ youth experiences as they relate to self-harm and suicide. Although sounds-as-voice and representation is a well-trodden path in scholarly conversations, the author centers her argument on the significance of sounds in the daily lives of LGBTQ students. This is significant as literature predominantly focuses on the signs of suicide as physical and visual rather than residing in sounded epistemologies. Expanding on previous work on the school-to-coffin pipeline, this article theorizes the sounds of students breaking to explore youth suicide and self-harm as they are nested in the everyday interactions of classrooms and corridors. Using a combination of personal narrative and interviews from a year-long sonic ethnography, the author explores how sounds are an important part of the school-to-coffin pipeline for LGBTQ youth and should therefore be regarded as a significant tool for unpacking some of the darkest experiences and notions learned through schooling- depression, self-harm, and suicide. © 2018, Copyright © American Educational Studies Association.

Evaluation of an avatar-based training program to promote suicide prevention awareness in a college setting - Rein, B.A.; McNeil, D.W.; Hayes, A.R.; Hawkins, T.A.; Ng, H.M.; Yura, C.A. (Journal of American College Health, 2018)
Objective: Training programs exist that prepare college students, faculty, and staff to identify and support students potentially at risk for suicide. Kognito is an online program that trains users through simulated interactions with virtual humans. This study evaluated Kognito's effectiveness in preparing users to intervene with at-risk students. Participants: Training was completed by 2,727 university students, faculty, and staff from April, 2014 through September, 2015. Methods: Voluntary and mandatory participants at a land-grant university completed Kognito modules designed for higher education, along with pre- and post-assessments. Results: All modules produced significant gains in reported Preparedness, Likelihood, and Self-Efficacy in intervening with troubled students. Despite initial disparities in reported abilities, after training participants reported being similarly capable of assisting at-risk students, including LGBTQ and veteran students. Conclusions: Kognito training appears to be effective, on a large scale, in educating users to act in a facilitative role for at-risk college students. © 2018, © 2018 Taylor & Francis Group, LLC.
Keywords: College students; LGBTQ; mental health; suicide prevention; veterans

Non-Suicidal Self-Injury, Sexuality Concerns, and Emotion Regulation among Sexually Diverse Adolescents: A Multiple Mediation Analysis - Fraser, G.; Wilson, M.S.; Garisch, J.A.; Robinson, K.; Brocklesby, M.; Kingi, T.; O’Connell, A.; Russell, L. (Archives of Suicide Research, 2018)
Despite increasing interest in the prevalence and correlates of Non-Suicidal Self-Injury (NSSI) in adolescent populations, relatively few studies have examined NSSI among lesbian, gay and bisexual (LGB) adolescents. The current study explored sexuality concerns and elevated emotion dysregulation as potential mechanisms underlying the relationship between sexual orientation and elevated non-suicidal self-injury (NSSI). A community sample of 1,799 adolescents completed a questionnaire assessing NSSI, sexual orientation, sexuality concerns, and emotion regulation. Across the study, 20.6% of adolescents reported a history of NSSI. Adolescents who identify as “mostly heterosexual,” “bisexual,” and “mostly homosexual” were more likely to engage in NSSI than gay/lesbian, heterosexual, and asexual adolescents. Multiple mediation analysis showed that emotion regulation, but not sexuality concerns, mediated the relationship between sexual orientation and NSSI. The current study tested two theoretical pathways by which sexual orientation could predict NSSI engagement. Findings suggest that literature on general psychological processes, as well as group-specific minority stressors, can shed light on high rates of NSSI among LGB populations. Specifically, the challenges faced by LGB adolescents may undermine the development of emotion regulation. As such, this should be a key target of intervention with LGB adolescents engaging in NSSI. © 2018, Copyright © International Academy for Suicide Research.
Keywords: emotion regulation; LGBT; non-suicidal self-injury; NSSI; sexual orientation; youth

