1
|
Alves Rodrigues C, Marguilho M, Ferreira B, Nascimento S, Nascimento M, Cardoso S, Silva M, Pablo AC, Soares C, Fernandes C, Gonçalves M. Gender Dysphoria: Concepts, Diagnosis and Clinical Management. ACTA MEDICA PORT 2024; 37:379-385. [PMID: 38577868 DOI: 10.20344/amp.21057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 03/04/2024] [Indexed: 04/06/2024]
Abstract
Gender dysphoria is defined as a condition characterized by mental suffering associated with the incongruence between one's experienced gender and their birth-assigned sex. Gender as a construct and gender dysphoria as a condition in need of multidisciplinary intervention have developed as swiftly as their visibility in society, making it mandatory to promote the literacy and education of all healthcare professionals in this area. This article aims to review information based on scientific evidence on people with gender dysphoria and its clinical approach, while contributing to a safe, inclusive, and non-discriminatory practice of healthcare.
Collapse
Affiliation(s)
- Carolina Alves Rodrigues
- Consulta de Sexologia. Hospital Júlio de Matos. Unidade Local de Saúde São José. Lisboa. Portugal
| | - Miriam Marguilho
- Consulta de Sexologia. Hospital Júlio de Matos. Unidade Local de Saúde São José. Lisboa. Portugal
| | - Bárbara Ferreira
- Consulta de Sexologia. Hospital Júlio de Matos. Unidade Local de Saúde São José. Lisboa. Portugal
| | - Sandra Nascimento
- Consulta de Sexologia. Hospital Júlio de Matos. Unidade Local de Saúde São José. Lisboa. Portugal
| | - Miguel Nascimento
- Consulta de Sexologia. Hospital Júlio de Matos. Unidade Local de Saúde São José. Lisboa. Portugal
| | - Sónia Cardoso
- Consulta de Sexologia. Hospital Júlio de Matos. Unidade Local de Saúde São José. Lisboa. Portugal
| | - Mariana Silva
- Serviço de Psiquiatria de Ligação. Hospital São José. Unidade Local de Saúde São José. Lisboa. Portugal
| | - Ana Cristina Pablo
- Consulta de Sexologia. Hospital Júlio de Matos. Unidade Local de Saúde São José. Lisboa. Portugal
| | - Catarina Soares
- Consulta de Sexologia. Hospital Júlio de Matos. Unidade Local de Saúde São José. Lisboa. Portugal
| | - Carlos Fernandes
- Consulta de Sexologia. Hospital Júlio de Matos. Unidade Local de Saúde São José. Lisboa. Portugal
| | - Marco Gonçalves
- Consulta de Sexologia. Hospital Júlio de Matos. Unidade Local de Saúde São José. Lisboa. Portugal
| |
Collapse
|
2
|
Miller GH, Marquez-Velarde G, Suárez MI, Glass C. Support Saves Lives: Exploring the Relationship Between Age of Transition, Family Support, and Retrospective K-12 Educational Experiences in Transgender Suicidality. Transgend Health 2024; 9:118-127. [PMID: 38585247 PMCID: PMC10998011 DOI: 10.1089/trgh.2022.0073] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Purpose The purpose of this study is to test the association between protective and risk factors, including age of transition, K-12 experiences, and family support, on suicidality among transgender and gender nonbinary/gender queer (TNB) adults. Methods Our analysis relies on data from the 2015 United States Transgender Survey. We used separate logistic regression models to predict lifetime suicidal ideation and suicide attempt among 19,121 survey respondents. Results Negative K-12 experiences significantly predict higher likelihood of both suicidal ideation and suicide attempt for transgender people, regardless of age of transition, and after controlling for a host of covariates. The age a transgender person begins to live full time in a gender different from the one assigned at birth has little association with suicidality. However, supportive families act as a buffer against suicidal ideation, and unsupportive families significantly predict higher likelihood of suicide attempt for transgender people when controlling for numerous covariates. Conclusion Our findings underscore the importance of supportive environments for TNB adolescents. Interventions that strengthen interpersonal relationships and local environments will reduce suicidality among TNB youth. Importantly, recent anti-trans legislation may interfere with the ability of teachers and families to provide needed supports and will likely have deleterious effects on the mental health of TNB individuals.
Collapse
Affiliation(s)
- Gabe H. Miller
- Department of Sociology and African American Studies Program, Mississippi State University, Mississippi State, Mississippi, USA
- Department of Sociology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Mario I. Suárez
- Department of School of Teacher Education and Leadership, Utah State University, Logan, Utah, USA
| | - Christy Glass
- Department of Sociology and Anthropology, Utah State University, Logan, Utah, USA
| |
Collapse
|
3
|
Stoody VB, Glick HR, Murphey AC, Sturza JM, Selkie EM. A Content Analysis of Transgender Health and Wellness Themes Shared Through Social Media. Clin Pediatr (Phila) 2023:99228231219499. [PMID: 38135918 DOI: 10.1177/00099228231219499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2023]
Abstract
Transgender and gender-diverse (TGD) adolescents experience limited access to gender-affirming care (GAC) and information and use social media platforms for informational and social support. We conducted conventional content analysis of posts on the platform, Tumblr and applied univariate statistics to characterize health and wellness themes represented by this content. Content was predominantly transmasculine-relevant. Posts addressing the trans health care paradigm often co-occurred with content referencing affirmation logs, the physical and emotional impact of affirmation, surgery, and unspecified medical interventions. Gender-affirming hormone therapy was the most prevalent intervention referenced in posts related to non-professional/non-licensed medical care and advice requests. Transgender and gender-diverse youth-serving individuals can use this information to mitigate harm, enhance patient education, and improve the overall well-being of TGD youth. Further research is needed to characterize the effect of content encountered on social media on pediatric patient experiences and on outcomes of GAC.
