Frequencies and patterns of adverse childhood events in LGBTQ+ youth

The Relationship Between State Level Policy, Insurance and Health Care Engagement for LGBTQ+ Foster Alumni

Minority stress theory posits that external environmental factors such as state level policies around equity and inclusion of LGBTQ+ people can have a significant impact on the health and wellness of those identifying as part of the larger LGBTQ+ community, as well as on their decisions to seek needed physical or mental health care. This secondary data analysis explored the relationship between state level policies related to LGBTQ+ equity and inclusion and physical and mental health care engagement for foster care alumni. Using data from the Jim Casey Opportunity Passport Survey (n = 2,420), the research team conducted a longitudinal analysis of youth's engagement with healthcare professional as needed physical and mental health care, using sociodemographic characteristics of the respondents and state level policies, such as Medicaid expansion and state level protections for LGBTQ+ citizens as predictors. Results indicate obtaining health insurance increased the likelihood that the youth would seek physical health care. LGBTQ+ young adults assigned female at birth had higher odds of not receiving physical health care relative to non-LGBTQ+ peers. Compared with non-LGBTQ+ youth, LGBTQ+ youth showed higher odds of not seeing mental health professionals when they needed to. Implications for practice, policy and advocacy are presented.

Setting the Game Agenda: Reviewing the Emerging Literature on Video Gaming and Psychological Well-Being of Sexual and Gender Diverse Youth

Video gaming is a popular youth pastime that has prompted scholarship into its relationship with psychological well-being. However, sexual and gender diverse youth (SGDY) who play video games are largely overlooked in this research. SGDY experience significant mental health challenges, but utilize coping strategies mediated by digital technologies, necessitating an examination of their video game playing and its effects on well-being. This literature review synthesizes the emerging evidence base by identifying key constructs related to SGDY well-being and video gaming. Five themes were derived from the literature: (a) SGDY identity development and self-expression in video games; (b) SGDY video gaming and coping skills; (c) Social support in SGDY video gaming communities; (d) SGDY digital microaggressions in video gaming; and (e) SGDY civic engagement through video gaming. The findings establish multiple risks and opportunities for harnessing video games to support SGDY's well-being. Recommendations for practice, research, and industry collaborations are presented.

Adverse Childhood Experiences and Intimate Partner Violence Among Sexual Minority Young Adults: The Roles of Alcohol Consequences and Discrimination

Adverse childhood experiences (ACEs) are associated with intimate partner violence (IPV) perpetration. A posited mechanism explaining the link between ACEs and IPV is alcohol use consequences. Yet, few studies have examined this relationship among sexual minority young adults or how chronic and unique discrimination due to their marginalized identity (i.e., minority stress) may influence these associations. This study examined whether alcohol use consequences mediated the relationship between ACEs and IPV perpetration, and whether minority stress moderated this mediated relationship. Sexual minority young adults who used alcohol in the past month (N = 344; age 18-25) in a dating relationship completed a survey on ACEs, IPV, alcohol and minority stress. We hypothesized: (a) alcohol use consequences would mediate the association between ACEs and IPV perpetration and (b) higher discrimination would moderate the mediation of alcohol use consequences in the relationship between ACEs and IPV perpetration. ACEs (B = 0.74, p = .010) and alcohol use consequences (B = 0.64, p = .007), were significantly associated with psychological, but not physical, IPV perpetration. Alcohol use consequences did not mediate the association between ACEs and any IPV type. In addition, everyday discrimination was not a significant moderator. ACEs and alcohol use consequences contribute to the risk for IPV perpetration among sexual minority young adults. Future research is needed to determine how alcohol use consequences may impact risk for IPV perpetration among those who have experienced ACEs.

Child Maltreatment, Mental Health Disorders, and Health Risk Behaviors in People With Diverse Gender Identities

This study examined rates of mental health disorders and health risk behaviors in people with diverse gender identities and associations with five types of child maltreatment. We used data from the Australian Child Maltreatment Study (ACMS), a nationally representative survey of Australian residents aged 16 years and more, which was designed to understand the experience of child maltreatment (physical abuse, sexual abuse, emotional abuse, neglect, exposure to domestic violence). Mental disorders-major depressive disorder, generalized anxiety disorder (GAD), alcohol use disorder, post-traumatic stress disorder (PTSD), and health risk behaviors-smoking, binge drinking, cannabis dependence, self-harm, and suicide attempt in the past 12 months were assessed. People with diverse gender identities who experienced child maltreatment were significantly more likely to have GAD (43.3%; 95% CI [30.3, 56.2]) than those who had experienced child maltreatment who were either cisgender men (13.8%; [12.0, 15.5]) or cisgender women (17.4%; [15.7, 19.2]). Similarly, higher prevalence was found for PTSD (21.3%; [11.1, 31.5]), self-harm (27.8%; [17.1, 38.5]) and suicide attempt (7.2%; [3.1, 11.3]) for people with diverse gender identities. Trauma-informed approaches, attuned to the high likelihood of any child maltreatment, and the co-occurrence of different kinds may benefit people with diverse gender identities experiencing GAD, PTSD, self-harm, suicidal behaviors, or other health risk behaviors.

Associations between early child adversity and lifetime suicide attempts among gender diverse individuals: A moderated mediation

BACKGROUND

This study examines the effect of adverse childhood experiences (ACEs) on lifetime suicide attempts (LSA) across five gender subgroups (i.e., transgender men, transgender women, transgender non-binary, cisgender men and cisgender women).

OBJECTIVE

To examine (1) the prevalence of LSA across gender identity subgroups; (2) whether the association between ACEs and LSA is moderated by gender identity subgroup; (3) depressive symptoms, alcohol use disorder, social support, and social well-being as mechanisms linking ACEs with LSA; and (4) the moderating role of gender identity on the four putative mediators.

PARTICIPANTS AND SETTINGS

We used nationally representative data from a population-based survey of N = 1368 transgender and cisgender individuals collected between 2016 and 2019.

METHODS

Structural equation modeling was used to explore the indirect effect of depressive symptoms on the relation between ACEs and LSA, and the moderating impact of gender identity.

RESULTS

LSA was significantly more prevalent among transgender respondents (cisgender man = 5 %; cisgender woman = 9 %; transgender man = 42 %; transgender woman = 33 %; transgender non-binary = 37 %; p < 0.001). Individuals with more ACEs had a greater risk of engaging in LSA regardless of gender identity; however, moderation results showed that the impact of each additional ACE on LSA was stronger for individuals with transgender identities: the likelihood of engaging in LSA was statistically similar for transgender men with no ACEs and cisgender men with all 8 ACEs. Indirect effects of ACEs on LSA via depressive symptoms were also observed, and the mediating effect was moderated by gender identity.

CONCLUSIONS

By examining the mechanisms linking childhood adversity to LSA, this study demonstrates that not all ACEs impact gender minority subgroups equally.

Adverse Childhood Experiences and Sexual Orientation: An Intersectional Analysis of Nationally Representative Data

INTRODUCTION

This study compared the prevalence of adverse childhood experiences across intersections of sexual orientation, gender, race/ethnicity, and economic status.

METHODS

Data collected between 1994 and 2018 from 12,519 participants in the National Longitudinal Study of Adolescent to Adult Health were analyzed in 2023 to generate adverse childhood experience prevalence estimates. Unadjusted 1-way ANOVAs and multivariate regressions were performed to compare differences in independent and cumulative adversity measures by sexual orientation, gender, race/ethnicity, and poverty status. A multilevel analysis of individual heterogeneity and discriminatory accuracy was conducted to estimate adversity scores across 24 groups that were stratified by sexual orientation, gender, race/ethnicity, and poverty status.

RESULTS

Adolescents with same-sex attractions and adults who identified with a sexual minority group reported more adverse childhood experiences overall than straight participants, although associations varied by type of adversity. Strikingly, adversity scores were higher among White youth with same-sex attractions than among Black youth with same-sex attractions, among more economically advantaged bisexual adults than among poorer ones, and among poor White participants than among poor Black and Hispanic participants, suggesting that the combination of disadvantaged and marginalized statuses does not necessarily correspond with greater childhood adversity. A multilevel analysis of individual heterogeneity and discriminatory accuracy interaction model showed that sexual orientation and poverty status contributed significant variance to cumulative adversity scores, whereas gender and race/ethnicity did not.

