Erratum: Beyond same-sex attraction: Gender-variant-based victimization is associated with suicidal behavior and substance use for other-sex attracted adolescents (PLoS One (2015) 10:6 (e0129976) DOI: 10.1371/journal.pone.0129976) - Ioerger, M.; Henry, K.L.; Chen, P.Y.; Cigularov, K.P.; Tomazic, R.G. (PLoS ONE, 2015)

Outcomes associated with anxiety and depression among men who have sex with men in Estonia - Parker, R.D.; Lõhmus, L.; Valk, A.; Mangine, C.; Rüütel, K. (Journal of Affective Disorders, 2015)
Abstract Background Evidence supports that gay, lesbian, and transgender populations are at increased risk for mental health problems. The current study was conducted to estimate the prevalence of anxiety and depressive symptoms and related factors among men who have sex with men (MSM) in Estonia. This is the only known study of its type in the Eastern European region. Methods In 2013, an Internet-based survey was conducted among men who have sex with men, collecting data on socio-demographics, sexuality, drug and alcohol use, mental health, suicidality, and internalized homonegativity. Results 265 MSM completed the questionnaire (median age 31 years, 90% Estonian, 71% from the capital; 73% employed full-time, 42% with at least college education; 44% in a steady relationship; 72% gay, 23% bisexual; 23% reported illegal drug use in the last 12 months). One third met criteria for problem drinking and depressive symptoms with one quarter for anxiety symptoms. Suicidality was 44% reported lifetime suicidal thoughts and 11% with at least one suicide attempt. Limitations The study instruments, EST-Q and CAGE, only measure symptoms and are not diagnostic tests. A non-random sample which could possibly include persons with easier internet access. Self-reported data and cross-sectional study design are prone to issues with recall bias and temporality. Conclusions With demonstrated high rates of anxiety, depression, drinking, and drug use among MSM which is consistent with similar studies in Western countries, further research could help determine effective MSM focused interventions to address the broad spectrum of issues among MSM. © 2015 Elsevier B.V.
Keywords: Anxiety; Depression; Estonia; Men who have sex with men; Substance use

Parental rejection following sexual orientation disclosure: Impact on internalized homophobia, social support, and mental health - Puckett, J.A.; Woodward, E.N.; Mereish, E.H.; Pantalone, D.W. (LGBT Health, 2015)
Sexual minority individuals face unique stressors because of their sexual identity. We explored associations between parental reactions to children's coming out, internalized homophobia (IH), social support, and mental health in a sample of 257 sexual minority adults. Path analyses revealed that higher IH and lower social support mediated the association between past parental rejection and current psychological distress. Mental health providers may benefit clients by utilizing interventions that challenge internalized stereotypes about homosexuality, increase social support, and process parental rejection, as well as focusing on how certain crucial experiences of rejection may impact clients' IH and mental health. © Mary Ann Liebert, Inc. 2015.
Keywords: internalized homophobia; LGBT; mental health; minority stress; parental rejection; social support.

A moderated mediation analysis of suicide proneness among lesbian, gay, and bisexual community members - Cramer, R.J.; Burks, A.C.; Stroud, C.H.; Bryson, C.N.; Graham, J. (Journal of Social and Clinical Psychology, 2015)
Internalized homophobia is common among lesbian, gay, and bisexual (LGB) persons; moreover, it can be associated with suicide proneness, among other mental health concerns. The present paper hypothesized cognitions concerning perceived burdensomeness, but not thwarted belongingness, as mediating pathways of the association of internalized homophobia and suicide proneness in a community sample of LGB persons. Further, prior hate crime victimization experiences, suicide attempt history, level of depressive symptoms, and gender were tested as moderators of the above mediation pathway. Participants consisted of 336 LGB community members from an urban primary care clinic. Results indicated that perceived burdensomeness, but not thwarted belongingness, mediated the relationship between internalized homophobia and suicide proneness Further, the following moderation patterns were observed: both gender (significant for males only) and depressive symptoms (significant for those with mild-to-severe levels of depressive symptoms) moderated the perceived burdensomeness pathway. Implications for theory and future research are discussed. © 2015 Guilford Publications, Inc.
Keywords: Internalized homophobia; LGB persons; Perceived burdensomeness; Suicide proneness; Thwarted belongingness

Why do we need to bother? Public library services for LGBTQI people - Vincent, J. (Library Trends, 2015)
In considering social justice, many commentators overlook (or disregard) the needs of people who identify as lesbian, gay, bisexual, trans, queer/questioning, or intersex (LGBTQI), assuming, for example, that they do not require any particular support or recognition, or that they “self-exclude” by “choosing” to be LGBTQI. This article aims to challenge these perceptions. Young (and not-so-young) people may find it easier to come out today—and, indeed, the necessity to have life framed by coming-out stories may be fading. Nevertheless, we know that many people still struggle and still have to face hostility, threats, even violence. Suicide rates among young LGBTQI people, often the result of bullying, are unacceptably high. The cultural sector, including public libraries, can play a huge part in combating prejudice by providing safe, informed (and informative) spaces where people can explore who they are, and be who they are as well. However, not all public libraries understand this, or want to play this role. This article identifies some of the needs and demands of LGBTQI people, demonstrates the good practice that public libraries have developed, and examines gaps where this is not happening. The focus will be primarily on public libraries’ work in the UK. It looks at some of the key background issues (prejudice against LGBTQI people, for example), then focuses on the ways in which the public library can intervene, concluding with practical examples of the range of work that is being undertaken and some suggestions of what still needs to be done. © 2015 The Board of Trustees, University of Illinois.

Predictors of suicidal ideation in a statewide sample of transgender individuals - Rood, B.A.; Puckett, J.A.; Pantalone, D.W.; Bradford, J.B. (LGBT Health, 2015)
Transgender individuals experience violence and discrimination, which, in addition to gender transitioning, are established correlates of psychological distress. In a statewide sample of 350 transgender adults, we investigated whether a history of violence and discrimination increased the odds of reporting lifetime suicidal ideation (SI) and whether differences in SI were predicted by gender transition status. Violence, discrimination, and transition status significantly predicted SI. Compared with individuals with no plans to transition, individuals with plans or who were living as their identified gender reported greater odds of lifetime SI. We discuss implications for SI disparities using Meyer's minority stress model. © Mary Ann Liebert, Inc. 2015.
Keywords: discrimination; suicide; transgender; transition; violence

Differences in alcohol use and alcohol-related problems between transgender- and nontransgender-identified young adults - Coulter, R.W.S.; Blosnich, J.R.; Bukowski, L.A.; Herrick, A.L.; Siconolfi, D.E.; Stall, R.D. (Drug and Alcohol Dependence, 2015)
Background: Little is known about differences in alcohol use and alcohol-related problems between transgender- and nontransgender-identified populations. Using data from a large-scale health survey, we compare the drinking patterns and prevalence of alcohol-related problems of transgender-identified individuals to nontransgender-identified males and females. For transgender-identified people, we examine how various forms of victimization relate to heavy episodic drinking (HED). Methods: Cross-sectional surveys were completed by 75,192 students aged 18-29 years attending 120 post-secondary educational institutions in the United States from 2011 to 2013. Self-reported measures included alcohol use, alcohol-related problems, victimization, and sociodemographics, including 3 gender-identity groups: transgender-identified individuals; nontransgender-identified males; and nontransgender-identified females. Results: Compared to transgender-identified individuals, nontransgender-identified males were more likely to report HED in the past 2 weeks (relative risk. =. 1.42; p=. 0.006); however, nontransgender-identified males and females reported HED on fewer days than transgender-identified people (incidence-rate ratios [IRRs] ranged from 0.28 to 0.43; p-values. <. 0.001). Compared to transgender-identified people, nontransgender-identified males and females had lower odds of past-year alcohol-related sexual assault and suicidal ideation (odds ratios ranged from 0.24 to 0.45; p-values. < 0.05). Among transgender-identified people, individuals who were sexually assaulted (IRR = 3.21, p= 0.011) or verbally threatened (IRR. = 2.42, p= 0.021) in the past year had greater HED days than those who did not experience those forms of victimization. Conclusions: Compared to transgender-identified people, nontransgender-identified males and females: have fewer HED occasions (despite nontransgender-identified males having greater prevalence of HED); and are at lower risk for alcohol-related sexual assaults and suicidal ideation. Experiences of sexual assault and verbal threats are associated with greater HED occasions for transgender-identified people. © 2015 Elsevier Ireland Ltd.
Keywords: Alcohol use; Alcohol-related problems; Heavy episodic drinking; Transgender; Violence

Lithium is associated with decrease in all-cause and suicide mortality in high-risk bipolar patients: A nationwide registry-based prospective cohort study - Toffol, E.; Hätönen, T.; Tanskanen, A.; Lönnqvist, J.; Wahlbeck, K.; Joffe, G.; Tiihonen, J.; Haukka, J.; Partonen, T. (Journal of Affective Disorders, 2015)
Abstract Background Mortality rates, in particular due to suicide, are especially high in bipolar patients. This nationwide, registry-based study analyses the associations of medication use with hospitalization due to attempted suicides, deaths from suicide, and overall mortality across different psychotropic agents in bipolar patients. Method Altogether 826 bipolar patients hospitalized in Finland between 1996-2003 because of a suicide attempt were followed-up for a mean of 3.5 years. The relative risk of suicide attempts leading to hospitalization, completed suicide, and overall mortality during lithium vs. no-lithium, antipsychotic vs. no-antipsychotic, valproic acid vs. no-valproic acid, antidepressant vs. no-antidepressant and benzodiazepine vs. no-benzodiazepine treatment was measured. Results The use of valproic acid (RR=1.53, 95% CI: 1.26-1.85, p<0.001), antidepressants (RR=1.49, 95% CI: 1.23-1.8, p<0.001) and benzodiazepines (RR=1.49, 95% CI: 1.23-1.80, p<0.001) was associated with increased risk of attempted suicide. Lithium was associated with a (non-significantly) lower risk of suicide attempts, and with significantly decreased suicide mortality in univariate (RR=0.39, 95% CI: 0.17-0.93, p=0.03), Cox (HR=0.37, 95% CI: 0.16-0.88, p=0.02) and marginal structural models (HR=0.31, 95% CI: 0.12-0.79, p=0.02). Moreover, lithium was related to decreased all-cause mortality by 49% (marginal structural models). Limitations Only high-risk bipolar patients hospitalized after a suicide attempt were studied. Diagnosis was not based on standardized diagnostic interviews; treatment regimens were uncontrolled. Conclusions Maintenance therapy with lithium, but not with other medications, is linked to decreased suicide and all-cause mortality in high-risk bipolar patients. Lithium should be considered for suicide prevention in high-risk bipolar patients. © 2015 Elsevier B.V.
Keywords: Abbreviations BPD bipolar disorder; HDR hospital discharge register; MSM marginal structural model; SGA second generation antipsychotic

Sexual (Minority) Trajectories, Mental Health, and Alcohol Use: A Longitudinal Study of Youth as They Transition to Adulthood - Fish, J.N.; Pasley, K. (Journal of Youth and Adolescence, 2015)
Lesbian, gay, bisexual, and queer/questioning youth health disparities are well documented; however, study limitations restrict our understanding of how the temporal interplay among domains of sexuality (attraction, behavior, and identity) situate individuals to be more or less at risk for poor mental health and alcohol use across the transition to adulthood. Four waves of data from the National Longitudinal Study of Adolescent to Adult Health (n = 12,679; 51.29 % female) were used with repeated measures latent class analysis to estimate sexual trajectory groups designated by prospective reports of romantic attraction, sexual/romantic behavior, and sexual identity from adolescence to adulthood. Five unique trajectories emerged: two heterosexual groups (heterosexual early daters [58.37 %] and heterosexual later daters [29.83 %]) and three sexual minority groups (heteroflexible [6.44 %], later bisexually identified [3.32 %], and LG[B] identified [2.03 %]). These sexual trajectories differentiate risk for depressive symptomology, suicidal thoughts and behaviors, and alcohol use during adolescence and early adulthood. Groups where individuals first reported same-sex attraction and sexual minority identities in adulthood (heteroflexible and later bisexually identified) had similar levels of depression, suicidality, and greater substance use than those who largely reported same-sex attraction and behavior during adolescence (the LG[B] identified group). These later recognition groups showed greater risk for poor outcomes in waves where they also first reported these changes in attraction, behaviors, and identities. The emergence of three sexual minority groups reveal within-group differences in sexuality and sexual trajectories and how these experiences relate to risk and timing of risk across the transition to adulthood. © 2015, Springer Science+Business Media New York.
Keywords: Alcohol use; Depression; LGB youth; Mental health; Sexual development; Suicide

Differentiating suicide attempters from suicide ideators using the Integrated Motivational-Volitional model of suicidal behaviour - Dhingra, K.; Boduszek, D.; O'Connor, R.C. (Journal of Affective Disorders, 2015)
Abstract Background Suicidal behaviour is a significant public health concern, yet little is known about the factors that enable or impede behavioural enactment (engaging in a suicide attempt). Aims Drawing on the Integrated Motivational-Volitional (IMV) Model of Suicidal Behaviour (2011), this study examined the factors associated with having thoughts of suicide (ideation) versus those associated with suicide enaction (attempts). Within a multivariate context, it was predicted that the factors associated with ideation formation (motivational factors) would be distinct from those factors which governed behavioural enaction (volitional moderators). Method Healthy adults (N=1, 288) completed an anonymous self-report survey. Analyses compared three groups: suicide attempters (n=230), suicide ideators (n=583), and those without any suicide history (n=475). Results Suicide attempters differed from suicide ideators on all volitional factors (fearlessness about death, impulsivity, and exposure to suicidal behaviour), with the exception of discomfort tolerance. Compared to ideators, attempters were more likely to have a family member and close friend who had self-injured or attempted suicide, and were more impulsive and fearless about death. Conversely, the two suicide groups did not differ on any of the variables (motivational factors) associated with the development of thoughts of death by suicide. Limitations This is a cross-sectional study based on self-report measures. Conclusions Further research efforts to distinguish between suicide ideators and suicide attempters is crucial to inform the development of intervention and treatment approaches. © 2015 Elsevier B.V.
Keywords: Integrated Motivational-Volitional Model (IMV); Suicide; Theoretical

The impact of childhood gender expression on childhood sexual abuse and psychopathology among young men who have sex with men - Hidalgo, M.A.; Kuhns, L.M.; Kwon, S.; Mustanski, B.; Garofalo, R. (Child Abuse and Neglect, 2015)
Young men who have sex with men (MSM) are a risk group highly vulnerable to HIV infection and psychiatric symptoms are direct predictors of sexual risk behavior in MSM. Childhood sexual abuse (CSA) is associated with psychiatric symptomology in adolescence, and MSM are disproportionately impacted by CSA compared to heterosexuals. Some evidence suggests that childhood gender nonconformity, a natural variation of human gender expression, is more common in MSM than heterosexual males and places MSM at greater risk for CSA. This study examined whether or not childhood gender expression moderated the association between incidents of unwanted, early sexual experiences occurring before age 13 (ESE) and current psychiatric symptomology in a community-based sample of 449 young MSM aged 16-20. Analyses revealed significant bivariate associations between ESE and psychological symptoms, and significant multivariable associations between ESE, gender nonconformity and psychiatric outcomes. Young MSM with childhood gender nonconformity may be disproportionately victimized by CSA thereby increasing their likelihood of developing psychiatric symptoms in adolescence. Early intervention addressing these factors may help reduce lifetime negative sequelae. © 2015 Elsevier Ltd.
Keywords: Childhood sexual abuse; Gender expression; Psychopathology; PTSD; Young MSM

Non-suicidal self-injury and identity distress in Flemish adolescents: Exploring gender differences and mediational pathways - Gandhi, A.; Luyckx, K.; Maitra, S.; Claes, L. (Personality and Individual Differences, 2015)
There is an increasing amount of research that examines non-suicidal self-injury (NSSI) in relation to identity formation in adolescents. However, little or no research to date has explored associations between NSSI and identity distress in specific domains. To address this shortcoming, we assessed NSSI, identity distress, anxiety, and depression using self-report questionnaires in 568 high school students. Gender differences in NSSI were found with lifetime prevalence of NSSI being twice as high in females as compared to males. Gender differences in terms of identity domains were also significant; adolescent females showed higher levels of distress in the identity domains of career goals, friendship, and group loyalties as compared to males. Adolescents engaging in NSSI showed higher distress in domains of long-term goals, friendship, sexual orientation and behavior, values and beliefs. Results indicated that it was not distress in specific domains as such but the impairment due to daily impact of identity distress that explained additional variance in lifetime prevalence of NSSI above and beyond gender, age, depression, and anxiety. We also demonstrated that gender differences in lifetime prevalence of NSSI were mediated by differences in such identity impairment. Clinical implications of these findings are discussed. © 2015 Elsevier Ltd.
Keywords: Adolescents; Identity domains; Non-suicidal self-injury

Nonsuicidal self-injury in sexual minority college students: A test of theoretical integration - Muehlenkamp, J.J.; Hilt, L.M.; Ehlinger, P.P.; McMillan, T. (Child and Adolescent Psychiatry and Mental Health, 2015)
Individuals identifying as a sexual minority report engaging in nonsuicidal self-injury (NSSI) at substantially higher rates compared to their heterosexual peers. Given that NSSI is a known risk factor for suicide, it is important to understand the processes unique to being a sexual minority that increases risk for NSSI so that adequate prevention efforts can be established. The current study integrated Minority Stress Theory and the Interpersonal Theory of Suicide to test a model of NSSI and suicide risk. Methods: A total of 137 college students who identified as a sexual minority completed an anonymous on-line study assessing NSSI, suicidal thoughts/behaviors, and constructs of the minority stress and interpersonal theories. Two linear regressions using bootstrapping analyses were conducted to test our hypotheses. Results: Minority stress was directly associated with NSSI and via perceived burdensomeness, explaining 27 % of the variance. NSSI was associated with increased risk for suicide thoughts/behaviors directly, and through acquired capability, explaining 45 % of the variance. Conclusions: These findings provide evidence that unique stressors individuals face as a result of their sexual minority status increases risk for self-harm by influencing cognitive and emotional processes such as burdensomeness and acquired capability. Implications for prevention, intervention, and future research are briefly discussed. © 2015 Muehlenkamp et al.
Keywords: Burdensomeness; College; Minority stress; NSSI; Self-harm; Self-injury; Sexual minority; Suicide; Youth

Suicide in pediatrics: epidemiology, risk factors, warning signs and the role of the pediatrician in detecting them - Dilillo, D.; Mauri, S.; Mantegazza, C.; Fabiano, V.; Mameli, C.; Zuccotti, G.V. (Italian Journal of Pediatrics, 2015)
Epidemiological data suggests suicide is uncommon in childhood but becomes an extremely serious issue among adolescents. Several risk factors have been identified and include the presence of psychiatric illness, a previous suicide attempt, family factors, substance abuse, sexual and physical abuse, disorders in gender identity or bullying. Pediatricians have a primary role in searching for these risk factors, recognizing them and acting synergistically with other specialists to prevent and treat suicidal behavior. Pediatricians should also be able to identify the "warning signs" for suicide since their presence implies a need for immediate action, as attempted suicide may occur in a few hours or days. The use of antidepressant drugs and its association with suicidal risk in pediatric age is another topic of ongoing debate. Food and Drug Administration has recently introduced the so-called "black box" on antidepressants' packages with the aim of gaining attention to the possible risk of suicide among adolescents who are treated with antidepressants, with a warning that the risk of suicide is higher when starting a therapy or while adjusting its dosage. © 2015 Dilillo et al.
Keywords: Antidepressive drugs; Protective factors; Risk factors; Suicide; Warning signs

Individual- and Structural-Level Risk Factors for Suicide Attempts among Transgender Adults - Perez-Brumer, A.; Hatzenbuehler, M.L.; Oldenburg, C.E.; Bockting, W. (Behavioral Medicine, 2015)
This study assessed individual (ie, internalized transphobia) and structural forms of stigma as risk factors for suicide attempts among transgender adults. Internalized transphobia was assessed through a 26-item scale including four dimensions: pride, passing, alienation, and shame. State-level structural stigma was operationalized as a composite index, including density of same-sex couples; proportion of Gay-Straight Alliances per public high school; 5 policies related to sexual orientation discrimination; and aggregated public opinion toward homosexuality. Multivariable logistic generalized estimating equation models assessed associations of interest among an online sample of transgender adults (N = 1,229) representing 48 states and the District of Columbia. Lower levels of structural stigma were associated with fewer lifetime suicide attempts (AOR 0.96, 95% CI 0.92-0.997), and a higher score on the internalized transphobia scale was associated with greater lifetime suicide attempts (AOR 1.18, 95% CI 1.04-1.33). Addressing stigma at multiple levels is necessary to reduce the vulnerability of suicide attempts among transgender adults. Copyright © Taylor & Francis Group, LLC.
Keywords: internalized transphobia; structural stigma; suicide attempts; transgender

Suicide related ideation and behavior among Canadian gay and bisexual men: A syndemic analysis - Ferlatte, O.; Dulai, J.; Hottes, T.S.; Trussler, T.; Marchand, R. (BMC Public Health, 2015)
Background: While several studies have demonstrated that gay and bisexual men are at increased risk of suicide less attention has been given to the processes that generate the inherent inequity with the mainstream population. This study tested whether syndemic theory can explain the excess suicide burden in a sample of Canadian gay and bisexual men. Syndemic theory accounts for co-occurring and mutually reinforcing epidemics suffered by vulnerable groups due to the effects of social marginalization. Methods: This study used data from Sex Now 2011, a cross-sectional survey of Canadian gay and bisexual men (n = 8382). The analysis measured the extent to which anti-gay marginalization and several psychosocial health problems are associated with suicide related ideation and attempts. Since psychosocial health problems were hypothesized to have an additive effect on suicide related ideation and attempts, the analysis calculated the effect of accumulated psychosocial health problems on suicide behavior. Results: Suicide ideation and attempts were positively associated with each individual marginalization indicator (verbal violence, physical violence, bullying, sexual violence and work discrimination) and psychosocial health problems (smoking, party drugs, depression, anxiety, STIs, HIV risk and HIV). Furthermore, prevalence of suicide ideation and attempts increased with each added psychosocial health problem. Those who reported 3 or more had 6.90 (5.47-8.70) times the odds of experiencing suicide ideation and 16.29 (9.82-27.02) times the odds of a suicide attempt compared to those with no psychosocial health problems. Conclusions: This investigation suggests that syndemics is a useful theory for studying suicide behavior among gay and bisexual men. Moreover, the findings highlight a need to address gay and bisexual men's health problems holistically and the urgent need to reduce this population's experience with marginalization and violence. © 2015 Ferlatte et al.
Keywords: Bisexual men; Canada; Gay men; Homophobia; Suicide; Syndemic; Violence

Predictors of switch from depression to mania in bipolar disorder - Niitsu, T.; Fabbri, C.; Serretti, A. (Journal of Psychiatric Research, 2015)
Manic switch is a relevant issue when treating bipolar depression. Some risk factors have been suggested, but unequivocal findings are lacking. We therefore investigated predictors of switch from depression to mania in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) sample. Manic switch was defined as a depressive episode followed by a (hypo)manic or mixed episode within the following 12 weeks. We assessed possible predictors of switch using generalized linear mixed models (GLMM).8403 episodes without switch and 512 episodes with switch (1720 subjects) were included in the analysis. Several baseline variables were associated with a higher risk of switch. They were younger age, previous history of: rapid cycling, severe manic symptoms, suicide attempts, amphetamine use and some pharmacological and psychotherapeutic treatments. During the current depressive episode, the identified risk factors were: any possible mood elevation, multiple mania-associated symptoms with at least moderate severity, and comorbid panic attacks.In conclusion, our study suggests that both characteristics of the disease history and clinical features of the current depressive episode may be risk factors for manic switch. © 2015 Elsevier Ltd.
Keywords: Amphetamine use; Bipolar depression; Manic switch; Manic symptom; Onset; Panic attack; Rapid-cycling; Suicide; Venlafaxine

Beyond same-sex attraction: Gender-variant-based victimization is associated with suicidal behavior and substance use for other-sex attracted adolescents - Ioerger, M.; Henry, K.L.; Chen, P.Y.; Cigularov, K.P.; Tomazic, R.G. (PLoS ONE, 2015)
Gender-variant-based victimization is victimization based on the way others perceive an individual to convey masculine, feminine, and androgynous characteristics through their appearance, mannerisms, and behaviors. Previous work identifies gender-variant-based victimization as a risk factor for health-risking outcomes among same-sex attracted youths. The current study seeks to examine this relationship among other-sex attracted youths and same-sex attracted youth, and determine if gender-variant-based victimization is similarly or differentially associated with poor outcomes between these two groups. Anonymous data from a school-based survey of 2,438 racially diverse middle and high school students in the Eastern U.S. was examined. For other-sex attracted adolescents, gender-variantbased victimization was associated with a higher odds of suicidal thoughts and behaviors, regular use of cigarettes, and drug use. When compared to same-sex attracted adolescents, the harmful relationship between gender-variant-based victimization and each of these outcomes was similar in nature. These findings suggest that gender-variant-based victimization has potentially serious implications for the psychological wellbeing and substance use of other-sex attracted adolescents, not just same-sex attracted adolescents, supporting the need to address gender expression as a basis for victimization separate from sexuality- or gender-minority status. The impact that gender-variant-based victimization has on all adolescents should not be overlooked in research and interventions aimed at addressing sexual orientation-based and gender-variant-based victimization, substance use, and suicide prevention. © 2015 Ioerger et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Prevalence of suicidal ideation and associated factors among HIV-positive MSM in Anhui, China - Wu, Y.; Yang, H.; Wang, J.; Yao, H.; Zhao, X.; Chen, J.; Ding, X.; Zhang, H.; Bi, P.; Sun, Y. (International Journal of STD and AIDS, 2015)
The aim of this study was to investigate the prevalence and factors associated with suicidal ideation among HIV-positive men who have sex with men (MSM) in Anhui, China. A cross-sectional study was conducted to recruit HIV-positive MSM in Anhui, China. A total of 184 HIV-positive MSM gave informed consent and completed the interview. Correlates of suicidal ideation were assessed using multivariable logistic regression. Fifty-seven (31%) of HIV-positive MSM had suicidal ideations within six months before the interview. Multivariable analyses showed that learning of their HIV status in the past 12 months (adjusted odds ratio (AOR) = 3.4, 95% CI = 1.6–7.3), perceived HIV stigma (AOR = 2.4, 95% CI = 1.1–5.2), depression symptoms (AOR = 2.6, 95% CI = 1.1–5.9) and anxiety symptoms (AOR = 2.7, 95% CI = 1.2–6.1) were significantly associated with the suicidal ideation among HIV-positive MSM. The results indicated that suicidal ideation was common among HIV-positive MSM in Anhui, China. There is an urgent need to establish psychological counselling services among HIV-positive MSM in China. Targeting of these potential risk factors could be an effective approach to reduce the suicide risk among this high-risk subgroup by the implementation of early intervention measurements. © The Author(s) 2014.
Keywords: AIDS; anxiety; depression; HIV; Men who have sex with men; suicidal ideation

Correlates of bullying in Quebec high school students: The vulnerability of sexual-minority youth - Cénat, J.M.; Blais, M.; Hébert, M.; Lavoie, F.; Guerrier, M. (Journal of Affective Disorders, 2015)
Purpose Bullying has become a significant public health issue, particularly among youth. This study documents cyberbullying, homophobic bullying and bullying at school or elsewhere and their correlates among both heterosexual and sexual-minority high school students in Quebec (Canada). Method A representative sample of 8194 students aged 14-20 years was recruited in Quebec (Canada) high schools. We assessed cyberbullying, homophobic bullying and bullying at school or elsewhere in the past 12 months and their association with current self-esteem and psychological distress as well as suicidal ideations. Results Bullying at school or elsewhere was the most common form of bullying (26.1%), followed by cyberbullying (22.9%) and homophobic bullying (3.6%). Overall, girls and sexual-minority youth were more likely to experience cyberbullying and other forms of bullying as well as psychological distress, low self-esteem and suicidal ideations. The three forms of bullying were significantly and independently associated with all mental health outcomes. Conclusions The results underscore the relevance of taking into account gender and sexual orientation variations in efforts to prevent bullying experience and its consequences. © 2015 Published by Elsevier B.V. All rights reserved.
Keywords: Cyberbullying; Homophobic bullying; Psychological distress; Self-esteem; Sexual-minority youth; Suicidal ideations

Intervenable factors associated with suicide risk in transgender persons: A respondent driven sampling study in Ontario, Canada Health behavior, health promotion and society - Bauer, G.R.; Scheim, A.I.; Pyne, J.; Travers, R.; Hammond, R. (BMC Public Health, 2015)
Background: Across Europe, Canada, and the United States, 22-43 % of transgender (trans) people report a history of suicide attempts. We aimed to identify intervenable factors (related to social inclusion, transphobia, or sex/gender transition) associated with reduced risk of past-year suicide ideation or attempt, and to quantify the potential population health impact. Methods: The Trans PULSE respondent-driven sampling (RDS) survey collected data from trans people age 16+ in Ontario, Canada, including 380 who reported on suicide outcomes. Descriptive statistics and multivariable logistic regression models were weighted using RDS II methods. Counterfactual risk ratios and population attributable risks were estimated using model-standardized risks. Results: Among trans Ontarians, 35.1 % (95 % CI: 27.6, 42.5) seriously considered, and 11.2 % (95 % CI: 6.0, 16.4) attempted, suicide in the past year. Social support, reduced transphobia, and having any personal identification documents changed to an appropriate sex designation were associated with large relative and absolute reductions in suicide risk, as was completing a medical transition through hormones and/or surgeries (when needed). Parental support for gender identity was associated with reduced ideation. Lower self-reported transphobia (10th versus 90th percentile) was associated with a 66 % reduction in ideation (RR = 0.34, 95 % CI: 0.17, 0.67), and an additional 76 % reduction in attempts among those with ideation (RR = 0.24; 95 % CI: 0.07, 0.82). This corresponds to potential prevention of 160 ideations per 1000 trans persons, and 200 attempts per 1,000 with ideation, based on a hypothetical reduction of transphobia from current levels to the 10th percentile. Conclusions: Large effect sizes were observed for this controlled analysis of intervenable factors, suggesting that interventions to increase social inclusion and access to medical transition, and to reduce transphobia, have the potential to contribute to substantial reductions in the extremely high prevalences of suicide ideation and attempts within trans populations. Such interventions at the population level may require policy change. © 2015 Bauer et al.; licensee BioMed Central.
Keywords: Social determinants of health; Social exclusion; Suicidal behaviour; Suicide; Transgender; Transphobia; Transsexual

Mental Health Service Use Among Youth with Mental Health Need: Do School-Based Services Make a Difference for Sexual Minority Youth? - Williams, K.A.; Chapman, M.V. (School Mental Health, 2015)
Evidence suggests that despite higher rates of mental health service use, sexual minority youth (SMY) have greater unmet mental health need than peers. Using a representative subsample of students with a mental health need from the National Longitudinal Study of Adolescent Health (n = 8,034), a multilevel analysis was conducted to explore whether: (1) Availability of school mental health services affects the odds that youth with a mental health need will use mental health services; and whether (2) sexual minority status (SMS) interacts with availability of school mental health services to moderate the relationship between SMS and mental health service use. SMY accounted for 10.3 % (n = 766) of the subsample. Mental health need was defined using measures for physical and sexual victimization, anxiety, depression, and suicidality. A hierarchical logistical regression tested for cross-level interaction (SMS × school mental health services). SMY had 82 % higher odds of using mental health services in any sector than their heterosexual peers (OR = 1.82, p < .001). Overall, youth with a mental health need had 40 % higher odds of using any type of mental health services if they attended schools offering mental health services (OR = 1.40, p < .001). The cross-level interaction test between SMS and service use was nonsignificant. Model-predicted probabilities are presented to better understand the findings. School-based mental health services are a crucial gateway to mental health service use in any sector for youth with a mental health need regardless of SMS. © 2014, Springer Science+Business Media New York.
Keywords: Adolescents; Lesbian, gay, bisexual, and transgender (LGBT); Mental health service use; Multilevel analysis; School-based mental health services; Sexual minority youth

