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Macedo D, McEvoy M, Crowley T, Loughhead M, Procter N. Self-harm and suicidality among trans and gender diverse youth from culturally and linguistically diverse backgrounds-A scoping review. Int J Ment Health Nurs 2024; 33:781-796. [PMID: 38291609 DOI: 10.1111/inm.13291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 12/10/2023] [Accepted: 01/04/2024] [Indexed: 02/01/2024]
Abstract
Rates of suicidality and self-harm are substantial among trans and gender diverse people, particularly among younger groups. The objective of this scoping review is to explore the state of the research conducted on determinants of mental distress, self-harm and suicidality among trans and gender diverse (TGD) youth from culturally and linguistically diverse (CALD) backgrounds. The Joanna Briggs Institute methodology for scoping reviews was used as a methodology guide. Inclusion criteria for study selection comprehended: publications on the intersectionality between gender non-conformity and cultural and linguistic diversity; focus on a young population (≤25 years of age); publications addressing self-harm and/or suicidality. Searches were conducted on eight databases and a public web search engine and yielded 474 results. Publications were screened and selected by two independent reviewers. Thematic analysis was used to identify key themes overarching the findings. The screening process yielded seven peer-reviewed studies and six research reports based on case studies, retrospective qualitative interviews, cross-sectional and longitudinal survey analyses. The key themes approached in the retrieved literature include: (1) precipitating factors for suicidality; (2) pathways contributing to self-harm and suicidality; and 3) barriers and facilitators for accessing services and mental health care. Practical actions to help mitigate suicidality among TGD youth from CALD backgrounds need to consider the impact of trauma and allow for the development of trust in the therapeutic relationship. Shifts in service delivery and policy formulation are necessary to reduce stigmatisation and potentialise the inclusion of different racial, ethnic, cultural, sexual and gender identity expressions in society.
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Affiliation(s)
- Davi Macedo
- Mental Health and Suicide Prevention Research and Education Group, UniSA, Adelaide, South Australia, Australia
| | - Monica McEvoy
- CAMHS CALD Team, Child and Adolescent Mental Health Service, Adelaide, South Australia, Australia
| | - Tim Crowley
- Complex Care and Trauma Mental Health, CAMHS, Adelaide, South Australia, Australia
| | - Mark Loughhead
- Mental Health and Suicide Prevention Research and Education Group, UniSA, Adelaide, South Australia, Australia
| | - Nicholas Procter
- Mental Health and Suicide Prevention Research and Education Group, UniSA, Adelaide, South Australia, Australia
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Steininger J, Knaus S, Kaufmann U, Ott J, Riedl S. Treatment trajectories of gender incongruent Austrian youth seeking gender-affirming hormone therapy. Front Endocrinol (Lausanne) 2024; 15:1258495. [PMID: 38774227 PMCID: PMC11106449 DOI: 10.3389/fendo.2024.1258495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 04/22/2024] [Indexed: 05/24/2024] Open
Abstract
Objective The aim of this study was to describe the treatment trajectories of Austrian children and adolescents with gender incongruence seeking gender-affirming medical care. Methods Patients who presented with gender incongruence at the pediatric outpatient clinic for differences in sex development at a large university hospital in Austria from January 2008 to December 2022 were included in a retrospective chart review, and analyzed regarding referral numbers, patient characteristics, treatment trajectories, fertility preservation, and legal gender marker changes. Results Of 310 eligible patients, 230 (74.2%) were assigned female at birth (AFAB), and 80 (25.8%) were assigned male at birth (AMAB). The number of referrals increased steeply from 2008 to 2018, whereafter it stabilized at around 50 per year. At the time of initial presentation, the median age of patients was 15.6 years (IQR 14.3-16.8). AMAB individuals tended to be younger (median 14.9 years, IQR 13.9-16.8) than AFAB individuals (median 15.8 years, IQR 14.4-16.8; p= 0.012). 207 (66,8%) completed the assessment process and were eligible for gender affirming medical treatment (GAMT). Of those, 89% (186/207) commenced gender affirming hormone therapy in the pediatric outpatient clinic (79/186 received GnRHa monotherapy, 91/186 GnRHa and sex steroids, and 16/186 sex steroid monotherapy). Of the 54 AMAB individuals receiving GAMT, 6 (11.1%) completed fertility preservation prior to therapy initiation. Only 1/132 AFAB adolescents receiving GAMT completed fertility preservation. Chest masculinization surgery was performed in 22 cases (16.7%), and breast augmentation in two cases (3.7%) between the ages of 16 and 18. Changes in legal gender marker were common, with 205 individuals (66.1%) having changed their legal gender marker. Conclusion This is the first time that treatment trajectories, fertility preservation rates, and changes of legal gender marker have been described in Austrian adolescents with gender incongruence seeking GAMT. The majority received GAMT and changed their legal gender marker, while gender affirming surgery rates were low, and utilization of fertility preservation treatment options was rare.