CONCLUSIONS

The results show that disparities in adverse experiences can be more fully and accurately represented when sexual orientation and other social identities are modeled as intersectional configurations. Given that adverse childhood experiences are linked to morbidity and mortality, the findings have salient implications for understanding health disparities that affect population subgroups.

Multi-omics in stress and health research: study designs that will drive the field forward

Despite decades of stress research, there still exist substantial gaps in our understanding of how social, environmental, and biological factors interact and combine with developmental stressor exposures, cognitive appraisals of stressors, and psychosocial coping processes to shape individuals' stress reactivity, health, and disease risk. Relatively new biological profiling approaches, called multi-omics, are helping address these issues by enabling researchers to quantify thousands of molecules from a single blood or tissue sample, thus providing a panoramic snapshot of the molecular processes occurring in an organism from a systems perspective. In this review, we summarize two types of research designs for which multi-omics approaches are best suited, and describe how these approaches can help advance our understanding of stress processes and the development, prevention, and treatment of stress-related pathologies. We first discuss incorporating multi-omics approaches into theory-rich, intensive longitudinal study designs to characterize, in high-resolution, the transition to stress-related multisystem dysfunction and disease throughout development. Next, we discuss how multi-omics approaches should be incorporated into intervention research to better understand the transition from stress-related dysfunction back to health, which can help inform novel precision medicine approaches to managing stress and fostering biopsychosocial resilience. Throughout, we provide concrete recommendations for types of studies that will help advance stress research, and translate multi-omics data into better health and health care.

Centering persons who use drugs: addressing social determinants of health among patients hospitalized with substance use disorders

Social workers have emerged as leaders within Addiction Consult Services (ACS) due to their ability to provide a wide range of services, from crisis work and brief therapeutic interventions to connecting patients to community resources. Many hospitals have implemented ACS to address the overdose crisis and the sharp rise in drug use-related infections, including skin and soft tissue infections, osteomyelitis, and endocarditis; a result of unaddressed systemic social determinants of health (SDOH). Yet, despite social workers being at the forefront of inpatient substance use work, little guidance exists regarding social work's role in leading person-centered addiction care and addressing SDOH in the hospital setting. The authors of this paper are licensed clinical social workers who have worked across five different health systems, engaging persons who use drugs (PWUD) in the context of an ACS. This paper examines five practice interventions of social work practice within hospitals that represent key points for innovation. Drawing on social work's unique commitments to social justice, strengths, and person-in-environment, these interventions operate within eco-social approaches to help us grapple more effectively with ways that health - and disease - are socially and economically produced by multiple interacting factors. We provide a clinical roadmap of interventions for social workers in hospital settings with PWUD to demonstrate how social work leadership within inpatient care models can help us better address the impacts of various intersecting SDOH on the care of PWUD.

Early Child Adversity and Delinquent Behavior in Foster Care Youth: Do Future Expectations and Sexual Identity Moderate the Mediating Role of Posttraumatic Stress?

Purpose

Delinquency in youth is a significant public health concern for individuals who experienced adversity and complex trauma as children. The present study explored the longitudinal associations between adverse child experiences and future engagement in delinquent behavior.

Methods

Using a sample of 1,245 foster youth who are aging out of the child welfare system, mediation, moderation, and moderated mediation analysis was used to test the mechanistic role of post-traumatic stress symptoms and the moderating role of sexual identity and positive future expectations on engagement in delinquent behavior.

Results

Results showed a positive and significant association between adverse child experiences and engagement in delinquent behavior. Post-traumatic stress symptoms partially mediated the ACEs-delinquency relationship. In addition, sexual minority youth and youth who were less optimistic about the future, but who experienced more ACEs, were at risk for heightened levels of post-traumatic stress.

Conclusions

Interventions that promote positive future outlooks may minimize the psychological sequelae of early child adversity and delinquent behavior particularly when tailored to the needs of sexual minority youth.

The Impact of Adverse Childhood Experiences on Mental Health and Suicidal Behaviors: A Study from Portuguese Language Countries

Background: Research on adverse childhood experiences (ACEs) demonstrates that they can be associated with physical and mental health problems throughout the lifecourse. However, few studies have examined this topic in the Community of Portuguese Language Countries (CPLC). Objective: This study aims to assess the impact of ACEs on mental health and suicidal behaviors in a sample of participants from the CPLC. Participants and Setting: The sample consists of 1006 participants aged between 18 and 80 years (mean = 41.76; SD = 14.19). Methods: This study used an online survey that included a sociodemographic questionnaire, the Brief Symptom Inventory-18 (BSI-18) to assess somatization, depression, and anxiety symptoms, and overall mental functioning, the Suicidal Behaviors Questionnaire-Revised (SBQ-R) to assess suicidal behaviors, and the Family Adverse Childhood Experiences Questionnaire to assess ACEs. Results: Emotional abuse was the most reported ACE (32.7%). Participants from Brazil had higher levels of somatization, depression, anxiety, and suicide ideation and attempt, while participants from Portugal had a higher probability of suicide in the future. ACEs were strong and significant predictors of psychological symptoms and the likelihood of suicide in the future, with emotional abuse and emotional neglect being the domains with the greatest contribution, respectively. Conclusions: ACEs are a prevalent and general phenomenon across several countries. It is urgent to alert policymakers and mental health professionals of the need to intervene with children and families to ensure their harmonious and adjusted development, thus promoting quality of life and well-being of populations.

The Association Between Sexual Identity, Depression, and Adolescent Substance Use

Sexual minority youth (SMY) represent a population vulnerable to several adverse health consequences. Specifically, SMY experience depression and substance use at substantially higher rates than heterosexual peers. Better understanding the relationship between depression and substance use among SMY may help reduce morbidity and mortality. We hypothesize that depression will moderate increased substance use rates seen in SMY. Weighted logistical analyses of covariance, adjusted for race/ethnicity, sex, and age, compared the relationship between sexual identity, depression, and substance use (14 outcomes), using data from the 2019 Youth Risk Behavior Survey (n = 13,677) of high school students. SMY reported depression at rates nearly double than heterosexual peers (63.9% vs 33.0%). Except for vaping and alcohol, SMY had significantly higher odds of all SU (aORs 1.41-2.45, p < 0.001-0.0011). After adjusting for depression, odds of all SMY substance use decreased; most relationships remained significant (aORs 0.73-1.89), though the relationship between SMY and lifetime cannabis use became non-significant. The relationship between SMY and current vaping became significant and the relationship between SMY and alcohol and binge-drinking remained non-significant. SMY are at higher risk for use of most substances and depression compared to heterosexual youth. As depression consistently plays a role in the relationship between sexual minority status and adolescent substance use across a wide variety of substances, it may be a modifiable risk factor for substance use among sexual minority youth that should be screened for and treated. This study additionally provides important information for future studies examining nuances of SMY substance use patterns.

Measuring the prevalence and impact of adverse childhood experiences in the lives of LGBTQ individuals: A much-needed expansion

BACKGROUND

Numerous studies indicate that LGBTQ people have extensive experiences with adverse childhood experiences (ACEs), more so than their heterosexual and cisgender counterparts. Research also shows that LGBTQ youth endure traumatic experiences with victimization, including bullying, harassment, and violence, based on their non-hetero-cis-normative genders and/or sexual identities. Yet, most ACE measurement strategies fail to: (1) explicitly link the risk of ACE exposure to the discrimination and stigmatization of LGBTQ people, and (2) account for the breadth of potential ACE exposure in LGBTQ populations.

OBJECTIVE

In the current article, we develop and present a more comprehensive ACE measurement strategy for understanding the cumulative and deleterious impacts of ACEs in the lives of LGBTQ individuals.

METHODS

Here, we offer three expansions to the current ACE framework: (1) the inclusion of an LGBTQ-specific ACE in addition to the standard ACE measures, (2) the addition of LGBTQ qualifiers for current ACE items (when applicable), and (3) the expansion of ACE measures to capture the unique ACE experiences of LGBTQ individuals in family life, schools, and faith communities.

CONCLUSIONS

The implementation of a more comprehensive ACE measurement strategy will assist scholars and policymakers in better understanding the impacts of ACEs in the lives of LGBTQ individuals. In all, ACE measurement strategies that capture the breath of exposure of ACEs in the lives of LGBTQ individuals will assist in ACE screening, public health policy, and clinical intervention efforts.