Associations of racial/ethnic identities and religious affiliation with suicidal ideation among lesbian, gay, bisexual, and questioning individuals - Lytle, M.C.; De Luca, S.M.; Blosnich, J.R.; Brownson, C. (Journal of Affective Disorders, 2015)
Background: Our aim was to examine the associations of racial/ethnic identity and religious affiliation with suicidal ideation among lesbian, gay, bisexual, and questioning (LGBQ) and heterosexual college students. An additional aim was to determine the prevalence of passive suicidal ideation (i.e., death ideation) and active suicidal ideation among culturally diverse LGBQ individuals. Methods: Data from the National Research Consortium probability-based sample of college students from 70 postsecondary institutions (n=24,626) were used to examine active and passive suicidal ideation in the past 12-months and lifetime active suicidal ideation among students by sexual orientation, racial/ethnic identity, and religious affiliation. Results: Across most racial/ethnic groups and religious affiliations, LGBQ students were more likely to report active suicidal ideation than non-LGBQ individuals. Among LGBQ students, Latino individuals had lower odds of reporting both past 12-month passive and active suicidal ideation than their non-Hispanic white LGBQ counterparts. Compared to Christian LGBQ students, Agnostic/Atheist LGBQ individuals had greater odds of reporting past 12-month passive suicidal ideation, and Jewish LGBQ students were less likely to endorse past 12-month passive and active suicidal ideation. Limitations: Cross-sectional design and self-reported data. Conclusions: Results corroborate previous research showing elevated prevalence of suicidal ideation among LGBQ individuals in comparison to their heterosexual counterparts. These findings are among the first to document prevalence differences within the LGBQ population based on intersectional identities (race/ethnicity and religious affiliation). Providers should recognize that LGBQ individuals might need support in negotiating the complex relationship between multiple identities, especially due to their elevated prevalence of suicidal ideation. © 2015 Elsevier B.V. All rights reserved.
Keywords: LGBT; Race/ethnicity; Religious affiliation; Suicidal ideation

Overdose of dolutegravir in combination with tenofovir disaproxil fumarate/emtricitabine in suicide attempt in a 21-year old patient - Lee, M.; Eyer, F.; Felgenhauer, N.; Klinker, H.H.F.; Spinner, C.D. (AIDS Research and Therapy, 2015)
A 21 year old MSM patient with newly diagnosed HIV infection was hospitalized in our department after ingestion of an overdose of his antiretroviral therapy (ART) comprising dolutegravir (DTG - Tivicay®) and tenofovir disaproxil fumarate/emtricitabine (Truvada®) in suicidal intention. On admission, the patient did not show any clinical signs of intoxication and laboratory findings were unremarkable. After 6 hours of intensive care monitoring, the patient was referred to a psychiatric clinic. 5 days after the day of intoxication, serum creatinine levels increased to high normal values (1.2 mg/dl). However, levels never exceeded the upper threshold. 8 and 12 weeks later, serum creatinine normalized to levels measured prior to the intoxication. No other adverse events occurred, and the patient does not suffer from permanent impairments. © 2015 Lee et al.; licensee BioMed Central.
Keywords: AIDS; Dolutegravir; Emtricitabine; HIV; Overdose; Suicide attempt; Tenofovir disaproxil fumarate

Minority stress and mechanisms of risk for depression and suicidal ideation among lesbian, gay, and bisexual youth - Baams, L.; Grossman, A.H.; Russell, S.T. (Developmental Psychology, 2015)
The experience of minority stress is often named as a cause for mental health disparities among lesbian, gay, and bisexual (LGB) youth, including higher levels of depression and suicidal ideation. The processes or mechanisms through which these disparities occur are understudied. The interpersonal-psychological theory of suicide posits 2 key mechanisms for suicidal ideation: perceived burdensomeness and thwarted belongingness (Joiner et al., 2009). The aim of the current study is to assess the mental health and adjustment among LGB youth emphasizing the minority stress model (Meyer, 2003) and the interpersonal-psychological theory of suicide (Joiner et al., 2009). With a survey of 876 LGB self-identified youth, levels of coming-out stress, sexual orientation victimization, perceived burdensomeness, thwarted belongingness, depression, and suicidal ideation were examined. The results of a multigroup mediation model show that for all gender and sexual identity groups, the association of sexual orientation victimization with depression and suicidal ideation was mediated by perceived burdensomeness. For gay, lesbian, and bisexual girls coming-out stress was also found to be related to depression and suicidal ideation, mediated by perceived burdensomeness. The results suggest that feeling like a burden to "people in their lives" is a critical mechanism in explaining higher levels of depression and suicidal ideation among LGB youth. These results have implications for community and social support groups, many of which base their interventions on decreasing social isolation rather than addressing youths' beliefs of burdensomeness. Implications for future research, clinical and community settings are discussed. © 2015 American Psychological Association.
Keywords: Depression; Interpersonal-psychological theory of suicide; LGB youth; Minority stress; Suicidal ideation

LGBT youth face the risk: Suicide and addictive practices - Firdion, J.-M.; Beckb, F. (Archives de Pediatrie, 2015)

He never said anything: A critical poetic response to suicide among young gay men - Phillips, G.A. (Cultural Studies - Critical Methodologies, 2015)
As gay suicide becomes more frequent, deaths of gay men (particularly young gay men) become less shocking. I believe we should still be shocked. Moreover, I believe we should be incited to speech and action. This work is the nexus of four different but interacting stories: a call for critical, qualitative researchers to promote change; a conversation about the use of poetry as critical voice; the stultifying suicide rates and stories of suicides among gay youth (10-25); and my own personal story as a largely closeted gay man. The organization of this piece includes a brief introduction of these four intersecting lines, a subsequent sequence of poetry and prose that connects them, and a final reflection on how the intersection(s) of critical inquiry and poetry should usher change. © 2014 SAGE Publications.
Keywords: Arts-based research; Gay; Poetry; Suicide

Understanding Linkages Between Bullying and Suicidal Ideation in a National Sample of LGB and Heterosexual Youth in the United States - Ybarra, M.L.; Mitchell, K.J.; Kosciw, J.G.; Korchmaros, J.D. (Prevention Science, 2015)
While there is an extant research base regarding suicidal ideation in relation to bullying and peer harassment, how findings may be similar and different for lesbian, gay, and bisexual (LGB) and non-LGB youth is less well understood. To address this gap, we analyzed data from 5,542 13- to 18-year-old youth who were nationally surveyed online in the United States in 2010. Results suggest that the relative odds of suicidal ideation are elevated for youth who are victims of bullying (OR = 5.61, 95 % CI, 4.11, 7.64), as well as those who are victims of peer harassment (OR = 2.06, 95 % CI, 1.53, 2.79). Within the context of other important factors, bullying was associated with odds of suicidal ideation twice that of non-victimized youth (aOR = 2.02, 95 % CI, 1.30, 3.13). Within sexual identity, the relation between bullying and suicidal ideation was particularly strong for gay, lesbian, and queer youth, even after adjusting for other influential factors (aOR = 6.29, 95 % CI, 2.69, 14.66). Across sexual identities, the odds of suicidal ideation are higher for bisexual youth (aOR = 1.77, 95 % CI, 1.23, 2.55) but not for other sexual minority youth when compared with otherwise similar heterosexual youth. Other factors, including depressive symptomatology and low self-esteem, were also predictive of recent ideation across all sexual identities. Findings highlight the complexity of bullying and suicidal ideation. Furthermore, given the relation between bullying and suicidal ideation, and the disproportionate level of bullying experienced by LGB youth, our findings suggest the need for more protective environments for LGB youth. © 2014, Society for Prevention Research.
Keywords: Adolescents; Bullying; Lesbian, gay, bisexual (LGB); Peer victimization; Suicidal ideation

Male-to-male sex among men who inject drugs in Delhi, India: Overlapping HIV risk behaviours - Armstrong, G.; Jorm, A.F.; Samson, L.; Joubert, L.; Singh, S.; Kermode, M. (International Journal of Drug Policy, 2015)
Background: HIV among people who inject drugs (PWID) is a major public health challenge in India. This paper examines PWID in Delhi who also have male-to-male sex with a focus on overlapping HIV risk behaviours and the psychosocial correlates of a history of male-to-male anal sex. Methods: We analysed data collected in April-May of 2012 from a community-based sample of 420 male PWID in Delhi obtained using time location sampling. Results: One third (37%) of the men reported a history of anal sex with men, among whom just 16% used a condom at last anal sex. Almost all (93%) participants who had a history of anal sex with men also had sex with women. Chi-square tests revealed that a history of anal sex with men was associated with a higher number of female sexual partners and sharing of needles and syringes. Additionally, unprotected sex at last sex with a male partner was significantly associated with unprotected sex at last sex with regular and paid female partners. Multivariate binary logistic regression revealed that the psychosocial correlates of a history of anal sex with other men were: being aged 18-24 (OR = 2.4, p = 0.014), illiteracy (OR = 1.9, p = 0.033), having never been married (OR = 2.6, p = 0.007), a main source of income of crime/begging (OR = 3.1, p = 0.019), a duration of injecting drug use greater than 20 years (OR = 3.4, p = 0.035) and suicidal ideation (OR = 1.7, p = 0.048). Conclusion: Male-to-male sex was associated with psychosocial vulnerability, including a longer history of injecting drug use, suicidal ideation and socio-economic disadvantage. Given the extent of overlapping HIV risk behaviours, HIV programs for PWID would benefit from a strong focus on prevention of sexual HIV transmission, especially among male injectors who also have sex with other men. © 2014 Elsevier B.V.
Keywords: India; Injecting drug use; Men who have sex with men; Overlapping HIV risks; Psychosocial context; Suicide

Domains of Distress Among People with Sexual Orientation Obsessions - Williams, M.T.; Wetterneck, C.; Tellawi, G.; Duque, G. (Archives of Sexual Behavior, 2015)
Although sexual obsessions in obsessive–compulsive disorder (OCD) are not uncommon, obsessions about sexual orientation have not been well studied. These obsessions focus on issues such as the fear of being or becoming gay, fear of being perceived by others as gay, and unwanted mental images involving homosexual acts. Sexual orientation obsessions in OCD are particularly distressing due to the ego-dystonic nature of the obsessions and, often, stigma surrounding a same-sex orientation. The purpose of this study was to better understand distress in people suffering from sexual orientation obsessions in OCD. Data were collected online (n = 1,176) and subjects were 74.6 % male, 72.0 % heterosexual, and 26.4 % with an OCD diagnosis from a professional. The survey consisted of 70 novel questions that were assessed using a principal components analysis and the items separated into six components. These components were then correlated to distress among those with a prior OCD diagnosis and sexual orientation obsessions. Results indicated that sexual orientation obsessions in OCD were related to severe distress, including suicidal ideation. Implications of these findings and future directions for research are discussed. © 2014, Springer Science+Business Media New York.
Keywords: Anxiety; Homophobia; Obsessive–compulsive disorder; Sexual obsessions; Sexual orientation; Suicide

Gender dysphoria "cured" by status epilepticus - Parkinson, J. (Australasian Psychiatry, 2015)
Objective: A case is described pointing to the biological factors in gender identity and personality structure. Methods: The history is presented of a transsexual patient who experienced a change of gender identity and personality following an episode of status epilepticus. Results: The patient presented as convincingly feminine and with features of Borderline Personality Disorder. She had an old brain injury. After a prolonged epileptic episode the Borderline features disappeared and the patient expressed a clearly male identity. Conclusions: The findings are equivocal: they may be seen both as reflecting a change in a neurologically structured identity and as a resetting of psychosocially acquired characteristics. © The Royal Australian and New Zealand College of Psychiatrists 2015.
Keywords: Borderline Personality; brain damage; gender identity; status epilepticus

Collecting sexual orientation and gender identity data in suicide and other violent deaths: A step towards identifying and addressing LGBT mortality disparities - Haas, A.P.; Lane, A. (LGBT Health, 2015)
Sexual orientation and gender identity (SO/GI) are not systematically recorded at time of death, limiting identification of mortality disparities in lesbian, gay, bisexual, and transgender (LGBT) people. LGBT populations are thought to have elevated risk of suicide based on high rates of reported lifetime suicide attempts. Lack of data on suicide deaths, however, hinders understanding of the prevalence and patterns of suicide among LGBT populations and development of targeted interventions and prevention programs. This report describes recent efforts to address this knowledge gap by systematically collecting SO/GI information in the investigation of suicide and other violent deaths. © Mary Ann Liebert, Inc. 2015.
Keywords: gender identity; health disparities; LGBT mortality; mortality disparities; postmortem data collection; sexual orientation; suicide; violent death

Mental health of transgender youth in care at an adolescent Urban community health center: A matched retrospective cohort study - Reisner, S.L.; Vetters, R.; Leclerc, M.; Zaslow, S.; Wolfrum, S.; Shumer, D.; Mimiaga, M.J. (Journal of Adolescent Health, 2015)
Purpose Transgender youth represent a vulnerable population at risk for negative mental health outcomes including depression, anxiety, self-harm, and suicidality. Limited data exist to compare the mental health of transgender adolescents and emerging adults to cisgender youth accessing community-based clinical services; the present study aimed to fill this gap. Methods A retrospective cohort study of electronic health record data from 180 transgender patients aged 12-29 years seen between 2002 and 2011 at a Boston-based community health center was performed. The 106 female-to-male (FTM) and 74 male-to-female (MTF) patients were matched on gender identity, age, visit date, and race/ethnicity to cisgender controls. Mental health outcomes were extracted and analyzed using conditional logistic regression models. Logistic regression models compared FTM with MTF youth on mental health outcomes. Results The sample (N = 360) had a mean age of 19.6 years (standard deviation, 3.0); 43% white, 33% racial/ethnic minority, and 24% race/ethnicity unknown. Compared with cisgender matched controls, transgender youth had a twofold to threefold increased risk of depression, anxiety disorder, suicidal ideation, suicide attempt, self-harm without lethal intent, and both inpatient and outpatient mental health treatment (all p <.05). No statistically significant differences in mental health outcomes were observed comparing FTM and MTF patients, adjusting for age, race/ethnicity, and hormone use. Conclusions Transgender youth were found to have a disparity in negative mental health outcomes compared with cisgender youth, with equally high burden in FTM and MTF patients. Identifying gender identity differences in clinical settings and providing appropriate services and supports are important steps in addressing this disparity. © 2015 Society for Adolescent Health and Medicine.
Keywords: Adolescent; Gender minority; Health disparity; Mental health; Transgender

Dying to be accepted - Dean, E. (Nursing standard (Royal College of Nursing (Great Britain) : 1987), 2015)

Estimating the Number of Men Who Have Sex with Men by Race/Ethnicity at the County Level in Texas - Campagna, J.; Poe, J.; Robbins, A.; Rowlinson, E. (Journal of Urban Health, 2015)
This analysis presents a method for estimating the population of men who have sex with men (MSM) at the county and metropolitan area level in Texas. Surveillance data consistently demonstrate that MSM experience a high burden of HIV and other sexually transmitted infections (STIs). Numerous studies have shown that MSM are also vulnerable to many other health concerns such as suicide, substance abuse, domestic violence and assault, homelessness, and mental illness. However, compilation of rates of HIV, STIs, and other health issues is dependent on estimation of population denominators. In the absence of systematic, consistent, and direct assessment of sexual orientation and gender identity in national surveys, it is difficult to estimate the size of at-risk populations. Previous estimates at the national and state level have been calculated using varied methodologies. However, to date, statewide estimates at the county level have only been produced for the state of Florida. County-level and metropolitan area estimates of MSM population were produced using three modified models developed by Lieb et al. These models used data on population and same-sex households from the US Census, along with estimates of sexual behavior from the National Survey on Family Growth. These models produce an estimate of 599,683 MSM in Texas (6.4 % of the adult male population). Metropolitan areas with the highest percentage of MSM population include Dallas and Austin (10.3 and 9.8 %, respectively). County-level estimates of MSM population range from 1.0 to 12.9 %. These local estimates are critical to targeting vulnerable populations and effective allocation of resources for prevention and treatment programs. © 2014, The New York Academy of Medicine.
Keywords: HIV surveillance; Men who have sex with men; MSM; Population estimates; Texas

Psychosocial Vulnerability and HIV-Related Sexual Risk Among Men who have Sex with Men and Women in the United States - Dyer, T.P.; Regan, R.; Pacek, L.R.; Acheampong, A.; Khan, M.R. (Archives of Sexual Behavior, 2015)
In the U.S., HIV is concentrated among men who have sex with men (MSM), some of whom have had female partners (MSMW). MSMW are disproportionately impacted by psychosocial vulnerabilities, like depression and substance use that increase sexually transmitted infection (STI) and HIV risk. Research on psychosocial vulnerability and HIV-related sexual risk among MSMW is warranted to reduce infection transmission among MSM and to prevent bridging to female partners. We analyzed data from Wave IV (2007–2008) of the National Longitudinal Study of Adolescent Health to assess psychosocial vulnerability and HIV risk-taking among MSMW. Using lifetime and past year sexual activity, we classified men as ever having sex with: women only (MSW), men only (MSMO) or MSMW, with further refined categorization of MSMW with male only partners in the past 12 months, only female partners in the past 12 months, and both male and female partners in the past 12 months (N = 6,945). We compared psychosocial vulnerability characteristics and HIV-related risk behaviors among the five categories of men. MSMW were more likely to report depression, suicidality, substance use, and incarceration than MSW and MSMO. Compared to MSW, MSMW with current female partners had greater odds of unprotected sex, exchange sex, and STI. MSMW with male partners in the past year had greater odds of multiple or concurrent partners in the past year. HIV risk and psychosocial vulnerability factors are elevated among MSMW, a priority population for HIV risk reduction. HIV risk reduction interventions should address this and heterogeneity of sexual partnerships among MSMW. © 2014, Springer Science+Business Media New York.
Keywords: Epidemiology; HIV; Sexual minorities; Sexual orientation; Sexually transmitted infections; Substance use

Connecting the Dots: Examining Transgender Women’s Utilization of Transition-Related Medical Care and Associations with Mental Health, Substance Use, and HIV - Wilson, E.C.; Chen, Y.-H.; Arayasirikul, S.; Wenzel, C.; Raymond, H.F. (Journal of Urban Health, 2015)
Findings on access to general healthcare for transgender people have emerged, but little is known about access to transition-related medical care for transwomen (i.e., hormones, breast augmentation, and genital surgery). Transgender women have low access to general medical care and are disproportionately at risk for substance use, mental illness, and HIV. We conducted an analysis to determine if utilization of transition-related medical care is a protective factor for health risks to transgender women and to investigate if care differs by important demographic factors and HIV status. A secondary analysis was conducted using data from a 2010 HIV surveillance study using respondent-driven sampling to recruit 314 transwomen in San Francisco. Survey-corrected logistic regression models were used to estimate odds ratios for six psychosocial health problems—binge drinking, injection drug use, anxiety, depression, suicidal ideation, and high-risk intercourse—comparing various levels of utilization of transition-related medical care. Odds ratios were also calculated to determine if utilization of transition-related medical care was related to less overlap of risk domains. We found that Latina and African American transwomen had significantly lower estimated utilization of breast augmentation and genital surgery, as did transwomen who identified as transgender rather than female. Overall, utilization of transition-related medical care was associated with significantly lower estimated odds of suicidal ideation, binge drinking, and non-injection drug use. Findings suggest that utilization of transition-related medical care may reduce risk for mental health problems, especially suicidal ideation, and substance use among transwomen. Yet, important racial/ethnic and gender identity disparities in utilization of transition-related medical care need to be addressed. © 2014, The New York Academy of Medicine.
Keywords: Healthcare utilization; HIV; Mental health; Substance use; Transgender women; Transition

Constructing the Suicide Risk Index (SRI): Does It Work in Predicting Suicidal Behavior in Young Adults Mediated by Proximal Factors? - O'Connor, M.; Dooley, B.; Fitzgerald, A. (Archives of Suicide Research, 2015)
Suicide is a key concern among young adults. The aim of the study was to (1) construct a suicide risk index (SRI) based on demographic, situational, and behavioral factors known to be linked to suicidal behavior and (2) investigate whether the association between the SRI and suicidal behavior was mediated by proximal processes (personal factors, coping strategies, and emotional states). Participants consisted of 7,558 individuals aged 17–25 years (M = 20.35, SD = 1.91). Nearly 22% (n = 1,542) reported self-harm and 7% (n = 499) had attempted suicide. Mediation analysis revealed both a direct effect (ß = .299, 95% CI = [.281,.317], p < .001), and a mediated effect (ß = .204, 95% CI = [.186,.222], p < .001), between the risk index and suicidal behavior. The strongest mediators were levels of self-esteem, depression, and avoidant coping. Interventions to increase self-esteem, reduce depression, and encourage adaptive coping strategies may prevent suicidal behavior in young people. © 2015, International Academy for Suicide Research.
Keywords: mediation; psychosocial factors; risk index; self-harm; suicide

Importance of health and social care research into gender and sexual minority populations in Nepal - Regmi, P.R.; Van Teijlingen, E. (Asia-Pacific Journal of Public Health, 2015)
Despite progressive legislative developments and increased visibility of sexual and gender minority populations in the general population, mass media often report that this population face a wide range of discrimination and inequalities. LGBT (lesbian, gay, and bisexual, and transgender) populations have not been considered as priority research populations in Nepal. Research in other geographical settings has shown an increased risk of poor mental health, violence, and suicide and higher rates of smoking, as well as alcohol and drugs use among LGBT populations. They are also risk for lifestyle-related illness such as cancer, diabetes, and heart diseases. Currently, in Nepal, there is a lack of understanding of health and well-being, social exclusion, stigma, and discrimination as experienced by these populations. Good-quality public health research can help design and implement targeted interventions to the sexual and gender minority populations of Nepal. © Asia-Pacific Academic Consortium for Public Health.
Keywords: culture; gender and sexual minority; LGBT; South Asia; stigma

Mortality risks among persons reporting same-sex sexual partners: Evidence from the 2008 general social survey-national death index data set - Cochran, S.D.; Mays, V.M. (American Journal of Public Health, 2015)
Objectives. We investigated the possibility that men who have sex with men (MSM) and women who have sex with women (WSW) may be at higher risk for early mortality associated with suicide and other sexual orientation-associated health risks. Methods. We used data from the 1988-2002 General Social Surveys, with respondents followed up for mortality status as of December 31, 2008. The surveys included 17 886 persons aged 18 years or older, who reported at least 1 lifetime sexual partner. Of these, 853 reported any same-sex partners; 17 033 reported only different-sex partners. Using gender-stratified analyses, we compared these 2 groups for all-cause mortality and HIV-, suicide-, and breast cancer-related mortality. Results. The WSW evidenced greater risk for suicide mortality than presumptively heterosexual women, but there was no evidence of similar sexual orientation-associated risk among men. All-cause mortality did not appear to differ by sexual orientation among either women or men. HIV-related deaths were not elevated among MSM or breast cancer deaths among WSW. Conclusions. The elevated suicide mortality risk observed among WSW partially confirms public health concerns that sexual minorities experience greater burden from suicide-related mortality.

Self-reported sexual and psychosocial health among non-heterosexual Danes - Graugaard, C.; Giraldi, A.; Frisch, M.; Falgaard Eplov, L.; Davidsen, M. (Scandinavian Journal of Public Health, 2015)
Introduction: Little is known about the sexual and psychosocial health of non-heterosexual Danes. Based on a large population study, the aim of this article was to compare quality-of-life-related key variables of heterosexual and non-heterosexual men and women, aged 16-66. Materials and methods: Cross-sectional data from the nationwide, representative Health and Morbidity Survey (n = 8496) were used to compare variables concerning both general and sexual well-being of self-identified heterosexual and non-heterosexual respondents. Results: Nearly twice as many non-heterosexual than heterosexual men rated their sexual life as bad or very bad (22.5% versus 12.8%), while no statistical difference was seen among women (13.6% versus 10.6%). For both genders, significantly more non-heterosexuals than heterosexuals stated that their sexual needs were not met (17.9% versus 7.7% for men and 14.8% versus 6.9% for women), and significantly more non-heterosexuals reported acts of sexual violence (8.3% versus 2.1% for men and 35.8% versus 13.0% for women). Finally, non-heterosexual respondents had contemplated suicide more than twice as often as heterosexuals (15.9% versus 7.4% for men and 19.7% versus 8.3% for women). Actual suicide attempts were roughly three times more frequent in the non-heterosexual groups (8.3% versus 2.6 % for men and 11.8% versus 4.2% for women). Conclusions: Overall, non-heterosexual Danes reported higher degrees of sexual and/or psychosocial distress than heterosexuals. Further research is needed; but scientists, clinicians and public health workers should be aware that non-heterosexuals may pose specific health-related challenges and requirements. © 2015, the Nordic Societies of Public Health. All rights reserved.
Keywords: Denmark; distress; homosexuality; mental health; psychosocial health; quality of life; sexual health; sexuality; suicide

Brief report coping styles and suicide in racially and ethnically diverse lesbian, bisexual, and queer women - Rabinovitch, A.E.; Perrin, P.B.; Tabaac, A.R.; Brewster, M.E. (Psychology of Sexual Orientation and Gender Diversity, 2015)
The purpose of the current study was to examine whether coping strategies are associated with past suicidal ideation and history of suicide attempts among sexual minority women (SMW). Participants were 150 racially and ethnically diverse lesbian, bisexual, queer, or "other" nonheterosexual-identified cisgender women who were recruited as part of a national online survey on the experiences of SMW. Simultaneous multiple regressions suggested that coping styles significantly explained 20.3% of the variance in past suicidal ideation and 30.4% of the variance in lifetime history of suicide attempts. Within these regressions, self-blame coping positively predicted past suicidal ideation, and religious coping and venting coping were associated with a higher lifetime history of suicide attempts. Based on these findings, directions for future research and interventions to reduce suicide risk among SMW are discussed. © 2015 American Psychological Association.
Keywords: Coping; Race/ethnicity; Religion; Sexual minority women; Suicide

Suffered violence, drug consumption and risk behaviors in homosexual and bisexual individuals - Albuquerque, G.A.; De Lima Garcia, C.; Moreira Belém, J.; Dos Santos Figueiredo, F.W.; Da Silva Paiva, L.; Arraes, T.M.S.N.; Da Silva Quirino, G.; De Abreu, L.C.; Valente, V.E.; Da Silva Maciel, E.; De Alcantara Sousa, L.V.; Adami, F. (International Archives of Medicine, 2015)
Background: This study examined the prevalence of violence suffered, drug use and risk behaviors in homosexual and bisexual individuals. Method: Cross-sectional, quantitative study involving 296 Lesbian, Gay, Bisexual individuals in the municipalities of Crato and Juazeiro do Norte, South of Ceará state, Brazil. Findings: Psychological/verbal abuse is the most prevalent and depressants of the central nervous system are chosen for consumption after victimization. Depressant and stimulant drugs were associated to dependence and risk behaviors in sexual minorities. Conclusion: Gay and bisexual people use drugs after suffering violence, with an association between drug use and developing risk behaviors. Further investigations inherent in these associations are necessary, since other factors may interact to violence, drug use and risk behaviors in sexual minorities. © Under License of Creative Commons Attribution 3.0 License.
Keywords: Bisexuality; Homosexuality; Illicit drugs; Violence

Substance-related coping, HIV-related factors, and mental health among an HIV-positive sexual minority community sample - Cramer, R.J.; Colbourn, S.L.; Gemberling, T.M.; Graham, J.; Stroud, C.H. (AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV, 2015)
HIV-positive status poses a unique set of social stressors, especially among lesbian, gay, and bisexual (LGB) persons. Among these difficulties are the internalization of HIV-related stigma and poor mental health. Unfortunately, substance use as a coping mechanism is also common, dependent on other demographic factors, among HIV-positive and LGB samples. The present study integrates these bodies of literature by examining main and interactive effects of HIV-related experiences (i.e., disclosure of HIV-positive status, fear of disclosure, HIV-related victimization, and internalized HIV-related stigma) and substance-related coping with discrimination as they impact mental health (i.e., stress, anxiety, depressive symptoms, and suicide and self-injury proneness). Participants were 216 HIV-positive LGB community members from an urban community medical clinic. Prominent results included: (1) robust negative effects of internalized HIV-related stigma on all mental health indicators when controlling for other HIV-related experiences and (2) a significant interaction in which substance-related coping significantly increases suicide proneness, only for those who have disclosed HIV-positive status to family or friends. Results are discussed with respect to theoretical perspectives of internalized stigma, implications for clinical work with LGB persons of HIV-positive status, and future research. © 2015 © 2015 Taylor & Francis.
Keywords: and bisexual (LGB); coping; gay; HIV; lesbian; stigma; substance abuse; suicide

Suicide ideation and bullying among US adolescents: Examining the intersections of sexual orientation, gender, and race/ethnicity - Mueller, A.S.; James, W.; Abrutyn, S.; Levin, M.L. (American Journal of Public Health, 2015)
Objectives: We examined how race/ethnicity, gender, and sexual orientation shape adolescents' likelihood of being bullied and vulnerability to suicide ideation. Methods: We analyzed pooled data from the 2009 and 2011 Youth Risk Behavior Surveys (n=75344) to assess race/ethnicity, gender, and sexual orientation variation in being bullied and suicide ideation. Results: White and Hispanic gay and bisexual males, White lesbian and bisexual females, and Hispanic bisexual females were more likely to be bullied than were White heterosexual adolescents. Black lesbian, gay, and bisexual youths' vulnerability to being bullied was not significantly different from that of White heterosexual youths. Black and Hispanic heterosexual youths were less likely to be bullied than were White heterosexual youths. Despite differences in the likelihood of being bullied, sexual minority youths were more likely to report suicide ideation, regardless of their race/ethnicity, their gender, or whether they have been bullied. Conclusions: Future research should examine how adolescents' intersecting identities shape their experience of victimization and suicidality. School personnel should develop antibullying and antihomophobia policies in response to the disproportionate risk of being bullied and reporting suicidality among sexual minority youths.