Collapse
Affiliation(s)
- Vishvanie B Stoody
- Division of Adolescent Medicine, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Hannah R Glick
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - Annie C Murphey
- Section of Emergency Medicine, The University of Chicago, Chicago, IL, USA
| | - Julie M Sturza
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - Ellen M Selkie
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| |
Collapse
|
4
|
Roden RC, Billman MG, Mullin R, Francesco A, Essayli JH. Rural Location of Residence is Not Associated With Use of Telemedicine for Initial Medical Contact for Gender-Related Healthcare. J Adolesc Health 2023; 73:940-945. [PMID: 37610385 DOI: 10.1016/j.jadohealth.2023.06.027] [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: 12/01/2022] [Revised: 06/23/2023] [Accepted: 06/26/2023] [Indexed: 08/24/2023]
Abstract
PURPOSE There is very little information available regarding the health needs of transgender and gender diverse adolescents and young adults with gender dysphoria who reside in rural areas of the United States. This study aims to determine if residing in a rural area is associated with the use of telemedicine services, such as synchronous voice-video appointments, for initial contact for medical interventions for gender-related reasons in adolescents and young adults with gender incongruence. METHODS This study is a retrospective chart review of patients (N = 176) ages 10-24 years who had an initial medical appointment for gender-related concerns between July 1, 2020 and June 30, 2022. Participants were determined to be rural or not based on address eligibility for rural-related health care services by the Centers for Medicare and Medicaid Services Rural Health Clinics Program or the Federal Office of Rural Health Policy grant programs. The use of telemedicine versus in-person appointments were compared, as were initial medical prescriptions (hormones, psychotropic medications, contraceptives, etc.) and recommendations for medical follow-ups made at this initial appointment. RESULTS Most participants did not reside in a rural location (N = 130). There was no statistically significant difference in the use of telemedicine versus in-person care in rural patients (22% vs. 78%) as compared to nonrural patients (21% vs. 79%), nor any statistically significant differences in the medical decisions made at the initial appointment with respect to rurality or modality of care. DISCUSSION Residing in a rural area is not associated with either choice of in-person care versus telemedicine services for initial medical appointments or medical decision-making.
Collapse
Affiliation(s)
- Rosemary Claire Roden
- Division of Adolescent Medicine, Department of Pediatrics, Penn State Health Children's Hospital, Hershey, Pennsylvania.
| | - Marley G Billman
- Division of Adolescent Medicine, Department of Pediatrics, Penn State Health Children's Hospital, Hershey, Pennsylvania
| | - Robert Mullin
- Internal Medicine/Pediatrics Residency Program, Department of Pediatrics, Penn State Health Children's Hospital, Hershey, Pennsylvania
| | - Angelea Francesco
- Rehabilitation and Human Services, Penn State University, Abington, Pennsylvania
| | - Jamal H Essayli
- Division of Adolescent Medicine, Department of Pediatrics, Penn State Health Children's Hospital, Hershey, Pennsylvania
| |
Collapse
|
5
|
Ghabrial MA, Scheim AI, Chih C, Santos H, Adams NJ, Bauer GR. Change in Finances, Peer Access, and Mental Health Among Trans and Nonbinary People During the COVID-19 Pandemic. LGBT Health 2023; 10:595-607. [PMID: 37347954 PMCID: PMC10712362 DOI: 10.1089/lgbt.2022.0296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023] Open
Abstract
Purpose: Due to structural transphobia, trans and nonbinary (TNB) individuals were particularly vulnerable to the negative effects of social isolation and financial instability resulting from COVID-19. The present study examined the effect of change in finances and access to TNB peer gatherings on anxiety and depression during the COVID-19 pandemic. Methods: Participants were 18 years and older (mean = 30) and completed prepandemic baseline (Fall 2019) and pandemic follow-up (Fall 2020) surveys. Multivariable regressions examined associations between mental health and change in (1) finances and (2) access to TNB peer gatherings (in person or online). Results: Of 780 participants, 50% reported that the COVID-19 pandemic had a negative impact on personal income and 58.3% reported negative impact on access to TNB peer gatherings. Depression and anxiety symptoms increased from prepandemic to follow-up, and most participants were above measurement cutoffs for clinical levels at both time points. Change in finances and access to TNB peer gatherings interacted with prepandemic depression scores to predict depression symptoms during the COVID-19 pandemic. For participants with high prepandemic depression scores, financial stability predicted pandemic depression scores comparable to that predicted by negative financial change. No interaction was found between these variables when predicting anxiety symptoms during the COVID-19 pandemic. Conclusion: Findings underscore the influence of inequality and prepandemic mental health when considering the impact of COVID-19 on wellbeing. Results suggest need for multifaceted programs and services, including financial support and meaningful TNB community engagement, to address barriers to health equity posed by systematic gender oppression.
Collapse
Affiliation(s)
- Monica A. Ghabrial
- Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Ayden I. Scheim
- Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Caiden Chih
- Mechanical and Industrial Engineering and University of Toronto, Toronto, Ontario, Canada
| | - Heather Santos
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Noah James Adams
- Ontario Institute for Studies in Education, University of Toronto, Toronto, Ontario, Canada
- Center for Applied Transgender Studies, Chicago, Illinois, USA
- Transgender Professional Association for Transgender Health, Canada
| | - Greta R. Bauer
- Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- Institute for Sexual and Gender Health, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| |
Collapse
|
6
|
Steiner A, Farmer J, Kamstra P, Carlisle K, McCosker A, Kilpatrick S. Online Mental Health Forums and Rural Resilience: Mixed Methods Study and Logic Model. JMIR Ment Health 2023; 10:e47459. [PMID: 37379080 PMCID: PMC10365586 DOI: 10.2196/47459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/09/2023] [Accepted: 05/11/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Rural mental health is a growing area of concern internationally, and online mental health forums offer a potential response to addressing service gaps in rural communities. OBJECTIVE The objective of this study was to explore and identify pathways by which online peer support mental health forums help to build resilience for rural residents experiencing mental ill-health by contributing to overcoming their specific contextual challenges. METHODS We developed a Theoretical Resilience Framework and applied it to 3000 qualitative posts from 3 Australian online mental health forums and to data from 30 interviews with rural forum users. RESULTS Drawing on the findings and an abductive approach, a logic model was developed to illustrate links between the resilience resources built and enabling features of forums that make them spaces that facilitate resilience. CONCLUSIONS The study demonstrated that online forums make valuable contributions to social well-being and access to a range of timely support services for rural people experiencing mental ill-health, and, while doing so, involve users in the processes of resilience building. The study provides a new way for practitioners to frame the work of and value produced by forums. It gives a logic model that can be used in evaluation and audit as it facilitates a causal framing of how forums, as an intervention, link with resilience outcomes. Ultimately, the study contributes to developing new knowledge about how rural resilience building can be conceptualized and measured while showing how forums are part of contemporary health service provision in rural places.