Reactions to Participation in Research on Violence Experiences and Minority Stress Among Sexual and Gender Minority Young Adults

Given the growing body of research seeking to examine adverse childhood experiences (ACEs) and intimate partner violence (IPV) among sexual and gender minority (SGM) individuals, Institutional Review Boards must consider whether participating in violence research is emotionally distressing for SGM people. Yet, little research has studied SGM participants' reactions to participating in research on ACEs, IPV, and minority stress. Thus, the current study examined reactions, including negative emotional reactions, to participating in violence research among SGM young adults. In total, 230 participants who self-identified as a sexual minority (30.1% also identified as a gender minority) in a dating relationship completed a cross-sectional assessment on ACEs, IPV (including identity abuse victimization and perpetration), minority stress (i.e., internalized homo/bi/transphobia), and reactions to research participation. Results indicated that participants identifying as a gender minority had significantly higher negative emotional reactions to study participation compared to cisgender participants, but this increase among gender minority individuals was small. In addition, gender minority participants and those with higher minority stress (i.e., internalized trans/bi/homo-negativity) and ACEs reported significantly higher negative emotional reactions to participation. Furthermore, gender minority participants scored worse on a scale indicating appreciation for contributing to research. Finally, reporting IPV victimization and perpetration was not associated with negative emotional reactions. Findings suggest that questions assessing minority stress and negative childhood experiences may be more emotionally salient or stressful for gender minority participants compared to questions measuring IPV.

Higher Prevalence of Adverse Childhood Experiences in Transgender Than in Cisgender Individuals: Results from a Single-Center Observational Study

Adverse childhood experiences (ACE) have been shown to have a tremendous negative impact on health outcomes later in life. This study presents data on the prevalence of ACEs, psychological distress, and trauma-related symptoms in transgender and gender-diverse (TGD) people compared to cisgender people. TGD adults (n = 35) and a matched sample of nonpsychiatric hospital patients (n = 35) were surveyed between September 2018 and March 2019. Participants completed the Maltreatment and Abuse Chronology of Exposure Scale to assess ACEs, as well as the Brief Symptom Inventory and the Essener Trauma Inventory to assess psychological distress and trauma-related symptoms. TGD patients reported a higher number of ACEs than cisgender patients (0.7 vs. 2.4; p < 0.001; d = 0.94). A total of 28.6% of TGD vs. 5.7% cisgender patients reported four or more ACEs (p < 0.001). The most common forms of ACEs were parental abuse (54.3%) and peer abuse (54.3%). No significantly increased prevalence of sexual abuse was found (p > 0.05). TGD patients also reported a higher prevalence of depression (48.4% vs. 5.7%, p < 0.001), posttraumatic stress disorder symptoms (59.4% vs. 13.8%, p < 0.001), and anxiety (58.1% vs. 28.6%, p = 0.016). Health care providers should be aware of and assess ACEs, especially in vulnerable groups such as TGD people, and create a safe place through open-minded, affirming care.

Intersectionality and Adverse Childhood Experiences: Comparing Subgroups of Sex, Race/Ethnicity, and Sexual Orientation

INTRODUCTION

This study investigated the intersectionality of adverse childhood experiences (ACEs) among subgroups of sex, race/ethnicity, and sexual orientation.

METHODS

Using data from the Behavioral Risk Factor Surveillance Survey across 34 states (N=116,712) from 2009 to 2018, authors stratified subgroups of sex (male/female), race/ethnicity (White/Hispanic/Black/multiracial/other), and sexual orientation (heterosexual/bisexual/gay) to investigate the number of ACEs across groups. Analyses were conducted in 2022.

RESULTS

Stratification resulted in 30 distinct subgroups (e.g., bisexual Black females, straight multiracial males) with significant post hoc differences per group. Generally, those identifying as sexual minority individuals had the highest number of ACEs (the top 14 of 30 subgroups), whereas seven of the top ten subgroups were female. Surprisingly, no clear patterns emerged by race/ethnicity, although the two largest groups (straight White females and straight White males) were 27th and 28th of 30, respectively.

CONCLUSIONS

Although studies have examined ACEs by individual demographic variables, less is known about the extent to which ACEs are present in stratified subgroups. Sexual minority subgroups (particularly female bisexual subgroups) trend toward a higher number of ACEs, whereas heterosexual subgroups (regardless of sex) comprised the lowest 6 groups with respect to ACEs. Implications include further examination of bisexual and female subgroups (including specific ACE domain investigations) to identify the vulnerable population.

The role of adverse childhood experiences in suicide among sexual minority undergraduate students

This study explores the rates and odds of adverse childhood experiences (ACEs) and their relationship to suicide attempts in a sample of undergraduate students (n = 924, 71.6% women), comparing lesbian, gay and bisexual (LGB) youth to their heterosexual counterparts. Using propensity score matching, we matched 231 sexual minority and 603 heterosexual participants at a ratio of 1:3, based on gender, age, socioeconomic status, and religious beliefs. Sexual minority participants reported a significantly higher ACE score (M = 2.70 vs. 1.85; t = 4.93; p <.001; d = .391) and higher rates of all but one type of ACEs than their heterosexual counterparts. They also reported a higher prevalence and risk of suicide attempts (33.3% vs. 11.8% respectively, odds ratio = 3.73; p < .001). In logistic regression analysis, sexual minority status, emotional abuse and neglect, bias attack, having a household member with mental health problems, bullying and cyberbullying were significantly associated with suicide attempts.

The impacts of adverse childhood experiences on socioeconomic disadvantage by sexual and gender identity in the U.S

BACKGROUND

Adverse childhood experiences (ACEs) predict low education and low income, but this has scarcely been examined by sexual orientation and gender identity.

OBJECTIVE

We investigated prevalence and associations between ACEs, low income, and low education in sexual and gender diverse (SGD) and cisgender heterosexual (CGH) sub-groups.

PARTICIPANTS AND SETTING

Data came from 14 states in the 2019 Behavioral Risk Factor Surveillance System survey (n = 79,303).

METHODS

Chi-square, logistic regression, and moderation analyses were implemented to examine the prevalence and associations between ACEs, low income, and low education. Sample stratification was used to examine differences between SGD and CGH sub-groups.

RESULTS

SGD participants reported higher prevalence of ACEs, low income, and low education compared to CGH participants (p < 0.0001) with the highest proportions in transgender and queer/something else groups. ACEs were associated with low income (AOR 1.084, CI 1.067-1.102) and low education (AOR 1.056, CI 1.041-1.071) in the entire sample. Transgender and queer/something else groups had higher odds of low income (AOR 3.345, CI 1.975-5.665; AOR 1.702, CI 1.096-2.643) and low education (AOR 1.702, CI 1.096-2.643; AOR 3.552, CI 2.842-4.440) and gay/lesbian identity had reduced odds of low education (AOR 0.586, CI 0.457-0.751) compared to CGH males. The strength of associations between ACEs and low income and low education were weaker among SGD compared to CGH sub-groups.

CONCLUSION

These findings highlight the importance of including categories of sexual identity cross-classified by gender identity in population-based analyses in order to facilitate a comprehensive characterization of the life course outcomes of SGD populations.

Differential Exposure to Adverse Childhood Experiences Among Florida High School Students: The Intersection of Race, Ethnicity, and Gender

PURPOSE

The prevalence of exposure to adverse childhood experiences (ACEs) across distinct intersections of race/ethnicity and gender among adolescents remains relatively unknown. The current study seeks to address this important gap in the literature using a statewide representative sample of Florida high school students.

METHODS

Data drawn from the 2020 Florida Youth Substance Abuse Survey (FYSAS) (N = 20,438) were analyzed to examine differences in ACE exposure among 26 racial/ethnic and gender subgroups of high-school aged youth. Lifetime exposure to ACEs was constructed using 10 different ACE categories to measure ACEs prevalence as reported exposure to 1+ ACEs and 4+ ACEs.

RESULTS

Exposure to ACEs was highly gendered and varied according to racial/ethnic subgroup. While notable differences across gender and racial/ethnic groups emerged when measuring prevalence as exposure to 1+ ACEs, several of these disparities were further amplified when prevalence was measured as exposure to 4+ ACEs. Native American female adolescents represented the group at greatest risk of high exposure to ACEs, with more than 50% of such youth reporting exposure to 4+ ACEs.

DISCUSSION

The prevalence of ACE exposure varies significantly across race/ethnic and gender subgroups of youth. These intersections should be considered for prevention efforts and clinical treatments of trauma exposure as ACEs may be linked to certain outcomes or behaviors based on high exposure in certain subpopulations of youth.