Suicide risk among college students: The intersection of sexual orientation and race - Shadick, R.; Dagirmanjian, F.B.; Barbot, B. (Crisis, 2015)
Research on young adults in the general population has identified a relationship between sexual minority identification and risk for suicide. Differential rates of suicidal ideation and attempts have also been found across racial and ethnic groups. Aims: This study examined risk for suicide among university students, based on membership in one or more marginalized groups (sexual minority and racial minority identification). Method: Data were collected from first-year college students (N = 4,345) at an urban university. Structural equation modeling was employed to model a suicidality construct, based on which a "risk for suicide" category system was derived. Chi-square and logistic regression analyses were then conducted to estimate the relationship between the background variables of interest and suicide risk. Results: Students who identified as lesbian, gay, or bisexual (LGB) were associated with higher suicide risk than their heterosexual peers. Students of colorwere slightly less at risk than their heterosexual peers. However, LGB students of color were associated with elevated suicide risk relative to heterosexual peers. Conclusion: Results indicate that belonging to multiple marginalized groups may increase one's risk for suicide, though these effects are not simply additive. Findings highlight the complexity ofthe intersection between marginalized identities and suicidality. © 2015 Hogrefe Publishing.
Keywords: College students; Ethnicity; Sexual orientation; Suicide risk

Are LGBT Populations at a Higher Risk for Suicidal Behaviors in Australia? Research Findings and Implications - Skerrett, D.M.; Kõlves, K.; De Leo, D. (Journal of Homosexuality, 2015)
The aim of this article is to review the Australian literature about suicidality in minority sexual identity and/or behavior groups in order to determine the evidence base for their reported higher vulnerability to suicidal behaviors than heterosexual and non-transgendered individuals in the Australian context, as well as to identify the factors that are predictive of suicidal behaviors in these groups in Australia. A literature search for all available years (until the end of 2012) was conducted using the databases Scopus, Medline, and Proquest for articles published in English in peer-reviewed academic journals. All peer-reviewed publications that provided empirical evidence for prevalence and predictive factors of suicidal behaviors among LGBT individuals (or a subset thereof) in Australia were included. Reference lists were also scrutinized to identify “gray” literature for inclusion. The results revealed that there is only limited research from Australia. Nevertheless, although no population-based studies have been published, research indicates that sexual minorities are indeed at a higher risk for suicidal behaviors. In order to further the understanding of suicidal behaviors and potential prevention among LGBT groups in the Australia, further research is needed, particularly on fatal suicidal behaviors. © , Copyright © Taylor & Francis Group, LLC.
Keywords: Australia; bisexual; gay; intersex; lesbian; self-harm; suicide; transgender

Suicide and HIV as leading causes of death among gay and bisexual men: a comparison of estimated mortality and published research - Hottes, T.S.; Ferlatte, O.; Gesink, D. (Critical Public Health, 2015)
Gay and bisexual men experience numerous health disparities relative to heterosexual men, including high rates of HIV and suicidal behavior. Systematic community health assessments could provide direct comparisons of the burden of mortality across diseases and thus facilitate the prioritization of public health activities; however, such assessments have been precluded by the absence of sexual orientation information in vital statistics records. In this context, we used population attributable fraction to derive and compare indirect estimates of mortality for both HIV and suicide. Assuming that 2% of Canadian men are gay or bisexual, and that these men are 42 times more likely to die from HIV and 4 times more likely to die from suicide, we estimated that in 2011, suicide resulted in 46 deaths per 100,000 gay and bisexual men, while HIV resulted in 30 deaths per 100,000. Based on these estimates, suicide surpassed HIV as a leading cause of premature mortality for gay and bisexual men in 2007. Despite the large burden of suicide among gay and bisexual men, research attending to the issue in biomedical, psychology, and social science literatures is sparse, with at least 10 times fewer citations than for HIV between 2003 and 2012. We urge researchers, practitioners, and community leaders to broaden the scope of gay and bisexual men’s public health priorities to include suicide and other high burden health inequities. © 2014 Taylor & Francis.
Keywords: gay; HIV/AIDS; mortality; suicide

Suicidal Ideation among Italian and Spanish Young Adults: The Role of Sexual Orientation - Baiocco, R.; Ioverno, S.; Lonigro, A.; Baumgartner, E.; Laghi, F. (Archives of Suicide Research, 2015)
The purpose of the current study was to identify demographic, social, and psychological variables associated with suicidal ideation in an Italian sample and a Spanish sample, taking into account the relevance of sexual orientation as a risk factor for suicide. Three hundred twenty gay and bisexual men, 396 heterosexual men, 281 lesbians and bisexual women, and 835 heterosexual women were recruited. In chi-square and multivariable logistic regression analyses we identified several consistent cross-national risk factors for suicidal ideation: having lower education, not being religious, being homosexual or bisexual, not being engaged in a stable relationship, having lower level of peer and parental attachment, and having depressive symptoms. Interestingly, the strongest risk factor in both samples, after depression symptoms, was sexual orientation. © 2015, International Academy for Suicide Research.
Keywords: gay; lesbian; sexual orientation; suicidal ideation; suicide; young adults

Suicide Risk Among Sexual Minority College Students: A Mediated Moderation Model of Sex and Perceived Burdensomeness - Silva, C.; Chu, C.; Monahan, K.R.; Joiner, T.E. (Psychology of Sexual Orientation and Gender Diversity, 2015)
Converging evidence suggests that individuals who identify as lesbian/gay or bisexual are consistently more likely to report suicidal ideation and attempts than heterosexual counterparts, and that these effects may be greater among males. The current study examined sex as a moderator of the relationship between sexual identity and suicidal ideation, and perceived burdensomeness as a mediator of this relationship, controlling for anxiety, and negative and positive affect. Undergraduates (n 140; mean age, 19.59 years; 71.4% female; 58.6% White; 34.3% lesbian/gay/bisexual) completed measures assessing sexual identity, suicidal ideation and behaviors, anxiety symptom severity, and general negative and positive affect cross-sectionally. Sexual minority undergraduates reported significantly higher levels of perceived burdensomeness, anxiety, and suicidal ideation, attempts, and nonsuicidal self-injury, and lower positive affect, than heterosexual counterparts. Analyses suggested that most of these associations were strongly driven by bisexuals; a notion that was supported by finding a quadratic relationship between the Kinsey Scale and suicidal ideation. A mediated moderation analysis revealed that the relationship between sexual identity and suicidal ideation was only significant among females, and that this relationship was fully mediated by perceived burdensomeness, while controlling for anxiety, and negative and positive affect. Perceived burdensomeness may be an important malleable risk factor for suicide assessment, prevention, and intervention efforts to address, especially among female sexual minority college students. Implications and future directions are discussed. © 2014 American Psychological Association
Keywords: Gender; Interpersonal theory of suicide; Perceived burdensomeness; Sexual identity; Suicide risk

Mental health disorders in young urban sexual minority men - Burns, M.N.; Ryan, D.T.; Garofalo, R.; Newcomb, M.E.; Mustanski, B. (Journal of Adolescent Health, 2015)
Purpose Very few studies have examined mental disorders among male sexual minority youth. We describe demographic correlates, comorbidity, and history of mental disorders and suicidality in a large sample of male sexual minority youth. Methods Structured diagnostic interviews were conducted with 449 racially diverse urban sexual minority males, aged 16-20 years, who were recruited using a social network-driven sampling methodology. Results Lifetime major depressive episode (MDE) affected 33.2% of the youth. Lifetime conduct disorder (23.6%), alcohol abuse/dependence (19.6%), posttraumatic stress disorder (PTSD; 16.0%), and nicotine dependence (10.7%) were also common. Black participants were less likely than white participants to be diagnosed with lifetime MDE, alcohol abuse/dependence, nicotine dependence, suicidal ideation, and anorexia, as well as past 12-month alcohol abuse/dependence (odds ratios [ORs] range from.08 to.46). Relative to participants identifying as gay, bisexual identified youth were at higher risk for lifetime PTSD (OR = 2.04), and participants who did not identify as gay or bisexual were at higher risk for both lifetime and past 12-month nicotine dependence (OR = 4.36 and 3.46, respectively). Most participants with mental disorders never received treatment, and comorbidity was common. Conclusions MDE, conduct disorder, alcohol abuse/dependence, PTSD, and nicotine dependence are common and infrequently treated in young sexual minority men. Some within-group disparities emerged, suggesting that factors related to racial background and self-identification may help to understand resilience to the unique stressors experienced by these young men. © 2015 Society for Adolescent Health and Medicine. All rights reserved.
Keywords: Adolescents, male; Age of onset; Comorbidity; Frequency; Homosexuality, male; Mental disorders; Minority health; Young adult

Cross-national investigation of health indicators among sexual minorities in Norway and the United States - Watson, R.J.; Wheldon, C.W.; Wichstrøm, L.; Russell, S.T. (Social Sciences, 2015)
A cross-national study of young adult sexual minorities was conducted in order to explore the associations between sexual orientation and measures of depression, suicidality, and substance use. Two nationally representative data sets were explored from the United States (N = 14,335) and Norway (N = 2423). Results indicated that sexual minorities experienced multiple health disparities (depression, suicidality, and substance use) compared to their heterosexual counterparts. We found similar patterns of depression, suicidality, and substance use for sexual minorities in both the United States and Norway. The highest odds of substance use were among heterosexual-identified Norwegian youth who reported same-sex sexual activity, and the highest odds of suicidality were found for bisexual young adults in Norway. These findings have implications for how we consider culture and social policy as barriers and/or opportunities for sexual minorities. © 2015 by the authors.
Keywords: Culture; Health disparities; LGB; MSM; Psychosocial adjustment; WSW

Religion-related stigma and discrimination experienced by lesbian, gay, bisexual and transgender students at a South African rural-based university - Mavhandu-Mudzusi, A.H.; Sandy, P.T. (Culture, Health and Sexuality, 2015)
This paper reports on the stigma and discrimination experienced by lesbian, gay, bisexual and transgender students at a rural university in South Africa. Twenty lesbian, gay, bisexual and transgender students recruited through snowball sampling participated in this study. Interpretative Phenomenological Analysis was used as a framework for data analysis. Findings indicate that religion-related stigma and discrimination are common at a rural-based university in South Africa. Lesbian, gay, bisexual and transgender students are typically ascribed a range of labels, including ‘sinners’, ‘devils’ and ‘demon possessed’. They are also exposed to a number of discriminatory acts, such as the denial of financial and healthcare services and threats of and/or actual rape. Study participants reported attempts to convert lesbian, gay, bisexual and transgender students' sexual orientation which involved the use of intervention in the form of prayers. Derogatory labelling and associated discriminatory acts, for example the threat of rape, led many students to conceal their sexual identity, not attend specific classes, terminate their studies and even attempt suicide. Universities should develop policies to promote greater social inclusion and the acceptance of lesbian, gay, bisexual and transgender students. Policies should also specify the steps or approaches to be taken in addressing discriminatory practices. © 2015, © 2015 Taylor & Francis.
Keywords: homophobia; lesbian, gay, bisexual and transgender students; religion; rural-based university; South Africa

Associations of sexual and gender minority status with health indicators, health risk factors, and social stressors in a national sample of young adults with military experience - Blosnich, J.R.; Gordon, A.J.; Fine, M.J. (Annals of Epidemiology, 2015)
Purpose: To assess the associations of self-identified lesbian, gay, bisexual, and questioning sexual orientation or transgender status (LGBTQ) and military experience with health indicators. Methods: We used data from the Fall 2012 National College Health Assessment. The survey included self-identified sociodemographic characteristics, mental (e.g., depression) and physical (e.g., human immunodeficiency virus) conditions, health risk behaviors (e.g., smoking), and social stressors (e.g., victimization). We used modified Poisson regression models, stratified by self-reported military service, to examine LGBTQ-related differences in health indicators, whereas adjusting for sociodemographic characteristics. Results: Of 27,176 in the sample, among the military-experienced group, LGBTQ individuals had increased adjusted risks of reporting a past-year suicide attempt (adjusted risk ratio [aRR]=4.37; 95% confidence interval [CI]= 1.39-13.67), human immunodeficiency virus (aRR=9.90; 95% CI= 1.04-79.67), and discrimination (aRR=4.67; 95% CI= 2.05-10.66) than their non-LGBTQ peers. Among LGBTQ individuals, military experience was associated with a nearly four-fold increased risk of reporting a past-year suicide attempt (aRR=3.61; 95% CI= 1.46-8.91) adjusting for age, sex, race and ethnicity, marital status, depression, and other psychiatric diagnoses. Conclusions: Military experience may moderate health indicators among LGBTQ populations, and likewise, LGBTQ status likely modifies health conditions among military-experienced populations. Results suggest that agencies serving military populations should assess how and if the health needs of LGBTQ individuals are met. © 2015.
Keywords: Health surveys; Mental health; Military personnel; Minority health; Sexuality; Transgendered persons; Veterans health

Differing identities but comparably high HIV and bacterial sexually transmitted disease burdens among married and unmarried men who have sex with men in Mumbai, India - Mayer, K.H.; Gangakhedkar, R.; Sivasubramanian, M.; Biello, K.B.; Abuelezam, N.; Mane, S.; Risbud, A.; Anand, V.; Safren, S.; Mimiaga, M.J. (Sexually Transmitted Diseases, 2015)
Background: Although HIV incidence has declined in India, men and transgender women who have sex with men (MSM) continue to have high rates of HIVand sexually transmitted disease (STD). IndianMSMface substantial pressures to marry and have families, but the HIV/STD burden among married Indian MSM is not well characterized. Methods: A diverse sample of Indian MSM were recruited through respondent-driven sampling. Independent variables that produced a P value of 0.10 or less were then added to a multivariable logistic regression model. Results: Most of the 307 MSM(95 married and 212 unmarried) recruited into the study were younger than 30 years, and less than one-third had more than a high school education. Almost two-thirds of the married men had children, compared with 1.4%of the unmarriedmen (P < 0.001). The numbers of condomless anal sex acts did not differ bymarriage status. Although unmarried MSM more often identified themselves as "kothi" (receptive role), their rates of HIV or bacterial STD were similar to married MSM, with 14.3% being HIV infected. The respondent-driven sampling-adjusted prevalence of any bacterial STD was 18.3% for married MSM and 20% for unmarried MSM (not significant). Participants reported high levels of psychological distress, with 27.4% of married and 20.1% of unmarried MSM reporting depressive symptoms (not significant). Conclusions: Men who have sex with men in Mumbai had high rates of HIV, STD, and behavioral health concerns. Clinicians need to become more comfortable in eliciting sexual histories so that they can identify MSM who need HIV/STD treatment and/or prevention services. © 2015 American Sexually Transmitted Diseases Association All rights reserved.

Sexual Orientation and Non-Suicidal Self-Injury: A Meta-Analytic Review - Batejan, K.L.; Jarvi, S.M.; Swenson, L.P. (Archives of Suicide Research, 2015)
The aim of this study was to conduct the first meta-analysis comparing risk for NSSI between sexual minority and heterosexual persons. Eleven published and 4 unpublished studies were reviewed, describing associations between sexual orientation and NSSI in 7,147 sexual minority and 61,701 heterosexual participants. The overall weighted effect size for the relationship between sexual orientation and NSSI using a random-effects model was OR = 3.00 (95% CI = 2.46–3.66), indicating a medium-to-large effect. Sexual minority adolescents and bisexuals were found to be at particularly high-risk. These findings highlight the need to examine mechanisms linking sexual orientation and NSSI in future research. Building on these findings can add to understanding the associations between sexual orientation, NSSI, and suicidality, as well as prevention/intervention. © 2015 International Academy for Suicide Research.
Keywords: LGBQ; meta-analysis; non-suicidal self-injury; NSSI; sexual orientation

Religious Conflict, Sexual Identity, and Suicidal Behaviors among LGBT Young Adults - Gibbs, J.J.; Goldbach, J. (Archives of Suicide Research, 2015)
This is the first known study to explore how religious identity conflict impacts suicidal behaviors among lesbian, gay, bisexual, and transgender (LGBT) young adults and to test internalized homophobia as a mediator. A secondary analysis of 2,949 youth was conducted using a national dataset collected by OutProud in 2000. Three indicators of identity conflict and an internalized-homophobia scale (mediator), were included in logistic regressions with three different suicide variable outcomes. Internalized homophobia fully mediates one conflict indicator and partially mediates the other two indicators’ relationship with suicidal thoughts. Internalized homophobia also fully mediates the relationship between one conflict indicator and chronic suicidal thoughts. Two indicators were associated with twice the odds of a suicide attempt. LGBT young adults who mature in religious contexts have higher odds of suicidal thoughts, and more specifically chronic suicidal thoughts, as well as suicide attempt compared to other LGBT young adults. Internalized homophobia only accounts for portions of this conflict. © 2015, Copyright © International Academy for Suicide Research.
Keywords: identity; LGBT; religion; suicide; young adults

Explaining Self-Harm: Youth Cybertalk and Marginalized Sexualities and Genders - McDermott, E.; Roen, K.; Piela, A. (Youth and Society, 2015)
This study investigates self-harm among young lesbian, gay, bisexual, and trans (LGBT) people. Using qualitative virtual methods, we examined online forums to explore young LGBT people’s cybertalk about emotional distress and self-harming. We investigated how youth explained the relationship between self-harm and sexuality and gender. We found that LGBT youth may articulate contradictory, ambiguous, and multiple accounts of the relationship but there were three strong explanations: (a) self-harm was because of homophobia and transphobia; (b) self-harm was due to self-hatred, fear, and shame; (c) self-harm was emphatically not related to sexuality or gender. There was evidence of youth negotiating LGBT identities, managing homophobia, resisting pathologization, and explaining self-harm as a way of coping. © 2013, © The Author(s) 2013.
Keywords: bisexual; gay; gender; homophobia; intersex; lesbian; pathologization; queer; self-harm; sexuality; stigma; suicide; transgender; youth

Internalized homophobia and suicidal ideation among LGB youth - Pereira, H.; Rodrigues, P. (African Journal of Psychiatry (South Africa), 2015)
Objective: The objectives of this study are to evaluate the relation between internalized homophobia and suicidal ideation in young lesbians, gays, bisexuals and heterosexuals; and also assess the influence of gender, discrimination experiences and disclosure of sexual orientation on suicidal ideation. Method: Participants- the sample consists of 389 participants, with a mean age of 19 years old. 51.9% were men and 48.1% were women. Regarding sexual orientation 36.0% were gay, 25.2% bisexual, 21.9% lesbian and17.0% heterosexual. The majority assume having already come out (61.4%). Most of the participants were in high school (51.4%).Instruments-we used a Demographic Questionnaire, the Suicide Ideation Questionnaire (SIQ) (Cronbach's alpha=0,975), and the Internalized Homophobia Questionnaire (Cronbach's alpha=0.81).Procedure - the data collection was done using the Internet. The questionnaires were available on a website built solely for this study. Publicity to this website was done through virtual communities, e-mail and several youth forums. Results: The results support the idea that there is a positive and statistically significant correlation between internalized homophobia and suicidal ideation. In addition, it was found that gay youngsters are the ones who have a stronger internalized homophobia, while young bisexuals are the ones who have higher levels of suicidal ideation. The teenagers who have not, yet, made their disclosure of sexual orientation and those who experienced discrimination, due to their sexual orientation, are those who had higher levels of suicidal ideation. Conclusion: More emphasis should be placed on suicide prevention for younger LGB individuals, in addition to the current emphasis on suicide prevention for adults. Future research should continue to examine unique, understudied LGB communities. © 2015, Henrique Pereira, et al.
Keywords: Internalized homophobia; LGB youth; Suicidal ideation

Asking for help online: Lesbian, gay, bisexual and trans youth, self-harm and articulating the ‘failed’ self - McDermott, E. (Health (United Kingdom), 2015)
International evidence suggests that young people are less likely to seek help for mental health problems in comparison with adults. This study focused on lesbian, gay, bisexual and trans young people who are a population group with an elevated risk of suicide and self-harm, and little is known about their help-seeking behaviour. Utilising qualitative virtual methods, lesbian, gay, bisexual and trans youth web-based discussions about seeking help for suicidal feelings and self-harming were investigated. Findings from a thematic analysis indicate that these young people wanted assistance but found it difficult to (1) ask for help, (2) articulate emotional distress and (3) ‘tell’ their selves as ‘failed’. This analysis suggests that key to understanding these problems are emotions such as shame which arise from negotiating norms connected to heterosexuality, adolescence and rationality. I argue that these norms act to regulate what emotions it is possible to feel, what emotions it is possible to articulate and what type of young lives that can be told. The future development of health and social care interventions which aim to reduce lesbian, gay, bisexual and trans youth suicide and self-harm need to work with a nuanced understanding of the emotional life of young people if they are to be effective. © 2014, © The Author(s) 2014.
Keywords: help-seeking; LGBT; online; suicide; youth

Non-Suicidal Self-Injury in Trans People: Associations with Psychological Symptoms, Victimization, Interpersonal Functioning, and Perceived Social Support - Claes, L.; Bouman, W.P.; Witcomb, G.; Thurston, M.; Fernandez-Aranda, F.; Arcelus, J. (Journal of Sexual Medicine, 2015)
Introduction: There is a paucity of systematic research in the area of non-suicidal self-injury (NSSI) in trans people. Aim: The aim of this study was to investigate the prevalence of NSSI in trans people and the associations with intra- and interpersonal problems. Methods: Participants were 155 untreated individuals with a diagnosis of transsexualism (according to International Classification of Disease-10 criteria) attending a national gender identity clinic. Main Outcome Measures: All participants completed the Self-Injury Questionnaire, the Symptom Checklist-90-Revised, the Rosenberg Self-Esteem Scale, the Hamburg Body Drawing Scale, the Experiences of Transphobia Scale, the Inventory of Interpersonal Problems-32, and the Multidimensional Scale of Perceived Social Support. Results: The sample consisted of 66.5% trans women and 33.5% trans men and 36.8% of them had a history of engaging in NSSI. The prevalence of NSSI was significantly higher in trans men (57.7%) compared with trans women (26.2%). Trans individuals with NSSI reported more psychological and interpersonal problems and perceived less social support compared with trans individuals without NSSI. Moreover, the probability of having experienced physical harassment related to being trans was highest in trans women with NSSI (compared with those without NSSI). The study found that with respect to psychological symptoms, trans women reported significantly more intrapersonal and interpersonal symptoms compared with trans men. Finally, the results of the regression analysis showed that the probability of engaging in NSSI by trans individuals was significantly positively related to a younger age, being trans male, and reporting more psychological symptoms. Conclusions: The high levels of NSSI behavior and its association with interpersonal and interpersonal difficulties and lack of social support need to be taken into consideration when assessing trans individuals. The effect of cross-sex hormones and sex reassignment surgery on psychological functioning, including NSSI behavior, as part of the transitional journey of trans individuals should be explored in future studies. © 2014 International Society for Sexual Medicine.
Keywords: Gender Dysphoria; Interpersonal Functioning; NSSI; Social Support; Trans; Transsexualism; Victimization

Sexual Minority Stress and Suicide Risk: Identifying Resilience Through Personality Profile Analysis - Livingston, N.A.; Flentje, A.; Heck, N.C.; Gleason, H.; Oost, K.M.; Cochran, B.N. (Psychology of Sexual Orientation and Gender Diversity, 2015)
Sexual minority-based victimization, which includes threats or enacted interpersonal violence, predicts elevated suicide risk among sexual minority individuals. However, research on personality factors that contribute to resilience among sexual minority populations is lacking. Using the Five-Factor Model, we hypothesized that individuals classified as adaptive (vs. at-risk) would be at decreased risk for a suicide attempt in the context of reported lifetime victimization. Sexual minority-identified young adults between the ages of 18 and 25 years (N 412) were recruited nationally and asked to complete an online survey containing measures of personality, sexual minority stress, and lifetime suicide attempts. A 2-stage cluster analytic method was used to empirically derive latent personality profiles and to classify respondents as adaptive (lower neuroticism and higher extroversion, agreeableness, conscientiousness, and openness) or at-risk (higher neuroticism, lower extroversion, agreeableness, conscientiousness, and openness) on the basis of their Five-Factor Personality trait scores. Adaptive individuals were slightly older and less likely to conceal their sexual orientation, but they reported similar rates of victimization, discrimination, and internalized heterosexism as their at-risk counterparts. Logistic regression results indicate that despite reporting similar rates of victimization, which was a significant predictor of lifetime suicide attempt, adaptive individuals evidenced decreased risk for attempted suicide in the context of victimization relative to at-risk individuals. These findings suggest that an adaptive personality profile may confer resilience in the face of sexual minority-based victimization. This study adds to our knowledge of sexual minority mental health and highlights new directions for future research. © 2015 American Psychological Association.
Keywords: Five-Factor Model; LGB; Personality; Sexual minority; Suicide

Bullying and Suicide: The Mental Health Crisis of LGBTQ Youth and How You Can Help - Ahuja, A.; Webster, C.; Gibson, N.; Brewer, A.; Toledo, S.; Russell, S. (Journal of Gay and Lesbian Mental Health, 2015)
Responding to increased awareness of the plight of lesbian, gay, bisexual, and transgender (LGBT) youth who may be isolated and subject to bullying, the Association of Gay and Lesbian Psychiatrists (AGLP) collaborated with the American Foundation for Suicide Prevention (AFSP), the Trevor Project and the Gay, Lesbian and Straight Education Network (GLSEN) to present a symposium on Bullying and Suicide at the American Psychiatric Association (APA) Annual Meeting in 2013. The objectives of the symposium were the following: to understand the link between anti-LGBTQ bullying and mental illness and to identify ways to help such patients. To identify the academic research being done on anti-LBGTQ bullying, and how this informs tactics to combat this problem. To identify areas of weakness in the approaches being used, ways to improve them, and areas of future research. To identify ways clinicians can be involved in furthering the awareness of bullying of all kinds, including research on prevention efforts. © 2015, Copyright © Taylor & Francis Group, LLC.
Keywords: adolescents and young adults; bullying; LGBT; public policy; suicide

High levels of emotional distress, trauma exposure, and self-injurious thoughts and behaviors among military personnel and veterans with a history of same sex behavior - Ray-Sannerud, B.N.; Bryan, C.J.; Perry, N.S.; Bryan, A.O. (Psychology of Sexual Orientation and Gender Diversity, 2015)
Rates of suicide deaths and attempts among military personnel and veterans have risen over the past decade. Research on the relationship of sexual minority status (whether by attraction, identity, or behavior) with self-injurious thoughts and behaviors (SITB) among military personnel and veterans is sparse, despite considerable evidence suggesting sexual minority individuals are at increased risk in the general population. The current study examined the relationship of sexual minority status (i.e., those reporting a history of same-sex partners) with emotional distress, trauma exposure, and SITB in a sample of 422 military personnel and veterans enrolled in college classes. Results indicated that military personnel who had a history of same-sex partners reported more severe depression, posttraumatic stress, and trauma exposure than military personnel who reported only other-sex partners. Female military personnel with a history of same-sex partners reported the highest rates of physical (48.3%) and sexual (41.4%) assault, and nonsuicidal self-injury (31%) and suicide attempts (20.7%). Military personnel with a history of same-sex partners reported significantly increased rates of suicide ideation (OR = 2.08, p <.05), nonsuicidal self-injury (OR = 2.29, p <.05), and suicide attempts (OR = 2.89, p <.05). Results suggest sexual minority military personnel and veterans, especially women, report greater emotional distress and trauma exposure. They are also at increased risk for SITB, as a function of these high levels of psychological distress and trauma. © 2015 American Psychological Association.
Keywords: Lgb; Military; Sexual minority; Suicide; Veteran

The role of help-seeking in preventing suicide attempts among lesbians, gay men, and bisexuals - Meyer, I.H.; Teylan, M.; Schwartz, S. (Suicide and Life-Threatening Behavior, 2015)
One possible approach to prevention of suicide attempts is to encourage help-seeking among individuals at risk. We assessed whether different forms of treatment were associated with lower odds of a suicide attempt in a diverse group of 388 lesbian, gay, and bisexual (LGB) adults aged 18-59, sampled from New York City venues. Of individuals who attempted suicide, 23% sought mental health or medical treatment and 14% sought religious or spiritual treatment prior to the suicide attempt. Black and Latino LGBs were underrepresented in mental health or medical treatment and Black LGBs were overrepresented in religious or spiritual treatment. Seeking mental health or medical treatment was not associated with lower odds of a suicide attempt; seeking religious or spiritual treatment was associated with higher odds of a suicide attempt. We discuss these results and posit hypotheses for further research of this understudied topic. © 2014 The American Association of Suicidology.

Queer conversations: improving access to, and quality of, mental health services for same-sex-attracted clients - Semp, D.; Read, J. (Psychology and Sexuality, 2015)
Lesbian, gay and bisexual (LGB) people have a higher prevalence of psychiatric problems. This is considered as a consequence of marginalisation of homosexuality. Despite much research and literature on lesbian and gay mental health, important questions remain largely unexplored regarding public mental health services (PMHS) for LGB. Two such questions are: Do clients feel able to disclose issues regarding sexual orientation to psychiatric services? How do PMHS services enable or hinder this? Foucauldian discourse analysis was used to explore these questions. Interviews were conducted with 13 same-sex-attracted male clients and 12 LGB staff in PMHS in New Zealand. Findings were that staff in PMHS rarely ask clients about sexual orientation. Correspondingly many clients report considerable difficulty disclosing their sexual orientation in PMHS, even when it is relevant to their mental health issues. The social and systemic conditions which create this barrier to effective treatment for LGB clients are explored. Practical suggestions are made for how staff in PMHS can raise the topic of sexual orientation with clients thereby improving access to and quality of treatment to LGB clients. © 2014 Taylor & Francis.
Keywords: discourse analysis; gay men; mental health services; suicide

Beyond the binary: (Trans)gender narratives and class distinction in Rituparno Ghoshs later films - Dutta, A. (South Asian History and Culture, 2015)
This essay will examine how the later films featuring or directed by Ghosh, with Arekti Premer Golpo (Just Another Love Story) onwards, oscillate and negotiate between two distinct narratives of (trans)gender identification, one based on a binary model of gender, and the other on a ternary model. The essay will argue that both these models are foundationally constituted through a class-/caste-restricted access to bourgeois modernity and enlightenment. The first model is of a woman in a (wrongly) male body, necessitating the external transition from male to female body. This model, corresponding to the biomedical discourse of transsexuality, has a relatively recent genealogy in the Bengali media and particularly in the much-publicized transition narratives of two trans women, Manobi Bandyopadhyay and Tista Das. In contradistinction to this narrative, Ghosh draws on an older narrative of thirdness and gender liminality - in distinction from, rather than in transition between, both genders - which is often associated with hijras and kothis (a diverse spectrum of third gender and feminine/effeminate persons assigned male or intersex at birth) in the ethnographic literature, but without making much reference to these communities. Ghosh establishes a double distanciation from working class/lower caste narratives of gender variance, and constructs a class-restricted script of gender choice and fluidity premised on bourgeois trajectories of modernization. This becomes particularly ironic and poignant in light of hir appropriation and celebration by both the middle class and working class gender-variant communities to different ends; Ghoshs posthumous gun salute and celebration by transgender/hijra/kothi communities accompanies the continuing, and perhaps increasing, criminalization, surveillance and pathologization of these communities. © 2015 © 2015 Taylor & Francis.
Keywords: class; kothi; modernity; performance; transgender

Suicidal risk and sexual orientation in adolescence: A population-based study in Iceland - Arnarsson, A.; Sveinbjornsdottir, S.; Thorsteinsson, E.B.; Bjarnason, T. (Scandinavian Journal of Public Health, 2015)
Aim: Suicidality is an important public health problem, particularly among lesbian, gay, and bisexual (LGB) adolescents and young adults. The purpose of the present study is to compare the rate of suicide ideations and attempts among LGB adolescent to that of non-LGB adolescents in a population-based sample, and to identify important protective factors as well as risk factors Method: We used the Icelandic data set from the 2009/2010 Health Behaviour in School-aged Children (HBSC) study. The sample consisted of 3813 grade 10 Icelandic adolescents; 1876 girls and 1937 boys. The participants were asked about attraction and/or activity, as well as about suicidal ideation and/or attempts. The questionnaire also included various other items regarding health and lifestyle. Results: LGB adolescents were five to six times more likely to have had frequent suicidal ideations. Factors that were associated with less suicide ideations and fewer attempts were easy communication and liking school. The LGB girls were six times more likely to have had frequent suicide attempts, whilst the LGB boys were 17 times more likely to have attempted suicide that often. No specific protective or risk factors were identified for suicidality in LGB adolescents other than bullying. Conclusions: Adolescents that had engaged in heterosexual activity and those that had LGB attraction had similarly heightened risk for suicidality, but sexually active LGB adolescents were far more likely to have suicidal ideations or to have attempted suicide. © 2015, the Nordic Societies of Public Health. All rights reserved.
Keywords: Adolescent; homosexuality; LGB; sexuality; suicide

Suicidal ideation in gay men and lesbians in South Korea: A test of the interpersonal-psychological model - Kim, S.; Yang, E. (Suicide and Life-Threatening Behavior, 2015)
Gay men and lesbians in South Korea are alienated and stigmatized due to the country's low tolerance of social differences, resulting in distress and suicidal impulses. This study investigated the predictors of suicidal ideation in a gay and lesbian group in South Korea based on the interpersonal-psychological theory of suicide. Differences between the gay and lesbian group and the heterosexual group were found in the direct path between perceived burdensomeness and suicidal ideation. The relationship was significant for both groups, but the path coefficient was greater for lesbians and gay men than for heterosexuals. These findings imply that perceived burdensomeness may be a more critical factor in suicidal ideation of lesbians and gay men. © 2014 The American Association of Suicidology.