Collapse
Affiliation(s)
- Artur Steiner
- Glasgow Caledonian University, Yunus Centre, Glasgow, United Kingdom
| | - Jane Farmer
- Swinburne University of Technology, Centre for Social Impact Swinburne, Melbourne, Australia
| | | | | | - Anthony McCosker
- Swinburne University of Technology, Centre for Social Impact Swinburne, Melbourne, Australia
| | | |
Collapse
|
7
|
Srikummoon P, Oonarom A, Manojai N, Maneeton B, Maneeton N, Wiriyacosol P, Chiawkhun P, Kawilapat S, Homkham N, Traisathit P. Experiences of Being Bullied and the Quality of Life of Transgender Women in Chiang Mai Province, Thailand. Transgend Health 2023; 8:175-187. [PMID: 37013090 PMCID: PMC10066783 DOI: 10.1089/trgh.2021.0068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose The objective of this study is to identify factors associated with depression and the quality of life of Thai transgender women (TGW) from Chiang Mai province, Thailand, who have experienced being bullied. Methods We conducted the study on TGW ≥18 years of age in Chiang Mai province, Thailand, from May to November 2020. Data were collected using self-reporting questionnaires at the MPlus Chiang Mai foundation. Binary logistic regression analysis was used to examine the association between potential factors associated with depression and quality of life. Results Of the 205 TGW individuals who participated in this study with a median age of 24 years, most were students (43.3%), and the most common type of bullying was verbal (30.9%). The prevalence of depression among the TGW participants was 30.1%, although most of the participants had a good overall quality of life (53.4%). The impacts of being physically bullied at primary or secondary school and experiencing cyberbullying at primary school were associated with a higher risk of depression. The impacts of being cyberbullied within the previous 6 months and physically bullied at primary or secondary school were associated with a fair quality of life. Conclusion Our results show that many TGW had experienced bullying in their childhood and within the previous 6 months. Screening for experiences of having been bullied and psychological problems might be advantageous for the wellbeing of TGW, while counseling programs or psychotherapy should be provided for those who have experienced bullying to mitigate depression and improve their quality of life.
Collapse
Affiliation(s)
- Pimwarat Srikummoon
- Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand
- Data Science Research Center, Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand
| | - Awirut Oonarom
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | - Benchalak Maneeton
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Narong Maneeton
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Punjaree Wiriyacosol
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Phisanu Chiawkhun
- Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand
| | - Suttipong Kawilapat
- Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Nontiya Homkham
- Faculty of Public Health, Thammasat University, Pathumthani, Thailand
| | - Patrinee Traisathit
- Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand
- Data Science Research Center, Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand
- Research Center in Bioresources for Agriculture, Industry and Medicine, Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand
| |
Collapse
|
8
|
Coon JJ, Alexander NB, Smith EM, Spellman M, Klimasmith IM, Allen‐Custodio LT, Clarkberg TE, Lynch L, Knutson D, Fountain K, Rivera M, Scherz M, Morrow LK. Best practices for
LGBTQ
+ inclusion during ecological fieldwork: Considering safety, cis/heteronormativity and structural barriers. J Appl Ecol 2023. [DOI: 10.1111/1365-2664.14339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Jaime J. Coon
- Department of Biology Earlham College Richmond Indiana USA
- Department of Environmental Sustainability Earlham College Richmond Indiana USA
| | - Nathan B. Alexander
- Department of Natural Resources and Environmental Sciences University of Illinois at Urbana‐Champaign Urbana Illinois USA
| | | | - Madeleine Spellman
- Department of Biology Earlham College Richmond Indiana USA
- Department of Environmental Sustainability Earlham College Richmond Indiana USA
| | - Isaac M. Klimasmith
- Department of Natural Resources and Environmental Sciences University of Illinois at Urbana‐Champaign Urbana Illinois USA
| | | | | | - Loren Lynch
- Department of Natural Resources and Environmental Sciences University of Illinois at Urbana‐Champaign Urbana Illinois USA
| | - Douglas Knutson
- School of Community Health Sciences, Counseling and Counseling Psychology Oklahoma State University Stillwater Oklahoma USA
| | | | - Michael Rivera
- Program in Ecology, Evolution, and Conservation Biology University of Illinois at Urbana‐Champaign Urbana Illinois USA
| | - Maxine Scherz
- Department of Biology Earlham College Richmond Indiana USA
- Department of Environmental Sustainability Earlham College Richmond Indiana USA
| | - Leslie K. Morrow
- Lesbian, Gay, Bisexual, and Transgender Resource Center University of Illinois at Urbana‐Champaign Urbana Illinois USA
- Department of Education Policy, Organization and Leadership University of Illinois Urbana‐Champaign Urbana Illinois USA
| |
Collapse
|
9
|
Bigelow LB. Mindfulness Meditation Programs Informed by Transgender Youth. Mindfulness (N Y) 2023; 14:128-140. [PMID: 36590761 PMCID: PMC9792306 DOI: 10.1007/s12671-022-02048-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/13/2022] [Indexed: 12/28/2022]
Abstract
Objectives This study explores the openness of transgender and gender diverse youth and young adults (TGDY) to mindfulness meditation programs in order to create culturally informed interventions to benefit this population. Method Two focus groups were conducted with a total of ten TGDY ages 14-24 years old at a transgender youth health center in a large metropolitan city in the USA. A 10-min guided mindfulness meditation was included for participants to experience and voice reactions to. The State-Trait Anxiety Inventory (STAI) was utilized to measure the quantitative impact of the meditation on participants' anxiety and thematic analysis for the qualitative data. Results Reflexive Thematic Analysis on qualitative focus group data revealed the following four themes: Active in Self-care, Silent Meditation Is "Not for Me," Guided Mindfulness Calms and Connects, and Program Ideas for Future. STAI results indicated a statistically significant reduction in anxiety following participation in the group meditation. Conclusions Participants were open to mindfulness as an additional method of self-care, and they emphasized future programs should include sensory stimulation, a pressure-free environment accepting of active minds and bodies, and a transgender instructor if possible. Meditation and mindfulness have the potential to be a very powerful healing modality for TGDY in clinical and therapeutic care. Preregistration This study is not preregistered. Supplementary Information The online version contains supplementary material available at 10.1007/s12671-022-02048-6.
