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O'Shea J, Jenkins R, Nicholls D, Downs J, Hudson LD. Prevalence, severity and risk factors for mental disorders among sexual and gender minority young people: a systematic review of systematic reviews and meta-analyses. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02552-1. [PMID: 39141104 DOI: 10.1007/s00787-024-02552-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 08/01/2024] [Indexed: 08/15/2024]
Abstract
Evidence suggests heightened prevalence and severity of mental disorders among sexual minority (SM) and gender minority (GM) young people. Several risk factors have been associated with these disparities. A systematic review of systematic reviews and meta-analysis was conducted to provide a comprehensive overview of the literature and to determine the field's current position. MEDLINE, PsycInfo, Scopus and Web of Science were searched in March 2022 and updated January 2024. Eligibility criteria were systematic reviews or meta-analyses assessing contemporaneous prevalence, severity and/or risk factors of mental disorders among SM or GM young people aged 25 and under. 42 reviews were included, all of which were low quality. The prevalence of depression among SM was 26% (95% CI 21-32%), and among GM was 46% (95% CI 36-56%). Greater depression severity was found among SM compared to heterosexual young people, with a significant albeit small effect size (Hedges' g = 0.38, 95% CI = 0.25 to 0.50); effect sizes were similar when separating by gender. GM also reported greater symptom severity compared to cisgender young people. Other mental disorders were more prevalent compared to those reported in the general population, and of greater severity compared to heterosexual/cisgender young people. Several proximal and distal risk factors were focused upon within the systematic reviews identified. Past systematic reviews consistently indicate a heightened risk of mental disorders among SM and GM young people. Services need to be aware of these disparities and adapt their care accordingly.
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Affiliation(s)
- Jonathan O'Shea
- Population, Policy and Practice Department, Great Ormond Street UCL Institute of Child Health, London, UK. jonathan.o'
| | - Rebecca Jenkins
- Hull York Medical School, University of York, University Road, Heslington, York, UK
| | - Dasha Nicholls
- Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, UK
| | - James Downs
- Independent Researcher and Expert by Experience, Cardiff, UK
| | - Lee D Hudson
- Population, Policy and Practice Department, Great Ormond Street UCL Institute of Child Health, London, UK
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2
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McGregor K, Rana V, McKenna JL, Williams CR, Vu A, Boskey ER. Understanding Family Support for Transgender Youth: Impact of Support on Psychosocial Functioning. J Adolesc Health 2024; 75:261-266. [PMID: 38842989 DOI: 10.1016/j.jadohealth.2024.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 04/03/2024] [Accepted: 04/03/2024] [Indexed: 07/20/2024]
Abstract
PURPOSE This study investigated the association between positive and negative family support and psychosocial outcomes among transgender and gender diverse (TGD) youth. METHODS A retrospective analysis was performed using psychological data collected from 175 TGD youth (aged 13-18 years) at time of hormone readiness assessment within a multispecialty gender clinic between May 2021 and February 2023. As part of this assessment process, TGD youth provided responses to a variety of measures, including the Youth Self-Report and the Family Environment Scale. RESULTS Negative family support scales were more strongly associated with more outcomes than positive support scales. The exclusion and abuse, viewing gender expression as morally wrong, and trying to change gender scales were each associated with significantly higher Youth Self-Report T-scores for internalizing problems (βs = 6.86, 6.26, 5.56, all p < .01), externalizing problems (βs = 4.58, 4.42, 4.19, all p < .02), and total problems (βs = 6.70, 6.45, 5.34, all p < .02). The explicit care and support scale was associated with significantly lower T-scores for externalizing problems (β = -3.54 p = .02) and total problems (β = -3.35, p = .04). Overall support was also associated with higher T-scores in internalizing problems (b = -2.90, p = .02), externalizing problems (β = -2.40, p = .03), and total problems (β = -2.79, p = .03). DISCUSSION Family support plays a critical role in the psychosocial wellbeing of TGD youth. TGD youth reporting positive family support reported fewer mental health concerns, less experiences of nonaffirmation, and lower levels of internalized transphobia. TGD youth reporting negative family support were found to have an increased risk of suicidal ideation.
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Affiliation(s)
- Kerry McGregor
- Boston Children's Hospital, Division of Endocrinology, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Vinisha Rana
- Boston Children's Hospital, Division of Endocrinology, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - John L McKenna
- Boston Children's Hospital, Division of Endocrinology, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Coleen R Williams
- Boston Children's Hospital, Division of Endocrinology, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Ava Vu
- Boston Children's Hospital, Division of Endocrinology, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Elizabeth R Boskey
- Harvard Medical School, Boston, Massachusetts; Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Boston Children's Hospital, Division of Gynecology, Boston, Massachusetts
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3
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Nagata JM, Chaphekar AV, Hur JO. Eating Disorders Across the Gender Spectrum: Clinical Presentation and Treatment Outcomes in Boys and Transgender and Gender-Expansive Youth. J Adolesc Health 2024; 75:209-210. [PMID: 39025587 DOI: 10.1016/j.jadohealth.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 04/05/2024] [Indexed: 07/20/2024]
Affiliation(s)
- Jason M Nagata
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California, San Francisco, San Francisco, California
| | - Anita V Chaphekar
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California, San Francisco, San Francisco, California
| | - Jacqueline O Hur
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California, San Francisco, San Francisco, California
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4
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Eisner L, Fischer S, Juster RP, Hässler T. The impact of marriage equality campaigns on stress: Did a Swiss public vote get under the skin? Proc Natl Acad Sci U S A 2024; 121:e2400582121. [PMID: 39042695 PMCID: PMC11295070 DOI: 10.1073/pnas.2400582121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 06/14/2024] [Indexed: 07/25/2024] Open
Abstract
Lesbian, gay, bisexual, trans, intersex, and queer (LGBTIQ+) individuals encounter persistent structural inequalities and discrimination that can lead to detrimental psychological and physiological health outcomes. Amid evolving legal landscapes, little attention has been directed toward understanding the physiological health effects of societal shifts on these communities. This study aims to explore the impact of a national marriage equality vote and associated debates on psychological and biological stress among LGBTIQ+ individuals and cisgender, heterosexual, endosex individuals (termed cis-heterosexual) in Switzerland. We gathered longitudinal survey and biological data collected in hair samples among LGBTIQ+ and cis-heterosexual individuals before, during, and after the 2021 national vote (survey data: NT1T2 = 954; NT2T3 = 880; biological data: NT1T2 = 393; NT2T3 = 354). Preregistered analyses reveal a notable increase in biological stress levels (i.e., cortisol and cortisone levels), but not perceived stress, among both LGBTIQ+ as well as cis-heterosexual individuals who were close to them during the campaign. Results further point out the negative impacts of the campaign against marriage equality (i.e., no-campaign) on LGBTIQ+ individuals' biological stress levels as well as on those of their allies. These effects were, however, moderated by exposure to the campaign for marriage equality (i.e., yes-campaign), indicating the powerful buffering effects of the yes-campaign on the impact of discrimination on individuals' health. However, these positive effects appear to come at a cost, potentially impacting the well-being of individuals engaged in advocating for the yes-campaign. This research underscores the lasting impact of political campaigns on individuals' health.