Sexual orientation and risk factors for suicidal ideation and suicide attempts: A multi-centre cross-sectional study in three Asian cities - Lian, Q.; Zuo, X.; Lou, C.; Gao, E.; Cheng, Y. (Journal of Epidemiology, 2015)
Purpose: Despite robust empirical and theoretical evidence for higher rates of suicide among lesbian, gay, and bisexual (LGB) youths, little is known about the relationship between suicide and sexual orientation among Asian youths. This study examined differences in prevalence of suicidal ideation and suicide attempts between LGB and heterosexual youths in the cities of Hanoi, Shanghai, and Taipei, China. Methods: The data are from a community-based multi-centre cross-sectional study conducted from 2006 to 2007, with a sample of 17 016 youths aged 15-24 years from Hanoi, Shanghai, and Taipei. Chi-square test and logistic regression were used to evaluate correlates of suicidal ideation and suicide attempts. Results: The overall prevalence of suicidal ideation and suicide attempts in the preceding 12 months in LGB youths were both higher than in heterosexual youth (12.8% vs. 8.1% and 4.0% vs. 2.4%, respectively). Stratified by city, the prevalence of suicidal ideation was lowest in Hanoi (2.2%), followed by Shanghai (8.0%) and Taipei (17.0%). Similar trends were observed in the prevalence of suicide attempts, which was lowest in Hanoi (0.3%), followed by Shanghai (1.2%) and Taipei (2.5%). Of note, however, multivariate logistic regression results revealed that LGB youth were at a higher risk for suicidal ideation than heterosexual youth only in Taipei (odds ratio 1.65). Conclusions: Suicidality is common among Asian youth, with higher prevalence observed in urbanized cities. LGB youths are at greater risk of suicidal ideation than their heterosexual counterparts in Taipei than in the other two examined cities. © 2014 Qiguo Lian et al.
Keywords: China; Sexual orientation; Suicide; Taiwan; Vietnam; Youth

The Social Costs of Gender Nonconformity for Transgender Adults: Implications for Discrimination and Health - Miller, L.R.; Grollman, E.A. (Sociological Forum, 2015)
Research suggests that transgender people face high levels of discrimination in society, which may contribute to their disproportionate risk for poor health. However, little is known about whether gender nonconformity, as a visible marker of one's stigmatized status as a transgender individual, heightens trans people's experiences with discrimination and, in turn, their health. Using data from the largest survey of transgender adults in the United States, the National Transgender Discrimination Survey (N = 4,115), we examine the associations among gender nonconformity, transphobic discrimination, and health-harming behaviors (i.e., attempted suicide, drug/alcohol abuse, and smoking). The results suggest that gender nonconforming trans people face more discrimination and, in turn, are more likely to engage in health-harming behaviors than trans people who are gender conforming. Our findings highlight the important role of gender nonconformity in the social experiences and well-being of transgender people. © 2015 Eastern Sociological Society.
Keywords: Discrimination; Gender nonconformity; Health; Minority stress; Stigma; Transgender

Screening for sexual orientation in psychiatric emergency departments - Currier, G.W.; Brown, G.; Walsh, P.G.; Jager-Hyman, S.; Chaudhury, S.; Stanley, B. (Western Journal of Emergency Medicine, 2015)
Introduction: Our goal was to explore whether emergency department (ED) patients would disclose their sexual orientation in a research evaluation and to examine demographic and clinical characteristics of patients by self-identified sexual orientation. Methods: Participants (n=177) presented for psychiatric treatment at three urban EDs in New York City, Rochester, NY, and Philadelphia, PA. Participants were interviewed in the context of a larger study of a standardized suicide risk assessment. We assessed participants' willingness to answer questions regarding sexual orientation along three dimensions: a self-description of sexual orientation, a self-description of sexual attraction, and the gender of any prior sexual partners. Results: No participants (0/177) refused to respond to the categorical question about sexual orientation, 168/177 (94.9%) agreed to provide information about prior sexual partners, and 100/109 (91.7%) provided information about current sexual attraction toward either gender. Of all 177 participants, 154 (87.0%) self-identified as heterosexual, 11 (6.2%) as bisexual, 10 (5.6%) as gay or lesbian, and 2 (1.1%) indicated they were not sure. As compared with heterosexual patients, lesbian, gay and bisexual (LGB) patients were significantly younger and more likely to be non-white, but did not differ significantly in terms of education, income, employment, or religious affiliation or participation. Further, LGB participants did not differ from self-identified heterosexual participants for lifetime suicide attempt rate or lifetime history of any mood, substance-related, psychotic spectrum, or other Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) Axis I disorder. Of self-identified heterosexual participants 5.6% (5/89) reported sexual attraction as other than 'only opposite sex,' and 10.3% (15/142) of sexually active 'heterosexual' participants reported previous same-gender sexual partners. Conclusion: Assessing patients' sexual orientation in the ED by a three-question approach appeared feasible in the ED and acceptable to ED patients. However, since many patients have sexual experiences not suggested by simple labels, self-report of sexual identity alone may not inform clinicians of health risks inherent in same or opposite gender sexual contact.
Keywords: Emergency medicine; Patient screening; Sexual orientation

Strategies Employed by Sexual Minority Adolescents to Cope With Minority Stress - Goldbach, J.T.; Gibbs, J. (Psychology of Sexual Orientation and Gender Diversity, 2015)
Sexual minority adolescents (SMA) experience disparities in health and behavioral health outcomes, including high rates of depression, anxiety, self-harm, substance use, HIV risk behavior, suicidal ideation, and suicide attempts. These outcomes are commonly attributed to minority stress. Stress experiences are different for SMA than their adult counterparts. For example, disclosing their sexual orientation may be more likely to result in homelessness because these youth more often live with parents or other family members. Although stress in this population has been explored in previous research, very little is known about how SMA cope. Relying on an adolescent coping model, this study examined the coping strategies, responses, and resources of SMA related to stress. Forty-eight racially and ethnically diverse SMA (age 14 –19) were recruited for 90-min tape-recorded interviews. The semistructured interviews were guided by a life history calendar. Recordings were transcribed verbatim and entered into QSR NVivo. All transcripts were coded by 2 members of the research team and went through a consensus process. Forty-three unique coping statements emerged that fit with the Compas model of adolescent coping. SMA cope with minority stress in similar ways to heterosexual youth coping with general stress, but findings suggest that SMA may also use different kinds of coping resources. Although further research is needed, the present study identified a variety of ways SMA cope with stress and can inform future research on the development interventions. © 2015 American Psychological Association.
Keywords: Behavioral health; Coping; Minority stress; Sexual minority adolescents

Internalized heterosexism and psychological distress: The mediating roles of self-criticism and community connectedness - Puckett, J.A.; Levitt, H.M.; Horne, S.G.; Hayes-Skelton, S.A. (Psychology of Sexual Orientation and Gender Diversity, 2015)
Internalized heterosexism refers to the development of a negative view of one's own and others' sexual minority identities as a product of living within a heterosexist society. Various negative mental health outcomes have been associated with internalized heterosexism (IH), such as anxiety, depression, and suicidality. However, little is known about the actual processes through which these outcomes take place. The current study examined the role of self-criticism (a psychological process) and lack of connectedness with other sexual minorities (a social process) in explaining the relation between IH and psychological distress. Data were collected via an online survey (N = 436) and analyzed using structural equation modeling. Results supported previous research, showing a significant direct positive relationship between IH and psychological distress. In addition, higher self-criticism (β =.28, p <.001; 95% CI:.22,.36) and lower connectedness with sexual minorities (β =.10, p <.01; 95% CI:.04,.16) partially explained the shared variance between IH and psychological distress. The final model, which included both mediators of the relation between IH and psychological distress, accounted for a significant amount of the variance in psychological distress (64.3%) and fit the data well. Both self-criticism and connectedness to a sexual minority community are mechanisms that could be targeted within therapy when working to improve the mental health of clients with high IH and specific therapeutic suggestions are presented. © 2015 American Psychological Association.
Keywords: Internalized heterosexism; LGB; Mental health; Minority stress; Sexual minorities

Experiences of homophobia among gay and bisexual men: results from a cross-sectional study in seven countries - Chard, A.N.; Finneran, C.; Sullivan, P.S.; Stephenson, R. (Culture, Health and Sexuality, 2015)
Experiences of homophobic discrimination are associated with an increased prevalence of psychological disorders and increased odds of reporting suicidal ideation among gay and bisexual men. We examine two domains of homophobia – external homophobic discrimination and internalised homophobia – and their associations with sexual orientation, demographic characteristics, relationships and social support among a sample of gay and bisexual men from seven countries. Sexually active gay and bisexual men aged over 18 and residing in Australia, Brazil, Canada, South Africa, Thailand, the UK and the USA were recruited through banner advertisements on Facebook. Two outcomes were examined: reporting experiences of homophobic discrimination and reporting feelings of internalised homophobia. No covariates were consistently significantly associated with experiencing external homophobic discrimination across countries. Across all countries, bisexually identifying respondents reported significantly greater feelings of internalised homophobia. Respondents in Brazil and the UK reporting a main partner, and respondents in Australia, Brazil, Canada, South Africa, Thailand and the USA reporting a larger gay/bisexual social network, reported significantly fewer feelings of internalised homophobia. Results suggest an ameliorative effect of social networks on experiencing homophobia. Additional research should focus on the mechanisms through which social networks reduce feelings of internalised homophobia. © 2015 Taylor & Francis.
Keywords: gay/bisexual men; homophobia; minority stress; social support

Non-suicidal self-injury in a large online sample of transgender adults - Dickey, L.M.; Reisner, S.L.; Lee Juntunen, C. (Professional Psychology: Research and Practice, 2015)
Non-suicidal self-injury (NSSI) has been increasing in clinical as well as nonclinical populations in recent years. There are few published reports examining lifetime occurrence of this behavior in transgender and gender nonconforming (TGNC) people. An online survey was conducted with selfidentified TGNC adults (n = 773) in the United States over the course of 6 months in 2009. The mean age for the sample was 40.4 years (SD = 13.9). Most participants identified on the trans masculine spectrum (female-to-male or FTM; 52.0%), 33.9% identified on the trans feminine spectrum (male-tofemale or MTF), and 8.0% identified as genderqueer. Participants completed the Body Investment Scale, the Depression, Anxiety, and Stress Scales, and the Inventory of Statements about Self-Injury. Results indicated that 41.9% of participants had a lifetime history of NSSI. Scores on the subscales of Protection and Feeling from the Body Investment Scale were found to be statistically predictive of NSSI. These findings shed new light on the lifetime prevalence of NSSI in this online TGNC respondent sample. Practice implications are discussed for mental health professionals who work with TGNC clients in addition to research recommendations. © 2015 American Psychological Association.
Keywords: FTM; MTF; Non-suicidal self-injury; NSSI; TGNC; Transgender

Unequal Treatment of Transgender Individuals in Domestic Violence and Rape Crisis Programs - Seelman, K.L. (Journal of Social Service Research, 2015)
Transgender people often face barriers in accessing culturally competent domestic violence and rape crisis services, yet few studies have used a national sample of transgender people to study this topic or examine differential rates of discrimination within this population. The National Transgender Discrimination Survey, conducted in 2008 to 2009 by the National Center for Transgender Equality and the National Gay and Lesbian Task Force, collected data about discrimination affecting transgender people across a variety of settings. The present study involves secondary data analysis of this data set to examine whether certain sociodemographic factors and psychosocial risks are significant predictors of unequal treatment of transgender people in domestic violence programs (N = 2,438) and rape crisis centers (N = 2,424). For both settings, findings indicate that transgender individuals who are low-income and not U.S. citizens are more likely to experience unequal treatment based upon being transgender or gender-nonconforming. Within domestic violence programs, transgender people of color, those with disabilities, and those more frequently perceived to be transgender by others are more likely to experience unequal treatment. Psychosocial risk factors (suicidality, sex work history, and disconnection from family) predict unequal treatment in both settings. The article concludes by discussing implications for social service practitioners and future research. © 2015 Taylor & Francis Group, LLC.
Keywords: discrimination; domestic violence; sexual assault; social services; Transgender

On Psychotherapy, LGBT Identity, and Cultural Visibility: In Conversation with Alison Bechdel - Critchfield, A.R.; Pula, J. (Journal of Gay and Lesbian Mental Health, 2015)
Alison Bechdel is an acclaimed graphic novelist whose graphic memoirs have examined her closeted gay father's suicide, her own developing sexual and gender identity, and her experiences in psychoanalysis. The authors of this article interv xpression, and considers the implications of her work for the mental health practitioner caring for LGBT individuals. Copyright © Taylor & Francis Group, LLC.
Keywords: Cultural studies; Graphic novel; LGBT; Mental health; Psychoanalysis; Psychotherapy; Transgender

Transgender care moves into the mainstream - Buchholz, L. (JAMA - Journal of the American Medical Association, 2015)

Understanding suicide attempts among gay men from their self-perceived causes - Wang, J.; Plöderl, M.; Häusermann, M.; Weiss, M.G. (Journal of Nervous and Mental Disease, 2015)
Gay men are at higher risk of suicidality. This paper describes the causes of suicide attempts as perceived by the men themselves and analyzes their impact on severity and recidivism. Mental health surveys conducted among gay men in Geneva, Switzerland, from two probability-based time-space samples in 2007 and 2011, were merged to yield a combined sample N = 762. Suicide ideation, plans, and attemptswere assessed, and respondentswho had ever attempted suicide answered open questions about perceived causes which were coded and categorized for analysis within the framework of cultural epidemiology. In all, 16.7% of the respondents reported a suicide attempt in their lifetime (59.5% of them with multiple attempts). At their latest attempt, over two thirds asserted intent to die, and half required medical assistance. There was a wide variety of perceived causes, with most individuals reporting multiple causes and many of the most common causes cited at both the first and most recent subsequent attempts. Social/inter-personal problems constitute the most prominent category. Problemswith love/relationship and accepting one's homosexuality figure consistently among the top three causes. Whereas the former tend to be associated with weaker intent to die, the latter are associated with the strongest intent to die and reported at multiple attempts. Problems with family are among the most common perceived causes at first attempt but not at the most recent subsequent attempt. Nevertheless, they tend to be related to the strongest intent to die and the greatest medical severity of all the perceived causes. Ten percent of men attempting suicide cited depression as a cause. Although it tended to be associated with weaker intent to die, depression was most likely to be reported at multiple attempts. Respondent-driven assessment yielded both common and idiosyncratic causes of suicide and their distinct effects. Some of these perceived causes are not prominent in the current literature, yet they have important implications for understanding risk and preventing suicide among gay men. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
Keywords: Cultural epidemiology; Homosexuality; Life events; Recidivism; Suicide

Perceived parental support as a protective factor against suicidal ideation of selfidentified lesbian and gay Filipino adolescents - Reyes, M.E.S.; Victorino, M.C.; Chua, A.P.; Oquendo, F.Y.; Puti, A.S.; Reglos, A.A.; McCutcheon, L.E. (North American Journal of Psychology, 2015)
This study aims to determine the relationship between perceived parental support and suicidal ideation among 340 self-identified Filipino lesbian and gay (LG) high school students. Findings showed that the greater the rejection of an LG adolescent, the higher the risk of suicidal ideation. Moreover, a rejecting maternal attitude is found to be more of a risk factor for suicidal ideation than a rejecting paternal attitude. © NAJP.

“Without This, I Would for Sure Already Be Dead”: A Qualitative Inquiry Regarding Suicide Protective Factors Among Trans Adults - Moody, C.; Peláez, S.; Fuks, N.; Smith, N.G. (Psychology of Sexual Orientation and Gender Diversity, 2015)
Despite an alarmingly high rate of attempted suicide among trans adults, few studies have investigated suicide protective factors among this population. The current study was aimed at identifying suicide protective factors among trans adults using a qualitative methodology. A sample of self-identified trans adults (N 133) was recruited from LGBT LISTSERVs across Canada. Participant were predominantly White and ranged in age from 18 to 75 years old (M 37). Qualitative data were collected online via open-ended questions and analyzed using thematic network analysis. A hybrid inductive– deductive coding framework was created by combining published suicide protective factors and participants’ responses. Five organizing themes were identified, namely social support, gender identity-related factors, transition-related factors, individual difference factors, and reasons for living. Results provide important insights for suicide prevention workers and mental/medical health professionals who work to promote the health and well-being of trans clients and their families. Clinical implications are discussed, such as the importance of aiding trans clients who seek transition-related care to gain access to care in a timely manner. © 2015 American Psychological Association.
Keywords: Protective factors; Suicide; Trans; Transgender; Transsexual

Transgender affirmative cognitive behavioral therapy: Clinical considerations and applications - Austin, A.; Craig, S.L. (Professional Psychology: Research and Practice, 2015)
Transgender individuals report pervasive discrimination, microaggressions, and victimization across the life span, contributing to disparate rates of suicide, anxiety, and depression. Clinical interventions must be empirically supported and affirming, competently and sensitively attending to the effect of transphobic discrimination on the lives and experiences of transgender people. Transgender affirmative clinical practice acknowledges and counters the oppressive contexts in which transgender clients often experience health and mental health care. The primary aim of this article is to introduce a transgender-affirming adaptation of a cognitive behavior therapy intervention (TA-CBT) for use with transgender individuals suffering from depression, anxiety, and/or suicidality. Clinical considerations such as the historical context of transgender issues in mental health care, the minority stress framework, current mental health disparities, and resilience will be explored. Transgender-affirming practice applications focused on psychoeducation, modifying problematic thinking styles, enhancing social support, and preventing suicidality will be provided. © 2015 American Psychological Association.
Keywords: Affirmative practice; Cognitive behavior therapy; Gender identity; Transgender

Dissociative symptoms in individuals with gender dysphoria: Is the elevated prevalence real? - Colizzi, M.; Costa, R.; Todarello, O. (Psychiatry Research, 2015)
This study evaluated dissociative symptomatology, childhood trauma and body uneasiness in 118 individuals with gender dysphoria, also evaluating dissociative symptoms in follow-up assessments after sex reassignment procedures were performed. We used both clinical interviews (Dissociative Disorders Interview Schedule) and self-reported scales (Dissociative Experiences Scale). A dissociative disorder of any kind seemed to be greatly prevalent (29.6%). Moreover, individuals with gender dysphoria had a high prevalence of lifetime major depressive episode (45.8%), suicide attempts (21.2%) and childhood trauma (45.8%), and all these conditions were more frequent in patients who fulfilled diagnostic criteria for any kind of dissociative disorder. Finally, when treated, patients reported lower dissociative symptoms. Results confirmed previous research about distress in gender dysphoria and improved mental health due to sex reassignment procedures. However, it resulted to be difficult to ascertain dissociation in the context of gender dysphoria, because of the similarities between the two conditions and the possible limited application of clinical instruments which do not provide an adequate differential diagnosis. Therefore, because the body uneasiness is common to dissociative experiences and gender dysphoria, the question is whether dissociation is to be seen not as an expression of pathological dissociative experiences but as a genuine feature of gender dysphoria. © 2015 Elsevier Ireland Ltd.
Keywords: Body uneasiness; Childhood trauma; Dissociative symptoms; Gender dysphoria; Gender reaffirming treatment; Transsexualism

Gender dysphoria - Atkinson, S.R.; Russell, D. (Australian Family Physician, 2015)
Background Gender dysphoria is the distress or discomfort that may occur when a person's biological sex and gender identity do not align. The true prevalence of gender dysphoria is unknown in Australia because of varying definitions, different cultural norms and paucity of data. Individuals who identify as transgender are vulnerable, and have higher rates of discrimination, depression and suicidality, compared with the general population. Objective The aim of this article is to familiarise general practitioners (GPs) with the principles of transgender care so they may provide a safe and supportive environment for patients presenting with concerns. Discussion It is important to have a basic understanding of how to conduct an initial consultation of gender dysphoria even if it is an uncommon presentation in general practice. Management should be individualised and may involve a combination of social work, education, counselling, hormone therapy and surgery. © The Royal Australian College of General practitioners 2015.

Risk factors associated with self-injurious behavior among a national sample of undergraduate college students - Taliaferro, L.A.; Muehlenkamp, J.J. (Journal of American College Health, 2015)
Objective: Nonsuicidal self-injury (NSSI) and suicidality among undergraduates represent important public health issues. This analysis identified risk factors that distinguished 3 groups, those who reported no history of self-harm; self-injury, but no suicide attempts (NSSI only); and self-injury and a suicide attempt (NSSI + SA) in the past year. Methods: Data came from 16,044 undergraduates who completed the Fall 2010 National College Health Assessment. Results: Over 3% of students reported NSSI, and one third of these individuals also attempted suicide. Factors that distinguished the NSSI only and NSSI + SA groups from the no self-harm group included current depressive symptoms, nonheterosexual orientation, an eating disorder/extreme weight control behavior, and diagnosis of an internalizing disorder. Factors that distinguished the NSSI + SA group from the NSSI only group were current depressive symptoms and diagnosis of an internalizing disorder. Conclusions: Students experiencing mental health problems demonstrate increased risk for NSSI and/or suicidal behavior. © 2015 Taylor & Francis Group, LLC.
Keywords: mental health; prevention; risk; self-injury; suicide

Social and parental support as moderators of the effects of homophobic bullying on psychological distress in youth - António, R.; Moleiro, C. (Psychology in the Schools, 2015)
The aim of this study was to explore homophobic bullying in Portugal, including its forms, prevalence, and consequences, and to verify whether parental and social support moderated the effects of homophobic bullying for victims. An online questionnaire was completed by 211 female and male students, aged 12 to 20 years. Results showed that psychological violence prevailed, male students were more often victims than female students were, and lesbian, gay, and bisexual adolescents were victims more often than their heterosexual peers were. The emotional impact on victims was higher when social support was low, including suicidal ideation and school difficulties. Furthermore, a main effect of parental support was found for emotional and behavioral distress indices experienced by adolescents. © 2015 Wiley Periodicals, Inc.

The Role of Social Connectedness and Sexual Orientation in the Prevention of Youth Suicide Ideation and Attempts among Sexually Active Adolescents - Stone, D.M.; Luo, F.; Lippy, C.; McIntosh, W.L. (Suicide and Life-Threatening Behavior, 2015)
The impact of types of social connectedness - family, other adult, and school - on suicide ideation and attempts among all youth, the relative impact of each type, and effect modification by sexual orientation was assessed. Data were from the 2007-2009 Milwaukee Youth Risk Behavior Surveys. Multivariable logistic regression analyses calculated the risk of suicide ideation and attempts by sexual orientation, types of social connectedness, and their interaction. Among all youth, each type of connectedness modeled singly conferred protective effects for suicide ideation. Family and other adult connectedness protected against suicide attempts. When modeled simultaneously, family connectedness protected against ideation and attempts. Sexual orientation modified the association between other adult connectedness and suicide ideation. Findings suggest that family connectedness confers the most consistent protection among all youth and sexual orientation does not generally modify the association between connectedness and suicidal behavior. © Published 2014. This article is a U.S. Government work and is in the public domain in the USA.

Religious belief, age, and sexual orientation on attributions of younger and older gay and heterosexual men - Kane, M.; Jacobs, R.J.; Sherman, D. (Mental Health, Religion and Culture, 2015)
Using 4 vignettes and 20 response items, this exploratory study investigated attributions about older or younger gay or heterosexual men with a history of multiple sex partners, substance abuse, and legal problems. The character is diagnosed with a terminal illness and two options for care: no treatment or an aggressive treatment protocol with a small chance of recovery. When controlling for respondents’ (N = 324) religious identification, frequency of attendance at religious services, and ethno-cultural identification, a General Linear Model was significant (F = 57.014, df = 20, p <.001). Differences in the vignette responses centred on perceptions of quality of life, the character's lifestyle, and suicide. © 2015 Taylor & Francis.
Keywords: ageism; illness; quality of life; religion; sexual orientation; substance misuse

Mike Penner ‘or’ Christine Daniels: the US media and the fractured representation of a transgender sportswriter - Pieper, L.P. (Sport in Society, 2015)
On 26 April 2007, US sportswriter Mike Penner told readers he was transsexual and that he would return to the paper as Christine Daniels. Journalists immediately analysed and assessed this column. Three months later, Daniels' first byline appeared as she assumed her former beats. Yet, after eight months in the spotlight, Daniels faded from view and, without explanation, Penner's name returned. Although the paper did not offer details on Penner's return, his re-emergence proved newsworthy. While the byline appeared consistently, Penner rarely appeared in public. On 27 November 2009, he committed suicide. By interrogating the fragmented coverage of Penner/Daniels in these three periods of his/her life – transition, (re/de)transition and suicide – this paper argues that the media selectively framed Penner/Daniels's gender identity and used gender pronouns purposefully to create specific meanings. Few described Penner/Daniels in entirety; as a result, the life was flattened into a one-dimensional category of gender advocacy. © 2013, © 2013 Taylor & Francis.

Portraits of (Un)settlement: Troubling multicultural masculinities in Dominique Hui’s quiet north and kent Monkman’s shooting geronimo - Lee, R. (GLQ, 2015)
This essay considers the production of racialized masculinities in the contemporary artwork of the Singaporean-born queer diasporic artist Dominique Hui and the queer Aboriginal/Cree artist Kent Monkman. Recent debates in anti-racist feminist, queer, and Native feminist scholarship illuminate how diasporic and Indigenous groups are unevenly positioned within a framework of neoliberal multiculturalism and settler state colonialism in the Americas. Accordingly, there are important distinctions in the way that queer diasporic and queer Native artists respond to and challenge hetero- and homonormative models of citizenship in Canada. I examine how Hui's and Monkman's works reflect and mediate the interactions of multiple racialized masculinities in an identity-driven and individualized culture of neoliberalism and global consumer capitalism. Overall, I suggest that applying Native feminist critiques to a relational analysis of queer diasporic and Indigenous masculinities can unsettle and imagine new possibilities for “multicultural” solidarity in Canada—and beyond. © 2015 by Duke University Press.

Critical military studies, queer theory, and the possibilities of critique: The case of suicide and family caregiving in the US military - Wool, Z.H. (Critical Military Studies, 2015)
This paper explores the expansive possibilities for a critical military studies that approaches the mechanisms of war-making as coextensive with broader arrangements of social life, rather than as intersecting or overlapping with distinguishable social spheres, like gender. The potential here is both analytical and theoretical: analytical in that it opens up productive avenues of critique through which to explore, but not resolve, the contradictions that animate war-making and military life; theoretical in that war-making and military life offer spaces through which to consider deep questions of social theory-of, for example, the contours of a life worth living in liberal fantasies of the good life-that are amplified in this context, but that resonate well beyond it. In conversation with queer theory, the paper illustrates these possibilities by thinking through the ways that concern about soldier and veteran suicide is imbricated with heteronormative ideals of the family and practices of caregiving in the contemporary US. © 2014 Taylor & Francis.
Keywords: Caregiving; Family; Queer theory; Suicide; US military

Opposing Abortion, Gay Adoption, Euthanasia, and Suicide - Deak, C.; Saroglou, V. (Archive for the Psychology of Religion, 2015)
In secularized modern Western societies, moral opposition to the liberalization of abortion, gay adoption, euthanasia, and suicide often relies on justifications based on other-oriented motives (mainly, protection of the weak, e.g., children). Moreover, some argue that the truly open-minded people may be those who, against the stream, oppose the established dominant liberal values in modern societies. We investigated whether moral and religious opposition to, vs. the acceptance of, the above four issues, as well as the endorsement of respective con vs. pro arguments reflect (a) "compassionate openness" (prosocial, interpersonal, dispositions and existential flexibility), (b) "compassionate conservatism" (prosocial dispositions and collectivistic moral concerns), or (c) "self-centered moral rigorism" (collectivistic moral concerns, low existential quest, and low humility instead of prosocial dispositions). The results, to some extent, confirmed the third pattern. Thus, compassionate openness does not seem to underline modern moral opposition, possibly in contrast to some rhetoric of the latter. © 2015 Koninklijke Brill NV, Leiden, The Netherlands.
Keywords: conservatism; euthanasia; homosexuality; moral opposition; prosociality; religion

Turning ‘fate’ into destiny by seizing a second chance at life - Bateman, C. (South African Medical Journal, 2015)
‘What happened in the past is totally out of my control now.’ With that simple yet life-giving affirmation, Daryl Brown, 27, legless in a wheel-chair after jumping into the path of a London underground train on 29 September  last year, sums up the sea-change in his world view. © 2014, South African Medical Association. All rights reserved.
Keywords: Cognitive behavioural therapy; Depression; Suicide

Retrospective autopsy study of deaths due to rodenticides - Venkata Raghava, S.; Sumangala, C.N.; Dileepkumar, K.B.; PradeepKumar, M.P. (Medico-Legal Update, 2015)
Rodents are mammals of the orderRodentia, characterized by a single pair of continuously growing incisors in each of the upper and lower jaws.About forty percent of all species of mammals are rodents, and they are found in vast numbers on all continents except Antartica.Rodenticides are commonly used to kill variety of rodents which cause great loss of food grains. Simple access and easy availability to these rodenticides results in their consumption. A detailed autopsy study of deaths due to rodenticides has been made, thereby studying the various factors like age, sex, manner of death, reasons for death etc. Majority were suicidal deaths, ill-healthbeing the leading reason for death among suicides. © 2015, World Informations Syndicate. All rights reserved.
Keywords: Ill-health; Rodenticide; Suicide

Treatment for gender dysphoria in children: The new legal, ethical and clinical landscape - Smith, M.K.; Mathews, B. (Medical Journal of Australia, 2015)
Gender dysphoria is a condition in which a child’s subjectively felt identity and gender are not congruent with her or his biological sex. Because of this, the child suffers clinically significant distress or impairment in social functioning. • The Family Court of Australia has recently received an increasing number of applications seeking authorisation for the provision of hormones to treat gender dysphoria in children. • Some medical procedures and interventions performed on children are of such a grave nature that court authorisation must be obtained to render them lawful. These procedures are referred to as special medical procedures. • Hormonal therapy for the treatment of gender dysphoria in children is provided in two stages occurring years apart. Until recently, both stages of treatment were regarded by courts as special medical treatments, meaning court authorisation had to be provided for both stages. • In a significant recent development, courts have drawn a distinction between the two stages of treatment, permitting parents to consent to the first stage. In addition, it has been held that a child who is determined by a court to be Gillick competent can consent to stage 2 treatment. • The new legal developments concerning treatment for gender dysphoria are of ethical, clinical and practical importance to children and their families, and to medical practitioners treating children with gender dysphoria. Medical practitioners should benefit from an understanding of the recent developments in legal principles. This will ensure that they have up-to-date information about the circumstances under which treatment may be conducted with parental consent, and those in which they must seek court authorisation. © 2015, MJA. All rights reserved.

Heavy alcohol use and suicidal behavior among people who use illicit drugs: A cohort study - Kennedy, M.C.; Marshall, B.D.L.; Hayashi, K.; Nguyen, P.; Wood, E.; Kerr, T. (Drug and Alcohol Dependence, 2015)
Background: People who use illicit drugs (PWUD) are known to experience high rates of suicidal behavior. While heavy alcohol use has been associated with suicide risk, its impact on the suicidal behavior of PWUD has not been well characterized. Therefore, we examined the relationship between heavy alcohol use and suicidal behavior among PWUD in Vancouver, Canada. Methods: Data are derived from two prospective cohort studies of PWUD in Vancouver, Canada, from 2005 to 2013. Participants completed questionnaires that elicited information regarding sociodemographics, drug use patterns, and mental health problems, including suicidal behavior. We used recurrent event survival analyses to estimate the independent association between at-risk/heavy drinking (based on National Institute of Alcohol Abuse and Alcoholism [NIAAA] criteria) and risk of incident, self-reported suicide attempts. Results: Of 1757 participants, 162 participants (9.2%) reported 227 suicide attempts over the 8-year study period, resulting in an incidence rate of 2.5 cases per 100 person-years. After adjusting for potential confounders, including intensive illicit drug use patterns, heavy alcohol use (adjusted hazard ratio [AHR] = 1.97; 95% confidence interval [CI] = 1.39, 2.78) was positively associated with an increased risk of suicidal behavior. Conclusions: We observed a high burden of suicidal behavior among a community-recruited sample of PWUD. Heavy alcohol use predicted a higher risk of suicide attempt, independent of other drug use patterns. These findings demonstrate the need for evidence-based interventions to address suicide risk among PWUD, particularly those who are heavy consumers of alcohol. © 2015 Elsevier Ireland Ltd.
Keywords: Alcohol; Canada; Illicit drug use; Suicide; Survival analysis

Queering catholic fundamentalism: On liking theology in masculinities research - Burke, K.J. (Masculinities and Social Change, 2015)
This article seeks to build on recent movement in the fields of religion and gender studies in order to analyze and critically reflect on “the relation, confrontation and intersection of gender and religion” (Korte, 2011, p. 2). Here the author works to investigate the possibility that emerges in new forms of analysis that marry theological interventions with masculinities studies as a way to newly attend to patriarchy and fundamentalism. Utilizing feminist Catholic theology, the work addresses unique and recent problems that have emerged in the Church in the face of a new era that appears both more progressive and that has engendered conservative backlash. Along the way the article addresses issues of gender and sexuality as they relate to the priesthood and Pope Francis’ recent assertions linking gender theory to ideological colonization and even nuclear armaments. © 2015, Hipatia Press. All rights reserved.
Keywords: Hegemonic masculinity; Homophobia; Homosexuality; Suicide behavior

Motivations for Participation in the YouTube-Based 'It Gets Better Project' - Honda, L.P. (Proceedings of the Annual Hawaii International Conference on System Sciences, 2015)
In response to multiple LGBTQ youth suicides in 2010, Dan Savage and Terry Miller sought to provide messages of hope to at-risk LGBTQ youth through the YouTube-based 'It Gets Better Project' (IGBP). With empirical data gathered through online chat-based in-depth interviews, this study offers insight into multi-dimensional motivations for participation in an online community. Pointedly, data show how the intersection of participants' identities and structural oppressions contribute to their motivations for participation. © 2015 IEEE.