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Affiliation(s)
- Jojo Steininger
- Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
- Division of Gynecological Endocrinology and Reproductive Medicine, Department of Gynecology and Obstetrics, Medical University of Vienna, Vienna, Austria
| | - Sarah Knaus
- Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Ulrike Kaufmann
- Division of Gynecological Endocrinology and Reproductive Medicine, Department of Gynecology and Obstetrics, Medical University of Vienna, Vienna, Austria
| | - Johannes Ott
- Division of Gynecological Endocrinology and Reproductive Medicine, Department of Gynecology and Obstetrics, Medical University of Vienna, Vienna, Austria
| | - Stefan Riedl
- Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
- Department of Pediatrics, St. Anna Kinderspital, Medical University of Vienna, Vienna, Austria
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Ho TF, Zenger B, Mark B, Hiatt L, Sullivan E, Steinberg BA, Lyons A, Spivak AM, Agarwal C, Adelman M, Hotaling J, Kiraly B, Talboys S. Characteristics of a transgender and gender-diverse patient population in Utah: Use of electronic health records to advance clinical and health equity research. PLoS One 2024; 19:e0302895. [PMID: 38713697 PMCID: PMC11075904 DOI: 10.1371/journal.pone.0302895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 04/15/2024] [Indexed: 05/09/2024] Open
Abstract
Transgender and gender-diverse (TGD) people, individuals whose gender identity differs from their sex assigned at birth, face unique challenges in accessing gender-affirming care and often experience disparities in a variety of health outcomes. Clinical research on TGD health is limited by a lack of standardization on how to best identify these individuals. The objective of this retrospective cohort analysis was to accurately identify and describe TGD adults and their use of gender-affirming care from 2003-2023 in a healthcare system in Utah, United States. International Classification of Disease (ICD)-9 and 10 codes and surgical procedure codes, along with sexual orientation and gender identity data were used to develop a dataset of 4,587 TGD adults. During this time frame, 2,985 adults received gender-affirming hormone therapy (GAHT) and/or gender-affirming surgery (GAS) within one healthcare system. There was no significant difference in race or ethnicity between TGD adults who received GAHT and/or GAS compared to TGD adults who did not receive such care. TGD adults who received GAHT and/or GAS were more likely to have commercial insurance coverage, and adults from rural communities were underrepresented. Patients seeking estradiol-based GAHT tended to be older than those seeking testosterone-based GAHT. The first GAS occurred in 2013, and uptake of GAS have doubled since 2018. This study provides a methodology to identify and examine TGD patients in other health systems and offers insights into emerging trends and access to gender-affirming care.