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Affiliation(s)
- Léïla Eisner
- Department of Psychology, University of Zurich, Zurich8050, Switzerland
- Department of Psychology, Princeton University, Princeton, NJ08540
| | - Susanne Fischer
- Department of Psychology, University of Zurich, Zurich8050, Switzerland
| | - Robert-Paul Juster
- Department of Psychiatry & Addiction, University of Montreal, Montréal, QuébecH3C 3J7, Canada
| | - Tabea Hässler
- Department of Psychology, University of Zurich, Zurich8050, Switzerland
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5
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Klepper M, Bosse J, Flores DD, Sanders R. Sibling Support for Transgender and Gender-Diverse Youth: A Scoping Review. J Adolesc Health 2024:S1054-139X(24)00250-7. [PMID: 39033456 DOI: 10.1016/j.jadohealth.2024.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 05/03/2024] [Accepted: 05/20/2024] [Indexed: 07/23/2024]
Abstract
Sibling support for transgender and nonbinary (TNB) youth has the potential to improve TNB youths' mental health. A scoping review was conducted to map the knowledge of TNB youths' sibling relationships to create a foundation for the development of sibling-based support interventions for TNB youth. Nine included articles covered two areas: TNB youths' perceptions of sibling support (n = 5) and cisgender siblings' lived experience with a TNB sibling (n = 4). Siblings were perceived to support TNB youth, and their support was associated with less depression, suicidal ideation, and externalizing problems. Siblings of TNB youth lacked knowledge of TNB identities and support for their own understanding and acceptance. Siblings may experience unique stressors around their TNB sibling's changing gender identity. Overall, having a TNB sibling was perceived as a positive experience. None of the studies included intervention with or for siblings of TNB youth. Sibling support can be helpful for TNB youths' mental health. However, cisgender siblings' unique needs are rarely addressed. Providing cisgender siblings with knowledge of TNB identity, a place to process fears and concerns, and skills to navigate situations that may arise in relation to their sibling's gender, has the potential to benefit both siblings.
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Affiliation(s)
- Meredith Klepper
- Johns Hopkins School of Nursing, Johns Hopkins University, Baltimore, Maryland.
| | - Jordon Bosse
- University of Rhode Island College of Nursing, Kingston, Rhode Island
| | | | - Renata Sanders
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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6
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Kirby AV, Krebs E, Hiatt L, Docherty A, Mihalopoulos NL, Keeshin BR, Peifer E, Craker M, Staley M, Bakian AV, Coon H. " It's not the 'being trans,' it's everything around that": Trans Community Perspectives for Suicide Prevention. BULLETIN OF APPLIED TRANSGENDER STUDIES 2024; 3:69-97. [PMID: 39007095 PMCID: PMC11244576 DOI: 10.57814/ec38-hh59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 07/16/2024]
Abstract
Trans people are at significantly elevated risk of suicide death, suicide attempts, and suicidal ideation than their cisgender peers. Suicide prevention efforts are needed that address the most important issues to the trans community. In this qualitative study conducted in the United States in 2021, we aimed to broadly explore trans community member perspectives on suicidality and suicide prevention needs. We conducted four virtual focus groups-including one exclusively for trans people of color. We also solicited additional online responses to the same focus group questions. A total of 56 trans individuals with a history of suicidality participated. We utilized reflexive thematic analysis to develop themes to inform suicide prevention efforts for the trans community. The themes were multicontextual, representing needs across healthcare, legal and political arenas, workplaces, community groups, and interpersonal relationships. The central organizing theme identified as crucial for suicide prevention was 'Having (Real) Rights and Respect.' Supporting themes were 'Being in Control of Our Own Bodies,' 'Being Safe as Ourselves,' and 'Feeling Support and Acceptance,' which also included a subtheme of 'Embracing Diversity within the Trans Community.' We provide suggestions and directions for suicide prevention, which build on these themes.
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Affiliation(s)
- Anne V Kirby
- Department of Occupational and Recreational Therapies, University of Utah, 520 Wakara Way, Salt Lake City, UT 84108, USA
| | - Emily Krebs
- Current: Emily Krebs is now at the Department of Communication and Media Studies, Fordham University, 2540 Belmont Ave, Bronx, NY 10458, USA. Former: Department of Communication, University of Utah, 255 S Central Campus Dr., Salt Lake City, UT 84112, USA
| | - Laurel Hiatt
- Department of Human Genetics, University of Utah, 15 N 2030 E, Salt Lake City 84112, UT, USA
| | - Anna Docherty
- Department of Psychiatry, Huntsman Mental Health Institute, University of Utah, 501 Chipeta Way, Salt Lake City, UT 84108, USA
| | - Nicole L Mihalopoulos
- Department of Pediatrics, University of Utah, 295 Chipeta Way, Salt Lake City, UT 84108, USA
| | - Brooks R Keeshin
- Department of Psychiatry, Huntsman Mental Health Institute, University of Utah, 501 Chipeta Way, Salt Lake City, UT 84108, USA
- Department of Pediatrics, University of Utah, 295 Chipeta Way, Salt Lake City, UT 84108, USA
- Department of Public Health and Caring Science, Child Health and Parenting (CHAP), Uppsala University, Uppsala, Sweden
| | - Elese Peifer
- Department of Occupational and Recreational Therapies, University of Utah, 520 Wakara Way, Salt Lake City, UT 84108, USA
| | - Marlee Craker
- Department of Occupational and Recreational Therapies, University of Utah, 520 Wakara Way, Salt Lake City, UT 84108, USA
| | - Michael Staley
- Office of the Medical Examiner, Utah Department of Health and Human Services, 4451 2700 W, Taylorsville, UT 84129, USA
| | - Amanda V Bakian
- Department of Psychiatry, Huntsman Mental Health Institute, University of Utah, 501 Chipeta Way, Salt Lake City, UT 84108, USA
| | - Hilary Coon
- Department of Psychiatry, Huntsman Mental Health Institute, University of Utah, 501 Chipeta Way, Salt Lake City, UT 84108, USA
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Tyni K, Wurm M, Nordström T, Bratt AS. A systematic review and qualitative research synthesis of the lived experiences and coping of transgender and gender diverse youth 18 years or younger. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2024; 25:352-388. [PMID: 39055629 PMCID: PMC11268253 DOI: 10.1080/26895269.2023.2295379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
Background Research on the daily experiences of transgender and gender diverse (TGD) youth 18 years or younger is limited, making it essential to gain a comprehensive understanding of their internal and external experiences related to gender identity. Aim This systematic review and qualitative research synthesis fills this research gap by examining the lived experiences and coping of TGD youth, including prepubertal children. Methods The review was pre-registered according to PROSPERO on the Open Science Framework and followed the ENTREQ reporting guidelines. A Qualitative research synthesis, according to Howell Major and Savin-Baden, was conducted. Results Seventeen peer-reviewed articles published between 2000 and 2023 fulfilled inclusion criteria and quality assessment. Synthesized themes were: (1) "Navigating gender identity", with two sub-themes, Meaning-making and Considering visibility (2) "Navigating relations", with four sub-themes: Longing for belonging, Supportive actions, Lack of safety and Coping inside out (3) "Navigating society with two sub-themes Inclusion and exclusion and Beyond control. Our findings demonstrate that TGD youth view gender identity as fluid and benefit from a supportive environment that facilitates genuine exploration. Coping strategies develop intricately, influenced by multifaceted factors. Discussion Unlike previous research on the negative effects of minority stress, our review underscores the cumulative impact of subtle daily stressors on TGD youth's well-being, highlighting the significance of an environment where gender is not a constant concern. By shedding light on these dynamics, this synthesis contributes to a comprehensive understanding of TGD youth's perspectives for professionals and a broader audience.