Erratum to "Psychiatric disorders, suicidality, and personality among young men by sexual orientation" [Eur. Psych. 29 (2014) 514-522] doi 10.1016/j.eurpsy.2014.05.001 - Wang, J.; Dey, M.; Soldati, L.; Weiss, M.G.; Gmel, G.; Mohler-Kuo, M. (European Psychiatry, 2015)

Limits of dissent, perils of activism: Spaces of resistance and the new security logic - Amir, M.; Kotef, H. (Antipode, 2015)
On 26 December 2003 an Israeli activist was shot by the Israeli Army while he was participating in a demonstration organized by Anarchists Against the Wall (AAtW) in the West Bank. This was the first time Israeli Soldiers have deliberately shot live bullets at a Jewish-Israeli activist. This paper is an attempt to understand the set of conditions, the enveloping frameworks, and the new discourses that have made this event, and similar shootings that soon followed, possible. Situating the actions of AAtW within a much wider context of securitization-of identities, movements, and bodies-we examine strategies of resistance which are deployed in highly securitized public spaces. We claim that an unexpected matrix of identity in which abnormality is configured as security threat render the bodies of activists especially precarious. The paper thus provides an account of the new rationales of security technologies and tactics which increasingly govern public spaces. © 2014 Antipode Foundation Ltd.
Keywords: Activism; Anarchists Against the Wall; Critical security studies; Israel/Palestine; Queer theory

Frequent callers to crisis helplines: Who are they and why do they call? - Spittal, M.J.; Fedyszyn, I.; Middleton, A.; Bassilios, B.; Gunn, J.; Woodward, A.; Pirkis, J. (Australian and New Zealand Journal of Psychiatry, 2015)
Objective: Frequent callers present a challenge for crisis helplines, which strive to achieve optimal outcomes for all callers within finite resources. This study aimed to describe frequent callers to Lifeline (the largest crisis helpline in Australia) and compare them with non-frequent callers, with a view to furthering knowledge about models of service delivery that might meet the needs of frequent callers. Method: Lifeline provided an anonymous dataset on calls made between December 2011 and May 2013. We assumed calls from the same (encrypted) phone number were made by the same person, and aggregated call level data up to the person level. Individuals who made 0.667 calls per day in any period from 1 week to the full 549 days for which we had data (i.e. 4.7 calls in 7 days, 20 calls in 30 days, 40 calls in 60 days, etc.) were regarded as frequent callers. Results: Our analysis dataset included 411,725 calls made by 98,174 individuals, 2594 (2.6%) of whom met our definition of frequent callers. We identified a number of predictors of being a frequent caller, including being male or transgender, and never having been married. The odds increased with age until 55-64 years, and then declined. Suicidality, self-harm, mental health issues, crime, child protection and domestic violence issues all predicted being a frequent caller. Conclusions: Collectively, frequent callers have a significant impact on crisis lines, and solutions need to be found for responding to them that are in everybody's best interests (i.e. the frequent callers themselves, other callers, telephone crisis supporters who staff crisis lines, and those who manage crisis lines). In striking this balance, the complex and multiple needs of frequent callers must be taken into account. © 2014 The Royal Australian and New Zealand College of Psychiatrists.
Keywords: Crisis helplines; frequent callers; self-harm; suicide

Constructing the victim in the bullying narrative: How bullying discourses affirm rather than challenge discriminatory notions of gender and sexuality - Foreman, V. (Crime, Media, Culture, 2015)
This project focuses on how bullying victims are constructed as victims through a content analysis of news articles on Phoebe Prince and Tyler Clementi, two teens who committed suicide after being bullied. While the discourse that emerges from these cases appears to do similar symbolic work as hate crime laws that condemn harassment based on sexual orientation, on closer examination the discourses can also be read as upholding discriminatory systems of patriarchy and heteronormativity in their attempts to explain the suicides as an expected or predictable response to homophobia and sexism. Framing Prince and Clementi as victims of bullying, rather than victims of poor mental health or family discord, creates a narrative that reifies rather than challenges repressive and discriminatory notions of sexuality and gender. © 2015 The Author(s).
Keywords: Bullying; heteronormativity; media; patriarchy; victim

Putting Health and Behavior in Context: Current Knowledge and Future Directions on Research Embracing Ecological Perspectives - Duncan, D.T. (Behavioral Medicine, 2015)

Pope Francis, weak theology, and the subtle transformation of Roman Catholic bioethics - Cherry, M.J. (Christian Bioethics, 2015)
Pope Francis has emerged as a popular, progressive, and potentially transformative figure for Roman Catholicism. However, he has been careful to avoid firm doctrinal accounts of Roman Catholicism's traditional positions on bioethics. Condemnations of abortion, the destruction of human embryos, artificial insemination, assisted suicide, euthanasia, homosexual acts, and so forth have been relocated within a pastoral discourse. Many of Francis' public statements on bioethics, especially as developed in Evangelii Gaudium, appear to adopt a weak postmodern position; that is, a position that avoids directly underscoring an objectively true moral-theological position. Such a "weak theology" does not require Roman Catholicism to confront secular bioethics directly, much less to convert the world to Christ. This short paper outlines the dramatic change in framing context that Pope Francis proposes for Roman Catholic theology, which will also subtly but substantially change the character of Roman Catholic bioethical concerns. © The Author 2015.
Keywords: Pope Francis; Roman catholic bioethics; Weak theology

The choking game: A deadly game. Analysis of two cases of "self-strangulation" in young boys and review of the literature - Re, L.; Birkhoff, J.M.; Sozzi, M.; Andrello, L.; Osculati, A.M.M. (Journal of Forensic and Legal Medicine, 2015)
The choking game is defined as a self-strangulation or strangulation by another person with the hands or a noose to achieve a brief euphoric state caused by cerebral hypoxia. Death may occur, but forensic pathologists often classify them as suicides or accidental deaths, without focusing on the possibility that they may result from a deliberate self-temporary-asphyxiation, turned into a deadly game. Presenting two fatal cases of self-strangulation involving an 11-year-old boy and a teenager of 15 years, the authors identify victims' characteristics and death scene's evidence, which may help to distinguish if a death is from an asphyxial suicide or an asphyxial game. © 2014 Elsevier Ltd and Faculty of Forensic and Legal Medicine.
Keywords: Asphyxial game; Choking game; Jeu du foulard; Self-strangulation

Ideological perspective detection using semantic features - Elfardy, H.; Diab, M.; Callison-Burch, C. (Proceedings of the 4th Joint Conference on Lexical and Computational Semantics, *SEM 2015, 2015)
In this paper, we propose the use of word sense disambiguation and latent semantic features to automatically identify a person's perspective from his/her written text. We run an Amazon Mechanical Turk experiment where we ask Turkers to answer a set of constrained and open-ended political questions drawn from the American National Election Studies (ANES). We then extract the proposed features from the answers to the open-ended questions and use them to predict the answer to one of the constrained questions, namely, their preferred Presidential Candidate. In addition to this newly created dataset, we also evaluate our proposed approach on a second standard dataset of "Ideological-Debates". This latter dataset contains topics from four domains: Abortion, Creationism, Gun Rights and Gay- Rights. Experimental results show that using word sense disambiguation and latentsemantics, whether separately or combined, beats the majority and random baselines on the cross-validation and held-out-test sets for both the ANES and the four domains of the "Ideological Debates" datasets. Moreover combining both feature sets outperforms a stronger unigram-only classification system.

Non-suicidal self-injury in patients with eating disorder: Associations with identity formation above and beyond anxiety and depression - Claes, L.; Luyckx, K.; Bijttebier, P.; Turner, B.; Ghandi, A.; Smets, J.; Norre, J.; Van Assche, L.; Verheyen, E.; Goris, Y.; Hoksbergen, I.; Schoevaerts, K. (European Eating Disorders Review, 2015)
In the present study, we investigated the association between non-suicidal self-injury (NSSI) and problems in identity formation among patients with eating disorder (ED). NSSI is highly prevalent in ED, and problems with identity formation are characteristic of both NSSI and ED. Few studies, however, have investigated identity formation in patients with ED with and without NSSI while taking into account comorbid psychopathology (e.g. anxiety and depression). Therefore, we investigated the relationships between NSSI characteristics, identity confusion/synthesis, and anxiety/depression in 99 female patients with ED by means of self-report questionnaires. The results showed that 58.6% of the patients with ED engaged in at least one type of NSSI (most frequently cutting), with no significant differences in rates of NSSI or identity problems among ED subtypes. Presence, versatility and automatic negative reinforcement functions of NSSI were each significantly and positively related to identity confusion and negatively related to identity synthesis. Even after controlling for age, anxiety, and depression, lack of identity synthesis remained a significant predictor of NSSI in patients with ED. Given that NSSI may constitute an effort to deal with identity confusion/synthesis in patients with ED, therapists should take this developmental task into account while treating patients with ED with NSSI. Copyright © 2014 John Wiley & Sons, Ltd and Eating Disorders Association.
Keywords: anxiety; depression; eating disorders; identity confusion; identity synthesis; non-suicidal self-injury

On liberty and the Fourteenth Amendment: The original understanding of the Lockean Natural Rights Guarantees - Calabresi, S.G.; Vickery, S.M. (Texas Law Review, 2015)
The debate as to what unenumerated rights, if any, are protected by the Constitution is directly relevant to the most controversial issues in constitutional law today—from gay marriage, to gun-control measures, to substance-control regulation, to specific personal liberties, and finally to property regulation, to name just a few. Much of the unenumerated rights debate centers on the U.S. Supreme Court’s substantive Due Process Clause case law interpreting the Fourteenth Amendment. These cases address the question of which specific rights are implicated by the protection of life, liberty, and property in the Due Process Clause of the Fourteenth Amendment. Some Justices on the U.S. Supreme Court have written or joined opinions that argue that the answer to this question can be found by looking for rights that are deeply rooted in American history and tradition at the most specific level of generality available. State constitutional case law from 1776 up to 1868 is thus potentially of great relevance to understanding American history and tradition because by 1868, the year the Fourteenth Amendment was ratified, two-thirds of the existing state constitutions contained what we refer to as “Lockean Natural Rights Guarantees,” provisions protecting life, liberty, and property and guaranteeing inalienable, natural, or inherent rights of an unenumerated rights type. In this Article, we identify and exhaustively analyze nearly a century of state case law from the time of the Founding until 1868, in which state courts interpret and apply state constitutional Lockean Natural Rights Guarantees to an enormous variety of issues. From this robust body of state constitutional case law, we conclude that the Lockean Natural Rights Guarantees in most state constitutions had great significance with respect to the abolition of slavery and the extension of civil and political rights to individuals and minority-group members living in the northern states. At the same time, with respect to property regulation, state courts struggled to give concrete meaning to the Lockean Natural Rights Guarantees in their state constitutions, and while not discounting the possibility that some regulations could violate the Guarantees, the state courts generally deferred to the legislature. This evidence suggests that “liberty,” in the context of the Fourteenth Amendment, is best understood broadly to encompass natural rights and to require that civil and political rights be extended to minorities, a finding of particular relevance to the debate on gay marriage. However, the range of issues potentially implicated by the Lockean Natural Rights Guarantees and inconsistent rulings in many areas also suggest that determining which specific rights are implicated by the protection of liberty posed the same challenge to state courts between 1776 and 1868 that present courts face today, and that the quest to identify unenumerated rights that are deeply rooted in American history and tradition is itself somewhat quixotic. © 2015 School of Law Publications. All rights reserved.

Fifty states, fifty attorneys general, and fifty approaches to the duty to defend - Devins, N.; Krishna Prakash, S. (Yale Law Journal, 2015)
Whether a state attorney general has a duty to defend the validity of state law is a complicated question, one that cannot be decided by reference either to the oath state officers must take to support the federal Constitution or the supremacy of federal law. Instead, whether a state attorney general must defend state law turns on her own state’s laws. Each state has its own constitution, statutes, bar rules, and traditions, and not surprisingly, the duties of attorneys general vary across the states. To simplify somewhat, we believe that there are three types of duties. One set of attorneys general has a duty to defend state law against state and federal challenges, while a second group has no duty to defend state law in such scenarios. A third cohort of attorneys general has a power (and in some cases a duty) to attack state statutes of dubious validity. They may (or must) proactively file suit to obtain judicial resolution of constitutional questions. Given that these duties vary across the states, politicians (including attorneys general) who blithely conclude that all state attorneys general must defend all state laws or, conversely, that all may refuse to defend whenever they believe a state law is unconstitutional evince a lamentable indifference to the power of states to craft an office that suits their particular needs. As the same-sex marriage debate reveals, categorical statements about whether state attorneys general must (or must not) defend bars on same-sex marriage are usually little more than self-serving sound bites from elected, politically ambitious attorneys general, intended for constituents focused on policy outcomes rather than legal questions. With Democrats and Republicans squarely divided on issues like same-sex marriage, gun control, and campaign finance, we predict that attorneys general will increasingly seek political advantage by refusing to defend (or insisting on the defense of) laws that divide the parties. We also foresee that failures to defend will be especially likely to occur in states where the attorney general is of a different political party than the governor, legislature, or the preceding attorney general. © 2014, Yale Law Journal. All rights reserved.

Different relational models underlie prototypical left and right positions on social issues - Simpson, A.; Laham, S.M. (European Journal of Social Psychology, 2015)
Social issues are important dividing lines in the "culture wars" between the political left and right. Despite much research into social issue stance and ideology, little research has explored these with Relational Models Theory (RMT). RMT proposes four distinct models that people use to construe social relations, each entailing distinct moral considerations. In two studies, participants read summaries of the models, rated how relevant each was to their positions on several social issues (e.g.,capital punishment), and expressed issue positions. In Study 1, Communal Sharing and Equality Matching construals predicted prototypical liberal positions across a range of issues; Authority Ranking and Market Pricing construals predicted prototypical conservative positions. By using multilevel modelling in Study 2, individual differences in average Communal Sharing and Authority Ranking construals predicted prototypical liberal and conservative positions, respectively, independent of several factors known to predict social issue stance. In issue-specific analyses (e.g.,focusing on euthanasia), all models showed effects independent of self-reported ideology, while for certain issues (same-sex marriage, animal testing, gun control, and flag burning), issue construal using different models predicted opposing positions, implicating relational models in moral disagreement. This paper provides novel tests of Relationship Regulation Theory and suggests that RMT is relevant in understanding political ideology, social issue stance, and moral judgement. © 2014 John Wiley & Sons, Ltd.

Psychiatric symptoms in temporal lobe epilepsy with left mesial hippocampal sclerosis - Jang, H.; Kim, S.H.; Park, S.H.; Choo, I.H.; Kim, S.G. (Psychiatry Investigation, 2015)
A 16-year-old woman was referred to us for depression and persistent suicidal and homicidal ideation. From 2010, the patient visited a neurologist due to recurrent grand mal epilepsy, auditory and visual hallucinations, episodic memory loss, and persistent depression. Upon admission, it was revealed through clinical history taking that she had suffered from chronic bullying from same-sex peers and sexual abuse, twice, from an adult male in the neighborhood when she was 10 years old. A brain magnetic resonance imaging study showed left mesial hippocampal sclerosis. The patient exhibited improvement of her psychiatric symptoms after treatment with a combination of fluoxetine (30 mg) and aripiprazole (10 mg). Children and adolescents with epilepsy experience conflicts in the family, challenges at school, stigma, and psychosocial limitations or deprivations due to their comorbid psychiatric symptoms and hence, psychiatric evaluation and early intervention is important when treating these patients. © 2015 Korean Neuropsychiatric Association.
Keywords: Homicidal ideation; Left mesial hippocampal sclerosis; Suicidal ideation; Temporal lobe epilepsy

Suicides among lesbian, gay, bisexual, and transgender populations in Australia: An analysis of the queensland suicide register - Skerrett, D.M.; Kõlves, K.; De Leo, D. (Asia-Pacific Psychiatry, 2014)
Introduction: Sexual orientation is seldom recorded at death in Australia, and to date there have been no studies on the relationship between those that have died by suicide and sexuality or minority gender identity in Australia. The aim of the present study is to determine whether or not lesbian, gay, bisexual, transgender (LGBT), and intersex individuals who die by suicide constitute a unique subpopulation of those who die by suicide, when compared with non-lesbian, gay, bisexual, transgender, and intersex suicide deaths. Methods: The Queensland Suicide Register holds records of all suicides in Queensland since 1990. All cases from 2000 to 2009 (inclusive; a total of 5,966 cases) were checked for potential indicators of individuals' sexual orientation and gender identification. A total of 35 lesbian (n=10), gay (n=22), bisexual (n=2), and transgender (n=1) suicide cases were identified. Three comparison cases of non-LGBT suicides for each LGBT suicide were then located, matched by age and gender. Conditional logistic regression was used to calculate odds ratios with 95% confidence intervals. Results: It was significantly more likely that depression was mentioned in the cases of LGBT suicides than in non-LGBT cases. While 12.4% of the comparison group had been diagnosed with psychotic disorders, there were no such diagnoses among LGBT individuals. LGBT individuals experienced relationship problems more often, with relationship conflict also being more frequent than in non-LGBT cases. Discussion: Despite its limitations, this study - the first of its kind in Australia - seems to indicate that LGBT people would require targeted approaches in mental and general health services. © 2014 Wiley Publishing Asia Pty Ltd.
Keywords: Australia; LGBT; Queensland suicide register; Suicide

Mortality among veterans with transgender-related diagnoses in the veterans health administration, FY2000-2009 - Blosnich, J.R.; Brown, G.R.; Wojcio, S.; Jones, K.T.; Bossarte, R.M. (LGBT Health, 2014)
Purpose: The aims of this project were to document all-cause and suicide mortality among Veteran Healthcare Administration (VHA) utilizers with The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis consistent with transgender status. Methods: The study population consisted of VHA patients identified as having any one of four diagnosis codes indicating transgender status (n=5,117) gathered from the VA National Patient Care Database. Mortality data were gathered from the National Death Index from 2000-2009 for 1,277 veterans with transgender-related ICD-9-CM diagnoses. The remaining 3,840 were not searched because they had VHA utilization after 2009 (indicating they were alive). Person-time at risk (person-years) for crude rates were calculated based on the time from an individual's index diagnosis to either death or the end of FY 2009. Causes of death were categorized using ICD-10 code groups. Results: Approximately 9.3% (n=309) veterans with transgender-related ICD-9-CM diagnoses died across the study period. Although diseases of the circulatory system and neoplasms were the first and second leading causes of death, respectively, the other ranked causes of mortality differed somewhat from patterns for the US during the same time span. The crude suicide rate among veterans with transgender-related ICD-9-CM diagnoses across the 10-year period was approximately 82/100,000 person-years, which approximated the crude suicide death rates for other serious mental illness in VHA (e.g., depression, schizophrenia). The average age of suicide decedents was 49.4 years. Conclusion: The crude suicide rate among veterans with transgender-related ICD-9-CM diagnoses is higher than in the general population, and they may be dying by suicide at younger ages than their veteran peers without transgender-related ICD-9-CM diagnoses. Future research, such as age-adjusted rates or accounting for psychiatric co-morbidities, will help to better clarify if the all-cause and suicide mortality rates are elevated for veterans with transgender-related ICD-9-CM diagnoses. © Mary Ann Liebert, Inc. 2014.
Keywords: mortality; suicide; transgender persons; veterans

Navigating Community Institutions: Black Transgender Women’s Experiences in Schools, the Criminal Justice System, and Churches - Graham, L.F. (Sexuality Research and Social Policy, 2014)
Young transgender women, especially those of color, are negatively impacted by suicidality, HIV, residential instability, survival sex work, and other challenges. This study used an oral narrative approach to collect life histories of 10 young black transwomen between 18 and 24 years of age residing in Detroit, Michigan. This study used grounded theory analysis to explore institutional violence, discrimination, and harassment (VDH). Participants described their experiences navigating three community institutions (schools, the criminal justice system, and churches) and broader society. Results highlight VDH through gender policing at school, sexual victimization in the criminal justice system, and negative judgment of gender variation in faith-based institutions. Participants reference the essential role of support systems, including other transgender individuals, in both their gender identity development and the navigation of institutions. Significant policy intervention is needed to protect and support transwomen, and prevent VDH perpetuated against them. Across all institutions, policy and practice interventions can focus on use of transgender appropriate and sensitive language, prevention of physical and sexual assaults, and anti-discrimination measures. Specific policy recommendations and future research directions are outlined. © 2014, Springer Science+Business Media New York.
Keywords: Discrimination; Narrative; Social support; Transgender; Violence

The ‘G’ men: A profile of GBL/GHB users in an area of high drug-related mortality - Durgahee, S.; Allen, G.; Williams, H. (Irish Journal of Psychological Medicine, 2014)
Objectives. Gamma-butyrolactone/gamma-hydroxybutyrate (GBL/GHB) and related analogues are increasingly misused. The study reports on patient characteristics, nature and pattern of use, complications and comorbidity for a cohort of patients presenting to a large Substance Misuse Service in Brighton and Hove City. Method. A retrospective case-note review of routinely collected clinical data on patients with primary GBL/GHB misuse. Results. In all, 24 individuals were male and 3 female, with a mean age of 34 years. A total of 21 males identified themselves as gay and 1 female as bisexual. Just over half (15, 56%), respectively, were living in stable accommodation and were in employment or third-level education. In all, 22 (81%) met criteria for physical dependence and two-thirds (18, 67%) had experienced overdose. The group was using large amounts of GBL (mean 53 ml/day) with a significant number (25, 93%) using ‘around the clock’ (every 1-3 hours). Over one-third (10, 37%) had a diagnosis of HIV and with 24 (89%) having a presumptive diagnosis of anxiety disorder. Conclusions. A profile of gay men with relatively stable lifestyles, but nevertheless with a high rate of complication of GBL/GHB use and with a significant comorbidity (HIV and psychological problems) was identified. The need for integrated specialist services and the importance of liaison with Emergency Departments and HIV services is highlighted. Received 3 April 2014; Revised 2 June 2014; Accepted 8 July 2014; First published online 11 August 2014. © College of Psychiatrists of Ireland 2014.
Keywords: Club drugs; Emergency department; Gamma-butyrolactone; Gamma-hydroxybutyrate; HIV; Novel psychoactive substances; Overdose

Impact of sexual orientation and gender identity on suicide risk: Implications for assessment and treatment - Haas, A.P.; Drescher, J. (Psychiatric Times, 2014)

Stressful life events, sexual orientation, and cardiometabolic risk among young adults in the United States - Hatzenbuehler, M.L.; Slopen, N.; McLaughlin, K.A. (Health Psychology, 2014)
Objective: The goal of the present study was to examine whether sexual minority young adults are more vulnerable to developing cardiometabolic risk following exposure to stressful life events than heterosexual young adults. Method: Data came from the National Longitudinal Study for Adolescent Health (Shin, Edwards, & Heeren, 2009; Brummett et al., 2013), a prospective nationally representative study of U.S. adolescents followed into young adulthood. A total of 306 lesbian, gay, and bisexual (LGB) respondents and 6,667 heterosexual respondents met inclusion criteria for this analysis. Measures of cumulative stressful life events were drawn from all 4 waves of data collection; sexual orientation and cardiometabolic biomarkers were assessed at Wave 4 (2008 -2009). Results: Gay/bisexual men exposed to 1-2 (β = 0.71, p = .01) and 5+ (β = 0.87, p = .01) stressful life events had a statistically significant elevation in cardiometabolic risk, controlling for demographics, health behaviors, and socioeconomic status. Moreover, in models adjusted for all covariates, lesbian/bisexual (β = 0.52, p = .046) women with 5+ stressful life events had a statistically significant elevation in cardiometabolic risk. There was no relationship between stressful life events and cardiometabolic risk among heterosexual men or women. Conclusion: Stressful life events during childhood, adolescence, and young adulthood place LGB young adults at heightened risk for elevated cardiometabolic risk as early as young adulthood. The mechanisms underlying this relationship require future study. © 2014 American Psychological Association.
Keywords: Cardiometabolic biomarkers; Sexual orientation; Stressful life events; Young adults

Psychiatric disorders, suicidality, and personality among young men by sexual orientation - Wang, J.; Dey, M.; Soldati, L.; Weiss, M.G.; Gmel, G.; Mohler-Kuo, M. (European Psychiatry, 2014)
Personality and its potential role in mediating risk of psychiatric disorders and suicidality are assessed by sexual orientation, using data collected among young Swiss men (n= 5875) recruited while presenting for mandatory military conscription. Mental health outcomes were analyzed by sexual attraction using logistic regression, controlling for five-factor model personality traits and socio-demographics. Homo/bisexual men demonstrated the highest scores for neuroticism-anxiety but the lowest for sociability and sensation seeking, with no differences for aggression-hostility. Among homo/bisexual men, 10.2% fulfilled diagnostic criteria for major depression in the past 2. weeks, 10.8% for ADHD in the past 12. months, 13.8% for lifetime anti-social personality disorder (ASPD), and 6.0% attempted suicide in the past 12. months. Upon adjusting (AOR) for personality traits, their odds ratios (OR) for major depression (OR = 4.78, 95% CI 2.81-8.14; AOR = 1.46, 95% CI 0.80-2.65) and ADHD (OR = 2.17, 95% CI = 1.31-3.58; AOR = 1.00, 95% CI 0.58-1.75) lost statistical significance, and the odds ratio for suicide attempt was halved (OR = 5.10, 95% CI 2.57-10.1; AOR = 2.42, 95% CI 1.16-5.02). There are noteworthy differences in personality traits by sexual orientation, and much of the increased mental morbidity appears to be accounted for by such underlying differences, with important implications for etiology and treatment. © 2014 Elsevier Masson SAS.
Keywords: ADHD; Anti-social personality disorder; Depression; Homosexuality; Personality; Suicidality

Do ask, do tell: High levels of acceptability by patients of routine collection of sexual orientation and gender identity data in four diverse American community health centers - Cahill, S.; Singal, R.; Grasso, C.; King, D.; Mayer, K.; Baker, K.; Makadon, H. (PLoS ONE, 2014)
Background: The Institute of Medicine and The Joint Commission have recommended asking sexual orientation and gender identity (SOGI) questions in clinical settings and including such data in Electronic Health Records (EHRs). This is increasingly viewed as a critical step toward systematically documenting and addressing health disparities affecting lesbian, gay, bisexual, and transgender (LGBT) people. The U.S. government is currently considering whether to include SOGI data collection in the Stage 3 guidelines for the incentive program promoting meaningful use of EHR. However, some have questioned whether acceptable standard measures to collect SOGI data in clinical settings exist. Methods: In order to better understand how a diverse group of patients would respond if SOGI questions were asked in primary care settings, 301 randomly selected patients receiving primary care at four health centers across the U.S. were asked SOGI questions and then asked follow-up questions. This sample was mainly heterosexual, racially diverse, and geographically and regionally broad. Results: There was a strong consensus among patients surveyed about the importance of asking SOGI questions. Most of the LGBT respondents thought that the questions presented on the survey allowed them to accurately document their SOGI. Most respondents - heterosexual and LGBT - answered the questions, and said that they would answer such questions in the future. While there were some age-related differences, respondents of all ages overwhelmingly expressed support for asking SOGI questions and understood the importance of providers' knowing their patients' SOGI. Conclusions: Given current deliberations within national health care regulatory bodies and the government's increased attention to LGBT health disparities, the finding that patients can and will answer SOGI questions has important implications for public policy. This study provides evidence that integrating SOGI data collection into the meaningful use requirements is both acceptable to diverse samples of patients, including heterosexuals, and feasible. © 2014 Cahill et al.

Characteristics of female patients admitted to an adolescent secure forensic psychiatric hospital - Hill, S.A.; Brodrick, P.; Doherty, A.; Lolley, J.; Wallington, F.; White, O. (Journal of Forensic Psychiatry and Psychology, 2014)
Bluebird House is the only mixed gender NHS secure forensic psychiatric hospital for adolescents in the South of England. It has admitted more than 30 female patients since the service opened in 2008. The admission criteria are that patients must be detained under the Mental Health Act and present evidence of being a risk of harm to others. This article describes the clinical characteristics of 30 consecutive female patients admitted to a highly specialised adolescent forensic inpatient service. Key results include a very high rate of incidents of risk behaviours exhibited by female patients within the unit but good clinical outcomes. The majority of patients had severe symptoms of mental disorder, especially emotional instability, self-harm behaviours and aggressive behaviours. Few had diagnoses of mental illness. Assessment findings from the Millon Adolescent Clinical Inventory and the Structured Assessment of Violence Risk are discussed, as are parallel with studies from other female secure services. © 2014, © 2014 Taylor & Francis.
Keywords: adolescent; borderline personality disorder; forensic psychiatry; risk assessment; secure units; young offenders

A compensatory model of risk and resilience applied to adolescent sexual orientation disparities in nonsuicidal self-injury and suicide attempts - Reisner, S.L.; Biello, K.; Perry, N.S.; Gamarel, K.E.; Mimiaga, M.J. (The American journal of orthopsychiatry, 2014)
This study investigated and applied a compensatory model of risk and resilience to differences in past-year nonsuicidal self-injury (NSSI) and suicide attempts by sexual orientation using representative data from the 2007 Massachusetts Youth Risk Behavior Survey (n = 3,131). Self-identified lesbian, gay, bisexual, and questioning (LGBQ) adolescents comprised 7% of the sample, but accounted for 67% of NSSI and 80% of suicide attempts. Compared with heterosexuals, LGBQ adolescents had an increased odds of NSSI (adjusted Odds Ratio (aOR) = 2.76; 95% Confidence Interval (CI) [2.00, 3.81] and suicide attempts (aOR = 2.73; 95% CI [1.47, 5.08]. NSSI was highly associated with suicidality (aOR = 10.87; 95% CI [6.17, 19.18]. Family support was independently associated with a decreased odds of both NSSI (aOR = 0.56; 95% CI [0.35, 0.89] and suicidality (aOR = 0.48; 95% CI [0.29, 0.79] supporting a compensatory model of resilience. Screening and preventive interventions for LGBQ adolescents are warranted, including at the family level. Sexual orientation should be included as a standard demographic to monitor health disparities.

Transgender health disparities: Comparing full cohort and nested matched-pair study designs in a community health center - Reisner, S.L.; White, J.M.; Bradford, J.B.; Mimiaga, M.J. (LGBT Health, 2014)
Purpose: U.S. health surveillance systems infrequently include measures to identify transgender respondents or monitor the health of this underserved and marginalized population. Methods: From 2001 to 2002, transgender and nontransgender adults were sampled at a Massachusetts clinic. Health differences were formatively examined by transgender identity using a cross-sectional, clinic-based sample (n=2,653) and a nested matched-pair subsample (n=155). Results: Both designs produced virtually identical findings: (1) the prevalence of HIV, substance abuse, and smoking did not differ significantly for transgender and nontransgender patients; (2) transgender patients were more likely to endorse a lifetime suicide attempt and ideation compared with nontransgender patients (p<0.05); (3) transgender patients disproportionately reported social stressors (violence, discrimination, childhood abuse) relative to nontransgender patients (p<0.05). Conclusion: Findings suggest that a nested design may provide an effective methodology for using clinical data to study transgender health and underscore the need for routine collection of gender identity in clinical settings. © Copyright 2014, Mary Ann Liebert, Inc. 2014.
Keywords: gender identity; health disparity; methods; study design; transgender

Mental health and substance use among bisexual youth and non-youth in Ontario, Canada - Ross, L.E.; Bauer, G.R.; MacLeod, M.A.; Robinson, M.; MacKay, J.; Dobinson, C. (PLoS ONE, 2014)
Research has shown that bisexuals have poorer health outcomes than heterosexuals, gays, or lesbians, particularly with regard to mental health and substance use. However, research on bisexuals is often hampered by issues in defining bisexuality, small sample sizes, and by the failure to address age differences between bisexuals and other groups or age gradients in mental health. The Risk & Resilience Survey of Bisexual Mental Health collected data on 405 bisexuals from Ontario, Canada, using respondent-driven sampling, a network-based sampling method for hidden populations. The weighted prevalence of severe depression (PHQ-9≥20) was 4.7%, possible anxiety disorder (OASIS≥8) was 30.9%, possible post-traumatic stress disorder (PCL-C≥50) was 10.8%, and past year suicide attempt was 1.9%. With respect to substance use, the weighted prevalence of problem drinking (AUDIT≥5) was 31.2%, and the weighted prevalence of illicit polydrug use was 30.5%. Daily smoking was low in this sample, with a weighted prevalence of 7.9%. Youth (aged 16-24) reported significantly higher weighted mean scores on depression and post-traumatic stress disorder, and higher rates of past year suicidal ideation (29.7% vs. 15.2%) compared with those aged 25 and older. The burden of mental health and substance use among bisexuals in Ontario is high relative to population-based studies of other sexual orientation groups. Bisexual youth appear to be at risk for poor mental health. Additional research is needed to understand if and how minority stress explains this burden. © 2014 Ross et al.