Collapse
Affiliation(s)
- Lou B. Bigelow
- grid.239546.f0000 0001 2153 6013Children’s Hospital Los Angeles, Los Angeles, USA ,grid.462719.f0000 0000 9562 7279Pacifica Graduate Institute, Carpinteria, USA
| |
Collapse
|
10
|
Scott M, Cornelius-White JHD. Mental health and social support experiences of transgender and gender nonconforming adults in rural America: A meta-synthesis. JOURNAL OF GAY & LESBIAN MENTAL HEALTH 2022. [DOI: 10.1080/19359705.2022.2128136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Matt Scott
- Department of Counseling, Leadership, and Special Education, Missouri State University, Springfield, Missouri, USA
| | | |
Collapse
|
11
|
Coleman E, Radix AE, Bouman WP, Brown GR, de Vries ALC, Deutsch MB, Ettner R, Fraser L, Goodman M, Green J, Hancock AB, Johnson TW, Karasic DH, Knudson GA, Leibowitz SF, Meyer-Bahlburg HFL, Monstrey SJ, Motmans J, Nahata L, Nieder TO, Reisner SL, Richards C, Schechter LS, Tangpricha V, Tishelman AC, Van Trotsenburg MAA, Winter S, Ducheny K, Adams NJ, Adrián TM, Allen LR, Azul D, Bagga H, Başar K, Bathory DS, Belinky JJ, Berg DR, Berli JU, Bluebond-Langner RO, Bouman MB, Bowers ML, Brassard PJ, Byrne J, Capitán L, Cargill CJ, Carswell JM, Chang SC, Chelvakumar G, Corneil T, Dalke KB, De Cuypere G, de Vries E, Den Heijer M, Devor AH, Dhejne C, D'Marco A, Edmiston EK, Edwards-Leeper L, Ehrbar R, Ehrensaft D, Eisfeld J, Elaut E, Erickson-Schroth L, Feldman JL, Fisher AD, Garcia MM, Gijs L, Green SE, Hall BP, Hardy TLD, Irwig MS, Jacobs LA, Janssen AC, Johnson K, Klink DT, Kreukels BPC, Kuper LE, Kvach EJ, Malouf MA, Massey R, Mazur T, McLachlan C, Morrison SD, Mosser SW, Neira PM, Nygren U, Oates JM, Obedin-Maliver J, Pagkalos G, Patton J, Phanuphak N, Rachlin K, Reed T, Rider GN, Ristori J, Robbins-Cherry S, Roberts SA, Rodriguez-Wallberg KA, Rosenthal SM, Sabir K, Safer JD, Scheim AI, Seal LJ, Sehoole TJ, Spencer K, St Amand C, Steensma TD, Strang JF, Taylor GB, Tilleman K, T'Sjoen GG, Vala LN, Van Mello NM, Veale JF, Vencill JA, Vincent B, Wesp LM, West MA, Arcelus J. Standards of Care for the Health of Transgender and Gender Diverse People, Version 8. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2022; 23:S1-S259. [PMID: 36238954 PMCID: PMC9553112 DOI: 10.1080/26895269.2022.2100644] [Citation(s) in RCA: 615] [Impact Index Per Article: 307.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Background: Transgender healthcare is a rapidly evolving interdisciplinary field. In the last decade, there has been an unprecedented increase in the number and visibility of transgender and gender diverse (TGD) people seeking support and gender-affirming medical treatment in parallel with a significant rise in the scientific literature in this area. The World Professional Association for Transgender Health (WPATH) is an international, multidisciplinary, professional association whose mission is to promote evidence-based care, education, research, public policy, and respect in transgender health. One of the main functions of WPATH is to promote the highest standards of health care for TGD people through the Standards of Care (SOC). The SOC was initially developed in 1979 and the last version (SOC-7) was published in 2012. In view of the increasing scientific evidence, WPATH commissioned a new version of the Standards of Care, the SOC-8. Aim: The overall goal of SOC-8 is to provide health care professionals (HCPs) with clinical guidance to assist TGD people in accessing safe and effective pathways to achieving lasting personal comfort with their gendered selves with the aim of optimizing their overall physical health, psychological well-being, and self-fulfillment. Methods: The SOC-8 is based on the best available science and expert professional consensus in transgender health. International professionals and stakeholders were selected to serve on the SOC-8 committee. Recommendation statements were developed based on data derived from independent systematic literature reviews, where available, background reviews and expert opinions. Grading of recommendations was based on the available evidence supporting interventions, a discussion of risks and harms, as well as the feasibility and acceptability within different contexts and country settings. Results: A total of 18 chapters were developed as part of the SOC-8. They contain recommendations for health care professionals who provide care and treatment for TGD people. Each of the recommendations is followed by explanatory text with relevant references. General areas related to transgender health are covered in the chapters Terminology, Global Applicability, Population Estimates, and Education. The chapters developed for the diverse population of TGD people include Assessment of Adults, Adolescents, Children, Nonbinary, Eunuchs, and Intersex Individuals, and people living in Institutional Environments. Finally, the chapters related to gender-affirming treatment are Hormone Therapy, Surgery and Postoperative Care, Voice and Communication, Primary Care, Reproductive Health, Sexual Health, and Mental Health. Conclusions: The SOC-8 guidelines are intended to be flexible to meet the diverse health care needs of TGD people globally. While adaptable, they offer standards for promoting optimal health care and guidance for the treatment of people experiencing gender incongruence. As in all previous versions of the SOC, the criteria set forth in this document for gender-affirming medical interventions are clinical guidelines; individual health care professionals and programs may modify these in consultation with the TGD person.