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Affiliation(s)
- Kristiina Tyni
- Department of Psychology, Linnaeus University, Växjö, Sweden
| | - Matilda Wurm
- School of Behavioral, Social and Legal Sciences, Örebro University, Örebro, Sweden
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8
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Taube LN, Mussap AJ. Coming Out to Family and Friends in the Trans and Gender Diverse Context. JOURNAL OF HOMOSEXUALITY 2024; 71:147-165. [PMID: 35917138 DOI: 10.1080/00918369.2022.2106465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Despite the risks of rejection and discrimination, "coming out" can be an important psychological milestone for transgender (trans) and gender diverse people (TGD). We evaluated the dimensions of identity that predict coming out to family and friends, and the role of social support in explaining the psychosocial benefits associated with coming out. An online survey was completed by 951 TGD adults, 516 (54.3%) who identify as gender binary (164 transwomen and 352 transmen) and 435 (45.7%) who identify as nonbinary. Overall, gender binary TGD people were more likely than nonbinary people to disclose their identity to family and friends. Hierarchical binary logistic regressions further revealed that appearance congruence and strength of TGD identity are associated with disclosure to family, whereas positive TGD identity is associated with disclosure to friends. Path analyses confirmed that coming out is associated with improved resilience, psychological adjustment, and wellbeing, and that social support is a partial mediator of these associations. The results highlight the importance of coming out in the TGD context and suggest that greater access to social support may account for some of these benefits.
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Affiliation(s)
- Lee N Taube
- School of Psychology, Deakin University, Melbourne, Australia
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9
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Lenne E, Sun CJ, Klawetter S. An Examination of Power in a Triadic Model of Parent-Child-Pediatrician Relationships Related to Early Childhood Gender Development. JOURNAL OF FAMILY THEORY & REVIEW 2023; 15:662-676. [PMID: 38351982 PMCID: PMC10861221 DOI: 10.1111/jftr.12527] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/12/2023] [Indexed: 02/16/2024]
Abstract
In this paper, the authors introduce the Triadic Model of Pediatric Care, an innovative conceptual framework for pediatric practice with transgender and gender diverse children. The Triadic Model of Pediatric Care consists of three experts-pediatricians, primary caregiver(s), and children-who each possess unique insights, knowledge, and decision-making power. This model guides pediatricians to provide gender-affirming care that acknowledges children as experts of their own experience and worthy of bodily autonomy, while also working to ensure primary caregiver(s) have the information and support necessary to provide a safe and nurturing developmental environment for their child. The authors provide a recommendation for how the Triadic Model of Pediatric Care might be applied in a pediatric healthcare setting and conclude with a summary of the model's implications, limitations, and future directions.
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Affiliation(s)
- Eline Lenne
- School of Social Work, Portland State University, Portland, OR, USA
| | - Christina J. Sun
- College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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10
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Miller-Jacobs C, Operario D, Hughto JM. State-Level Policies and Health Outcomes in U.S. Transgender Adolescents: Findings from the 2019 Youth Risk Behavior Survey. LGBT Health 2023; 10:447-455. [PMID: 36862538 PMCID: PMC10623461 DOI: 10.1089/lgbt.2022.0247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
Abstract
Purpose: Policies have been shown to bear a considerable influence on transgender health. The few studies that have examined policy-related health outcomes in adolescent transgender populations have rarely included policies that directly affect them. Our study explores associations between four state-level policies and six health outcomes in a sample of transgender adolescents. Methods: Our analytic sample consisted of adolescents residing in 14 states that used the 2019 Youth Risk Behavior Survey's optional gender identity question in their surveys (n = 107,558). Chi-square analyses were performed to examine differences between transgender and cisgender adolescents in demographic variables and suicidal ideation, depression status, cigarette use, binge drinking, grades in school, and perceptions of school safety. Multivariable logistic regression models were run for transgender adolescents only to examine associations between policies and health outcomes, adjusting for demographics. Results: Transgender adolescents comprised 1.7% (n = 1790) of our sample. Compared with cisgender adolescents, transgender adolescents were more likely to experience adverse health outcomes in chi-square analyses. Multivariable models indicated that transgender adolescents who lived in a state that had explicit transgender guidance in their antidiscrimination laws were less likely to experience depressive symptoms, and those who lived in a state with positive or neutral athlete guidance were less likely to report past 30-day cigarette use. Conclusion: Our study is one of the first to show protective associations between affirming transgender-specific policies and health outcomes in transgender adolescents. Findings could have important implications for policymakers and school administrators.
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Affiliation(s)
| | - Don Operario
- School of Public Health, Brown University, Providence, Rhode Island, USA
- Department of Social and Behavioral Sciences, School of Public Health, Brown University, Providence, Rhode Island, USA
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Jaclyn M.W. Hughto
- School of Public Health, Brown University, Providence, Rhode Island, USA
- Department of Social and Behavioral Sciences, School of Public Health, Brown University, Providence, Rhode Island, USA
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, USA
- Center for Health Promotion and Health Equity, Brown University, Providence, Rhode Island, USA
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
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11
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Hoyt LT, Dotson MP, Suleiman AB, Burke NL, Johnson JB, Cohen AK. Internalizing the COVID-19 pandemic: Gendered differences in youth mental health. Curr Opin Psychol 2023; 52:101636. [PMID: 37454638 DOI: 10.1016/j.copsyc.2023.101636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 05/31/2023] [Accepted: 06/12/2023] [Indexed: 07/18/2023]
Abstract
We review research on gendered patterns of internalizing behaviors in adolescents and emerging adults during the COVID-19 pandemic. We find that young women reported worse mental health than young men. Transgender and gender-diverse (TGD) youth are underrepresented in mental health research but often report the highest internalizing disorders of any gender group. Finally, we use intersectionality as a lens to acknowledge how gender and other social identities (e.g., race, socioeconomic position) impact mental health. Overall, this review points to gender as a meaningful social construct that is relevant for understanding young people's internalizing symptoms during the pandemic. We call attention to the structural factors underlying gender disparities and the need for intersectionality-informed approaches to work towards mental health equity.
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Affiliation(s)
| | - Miranda P Dotson
- Department of Sociology & Anthropology, Northeastern University, MA, USA
| | | | | | | | - Alison K Cohen
- Department of Epidemiology & Biostatistics, School of Medicine, University of California, San Francisco, USA
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12
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Culbreth RE, Salazar LF, Spears CA, Crosby R, Hayat MJ, Aycock DM. Stressors Associated with Tobacco Use Among Trans Women. Transgend Health 2023; 8:282-292. [PMID: 37342482 PMCID: PMC10277983 DOI: 10.1089/trgh.2020.0168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose Tobacco use is prevalent among sexual and gender minorities (SGM), yet few studies have examined the specific drivers of tobacco use among trans women. The purpose of this study is to examine the impact of proximal, distal, and structural stressors associated with tobacco use among trans women. Methods This study is based on a cross-sectional sample of trans women (n=162) living in Chicago and Atlanta. Analyses were conducted to examine the association between stressors, protective factors, and tobacco use using a structural equation modeling framework. Proximal stressors (transgender roles scale, transgender congruence scale, internalized stigma, and internalized moral acceptability) were operationalized as a higher order latent factor, while distal stressors were operationalized as observed variables (discrimination, intimate partner violence, sex work, rape, child sexual abuse, HIV, and violence). Protective factors included social support, trans-related family support, and trans-related peer support. All analyses adjusted for sociodemographic variables (age, race/ethnicity, education, homelessness and health insurance). Results The prevalence of smoking among trans women in this study was 42.9%. In the final model, homelessness (odds ratio [OR]: 3.78; 95% confidence interval [CI]: 1.97, 7.25), intimate partner violence (OR: 2.14; 95% CI: 1.07, 4.28), and commercial sex work (OR: 2.22; 95% CI: 1.09, 4.56) were all associated with tobacco use. There was no association between proximal stressors and tobacco use. Conclusion Among trans women, tobacco use prevalence was high. Tobacco use was associated with homelessness, intimate partner violence, and commercial sex work. Targeted tobacco cessation programs should account for the co-occurring stressors that trans women face.