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Affiliation(s)
- Tiffany F. Ho
- Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Brian Zenger
- Department of Internal Medicine, Washington University in St. Louis, St. Louis, Missouri, United States of America
| | - Bayarmaa Mark
- Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Laurel Hiatt
- Department of Human Genetics, Us1niversity of Utah, Salt Lake City, Utah, United States of America
| | - Erika Sullivan
- Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Benjamin A. Steinberg
- Division of Cardiology, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Ann Lyons
- Data Science Services, University of Utah, Salt Lake City, Utah, United States of America
| | - Adam M. Spivak
- Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Cori Agarwal
- Department of Surgery, Division of Plastic Surgery, University of Utah, Salt Lake City, Utah, United States of America
| | - Marisa Adelman
- Department of Obstetrics & Gynecology, University of Utah, Salt Lake City, Utah, United States of America
| | - James Hotaling
- Department of Surgery, Division of Urology, University of Utah, Salt Lake City, Utah, United States of America
| | - Bernadette Kiraly
- Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
| | - Sharon Talboys
- Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah, United States of America
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Li J, Jin Y, Xu S, Wilson A, Chen C, Wang Y. The influence of the severity of gender dysphoria on anxiety, depression, suicidal ideation, and non-suicidal self-injury in Chinese transgender, nonbinary, and gender-diverse youth. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2024; 25:456-470. [PMID: 39055632 PMCID: PMC11268234 DOI: 10.1080/26895269.2023.2273360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
Background: Gender dysphoria (GD) is frequently reported among transgender, nonbinary, and gender-diverse (TNG) populations, and is closely related to anxiety, depression, suicidal ideation, and non-suicidal self-injury (NSSI). This study aimed to understand how GD influences the four mental health disparities among TNG youth, and to compare these outcomes depending on the severity of GD. Methods: 96,218 College students participated in the survey, of which the analysis was run on an extracted sub-set data of 2,315 (2.40%) TNG youth, with a mean age of 19.46 (SD = 1.52). Self-reported inventories measured sociodemographic factors, the severity of GD (Utrecht Gender Dysphoria Scale-Gender Spectrum), anxiety (seven-item Generalized Anxiety Disorder Questionnaire), depression (nine-item Patient Health Questionnaire), suicidal ideation (Suicidal Behaviors Questionnaire-Revised), and NSSI (Clinician-Rated Severity of Non-Suicidal Self-Injury Scale). Binary logistic regression assessed the association between significant GD and the four psychiatric disorders. Adjusted multiple logistic regression, and directed acyclic graph (DAG) analyses were conducted to explore the activating relationship among GD, sociodemographic factors, and psychiatric disorders. Results: 1,582 (68.30%) TNG youth who experienced significant levels of GD (total scores cutoff >= 46) were entered into the analyses. Binary logistic regression displayed significantly positive associations between significant GD and anxiety, depression, suicidal ideation, and NSSI. Multiple regression models showed risk factors included poor relationship with one's father/mother, tobacco smoking, alcohol consumption, and having a lower subjective social status. While family harmony, a higher father's educational level, and partaking in exercise were protective factors that exerted distinct impacts on these four psychiatric disorders. DAG findings showed a poor relationship with one's father with significant GD via other socio-demographic characteristics, activated psychiatric disorders. Conclusions: TNG youth with higher levels of GD also exhibited more severe anxiety, depression, suicidal ideation, and NSSI. Tailored interventions should be provided to prioritize relieving those with severe GD to protect TNG youth from psychiatric outcomes further.
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Affiliation(s)
- Jiaqi Li
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, China; School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, China
| | - Yu Jin
- College of Education for the Future, Beijing Normal University, Beijing, China
| | - Shicun Xu
- Northeast Asian Research Center, Jilin University, Changchun, China
- China Center for Aging Studies and Social-Economic Development, Jilin University, Changchun, China
- Department of Population, Resources, and Environment, Northeast Asian Studies College, Jilin University, Changchun, China
| | - Amanda Wilson
- Division of Psychology, Faculty of Health and Life Sciences, De Montfort University, Leicester, UK
| | - Chang Chen
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, China; School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, China
| | - Yuanyuan Wang
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, China; School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, China
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Park JL, Clark CA, Bagshawe M, Kuntz J, Perri A, Deegan A, Marriott B, Rahman A, Graham S, McMorris CA. A comparison of psychiatric inpatient admissions in youth before and during the COVID-19 pandemic. JOURNAL OF THE CANADIAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY = JOURNAL DE L'ACADEMIE CANADIENNE DE PSYCHIATRIE DE L'ENFANT ET DE L'ADOLESCENT 2024; 33:3-17. [PMID: 38449720 PMCID: PMC10914150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 10/10/2023] [Indexed: 03/08/2024]
Abstract
Background The current understanding of the effect of COVID-19 on child and youth admissions to psychiatric inpatient units over time is limited, with conflicting findings and many studies focusing on the initial wave of the pandemic. Objectives This study identified changes in psychiatric inpatient admissions, and reasons for admission, including suicidality and self-harm, before and during the COVID-19 pandemic. Method This time series study analyzed 3,723 admissions of youth (ages 0-18.88 years) admitted to four major psychiatry inpatient units in a large Canadian city between January 1st, 2016 and December 31st, 2021. Pre-pandemic (before March 11, 2020) and during-pandemic (after March 11, 2020) trends of admissions were explored using a Bayesian structural time series model (BSTS). Results The model revealed that overall admissions during the pandemic period exceeded what would have been predicted in the absence of a pandemic, a relative increase of 29%. Additionally, a rise in the total number of admissions due to self-harm and suicidality (29% increase), externalizing/behavioral issues (69% increase), and internalizing/emotional issues (28% increase) provided strong evidence of increased admissions compared to what might have been expected from pre-pandemic numbers. Conclusions There was strong evidence of increases in psychiatric inpatient admissions during the COVID-19 pandemic compared to expected trends based on pre-pandemic data. To ensure accessible and continuous mental health supports and services for youth and their families during future pandemics, these findings highlight the need for rapid expanse of inpatient mental health services, similar to what occurred in many intensive care units across Canada.