Collapse
Affiliation(s)
- E Coleman
- Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - A E Radix
- Callen-Lorde Community Health Center, New York, NY, USA
- Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - W P Bouman
- Nottingham Centre for Transgender Health, Nottingham, UK
- School of Medicine, University of Nottingham, Nottingham, UK
| | - G R Brown
- James H. Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA
- James H. Quillen VAMC, Johnson City, TN, USA
| | - A L C de Vries
- Department of Child and Adolescent Psychiatry, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - M B Deutsch
- Department of Family & Community Medicine, University of California-San Francisco, San Francisco, CA, USA
- UCSF Gender Affirming Health Program, San Francisco, CA, USA
| | - R Ettner
- New Health Foundation Worldwide, Evanston, IL, USA
- Weiss Memorial Hospital, Chicago, IL, USA
| | - L Fraser
- Independent Practice, San Francisco, CA, USA
| | - M Goodman
- Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - J Green
- Independent Scholar, Vancouver, WA, USA
| | - A B Hancock
- The George Washington University, Washington, DC, USA
| | - T W Johnson
- Department of Anthropology, California State University, Chico, CA, USA
| | - D H Karasic
- University of California San Francisco, San Francisco, CA, USA
- Independent Practice at dankarasic.com
| | - G A Knudson
- University of British Columbia, Vancouver, Canada
- Vancouver Coastal Health, Vancouver, Canada
| | - S F Leibowitz
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - H F L Meyer-Bahlburg
- New York State Psychiatric Institute, New York, NY, USA
- Department of Psychiatry, Columbia University, New York, NY, USA
| | | | - J Motmans
- Transgender Infopunt, Ghent University Hospital, Gent, Belgium
- Centre for Research on Culture and Gender, Ghent University, Gent, Belgium
| | - L Nahata
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
- Endocrinology and Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - T O Nieder
- University Medical Center Hamburg-Eppendorf, Interdisciplinary Transgender Health Care Center Hamburg, Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, Hamburg, Germany
| | - S L Reisner
- Harvard Medical School, Boston, MA, USA
- Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - C Richards
- Regents University London, UK
- Tavistock and Portman NHS Foundation Trust, London, UK
| | | | - V Tangpricha
- Division of Endocrinology, Metabolism & Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Atlanta VA Medical Center, Decatur, GA, USA
| | - A C Tishelman
- Boston College, Department of Psychology and Neuroscience, Chestnut Hill, MA, USA
| | - M A A Van Trotsenburg
- Bureau GenderPRO, Vienna, Austria
- University Hospital Lilienfeld-St. Pölten, St. Pölten, Austria
| | - S Winter
- School of Population Health, Curtin University, Perth, WA, Australia
| | - K Ducheny
- Howard Brown Health, Chicago, IL, USA
| | - N J Adams
- University of Toronto, Ontario Institute for Studies in Education, Toronto, Canada
- Transgender Professional Association for Transgender Health (TPATH)
| | - T M Adrián
- Asamblea Nacional de Venezuela, Caracas, Venezuela
- Diverlex Diversidad e Igualdad a Través de la Ley, Caracas, Venezuela
| | - L R Allen
- University of Nevada, Las Vegas, NV, USA
| | - D Azul
- La Trobe Rural Health School, La Trobe University, Bendigo, Australia
| | - H Bagga
- Monash Health Gender Clinic, Melbourne, Victoria, Australia
- Monash University, Melbourne, Victoria, Australia
| | - K Başar
- Department of Psychiatry, Hacettepe University, Ankara, Turkey
| | - D S Bathory
- Independent Practice at Bathory International PLLC, Winston-Salem, NC, USA
| | - J J Belinky
- Durand Hospital, Guemes Clinic and Urological Center, Buenos Aires, Argentina
| | - D R Berg
- National Center for Gender Spectrum Health, Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - J U Berli
- Oregon Health & Science University, Portland, OR, USA
| | - R O Bluebond-Langner
- NYU Langone Health, New York, NY, USA
- Hansjörg Wyss Department of Plastic Surgery, New York, NY, USA
| | - M-B Bouman
- Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Plastic Surgery, Amsterdam UMC Location Vrije Universiteit Amsterdam, , Amsterdam, Netherlands
| | - M L Bowers
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mills-Peninsula Medical Center, Burlingame, CA, USA
| | - P J Brassard
- GrS Montreal, Complexe CMC, Montreal, Quebec, Canada
- Université de Montreal, Quebec, Canada
| | - J Byrne
- University of Waikato/Te Whare Wānanga o Waikato, Hamilton/Kirikiriroa, New Zealand/Aotearoa
| | - L Capitán
- The Facialteam Group, Marbella International Hospital, Marbella, Spain
| | | | - J M Carswell
- Harvard Medical School, Boston, MA, USA
- Boston's Children's Hospital, Boston, MA, USA
| | - S C Chang
- Independent Practice, Oakland, CA, USA
| | - G Chelvakumar
- Nationwide Children's Hospital, Columbus, OH, USA
- The Ohio State University, College of Medicine, Columbus, OH, USA
| | - T Corneil
- School of Population & Public Health, University of British Columbia, Vancouver, BC, Canada
| | - K B Dalke
- Penn State Health, PA, USA
- Penn State College of Medicine, Hershey, PA, USA
| | - G De Cuypere
- Center for Sexology and Gender, Ghent University Hospital, Gent, Belgium
| | - E de Vries
- Nelson Mandela University, Gqeberha, South Africa
- University of Cape Town, Cape Town, South Africa
| | - M Den Heijer
- Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Endocrinology, Amsterdam UMC Location Vrije Universiteit Amsterdam, , Amsterdam, Netherlands
| | - A H Devor
- University of Victoria, Victoria, BC, Canada
| | - C Dhejne
- ANOVA, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - A D'Marco
- UCTRANS-United Caribbean Trans Network, Nassau, The Bahamas
- D M A R C O Organization, Nassau, The Bahamas
| | - E K Edmiston
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - L Edwards-Leeper
- Pacific University, Hillsboro, OR, USA
- Independent Practice, Beaverton, OR, USA
| | - R Ehrbar
- Whitman Walker Health, Washington, DC, USA
- Independent Practice, Maryland, USA
| | - D Ehrensaft
- University of California San Francisco, San Francisco, CA, USA
| | - J Eisfeld
- Transvisie, Utrecht, The Netherlands
| | - E Elaut
- Center for Sexology and Gender, Ghent University Hospital, Gent, Belgium
- Department of Clinical Experimental and Health Psychology, Ghent University, Gent, Belgium
| | - L Erickson-Schroth
- The Jed Foundation, New York, NY, USA
- Hetrick-Martin Institute, New York, NY, USA
| | - J L Feldman
- Institute for Sexual and Gender Health, Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - A D Fisher
- Andrology, Women Endocrinology and Gender Incongruence, Careggi University Hospital, Florence, Italy
| | - M M Garcia
- Department of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Departments of Urology and Anatomy, University of California San Francisco, San Francisco, CA, USA
| | - L Gijs
- Institute of Family and Sexuality Studies, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | | | - B P Hall
- Duke University Medical Center, Durham, NC, USA
- Duke Adult Gender Medicine Clinic, Durham, NC, USA
| | - T L D Hardy
- Alberta Health Services, Edmonton, Alberta, Canada
- MacEwan University, Edmonton, Alberta, Canada
| | - M S Irwig
- Harvard Medical School, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - A C Janssen