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Affiliation(s)
- Rachel E. Culbreth
- Department of Respiratory Therapy, Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, Georgia, USA
- Center for Research on Interpersonal Violence, Georgia State University, Atlanta, Georgia, USA
| | - Laura F. Salazar
- Center for Research on Interpersonal Violence, Georgia State University, Atlanta, Georgia, USA
- Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | - Claire A. Spears
- Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | - Richard Crosby
- Department of Health Behavior and Society, College of Public Health, University of Kentucky, Lexington, Kentucky, USA
- Kinsey Institute for Research on Sex, Gender, and Reproduction, Indiana University, Bloomington, Indiana, USA
| | - Matthew J. Hayat
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | - Dawn M. Aycock
- School of Nursing, Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, Atlanta, Georgia, USA
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Abstract
Transgender and gender diverse (TGD) children and adolescents are an increasingly visible yet highly stigmatized group. These youth experience more psychological distress than not only their cisgender, heterosexual peers but also their cisgender, sexual minority peers. In this review, we document these mental health disparities and discuss potential explanations for them using a minority stress framework. We also discuss factors that may increase and decrease TGD youth's vulnerability to psychological distress. Further, we review interventions, including gender-affirming medical care, that may improve mental health in TGD youth. We conclude by discussing limitations of current research and suggestions for the future.
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Affiliation(s)
- Natalie M Wittlin
- Department of Psychology, Princeton University, Princeton, New Jersey, USA;
| | - Laura E Kuper
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Endocrinology, Children's Health Systems of Texas, Dallas, Texas, USA
| | - Kristina R Olson
- Department of Psychology, Princeton University, Princeton, New Jersey, USA;
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Schumm WR, Crawford DW. Difficulties With Methodology in Social Science Research With Controversial Issues Regarding Human Sexuality. LINACRE QUARTERLY 2023; 90:194-216. [PMID: 37325432 PMCID: PMC10265389 DOI: 10.1177/00243639221082213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
Social science is commonly used in debates about controversial issues, especially for those concerning human sexuality. However, caution must be exercised in interpreting such social science literature, because of a variety of methodological and theoretical weaknesses that are not uncommon. Families are complex structurally and over time; such data are not easily analyzed. Merely determining the number of, for example, sexual minority families has been a difficult task. While some new theories are popular with social scientists, for example, sexual minority theory, they are often used to the exclusion of other, equally valid theories and often are not well tested empirically. Some types of families remain relatively unexamined. Social scientists can be biased by their own values, which are reflected in weak use of theory and in a variety of methodological problems. Eight studies are presented as examples of probable confirmation bias, in which methods and theory were modified in unusual ways that may have affected the outcomes and conclusions. Suggestions for improving social science include greater attention to effect sizes rather than statistical significance per se, deliberately minimizing the politicization of science, developing a culture of humility with respect to social science, deliberately reducing common biases, and maintaining a deeper curiosity about social science than is often seen. Scientists must be open to seeing their best "sacred cow" ideas or theories disproven or modified with increases in research on such issues. Summary In controversial areas of social science, there can be numerous threats to the validity of science. Here, some of the more common risks for social science research and theory are examined, with several specific illustrations of how bias appears to have crept into social science, often as confirmation bias. Recommendations are made for reducing bias in future research.
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Affiliation(s)
- Walter R. Schumm
- Department of Applied Human Sciences, Kansas State University College of Health and Human Sciences, Manhattan, KS, USA
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Olsavsky AL, Grannis C, Bricker J, Chelvakumar G, Indyk JA, Leibowitz SF, Mattson WI, Nelson EE, Stanek CJ, Nahata L. Associations Among Gender-Affirming Hormonal Interventions, Social Support, and Transgender Adolescents' Mental Health. J Adolesc Health 2023; 72:860-868. [PMID: 37029048 DOI: 10.1016/j.jadohealth.2023.01.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 01/06/2023] [Accepted: 01/30/2023] [Indexed: 04/09/2023]
Abstract
PURPOSE We aimed to examine the concurrent associations of gender-affirming hormonal interventions (i.e., puberty blockers, testosterone, estrogen), as well as family and friend social support, on transgender and nonbinary (TNB) adolescents' reports of anxiety symptoms, depressive symptoms, nonsuicidal self-injury (NSSI), and suicidality. We hypothesized that gender-affirming hormonal interventions and greater social support would be associated with lower levels of mental health concerns. METHODS Participants (n = 75; aged 11-18; Mage = 16.39 years) were recruited for this cross-sectional study from a gender-affirming multidisciplinary clinic. Fifty-two percent were receiving gender-affirming hormonal interventions. Surveys assessed anxiety and depressive symptoms, NSSI and suicidality in the past year, and social support from family, friends, and significant others. Hierarchical linear regression models examined associations between gender-affirming hormonal interventions and social support (i.e., family, friend) with mental health while accounting for nonbinary gender identity. RESULTS Regression models explained 15%-23% of variance in TNB adolescents' mental health outcomes. Gender-affirming hormonal interventions were associated with fewer anxiety symptoms (β = -0.23; p < .05). Family support was associated with fewer depressive symptoms (β = -0.33; p = .003) and less NSSI (β = -0.27; p = .02). Friend support was associated with fewer anxiety symptoms (β = -0.32; p = .007) and less suicidality (β = -0.25; p = .03). DISCUSSION TNB adolescents had better mental health outcomes in the context of receiving gender-affirming hormonal interventions and having greater support from family and friends. Findings highlight the important role of quality family and friend support for TNB mental health. Providers should aim to address both medical and social factors to optimize TNB mental health outcomes.
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Affiliation(s)
- Anna L Olsavsky
- Center for Biobehavioral Health, The Abigail Wexner Research Institute, Columbus, Ohio; The Ohio State University College of Medicine, Columbus, Ohio.
| | - Connor Grannis
- Center for Biobehavioral Health, The Abigail Wexner Research Institute, Columbus, Ohio
| | - Josh Bricker
- Center for Biobehavioral Health, The Abigail Wexner Research Institute, Columbus, Ohio
| | - Gayathri Chelvakumar
- The Ohio State University College of Medicine, Columbus, Ohio; Nationwide Children's Hospital, Columbus, Ohio
| | - Justin A Indyk
- The Ohio State University College of Medicine, Columbus, Ohio; Nationwide Children's Hospital, Columbus, Ohio
| | - Scott F Leibowitz
- The Ohio State University College of Medicine, Columbus, Ohio; Nationwide Children's Hospital, Columbus, Ohio
| | - Whitney I Mattson
- Center for Biobehavioral Health, The Abigail Wexner Research Institute, Columbus, Ohio
| | - Eric E Nelson
- Center for Biobehavioral Health, The Abigail Wexner Research Institute, Columbus, Ohio; Nationwide Children's Hospital, Columbus, Ohio
| | - Charis J Stanek
- Center for Biobehavioral Health, The Abigail Wexner Research Institute, Columbus, Ohio
| | - Leena Nahata
- Center for Biobehavioral Health, The Abigail Wexner Research Institute, Columbus, Ohio; The Ohio State University College of Medicine, Columbus, Ohio; Nationwide Children's Hospital, Columbus, Ohio
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16
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Morandini JS, Kelly A, de Graaf NM, Malouf P, Guerin E, Dar-Nimrod I, Carmichael P. Is Social Gender Transition Associated with Mental Health Status in Children and Adolescents with Gender Dysphoria? ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:1045-1060. [PMID: 37014582 PMCID: PMC10101898 DOI: 10.1007/s10508-023-02588-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 03/11/2023] [Accepted: 03/13/2023] [Indexed: 05/11/2023]
Abstract
Social gender transition is an increasingly accepted intervention for gender variant children and adolescents. To date, there is scant literature comparing the mental health of children and adolescents diagnosed with gender dysphoria who have socially transitioned versus those who are still living in their birth-assigned gender. We examined the mental health of children and adolescents referred to the Gender Identity Development Service (GIDS), a specialist clinic in London, UK, who had socially transitioned (i.e., were living in their affirmed gender and/or had changed their name) versus those who had not socially transitioned. Referrals to the GIDS were aged 4-17 years. We assessed mental health correlates of living in one's affirmed gender among 288 children and adolescents (208 birth-assigned female; 210 socially transitioned) and of name change in 357 children and adolescents (253 birth-assigned female; 214 name change). The presence or absence of mood and anxiety difficulties and past suicide attempts were clinician rated. Living in role and name change were more prevalent in birth-assigned females versus birth-assigned males. Overall, there were no significant effects of social transition or name change on mental health status. These findings identify the need for more research to understand how social transition influences mental health, including longitudinal studies that allow for more confident inferences to be made regarding the relationship between social transition and mental health in young people with gender dysphoria.