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Affiliation(s)
- Joanne L Park
- Department of Psychology, University of Calgary, Calgary, Alberta
- Alberta Children's Hospital Research Institute, Calgary, Alberta
| | - Chris A Clark
- Werklund School of Education, University of Calgary, Calgary, Alberta
| | - Mercedes Bagshawe
- Werklund School of Education, University of Calgary, Calgary, Alberta
- Owerko Centre, Alberta Children's Hospital Research Institute, Calgary, Alberta
| | - Jennifer Kuntz
- Child and Adolescent Addiction, Mental Health and Psychiatry Program, Alberta Health Services (AHS), Calgary, Alberta
| | - Andrea Perri
- Child and Adolescent Addiction, Mental Health and Psychiatry Program, Alberta Health Services (AHS), Calgary, Alberta
| | - Avril Deegan
- Child and Adolescent Addiction, Mental Health and Psychiatry Program, Alberta Health Services (AHS), Calgary, Alberta
| | - Brian Marriott
- Child and Adolescent Addiction, Mental Health and Psychiatry Program, Alberta Health Services (AHS), Calgary, Alberta
| | - Abdul Rahman
- Child and Adolescent Addiction, Mental Health and Psychiatry Program, Alberta Health Services (AHS), Calgary, Alberta
| | - Susan Graham
- Department of Psychology, University of Calgary, Calgary, Alberta
- Owerko Centre, Alberta Children's Hospital Research Institute, Calgary, Alberta
| | - Carly A McMorris
- Werklund School of Education, University of Calgary, Calgary, Alberta
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Bullock Morse A, Emerson ND, Bursch B. Gender-Affirming Care Recommendations for Health Providers Treating Gender Diverse Adolescents and Young Adults with Cancer. J Adolesc Young Adult Oncol 2023; 12:795-798. [PMID: 36880958 DOI: 10.1089/jayao.2022.0171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Affiliation(s)
- Amy Bullock Morse
- MemorialCare Miller Children's and Women's Hospital Long Beach, Long Beach, California, USA
| | - Natacha D Emerson
- Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Brenda Bursch
- Psychiatry and Biobehavioral Sciences and Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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Shah NR, Cockrell HC, Keller NE, Diaz-Miron J, Meckmongkol TT, Yu P, Englum B, Richards MK, Martin K. Debunking Myths of Gender Informed Care: What Every Pediatric Surgeon Should Know. J Pediatr Surg 2023; 58:2286-2293. [PMID: 37690870 DOI: 10.1016/j.jpedsurg.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/09/2023] [Accepted: 08/13/2023] [Indexed: 09/12/2023]
Abstract
As the transgender population in the United States grows, gender-affirming care is becoming increasingly relevant to the practice of pediatric surgery. Medical care for the transgender and gender diverse population is a politically charged topic with significant complexity and opportunities for clarification. It is important for providers to better understand this population's unique health and social needs. This review aims to debunk long-standing myths regarding gender-affirming care and highlight the current therapeutic and legislative landscapes within the scope of pediatric surgical practice. LEVEL OF EVIDENCE: IV.
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Affiliation(s)
- Nikhil R Shah
- Section of Pediatric Surgery, University of Michigan, Ann Arbor, MI, USA.