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - K Johnson
- RMIT University, Melbourne, Australia
- University of Brighton, Brighton, UK
| | - D T Klink
- Department of Pediatrics, Division of Pediatric Endocrinology, Ghent University Hospital, Gent, Belgium
- Division of Pediatric Endocrinology and Diabetes, ZNA Queen Paola Children's Hospital, Antwerp, Belgium
| | - B P C Kreukels
- Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Medical Psychology, Amsterdam UMC Location Vrije Universiteit Amsterdam, , Amsterdam, Netherlands
| | - L E Kuper
- Department of Psychiatry, Southwestern Medical Center, University of Texas, Dallas, TX, USA
- Department of Endocrinology, Children's Health, Dallas, TX, USA
| | - E J Kvach
- Denver Health, Denver, CO, USA
- University of Colorado School of Medicine, Aurora, CO, USA
| | - M A Malouf
- Malouf Counseling and Consulting, Baltimore, MD, USA
| | - R Massey
- WPATH Global Education Institute
- Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - T Mazur
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- John R. Oishei Children's Hospital, Buffalo, NY, USA
| | - C McLachlan
- Professional Association for Transgender Health, South Africa
- Gender DynamiX, Cape Town, South Africa
| | - S D Morrison
- Division of Plastic Surgery, Seattle Children's Hospital, Seattle, WA, USA
- Division of Plastic Surgery, Department of Surgery, University of Washington Medical Center, Seattle, WA, USA
| | - S W Mosser
- Gender Confirmation Center, San Francisco, CA, USA
- Saint Francis Memorial Hospital, San Francisco, CA, USA
| | - P M Neira
- Johns Hopkins Center for Transgender Health, Baltimore, MD, USA
- Johns Hopkins Medicine Office of Diversity, Inclusion and Health Equity, Baltimore, MD, USA
| | - U Nygren
- Division of Speech and Language Pathology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Speech and Language Pathology, Medical Unit, Karolinska University Hospital, Stockholm, Sweden
| | - J M Oates
- La Trobe University, Melbourne, Australia
- Melbourne Voice Analysis Centre, East Melbourne, Australia
| | - J Obedin-Maliver
- Stanford University School of Medicine, Department of Obstetrics and Gynecology, Palo Alto, CA, USA
- Department of Epidemiology and Population Health, Stanford, CA, USA
| | - G Pagkalos
- Independent PracticeThessaloniki, Greece
- Military Community Mental Health Center, 424 General Military Training Hospital, Thessaloniki, Greece
| | - J Patton
- Talkspace, New York, NY, USA
- CytiPsychological LLC, San Diego, CA, USA
| | - N Phanuphak
- Institute of HIV Research and Innovation, Bangkok, Thailand
| | - K Rachlin
- Independent Practice, New York, NY, USA
| | - T Reed
- Gender Identity Research and Education Society, Leatherhead, UK
| | - G N Rider
- National Center for Gender Spectrum Health, Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - J Ristori
- Andrology, Women Endocrinology and Gender Incongruence, Careggi University Hospital, Florence, Italy
| | | | - S A Roberts
- Harvard Medical School, Boston, MA, USA
- Division of Endocrinology, Boston's Children's Hospital, Boston, MA, USA
| | - K A Rodriguez-Wallberg
- Department of Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
- Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
| | - S M Rosenthal
- Division of Pediatric Endocrinology, UCSF, San Francisco, CA, USA
- UCSF Child and Adolescent Gender Center
| | - K Sabir
- FtM Phoenix Group, Krasnodar Krai, Russia
| | - J D Safer
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Mount Sinai Center for Transgender Medicine and Surgery, New York, NY, USA
| | - A I Scheim
- Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
- Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, Ontario, Canada
| | - L J Seal
- Tavistock and Portman NHS Foundation Trust, London, UK
- St George's University Hospitals NHS Foundation Trust, London, UK
| | | | - K Spencer
- National Center for Gender Spectrum Health, Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - C St Amand
- University of Houston, Houston, TX, USA
- Mayo Clinic, Rochester, MN, USA
| | - T D Steensma
- Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Medical Psychology, Amsterdam UMC Location Vrije Universiteit Amsterdam, , Amsterdam, Netherlands
| | - J F Strang
- Children's National Hospital, Washington, DC, USA
- George Washington University School of Medicine, Washington, DC, USA
| | - G B Taylor
- Atrium Health Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Charlotte, NC, USA
| | - K Tilleman
- Department for Reproductive Medicine, Ghent University Hospital, Gent, Belgium
| | - G G T'Sjoen
- Center for Sexology and Gender, Ghent University Hospital, Gent, Belgium
- Department of Endocrinology, Ghent University Hospital, Gent, Belgium
| | - L N Vala
- Independent Practice, Campbell, CA, USA
| | - N M Van Mello
- Center of Expertise on Gender Dysphoria, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of Obstetrics and Gynaecology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - J F Veale
- School of Psychology, University of Waikato/Te Whare Wānanga o Waikato, Hamilton/Kirikiriroa, New Zealand/Aotearoa
| | - J A Vencill
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN, USA
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - B Vincent
- Trans Learning Partnership at https://spectra-london.org.uk/trans-learning-partnership, UK
| | - L M Wesp
- College of Nursing, University of Wisconsin MilwaukeeMilwaukee, WI, USA
- Health Connections Inc., Glendale, WI, USA
| | - M A West
- North Memorial Health Hospital, Robbinsdale, MN, USA
- University of Minnesota, Minneapolis, MN, USA
| | - J Arcelus
- School of Medicine, University of Nottingham, Nottingham, UK
- Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| |
Collapse
|
12
|
Ricks JM, Arthur EK, Stryker SD, Yockey RA, Anderson AM, Allensworth-Davies D. A Systematic Literature Review of Community-Based Participatory Health Research with Sexual and Gender Minority Communities. Health Equity 2022; 6:640-657. [PMID: 36081887 PMCID: PMC9448519 DOI: 10.1089/heq.2022.0039] [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] [Accepted: 07/18/2022] [Indexed: 11/12/2022] Open
Abstract
Purpose: The objective was to review sexual and gender minority (SGM) health research studies to gain an understanding of how the community-based participatory research (CBPR) framework has been operationalized. Methods: We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to conduct a review of all SGM health research studies published in the past 10 years that cited a CBPR approach (PROSPERO Registration No. CRD42016036608). CINAHL, PubMed, and PsycINFO databases were systematically searched in October 2020. Dimensions of community involvement (e.g., shared decision-making; flexibility to community needs and priorities) and the strength of evidence for each dimension were rated using guidance from the Agency of Healthcare Research and Quality. Results: The 48 eligible articles identified reported a range of 0–11 (out of 13) community elements. Seven studies reported zero elements. Qualitative studies (n=28; 58.3%) had an average quality score of 2.32 (range: 1.43–2.5). The 15 (31.3%) cross-sectional studies had an average quality score of 2.08 (range: 1.64–2.27). Conclusion: Adhering to the CBPR framework is challenging. The benefits of striving toward its principles, however, can move us toward transformative and sustainable social change within SGM communities.