Experiences of community and parental violence among HIV-positive young racial/ethnic minority men who have sex with men - Phillips, G.; Hightow-Weidman, L.B.; Fields, S.D.; Giordano, T.P.; Outlaw, A.Y.; Halpern-Felsher, B.; Wohl, A.R. (AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV, 2014)
Adolescents and young adults (ages 13-24) in the USA are frequently exposed to violence in their community and home. While studies have examined the prevalence and impact of violence exposure among adolescents, there is a lack of data focusing specifically on adolescent men of color who have sex with men. Eight demonstration sites funded through a Special Projects of National Significance (SPNS) Initiative recruited 363 HIV-positive racial/ethnic minority young men who have sex with men (YMSM) for a longitudinal study between 2006 and 2009. Over two-thirds of participants (83.8%) had witnessed community violence, 55.1% in the prior three months. Witnessing violence committed with a deadly weapon was significantly associated with being African-American, having ever used drugs, and drinking alcohol in the prior two weeks. Fear of violence in the community was significantly associated with depressive symptomatology, having less than a high school degree, not possessing health insurance, and site of enrollment. Having been emotionally or physically abused by a parent or caretaker was significantly associated with depressive symptomatology, attempting suicide, site of enrollment, and increased age. Witnessing violence with a deadly weapon was significantly associated with alcohol and drug use but not with high-risk sexual behaviors. As this was one of the first studies on the prevalence and correlates of violence exposure among racial/ethnic minority YMSM living with HIV, the findings can be used to inform the development of culturally appropriate resilience-focused interventions to address the aftereffects of violence exposures and help develop social support systems outside of the family. © 2013 Taylor & Francis.
Keywords: Community violence; HIV; MSM; Parental violence; Violence

The moderating role of sexual identity in group teletherapy for adults aging with HIV - Heckman, B.D.; Lovejoy, T.I.; Heckman, T.G.; Anderson, T.; Grimes, T.; Sutton, M.; Bianco, J.A. (Behavioral Medicine, 2014)
Older adults living with HIV/AIDS experience high rates of depression and suicidal ideation but are less likely than their younger counterparts to seek psychological services. HIV continues to disproportionately impact older men who have sex with men (MSM), many of whom were infected in their 20s and 30s. This study examined whether therapy attendance rates and the efficacies of two group-format teletherapies for the treatment of depression (coping effectiveness group training and supportive-expressive group therapy) were comparable for older MSM and older heterosexuals living with HIV. Intervention-outcome analyses found that older MSM and older heterosexuals living with HIV attended comparable numbers of teletherapy sessions. Older heterosexuals living with HIV who received telephone-administered supportive-expressive group therapy reported significantly greater reductions in depressive symptoms than SOC controls. A similar pattern was not found in older MSM. More research is needed to personalize and tailor group teletherapies for older MSM living with HIV. © 2014 Copyright © Taylor & Francis Group, LLC.
Keywords: aging; depression; HIV; teletherapy

What Every Educator Needs to Know About Queer Youth - Miller, P.C.; Mikulec, E.A. (New Educator, 2014)
In recent years, queer youth have been in the media spotlight on issues ranging from attending prom to suicide. As novice teachers adapt to their new profession, in order to truly meet the needs of all students, they must understand the variety of issues that impact their success. Where this topic is concerned, this article fills a major gap in the literature for teacher preparation and induction. The article discusses the plight of queer youth and provides suggestions for new and veteran teachers to become advocates for queer youth. ©, Copyright © CCNY and ATE.

Medical treatment in gender dysphoric adolescents endorsed by SIAMS-SIE-SIEDP-ONIG - Fisher, A.D.; Ristori, J.; Bandini, E.; Giordano, S.; Mosconi, M.; Jannini, E.A.; Greggio, N.A.; Godano, A.; Manieri, C.; Meriggiola, C.; Ricca, V.; Dettore, D.; et al. (Journal of Endocrinological Investigation, 2014)
Purpose: Despite international guidelines being available, not all gender clinics are able to face gender dysphoric (GD) youth population needs specifically. This is particularly true in Italy. Centers offering specialized support are relatively few and a commonly accepted Italian approach to GD youth has still not been defined. The aim of the present Position Statement is to develop and adhere to Italian guidelines for treatment of GD adolescents, in line with the "Dutch Approach", the Endocrine Society (ES), and the World Professional Association for Transgender Health (WPATH) guidelines. Methods: An in-depth brainstorming on the application of International guidelines in the Italian context was performed by several dedicated professionals. Results: A staged approach, combining psychological support as well as medical intervention is suggested. In the first phase, individuals requesting medical help will undergo a psycho-diagnostic procedure to assess GD; for eligible adolescents, pubertal suppression should be made available (extended diagnostic phase). Finally, from the age of 16 years, cross-sex hormonal therapy can be added, and from the age of 18 years, surgical sex reassignment can eventually be performed. Conclusions: The current inadequacy of Italian services offering specialized support for GD youth may lead to negative consequences. Omitting or delaying treatment is not a neutral option. In fact, some GD adolescents may develop psychiatric problems, suicidality, and social marginalization. With access to specialized GD services, emotional problems, as well as self-harming behavior, may decrease and general functioning may significantly improve. In particular, puberty suppression seems to be beneficial for GD adolescents by relieving their acute suffering and distress and thus improving their quality of life. © 2014 Italian Society of Endocrinology (SIE).
Keywords: Adolescents; Gender Dysphoria; Puberty suppression

Why alternative teenagers self-harm: Exploring the link between non-suicidal self-injury, attempted suicide and adolescent identity - Young, R.; Sproeber, N.; Groschwitz, R.C.; Preiss, M.; Plener, P.L. (BMC Psychiatry, 2014)
Background: The term 'self-harm' encompasses both attempted suicide and non-suicidal self-injury (NSSI). Specific adolescent subpopulations such as ethnic or sexual minorities, and more controversially, those who identify as 'Alternative' (Goth, Emo) have been proposed as being more likely to self-harm, while other groups such as 'Jocks' are linked with protective coping behaviours (for example exercise). NSSI has autonomic (it reduces negative emotions) and social (it communicates distress or facilitates group 'bonding') functions. This study explores the links between such aspects of self-harm, primarily NSSI, and youth subculture.Methods: An anonymous survey was carried out of 452 15 year old German school students. Measures included: identification with different youth cultures, i.e. Alternative (Goth, Emo, Punk), Nerd (academic) or Jock (athletic); social background, e.g. socioeconomic status; and experience of victimisation. Self-harm (suicide and NSSI) was assessed using Self-harm Behavior Questionnaire and the Functional Assessment of Self-Mutilation (FASM).Results: An " Alternative" identity was directly (r ≈ 0.3) and a " Jock" identity inversely (r ≈ -0.1) correlated with self-harm. " Alternative" teenagers self-injured more frequently (NSSI 45.5% vs. 18.8%), repeatedly self-injured, and were 4-8 times more likely to attempt suicide (even after adjusting for social background) than their non-Alternative peers. They were also more likely to self-injure for autonomic, communicative and social reasons than other adolescents.Conclusions: About half of 'Alternative' adolescents' self-injure, primarily to regulate emotions and communicate distress. However, a minority self-injure to reinforce their group identity, i.e. 'To feel more a part of a group'. © 2014 Young et al.; licensee BioMed Central Ltd.

Prevalence of sexual victimization and correlates of forced sex in Japanese men who have sex with men - Hidaka, Y.; Operario, D.; Tsuji, H.; Takenaka, M.; Kimura, H.; Kamakura, M.; Ichikawa, S. (PLoS ONE, 2014)
Studies of men who have sex with men (MSM) in diverse geographic and cultural contexts have identified health challenges affecting this population. MSM might be particularly vulnerable to sexual victimization and forced sex. The aim of this research study was to examine prevalence of sexual victimization and correlates of forced sex among Japanese MSM. We recruited a sample of 5,731 Japanese MSM who completed an internet-administered survey. Participants reported on history of different types of sexual victimization, unprotected anal sex, other health risk behaviors, exposure to gay-related teasing and bullying, depression, and suicidality. Over one-fifth of the sample (21.4%) reported experiencing at least one form of sexual victimization, and 8.7% reported a history of forced sex. MSM who had ever experienced forced sex were significantly more likely to report experiencing psychological risks (depression OR = 1.55, 95% CI = 1.28-1.89; attempted suicide OR = 2.25, 95% CI = 1.81-2.81; other forms of bullying OR = 1.38, 95% CI = 1.13-1.68) and other behavioral risks (unprotected anal sex OR = 1.56, 95% CI = 1.29-1.90; sex venue attendance OR = 1.27, 95% CI = 1.04-1.54; methamphetamine use OR = 1.57, 95% CI = 1.05-1.36), compared to MSM who had not experienced forced sex. Efforts to develop holistic and integrated health services for Japanese MSM are warranted, particularly related to psychosocial determinants of HIV prevention. However, due to cultural factors that emphasize familial and social relations and that stigmatize same-sex behavior, Japanese MSM might experience challenges to seeking social support and health services. Interventions must be provided in safe and non-judgmental settings where Japanese MSM feel comfortable disclosing their health and social support needs. © 2014 Hidaka et al.

Religion and Suicide Risk in Lesbian, Gay and Bisexual Austrians - Kralovec, K.; Fartacek, C.; Fartacek, R.; Plöderl, M. (Journal of Religion and Health, 2014)
Religion is known to be a protective factor against suicide. However, religiously affiliated sexual minority individuals often report a conflict between religion and sexual identity. Therefore, the protective role of religion against suicide in sexual minority people is unclear. We investigated the effect of religion on suicide risk in a sample of 358 lesbian, gay and bisexual Austrians. Religion was associated with higher scores of internalized homophobia, but with fewer suicide attempts. Our data indicate that religion might be both a risk and a protective factor against suicidality in religiously affiliated sexual minority individuals. © 2012 Springer Science+Business Media New York.
Keywords: Homosexuality; Internalized homophobia; Religion; Suicide

Complex care needs of patients with late-stage HIV disease: A retrospective study - Halman, M.; Chan Carusone, S.; Stranks, S.; Schaefer-Mcdaniel, N.; Stewart, A. (AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV, 2014)
This retrospective chart review provides a profile of an emerging population of vulnerable HIV patients with complex comorbidities. Data were abstracted from all 83 patients admitted in 2008 to Casey House, a community-based hospital dedicated to supportive and palliative care for persons with HIV in Toronto, Canada. We describe patient characteristics, including medical and psychiatric conditions, and use a Venn diagram and case study to illustrate the frequency and reality of co-occurring conditions that contribute to the complexity of patients' health and health care needs. The mean age at admission was 49.2 years (SD = 10.5). Sixty-seven patients (80.7%) were male. Patients experienced a mean of 5.9 medical comorbidities (SD = 2.3) and 1.9 psychiatric disorders (lifetime Axis I diagnoses). Forty patients (48.2%) experienced cognitive impairment including HIV-associated dementia. Patients were on a mean of 11.5 (SD = 5.3) medications at admission; 74.7% were on antiretroviral medications with 55.0% reporting full adherence. Current alcohol and drug use was common with 50.6% reporting active use at admission. Our Venn diagram illustrates the breadth of complexity in the clients with 8.4% of clients living in unstable housing with three or more medical comorbidities and two or more psychiatric diagnoses.comprehensive HIV program planning should include interventions that can flexibly adapt to meet the multidimensional and complex needs of this segment of patients. Researchers, policy-makers, and clinicians need to have greater awareness of overlapping medical, psychiatric and psychosocial comorbidities. Inclusion of the needs of these most vulnerable patients in the development of evidence-based guidelines is an important step for effectively treating, preventing, and planning for the future of HIV/AIDS care. © 2013 Taylor & Francis.
Keywords: Comorbidities; HIV-associated; HIV/AIDS; Homelessness; Mental health; Neurocognitive disorders; Vulnerable populations

Isolation of lesbian, gay, bisexual and transgender youth: A dimensional concept analysis - Johnson, M.J.; Amella, E.J. (Journal of Advanced Nursing, 2014)
Aim: To present the findings of a dimensional analysis of isolation in the context, and from the perspective, of lesbian, gay, bisexual and transgender youth. Background: Lesbian, gay, bisexual and transgender youth are often at greater risk for negative health outcomes compared with heterosexual youth. Isolation is one risk factor cited throughout the literature; however, the concept is complicated and has many uses and thus warrants clarification. Design: Concept Analysis. Data Sources: Sources comprise 35 English language research articles retrieved from CINAHL and EBSCOHost (1987-2012). Methods: A dimensional concept analysis was undertaken to analyse how the concept, isolation, is socially constructed. Results: This dimensional analysis revealed five socially constructed dimensions and four sub-dimensions. These findings indicate that there is substantial variability in the concept of isolation. These differences and variations are most notably observed in the 20 articles (57%) that had more than one dimension. Although some of these articles were explicit with the different meanings and use of the concept, most of the papers had wide variability in the use and meaning of the concept. Conclusion: The disproportionately greater physical and mental health disparities between lesbian, gay, bisexual and transgender and heterosexual youth are a signal to conduct more research to clarify the concept of isolation, to develop instrumentation to identify at-risk youth and to explore predictors and consequences of isolation. Nurses and others can lead the way in translating this knowledge into strategies that will improve the health and lives of these young people. © 2013 John Wiley & Sons Ltd.
Keywords: Adolescent; Bisexuality; Child; Concept analysis; Homosexuality; Nursing; Nursing research; Nursing theory; Suicide; Transgendered persons

Operational definitions of sexual orientation and estimates of adolescent health risk behaviors - Matthews, D.D.; Blosnich, J.R.; Farmer, G.W.; Adams, B.J. (LGBT Health, 2014)
Purpose: Increasing attention to the health of lesbian, gay, and bisexual (LGB) populations comes with requisite circumspection about measuring sexual orientation in surveys. However, operationalizing these variables also requires considerable thought. This research sought to document the consequences of different operational definitions of sexual orientation by examining variation in health risk behaviors. Methods: Using Massachusetts Youth Risk Behavior Survey data, we examined how operational definitions of sexual behavior and sexual identity influenced differences among three health behaviors known to disparately affect LGB populations: smoking, suicide risk, and methamphetamine use. Sexual behavior and sexual identity were also examined together to explore if they captured unique sources of variability in behavior. Results: Estimates of health disparities changed as a result of using either sexual behavior or sexual identity. Youth who reported their sexual identity as "not sure" also had increased odds of health risk behavior. Disaggregating bisexual identity and behavior from same-sex identity and behavior frequently resulted in the attenuation or elimination of health disparities that would have otherwise been attributable to exclusively same-sex sexual minorities. Finally, sexual behavior and sexual identity explained unique and significant sources of variability in all three health behaviors. Conclusion: Researchers using different operational definitions of sexual orientation could draw different conclusions, even when analyzing the same data, depending upon how they chose to represent sexual orientation in analyses. We discuss implications that these manipulations have on data interpretation and provide specific recommendations for best-practices when analyzing sexual orientation data collected from adolescent populations. © Mary Ann Liebert, Inc.
Keywords: adolescents; data analysis; health behavior; measurement; sexual orientation

HIV prevention interventions for young male commercial sex workers - Ballester-Arnal, R.; Gil-Llario, M.D.; Salmeron-Sánchez, P.; Giménez-García, C. (Current HIV/AIDS Reports, 2014)
The sex industry, where men sell sexual services to other men or women, has grown in recent years. These men who offer sexual services are particularly vulnerable to HIV infection due to such factors as: frequency of risky sexual practices, number of sex partners, drug-taking, prevalence of sexually-transmitted infections (STI) and their specific situation of social exclusion which may hinder access to health services. These multi-faceted realities faced by sex workers explain the burgeoning interest in new avenues of scientific research. There are too few preventive programs however aimed at this population group and the studies that evaluate their effectiveness are fewer still. In this article we survey more recent studies on the difficulties of implementing programs for HIV prevention in male sex workers (MSW), as well as the studies that have gauged the impact of preventive programs in this group. © 2013 Springer Science+Business Media.
Keywords: Effectiveness; HIV; HIV infection; HIV prevention; HIV prevention in male sex workers; Male sex workers; MSW; Prevention; Preventive programs; Risky sexual practices; Sex workers; Sexually-transmitted infection; STI

Determinants of suicide and accidental or violent death in the Australian HIV observational database - McManus, H.; Petoumenos, K.; Franic, T.; Kelly, M.D.; Watson, J.; O'Connor, C.C.; Jeanes, M.; Hoy, J.; Cooper, D.A.; Law, M.G. (PLoS ONE, 2014)
Background: Rates of suicide and accidental or violent death remain high in HIV-positive populations despite significantly improved prognosis since the introduction of cART. Methods: We conducted a nested case-control study of suicide and accidental or violent death in the Australian HIV Observational Database (AHOD) between January 1999 and March 2012. For each case, 2 controls were matched by clinic, age, sex, mode of exposure and HIV-positive date to adjust for potential confounding by these covariates. Risk of suicide and accidental or violent death was estimated using conditional logistic regression. Results: We included 27 cases (17 suicide and 10 violent/accidental death) and 54 controls. All cases were men who have sex with men (MSM) or MSM/ injecting drug use (IDU) mode of exposure. Increased risk was associated with unemployment (Odds Ratio (OR) 5.86, 95% CI: 1.69-20.37), living alone (OR 3.26, 95% CI: 1.06-10.07), suicidal ideation (OR 6.55, 95% CI: 1.70-25.21), and >2 psychiatric/cognitive risk factors (OR 4.99, 95% CI: 1.17-30.65). CD4 cell count of >500 cells/μL (OR 0.25, 95% CI: 0.07-0.87) and HIV-positive date ≥1990 (1990-1999 (OR 0.31, 95% CI: 0.11-0.89), post-2000 (OR 0.08, 95% CI: 0.01- 0.84)) were associated with decreased risk. CD4 cell count ≥500 cells/μL remained a significant predictor of reduced risk (OR 0.15, 95% CI: 0.03-0.70) in a multivariate model adjusted for employment status, accommodation status and HIV-positive date. Conclusions: After adjustment for psychosocial factors, the immunological status of HIV-positive patients contributed to the risk of suicide and accidental or violent death. The number of psychiatric/cognitive diagnoses contributed to the level of risk but many psychosocial factors were not individually significant. These findings indicate a complex interplay of factors associated with risk of suicide and accidental or violent death. © 2014 McManus et al.

Lesbian, gay, bisexual, and transgender hate crimes and suicidality among a population-based sample of sexual-minority adolescents in Boston - Duncan, D.T.; Hatzenbuehler, M.L. (American Journal of Public Health, 2014)
Objectives. We examined whether past-year suicidality among sexualminority adolescents was more common in neighborhoods with a higher prevalence of hate crimes targeting lesbian, gay, bisexual, and transgender (LGBT) individuals. Methods. Participants' data came from a racially/ethnically diverse population-based sample of 9th- through 12th-grade public school students in Boston, Massachusetts (n = 1292). Of these, 108 (8.36%) reported a minority sexual orientation. We obtained data on LGBT hate crimes involving assaults or assaults with battery between 2005 and 2008 from the Boston Police Department and linked the data to the adolescent's residential address. Results. Sexual-minority youths residing in neighborhoods with higher rates of LGBT assault hate crimes were significantly more likely to report suicidal ideation (P = .013) and suicide attempts (P = .006), than were those residing in neighborhoods with lower LGBT assault hate crime rates. We observed no relationships between overall neighborhood-level violent and property crimes and suicidality among sexual-minority adolescents (P > .05), providing evidence for specificity of the results to LGBT assault hate crimes. Conclusions. Neighborhood context (i.e., LGBT hate crimes) may contribute to sexual-orientation disparities in adolescent suicidality, highlighting potential targets for community-level suicide-prevention programs.

Protective school climates and reduced risk for suicide ideation in sexual minority youths - Hatzenbuehler, M.L.; Birkett, M.; Van Wagenen, A.; Meyer, I.H. (American Journal of Public Health, 2014)
Objectives. We examined whether sexual minority students living in states and cities with more protective school climates were at lower risk of suicidal thoughts, plans, and attempts. Methods. Data on sexual orientation and past-year suicidal thoughts, plans, and attempts were from the pooled 2005 and 2007 Youth Risk Behavior Surveillance Surveys from 8 states and cities. We derived data on school climates that protected sexual minority students (e.g., percentage of schools with safe spaces and Gay-Straight Alliances) from the 2010 School Health Profile Survey, compiled by the Centers for Disease Control and Prevention. Results. Lesbian, gay, and bisexual students living in states and cities with more protective school climates reported fewer past-year suicidal thoughts than those living in states and cities with less protective climates (lesbians and gays: odds ratio [OR] = 0.68; 95% confidence interval [CI] = 0.47, 0.99; bisexuals: OR = 0.81; 95% CI = 0.66, 0.99). Results were robust to adjustment for potential state-level confounders. Sexual orientation disparities in suicidal thoughts were nearly eliminated in states and cities with the most protective school climates. Conclusions. School climates that protect sexual minority students may reduce their risk of suicidal thoughts.

A Syndemic of Psychosocial Health Disparities and Associations With Rifor Attempting Suicide Among Young Sexual Minority Men - Mustanski, B.; Andrews, R.; Herrick, A.; Stall, R.; Schnarrs, P.W. (American Journal of Public Health, 2014)
Objectives. We examined a syndemic of psychosocial health issues among young men who have sex with men (MSM), with men and women (MSMW), and with women (MSW). We examined hypothesized drivers of syndemic production and effects on suicide attempts. Methods. Using a pooled data set of 2005 and 2007 Youth Risk Behavior Surveys from 11 jurisdictions, we used structural equation modeling to model a latent syndemic factor of depression symptoms, substance use, risky sex, and intimate partner violence. Multigroup models examined relations between victimization and bullying experiences, syndemic health issues, and serious suicide attempts. Results. We found experiences of victimization to increase syndemic burden among all male youths, especially MSMW and MSM compared with MSW (variance explained = 44%, 38%, and 10%, respectively). The syndemic factor was shown to increase the odds of reporting a serious suicide attempt, particularly for MSM (odds ratio [OR] = 5.75; 95% confidence interval [CI] = 1.36, 24.39; P > .001) and MSMW (OR = 5.08; 95% CI = 2.14, 12.28; P > .001) compared with MSW (OR = 3.47; 95% CI = 2.50, 4.83; P > .001). Conclusions. Interventions addressing multiple psychosocial health outcomes should be developed and tested to better meet the needs of young MSM and MSMW.

Exploring a Dutch paradox: an ethnographic investigation of gay men's mental health - Aggarwal, S.; Gerrets, R. (Culture, Health and Sexuality, 2014)
Despite the Netherlands' reputation as a world leader with respect to gay rights, homosexual Dutch men have much higher rates of mood disorders, anxiety disorders and suicide attempts than heterosexual Dutch men. Epidemiologists report similar disparities elsewhere in Western Europe and North America. These findings have been the focus of a blossoming psychological literature, inspired by minority stress theory and deploying quantitative methods. Our investigation aims to complement this body of work by adopting an ethnographic approach. Drawing from fieldwork conducted in the Netherlands from 2009 to 2010, we explore sociocultural and contextual factors that have received relatively little attention with respect to gay mental health. In the Netherlands - considered a model for gay equality - how can one understand high rates of psychiatric disorders among gay men? This study points to heteronormativity, complex dynamics involving long-term relationships and processes within gay subcultures as key issues. Notwithstanding their putative socioeconomic, legal and political equality, gay men struggled - at various stages of the life cycle - with internalised norms that they found difficult to fulfil. The desire to embody these ideals, and structural constraints in meeting them, could be potent sources of disappointment and distress. © 2014 © 2013 Taylor & Francis.
Keywords: ethnography; gay men; Netherlands; self-esteem; stigma

Risk and protective factors that distinguish adolescents who attempt suicide from those who only consider suicide in the past year - Taliaferro, L.A.; Muehlenkamp, J.J. (Suicide and Life-Threatening Behavior, 2014)
Data from the 2010 Minnesota Student Survey was analyzed to identify risk and protective factors that distinguished adolescents across three groups: no suicidality, suicidal ideation only, and suicide attempt. The population-based sample included 70,022 students in grades 9 and 12. Hopelessness and depressive symptoms emerged as important risk factors to distinguish youth who reported suicidal ideation or behavior from those without a history of suicidality. However, these factors were not as important in differentiating adolescents who attempted suicidal from those who considered suicide but did not act on their thoughts. Instead, for both genders, self-injury represented the most important factor to distinguish these youth. Other risk factors that differentiated the latter groups, but not the former groups, for males were dating violence victimization and cigarette smoking, and for females was a same-sex sexual experience. Running away from home also seemed to increase the risk of a suicide attempt among youth in this study. Parent connectedness and academic achievement emerged as important protective factors to differentiate all the groups, yet neighborhood safety appeared to protect against the transition from suicidal thoughts to behavior. Findings from this study suggest risk and protective factors practitioners should target in clinical assessments and intervention programs to help prevent suicidal behavior among youth at greatest risk. © 2013 The American Association of Suicidology.

Interrelationships between LGBT-based victimization, suicide, and substance use problems in a diverse sample of sexual and gender minorities - Mereish, E.H.; Ocleirigh, C.; Bradford, J.B. (Psychology, Health and Medicine, 2014)
Research has documented significant relationships between sexual and gender minority stress and higher rates of suicidality (i.e. suicidal ideation and attempts) and substance use problems. We examined the potential mediating role of substance use problems on the relationship between sexual and gender minority stress (i.e. victimization based on lesbian, gay, bisexual, or transgender identity [LGBT]) and suicidality. A nonprobability sample of LGBT patients from a community health center (N = 1457) ranged in age from 19-70 years. Participants reported history of lifetime suicidal ideation and attempts, substance use problems, as well as experiences of LGBT-based verbal and physical attacks. Substance use problems were a significant partial mediator between LGBT-based victimization and suicidal ideation and between LGBT-based victimization and suicide attempts for sexual and gender minorities. Nuanced gender differences revealed that substance use problems did not significantly mediate the relationship between victimization and suicide attempts for sexual minority men. Substance use problems may be one insidious pathway that partially mediates the risk effects of sexual and gender minority stress on suicidality. Substances might be a temporary and deleterious coping resource in response to LGBT-based victimization, which have serious effects on suicidal ideation and behaviors. © 2013 Taylor & Francis.
Keywords: LGBT; sexual and gender minority stress; substance use problems; suicide; victimization

A Retrospective Examination of Completed Sexual and Gender Minority Youth Suicides in the United States: What Can Be Learned from Written Online Media? - Wolff, J.R.; Allen, K.D.; Himes, H.L.; Fish, A.E.; Losardo, J.R. (Journal of Gay and Lesbian Mental Health, 2014)
Due to several high profile suicides and increased social acceptance of lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) persons in the United States, significant media attention has focused on the occurrence of and factors that contribute to sexual and gender minority youth (SGMY) suicide. Although previous research has established an increased likelihood of suicidal ideation among SGMY, no data exist on completed SGMY suicides in the United States or subsequent media coverage. This study examines variables related to completed SGMY suicides in the United States from written electronic media (N = 78) reports from 2004-12 using a mixed-method content analysis. Qualitative results indicate the presence of three major content domains: warning signs, denial of the problem, and conflicting reports. Quantitative results suggest a lack of contextual information but also increased media citation of prevention resources between 2010 and 2012. Clinical and public health implications of SGMY suicide media coverage are discussed. © 2014 Copyright Taylor and Francis Group, LLC.
Keywords: bullying; gender minority; LGBT; media; sexual minority; suicide; youth

Buried Above Ground: A University-Based Study of Risk/Protective Factors for Suicidality Among Sexual Minority Youth in Canada - Peter, T.; Taylor, C. (Journal of LGBT Youth, 2014)
This study examined differences in suicidal behavior between lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) and non-LGBTQ university students as well as investigated the importance of risk and protective factors in the prediction of suicidality between these two groups. A total of 1,205 university students participated in the survey. Findings show, compared to non-LGBTQ respondents, sexual minority youth are at a greater risk for serious suicidal ideation (8.9% versus 23%, respectively) and suicide attempt (3.5% versus 26.2%). Among LGBTQ respondents, significant risk covariates for suicidality were depressive symptoms, socioeconomic status, being bullied, age, and childhood trauma. The only significant protective factor was self-esteem. © 2014 Taylor & Francis Group, LLC.
Keywords: At-risk youth; bullying; Canada; higher education; mental health; minority stress theory; protective factors; sexual minority youth; students; suicidality; Suicide Behavior Questionnaire

Sexual Orientation and the Effects of Intimate Partner Violence - Koeppel, M.D.H.; Bouffard, L.A. (Women and Criminal Justice, 2014)
Studies have demonstrated a relationship between intimate partner violence (IPV) and depression and other mental health issues such as suicidal behavior and posttraumatic stress disorder. Despite the breadth of the literature, there is a dearth of information specifically regarding the effects of IPV in same-sex relationships. Information regarding the prevalence of substance abuse and health issues in non-heterosexual IPV victims when compared to heterosexual IPV victims will be extremely helpful in developing tailored victim services to sexual minorities. This study uses the National Violence Against Women Survey to examine hypothesized relationships between IPV, its effects, and sexual orientation. Given the higher prevalence rates of IPV in same-sex relationships (Messinger, 2011), logistic regression models are used to test the hypotheses that non-heterosexual victims of IPV will have higher rates of depression, substance use, and health issues. © 2014 Taylor & Francis Group, LLC.
Keywords: intimate partner violence; sexual orientation; victimization

Explaining the Suicide Risk of Sexual Minority Individuals by Contrasting the Minority Stress Model with Suicide Models - Plöderl, M.; Sellmeier, M.; Fartacek, C.; Pichler, E.-M.; Fartacek, R.; Kralovec, K. (Archives of Sexual Behavior, 2014)
Many studies have found elevated levels of suicide ideation and attempts among sexual minority (homosexual and bisexual) individuals as compared to heterosexual individuals. The suicide risk difference has mainly been explained by minority stress models (MSTM), but the application of established suicidological models and testing their interrelations with the MSTM has been lacking so far. Therefore, we have contrasted two established models explaining suicide risk, the Interpersonal Psychological Theory (IPT) (Joiner, 2005) and the Clinical Model (CM) (Mann et al., 1999), with the MSTM (Meyer, 2003) in a Bavarian online-sample of 255 adult sexual minority participants and 183 heterosexual participants. The results suggested that the CM and the IPT model can well explain suicide ideation among sexual minorities according to the factors depression, hopelessness, perceived burdensomeness, and failed belongingness. The CM and the IPT were intertwined with the MSTM via internalized homophobia, social support, and early age of coming out. Early coming out was associated with an increased suicide attempt risk, perhaps through violent experiences that enhanced the capability for suicide; however, coming out likely changed to a protective factor for suicide ideation by enhanced social support and reduced internalized homophobia. These results give more insight into the development of suicide risk among sexual minority individuals and may be helpful to tailor minority-specific suicide prevention strategies. © 2014, Springer Science+Business Media New York.
Keywords: Bisexual; Gay; Homosexuality; Lesbian; Sexual orientation; Suicide

Suicide risk among lesbian, gay, bisexual, and transgender military personnel and veterans: What does the literature tell us? - Matarazzo, B.B.; Barnes, S.M.; Pease, J.L.; Russell, L.M.; Hanson, J.E.; Soberay, K.A.; Gutierrez, P.M. (Suicide and Life-Threatening Behavior, 2014)
Research suggests that both the military and veteran and the lesbian, gay, bisexual, and transgender (LGBT) populations may be at increased risk for suicide. A literature review was conducted to identify research related to suicide risk in the LGBT military and veteran populations. Despite the paucity of research directly addressing this issue, themes are discussed evident in the literature on LGBT identity and suicide risk as well as LGBT military service members and veterans. Factors such as social support and victimization appear to be particularly relevant. Suggestions are made with respect to future research that is needed on this very important and timely topic. © Published 2014. This article is a U.S. Government work and is in the public domain in the USA.