| | - Hannah C Cockrell
- Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, Seattle, WA, USA
| | - Noah E Keller
- Department of Pediatric Surgery, Roseville Medical Center, Roseville, CA, USA
| | - Jose Diaz-Miron
- Division of Pediatric Surgery, Children's Hospital Colorado, Aurora, CO, USA
| | - Teerin T Meckmongkol
- Division of Pediatric Surgery, Nemours Children's Health Orlando, Orlando, FL, USA
| | - Peter Yu
- Division of General and Thoracic Surgery, Children's Hospital of Orange County, Orange CA, USA
| | - Brian Englum
- Division of Pediatric Surgery, University of Maryland Children's Hospital, Baltimore, MD, USA
| | - Morgan K Richards
- Division of Pediatric Surgery, St. Luke's Children's Hospital, Boise, ID, USA
| | - Kathryn Martin
- Maria Fareri Children's Hospital, Westchester Medical Center, Valhalla, NY, USA
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Cossu G, Vecchio A, Orlandi M, Casini E, Borgatti R, Mensi MM. Multiphasic Personality Assessment in a Case Series of Adolescent Patients with Suicidal Ideation and/or Attempts. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1794. [PMID: 38002885 PMCID: PMC10670834 DOI: 10.3390/children10111794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 11/03/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023]
Abstract
Suicide is an important public health issue. To examine the differences in personality characteristics between a group of adolescents with suicidal ideation (SI) and a group with a history of suicidal attempts (SA), we conducted a cross-sectional study. We enrolled 55 adolescents (51 females; 12-18 y.o.) who presented SI and/or SA. Using the Columbia Suicide Severity Rating Scale, we divided the sample into two groups: adolescents with SI and adolescents with SA. All participants filled in the Minnesota Multiphasic Personality Inventory-Adolescent (MMPI-A). Adolescents in the SA group had greater difficulties in social relations, risky behaviors, and more intense suicidal ideation compared to those in the SI group. Adolescents in the SA group scored higher in Omission, in the Lie Scale, the Conduct Problem Scale, the Less Aspirations Scale, the Repression Scale in the MMPI-A, and item 283 of the MAST compared to the other group. The results suggest that using the MMPI-A to assess certain features (e.g., tendency to lie, repression) may be helpful in identifying young people who are at high risk of suicide. However, further research is required to determine the effectiveness of using this instrument.
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Affiliation(s)
- Giulia Cossu
- Department of Brain and Behavioural Sciences, University of Pavia, 27100 Pavia, Italy
| | - Arianna Vecchio
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, 27100 Pavia, Italy
| | - Marika Orlandi
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, 27100 Pavia, Italy
| | - Erica Casini
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, 27100 Pavia, Italy
| | - Renato Borgatti
- Department of Brain and Behavioural Sciences, University of Pavia, 27100 Pavia, Italy
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, 27100 Pavia, Italy
| | - Martina Maria Mensi
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, 27100 Pavia, Italy
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Marconi E, Monti L, Marfoli A, Kotzalidis GD, Janiri D, Cianfriglia C, Moriconi F, Costa S, Veredice C, Sani G, Chieffo DPR. A systematic review on gender dysphoria in adolescents and young adults: focus on suicidal and self-harming ideation and behaviours. Child Adolesc Psychiatry Ment Health 2023; 17:110. [PMID: 37735422 PMCID: PMC10515052 DOI: 10.1186/s13034-023-00654-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 08/30/2023] [Indexed: 09/23/2023] Open
Abstract
INTRODUCTION Gender dysphoria (GD) is characterized by the incongruence between one's experienced and expressed gender and assigned-sex-at-birth; it is associated with clinically significant distress. In recent years, the number of young patients diagnosed with GD has increased considerably. Recent studies reported that GD adolescents present behavioural and emotional problems and internalizing problems. Furthermore, this population shows a prevalence of psychiatric symptoms, like depression and anxiety. Several studies showed high rates of suicidal and non-suicidal self-injurious thoughts and behaviour in GD adolescents. To increase understanding of overall mental health status and potential risks of young people with GD, this systematic review focused on risk of suicide and self-harm gestures. METHODS We followed the PRISMA 2020 statement, collecting empirical studies from four electronic databases, i.e., PubMed, Scopus, PsycINFO, and Web of Science. RESULTS Twenty-one studies on GD and gender nonconforming identity, suicidality, and self-harm in adolescents and young adults met inclusion criteria. Results showed that GD adolescents have more suicidal ideation, life-threatening behaviour, self-injurious thoughts or self-harm than their cisgender peers. Assessment methods were heterogeneous. CONCLUSION A standardised assessment is needed. Understanding the mental health status of transgender young people could help develop and provide effective clinical pathways and interventions.