Youth Suicide and Self-Harm: Latent Class Profiles of Adversity and the Moderating Roles of Perceived Support and Sense of Safety

Research suggests that exposure to adversity can lead to an increased risk of experiencing suicidal and self-injurious thoughts or behaviours, but few studies have examined whether different patterns of adversity are differentially associated with youth suicide/self-harm. The current study aims to explore the relationship between exposure to adversity across various social domains and youth self-harm and suicidality, using a person centred approach, and examines whether access to social support and a sense of safety across home, peer or school settings buffer the relationship between adversity and self-harm/suicidality. Secondary data analyses were carried out on cross-sectional self-report data collected from 4848 (M_age=15.78, SD = 0.59; 50% female) adolescents who participated in the Irish Planet Youth survey. Latent Class Analyses identified four distinct profiles of adversity; low-adversity (n = 2043, 42%); peer-adversity (n = 972, 20%); parental-adversity (n = 1189, 25%); and multiple-adversity (n = 644, 13%). Findings from logistic moderated regressions indicated that there were significant differences in self-harm and suicidality across the adversity classes. Although parental support and perceived safety at school were negatively associated with suicidality and self-harm outcomes, no significant moderation effects were observed. These findings suggest that youth who experience adversity across multiple social domains are more likely to report suicidal and self-harm thoughts and behaviours, and should be key targets for intervention/prevention efforts. While parental support and school safety may act as significant compensatory factors, further work is needed to identify the social resources that can offset the risk imposed by youth's adverse experiences.

The Complexity of Trauma for LGBTQ+ People

Trauma care is complex. Acute and critical care clinicians perceive trauma as a skilled response to critical injury or accident that occurs to patients, but trauma exists on many levels. One of those is a grim reality for patients who are lesbian, gay, bisexual, transgender, queer or questioning, and from other sexual and gender minorities (LGBTQ+). A lifetime of trauma through stigma, discrimination, and victimization is too often present. Owing to distrust of the health care system and clinicians, LGBTQ+ experience health and health care disparities.

Mental healthcare for young and adolescent LGBTQ+ individuals in the Indian subcontinent

The coronavirus disease (COVID-19) pandemic has led to a significant change in the way healthcare is dispensed. During the pandemic, healthcare inequities were experienced by various sections of society, based on gender, ethnicity, and socioeconomic status. The LGBTQ individuals were also affected by this inequity. There is a lack of information on this topic especially in the developing countries. Hence this issue requires further exploration and understanding. Previous literature briefly explored the mental, physical, and emotional turmoil faced by the LGBTQ community on a regular basis. They feared rejection by family and friends, bullying, physical assault, and religious biases. These issues prevented them from publicly speaking about their sexual orientation thereby making it difficult to collect reliable data. Although they require medical and psychological treatment, they are afraid to ask for help and access healthcare and mental health services. Being mindful of these difficulties, this article explores the various underlying causes of the mental health problems faced by LGBTQ individuals, especially, in the Indian subcontinent. The article also examines the status of healthcare services available to Indian sexual minorities and provides recommendations about possible remedial measures to ensure the well-being of LGBTQ individuals.

Processes and Manifestations of Digital Resilience: Video and Textual Insights From Sexual and Gender Minority Youth

Minority stressors harm sexual and gender minority youth (SGMY). This may be mitigated by promotive and protective factors and processes that manifest resilient coping. SGMY increasingly interact with information communication technologies (ICTs) to meet psychological needs, yet research often problematizes youths’ ICT use, inhibiting understanding about ICTs’ potential resilience-enhancing utilities. This study analyzes text and video responses of 609 SGMY aged 14 to 29 residing in Canada or the United States to an open-ended survey question about the benefits of using ICTs. Constructivist grounded theory integrating multimodal coding was used to analyze the data, producing a framework of digital resilience—digital processes and actions that generate positive growth—with four themes: Regulating Emotions and Curating Microsystems; Learning and Integrating; Advocating and Leading; and Cultivating Relationships and Communities of Care. Implications for clinical practice, survey innovation, and application of findings in fostering affirming digital microsystems for SGMY are discussed.

LGBTQIA+ Adapted Telehealth Intensive Outpatient Program for Youth and Young Adults: Subgroup Analysis of Acuity and Improvement Following Treatment (Preprint)

BACKGROUND

Lesbian, gay, bisexual, transgender, queer, intersex, asexual, and other minoritized gender and sexual identities (LGBTQIA+) youth have disproportionately high levels of depression, self-harm, and suicidal thoughts and behaviors. In addition, LGBTQIA+ youth frequently report lower levels of satisfaction or comfort with their health care providers because of stigmatization, which may prevent continuation of care, yet there is a lack of mental health treatment and outcome research addressing these disparities. However, there is some indication that LGBTQIA+ individuals feel more comfortable with web-based formats, indicating that telehealth services may be beneficial for this population.

OBJECTIVE

This program evaluation explored the effectiveness of a remote intensive outpatient program with a curriculum tailored specifically to LGBTQIA+ youth with high-acuity depression, anxiety, and suicidality. This study sought to understand baseline acuity differences between LGBTQIA+ and non-LGBTQIA+ youth and young adult patients and to determine if there were differences in clinically significant improvement by subtypes within the LGBTQIA+ population following participation in LGBTQIA+-specific programming.

METHODS

Data were collected from intake and discharge outcome surveys measuring depression, suicidality, and nonsuicidal self-injury (NSSI) in 878 patients who attended at least six sessions of a remote intensive outpatient program for youth and young adults. Of these 878 clients, 551 (62.8%) were identified as having at least one LGBTQIA+ identity; they participated in an LGBTQIA+-adapted program of the general curriculum.

RESULTS

LGBTQIA+ patients had more clinically severe intake for depression, NSSI, and suicidal ideation. Nonbinary clients had greater NSSI within the LGBTQIA+ sample at intake than their binary counterparts, and transgender clients had significantly higher depressive scores at intake than their nontransgender counterparts. LGBTQIA+ patients demonstrated improvements in all outcomes from intake to discharge. The Patient Health Questionnaire for Adolescents depression scores improved from 18.15 at intake to 10.83 at discharge, representing a 41.5% reduction in depressive symptoms. Overall, 50.5% (149/295) of the LGBTQIA+ youth who endorsed passive suicidal ideation at intake no longer reported it at discharge, 72.1% (160/222) who endorsed active suicidal ideation at intake no longer reported it at discharge, and 55.1% (109/198) of patients who met the criteria for clinical NSSI no longer met the criteria at discharge. In the subgroup analysis, transgender patients were still 2 times more likely to report clinical NSSI at discharge.

CONCLUSIONS

This program evaluation found substantial differences in rates of depression, NSSI, and suicidal ideation between LGBTQIA+ clients compared with their non-LGBTQIA+ counterparts. In addition, this evaluation showed a considerable decrease in symptoms when clients attended LGBTQIA+-affirming care. The findings provide support for the role of LGBTQIA+-specific programming to meet the elevated mental health needs of these youth and that more research is needed to understand barriers that may negatively affect transgender clients, specifically.

Environmental contaminants, endocrine disruption, and transgender: Can "born that way" in some cases be toxicologically real?

Gender is viewed by many as strictly binary based on a collection of body traits typical of a female or male phenotype, presence of a genotype that includes at least one copy of a Y chromosome, or ability to produce either egg or sperm cells. A growing non-binary view is that these descriptors, while compelling, may nonetheless fail to accurately capture an individual's true gender. The position of the American Psychological Association (APA) agrees with this view and is that transgender people are a defendable and real part of the human population. The considerable diversity of transgender expression then argues against any unitary or simple explanations, however, prenatal hormone levels, genetic influences, and early and later life experiences have been suggested as playing roles in development of transgender identities. The present review considers existing and emerging toxicologic data that may also support an environmental chemical contribution to some transgender identities, and suggest the possibility of a growing nonbinary brain gender continuum in the human population.

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

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.

Adverse childhood experiences are associated with increased overdose risk in predominately Latinx adults seeking treatment for substance use disorders

Introduction

Almost no previous studies explored the relationship between adverse childhood experiences (ACEs) and overdose risk for individuals with substance use disorders (SUDs), and these did not focus on a Latinx population. This study examined the relationship between ACEs, reporting PTSD symptoms, and lifetime experience of overdose in a sample (n = 149) of primarily Latinx adults seeking treatment for substance use disorder (SUD).