Collapse
Affiliation(s)
- JaNelle M. Ricks
- Health Behavior and Health Promotion, The Ohio State University College of Public Health, Columbus, Ohio, USA
- Equitas Health Institute Midwest SGM Health Research Consortium, Columbus, Ohio, USA
| | - Elizabeth K. Arthur
- Equitas Health Institute Midwest SGM Health Research Consortium, Columbus, Ohio, USA
- The Ohio State University Comprehensive Cancer, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio, USA
- The Ohio State University College of Nursing, Columbus, Ohio, USA
| | - Shanna D. Stryker
- Equitas Health Institute Midwest SGM Health Research Consortium, Columbus, Ohio, USA
- Family and Community Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - R. Andrew Yockey
- Equitas Health Institute Midwest SGM Health Research Consortium, Columbus, Ohio, USA
- Biostatistics and Epidemiology, University of North Texas Health Science Center at Fort Worth, Fort Worth, Texas, USA
| | - Avery M. Anderson
- Equitas Health Institute Midwest SGM Health Research Consortium, Columbus, Ohio, USA
- The Ohio State University College of Nursing, Columbus, Ohio, USA
| | - Donald Allensworth-Davies
- Equitas Health Institute Midwest SGM Health Research Consortium, Columbus, Ohio, USA
- Cleveland State University College of Sciences and Health Professions, Cleveland, Ohio, USA
| |
Collapse
|
13
|
Gonzalez Rodriguez H, Barrington C, McCallister KN, Guy J, Hightow-Weidman L, Hurt CB, McNeil CJ, Sena AC. Perceptions, experiences, and preferences for partner services among Black and Latino men who have sex with men and transwomen in North Carolina. ETHNICITY & HEALTH 2022; 27:1241-1255. [PMID: 33734826 PMCID: PMC8448793 DOI: 10.1080/13557858.2021.1899137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 03/01/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES In the United States, sexually transmitted infections (STIs) disproportionately affect men who have sex with men (MSM) and transwomen of color. Partner services can prevent STI transmission by facilitating testing and treatment for partners of individuals diagnosed with an STI. Understanding client perspectives towards partner services is critical to their acceptance and uptake. This study examined perceptions, experiences, and preferences for partner services among Black and Latino MSM and transwomen in North Carolina. DESIGN We conducted seven audio-recorded focus groups in English (n = 5) and Spanish (n = 2). The audio was transcribed verbatim and we inductively analyzed data using field notes, systematic coding, and thematic comparison. RESULTS Black MSM reported the most exposure and experiences with partner services, and most perceived partner services negatively. Feeling supported and having flexibility characterized positive experiences with partner services among Black MSM; feeling judged or harassed characterized negative experiences. Black transwomen had less exposure to partner services and had a mix of positive reactions to the approach, along with concerns about client confidentiality. Most Latino participants were unaware of partner services and expressed openness to their potential. All participants preferred self-notifying and wanted flexible, discreet, supportive partner services with linkages to other wellness resources. CONCLUSION Building off positive partner services experiences and responding to client preferences can enhance trust, acceptability, and service use.
Collapse
Affiliation(s)
- Humberto Gonzalez Rodriguez
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Clare Barrington
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Katherine Nicole McCallister
- Institute for Global Health & Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jalila Guy
- Institute for Global Health & Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lisa Hightow-Weidman
- Institute for Global Health & Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Christopher Browning Hurt
- Institute for Global Health & Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Candice Joy McNeil
- Department of Medicine, Section on Infectious Diseases, Wake Forest University Health Sciences, Winston-Salem, NC, USA
| | - Arlene Carmela Sena
- Institute for Global Health & Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| |
Collapse
|
14
|
Sun M, Ji H, Chen X, Xu J, Lu J, Yi Y, Pan Y, Wu R, Chen Y, Duan Y, Dou X, Zhou L. The factors influencing the psychological distress of transgender women in Shandong, China: a cross-sectional study. BMC Public Health 2022; 22:955. [PMID: 35549903 PMCID: PMC9101853 DOI: 10.1186/s12889-022-13357-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 04/25/2022] [Indexed: 11/15/2022] Open
Abstract
Background As a group at high-risk for acquired immune deficiency syndrome (AIDS) infection, the psychological distress of transgender women cannot be ignored while preventing and controlling AIDS risks. Transgender women are a vulnerable group, and their psychological distress deserves attention. The purpose of this study was to evaluate the psychological distress of transgender women and further determine the influences of factors on the psychological distress of transgender women. Methods From March 2021 to August 2021, a cross-sectional survey was conducted in Shandong province, China. Data were collected by a questionnaire designed for transgender women, and the GHQ-12 scale was used to measure their psychological distress. The questionnaire combined sociodemographic characteristics, HIV/AIDS cognition, related behaviors, substance abuse, social support, gender identity and other factors. Univariate logistic regression and multivariate logistic regression models were used to explore the psychological factors of transgender women. Results In this study, the rate of transgender women with psychological distress was 20.08%. Earned monthly income between 10,000–15,000 yuan (OR:0.16, 95% CI:0.06–0.45) and a monthly income greater than 15,000 yuan (OR:0.07, 95% CI:0.01–0.43) were protective factors in the psychology of transgender women. Transgender women who never disclosed sexual orientation and identity (OR: 0.19, 95% CI: 0.06–0.58), who only disclosed their sexual orientation and identity to families or friends (OR: 0.41, 95% CI: 0.18–0.93) were also less likely to have psychological distress. Additionally, transgender women who did not desire to be identified with their sexual orientation and identity (OR: 3.31, 95%CI: 1.08–10.16) and who reported that the Internet did not play an essential role in helping determine sexual orientation (OR: 5.96, 95% CI: 2.91–12.20) were more likely to have psychological distress. Conclusion Transgender women were at risk of psychological distress. Earning more money can help transgender women's psychological health. When formulating measures for transgender women, we should pay attention to enhance social inclusion and social acceptance of their gender identity and sexual orientation. Strengthening the role of the internet in transgender women's confirmation of sexual orientation and improving the social acceptance of transgender women will have a positive impact on the psychological status of transgender women. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13357-9.
Collapse
Affiliation(s)
- Meng Sun
- School of Public Health, Dalian Medical University, Dalian, 116044, Liaoning, China
| | - Haoqiang Ji
- School of Public Health, Dalian Medical University, Dalian, 116044, Liaoning, China
| | - Xu Chen
- School of Public Health, Dalian Medical University, Dalian, 116044, Liaoning, China
| | - Jia Xu
- School of Public Health, Dalian Medical University, Dalian, 116044, Liaoning, China
| | - Jiachen Lu
- School of Public Health, Dalian Medical University, Dalian, 116044, Liaoning, China
| | - Yaohui Yi
- School of Public Health, Dalian Medical University, Dalian, 116044, Liaoning, China
| | - Yuanping Pan
- School of Public Health, Dalian Medical University, Dalian, 116044, Liaoning, China
| | - Ruiheng Wu
- School of Public Health, Dalian Medical University, Dalian, 116044, Liaoning, China
| | - Yunting Chen
- School of Public Health, Dalian Medical University, Dalian, 116044, Liaoning, China
| | - Yuxin Duan
- School of Public Health, Dalian Medical University, Dalian, 116044, Liaoning, China
| | - Xiaofeng Dou
- School of Public Health, Dalian Medical University, Dalian, 116044, Liaoning, China
| | - Ling Zhou
- School of Public Health, Dalian Medical University, Dalian, 116044, Liaoning, China.