Psychodynamics of Suicide in Lesbian, Gay, Bisexual, or Transgender Youth - Bojarski, E.; Qayyum, Z. (Journal of Infant, Child, and Adolescent Psychotherapy, 2018)
Lesbian, gay, bisexual, and transgender (LGBT) youth are a vulnerable population at high risk of suicide and, as such, benefit from an informed psychotherapeutic approach to treatment. While it is clear that sexual orientation and gender identity are independent dimensions from psychopathology, LGBT youth are frequently marginalized and may face unique challenges with self-acceptance and identification with peers, family, and society, increasing risk of social isolation, which in turn increases vulnerability to anxiety, mood disorders, substance use, and suicide. We elaborate on the common phenomenon of ambivalent repression of the sexual self in adolescents associated with intertwined themes frequently expressed in suicidal lesbian, gay, transgender, bisexual, and queer patients on the inpatient adolescent unit: anger directed toward internal and external objects; desire for self-punishment, atonement, and possibly rebirth; and desperation and desire to escape psychic pain. We enhance our discussion with case examples and practical therapeutic considerations that emerge from these themes that can be harnessed across treatment settings. © 2018, © 2018 JICAP Foundation, Inc.

Differences in well-being between sexual minority and heterosexual college students - Crawford, T.N.; Ridner, S.L. (Journal of LGBT Youth, 2018)
This study examines differences in well-being between sexual minority and heterosexual college students and identifies factors associated with well-being among sexual minority college students. A secondary analysis of cross-sectional web-based survey data was conducted. Using propensity score matching, 43 sexual minority students were matched to 43 heterosexual students on age, race, sex, and year in school. Sexual minorities had significantly lower well-being scores compared to heterosexual college students. Among sexual minorities, physical activity, depression, thoughts of suicide, and sleep quality were all predictive of well-being. Understanding issues related to well-being among sexual minorities is important and strategies need to be developed to improve well-being. © 2018, © 2018 Taylor & Francis.
Keywords: College Students; Sexual Minority; Well-Being

Overcoming Internalised Phobia among Buddhist sexual Minorities through Mindfulness - Cheng, F.K. (Contemporary Buddhism, 2018)
When heterosexuality dominates sexual culture, sexual minorities are marginalised, yielding minority stress and internalised phobia which devastate psychological well-being and raise suicide risks. A growing trend in using mindfulness-related interventions in health care shows positive signs, but there is a paucity of research on mindfulness for sexual minorities. This qualitative research, through interpretative phenomenological analysis, looks into how Buddhist sexual minorities (from various countries) interpret mindfulness from which their increased self-awareness, self-esteem and self-acceptance become prominent intrinsic resources, resulting in enhanced mental health and quality of life. Such an exploratory study extends the horizon of health care benefits for helping professionals and sexual minorities with alternative views in overcoming external and internalised phobia. © 2019, © 2019 Informa UK Limited, trading as Taylor & Francis Group.

A threat to Canadian national security: a lesbian soldier’s story - Gouliquer, L.; Poulin, C.; Moore, J. (Qualitative Research in Psychology, 2018)
Before 1992, lesbians and gay soldiers were purged and discharged from the Canadian military for “reasons of homosexuality.” Those caught or suspected of homosexuality were subject to lengthy, humiliating, and degrading interrogations. This short story sheds light on this painful past. It is based on findings of a nationally funded pan-Canadian longitudinal study examining how Canadian military policies and practices influenced the lives of lesbian, gay, bisexual, and transgender soldiers and their partners. In total, 126 people were interviewed. While in the military, countless soldiers were investigated, numerous interrogated, many lost their careers, some committed suicide and others survived. Personal details have been changed to ensure the anonymity of the people, but it is their voices that tell this story. An official state apology was delivered November 28, 2017. Due to an impending class action court case, an agreement for compensation was also reached. Compensation and memorials will be forthcoming to those who were affected by the LGBTQI2+ purge campaign. To this day, no evidence exits that these soldiers were “ever” a threat to national security. © 2018 The Author(s). Published by Taylor & Francis.
Keywords: Canadian military; discharged soldiers; homosexuality; interrogations; justice; LGBT; national security; purge campaign

