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Camp J, Morris A, Wilde H, Smith P, Rimes KA. Gender- and Sexuality-Minoritised Adolescents in DBT: A Reflexive Thematic Analysis of Minority-Specific Treatment Targets and Experience. COGNITIVE BEHAVIOUR THERAPIST 2023; 16:s1754470x23000326. [PMID: 38125010 PMCID: PMC7615396 DOI: 10.1017/s1754470x23000326] [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: 12/23/2023]
Abstract
Gender- and sexuality-minoritised (GSM) adolescents are at increased risk of self-harm and suicidal behaviours compared to their cisgender and heterosexual peers. This increased risk is thought to be explained in part by exposure to stigma and societal oppression. Dialectical Behaviour Therapy (DBT) is an evidence-based intervention for self-harm and suicidal behaviour that may have advantages for supporting GSM young people in distress. No study has yet sought to understand what GSM-associated difficulties may be important to consider in DBT for adolescents, or the experiences of GSM young people in a standard DBT programme. Therefore, this study aimed to understand the experiences of GSM young people in DBT and what difficulties and dilemmas associated with their gender and sexuality diversity were thought by them to be important to target in DBT. Qualitative interviews were conducted with 14 GSM young people in a comprehensive DBT programme and were analysed using Reflexive Thematic Analysis. The analysis was supported by two further GSM young people who had finished DBT. The findings were split into three overarching themes (Identity, Impact of Others, and Space for Sexual and Gender Identity in DBT), each with themes within. The identity-based theme included "identity confusion and acceptance"; the relationship-based themes included "cis-Heterosexism" and "community connectedness"; and the space within DBT themes included "negotiating focus and targeting in DBT" and "creating safety in DBT". Findings are discussed in relation to implications and recommendations for therapists working with GSM young people within and outside of DBT.
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Affiliation(s)
- J Camp
- Department of Psychology, Institute of Psychiatry, Psychology, & Neuroscience, King's College London, London, SE5 8AB
- National & Specialist CAMHS, DBT Service, South London & Maudsley NHS Foundation Trust, Michael Rutter Centre, Maudsley Hospital, London, SE5 8AZ
| | - A Morris
- National & Specialist CAMHS, DBT Service, South London & Maudsley NHS Foundation Trust, Michael Rutter Centre, Maudsley Hospital, London, SE5 8AZ
| | - H Wilde
- National & Specialist CAMHS, DBT Service, South London & Maudsley NHS Foundation Trust, Michael Rutter Centre, Maudsley Hospital, London, SE5 8AZ
| | - P Smith
- Department of Psychology, Institute of Psychiatry, Psychology, & Neuroscience, King's College London, London, SE5 8AB
| | - K A Rimes
- Department of Psychology, Institute of Psychiatry, Psychology, & Neuroscience, King's College London, London, SE5 8AB
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Coyne CA, Yuodsnukis BT, Chen D. Gender Dysphoria: Optimizing Healthcare for Transgender and Gender Diverse Youth with a Multidisciplinary Approach. Neuropsychiatr Dis Treat 2023; 19:479-493. [PMID: 36879947 PMCID: PMC9985385 DOI: 10.2147/ndt.s359979] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 01/20/2023] [Indexed: 03/04/2023] Open
Abstract
Transgender and gender diverse (TGD) youth and their families are seeking medical and mental health care at increasing rates. As the number of multidisciplinary pediatric gender programs expands, we consider the history and evidence base for gender affirmative care and highlight existing models of care that can flexibly accommodate the diverse needs of TGD youth and their families. Comprehensive multidisciplinary care includes both medical and mental health providers who work collaboratively with TGD youth and their caregivers to assess gender-related support needs and facilitate access to developmentally appropriate medical and mental health interventions. In addition to direct health-care services, multidisciplinary care for TGD youth and their families extends into community training, education, community outreach, nonmedical programming, and advocacy for TGD youth.
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Affiliation(s)
- Claire A Coyne
- Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Briahna T Yuodsnukis
- Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Diane Chen
- Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.,Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Madireddy S, Madireddy S. Supportive model for the improvement of mental health and prevention of suicide among LGBTQ+ youth. INTERNATIONAL JOURNAL OF ADOLESCENCE AND YOUTH 2022. [DOI: 10.1080/02673843.2022.2025872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Silva FVD, Jales RD, Pereira IL, Almeida LRD, Nogueira JDA, Almeida SAD. Childhood transgenderity under the perspective of elementary school teachers. Rev Lat Am Enfermagem 2021; 29:e3459. [PMID: 34190949 PMCID: PMC8253356 DOI: 10.1590/1518-8345.3792.3459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 12/13/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE to analyze teachers' conceptions about transgenderity in childhood and to identify the possibilities and limits of working with these children in the school context. METHOD a qualitative research study, carried out with 23 teachers from two municipal elementary schools. Semi-structured interviews were used to produce empirical material. As an analytical resource, the content analysis technique, thematic modality, was used. RESULTS six thematic categories emerged in the set of empirical material: There is transgenderity in childhood; The construction of gender identity and roles in childhood; The experience of trans children in the school context; Trans children: How to deal with?; Discussing the differences in the classroom: Is this the way?; and Dilemmas of school and family interaction. It was found that the gender dichotomy is reinforced in the classroom, causing tensions and stereotyped divisions for male and female roles. Various forms of violence have been reproduced by classmates and teachers, who, due to lack of knowledge or to unpreparedness, reinforce concepts and attitudes that lead to the maintenance of exclusion. CONCLUSION the schools find it difficult to promote the inclusion of trans children. It is necessary to create strategies aimed at raising awareness and training the professionals who make up the school environment, especially teachers in the initial grades.