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Affiliation(s)
- Elisa Marconi
- Clinical Psychology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 1, 00168, Rome, Italy.
| | - Laura Monti
- Clinical Psychology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 1, 00168, Rome, Italy
| | - Angelica Marfoli
- Catholic University of the Sacred Heart-Rome, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Georgios D Kotzalidis
- NESMOS Department (Neurosciences, Mental Health, and Sensory Organs), University of Rome "La Sapienza", Via Di Grottarossa1035-1039, 00198, Rome, Italy
- Department of Psychiatry, Department of Neuroscience, Head, Neck and Thorax, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 1, 00168, Rome, Italy
- Institute of Psychiatry, Department of Neuroscience, Catholic University of the Sacred Heart-Rome, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Delfina Janiri
- Department of Psychiatry, Department of Neuroscience, Head, Neck and Thorax, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 1, 00168, Rome, Italy
- Institute of Psychiatry, Department of Neuroscience, Catholic University of the Sacred Heart-Rome, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Cecilia Cianfriglia
- Catholic University of the Sacred Heart-Rome, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Federica Moriconi
- Clinical Psychology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 1, 00168, Rome, Italy
| | - Stefano Costa
- UOSD Operative Unit Psychiatry and Psychotherapy for Adolescents, Azienda USL Di Bologna, Ospedale MaggioreLargo Bartolo Nigrisoli, 2, 40133, Bologna, Italy
| | - Chiara Veredice
- Pediatric Neuropsychiatry Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168, Rome, Italy
| | - Gabriele Sani
- Department of Psychiatry, Department of Neuroscience, Head, Neck and Thorax, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 1, 00168, Rome, Italy
- Institute of Psychiatry, Department of Neuroscience, Catholic University of the Sacred Heart-Rome, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Daniela Pia Rosaria Chieffo
- Clinical Psychology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 1, 00168, Rome, Italy
- Departement of Life Sciences and Public Health Department, Catholic University of Sacred Heart, 00168, Rome, Italy
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Pampati S, Dana Flanders W, Zhang Q, Ahmedani BK, Bhasin S, Getahun D, Lash TL, McCracken C, Sandberg DE, Silverberg MJ, Tangpricha V, Vupputuri S, Goodman M. Prevalence of self-inflicted injuries among transgender and gender diverse adolescents and young adults compared to their peers: an examination of interaction with mental health morbidity. Ann Epidemiol 2023; 81:40-46.e2. [PMID: 36907519 PMCID: PMC10424574 DOI: 10.1016/j.annepidem.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 03/06/2023] [Accepted: 03/06/2023] [Indexed: 03/13/2023]
Abstract
PURPOSE Compare occurrence of self-inflicted injuries among transgender and gender diverse (TGD) youth to that of their cisgender peers while accounting for mental health diagnoses. METHODS Review of electronic health records from three integrated health care systems identified 1087 transfeminine and 1431 transmasculine adolescents and young adults. Poisson regression was used to calculate prevalence ratios comparing the proportion of TGD participants with at least one self-inflicted injury (a surrogate for suicide attempt) before index date (first evidence of TGD status) to the corresponding proportions in presumed cisgender male and female referents matched on age, race/ethnicity, and health plan. Interactions between gender identities and mental health diagnoses were assessed on multiplicative and additive scales. RESULTS TGD adolescents and young adults were more likely to have a self-inflicted injury, various mental health diagnoses, and multiple mental health diagnoses than their cisgender peers. The prevalence of self-inflicted injuries among TGD adolescents and young adults was high even in the absence of mental health diagnoses. Results were consistent with positive additive interaction and negative multiplicative interaction. CONCLUSIONS Universal suicide prevention efforts for all youth, including those with no mental health diagnoses, and more intensive suicide prevention efforts for TGD adolescents and young adults and those with at least one mental health diagnosis are warranted.
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Affiliation(s)
- Sanjana Pampati
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA.