Measures of Sexual Minority Status and Suicide Risk among Young Adults in the United States - Almazan, E.P.; Roettger, M.E.; Acosta, P.S. (Archives of Suicide Research, 2014)
Multiple measures of sexual minority status are necessary to accurately describe the diversity of attractions, identities, and behaviors in sexual minority populations. We investigated whether four measures of sexual minority status (sexual minority attraction, sexual minority identity, sexual minority lifetime behavior, and sexual minority recent 12-month behavior) were associated with suicidal thoughts and suicide attempts among young adults ages 24 to 34 in the United States. We analyzed data from Wave IV (2007-2008) of the National Longitudinal Study of Adolescent Health. We employed logistic regression models in the analysis. Multiple sexual minority status measures had significant associations with increased suicidal thoughts among women and men. Multiple sexual minority status measures had significant associations with increased suicide attempts among women, but not among men. Diverse sexual minority populations are at increased risk for suicidal thoughts and suicide attempts. Multiple measures of sexual minority status should be utilized in future studies of sexual minority status and suicide risk. Suicide prevention programs should ensure intervention is available across diverse sexual minority populations. © 2014 Copyright International Academy for Suicide Research.
Keywords: disparities; homosexuality; LGB; measurement; sexual orientation; suicide

Associations between bullying and engaging in aggressive and suicidal behaviors among sexual minority youth: The moderating role of connectedness - Duong, J.; Bradshaw, C. (Journal of School Health, 2014)
BACKGROUND: Research on the extent to which cyberbullying affects sexual minority youth is limited. This study examined associations between experiencing cyber and school bullying and engaging in aggressive and suicidal behaviors among sexual minority youth. We also explored whether feeling connected to an adult at school moderated these associations. METHODS: Data came from 951 self-identified lesbian, gay, and bisexual (LGB) youth, who completed the New York City Youth Risk Behavior Survey during fall 2009. We used multiple logistic regression to examine the hypothesized associations and test for effect modification. RESULTS: Cyber and school bullying were associated with engaging in aggressive and suicidal behaviors among LGB youth. Youth experiencing both cyber and school bullying had the greatest odds of engaging in aggressive and suicidal behaviors. However, feeling connected to an adult at school moderated these associations such that bullied youth who felt connected were not more likely to report aggressive and suicidal behaviors. CONCLUSIONS: The findings highlight the challenges faced by bullied LGB youth. Practitioners should work with school administrators to establish supportive environments for sexual minority youth. Helping victimized LGB youth develop meaningful connections with adults at school can minimize the negative impacts of cyber and school bullying. © 2014, American School Health Association.
Keywords: Aggression; Bisexual; Bullying; Connectedness; Cyber bullying; Gay; High school; Lesbian; Prevention; Sexual minorities; Suicide; Youth risk behavior survey

Evaluating Thwarted Belongingness and Perceived Burdensomeness as Predictors of Suicidal Ideation in Sexual Minority Adults - Woodward, E.N.; Gray, T.W.; Wingate, L.; Pantalone, D.W. (Psychology of Sexual Orientation and Gender Diversity, 2014)
Research suggests that sexual minority individuals are at significantly higher risk of considering suicide than their heterosexual peers. Little data exist on the reasons for this disparity. We aimed to assess whether 2 interpersonal constructs—thwarted belongingness and perceived burdensomeness—were associated with higher levels of suicidal ideation (SI) in a sexual minority sample. Participants, recruited online from U.S. LGBQ support groups, completed a 1-time anonymous online survey. In this sample (N 210, Mage 36.11, SD 13.9), 52.9% of participants identified as women, 47.1% as men, 77.6% as White, 7.1% as African American or Black, and 7.6% as Hispanic or Latino. Most participants identified as gay or lesbian (77.1%), with 22.9% identifying as bisexual. Measures assessed current SI, thwarted belongingness, and perceived burdensomeness. Approximately 21% of participants endorsed current SI. Perceived burdensomeness (Wald 12.108, odds ratio [OR] 3.456, 95% CI [1.719, 6.950]) was a significant predictor of SI, although thwarted belongingness was not (p .494), even after controlling for demographic factors. Perceived burdensomeness was also a significant predictor of SI within subgroups of gay men (OR 3.462, 95% CI [1.215, 9.863]), lesbian women (OR 6.948, 95% CI [1.164, 41.46]), and bisexual women (OR 5.785, 95% CI [1.199, 27.915]). Results provided support for perceived burdensomeness as a predictor of SI for sexual minority individuals, but requires replication. Perceived burdensomeness and SI should be addressed during medical or mental health visits for sexual minority individuals. © 2014 American Psychological Association
Keywords: Belongingness; Burdensomeness; Interpersonal; SI; Suicidal ideation; Suicide

Correlates of Suicide Ideation Among LGBT Nebraskans - Irwin, J.A.; Coleman, J.D.; Fisher, C.M.; Marasco, V.M. (Journal of Homosexuality, 2014)
The aim of this investigation is to outline correlates of suicide ideation among LGBT individuals living in Nebraska. A community-based participatory research approach was utilized to develop a 30-minute, online anonymous survey. Almost half of the sample had seriously considered suicide at some point in their lives. Significant correlates of increased likelihood of suicide ideation are age, gender, transgender identity, income, depression, and discrimination. Suicide ideation is a serious concern for the health of LGBT Nebraskans. Steps should be taken to incorporate individuals who fall into these high-risk categories in suicide outreach programs. © Taylor & Francis Group, LLC.
Keywords: bisexual; gay; lesbian; mental health; suicide; transgender

Mental health and suicidality among racially/ethnically diverse sexual minority youths - Bostwick, W.B.; Meyer, I.; Aranda, F.; Russell, S.; Hughes, T.; Birkett, M.; Mustanski, B. (American Journal of Public Health, 2014)
Objectives. Weexamined the relationships among sexual minority status, sex, and mental health and suicidality, in a racially/ethnically diverse sample of adolescents. Methods. Using pooled data from 2005 and 2007 Youth Risk Behavior Surveys within 14 jurisdictions, we used hierarchical linear modeling to examine 6 mental health outcomes across 6 racial/ethnic groups, intersecting with sexual minority status and sex. Based on an omnibus measure of sexual minority status, there were 6245 sexual minority adolescents in the current study. The total sample was n = 72 691. Results. Compared with heterosexual peers, sexual minorities reported higher odds of feeling sad; suicidal ideation, planning and attempts; suicide attempt treated by a doctor or nurse, and self-harm. Among sexual minorities, compared with White youths, Asian and Black youths had lower odds of many outcomes, whereas American Native/Pacific Islander, Latino, and Multiracial youths had higher odds. Conclusions. Although in general, sexual minority youths were at heightened risk for suicidal outcomes, risk varied based on sex and on race/ethnicity. More research is needed to better understand the manner in which sex and race/ ethnicity intersect among sexual minorities to influence risk and protective factors, and ultimately, mental health outcomes.

A trait-interpersonal analysis of suicide proneness among lesbian, gay, and bisexual community members - Cramer, R.J.; Stroud, C.H.; Fraser, T.; Graham, J. (Suicide and Life-Threatening Behavior, 2014)
Suicide remains a concerning issue for lesbian, gay, and bisexual (LGB) persons. The integrated effects of five-factor model personality traits and interpersonal-psychological theory of suicide (IPTS) constructs on suicide proneness in a community sample of 336 LGB adults were examined. Results supported a model inclusive of all five-factor model domains predicting IPTS constructs leading to suicide proneness. Effects of neuroticism and extraversion were both mediated by perceived burdensomeness and thwarted belongingness. Thwarted belongingness mediated the effect of agreeableness on suicide proneness. Identified mediation pathways build on existing trait-interpersonal theory and may inform clinical services for sexual minority persons. © 2014 The American Association of Suicidology.

Lesbian, gay, and bisexual adolescent suicidality: the impact of social stigma. - Carney, A. (Kentucky nurse, 2014)

Suicidal ideation in spanish and italian lesbian and gay young adults: The role of internalized sexual stigma - Baiocco, R.; Ioverno, S.; Cerutti, R.; Santamaria, F.; Fontanesi, L.; Lingiardi, V.; Baumgartner, E.; Laghi, F. (Psicothema, 2014)
Background: A growing body of research claims that sexual minority individuals have nearly twice the suicidal ideation rate of heterosexual individuals. Method: The main objective of the current study was to test a model wherein internalized sexual stigma (ISS) mediates the association between some gay-related stressors and suicidal ideation. The present cross-sectional survey involved two samples of lesbian and gay young adults from Spain (N = 209) and Italy (N = 345). The total sample included 316 gay men and 228 lesbian women. Path analysis was used to test the direct and indirect (mediated) effects of the variables from different domains on repulsion by life. Results: In both the Spanish and Italian samples, past victimization experiences and ISS had a significant direct effect on repulsion by life. In both samples, ISS acted as a significant mediator in the effect of the concealment of one’s sexual orientation and the religious involvement of repulsion by life. Conclusion: The current study indicates that ISS is a potential moderator of the effect of concealing one’s sexual orientation, religious involvement, and past experiences of victimization on suicidal attitudes. © 2014 Psicothema.
Keywords: Gay men; Homophobia; Internalized sexual stigma; Lesbians; Sexual minority; Suicidal ideation

Suicidality among veterans: Implications of sexual minority status - Blosnich, J.R.; Mays, V.M.; Cochran, S.D. (American Journal of Public Health, 2014)
Using the California Quality of Life surveys, we examined suicidal ideation and attempts in 129 lesbian, gay, and bisexual (LGB) veterans and in 315 heterosexual veterans in 2008-2009 and 2012- 2013. Although there were no significant differences in the past 12-month suicidal ideation and lifetime attempts, LGB veterans had higher odds of lifetime suicidal ideation than heterosexual veterans (adjusted odds ratio = 3.00; 95% confidence interval = 1.38, 6.53). Suicide assessment and prevention efforts in LGB veterans could benefit fromalife-course perspective regarding suicide risk.

Associations Between Sexual Abuse and Negative Health Consequences Among High-Risk Men Who Have Sex with Men - Rusow, J.A.; Fletcher, J.B.; Le, H.; Reback, C.J. (Journal of Gay and Lesbian Social Services, 2014)
This study evaluated whether a history of sexual abuse could differentiate negative health consequences among men who have sex with men (MSM; N = 148) enrolled in a risk counseling program. More than half (51.4%) reported an experience of sexual abuse. A history of sexual abuse was associated with increased psychological distress, increased rates of alcohol (AOR = 2.91; p <.01) and/or drug abuse (AOR = 2; p <.01) treatment, increased risk of housing instability (AOR = 2.13; p <.05), and increased risk for suicidality (AOR = 4.3; p <.001). Findings demonstrate that screening for sexual abuse may be useful in determining the service needs of high-risk MSM. © 2014 © Taylor & Francis Group, LLC.
Keywords: homelessness; mental health; MSM; sexual abuse; substance abuse treatment; suicide

The influence of intersecting identities on self-harm, suicidal behaviors, and depression among lesbian, gay, and bisexual individuals - Lytle, M.C.; De Luca, S.M.; Blosnich, J.R. (Suicide and Life-Threatening Behavior, 2014)
Individuals with lesbian, gay, and bisexual (LGB) identities have higher prevalence of self-directed violence, but very little is known about racial/ethnic differences between LGB populations. This study aimed to examine racial/ethnic differences in self-harm, suicidal ideation, suicide attempt, and depression among LGB and heterosexual emerging adults. Data are compiled from the Fall 2008 and Spring 2009 National College Health Assessment and limited to respondents within emerging adulthood (ages 18-24) who indicated their sexual orientation and racial/ethnic identities (n = 89,199). Within each racial/ethnic group, LGB individuals were significantly more likely to report self-harm, suicidal ideation, suicide attempt, and depression than non-LGB individuals. © 2014 The American Association of Suicidology.

"It Gets Better"... but How? Exploring Resilience Development in the Accounts of LGBTQ Adults - Asakura, K.; Craig, S.L. (Journal of Human Behavior in the Social Environment, 2014)
As reports of bullying and suicide increase, research on lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth must expand its focus from vulnerabilities to resilience development. The purpose of this inductive qualitative study was to explore resilience development in the accounts of LGBTQ adults by analyzing videos posted for the It Gets Better social media campaign (n = 21). Four major themes emerged: (1) leaving hostile social environments; (2) experiencing "coming out" in meaningful ways; (3) remembering the social environment; and (4) turning challenges into opportunities and strengths. These findings suggest that, despite the campaign's premise, life did not automatically get better for the LGBTQ participants. Rather, the findings offer a nuanced look at the pathways to resilience development. Implications for social work practice are discussed. Copyright Taylor & Francis.
Keywords: bisexual; Gay; It Gets Better project; lesbian; qualitative research; queer; resilience; transgender; video analysis

"A Hope to Lift Both My Spirits": Preventing Bisexual Erasure in Aboriginal Schools - Robinson, M. (Journal of Bisexuality, 2014)
Education is a treaty right for Aboriginal people in Canada and the United States, and Aboriginal schools aim to provide a comprehensive education rooted in indigenous knowledge and culture. In an Aboriginal context, antibullying programs may address microaggressions against lesbian, gay, bisexual, trans, queer, and two-spirited youth. Two-spirited identity offers a model of sexuality that may reduce youth suicide by providing a sense of cultural belonging and purpose for sexual and gender minority Aboriginal people. Yet even as it offers social support, the two-spirited identity model risks replicating the dichotomous constructions of sexuality that form the basis of bisexual erasure. This article discusses strategies for preventing such erasure within Aboriginal schools. © 2014 Copyright Taylor & Francis Group, LLC.
Keywords: Aboriginal; bisexual; bullying; cultural continuity; First Nations; two-spirited

Out on the street: A public health and policy Agenda for lesbian, gay, bisexual, and transgender youth who are homeless - Keuroghlian, A.S.; Shtasel, D.; Bassuk, E.L. (American Journal of Orthopsychiatry, 2014)
A disproportionate number of lesbian, gay, bisexual, and transgender (LGBT) youth experience homelessness each year in the United States. LGBT youth who are homeless have particularly high rates of mental health and substance use problems, suicidal acts, violentvictimization, and a range of HIV risk behaviors. Given the intense needs of LGBT youth experiencing homelessness, it is imperative to understand their unique experiences and develop responsive practices and policies. The range and severity of health risks vary across subgroups of all homeless LGBT youth, and because the population is nonhomogeneous, their particular needs must be identified and addressed. Thus, the purpose of this article is to review the causes of homelessness among LGBT youth, discuss the mental health and victimization risks faced by this population, address differences among homeless LGBT subgoups, and recommend effective interventions and best practices. The authors conclude by discussing promising future research and public policy directions. © 2014 American Orthopsychiatric Association.
Keywords: Depression; HIV risk behaviors; Homelessness; LGBT youth; Substance use

Queer youth suicide and the psychopolitics of “It Gets Better” - Grzanka, P.R.; Mann, E.S. (Sexualities, 2014)
This article investigates a mass-mediated campaign against a perceived increase in suicides among gay (or presumed-to-be-gay) youth in the USA since September 2010. “It Gets Better” (IGB) became a rallying cry for “anti-bullying” activists, politicians, celebrities and ordinary people who created YouTube videos addressed to gay, lesbian, bisexual and transgender (LGBT) youth who might be considering suicide. A critical discourse analysis of a sample of IGB videos reveals a neoliberal frame that places the burden of a “better” life onto the emotional lives of LGBT youth, who are instructed to endure suffering in the interest of inevitable happiness. Drawing on Foucault and Orr's work on the construction and management of mental illness, we use the concept of “psychopower” to explore how these IGB videos render queer youth suicide both a psychological disorder and a sociological crisis for which the only viable solution is “homonormative” subjectivity. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.
Keywords: Homonormativity; mental health; neoliberalism; suicide; youth

Psychosocial Health Conditions and HIV Prevalence and Incidence in a Cohort of Men Who have Sex with Men in Bangkok, Thailand: Evidence of a Syndemic Effect - Guadamuz, T.E.; McCarthy, K.; Wimonsate, W.; Thienkrua, W.; Varangrat, A.; Chaikummao, S.; Sangiamkittikul, A.; Stall, R.D.; van Griensven, F. (AIDS and Behavior, 2014)
Men who have sex with men (MSM) in Bangkok may experience multiple psychosocial health conditions, such as substance use, suicidality, and a history of sexual abuse. These factors may contribute to HIV vulnerability in a syndemic way. A syndemic is defined as a number of synergistically interacting health conditions producing excess disease in a population. The objective of this study is to examine whether psychosocial health conditions among MSM have a syndemic association with HIV prevalence and HIV incidence. To do this, we evaluated psychosocial health conditions and their associations with unprotected sex, HIV prevalence and HIV incidence in a cohort of Thai MSM (N = 1,292). There was a positive and significant association between the number of psychosocial health conditions and increased levels of unprotected sex and HIV prevalence at study baseline. The number of psychosocial health conditions at baseline was also associated with increased HIV incidence during follow-up (no conditions, HIV incidence = 15.3 %; one to three conditions, 23.7 %; four to five conditions, 33.2 %). The number of psychosocial health conditions was positively associated with HIV risk behavior and HIV prevalence and incidence. Prevention efforts among MSM need to address the existence of multiple psychosocial health conditions and their synergy to effectively decrease the spread of HIV infection. © 2014, Springer Science+Business Media New York.
Keywords: HIV/AIDS; Men who have sex with men; Syndemics; Thailand

Structural stigma and all-cause mortality in sexual minority populations - Hatzenbuehler, M.L.; Bellatorre, A.; Lee, Y.; Finch, B.K.; Muennig, P.; Fiscella, K. (Social Science and Medicine, 2014)
Stigma operates at multiple levels, including intrapersonal appraisals (e.g., self-stigma), interpersonal events (e.g., hate crimes), and structural conditions (e.g., community norms, institutional policies). Although prior research has indicated that intrapersonal and interpersonal forms of stigma negatively affect the health of the stigmatized, few studies have addressed the health consequences of exposure to structural forms of stigma. To address this gap, we investigated whether structural stigma-operationalized as living in communities with high levels of anti-gay prejudice-increases risk of premature mortality for sexual minorities. We constructed a measure capturing the average level of anti-gay prejudice at the community level, using data from the General Social Survey, which was then prospectively linked to all-cause mortality data via the National Death Index. Sexual minorities living in communities with high levels of anti-gay prejudice experienced a higher hazard of mortality than those living in low-prejudice communities (Hazard Ratio [HR]=3.03, 95% Confidence Interval [CI]=1.50, 6.13), controlling for individual and community-level covariates. This result translates into a shorter life expectancy of approximately 12 years (95% C.I.: 4-20 years) for sexual minorities living in high-prejudice communities. Analysis of specific causes of death revealed that suicide, homicide/violence, and cardiovascular diseases were substantially elevated among sexual minorities in high-prejudice communities. Strikingly, there was an 18-year difference in average age of completed suicide between sexual minorities in the high-prejudice (age 37.5) and low-prejudice (age 55.7) communities. These results highlight the importance of examining structural forms of stigma and prejudice as social determinants of health and longevity among minority populations. © 2013 Elsevier Ltd.
Keywords: Mortality; Prejudice; Sexual orientation; Stigma; United States

Survey of New Mexico school health professionals regarding preparedness to support sexual minority students - Mahdi, I.; Jevertson, J.; Schrader, R.; Nelson, A.; Ramos, M.M. (Journal of School Health, 2014)
BACKGROUND: For schools to be safe and supportive for students, school health professionals should be aware of the particular challenges lesbian, gay, bisexual, transgender, or questioning (LGBTQ) students face, especially the risk for discrimination, violent victimization, and depression in the school setting. We assessed school health professionals' preparedness to address needs of LGBTQ students. METHODS: We conducted a secondary analysis of data collected during a New Mexico school health conference. This analysis focused on the preparedness of 183 school nurses, counselors, and social workers to address needs of LGBTQ students. Data were analyzed by using chi-square tests, other non-parametric tests, and logistic regression. RESULTS: Social workers (84.6%) and counselors (81.5%) were more likely than school nurses (55.8%) to report moderate or high knowledge of LGBTQ youth health risks, including suicide and depression (p < .001). Approximately half of school counselors and social workers reported no or low knowledge of LGBTQ community-based organizations or knowledge of counselors experienced with LGBTQ concerns. CONCLUSION: School health professionals in New Mexico do not appear prepared to address needs of LGBTQ students. Schools should consider integrating specific content about LGBTQ health risks and health disparities in trainings regarding bullying, violence, cultural competency, and suicide prevention. © 2013. Published 2013. This article is a U.S. Government work and is in the public domain in the USA.
Keywords: Bullying; Cultural competency; Health status disparities; School health; Suicide

Australian trans men: Development, sexuality, and mental health - de Bolger, A.P.; Jones, T.; Dunstan, D.; Lykins, A. (Australian Psychologist, 2014)
The aim of the study reported in this article was to gain an understanding of the experiences, developmental trajectories, and mental health status of Australian trans men. Participants were 279 trans men. The majority preferred to identify as "male"; from an early age, they had experienced their gender identity as different from that normatively expected of their natally assigned sex and had undertaken practices so as to facilitate their presentation as male in accordance with their gender identity. A majority reported a diagnosis of depression or anxiety within the last 12 months and attributed suicidal ideation and self-harm and attempted suicide to personal issues with gender identity. Going through a masculinisation process and coming out reportedly led to improved mental health. The findings highlight the need to educate mental health and health care professionals on trans issues.
Keywords: Gender identity; Mental health; Trans men; Transgender; Transsexual

Minority Stress in Lesbian, Gay, and Bisexual Young Adults in Australia: Associations with Psychological Distress, Suicidality, and Substance Use - Lea, T.; de Wit, J.; Reynolds, R. (Archives of Sexual Behavior, 2014)
Lesbian, gay, bisexual, and other same-sex attracted young people have been shown to be at a higher risk of mental health problems, including depression, anxiety, suicidality, and substance abuse, compared to their heterosexual peers. Homophobic prejudice and stigma are often thought to underlie these disparities. In this study, the relationship between such experiences of social derogation and mental health and substance use in same-sex attracted young people was examined using Meyer’s minority stress theory. An online survey recruited 254 young women and 318 young men who identified as same-sex attracted, were aged 18–25 years, and lived in Sydney, Australia. Multivariate logistic regression analyses showed that internalized homophobia, perceived stigma, and experienced homophobic physical abuse were associated with higher levels of psychological distress and self-reported suicidal thoughts in the previous month. Furthermore, perceived stigma and homophobic physical abuse were associated with reporting a lifetime suicide attempt. The association between minority stress and substance use was inconsistent. While, as expected, higher levels of perceived stigma were associated with club drug dependence, there was an inverse association between internalized homophobia and club drug use, and between perceived stigma and hazardous alcohol use. The findings of this study provide support for the minority stress theory proposition that chronic social stress due to sexual orientation is associated with poorer mental health. The high rates of mental health and substance use problems in the current study suggest that same-sex attracted young people should continue to be a priority population for mental health and substance use intervention and prevention. © 2014, Springer Science+Business Media New York.
Keywords: Alcohol; Drugs; Mental health; Minority stress; Sexual orientation; Substance use

'I thought I was the only one': the misrecognition of LGBT youth in contemporary Vietnam - Horton, P. (Culture, Health and Sexuality, 2014)
While recent LGBT rights demonstrations and discussions about same-sex marriage have thrust the issue of homosexuality into the spotlight, it was not long ago that the issue of homosexuality was notable by its absence in Vietnam. Drawing on semi-structured interviews with young gay, lesbian and bisexual people in Vietnam's capital city Hanoi, this paper considers the increasing visibility of homosexuality through the theoretical lens of recognition, and illustrates the heterosexist misrecognition that LGBT young people have been subjected to in legislation, the media, their families, and through the education system. Drawing on the narratives of LGBT young people, the paper highlights the potentially negative impact such misrecognition may have on psychological and social wellbeing. © 2014 Taylor & Francis.
Keywords: LGBT; sexuality; suicide; urban youth; Vietnam

The Mental Health of Multiethnic Lesbian and Bisexual Adolescent Females: The Role of Self-Efficacy, Stress and Behavioral Risks - Craig, S.L.; Keane, G. (Journal of Gay and Lesbian Mental Health, 2014)
Multiethnic lesbian and bisexual adolescent females (MLBAF) are vulnerable to health and mental health risks, such as depression, suicide, self-harm, family and school concerns, and stress resulting from a "triple jeopardy" of marginalization, yet these risks remain virtually unstudied. Based on minority stress theory, this pilot study found that for a sample of MLBAF (n = 116), the odds of self-reported poor mental health were more than five times higher for each unit increase in stress and almost seven times higher for sexual abuse. The presence of youth substance abuse academic problems and younger age made a significant contribution to poor self-reported mental health while high self-efficacy scores resulted in significantly fewer mental health concerns. Implications for practice are discussed. © 2014 Copyright Taylor & Francis Group, LLC.
Keywords: bisexual; Hispanic; lesbian; mental health; self-efficacy; sexual minority youth; stress

Using a Two-Step Method to Measure Transgender Identity in Latin America/the Caribbean, Portugal, and Spain - Reisner, S.L.; Biello, K.; Rosenberger, J.G.; Austin, S.B.; Haneuse, S.; Perez-Brumer, A.; Novak, D.S.; Mimiaga, M.J. (Archives of Sexual Behavior, 2014)
Few comparative data are available internationally to examine health differences by transgender identity. A barrier to monitoring the health and well-being of transgender people is the lack of inclusion of measures to assess natal sex/gender identity status in surveys. Data were from a cross-sectional anonymous online survey of members (n > 36,000) of a sexual networking website targeting men who have sex with men in Spanish- and Portuguese-speaking countries/territories in Latin America/the Caribbean, Portugal, and Spain. Natal sex/gender identity status was assessed using a two-step method (Step 1: assigned birth sex, Step 2: current gender identity). Male-to-female (MTF) and female-to-male (FTM) participants were compared to non-transgender males in age-adjusted regression models on socioeconomic status (SES) (education, income, sex work), masculine gender conformity, psychological health and well-being (lifetime suicidality, past-week depressive distress, positive self-worth, general self-rated health, gender related stressors), and sexual health (HIV-infection, past-year STIs, past-3 month unprotected anal or vaginal sex). The two-step method identified 190 transgender participants (0.54 %; 158 MTF, 32 FTM). Of the 12 health-related variables, six showed significant differences between the three groups: SES, masculine gender conformity, lifetime suicidality, depressive distress, positive self-worth, and past-year genital herpes. A two-step approach is recommended for health surveillance efforts to assess natal sex/gender identity status. Cognitive testing to formally validate assigned birth sex and current gender identity survey items in Spanish and Portuguese is encouraged. © 2014, Springer Science+Business Media New York.
Keywords: Gender identity; Health; HIV; Surveillance; Transgender

Sexual orientation and anabolic-androgenic steroids in US adolescent boys - Blashill, A.J.; Safren, S.A. (Pediatrics, 2014)
OBJECTIVES: We compared the lifetime prevalence of anabolic-androgenic steroid (AAS) misuse among sexual minority versus heterosexual US adolescent boys, and secondarily, sought to explore possible intermediate variables that may explain prevalence differences. METHODS: Participants were 17 250 adolescent boys taken from a pooled data set of the 14 jurisdictions from the 2005 and 2007 Youth Risk Behavior Surveys that assessed sexual orientation. Data were analyzed for overall prevalence of AAS misuse and possible intermediary risk factors. RESULTS: Sexual minority adolescent boys were at an increased odds of 5.8 (95% confidence interval 4.1-8.2) to report a lifetime prevalence of AAS (21% vs 4%) compared with their heterosexual counterparts, P < .001. Exploratory analyses suggested that increased depressive symptoms/suicidality, victimization, and substance use contributed to this disparity. CONCLUSIONS: This is the first known study to test and find substantial health disparities in the prevalence of AAS misuse as a function of sexual orientation. Prevention and intervention efforts are needed for sexual minority adolescent boys. Copyright © 2014 by the American Academy of Pediatrics.
Keywords: Anabolic-androgenic steroids, adolescents, boys; Sexual orientation

Discreet and indiscreet barriers to adolescent health-seeking efforts - Anthony, I. (Clinical Pediatrics, 2014)

The intersecting roles of violence, gender, and substance use in the emergency department: A research agenda - Choo, E.K.; Benz, M.; Rybarczyk, M.; Broderick, K.; Linden, J.; Boudreaux, E.D.; Ranney, M.L. (Academic Emergency Medicine, 2014)
The relationship between gender, violence, and substance use in the emergency department (ED) is complex. This article examines the role of gender in the intersection of substance use and three types of violence: peer violence, intimate partner violence, and firearm violence. Current approaches to treatment of substance abuse and violence are similar across both genders; however, as patterns of violence and substance abuse differ by gender, interventions may be more effective if they are designed with a specific gender focus. © 2014 by the Society for Academic Emergency Medicine.