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Affiliation(s)
- James S Morandini
- School of Psychology, The University of Sydney, Sydney, NSW, 2006, Australia.
| | - Aidan Kelly
- Gender Service Organization, Kelly Psychology, London, UK
| | - Nastasja M de Graaf
- Center of Expertise on Gender Dyphoria, VU University Medical Center, Amsterdam, The Netherlands
| | - Pia Malouf
- King Street Psychology Clinic, Newtown, Australia
| | - Evan Guerin
- School of Behavioural and Health Sciences, Australian Catholic University, Sydney, Australia
| | - Ilan Dar-Nimrod
- School of Psychology, The University of Sydney, Sydney, NSW, 2006, Australia
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17
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Jha S, Bouman WP. Introduction to healthcare for transgender and gender-diverse people. Best Pract Res Clin Obstet Gynaecol 2023; 87:102299. [PMID: 36702654 DOI: 10.1016/j.bpobgyn.2022.102299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 11/07/2022] [Indexed: 12/24/2022]
Abstract
This editorial provides a broad introduction to transgender health for transgender and gender-diverse people. Following a brief description of the history of transgender and gender-diverse people, the development of medical treatment is discussed, together with the use of appropriate terminology and language. The content largely draws attention to the guidance in the Standards of Care for the Health of Transgender and Gender Diverse People Version 8 developed by the World Professional Association for Transgender Health (WPATH) and published in 2022. Further key areas addressed are as follows. • The use of names and pronouns. • Population estimates of transgender and gender diverse people. • Diagnostic classification systems in transgender health. • A wide range of gender-affirming medical interventions, including hormones and surgeries. • Ethical considerations for research with transgender and gender diverse populations.
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Affiliation(s)
- Swati Jha
- Department of Urogynaecology, Sheffield Teaching Hospitals NHS Foundation Trust, Level 4, Jessop Wing, Tree Root Walk, Sheffield. S10 2SF, UK; Honorary Professor School of Medicine, University of Sheffield, UK.
| | - Walter Pierre Bouman
- Nottingham National Centre for Transgender Health, 12 Broad Street, Nottingham NG1 3AL, UK; Honorary Professor School of Medicine, University of Nottingham, UK.
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18
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Mezzalira S, Scandurra C, Mezza F, Miscioscia M, Innamorati M, Bochicchio V. Gender Felt Pressure, Affective Domains, and Mental Health Outcomes among Transgender and Gender Diverse (TGD) Children and Adolescents: A Systematic Review with Developmental and Clinical Implications. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:ijerph20010785. [PMID: 36613106 PMCID: PMC9819455 DOI: 10.3390/ijerph20010785] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 12/28/2022] [Accepted: 12/28/2022] [Indexed: 05/04/2023]
Abstract
Although capable of mobilizing significant resilience factors to face stigma and discrimination, transgender and gender diverse (TGD) children and adolescents tend to suffer from more adverse mental health outcomes compared to their cisgender counterparts. The minority stressors that this population faces are mainly due to the gender-based pressure to conform to their assigned gender. This systematic review was aimed at assessing the potential mental health issues that affect the TGD population. The literature search was conducted in three databases; namely, Scopus, PubMed, and Web of Science, based on the PRISMA guidelines. The 33 articles included in the systematic review pointed out how TGD children and adolescents experience high levels of anxiety and depression, as well as other emotional and behavioral problems, such as eating disorders and substance use. Resilience factors have been also pointed out, which aid this population in facing these negative mental health outcomes. The literature review highlighted that, on the one hand, TGD individuals appear to exhibit high levels of resilience; nonetheless, health disparities exist for TGD individuals compared with the general population, which are mainly attributable to the societal gender pressure to conform to their assigned gender. Considerations for research and clinical practice are provided.
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Affiliation(s)
- Selene Mezzalira
- Department of Humanities, University of Calabria, 87036 Rende, Italy
| | - Cristiano Scandurra
- Department of Neuroscience, Reproductive Sciences, and Dentistry, University of Naples Federico II, 80131 Naples, Italy
| | - Fabrizio Mezza
- SInAPSi Center, University of Naples Federico II, 80133 Naples, Italy
| | - Marina Miscioscia
- Department of Developmental Psychology and Socialization, University of Padua, 35131 Padua, Italy
| | - Marco Innamorati
- Department of History, Cultural Heritage, Education, and Society, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Vincenzo Bochicchio
- Department of Humanities, University of Calabria, 87036 Rende, Italy
- Correspondence:
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19
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Tebbe EA, Budge SL. Factors that drive mental health disparities and promote well-being in transgender and nonbinary people. NATURE REVIEWS PSYCHOLOGY 2022; 1:694-707. [PMID: 36187743 PMCID: PMC9513020 DOI: 10.1038/s44159-022-00109-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/23/2022] [Indexed: 01/09/2023]
Abstract
Transgender (or trans) is an umbrella term for individuals who experience their gender differently from what is associated with the sex they were assigned at birth. Individuals who are nonbinary experience their gender outside binary conceptions of gender. Although research has predominantly focused on negative mental health outcomes for transgender and non-binary (TNB) individuals, an emergent literature has begun to explore protective and health-promoting factors and dimensions of psychological well-being. In this Review, we discuss the sociocultural context for TNB people, beginning with a brief history of TNB identity before highlighting frameworks for understanding the higher prevalence of certain mental health concerns among TNB individuals. Next, we summarize the predictive factors associated with higher rates of depression, anxiety, suicidality, trauma-related concerns, disordered eating behaviours and substance use. We also review TNB coping, resilience and resistance to anti-trans stigma, as well as psychological well-being, flourishing and gender euphoria. Tying these topics together, we discuss affirming interventions for reducing mental health disparities and promoting psychological health in TNB individuals and communities. We conclude by discussing future research directions.