Materials and methods

Administrative data from an integrated behavioral health and primary care treatment system in Massachusetts were analyzed through bivariate analyses and multiple logistic regression. The final model examined the association between self-reported ACEs, PTSD screen, and lifetime drug overdose. We controlled for demographic characteristics and heroin use and explored alternative measure specifications.

Results

ACEs scores were high with 58% having experienced 4+ ACEs. Female gender was associated with a 24% higher ACE score than male gender (p < 0.01). In the multiple logistic model each additional ACE was associated with 1.3 times greater odds of overdose (p < 0.01). Those reporting heroin use had 8.8 times greater odds of reporting overdose compared to those reporting no heroin use (p < 0.001). Gender, age, Puerto Rican ethnicity, years of cocaine use, receiving public assistance income, and a positive initial PTSD screen were not significant. Findings were robust in sensitivity testing.

Discussion and conclusion

We found the number of ACEs and reported heroin use significantly and positively associated with self-report of overdose in both bivariate and multiple logistic regression analyses. In contrast, a positive initial screen for PTSD was only significantly associated with overdose in the bivariate analysis. Increased screening for ACEs is warranted and ACE-specific treatment is suggested for SUD treatment programs offering trauma-informed services for adults.

Associations between Adverse Childhood Experiences and Pandemic-Related Stress and the Impact on Adolescent Mental Health during the COVID-19 Pandemic

Vulnerabilities of adolescents during times of crisis have been previously identified, but little research has investigated the compounding effects of lifetime adversities and pandemic-related stress on adolescent mental health. This study uses adolescent self-report data to model relationships between stress exposures and indicators of poor mental health from the longitudinal COVID Experiences (CovEx) Surveys. These surveys were administered online in English to U.S. adolescents ages 13-19 using the NORC AmeriSpeak® panel, a probability-based panel designed to be representative of the U.S. household population. Two waves of data were collected (Wave 1: October-November 2020, n = 727; Wave 2: March-May 2021, n = 569). Measures included demographics, adverse childhood experiences (ACEs, 8 items), pandemic-related stress (Pandemic-Related Stress Index [PRSI], 7 items), and depression symptoms (Patient Health Questionnaire for Adolescents [PHQ-A], 9 items). Path analyses were conducted to examine pathways between Wave 1 ACEs, Wave 1 PRSI, and Wave 2 PHQ with covariates of sex and race/ethnicity. Females had higher ACEs, PRSI, and PHQ scores than males. The PRSI score at Wave 1 was positively associated with the PHQ at Wave 2 (b = 0.29, SE = 0.14, p < 0.001). ACEs at Wave 1 were positively associated with PRSI at Wave 1 (b = 0.31, SE = 0.03, p < 0.001) and with PHQ at Wave 2 (b = 0.32, SE = 0.12, p < 0.001). The direct effect of ACEs on PHQ (b = 0.23, SE = 0.12, p < 0.001) remained significant even after accounting for the indirect effect of pandemic-related stress (b = 0.09, SE = 0.05, p < 0.001). Pandemic-related stress had a direct, adverse impact on adolescent depressive symptoms and demonstrates a compounding effect of childhood adversity and pandemic-related stress on depression. Findings can aid the design of interventions that promote mental health and support adolescent coping and recovery.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40653-022-00502-0.

Mental Health Among Sexual and Gender Minority Youth Incarcerated in Juvenile Corrections

OBJECTIVES

This study examined differences by sexual and gender minority (SGM) and incarceration statuses in mental health indicators among youth.

METHODS

Population-based, cross-sectional data are from the 2019 Minnesota Student Survey (N = 72 324) and includes public school students (Mage = 15.49) and youth incarcerated in juvenile correctional facilities (Mage = 15.48). We categorized youth into 4 groups: (1) non-SGM youth in public schools, (2) non-SGM youth in correctional facilities, (3) SGM youth in public schools, and (4) SGM youth in correctional facilities. Multivariable regression models assessed associations among SGM and incarceration statuses and mental health indicators after controlling for sociodemographic characteristics and exposure to adverse childhood experiences.

RESULTS

More youth in juvenile correctional facilities identified as SGM (28.8%) compared with youth in public schools (20.4%, P = .002). SGM youth in correctional facilities reported a higher prevalence of suicidal ideation (42.2%), suicide attempt (37.5%), and self-harm (57.8%) compared with all other groups. Depressive symptom severity was similarly elevated among SGM youth in correctional facilities and SGM youth in public schools. SGM youth in correctional facilities, compared with non-SGM youth in public schools, demonstrated elevated odds of suicide ideation (adjusted odds ratio [aOR] = 2.2, 95% confidence interval [95% CI] = 1.3-3.9), suicide attempt (aOR = 6.3, 95% CI = 3.6-10.9), and self-harm (aOR = 3.6, 95% CI = 2.1-6.3).

CONCLUSIONS

Incarcerated SGM youth disproportionately experience negative mental health indicators. Findings suggest that tailored, intersectional, and responsive mental health interventions are needed to support incarcerated SGM youth.

Medial Prefrontal Cortex Activity to Reward Outcome Moderates the Association Between Victimization Due to Sexual Orientation and Depression in Youth

BACKGROUND

Sexual minority youth (SMY) are 3 times more likely to experience depression than heterosexual peers. Minority stress theory posits that this association is explained by sexual orientation victimization, which acts as a stressor to impact depression. For those vulnerable to the effects of stress, victimization may worsen depression by altering activity in neural reward systems. This study examines whether neural reward systems moderate the influence of sexual orientation victimization, a common and distressing experience in SMY, on depression.

METHODS

A total of 81 participants ages 15 to 22 years (41% SMY, 52% marginalized race) reported sexual orientation victimization, depression severity, and anhedonia severity, and underwent a monetary reward functional magnetic resonance imaging task. Significant activation to reward > neutral outcome (p_{familywise error} < .05) was determined within a meta-analytically derived Neurosynth reward mask. A univariate linear model examined the impact of reward activation and identity on victimization-depression relationships.

RESULTS

SMY reported higher depression (p < .001), anhedonia (p = .03), and orientation victimization (p < .001) than heterosexual youth. The bilateral ventral striatum, medial prefrontal cortex (mPFC), anterior cingulate cortex, and right orbitofrontal cortex were significantly active to reward. mPFC activation moderated associations between sexual orientation victimization and depression (p = .03), with higher depression severity observed in those with a combination of higher mPFC activation and greater orientation victimization.

CONCLUSIONS

Sexual orientation victimization was related to depression but only in the context of higher mPFC activation, a pattern observed in depressed youth. These novel results provide evidence for neural reward sensitivity as a vulnerability factor for depression in SMY, suggesting mechanisms for disparities, and are a first step toward a clinical neuroscience understanding of minority stress in SMY.

Factors influencing the well-being of Asian American LGBT individuals across the lifespan: perspectives from leaders of community-based organizations

BACKGROUND

Lesbian, gay, bisexual, and transgender (LGBT) individuals have documented disparities in mental health that are experienced across the life course. However, limited research has been conducted to identify the factors which contribute to evaluated risk for poor mental health among older Asian Americans who identify as LGBT. The purpose of this study was to determine the perspectives of leaders of community-based organizations about the mental health needs and concerns of their LGBT constituents from diverse Asian backgrounds.

METHODS

Semi-structured qualitative interviews were conducted with leaders of community-based organizations serving the needs of LGBT individuals. A qualitative framework analysis approach was used to identify, analyze and report themes within the data.

RESULTS

11 members of community organizations located in California (54.5%), Chicago (27.2%), and New York (18.1%) were interviewed. Chronic stress was identified as negatively impacting constituents' lives and was attributed to social determinants of health, including inadequate housing, financial insecurity, discrimination, barriers to adequate health care, and immigration status. Ageism, social isolation, language barriers, and limited connections to cultural, religious, or LGBT communities were identified as factors impacting middle-aged and older adults. Participants identified homelessness, violence, and lack of parental acceptance as contributing to distress among youth and younger adults. The most vulnerable community members were identified as gender minorities, undocumented individuals, and individuals with limited English proficiencies. Organizational leaders described strategies to address social determinants.

CONCLUSIONS

Asian Americans who are LGBT are confronted with substantial risks for poor mental health that are linked to modifiable social determinants of health. Organizations serving these populations play a vital role in meeting the needs of a highly underserved population.

The impacts of COVID-19 on LGBTQ+ foster youth alumni

BACKGROUND

LGBTQ+ youth frequently experience disparities in outcomes related to permanency and overall well-being while in out-of-home care. These negative outcomes often persist after youth have transitioned out of care, particularly in the domains of housing, education, employment, and mental health. Initial research has found that the ongoing COVID-19 pandemic has exacerbated negative physical and mental health outcomes, as well as decreased economic stability among transition age youth.