Suicide risk in the UK Trans population and the role of gender transition in decreasing suicidal ideation and suicide attempt - Bailey, L.; Ellis, S.J.; McNeil, J. (Mental Health Review Journal, 2014)
Purpose: The purpose of this paper is to present findings from the Trans Mental Health Study (McNeil et al., 2012) - the largest survey of the UK trans population to date and the first to explore trans mental health and well-being within a UK context. Findings around suicidal ideation and suicide attempt are presented and the impact of gender dysphoria, minority stress and medical delay in particular, are highlighted. Design/methodology/approach: This represents a narrative analysis of qualitative sections of a survey that utilised both open and closed questions. The study drew on a non-random sample (n = 889), obtained via a range of UK-based support organisations and services. Findings: The study revealed high rates of suicidal ideation (84 per cent lifetime prevalence) and attempted suicide (48 per cent lifetime prevalence) within this sample. A supportive environment for social transition and timely access to gender reassignment, for those who required it, emerged as key protective factors. Subsequently, gender dysphoria, confusion/denial about gender, fears around transitioning, gender reassignment treatment delays and refusals, and social stigma increased suicide risk within this sample. Research limitations/implications: Due to the limitations of undertaking research with this population, the research is not demographically representative. Practical implications: The study found that trans people are most at risk prior to social and/or medical transition and that, in many cases, trans people who require access to hormones and surgery can be left unsupported for dangerously long periods of time. The paper highlights the devastating impact that delaying or denying gender reassignment treatment can have and urges commissioners and practitioners to prioritise timely intervention and support. Originality/value: The first exploration ofsuicidal ideation and suicide attempt within the UK trans population revealing key findings pertaining to social and medical transition, crucial for policy makers, commissioners and practitioners working across gender identity services, mental health services and suicide prevention. © Emerald Group Publishing Limited.
Keywords: Gender dysphoria; Gender transition; Health inequalities; Suicidal ideation; Suicide attempt; Trans suicide risk

Adolescence, sexual behavior and risk factors to health - de Assis, S.G.; Gomes, R.; Pires, T.O. (Revista de Saude Publica, 2014)
Objective: To analyze the relationships between sexual behavior and risk factors to physical and mental health in adolescents. Methods: Study of 3,195 pupils aged 15 to 19 in secondary education, in public and private schools in 10 state capitals in Brazil between 2007 and 2008. Multi-stage (schools and pupils) cluster sampling was used in each city and public and private educational network. All of the students selected completed a questionnaire on the following items: socioeconomic and demographic data; sexual behavior having sex with those of the same sex, the opposite sex, or both; alcohol and cannabis use; using condoms; traumatic sexual experiences as a child or adolescent suicidal thoughts. The analysis included describing frequencies, Chi-square test, analysis of multiple and cluster correspondence. Responses to an open ended question in which the adolescent expressed general comments about themselves and their lives were qualitatively analyzed using content analysis. Results: Around 3.0% of adolescents reported homosexual or bisexual behavior, with no difference according to sex, age, skin color, social status family structure or educational network. Adolescents with homosexual/ bisexual sexual behavior, compared to their heterosexual peers, reported: (p < 0.05): getting drunk (18.7% and 10.5%, respectively), frequent cannabis use (6.1% and 2.1%, respectively), suicidal thoughts (42.5% and 18.7%, respectively), and having been the victim of sexual violence (11.7% and 1.5%; respectively). Adolescents with homosexual/bisexual sexual behavior reported that they used condoms less frequently (74.2%) than their heterosexual peers (48.6%, p < 0.001). In the correspondence analysis, three groups were found, one composed of adolescents with homosexual/bisexual behavior and experiencing risk factors; suffering sexual violence, never using a condom, suicidal thoughts, frequent cannabis use; another composed of occasional cannabis and condom users, who got drunk frequently, and adolescents with heterosexual behavior and none of the risk factors investigated. More of the risk factors were found in adolescents with homosexual/bisexual behavior compared with those with heterosexual behavior. Adolescents with homosexual/bisexual sexual behavior were more likely to talk about their positive personal experiences and negative relationship experiences that their heterosexual peers, but spoke less about religion. Conclusions: Not only should this issue be studied in more detail, but preventative actions aimed at adolescents with homosexual/bisexual behavior should be widened.
Keywords: Adolescent; Adolescent behavior; Dangerous behavior; Risk factors; Sexual behavior

General Strain Theory for LGBQ and SSB Youth: The Importance of Intersectionality in the Future of Feminist Criminology - Button, D.M.; Worthen, M.G.F. (Feminist Criminology, 2014)
This study applies an intersectional general strain theory (GST) framework to understand the experiences of lesbian, gay, bisexual, questioning (LGBQ) youth, and youth involved in same-sex sexual behavior (SSB). Using a statewide probability sample of LGBQ and SSB youth (N = 539) in grades 9 to 12, results show that understanding LGBQ and SSB youths’ experiences with victimization (feeling unsafe, threatened/injured, property stolen) and negative outcomes (poor academic performance, substance use, suicidality) must be underscored with the significance of and intersections between gender, sexual identity, and sexual behavior. Implications for the importance of intersectionality in GST and the future of feminist criminology are offered. © The Author(s) 2014.
Keywords: gay; gender; general strain theory; intersectionality; lesbian; LGBQ youth

Characteristics of children and adolescents with gender dysphoria referred to the Hamburg gender identity clinic - Becker, I.; Gjergji-Lama, V.; Romer, G.; Möller, B. (Praxis der Kinderpsychologie und Kinderpsychiatrie, 2014)
Given the increasing demand for counselling in gender dysphoria in childhood in Germany, there is a definite need for empirical data on characteristics and developmental trajectories of this clinical group. This study aimed to provide a first overview by assessing demographic characteristics and developmental trajectories of a group of gender variant boys and girls referred to the specialised Gender Identity Clinic in Hamburg. Data were extracted from medical charts, transcribed and analysed using qualitative content analysis methods. Categories were set up by inductive-deductive reasoning based on the patients', parents' and clinicians' information in the files. Between 2006 and 2010, 45 gender variant children and adolescents were seen by clinicians; 88.9 % (n = 40) of these were diagnosed with gender identity disorder (ICD-10). Within this group, the referral rates for girls were higher than for boys (1:1.5). Gender dysphoric girls were on average older than the boys and a higher percentage of girls was referred to the clinic at the beginning of adolescence (> 12 years of age). At the same time, more girls reported an early onset age. More girls made statements about their (same-sex) sexual orientation during adolescence and wishes for gender confirming medical interventions. More girls than boys revealed self-mutilation in the past or present as well as suicidal thoughts and/or attempts. Results indicate that the presentation of clinically referred gender dysphoric girls differs from the characteristics boys present in Germany; especially with respect to the most salient age differences. Therefore, these two groups require different awareness and individual treatment approaches. © Vandenhoeck & Ruprecht GmbH & Co. KG, Göttingen 2014.
Keywords: Age of onset; Gender dysphoria in childhood; Gender identity disorder of childhood; Gender variance; Sociodemographic characteristics

Emerging issues in the relationship between adolescent substance use and suicidal behavior - Shlosberg, D.; Zalsman, G.; Shoval, G. (Israel Journal of Psychiatry and Related Sciences, 2014)
Adolescent suicidal behavior poses a major global public health concern as it is highly prevalent and associated with mortality and morbidity worldwide. Substanceuse disorders are also an issue of increasing concern among adolescents and have been shown to increase the risk for suicidal behaviors. In this review we address emerging issues in the relationship between adolescent substance use disorders and suicidal behaviors. We focus on common hazardous patterns of substance abuse such as binge drinking and poly-substance abuse and point out developing patterns of substance preferences as evidenced by the contemporary widespread use of synthetic cannabinoids. We address these issues in the context of vulnerable populations such as sexual-minority adolescents and youth with co-occurring mental-disorder diagnoses. Finally, we relate to the present and future challenges presented by these issues to implement effective anti-suicidal treatment and prevention strategies in adolescents with substance use disorders. © 2015, Mediafarm Group. All rights reserved.

The peripubertal gender-dysphoric child: Puberty suppression and treatment paradigms - Olson, J.; Garofalo, R. (Pediatric Annals, 2014)
Gender-nonconforming youth are emerging at increasingly younger ages, and those experiencing gender dysphoria are seeking medical care at, or sometimes even before, the onset of puberty. Youth with gender dysphoria are at high risk for depression, anxiety, isolation, self-harm, and suicidality at the onset of a puberty that feels wrong. Medical providers would benefit from understanding interventions that help gender-nonconforming children and youth thrive. The use of gonadotropin-releasing hormone (GnRH) agonists to block the onset of an undesired puberty in youth with gender dysphoria is a relatively new practice, particularly in the United States. These medications shut down the hypothalamic-pituitary-gonadal axis (HPG), and the production of either testosterone or estrogen is temporarily halted. Puberty blocking allows a young person to explore gender and participate more fully in the mental health therapy process without being consumed by the fear of an impending developmental process that will result in the acquisition of undesired secondary sexual characteristics. GnRH agonists have been used safely for decades in children with other medical conditions, including central precocious puberty. Potential side effects of GnRH agonists include diminished bone density, injection site problems, emotional instability, and weight gain. Preliminary data have shown GnRH agonists to be very helpful in improving behavioral and overall functioning outcomes. Puberty suppression should ideally begin in the first stages of pubertal development and can be given via intramuscular or subcutaneous injections, or via an implant that is inserted in the upper arm. Monitoring to assure suppression of the HPG axis should occur regularly. Gender-nonconforming youth who remain gender dysphoric can go on to receive cross-sex hormones for phenotypic gender transition when they are older. GnRH agonists have changed the landscape of medical intervention for youth with gender dysphoria and are rapidly becoming the standard of practice. © SLACK Incorporated.

Connections between social support and suicidal tendency in homosexual and bisexual persons - Widmer, A.; Regli, D.; Frei, L.; Znoj, H. (Zeitschrift fur Sexualforschung, 2014)

Causes of death in HIV-infected patients from the Cologne-Bonn cohort - Ehren, K.; Hertenstein, C.; Kümmerle, T.; Vehreschild, J.J.; Fischer, J.; Gillor, D.; Wyen, C.; Lehmann, C.; Cornely, O.A.; Jung, N.; Gravemann, S.; Platten, M.; et al. (Infection, 2014)
Purpose: Causes of death in human immunodeficiency virus (HIV)-infected subjects have changed in countries with high resources over the last several years. Acquired immunodeficiency syndrome (AIDS)-related diseases have become less prevalent, whereas deaths due to non-AIDS causes are increasing. The aim of the present study was to analyse causes of death in the Cologne-Bonn cohort. Methods: Causes of death from the Cologne-Bonn cohort between 2004 and 2010 were systematically recorded using the CoDe algorithm (The Coding Causes of Death in HIV Project). Results: In 3,165 patients followed from 2004 to 2010, 182 deaths occurred (5.7%, 153 males, 29 females). The median age at the time of death was 47 years (range 24-85 years). The most frequent causes of death were AIDS-defining events (n = 60, 33%), with non-Hodgkin lymphoma (NHL) (n = 29, 16%) and infections (n = 20, 11%) being the leading entities in this category. Non-AIDS malignancies accounted for 16% (n = 29), non-HIV-related infections for 10% (n = 18), cardiovascular diseases for 7% (n = 14), suicide or accident for 4% (n = 7) and liver diseases for 3% (n = 5) of deaths (unknown n = 47, 26%). Although the majority of patients (92.5%) was on antiretroviral therapy (ART), only 50% were virologically suppressed (HIV-RNA <50 copies/mL) and 44% had a decreased CD4+ count (<200/μL) at their last visit before death. Conclusion: One-third of the causes of death in our cohort between 2004 and 2010 was AIDS-related. Since most of these deaths occur with severe immune suppression, they can possibly be prevented by the early diagnosis and treatment of HIV infection. Care providers must be aware of an increased risk for a broad range of diseases in HIV-infected patients and should apply appropriate preventive measures. © Springer-Verlag 2013.
Keywords: AIDS; Antiretroviral therapy; Causes of death; HIV; Mortality

How gay-straight alliance groups mitigate the relationship between gay-bias victimization and adolescent suicide attempts - Davis, B.; Royne Stafford, M.B.; Pullig, C. (Journal of the American Academy of Child and Adolescent Psychiatry, 2014)
Objective We examined the relationships between victimization from being bullied, suicide, hopelessness, and the presence of a Gay-Straight Alliance (GSA) on a school campus. Method We analyzed data from the California Healthy Kids Survey from 2005 to 2007 using hierarchical modeling. Results We found that gay-bias (versus non-gay-bias) victimization is meaningfully connected with the inwardly destructive behavior of attempted suicide among adolescents. We also found that hopelessness helps explain associations between gay-bias victimization and suicide attempts and that the presence of a GSA club on a school's campus attenuates significant connections between gay-bias victimization and suicide attempts by reducing hopelessness. Conclusion Gay-bias victims are more likely than other victims to attempt suicide while also feeling more hopeless. The presence of a GSA on campus may help to reduce the attempted suicide and hopelessness associated with gay-bias victimization. © 2014 American Academy of Child and Adolescent Psychiatry..
Keywords: bully; gay; hopelessness; suicide; victimization

Sexual Orientation, Psychological Well-Being, and Mental Health: A Longitudinal Analysis From Adolescence to Young Adulthood - Becker, M.; Cortina, K.S.; Tsai, Y.-M.; Eccles, J.S. (Psychology of Sexual Orientation and Gender Diversity, 2014)
In the past, mainly cross-sectional research has shown that nonheterosexuals report lower levels of psychological well-being and functioning than heterosexuals. Drawing on minority stress theory (Meyer, 2003), life span theory, and identity formation theory (Erikson, 1968), the present study analyzed developmental trajectories in psychological functioning from adolescence to young adulthood in nonheterosexual and heterosexual populations. Based on data from the Michigan Study of Adolescent and Adult Life Transitions (MSALT), nonheterosexual adolescents and young adults were compared with their heterosexual peers regarding their psychological development from the ages of 16 to 28. Overall levels of depressive affect, suicidal ideation, alcohol consumption, and social alienation were elevated for nonheterosexual young adolescents. For depressive affect and social alienation as well as suicidal ideation, the 2 groups grew apart during their high-school years but converged after leaving high school. For alcohol consumption, a divergent trend emerged after high school. No differences were found for self-esteem. None of the interactions between sexual orientation and gender reached statistical significance. The results point toward a higher degree of complexity in developmental patterns compared with results of previous studies. The study underscores the nonstatic nature of mental health disparities and highlights the potential and the need to prevent psychological maladjustment for nonheterosexual populations. © 2014 American Psychological Association.
Keywords: Longitudinal study; Mental health; Psychological well-being; Sexual orientation

Gender dysphoria in adolescents: Difficulties in treatment - Meyenburg, B. (Praxis der Kinderpsychologie und Kinderpsychiatrie, 2014)
In many children and adolescents with gender dysphoria only minor or no psychopathology is found. 43 % of patients seen in the Frankfurt University Gender Identity Clinic for children and adolescents suffer from major psychopathology. To demonstrate difficulties in treatment of these patients courses of treatment in four such patients are presented. In two natal females major psychopathology made decision for reassignment very difficult. Two natal males were in addition not able to follow recommended treatment steps, in these patients diagnostic doubts arose. © Vandenhoeck & Ruprecht GmbH & Co. KG, Göttingen 2014.
Keywords: Gender dysphoria in adolescents; Psychopathology and gender dysphoria; Psychotherapy in gender dysphoric adolescents

The health and well-being of transgender high school students: Results from the New Zealand adolescent health survey (youth'12) - Clark, T.C.; Lucassen, M.F.G.; Bullen, P.; Denny, S.J.; Fleming, T.M.; Robinson, E.M.; Rossen, F.V. (Journal of Adolescent Health, 2014)
Purpose To report the prevalence of students according to four gender groups (i.e., those who reported being non-transgender, transgender, or not sure about their gender, and those who did not understand the transgender question), and to describe their health and well-being. Methods Logistic regressions were used to examine the associations between gender groups and selected outcomes in a nationally representative high school health and well-being survey, undertaken in 2012. Results Of the students (n = 8,166), 94.7% reported being non-transgender, 1.2% reported being transgender, 2.5% reported being not sure about their gender, and 1.7% did not understand the question. Students who reported being transgender or not sure about their gender or did not understand the question had compromised health and well-being relative to their non-transgender peers; in particular, for transgender students perceiving that a parent cared about them (odds ratio [OR],.3; 95% confidence interval [CI],.2-.4), depressive symptoms (OR, 5.7; 95% CI, 3.6-9.2), suicide attempts (OR, 5.0; 95% CI, 2.9-8.8), and school bullying (OR, 4.5; 95% CI, 2.4-8.2). Conclusions This is the first nationally representative survey to report the health and well-being of students who report being transgender. We found that transgender students and those reporting not being sure are a numerically small but important group. Transgender students are diverse and are represented across demographic variables, including their sexual attractions. Transgender youth face considerable health and well-being disparities. It is important to address the challenging environments these students face and to increase access to responsive services for transgender youth. © 2014 Society for Adolescent Health and Medicine. All rights reserved.
Keywords: Adolescent; Health; Sexuality; Transgender; Well-Being

An unresolved journey: Religious discourse and same-sex attracted and gender questioning young people - Gahan, L.; Jones, T.; Hillier, L. (Research in the Social Scientific Study of Religion, 2014)
Most religious same-sex attracted and gender questioning (ssagq) young people discover their sense of self within contexts in which homonegative truths dominate. Historically this group only had the choice of repressing their identities, hiding them, or leaving their faiths. However, religious change and marriage and education rights movements are contributing to more homopositive discourses. This research analyzed quantitative and qualitative data on the experiences of a subgroup of ssagq young people who mentioned religion within an anonymous online survey of 3,134 ssagq Australians aged 14-21. Comparisons are made between this 2010 study and the results of a 2004 study. The subgroup members were more likely to be socially isolated and at greater risk of self-harm and suicide ideation. They also had particularly negative experiences at school. However, compared to previous years, the religious sub-group members had higher expectations of how they should be treated. Unlike in the past, they saw fewer contradictions in keeping their faith and being gay (or otherwise), and they expected to marry and have children. With religious leaders such as the Catholic Pope Francis I recently pushing for greater integration of gays, we argue that future research should consider the influence of media statements on religious ssagq young people. © KONINKLIJKE BRILL NV, LEIDEN, 2014
Keywords: Marriage; Religion; Sexuality; Suicide; Young people

Rural-urban disparities in school nursing: Implications for continuing education and rural school health - Ramos, M.M.; Fullerton, L.; Sapien, R.; Greenberg, C.; Bauer-Creegan, J. (Journal of Rural Health, 2014)
Purpose: Little is known about the professional and educational challenges experienced by rural school nurses. We conducted this study to describe disparities between the urban and rural professional school nurse workforce in New Mexico and to identify how best to meet the continuing education needs of New Mexico's rural school nurse workforce. Methods: We analyzed state data from a 2009 New Mexico Department of Health school nurse workforce survey (71.7% response rate). We included all survey respondents who indicated working as a school nurse in a public school setting in any grade K-12 and who identified their county of employment (N = 311). Findings: Rural school nurses were twice as likely as metropolitan nurses to provide clinical services to multiple school campuses (67.3% compared to 30.1%, P < .0001). They were less likely to hold a nursing degree at the baccalaureate level or higher (62.7% compared to 82.3%, P = .0002). Rural school nurses were less likely than metropolitan nurses to have received recent continuing education on anaphylaxis (P < .0001), asthma (P = .027), body mass index (BMI)/healthy weight (P = .0002), diabetes (P < .0001), lesbian, gay, bisexual and transgender (LGBT) health (P = .0004), and suicide risk identification and prevention (P = .015). Online courses and telehealth were identified by rural school nurses as among the preferred means for receiving continuing education. Conclusions: Our findings support the provision of online courses and telehealth content to address urban-rural disparities in school nursing education and support rural school health. © 2014 National Rural Health Association.
Keywords: Health disparities; Health services research; Nursing; Rural health; School health

PTSD as Aftermath for Bullied LGBT Adolescents: The Case for Comprehensive Assessment - Beckerman, N.L.; Auerbach, C. (Social Work in Mental Health, 2014)
There is overwhelming research that demonstrates a positive correlation between various forms of adolescent bullying and subsequent and serious psychological repercussions such as anxiety, depression, suicidal ideation and attempt as well as posttraumatic stress disorder (PTSD; D'Augelli et al., 2005; Herek & Garnets, 2007; Mustanski, Garofalo, & Emerson, 2010). This study examines a particularly vulnerable adolescent and young adult population: lesbian, gay, and transgendered adolescents who have been bullied (Herek & Garnets, 2006). This study (n = 23) identifies which forms of bullying are more likely to manifest in subsequent symptoms of PTSD. Although there are numerous confounding variables, there are statistically significant findings that demonstrate which forms of bullying are more psychologically treacherous, and employing the PTSD checklist-civilian version (PCL) screening instrument, we learned who and what conditions might predict PTSD in our clients. Clinical implications for comprehensive PTSD screening and assessment are provided for mental health practitioners. Copyright © Taylor & Francis Group, LLC.
Keywords: adolescents; assessment; bullying; LGBT; PTSD

Effects of Different Steps in Gender Reassignment Therapy on Psychopathology: A Prospective Study of Persons with a Gender Identity Disorder - Heylens, G.; Verroken, C.; De Cock, S.; T'Sjoen, G.; De Cuypere, G. (Journal of Sexual Medicine, 2014)
Introduction: At the start of gender reassignment therapy, persons with a gender identity disorder (GID) may deal with various forms of psychopathology. Until now, a limited number of publications focus on the effect of the different phases of treatment on this comorbidity and other psychosocial factors. Aims: The aim of this study was to investigate how gender reassignment therapy affects psychopathology and other psychosocial factors. Methods: This is a prospective study that assessed 57 individuals with GID by using the Symptom Checklist-90 (SCL-90) at three different points of time: at presentation, after the start of hormonal treatment, and after sex reassignment surgery (SRS). Questionnaires on psychosocial variables were used to evaluate the evolution between the presentation and the postoperative period. The data were statistically analyzed by using SPSS 19.0, with significance levels set at P<0.05. Main Outcome Measures: The psychopathological parameters include overall psychoneurotic distress, anxiety, agoraphobia, depression, somatization, paranoid ideation/psychoticism, interpersonal sensitivity, hostility, and sleeping problems. The psychosocial parameters consist of relationship, living situation, employment, sexual contacts, social contacts, substance abuse, and suicide attempt. Results: A difference in SCL-90 overall psychoneurotic distress was observed at the different points of assessments (P=0.003), with the most prominent decrease occurring after the initiation of hormone therapy (P<0.001). Significant decreases were found in the subscales such as anxiety, depression, interpersonal sensitivity, and hostility. Furthermore, the SCL-90 scores resembled those of a general population after hormone therapy was initiated. Analysis of the psychosocial variables showed no significant differences between pre- and postoperative assessments. Conclusions: A marked reduction in psychopathology occurs during the process of sex reassignment therapy, especially after the initiation of hormone therapy. © 2013 International Society for Sexual Medicine.
Keywords: Gender Dysphoria; Gender Identity Disorder; Gender Reassignment Therapy; Psychopathology

Disgust sensitivity selectively predicts attitudes toward groups that threaten (or uphold) traditional sexual morality - Crawford, J.T.; Inbar, Y.; Maloney, V. (Personality and Individual Differences, 2014)
Previous research has linked disgust sensitivity to negative attitudes toward gays and lesbians. We extend this existing research by examining the extent to which disgust sensitivity predicts attitudes more generally toward groups that threaten or uphold traditional sexual morality. In a sample of American adults (N= 236), disgust sensitivity (and particularly contamination disgust) predicted negative attitudes toward groups that threaten traditional sexual morality (e.g., pro-choice activists), and positive attitudes toward groups that uphold traditional sexual morality (e.g., Evangelical Christians). Further, disgust sensitivity was a weaker predictor of attitudes toward left-aligned and right-aligned groups whose objectives are unrelated to traditional sexual morality (e.g., gun-control/gun-rights activists). Together, these findings are consistent with a sexual conservatism account for understanding the relationship between disgust sensitivity and intergroup attitudes. © 2014 Elsevier Ltd.
Keywords: Disgust sensitivity; Intergroup attitudes; Prejudice; Sex

Popular journalism, religious morality, and the Canadian imaginary: Queers and immigrants as threats to the public sphere - Mosurinjohn, S. (Journal of Religion and Popular Culture, 2014)
In Canada, opposition toward GLBQ identities and practices has been almost entirely religious in nature. On the other hand, antipathy toward "undesirable" immigrant profiles - ironically, often those perceived as homophobic and misogynistic - has been articulated through arguments about the supposed incompatibility of their religious values (usually Islamic) with "Canadian" mores. This paper analyzes a variety of national news media to demonstrate how the transgressive figures of the immigrant and the queer are composed in a powerful and particular way through journalistic attitudes toward and understandings of religion. In particular, I examine a discursive framework emergent in reporting on two recent tragediesone, the 2011 suicide of the gay Ottawa teenager Jamie Hubley, and the other, the 2009 Shafia family "honour killings." I argue that this reporting disingenuously evokes a commitment to tolerance without occasioning a substantial interrogation of what is really being tolerated and why.
Keywords: Canada; Christianity; Immigration; Islam; Jamie Hubley; Journalism; Queerness; Shafia trial; Toleration; Youth suicide

Adolescent Gender-Related Abuse, Androphilia, and HIV Risk Among Transfeminine People of Color in New York City - Hwahng, S.J.; Nuttbrock, L. (Journal of Homosexuality, 2014)
Public health research has indicated extremely high HIV seroprevalence (13%-63%) among low-income transfeminine people of color of African, Latina, and Asian descent living in the U.S. This article combines two data sets. One set is based on an ethnographic study (N = 50, 120 hours of participant observation). The other set is based on a longitudinal quantitative study (baseline N = 600, N = 275 followed for 3 years). Transfeminine people of color are much more likely to be androphilic and at high HIV risk. A greater understanding of adolescent gender-related abuse and trauma-impacted androphilia contributes toward a holistic conceptual model of HIV risk. A theoretical model is proposed that incorporates findings from both studies and integrates sociostructural, interpersonal, and intrapsychic levels of HIV risk. © Taylor & Francis Group, LLC.
Keywords: androphilia; childhood abuse; developmental; diachronic analysis; gender identity; gender-related abuse/violence; HIV risk; life course perspective; low-income; mental health; people of color; poverty; re-traumatization; sex work; sexual health; social determinants of health; social ecology; transgender; transwomen of color; victimization

Risk and Resilience During Transgender Identity Development: The Effects of Awareness and Engagement with Other Transgender People on Affect - Testa, R.J.; Jimenez, C.L.; Rankin, S. (Journal of Gay and Lesbian Mental Health, 2014)
Research examining risk and resilience among transgender individuals suggests that connection to a transgender community may be protective. Utilizing archival survey data of 3,087 adult transgender participants collected in 2005-06, this study further evaluated how awareness and engagement with other transgender people influences risk and resilience during early gender identity development. As hypothesized, among male-to-female and female-to-male respondents, both prior awareness and prior engagement with other transgender people were independently related to less fearfulness, less suicidality, and more comfort. These relationships were not significant among male-to-different-gender or female-to-different-gender participants. Implications of these findings are discussed. © 2014 Copyright Taylor and Francis Group, LLC.
Keywords: anxiety; community support; resilience; suicidal ideation; transgender

Rupture, resilience, and risk: Relationships between mental health and migration among gay-identified men in North America - Lewis, N.M. (Health and Place, 2014)
An established body of research in psychology, psychiatry and epidemiology links social stigma and stress with poor mental and sexual health outcomes among gay-identified men. Less work considers how these linkages are mediated by place and almost none considers the role of movement across places. This qualitative study, based on the migration narratives of 48 gay-identified men living in Ottawa, Ontario, Canada, and Washington, D.C., U.S.A. gives more careful consideration to the ways in which mental and emotional health issues (e.g., anxiety, depression, substance use) in this population both precipitate migration and stem from migration. The narratives show that decisions to migrate often emerge from men[U+05F3]s experiences of place-based minority stress and associated health outcomes. At the same time, moving to urban gay communities, when coupled with other life circumstances, can create or reinforce physical and emotional insecurities that lead to low self-esteem, substance use and sexual risk-taking. © 2014 Elsevier Ltd.
Keywords: Gay; HIV/AIDS; Mental health; Migration; Sexuality

Risk of adolescent offspring's completed suicide increases with prior history of their same-sex parents' death by suicide - Cheng, C.-C.J.; Yen, W.-J.; Chang, W.-T.; Wu, K.C.-C.; Ko, M.-C.; Li, C.-Y. (Psychological Medicine, 2014)
Background To investigate the risk of completed suicide in offspring during adolescence in relation to prior history of the same-sex parent's death by suicide and other causes. Method A total of 500 adolescents who died by suicide at age 15-19 years between 1997 and 2007 were identified from the Taiwan Mortality Registration (TMR). For each case, 30 age-and time-matched controls were selected randomly from all adolescents registered in the Taiwan Birth Registry (TBR). A multivariate conditional logistic regression model was used to assess the risk of adolescent completed suicide in relation to their same-sex parent. Results Adolescent suicide risk was positively associated with both paternal [odds ratio (OR) 5.38, 95% confidence interval (CI) 2.17-13.33] and maternal suicide (OR 6.59, 95% CI 1.82-23.91). The corresponding risk estimates associated with paternal and maternal deaths from non-suicidal causes were much lower, at 1.88 and 1.94 respectively. The risk of suicide in male adolescents was significantly associated with prior history of paternal death by suicide (OR 8.23, 95% CI 2.96-22.90) but not of maternal death by suicide (OR 3.50, 95% CI 0.41-30.13). On the other contrary, the risk of suicidal death in female adolescents was significantly associated with prior history of maternal suicide (OR 9.71, 95% CI 1.89-49.94) but not of paternal suicide (OR 2.42, 95% CI 0.30-19.57). However, these differences did not reach statistical significance. Conclusions Although limited by sample size, our study indicates that adolescent offspring suicidal death is associated with prior history of their same-sex parent's death by suicide. © 2013 Cambridge University Press.
Keywords: case-control studies; Key words Adolescent; parent; suicide

Family Rejection, Social Isolation, and Loneliness as Predictors of Negative Health Outcomes (Depression, Suicidal Ideation, and Sexual Risk Behavior) Among Thai Male-to-Female Transgender Adolescents - Yadegarfard, M.; Meinhold-Bergmann, M.E.; Ho, R. (Journal of LGBT Youth, 2014)
This study examined the influence of family rejection, social isolation, and loneliness on negative health outcomes among Thai male-to-female transgender adolescents. The sample consisted of 260 male respondents, of whom 129 (49.6%) were self-identified as transgender and 131 (50.4%) were self-identified as cisgender (nontransgender). Initial multivariate analysis of variance indicated that the transgender respondents, when compared to the cisgender respondents, reported significantly higher family rejection, lower social support, higher loneliness, higher depression, lower protective factors (PANSI-positive) and higher negative risk factors (PANSI-negative) related to suicidal behavior, and were less certain in avoiding sexual risk behaviors. Multiple regression analysis indicated that the exogenous variables of family rejection, social isolation, and loneliness were significant predictors of both transgender and cisgender adolescents’ reported levels of depression, suicidal thinking, and sexual risk behaviors. The implications of these findings are discussed. © 2014, Copyright © Taylor & Francis Group, LLC.
Keywords: Adolescents; depression; family rejection; loneliness; sexual risk behavior; social isolation; suicidal ideation; transgender

Gender-Related Victimization, Perceived Social Support, and Predictors of Depression Among Transgender Australians - Boza, C.; Nicholson Perry, K. (International Journal of Transgenderism, 2014)
This study examined mental health outcomes, gender-related victimization, perceived social support, and predictors of depression among 243 transgender Australians (n = 83 assigned female at birth, n = 160 assigned male at birth). Overall, 69% reported at least 1 instance of victimization, 59% endorsed depressive symptoms, and 44% reported a previous suicide attempt. Social support emerged as the most significant predictor of depressive symptoms (p >.05), whereby persons endorsing higher levels of overall perceived social support tended to endorse lower levels of depressive symptoms. Second to social support, persons who endorsed having had some form of gender affirmative surgery were significantly more likely to present with lower symptoms of depression. Contrary to expectations, victimization did not reach significance as an independent risk factor of depression (p =.053). The pervasiveness of victimization, depression, and attempted suicide represents a major health concern and highlights the need to facilitate culturally sensitive health care provision. © 2014 Copyright © Taylor & Francis Group, LLC.
Keywords: depression; discrimination; gender affirmative surgery; hormones; social support; Transgender; victimization

Genital self-mutilation in a suicide attempt: A rare sequela of a hypochondriacal delusion of infection with HIV - Mishra, K.K.; Reddy, S.; Khairkar, P. (International Journal of STD and AIDS, 2014)
Genital self-mutilation is mostly seen among psychotic, affective and gender identity disorder(s). We present here a rare case report of such genital self-mutilation in a person with a hypochondriacal delusion of infection with HIV precipitated by erroneous and anxiety-provoking miscommunication during HIV testing. Such cases remind us of the need for systematic and appropriate pre-test and post-test HIV counseling, to help prevent such outcomes. © The Author(s) 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.
Keywords: AIDS; genital self-mutilation; high-risk behaviour; HIV; sexual behaviour; testing

Dying protagonists in two gay southern novels: Randall Kenan's a visitation of spirits and Jim Grimsley's dream boy - Trušník, R. (American and British Studies Annual, 2014)
The present article explores two southern novels, Randall Kenan's A Visitation of Spirits (1989) and Jim Grimsley's Dream Boy (1995). These two novels are at first sight a deviation from the contemporary tradition of coming-out (i.e., gay coming-of-age) novels, as their teenage protagonists do not successfully develop a proud gay identity but die a violent death, by suicide and murder, respectively. However, a closer exploration of the texts themselves as well as the literary context will also reveal that even though both novels do constitute a departure from the previous tradition of gay coming-of-age novels by their extensive use of Gothic elements, they still contain a plausible story portraying the interplay of the social and psychological facets of growing up.
Keywords: A Visitation of Spirits; American novel; Dream Boy; Gay literature; Gothic elements; Jim Grimsley; Randall Kenan; Southern literature

Employment, Mental Health, Internalized Stigma, and Coping With Transphobia Among Transgender Individuals - Mizock, L.; Mueser, K.T. (Psychology of Sexual Orientation and Gender Diversity, 2014)
Transgender individuals encounter stigma related to nonconforming gender identity, contributing to elevated symptoms of depression, anxiety, and suicidality. Stigma toward transgender individuals (i.e., transphobia) poses significant barriers to employment and other areas of functioning. Transgender individuals with a history of mental health concerns may encounter double stigma. The present 2-part study was conducted to investigate experiences of double stigma, internalized stigma, and coping strategies for dealing with transphobia. In Study 1, quantitative findings with 55 transgender participants indicated that employed participants reported higher levels of stigma (both internalized and external). Higher levels of coping with stigma were associated with lower levels of stigma (both internalized and external). Higher levels of coping were reported by participants utilizing psychiatric medication, with lower levels of coping with mental health stigma in particular found among those receiving outpatient mental health services. In Study 2, a grounded theory analysis was conducted with 45 of these participants to identify coping strategies that transgender individuals use to deal with transphobia. Coping strategies were categorized into individual factors (gender normative coping, self-affirmative coping, emotional regulation coping, cognitive reframe coping); interpersonal factors (social-relational coping, preventative-preparative coping, disengagement coping); and systemic factors (resource access coping, spiritual and religious coping, and political empowerment coping). Findings of Study 2 also revealed the presence of disclosure strategies— decisions to reveal or conceal one’s transgender identity, and anticipatory stigma— expecting and preparing for prejudice and discrimination. Results suggest the need for interventions for transgender individuals to enhance coping with stigma and reduce internalized stigma. © 2014 American Psychological Association.
Keywords: Coping; Internalized stigma; Qualitative; Transgender; Transphobia