Mental Health of Transgender People in Hong Kong: A Community-Driven, Large-Scale Quantitative Study Documenting Demographics and Correlates of Quality of Life and Suicidality - Suen, Y.T.; Chan, R.C.H.; Wong, E.M.Y. (Journal of Homosexuality, 2018)
A community-driven survey of 106 transgender people (the first such survey in Hong Kong) showed that: (1) more than half the sample (50.9%) had a university degree or higher qualification; (2) despite this, 43.4% had a monthly income below HK$6,000 (about USD$775); (3) 66% reported “fair” or “poor” quality of life; (4) 67% of the sample (87.1% of respondents aged 15–24 years) had contemplated suicide; and (5) 20.8% of the sample (35.5% of respondents aged 15–24 years) had attempted suicide. It was found that (1) those who were single, had a lower monthly income, and identified as transgender women reported lower quality of life; and (2) those who were younger and on a lower income expressed higher suicidality. The findings suggest that service providers and policy makers urgently need to address the mental health needs of transgender people, particular younger transgender people. © 2018 Taylor & Francis.
Keywords: Hong Kong; LGBT; mental health; quality of life; suicide attempt; suicide ideation; transgender

Depressive Symptoms and Suicidal Ideation among Irish Undergraduate College Students - Horgan, A.; Kelly, P.; Goodwin, J.; Behan, L. (Issues in Mental Health Nursing, 2018)
This study examined the prevalence of depressive symptoms and suicidal ideation among 220 first year undergraduate university students in Ireland. Data were collected using the Centre for Epidemiological Studies Depression Scale and the Suicidal Behaviours Questionnaire. Findings indicated that 59% of participants experienced depressive symptoms and 28.5% had suicidal ideation. Financial stress and poor relationships with both parents, increased the odds of experiencing depressive symptoms. Sexual orientation, financial stress, and poor relationships with fathers, increased the odds of experiencing suicidal ideation. Suicidal ideation was also higher in those who had sought help in the past from mental health professionals. Nurses need to be aware of the factors associated with mental ill-health in this population. © 2018, © 2018 Taylor & Francis Group, LLC.

Mental health service utilization among men who have sex with men who are at risk of mental health problems in Hong Kong: Prevalence and associated factors - Mo, P.K.H.; Lau, J.T.F.; Lau, M.M.C.; Kim, Y. (Psychology of Men and Masculinity, 2018)
Mental health problems are prevalent among men who have sex with men (MSM); however, underutilization of mental health services among MSM with mental health problems has been widely documented. To explore factors associated with mental health service utilization (i.e., having sought help from mental health professionals; and intention to seek mental health services if one were to have mental health problems) among 2 subsamples of MSM who were at risk of mental health problems (Subsample 1: those who scored above the cut-off for probable depression or probable anxiety, or had suicidal ideation; Subsample 2: those self-perceived to have had mental health problems in the past 12 months) in Hong Kong. A cross-sectional telephone survey was conducted among MSM (N = 175 for Subsample 1 and N = 143 for Subsample 2). Multivariate logistic regressions showed that factors for having sought help from mental health professionals included disclosure of MSM behavior to all family members and positive attitudes toward seeking professional psychological help for Subsample 1, and positive attitudes toward seeking professional psychological help, ever diagnosed for mental disorders, and enacted stigma for Subsample 2. In addition, factors associated with intention to seek help from mental health professionals included willingness to disclose MSM behavior to mental health professionals for Subsample 1, and positive attitudes toward seeking professional psychological help for both subsamples. Interventions to promote help seeking for mental health problems among MSM should promote positive attitudes toward seeking psychological help and reduce stigma. © 2017 American Psychological Association.
Keywords: Help seeking; Men who have sex with men; Mental health problems; Mental health services