OBJECTIVE

This study seeks to determine if COVID-19 has resulted in unique impacts on foster care alumni, and if these impacts are the same for LGBTQ+ and non-LGBTQ+ transition age youth.

PARTICIPANTS AND SETTING

This study used data from the 2020 Jim Casey Youth Opportunities Initiative Opportunity Passport Survey to explore these questions.

METHODS

This survey was administered electronically to a national sample of 1223 youth ages 18-26 with lived experience in foster care.

RESULTS

Results indicate that relative to non-LGBTQ+ foster care alumni, LGBTQ+ foster care alumni experienced more negative outcomes in housing stability, employment, and mental health/trauma due to COVID-19. No significant differences were found for education-related impacts. Outcomes varied by sex assigned at birth, ethnicity, and sexual orientation, gender identity and expression (SOGIE) of respondents, with female respondents, black, indigenous and other people of color (BIPOC) youth and LGBTQ+ youth being most frequently impacted.

CONCLUSIONS

Results indicate that relative to non-LGBTQ+ foster care alumni, LGBTQ+ foster care alumni experienced more negative outcomes in housing stability, employment, and mental health/trauma due to COVID-19. No significant differences were found for education-related impacts. Outcomes varied by sex assigned at birth, ethnicity, and sexual orientation, gender identity and expression (SOGIE) of respondents, with female respondents, BIPOC youth and LGBTQ+ youth being most frequently impacted. Implications for practice and policy are explored.

Transphobic Adverse Childhood Experiences as a Determinant of Mental and Sexual Health for Young Trans Women in the San Francisco Bay Area

This study characterized the prevalence of transphobic adverse childhood experiences (ACEs) among young trans women (YTW) and assessed its relationship with poor mental health and sexual risk. A survey was administered between 2012 and 2014 to 300 YTW aged 16-24 living in the San Francisco Bay Area. Transphobic childhood verbal abuse, physical abuse, and high transphobic childhood adversity were endemic, and we found strong associations with depression, posttraumatic stress disorder, and any and receptive anal intercourse. ACEs may be critical social determinants of mental and sexual health for YTW and validated measures to screen for ACEs are needed, along with interventions that provide gender-affirmative support for parents.

Sexual and Gender Diverse Young Adults’ Perception of Behaviors that are Supportive and Unsupportive of Sexual Orientation and Gender Identities

To explore specific responses that sexual and gender diverse young adults (SGD YA) perceive to be supportive and unsupportive of sexual orientation and gender identity by caregivers and other adults following identity disclosure. SGD YA ( N = 101), ages 18 to 25 years ( M = 21.2) were predominantly White (83.1%), non-Hispanic (89.1%), assigned female at birth (82.2%). The majority (97.8%) were sexually diverse (e.g., queer, pansexual, lesbian, gay, asexual, bisexual) and half (50%) were gender diverse (e.g. transgender, agender, genderqueer, nonbinary). Participants completed an online survey. This analysis is focused on participants’ responses to open-ended questions regarding responses they perceived to be supportive and unsupportive of their SGD identity/identities. Content analysis of participants’ open-ended survey responses was conducted using a combination of inductive and deductive coding. Six themes emerged for both supportive responses (communication, actions, acceptance, open-mindedness, unconditional love, and advocacy) and unsupportive responses (distancing, hostility, minimizing, controlling, blaming, and bumbling). For some themes, different sub-themes emerged based on identity. Parents/caregivers as well as other adults in the lives of SGD YA can implement specific responses to demonstrate support for sexual orientation and gender identity with the potential to improve the mental health of SGD YA.

Management of eating disorders for people with higher weight: clinical practice guideline

INTRODUCTION

The prevalence of eating disorders is high in people with higher weight. However, despite this, eating disorders experienced by people with higher weight have been consistently under-recognised and under-treated, and there is little to guide clinicians in the management of eating disorders in this population.

AIM

The aim of this guideline is to synthesise the current best practice approaches to the management of eating disorders in people with higher weight and make evidence-based clinical practice recommendations.

METHODS

The National Eating Disorders Collaboration Steering Committee auspiced a Development Group for a Clinical Practice Guideline for the treatment of eating disorders for people with higher weight. The Development Group followed the 'Guidelines for Guidelines' process outlined by the National Health and Medical Research Council and aim to meet their Standards to be: 1. relevant and useful for decision making; 2. transparent; 3. overseen by a guideline development group; 4. identifying and managing conflicts of interest; 5. focused on health and related outcomes; 6. evidence informed; 7. making actionable recommendations; 8. up-to-date; and, 9. accessible. The development group included people with clinical and/or academic expertise and/or lived experience. The guideline has undergone extensive peer review and consultation over an 18-month period involving reviews by key stakeholders, including experts and organisations with clinical academic and/or lived experience.

RECOMMENDATIONS

Twenty-one clinical recommendations are made and graded according to the National Health and Medical Research Council evidence levels. Strong recommendations were supported for psychological treatment as a first-line treatment approach adults (with bulimia nervosa or binge-eating disorder), adolescents and children. Clinical considerations such as weight stigma, interprofessional collaborative practice and cultural considerations are also discussed.

CONCLUSIONS

This guideline will fill an important gap in the need to better understand and care for people experiencing eating disorders who also have higher weight. This guideline acknowledges deficits in knowledge and consequently the reliance on consensus and lower levels of evidence for many recommendations, and the need for research particularly evaluating weight-neutral and other more recent approaches in this field.

Childhood emotional abuse, rejection sensitivity, and depression symptoms in young Chinese gay and bisexual men: Testing a moderated mediation model

BACKGROUND

There is a high and increasing prevalence of depression symptoms among gay and bisexual individuals. Studies have found that childhood emotional abuse (CEA) can impact mental-health problems in adulthood; however, limited research on this association among marginalized populations, especially in China. This study aimed to explore the relationship between CEA and depression symptoms in adulthood among gay and bisexual youths in China and to test the mediating role of rejection sensitivity and the moderating role of sexual identity in this relationship.

METHODS

Participants comprised 496 gay and bisexual Chinese men aged 18-29 years. They responded to a questionnaire that assessed history of CEA, rejection sensitivity, and depression symptoms.

RESULTS

CEA showed a positive association with depression symptoms among participants. Participants' rejection sensitivity played a partial mediating role in the relationship between CEA and depression symptoms. Sexual identity had a moderating effect on the CEA's influence on depression symptoms, with a stronger impact for gay men than bisexual men.

LIMITATIONS

Cross-sectional approach limited casual inferences among variables. Recall bias regarding CEA may have impacted the accuracy of the effect sizes observed.

CONCLUSION

This study contributes to improving understanding of CEA's role as a substantial risk factor for strong depression symptoms in adulthood among gay and bisexual youths and it demonstrates that focusing on educating families and establishing equal policies is important to decrease and eliminate depression symptoms. Theories of sexual minority stress and biphobia are applicable for explaining mental health outcomes among young members of sexual minorities in China.

A systematic review and meta-analysis investigating the impact of childhood adversities on the mental health of LGBT+ youth

Background

The presence of trauma as a backdrop to the lives of LGBT+ youth has been recognised in recent literature. LGBT+ youth report a higher frequency, severity and pervasiveness of adverse childhood experiences when compared to their heterosexual and cisgender counterparts. This exposure has been directly related to an increased risk of mental health problems.

Method

A systematic literature search of Medline, Embase, PsycINFO, PubMed and Web of Science was conducted from the date of their inception until the 1st September 2021. The study protocol was registered in PROSPERO (CRD42021240472).

Results

A total of 27 studies satisfied the inclusion criteria and were used in the systematic review, representing 199,285 participants, 26,505 of whom identified as LGBT+ (mean age 16.54). Female participants (ranging from 11% to 74%) and white participants (7.7%-96%) made up the largest percentage of most samples. Depressive symptoms were the most commonly described psychiatric outcome (n = 17, 63%), followed by anxiety symptoms (n = 6, 31.5%). 18 studies provided meta-analysable data, compromising 21,781 LGBT+ young people. LGBT+ youth reported a higher prevalence of adverse experiences in comparison to their heterosexual or cisgender counterparts (p < .001), with sexual abuse representing the most commonly reported experience (29.7%), followed by verbal abuse (28.7%), physical abuse (26.5%) and cyberbullying (19.1%). LGBT+ youth were also at a heightened risk of mental health disorders (p < .001), with 36.9% and 31.5% of sample meeting the clinical criteria for depression and anxiety, respectively.