| | - W Dana Flanders
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Qi Zhang
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Brian K Ahmedani
- Center for Health Policy & Health Services Research, Henry Ford Health System, Detroit, MI
| | - Shalender Bhasin
- Brigham and Women's Hospital, Boston, MA; Harvard School of Medicine, Boston, MA
| | - Darios Getahun
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena; Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA
| | - Timothy L Lash
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | | | - David E Sandberg
- Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan Medical School, Ann Arbor
| | | | - Vin Tangpricha
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University, School of Medicine, Atlanta, GA; The Atlanta VA Medical Center, Atlanta, GA
| | - Suma Vupputuri
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlanta States, Rockville, MD
| | - Michael Goodman
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
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Zheng W, Gao L, Fan Y, Wang C, Liu Y, Tian F, Yi M, Peng X, Liu C. Identification of risk factors for attempted suicide by self-poisoning and a nomogram to predict self-poisoning suicide. Front Public Health 2023; 11:1106454. [PMID: 36969682 PMCID: PMC10031109 DOI: 10.3389/fpubh.2023.1106454] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 02/16/2023] [Indexed: 03/11/2023] Open
Abstract
PurposeSuicide is a global concern, especially among young people. Suicide prediction models have the potential to make it easier to identify patients who are at a high risk of suicide, but they have very little predictive power when there is a positive value for suicide mortality. Therefore, the aim of the study is to uncover potential risk factors associated with suicide by self-poisoning and further to provide a trustworthy nomogram to predict self-poisoning suicide among poisoned patients.MethodsThis study prospectively enrolled 237 patients who were treated for poisoning at the Fifth Medical Center of PLA General Hospital (Beijing) between May 2021 and May 2022. Patient's basic characteristics, daily activities, mental health status, and history of psychological illnesses were gathered to examine their predictive power for self-poisoning suicide. On developing a prediction model, patients were split 8:2 into a training (n = 196) group and a validation (n = 41) group at random via computer. The training group worked on model development, while the validation group worked on model validation. In this study, the Hosmer and Lemeshow test, accuracy, and area under the curve were the primary evaluation criteria. Shapley Additive exPlanations (SHAP) was determined to evaluate feature importance. To make the prediction model easy for researchers to utilize, it was presented in nomogram format. Two risk groups of patients were identified based on the ideal cut-off value.ResultsOf all poisoned patients, 64.6% committed suicide by self-poisoning. With regard to self-poisoning attempted suicide, multivariate analysis demonstrated that female gender, smoking, generalized anxiety disorder-7 (GAD-7), and beck hopelessness scale-20 (BHS-20) were significant risk factors, whereas married status, relatively higher education level, a sedentary time of 1–3 h per day, higher sport frequency per week, higher monthly income were significant protective features. The nomogram contained each of the aforementioned nine features. In the training group, the area under curve (AUC) of the nomogram was up to 0.938 (0.904–0.972), whereas in the validation group, it reached a maximum of 0.974 (0.937–1.000). Corresponding accuracy rates were up to 0.883 and 0.927, respectively, and the P-values for the Hosmer and Lemeshow test were 0.178 and 0.346, respectively. SHAP demonstrated that the top three most important features were BHS-20, GAD-7, and marital status. Based on the best cut-off value of the nomogram (40%), patients in the high-risk group had a nearly six-time larger likelihood of committing suicide by self-poisoning than patients in the low-risk group (88.68 vs. 15.38%, P < 0.001). The dynamic nomogram was made available at the following address: https://xiaobo.shinyapps.io/Nomogramselfpoisoningsuicide/.ConclusionsThis study proposes a prediction model to stratify patients at a high risk of suicide by self-poisoning and to guide individual preventive strategies. Patients in the high-risk group require further mental health counseling to alleviate anxiety and hopelessness, healthy lifestyle like quitting smoking and exercising more, and restriction of access to poison and psychiatric drugs.
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Affiliation(s)
- Wenjing Zheng
- Department of Chemical Poisoning Treatment, Senior Department of Hematology, The Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Le Gao
- Department of Oncology, Senior Department of Oncology, The Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Yanna Fan
- Department of Radiation Oncology, Senior Department of Oncology, The Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Chunyan Wang
- Department of Chemical Poisoning Treatment, Senior Department of Hematology, The Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Yanqing Liu
- Department of Chemical Poisoning Treatment, Senior Department of Hematology, The Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Fei Tian
- Department of Chemical Poisoning Treatment, Senior Department of Hematology, The Fifth Medical Center of PLA General Hospital, Beijing, China
| | - Min Yi
- Institute of Medical Information and Library, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaobo Peng
- Department of Chemical Poisoning Treatment, Senior Department of Hematology, The Fifth Medical Center of PLA General Hospital, Beijing, China
- *Correspondence: Xiaobo Peng
| | - Chunzi Liu
- Senior Department of Oncology, The Fifth Medical Center of PLA General Hospital, Beijing, China
- Chunzi Liu
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