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Affiliation(s)
- Elliot A. Tebbe
- School of Nursing, University of Wisconsin-Madison, Madison, WI USA
| | - Stephanie L. Budge
- Department of Counseling Psychology, University of Wisconsin-Madison, Madison, WI USA
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20
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Coleman E, Radix AE, Bouman WP, Brown GR, de Vries ALC, Deutsch MB, Ettner R, Fraser L, Goodman M, Green J, Hancock AB, Johnson TW, Karasic DH, Knudson GA, Leibowitz SF, Meyer-Bahlburg HFL, Monstrey SJ, Motmans J, Nahata L, Nieder TO, Reisner SL, Richards C, Schechter LS, Tangpricha V, Tishelman AC, Van Trotsenburg MAA, Winter S, Ducheny K, Adams NJ, Adrián TM, Allen LR, Azul D, Bagga H, Başar K, Bathory DS, Belinky JJ, Berg DR, Berli JU, Bluebond-Langner RO, Bouman MB, Bowers ML, Brassard PJ, Byrne J, Capitán L, Cargill CJ, Carswell JM, Chang SC, Chelvakumar G, Corneil T, Dalke KB, De Cuypere G, de Vries E, Den Heijer M, Devor AH, Dhejne C, D'Marco A, Edmiston EK, Edwards-Leeper L, Ehrbar R, Ehrensaft D, Eisfeld J, Elaut E, Erickson-Schroth L, Feldman JL, Fisher AD, Garcia MM, Gijs L, Green SE, Hall BP, Hardy TLD, Irwig MS, Jacobs LA, Janssen AC, Johnson K, Klink DT, Kreukels BPC, Kuper LE, Kvach EJ, Malouf MA, Massey R, Mazur T, McLachlan C, Morrison SD, Mosser SW, Neira PM, Nygren U, Oates JM, Obedin-Maliver J, Pagkalos G, Patton J, Phanuphak N, Rachlin K, Reed T, Rider GN, Ristori J, Robbins-Cherry S, Roberts SA, Rodriguez-Wallberg KA, Rosenthal SM, Sabir K, Safer JD, Scheim AI, Seal LJ, Sehoole TJ, Spencer K, St Amand C, Steensma TD, Strang JF, Taylor GB, Tilleman K, T'Sjoen GG, Vala LN, Van Mello NM, Veale JF, Vencill JA, Vincent B, Wesp LM, West MA, Arcelus J. Standards of Care for the Health of Transgender and Gender Diverse People, Version 8. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2022; 23:S1-S259. [PMID: 36238954 PMCID: PMC9553112 DOI: 10.1080/26895269.2022.2100644] [Citation(s) in RCA: 648] [Impact Index Per Article: 324.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Background: Transgender healthcare is a rapidly evolving interdisciplinary field. In the last decade, there has been an unprecedented increase in the number and visibility of transgender and gender diverse (TGD) people seeking support and gender-affirming medical treatment in parallel with a significant rise in the scientific literature in this area. The World Professional Association for Transgender Health (WPATH) is an international, multidisciplinary, professional association whose mission is to promote evidence-based care, education, research, public policy, and respect in transgender health. One of the main functions of WPATH is to promote the highest standards of health care for TGD people through the Standards of Care (SOC). The SOC was initially developed in 1979 and the last version (SOC-7) was published in 2012. In view of the increasing scientific evidence, WPATH commissioned a new version of the Standards of Care, the SOC-8. Aim: The overall goal of SOC-8 is to provide health care professionals (HCPs) with clinical guidance to assist TGD people in accessing safe and effective pathways to achieving lasting personal comfort with their gendered selves with the aim of optimizing their overall physical health, psychological well-being, and self-fulfillment. Methods: The SOC-8 is based on the best available science and expert professional consensus in transgender health. International professionals and stakeholders were selected to serve on the SOC-8 committee. Recommendation statements were developed based on data derived from independent systematic literature reviews, where available, background reviews and expert opinions. Grading of recommendations was based on the available evidence supporting interventions, a discussion of risks and harms, as well as the feasibility and acceptability within different contexts and country settings. Results: A total of 18 chapters were developed as part of the SOC-8. They contain recommendations for health care professionals who provide care and treatment for TGD people. Each of the recommendations is followed by explanatory text with relevant references. General areas related to transgender health are covered in the chapters Terminology, Global Applicability, Population Estimates, and Education. The chapters developed for the diverse population of TGD people include Assessment of Adults, Adolescents, Children, Nonbinary, Eunuchs, and Intersex Individuals, and people living in Institutional Environments. Finally, the chapters related to gender-affirming treatment are Hormone Therapy, Surgery and Postoperative Care, Voice and Communication, Primary Care, Reproductive Health, Sexual Health, and Mental Health. Conclusions: The SOC-8 guidelines are intended to be flexible to meet the diverse health care needs of TGD people globally. While adaptable, they offer standards for promoting optimal health care and guidance for the treatment of people experiencing gender incongruence. As in all previous versions of the SOC, the criteria set forth in this document for gender-affirming medical interventions are clinical guidelines; individual health care professionals and programs may modify these in consultation with the TGD person.
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Affiliation(s)
- E Coleman
- Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - A E Radix
- Callen-Lorde Community Health Center, New York, NY, USA
- Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - W P Bouman
- Nottingham Centre for Transgender Health, Nottingham, UK
- School of Medicine, University of Nottingham, Nottingham, UK
| | - G R Brown
- James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA
- James H. Quillen VAMC, Johnson City, TN, USA
| | - A L C de Vries
- Department of Child and Adolescent Psychiatry, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - M B Deutsch
- Department of Family & Community Medicine, University of California-San Francisco, San Francisco, CA, USA
- UCSF Gender Affirming Health Program, San Francisco, CA, USA
| | - R Ettner
- New Health Foundation Worldwide, Evanston, IL, USA
- Weiss Memorial Hospital, Chicago, IL, USA
| | - L Fraser
- Independent Practice, San Francisco, CA, USA
| | - M Goodman
- Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - J Green
- Independent Scholar, Vancouver, WA, USA
| | - A B Hancock
- The George Washington University, Washington, DC, USA
| | - T W Johnson
- Department of Anthropology, California State University, Chico, CA, USA
| | - D H Karasic
- University of California San Francisco, San Francisco, CA, USA
- Independent Practice at dankarasic.com
| | - G A Knudson
- University of British Columbia, Vancouver, Canada
- Vancouver Coastal Health, Vancouver, Canada
| | - S F Leibowitz
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - H F L Meyer-Bahlburg
- New York State Psychiatric Institute, New York, NY, USA
- Department of Psychiatry, Columbia University, New York, NY, USA
| | | | - J Motmans
- Transgender Infopunt, Ghent University Hospital, Gent, Belgium
- Centre for Research on Culture and Gender, Ghent University, Gent, Belgium
| | - L Nahata
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
- Endocrinology and Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - T O Nieder
- University Medical Center Hamburg-Eppendorf, Interdisciplinary Transgender Health Care Center Hamburg, Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, Hamburg, Germany
| | - S L Reisner
- Harvard Medical School, Boston, MA, USA
- Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - C Richards
- Regents University London, UK
- Tavistock and Portman NHS Foundation Trust, London, UK
| | | | - V Tangpricha
- Division of Endocrinology, Metabolism & Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Atlanta VA Medical Center, Decatur, GA, USA
| | - A C Tishelman
- Boston College, Department of Psychology and Neuroscience, Chestnut Hill, MA, USA
| | - M A A Van Trotsenburg
- Bureau GenderPRO, Vienna, Austria
- University Hospital Lilienfeld-St. Pölten, St. Pölten, Austria
| | - S Winter
- School of Population Health, Curtin University, Perth, WA, Australia
| | - K Ducheny
- Howard Brown Health, Chicago, IL, USA
| | - N J Adams
- University of Toronto, Ontario Institute for Studies in Education, Toronto, Canada
- Transgender Professional Association for Transgender Health (TPATH)
| | - T M Adrián
- Asamblea Nacional de Venezuela, Caracas, Venezuela
- Diverlex Diversidad e Igualdad a Través de la Ley, Caracas, Venezuela
| | - L R Allen
- University of Nevada, Las Vegas, NV, USA
| | - D Azul
- La Trobe Rural Health School, La Trobe University, Bendigo, Australia
| | - H Bagga