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Lothwell LE, Libby N, Adelson SL. Mental Health Care for LGBT Youths. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2020; 18:268-276. [PMID: 33162863 PMCID: PMC7587912 DOI: 10.1176/appi.focus.20200018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Lesbian, gay, bisexual, and transgender (LGBT) youths comprise a diverse population with unique developmental experiences and needs. Many experience some form of anti-LGBT stigma. Although most LGBT youths cope well and are free from mental illness, they are at increased risk for a number of psychiatric and other health problems compared with the general population. These problems include depression, anxiety, suicidality, tobacco and substance use, and disordered eating. These disorders are significant sources of morbidity and mortality and are risk factors for other health problems, including HIV and other sexually transmitted infections. Preliminary evidence suggests the same is true for gender dysphoric youths. The minority stress hypothesis holds that exposure to LGBT-specific stigma causes these disparities among LGBT youth. During the past decade, increasing attention has been devoted to developing evidence-based practice guidelines to address the mental health needs of LGBT youths, with an emphasis on core clinical competencies for practitioners working with this population. This review addresses key principles for mental health promotion and care of LGBT youths. Key resources for clinicians and two clinical vignettes are included.
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Affiliation(s)
- Lorraine E Lothwell
- Department of Psychiatry, New York University School of Medicine, New York (Lothwell); Yale Child Study Center, Yale School of Medicine, New Haven, Connecticut (Libby); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, and Department of Psychiatry, Weill Cornell Medical College, New York (Adelson)
| | - Naomi Libby
- Department of Psychiatry, New York University School of Medicine, New York (Lothwell); Yale Child Study Center, Yale School of Medicine, New Haven, Connecticut (Libby); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, and Department of Psychiatry, Weill Cornell Medical College, New York (Adelson)
| | - Stewart L Adelson
- Department of Psychiatry, New York University School of Medicine, New York (Lothwell); Yale Child Study Center, Yale School of Medicine, New Haven, Connecticut (Libby); Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, and Department of Psychiatry, Weill Cornell Medical College, New York (Adelson)
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Bosse JD. Sexual and Gender Identity Development in Young Adults and Implications for Healthcare. CURRENT SEXUAL HEALTH REPORTS 2019. [DOI: 10.1007/s11930-019-00215-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Boos MD, Ginsberg BA, Peebles JK. Prescribing isotretinoin for transgender youth: A pledge for more inclusive care. Pediatr Dermatol 2019; 36:169-171. [PMID: 30318854 DOI: 10.1111/pde.13694] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
As the transgender community has become increasingly visible in public life, a greater awareness of this group's unique health needs and obstacles to optimal medical care has developed. Unfortunately, transgender youth face multiple barriers within the health care system, including access to equitable and gender-affirming care. As dermatologists who care for children and adolescents, we must be aware of the challenges facing transgender youth and work to correct the disparities that exist for this vulnerable group. An initial step in supporting our transgender patients is to advocate for changes to the iPLEDGE system for prescribing isotretinoin (and other Risk Evaluation and Mitigation Strategy systems), specifically requesting a change to its gender-binary categorization model that compromises an individual's right to self-identify. By promoting a gender-neutral patient categorization that is based instead upon reproductive potential, a simple change to the iPLEDGE program allows us to safely treat all of our patients requiring isotretinoin, while preserving our transgender patients' rights to self-determination and self-identification.
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Affiliation(s)
- Markus D Boos
- Division of Dermatology, Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington, USA
| | - Brian A Ginsberg
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Jon Klint Peebles
- Department of Dermatology, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA
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Baams L. Disparities for LGBTQ and Gender Nonconforming Adolescents. Pediatrics 2018; 141:peds.2017-3004. [PMID: 29661940 DOI: 10.1542/peds.2017-3004] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/22/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To identify patterns of childhood adversity in a sample of adolescents and assess disparities in these experiences for lesbian, gay, bisexual, transgender, and questioning adolescents and by level of gender nonconformity. METHOD By using the cross-sectional, statewide, anonymous 2016 Minnesota Student Survey, 81 885 students were included in the current study (50.59% male; mean age = 15.51). Participants were enrolled in grades 9 and 11 in a total of 348 schools. RESULTS Four patterns of childhood adversity were identified with sex-stratified latent class analyses (entropy = 0.833 males; 0.833 females), ranging from relatively low levels of abuse (85.3% males; 80.1% females) to polyvictimization (0.84% males; 1.98% females). A regression analysis showed that compared with heterosexual adolescents, gay, lesbian, bisexual, and questioning adolescents were more likely to be classified into profiles characterized by polyvictimization (odds ratio [OR] 1.81-7.53) and psychological and/or physical abuse (OR 1.29-3.12), than no or low adversity. Similarly, compared with nontransgender adolescents, transgender adolescents were more likely to be classified into profiles characterized by patterns of polyvictimization (OR 1.49-2.91) and psychological and/or physical abuse (OR 1.23-1.96). A higher level of gender nonconformity predicted a higher likelihood of being classified into each adversity profile compared with the no or low adversity profile (OR 1.14-1.45). CONCLUSIONS Sexual minority adolescents and adolescents with high levels of gender nonconformity are vulnerable to experience adversity. The disparities for lesbian, gay, bisexual, transgender, and questioning adolescents and adolescents with high gender nonconformity highlight the variation in patterns of childhood adversity that these youth are at risk of experiencing. The findings reveal the need for further research on the benefits and harm of screening for childhood adversity by physicians and pediatricians.
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Affiliation(s)
- Laura Baams
- Pedagogy and Educational Sciences, University of Groningen, Groningen, Netherlands
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