Conclusions

Continued advocacy is needed from communities and Allies to support and empower LGBT+ youth in the face of adversity. Longitudinal and longer-term studies are required to further understand the relationship between adverse experiences in LGBT+ youth and the impact on mental health.

The Impact of Life Trauma on Mental Health and Suicidal Behavior: A Study from Portuguese Language Countries

Several studies report the incidence of traumatic experiences in community and clinical samples, and substantial research demonstrates the impact of traumatic events on mental health and suicidal behavior, but this area remains unexplored in the Community of Portuguese Language Countries (CPLC). Thus, this study aims to (1) describe traumatic experiences, mental health levels and suicidal behavior among individuals from Portugal, Brazil and African Countries with Portuguese as an Official Language (ACPOL); (2) assess correlations between traumatic experiences and mental health and suicidal behavior; and (3) assess the impact of exposure to a traumatic event on mental health and suicidal behavior. The measurement instruments included a sociodemographic questionnaire, Brief Trauma Questionnaire, Brief Symptoms Inventory-18, and the Portuguese version of the Suicidal Behaviors Questionnaire-Revised. ACPOL participants reported greater impact of war, Portuguese participants reported greater impact of disasters, and Brazilian participants reported greater impact of psychological and sexual abuse, assault, and death of a family member. Brazilian participants showed the worst levels of mental health and suicidal thoughts. Strong correlations were found between traumatic experiences and mental health levels and suicidal behavior. Traumatic experiences contributed to the explanation of mental health levels and probability of committing suicide.

Adverse Childhood Experiences Across Birth Generation and LGBTQ Identity, Behavioral Risk Factor Surveillance System, 2019

Objectives. To identify and describe differences in exposure to adverse childhood events (ACEs) by birth generation and lesbian, gay, bisexual, transgender, and queer plus (LGBTQ+) identity. Methods. Using data from the 2019 Behavioral Risk Factor Surveillance System, we examined the odds of experiencing 4 or more ACEs for Generation X, millennials, and Generation Z relative to baby boomers (n = 56 262). We also explored differences between generations based on LGBTQ+ identity. Results. The odds of experiencing 4 or more ACEs were higher for Generation X (odds ratio [OR] = 1.67; 95% confidence interval [CI] = 1.52, 1.83), millennials (OR = 2.12; 95% CI = 1.92, 2.35), and Generation Z (OR = 2.12; 95% CI = 1.79, 2.52) than for baby boomers. This disparity was amplified by LGBTQ+ identity (P = .016). The frequency of individual ACEs also varied by generation. Conclusions. Exposure to 4 or more ACEs has increased for each generation since the baby boomers, and more so for the LGBTQ+ population. The ACEs experienced differ by generation. Public Health Implications. Increasing ACE scores suggest that younger generations may have an increased risk of ACE-related health problems. Policies are needed to prevent ACE exposure and address the potential fallout from the ACEs that have seen the largest increases. (Am J Public Health. 2022;112(4):662-670. https://doi.org/10.2105/AJPH.2021.306642).

Are pediatric surgery clinics LGBTQ+ inclusive?

PURPOSE

Creating inclusive LGBTQ+ environments is important in the provision of inclusive care. This cross sectional study assessed whether patient intake forms in pediatric surgery departments were LGBTQ+ inclusive (L-I).

METHODS

North American pediatric surgery departments affiliated with pediatric surgery fellowships or general surgery residencies were contacted to retrieve patient intake forms. Forms were assessed for LGBTQ+ inclusivity using a novel L-I scoring system consisting of 6 criteria: preferred name, pronouns, preferred language, gender identity, sex assigned at birth, and l-I guardianship. Institutions without intake forms were invited to comment on their use of l-I intake questions.

RESULTS

59/125 programs responded to our query, 10 of which provided intake forms. Median l-I score was 2/6 points (range 1-4). l-I guardianship was the most common question asked. No intake form asked for pronouns. Of the 49 institutions without forms, 30.5% reported asking l-I questions during initial visits. Narratives from these institutions varied widely. Some institutions supported routine l-I questions while others stated l-I questions were unnecessary, irrelevant, and/or offensive.

CONCLUSIONS

Few North American pediatric surgery departments consistently ask l-I questions during the intake process. Comments questioning the appropriateness and necessity of l-I questions highlight the need for LGBTQ+ education.

LEVEL OF EVIDENCE

Level III.

TYPE OF STUDY

Cross sectional study.

Methods of attempted suicide and risk factors in LGBTQ+ youth

BACKGROUND

This study aimed to identify patterns of attempted suicide methods and risk factors in lesbian, gay, bisexual, transgender, queer and other gender/sexual minority (LGBTQ+) youth by comparing them to non-LGBTQ+ youth.

METHODS

A total of 9281 Chinese college students completed the study, 8313 participants were included in the analysis of which 1032 were LGBTQ+ youth and 7281 were non-LGBTQ+ youth. Sociodemographic information was collected along with several scales and self-report items. This included anxiety scores using the Generalized Anxiety Disorder (GAD)-7, depression scores using the Patient Health Questionnaire (PHQ)-9, mania score using the Altman Self-Rating Mania (ASRM), Childhood Trauma Questionnaire (CTQ), and Intimate Partner Violence (IPV) victimization using the World Health Organization's definition. Self-report items were used to further collect history of non-fatal self-injurious behaviors, parents' related risk factors, history of suicide attempts, and methods of attempted suicide.

RESULTS

The prevalence of attempted suicide in LGBTQ+ youth was 4.2%, which in comparison was more than four times higher than non-LGBTQ+ youth. LGBTQ+ youth 19-22 years old were at a significantly higher risk of attempting suicide than non-LGBTQ+ youth. The most common method of attempted suicide was cutting of the wrist, followed by jumping from a high height. There were some common suicide risk factors that were similar between LGBTQ+ and non-LGBTQ+ youth, such as living in a rural area, having a history of a psychiatric disorder, and having a history of non-fatal self-injurious behaviors. The associated increased risk factors for LGBTQ+ youth were having a higher score for CTQ-emotional abuse and CTQ-sexual abuse.

LIMITATION

The causality of risk factors to attempted suicide cannot be assumed due to the cross-sectional nature of the survey. Also, due to the relatively small sample size within the subgroups, we did not assess LGBTQ+ youth separately according to the different sexuality groups.

CONCLUSION

LGBTQ+ youth showed a higher prevalence of attempted suicide when compared to their heterosexual peers. Emotional and sexual abuse showed higher rates among LGBTQ+ youth, the cumulative effects of childhood trauma might explain the difficulties in developing healthy coping styles.

Feasibility of Using Child Maltreatment Measurement Instruments in the Primary Care Setting: A Systematic Review

PROBLEM

Child maltreatment is a devastating epidemic affecting millions of children and adolescents in the United States (U.S.) every year. Primary care providers (PCPs) encounter these victims but need resources to aid in the recognition of maltreatment. The purpose of this review is to evaluate child maltreatment measurement instruments and determine feasibility of use by U.S. PCPs.

ELIGIBILITY CRITERIA

A systematic search was conducted in the PubMed, CINAHL, and PsycInfo databases from 2014 until 2020. Eligibility criteria included articles conducted in the U.S., with use of a child maltreatment measurement instrument, and subjects less than 18 years old. Eligible articles were reference searched to find the original studies for each instrument and were included if they were published in a peer-reviewed paper, could be located, and addressed the development or validation of the instrument.

SAMPLE

Of the 3816 articles, 111 used a child maltreatment measurement instrument. Sixteen of the 27 identified instruments were evaluated for feasibility using a quality rating with criteria including psychometrics, construct measurement, administration, availability, and cost.

RESULTS

Six instruments were recommended for use by PCPs.

CONCLUSIONS

This is the first review evaluating the use of child maltreatment measurement instruments by PCPs and it highlights the combination of psychometric evaluation and other pertinent feasibility criteria to recommend several instruments for use by PCPs.

IMPLICATIONS

Use of these instruments by PCPs may serve to identify children and families who are at risk for or suffering from maltreatment.