- Monash Health Gender Clinic, Melbourne, Victoria, Australia
- Monash University, Melbourne, Victoria, Australia
| | - K Başar
- Department of Psychiatry, Hacettepe University, Ankara, Turkey
| | - D S Bathory
- Independent Practice at Bathory International PLLC, Winston-Salem, NC, USA
| | - J J Belinky
- Durand Hospital, Guemes Clinic and Urological Center, Buenos Aires, Argentina
| | - D R Berg
- National Center for Gender Spectrum Health, Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - J U Berli
- Oregon Health & Science University, Portland, OR, USA
| | - R O Bluebond-Langner
- NYU Langone Health, New York, NY, USA
- Hansjörg Wyss Department of Plastic Surgery, New York, NY, USA
| | - M-B Bouman
- Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Plastic Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, , Amsterdam, Netherlands
| | - M L Bowers
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mills-Peninsula Medical Center, Burlingame, CA, USA
| | - P J Brassard
- GrS Montreal, Complexe CMC, Montreal, Quebec, Canada
- Université de Montreal, Quebec, Canada
| | - J Byrne
- University of Waikato/Te Whare Wānanga o Waikato, Hamilton/Kirikiriroa, New Zealand/Aotearoa
| | - L Capitán
- The Facialteam Group, Marbella International Hospital, Marbella, Spain
| | | | - J M Carswell
- Harvard Medical School, Boston, MA, USA
- Boston's Children's Hospital, Boston, MA, USA
| | - S C Chang
- Independent Practice, Oakland, CA, USA
| | - G Chelvakumar
- Nationwide Children's Hospital, Columbus, OH, USA
- The Ohio State University, College of Medicine, Columbus, OH, USA
| | - T Corneil
- School of Population & Public Health, University of British Columbia, Vancouver, BC, Canada
| | - K B Dalke
- Penn State Health, PA, USA
- Penn State College of Medicine, Hershey, PA, USA
| | - G De Cuypere
- Center for Sexology and Gender, Ghent University Hospital, Gent, Belgium
| | - E de Vries
- Nelson Mandela University, Gqeberha, South Africa
- University of Cape Town, Cape Town, South Africa
| | - M Den Heijer
- Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Endocrinology, Amsterdam UMC Location Vrije Universiteit Amsterdam, , Amsterdam, Netherlands
| | - A H Devor
- University of Victoria, Victoria, BC, Canada
| | - C Dhejne
- ANOVA, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - A D'Marco
- UCTRANS-United Caribbean Trans Network, Nassau, The Bahamas
- D M A R C O Organization, Nassau, The Bahamas
| | - E K Edmiston
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - L Edwards-Leeper
- Pacific University, Hillsboro, OR, USA
- Independent Practice, Beaverton, OR, USA
| | - R Ehrbar
- Whitman Walker Health, Washington, DC, USA
- Independent Practice, Maryland, USA
| | - D Ehrensaft
- University of California San Francisco, San Francisco, CA, USA
| | - J Eisfeld
- Transvisie, Utrecht, The Netherlands
| | - E Elaut
- Center for Sexology and Gender, Ghent University Hospital, Gent, Belgium
- Department of Clinical Experimental and Health Psychology, Ghent University, Gent, Belgium
| | - L Erickson-Schroth
- The Jed Foundation, New York, NY, USA
- Hetrick-Martin Institute, New York, NY, USA
| | - J L Feldman
- Institute for Sexual and Gender Health, Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - A D Fisher
- Andrology, Women Endocrinology and Gender Incongruence, Careggi University Hospital, Florence, Italy
| | - M M Garcia
- Department of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Departments of Urology and Anatomy, University of California San Francisco, San Francisco, CA, USA
| | - L Gijs
- Institute of Family and Sexuality Studies, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | | | - B P Hall
- Duke University Medical Center, Durham, NC, USA
- Duke Adult Gender Medicine Clinic, Durham, NC, USA
| | - T L D Hardy
- Alberta Health Services, Edmonton, Alberta, Canada
- MacEwan University, Edmonton, Alberta, Canada
| | - M S Irwig
- Harvard Medical School, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - A C Janssen
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - K Johnson
- RMIT University, Melbourne, Australia
- University of Brighton, Brighton, UK
| | - D T Klink
- Department of Pediatrics, Division of Pediatric Endocrinology, Ghent University Hospital, Gent, Belgium
- Division of Pediatric Endocrinology and Diabetes, ZNA Queen Paola Children's Hospital, Antwerp, Belgium
| | - B P C Kreukels
- Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Medical Psychology, Amsterdam UMC Location Vrije Universiteit Amsterdam, , Amsterdam, Netherlands
| | - L E Kuper
- Department of Psychiatry, Southwestern Medical Center, University of Texas, Dallas, TX, USA
- Department of Endocrinology, Children's Health, Dallas, TX, USA
| | - E J Kvach
- Denver Health, Denver, CO, USA
- University of Colorado School of Medicine, Aurora, CO, USA
| | - M A Malouf
- Malouf Counseling and Consulting, Baltimore, MD, USA
| | - R Massey
- WPATH Global Education Institute
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - T Mazur
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- John R. Oishei Children's Hospital, Buffalo, NY, USA
| | - C McLachlan
- Professional Association for Transgender Health, South Africa
- Gender DynamiX, Cape Town, South Africa
| | - S D Morrison
- Division of Plastic Surgery, Seattle Children's Hospital, Seattle, WA, USA
- Division of Plastic Surgery, Department of Surgery, University of Washington Medical Center, Seattle, WA, USA
| | - S W Mosser
- Gender Confirmation Center, San Francisco, CA, USA
- Saint Francis Memorial Hospital, San Francisco, CA, USA
| | - P M Neira
- Johns Hopkins Center for Transgender Health, Baltimore, MD, USA
- Johns Hopkins Medicine Office of Diversity, Inclusion and Health Equity, Baltimore, MD, USA
| | - U Nygren
- Division of Speech and Language Pathology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Speech and Language Pathology, Medical Unit, Karolinska University Hospital, Stockholm, Sweden
| | - J M Oates
- La Trobe University, Melbourne, Australia
- Melbourne Voice Analysis Centre, East Melbourne, Australia
| | - J Obedin-Maliver
- Stanford University School of Medicine, Department of Obstetrics and Gynecology, Palo Alto, CA, USA
- Department of Epidemiology and Population Health, Stanford, CA, USA
| | - G Pagkalos
- Independent PracticeThessaloniki, Greece
- Military Community Mental Health Center, 424 General Military Training Hospital, Thessaloniki, Greece
| | - J Patton
- Talkspace, New York, NY, USA
- CytiPsychological LLC, San Diego, CA, USA
| | - N Phanuphak
- Institute of HIV Research and Innovation, Bangkok, Thailand
| | - K Rachlin
- Independent Practice, New York, NY, USA
| | - T Reed
- Gender Identity Research and Education Society, Leatherhead, UK
| | - G N Rider
- National Center for Gender Spectrum Health, Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - J Ristori
- Andrology, Women Endocrinology and Gender Incongruence, Careggi University Hospital, Florence, Italy
| | | | - S A Roberts
- Harvard Medical School, Boston, MA, USA
- Division of Endocrinology, Boston's Children's Hospital, Boston, MA, USA
| | - K A Rodriguez-Wallberg
- Department of Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
- Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
| | - S M Rosenthal
- Division of Pediatric Endocrinology, UCSF, San Francisco, CA, USA
- UCSF Child and Adolescent Gender Center
| | - K Sabir
- FtM Phoenix Group, Krasnodar Krai, Russia
| | - J D Safer
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mount Sinai Center for Transgender Medicine and Surgery, New York, NY, USA
| | - A I Scheim
- Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
- Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, Ontario, Canada
| | - L J Seal
- Tavistock and Portman NHS Foundation Trust, London, UK
- St George's University Hospitals NHS Foundation Trust, London, UK
| | | | - K Spencer
- National Center for Gender Spectrum Health, Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - C St Amand
- University of Houston, Houston, TX, USA
- Mayo Clinic, Rochester, MN, USA
| | - T D Steensma
- Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Medical Psychology, Amsterdam UMC Location Vrije Universiteit Amsterdam, , Amsterdam, Netherlands
| | - J F Strang
- Children's National Hospital, Washington, DC, USA
- George Washington University School of Medicine, Washington, DC, USA
| | - G B Taylor
- Atrium Health Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Charlotte, NC, USA
| | - K Tilleman
- Department for Reproductive Medicine, Ghent University Hospital, Gent, Belgium
| | - G G T'Sjoen
- Center for Sexology and Gender, Ghent University Hospital, Gent, Belgium
- Department of Endocrinology, Ghent University Hospital, Gent, Belgium
| | - L N Vala