The S axis in PDM-2. Symptom patterns: The subjective experience - Mundo, E.; Persano, H.; Moore, K. (Psychoanalytic Psychology, 2018)
In this paper we address the main innovations included in the Subjective Experience chapter (S Axis) of the PDM-2, that is, its conceptualization of adult symptom patterns. We include some comparison between, and discussion of, ICD-10, DSM-5, and PDM-2. A primary goal of the PDM is to consider both biological and psychological susceptibility factors in shaping specific symptom patterns in adults; we pursue this goal by considering specific sections; for example, suicidal behaviors. We discuss the core PDM-2 innovations: a better definition of the subjective experience of symptoms and symptom patterns, the inclusion of (and the assessment guidelines for) suicide and suicidal and parasuicidal behavior, the inclusion of the subjective experience of the therapist when encountering a specific subject with specific symptom patterns, and the addition of the description of some nonpathological conditions that may require clinical attention (i.e., demographic minorities, lesbian, gay, and bisexual populations, and gender incongruent populations). With respect to the gender incongruent subjects, we note as a significant step forward the depathologization of this condition, formerly termed "gender identity disorder" and now, in DSM-5, termed "gender dysphoria." We make a case for the value of including a section on nonpathological conditions in a psychodynamically oriented diagnostic manual. Finally, we discuss the implications and limitations of such PDM-2 innovations with respect to clinical settings and future clinical research purposes. © 2018 American Psychological Association.
Keywords: Adult psychopathology; Nonpathological conditions; PDM-2; S Axis; Symptom patterns

Depression and attempted suicide among LGBTQ college students: Fostering resilience to the effects of heterosexism and cisgenderism on campus - Woodford, M.R.; Weber, G.; Nicolazzo, Z.; Hunt, R.; Kulick, A.; Coleman, T.; Coulombe, S.; Renn, K.A. (Journal of College Student Development, 2018)
Little is known is about the impacts of covert and overt discrimination and the protective factors for depression and suicide among LGBTQ students. Using multivariable regression analyses of a national sample of cisgender lesbian, gay, bisexual, and queer students and trans* students (n = 776), we examined the association between mental health and microaggressions, victimization, psychological resilience, pride, and outness. In models of all risk and protective factors, interpersonal microaggressions was a risk factor for depression and attempted suicide among cisgender LGBQ students and was also a risk factor among trans* students for depression. In all but 1 model, resilience was a protective factor. Resilience moderated the microaggressions–suicide relationship among cisgender LGBQ students, whereas pride moderated the victimization– depression relationship among trans* students. © 2018, Johns Hopkins University Press. All rights reserved.

Characteristics of adolescents referred to a gender clinic: Are youth seen now different from those in initial reports? - Chiniara, L.N.; Bonifacio, H.J.; Palmert, M.R. (Hormone Research in Paediatrics, 2018)
Background/Aims: To examine characteristics, including mental health comorbidities, among adolescents presenting to a transgender clinic and to compare these data to previous reports. Methods: Retrospective chart review among youth seen at The Hospital for Sick Children between January 2014 and June 2016. Demographic data, clinical characteristics, and mental health comorbidities were assessed. Baseline and repeat blood work were also examined. Results: Charts from 203 adolescents aged 12-18 years were reviewed (156 assigned female at birth [AFAB] (77%) aged 16.3 ± 1.63 years, 47 assigned male at birth [AMAB] aged 16.1 ± 1.70 years). There was no statistically significant difference between gender groups except for Tanner stage (AFAB, mean 4.42 ± 0.8 and AMAB, mean 4.03 ± 1.1, p = 0.040). Individuals from racial/ethnic minority populations were under-represented compared to the background population. Self-report and baseline psychological questionnaires showed high levels of gender dysphoria, mood disorders, and suicidal ideation, with higher levels of anxiety detected on questionnaires among AFAB (p = 0.03). Laboratory abnormalities identified on baseline and repeat testing were minor; on cross-sex hormones, hemoglobin levels increased slightly in AFAB (p = 0.002, highest = 166 g/L) and decreased among AMAB (p = 0.02, lowest = 132 g/L). Conclusion: Our study supports an evolving demographic trend with more AFAB than AMAB youth now presenting to gender clinics. The data also corroborate studies indicating that extensive laboratory testing may not be a necessary part of caring for these youths. Why more AFAB are now presenting to clinic and racial/ethnic minorities are underrepresented is not clear, but these trends have important implications for clinical care and warrant further study. © 2018 S. Karger AG, Basel. Copyright: All rights reserved.
Keywords: Gender dysphoria; Gender variance; Gender-affirming hormones; Pubertal suppression; Transgender youth