Suicidality Among Psychiatrically Hospitalized Lesbian, Gay, Bisexual, Transgender, Queer, and/or Questioning Youth: Risk and Protective Factors

Purpose: The study purpose was to compare suicide risk between lesbian, gay, bisexual, transgender, queer, and/or questioning (LGBTQ) and non-LGBTQ adolescents in a psychiatric hospital. Methods: Data were obtained from self-report measures completed by patients 12-17 years of age (n = 334) in a Midwestern psychiatric hospital from 2016 to 2017. Factors analyzed included sexual orientation, gender identity, suicidality, depression, nonsuicidal self-injury, abuse, substance use, bullying, perceived discrimination, and adult support. Results: Nearly one-third of patients identified as LGBTQ. A lifetime suicide attempt was reported by 69.6% of LGBTQ patients compared with 43.6% of non-LGBTQ patients. However, the prevalence of suicide attempts among LGBTQ patients with high adult support did not differ from that of non-LGBTQ patients. In the full logistic regression model adjusting for 13 factors, the adjusted odds ratio of a suicide attempt was 5.25 among transgender/questioning patients and 2.41 among nontransgender lesbian, gay, bisexual, queer, or questioning patients. All risk factors, apart from substance use, were more prevalent among LGBTQ than non-LGBTQ patients (p < 0.005). Among LGBTQ patients of color (Black/Latinx/Other), 91.3% had a lifetime suicide attempt versus 62.3% of White LGBTQ patients (p = 0.009). Conclusion: LGBTQ patients overall, and LGBTQ patients of color in particular, had higher rates of suicide attempts than non-LGBTQ patients. LGBTQ patients also had a higher prevalence of risk factors for suicide; however, the study variables did not fully explain the higher prevalence of suicide attempts. Future research should further examine possible risk factors for suicide among LGBTQ youth, such as stigma and discrimination.

Towards an integrative self: a digital photo elicitation study of resilience among key marginalized populations of sexual and gender minority youth

Purpose: Sexual and gender minority youth (SGMY) experience unique challenges related to identity and disclosure, and cope in vibrant ways. Qualitative research has not yet fulsomely explored the risk, resilience, and identity intersections that impact vulnerable SGMY wellbeing. Methods: This digital photo-elicitation study (QueerView) recruited thirty SGMY (aged 14–29) from priority populations that had one or more of the following experiences:  trans and gender diverse, homelessness, child welfare, and immigration. From submission of fifteen photos representing resilience and a semi-structured interview via web conferencing, constructivist grounded theory was utilized for multimodal analysis of photos, interview video, and interview transcript. Triangulation, an audit trail, and member checking were employed to support trustworthiness. Results: A visual model emerged showing how participants work towards an integrative self, with themes of reflecting and knowing, discrimination and intersectional challenges, connecting, performing, curating, coping, (re)defining and (re)creating, growing and being. Sub-themes of the impact of family dynamic and values, mental health and trauma, and the cathartic benefit from advocacy and leadership offered insight. Participant images were captured in a digital gallery. Conclusions: QueerView animates the complex lives of multiply marginalized SGMY and their intersectional strengths and challenges while demonstrating the utility of a digital multimodal approach.

Early trauma and associations with altruistic attitudes and behaviours among young adults

BACKGROUND

Childhood and adolescent traumas are exceptionally prevalent worldwide. Despite their high prevalence and substantial impact, little research has investigated the rates and specific types of early trauma by gender. It is also unknown whether the types of early trauma are differentially associated with heightened or hindered prosocial attitudes and behaviours.

OBJECTIVE

To address this gap, this study aims to explore the rates of different types of early trauma (i.e., abuse: sexual, physical, and emotional; neglect: physical and emotional) among young Australian adults and investigate whether these differ according to participant gender (female, male and transgender/gender diverse). The study will also examine the associations between the different types of early trauma and current altruistic attitudes and behaviours (including the affective, behavioural and cognitive altruism domains), among a young adult Australian cohort.

METHODS

Cross-sectional data was collected from 511 young Australians aged 18-20 years using an online self-report survey.

RESULTS

Multiple regression analyses revealed that transgender/gender diverse individuals were over 3-times more likely to experience all types of maltreatment than females and over 3-times more likely to experience emotional and sexual abuse and emotional neglect than males. Experiencing one or more trauma types was negatively associated with the cognitive domain of altruism, experiencing physical neglect was associated with the affective domain, and having a family member involved in domestic violence was associated with the behavioural domain, after controlling for gender.

CONCLUSIONS

Findings show how early traumatic experiences can influence individuals' attitudes and behaviours during the pivotal developmental period of young adulthood.

Efficacy of affirmative cognitive behavioural group therapy for sexual and gender minority adolescents and young adults in community settings in Ontario, Canada

OBJECTIVE

This study tested the efficacy of AFFIRM, a brief affirmative cognitive-behavioural group intervention tailored to reduce psychosocial distress and improve coping among sexual and gender minority adolescents and young adults (SGMY).

METHOD

SGMY (n = 138; M age = 22.44) were allocated to immediate 8-week AFFIRM intervention delivered at 12 community-based organisations or an 8-week waitlisted control. At baseline, post-intervention or post-waitlist, participants completed self-reported assessments of depression, hope, coping, and stress appraisal. Implementation outcomes of feasibility and acceptability were also assessed.

RESULTS

Compared to waitlist, SGMY in the intervention condition significantly reduced their depressive symptoms (b = - 5.79, p = .001) as well as increased reports of hope (agency: b = 0.84, p = .001; pathway: b = 0.79, p = .001), and coping by emotional support (b = 0.59, p < .001), instrumental support (b = 0.67, p < .001), positive framing (b = 0.59, p < .001), humour (b = 0.36, p = .014), planning (b = 0.49, p < .001) as well as reflective coping (b = 0.27, p = .009). Intervention participants were also less likely to perceive stress as a threat (b = - 0.43, p = .001), and more likely to perceive stress as challenge (b = 0.67, p < .001) and have the resources to deal with that stress (b = 0.38, p = .016) in comparison to waitlisted control participants. All outcomes had medium to large effect sizes. AFFIRM participants reported low attrition (8.5%) and high levels of engagement and acceptability (e.g. 99% agreed intervention was relevant to their lives). Over 63% of the community organizations that participated in the training hosted AFFIRM at least once during the study.

CONCLUSIONS

Results demonstrate efficacy for the community-based implementation of an affirmative clinical intervention designed for SGMY to address depression and foster coping with universal and minority stressors.

QueerVIEW: Protocol for a Technology-Mediated Qualitative Photo Elicitation Study With Sexual and Gender Minority Youth in Ontario, Canada

BACKGROUND

The experiences of resilience and intersectionality in the lives of contemporary sexual and gender minority youth (SGMY) are important to explore. SGMY face unique experiences of discrimination in both online and offline environments, yet simultaneously build community and seek support in innovative ways. SGMY who identify as transgender, trans, or gender nonconforming and have experiences with child welfare, homelessness, or immigration have been particularly understudied. A qualitative exploration that leverages technology may derive new understanding of the negotiations of risk, resilience, and identity intersections that impact the well-being of vulnerable SGMY.

OBJECTIVE

The objectives of the QueerVIEW study were to (1) enhance understanding of SGMY identities, both online and offline, (2) identify experiences of intersectionality among culturally, regionally, and racially diverse SGMY in Ontario, Canada, (3) explore online and offline sources of resilience for SGMY, and (4) develop and apply a virtual photo elicitation methodological approach.

METHODS

This is the first study to pilot a completely virtual approach to a photo elicitation investigation with youth, including data collection, recruitment, interviewing, and analysis. Recruited through social media, SGMY completed a brief screening survey, submitted 10 to 15 digital photos, and then participated in an individual semistructured interview that focused on their photos and related life experiences. Online data collection methods were employed through encrypted online file transfer and secure online interviews. Data is being analyzed using a constructivist grounded theory approach, with six coders participating in structured online meetings that triangulated photo, video, and textual data.

RESULTS

Data collection with 30 participants has been completed and analyses are underway. SGMY expressed appreciation for the photo elicitation and online design of the study and many reported experiencing an emotional catharsis from participating in this process. It is anticipated that results will form a model of how participants work toward integrating their online and offline experiences and identities into developing a sense of themselves as resilient.

CONCLUSIONS

This protocol presents an innovative, technology-enabled qualitative study that completely digitized a popular arts-based methodology-photo elicitation-that has potential utility for contemporary research with marginalized populations. The research design and triangulated analyses can generate more nuanced conceptualizations of SGMY identities and resilience than more traditional approaches. Considerations for conducting online research may be useful for other qualitative research.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/20547.