- Independent Practice, Campbell, CA, USA
| | - N M Van Mello
- Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Obstetrics and Gynaecology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - J F Veale
- School of Psychology, University of Waikato/Te Whare Wānanga o Waikato, Hamilton/Kirikiriroa, New Zealand/Aotearoa
| | - J A Vencill
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - B Vincent
- Trans Learning Partnership at https://spectra-london.org.uk/trans-learning-partnership, UK
| | - L M Wesp
- College of Nursing, University of Wisconsin MilwaukeeMilwaukee, WI, USA
- Health Connections Inc., Glendale, WI, USA
| | - M A West
- North Memorial Health Hospital, Robbinsdale, MN, USA
- University of Minnesota, Minneapolis, MN, USA
| | - J Arcelus
- School of Medicine, University of Nottingham, Nottingham, UK
- Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
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Durwood L, Kuvalanka KA, Kahn-Samuelson S, Jordan AE, Rubin JD, Schnelzer P, Devor AH, Olson KR. Retransitioning: The experiences of youth who socially transition genders more than once. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2022; 23:409-427. [PMID: 36324883 PMCID: PMC9621273 DOI: 10.1080/26895269.2022.2085224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Background: Retransitions in youth are critical to understand, as they are an experience about which little is known and about which families and clinicians worry. Aims: This study aims to qualitatively describe the experiences of youth who made binary social transitions (came to live as the binary gender different from the one assigned at birth) in childhood by the age of 12, and who later socially transitioned genders again (here, called "retransitioning"). Methods: Out of 317 participants in an ongoing longitudinal study of (initially) binary transgender youth, 23 participants had retransitioned at least once and were therefore eligible for this study. Of those youth, 8 were cisgender at the time of data collection, 11 were nonbinary, and 4 were binary transgender youth (after having retransitioned to nonbinary identities for a period). Fifteen youth and/or their parent(s) participated in semi-structured interviews (MYouthA ge = 11.3 years; 9 non-Hispanic White; 3 Hispanic White; 3 Multiracial; 10 assigned male; 5 assigned female). Interviews gauged antecedents of transitions, others' reactions to transitions, and participants' general reflections. Responses were coded and thematically analyzed. Results: Participants described various paths to retransitions, including that some youth identified differently over time, and that some youth learned about a new identity (e.g., nonbinary) that fit them better. Social environments' responses to retransitions varied but were often neutral or positive. No participants spontaneously expressed regret over initial transitions. Conclusions: These findings largely do not support common concerns about retransitions. In supportive environments, gender diverse youth can retransition without experiencing rejection, distress, and regret.
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Affiliation(s)
- Lily Durwood
- Department of Psychology, University of Washington, Seattle, WA, USA
| | | | | | - Ashley E. Jordan
- Department of Psychology, Princeton University, Princeton, NJ, USA
| | - Jennifer D. Rubin
- Department of Psychology, University of Washington, Seattle, WA, USA
| | | | - Aaron H. Devor
- Department of Sociology, University of Victoria, Victoria, BC, Canada
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22
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deMayo B, Kahn-Samuelson S, Olson KR. Endorsement of gender stereotypes in gender diverse and cisgender adolescents and their parents. PLoS One 2022; 17:e0269784. [PMID: 35700172 PMCID: PMC9197027 DOI: 10.1371/journal.pone.0269784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 05/30/2022] [Indexed: 02/01/2023] Open
Abstract
Previous work has documented adolescents' gender stereotype endorsement, or the extent to which one believes men or women should embody distinct traits. However, understanding of gender stereotype endorsement in gender diverse adolescents-those who identify as transgender, nonbinary, and/or gender nonconforming-is limited. Gender diverse adolescents' experiences with gender raise the question of whether they endorse gender stereotypes with the same frequency as cisgender adolescents. In this study, we investigated three primary research questions: (1) if gender diverse (N = 144) and cisgender (N = 174) adolescents (13-17 years) and their parents (N = 143 parents of gender diverse adolescents, N = 160 parents of cisgender adolescents) endorse gender stereotypes; (2) whether these groups differed from one another in their endorsement of gender stereotypes; and (3) whether parents' gender stereotyping was related to either their adolescents' stereotyping and/or their adolescents' predictions of their parents' stereotyping. We found (1) that participants showed low amounts of stereotyping; (2) there were no significant differences between gender stereotype endorsement in gender diverse and cisgender adolescents (or between their parents), though parents endorsed stereotypes slightly less than adolescents; and (3) there was a small positive association between adolescents' stereotyping and their parents' gender stereotyping. We discuss the limitations of our methods, and the possibility that rates of explicit stereotype endorsement may be changing over time.
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Affiliation(s)
- Benjamin deMayo
- Department of Psychology, Princeton University, Peretsman Scully Hall, Princeton, New Jersey, United States of America
| | - Shira Kahn-Samuelson
- Department of Psychology, Princeton University, Peretsman Scully Hall, Princeton, New Jersey, United States of America
| | - Kristina R. Olson
- Department of Psychology, Princeton University, Peretsman Scully Hall, Princeton, New Jersey, United States of America
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23
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Yaghoubirad M, Azadfallah P, Cameron CA, Farahani H. Talking with Iranian trans men: Their experiences and identity development. JOURNAL OF GAY & LESBIAN MENTAL HEALTH 2022. [DOI: 10.1080/19359705.2022.2072034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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24
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van Dyk IS, Shao J, Sohn L, Smiley PA, Olson K, Borelli JL. Responding to Children's Diverse Gender Expression: Validation of a Parent-Report Measure of Gender-Related Conditional Regard. JOURNAL OF GLBT FAMILY STUDIES 2021; 17:482-500. [PMID: 37693120 PMCID: PMC10489244 DOI: 10.1080/1550428x.2021.1931615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
Epidemiological studies suggest that more youth are identifying as gender expansive (e.g., transgender, gender nonconforming) than ever before. However, due to stressors like discrimination, gender minorities remain at significantly higher risk for mental and physical health problems than their cisgender peers. While initial research has shown that parental support of youth's minority gender identities may be protective, further research is needed regarding specific parenting practices and their impact on children. We propose that parental conditional regard-the selective provision of warmth and esteem when children's behavior conforms to parental standards or values - may be a critical component of parenting behaviors that predicts maladaptation in gender expansive children. Across three studies involving parents of cisgender and gender expansive children ages 3-15 (Study 1: N = 601, community sample; Study 2: N = 793, parents of gender expansive and cisgender children; Study 3, same sample as in Study 1), we describe the development of a novel measure of parental conditional regard for gender expression and test its validity and reliability. Finally, we demonstrate that conditional regard for gender expression is distinct from existing conditional regard measures, and is uniquely associated with children's psychopathology.
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Affiliation(s)
| | - Jianmin Shao
- Department of Psychological Science, University of California, Irvine, Irvine, CA, U.S.A
| | - Lucas Sohn
- Department of Psychological Science, University of California, Irvine, Irvine, CA, U.S.A
| | | | - Kristina Olson
- Department of Psychology, University of Washington, Seattle, WA, U.S.A
| | - Jessica L. Borelli
- Department of Psychological Science, University of California, Irvine, Irvine, CA, U.S.A
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