The Role of Distal Minority Stress and Internalized Transnegativity in Suicidal Ideation and Nonsuicidal Self-Injury Among Transgender Adults - Staples, J.M.; Neilson, E.C.; Bryan, A.E.B.; George, W.H. (Journal of Sex Research, 2018)
Transgender people are at elevated risk for nonsuicidal self-injury (NSSI) and suicidal ideation compared to the general population. Transgender (trans) refers to a diverse group of people who experience incongruence between their gender identity and sex assigned at birth. The present study is guided by the minority stress model and the psychological mediation framework, which postulate that sexual minority groups experience elevated stress as a result of anti-minority prejudice, contributing to negative mental health outcomes. This study utilized these theories to investigate the role of internalized transnegativity—internalization of negative societal attitudes about one’s trans identity—in the relationships of distal trans stress to suicidal ideation and NSSI. A U.S. national sample of trans adults (N = 237) completed a battery of online measures. Structural equation modeling (SEM) was used to compare models with mediation and moderation effects. Results suggested that internalized transnegativity acts as both a mediator and a moderator in the relationship between distal trans stress and suicidal ideation. Log likelihood comparisons suggested moderation models had the superior fit for these data. Results suggest that clinical interventions should directly target individuals’ internalized transnegativity as well as societal-level transnegativity. Copyright © The Society for the Scientific Study of Sexuality.

Family Functioning and Mental Health of Transgender and Gender-Nonconforming Youth in the Trans Teen and Family Narratives Project - Katz-Wise, S.L.; Ehrensaft, D.; Vetters, R.; Forcier, M.; Austin, S.B. (Journal of Sex Research, 2018)
Transgender and gender-nonconforming (TGN) youth are at increased risk for adverse mental health outcomes, but better family functioning may be protective. This study describes TGN youth’s mental health and associations with family functioning in a community-based sample. Participants were from 33 families (96 family members) and included 33 TGN youth, ages 13 to 17 years; 48 cisgender (non-transgender) caregivers; and 15 cisgender siblings. Participants completed a survey with measures of family functioning (family communication, family satisfaction) and mental health of TGN youth (suicidality, self-harm, depression, anxiety, self-esteem, resilience). TGN youth reported a high risk of mental health concerns: suicidality (15% to 30%), self-harm (49%), clinically significant depressive symptoms (61%); and moderate self-esteem (M = 27.55, SD = 7.15) and resiliency (M = 3.67, SD = 0.53). In adjusted models, better family functioning from the TGN youth’s perspective was associated with better mental health outcomes among TGN youth (β ranged from −0.40 to −0.65 for self-harm, depressive symptoms, and anxious symptoms, and 0.58 to 0.70 for self-esteem and resiliency). Findings from this study highlight the importance of considering TGN youth’s perspectives on the family to inform interventions to improve family functioning in families with TGN youth. Copyright © The Society for the Scientific Study of Sexuality.

Representation and erasure of bisexual people of color: A content analysis of quantitative bisexual mental health research - Ghabrial, M.A.; Ross, L.E. (Psychology of Sexual Orientation and Gender Diversity, 2018)
Bisexual people of color (BPOC) live with a complex intersection of identities, facing binegativity, racism, and invisibility. These issues result in a wide range of stressors that incorporate the intersecting stigmas they face in various contexts. Sexual minority research has limited applications to bisexual people, as most of the existing theories and approaches are based on research that included only lesbian and gay populations. The present study was designed to investigate the representation of BPOC in mental health research. To satisfy this objective, we extracted race/ethnicity data from a pool of quantitative studies on depression, anxiety, smoking, substance use, and suicidality that included bisexual participants, and conducted a content analysis with the resulting 324 articles. Seventy-two percent of studies reported the racial/ethnic makeup of their total sample; however, only 40% reported the number of BPOC present in the sample, and only 7% reported outcomes for BPOC separately from White participants and other sexual minority groups. Details on racial groups included, recruitment methods utilized in studies with diverse samples, and the nature of research involving racial/ethnic minority persons are presented and discussed. Results of this investigation reveal that there is marginal emphasis on people of color in bisexual research and that this representation has not seen significant progress over the last 2 decades. © 2018 American Psychological Association.
Keywords: Biphobia; Bisexuality; Intersectionality; Minority stress; Racism