| |
Collapse
|
15
|
Igarashi Y, Staples J, Vigil S, Pero G, Gardner R, Thomat A, Abascal L. The impact of psychological flexibility in the relationship between discrimination and internalized transnegativity among transgender and gender expansive adults. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2022. [DOI: 10.1016/j.jcbs.2022.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
|
16
|
Restriction of Access to Healthcare and Discrimination of Individuals of Sexual and Gender Minority: An Analysis of Judgments of the European Court of Human Rights from an Ethical Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052650. [PMID: 35270340 PMCID: PMC8909593 DOI: 10.3390/ijerph19052650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 02/18/2022] [Accepted: 02/23/2022] [Indexed: 01/27/2023]
Abstract
Individuals of sexual and gender minority (SGM) form a vulnerable group with specific healthcare needs that might be prone to experience discrimination and restrictions regarding their access to healthcare. As the judgments of the European Court of Human Rights (ECtHR) offer a normative perspective on these issues, we analyzed them systematically (1) to identify whether and in what manner ECtHR's judgments concern restriction of access to healthcare for SGM individuals and (2) to identify and categorize the ways of discrimination to which SGM individuals are exposed. We conducted a systematic search of the database of the ECtHR's judgments with the use of specified search terms. Descriptive statistics were performed on the identified judgments. Subsequently, we analyzed the judgments with the use of a qualitative method of thematic analysis. We identified n = 73 cases relevant for our study. In n = 7 (9.59%) of judgments, we found limitations of access to healthcare for SGM individuals, e.g., in cases of restrictions for transsexual individuals to receive hormone or surgical therapy. We regard this as a specific form of discrimination. Furthermore, we identified five other categories of discrimination: restriction of parental rights, failure to respect one's gender identity/sexual orientation, discrimination by jurisdiction, prohibition of promotion, and verbal/physical attacks. The ECtHR proves to have a balanced view on the sensitive topic of sexual self-determination condemning any form of discrimination or restriction of access to healthcare. However, there is a need for further research on discriminatory acts by other individuals, e.g., healthcare providers, rather than by public authorities.
Collapse
|
17
|
Trans*Forming Access and Care in Rural Areas: A Community-Engaged Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312700. [PMID: 34886426 PMCID: PMC8656493 DOI: 10.3390/ijerph182312700] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 11/22/2021] [Accepted: 11/29/2021] [Indexed: 11/30/2022]
Abstract
Research indicates that rural transgender and gender diverse (TGD) populations have a greater need for health services when compared with their urban counterparts, face unique barriers to accessing services, and have health disparities that are less researched than urban TGD populations. Therefore, the primary aim of this mixed-methods study (n = 24) was to increase research on the health care needs of TGD people in a rural Appalachian American context. This study was guided by a community-engaged model utilizing a community advisory board of TGD people and supportive parents of TGD children. Quantitative results indicate that travel burden is high, affirming provider availability is low, and the impacts on the health and mental health of TGD people in this sample are notable. Qualitative results provide recommendations for providers and health care systems to better serve this population. Integrated mixed-methods results further illustrate ways that rural TGD people and families adapt to the services available to them, sometimes at significant economic and emotional costs. This study contributes to the small but growing body of literature on the unique needs of rural TGD populations, including both adults and minors with supportive parents, by offering insights into strategies to address known disparities.
Collapse
|
18
|
Bohnert CA, Combs RM, Noonan EJ, Weathers AE, Weingartner LA. Gender Minorities in Simulation: A Mixed Methods Study of Medical School Standardized Patient Programs in the United States and Canada. Simul Healthc 2021; 16:e151-e158. [PMID: 33273422 DOI: 10.1097/sih.0000000000000532] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE A provider's ability to translate knowledge about transgender health to affirming patient care is key to addressing disparities. However, standardized patient (SP) programs have little published guidance for gender-affirming care or addressing disparities experienced by transgender and nonbinary patients. METHOD Between 2018 and 2019, we invited all 208 accredited US and Canadian medical schools to participate in a study to determine how gender minorities are represented in SP encounters. Responding programs (n = 59, response rate = 28%) that represented patients with diverse gender identities were invited to complete semistructured interviews about SP case content, impact, and barriers to this work. Discussions were analyzed using a modified grounded theory method. RESULTS Fifty nine of 208 eligible programs (response rate = 28.3%) completed our survey and 24 completed interviews. More than half of programs used gender minority SPs (n = 35, 59.3%). More than half of the programs also reported portraying gender minority cases (n = 31, 52.5%). Interviewees described how effective SP simulation required purposeful case development, engaging subject matter experts with lived experience, and ensuring psychological safety of gender minority SPs. Barriers included recruitment, fear of disrespecting gender minority communities, and transphobia. Engaging gender minorities throughout case development, training, and implementation of SP encounters was perceived to reduce bias and stereotyping, but respondents unanimously desired guidance on best practices on SP methodology regarding gender identity. CONCLUSIONS Many programs have established or are developing SP activities that portray gender minority patients. Effective SP simulation hinges on authenticity, but the decisions around case development and casting vary. Specifically, programs lack consensus about who should portray gender minority patients. This research suggests that input from gender minority communities both to inform best practices at the macro level and in an ongoing advisory capacity at the program level will be essential to teach gender-affirming care.
Collapse
Affiliation(s)
- Carrie A Bohnert
- From the Standardized Patient Program (C.A.B.), Medical Education Research Unit (E.J.N., L.A.W.), Department of Undergraduate Medical Education, University of Louisville School of Medicine; Health Promotion and Behavioral Sciences (R.M.C.), University of Louisville School of Public Health and Information Sciences; and LGBT Center Health Sciences Campus (A.E.W.), University of Louisville, Louisville, KY
| | | | | | | | | |
Collapse
|
19
|
Teti M, Bauerband LA, Myroniuk TW, Koegler E. Listening to Transgender Patients and Their Providers in Non-Metropolitan Spaces: Needs, Gaps, and Patient-Provider Discrepancies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10843. [PMID: 34682595 PMCID: PMC8535616 DOI: 10.3390/ijerph182010843] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 10/09/2021] [Accepted: 10/12/2021] [Indexed: 01/26/2023]
Abstract
Trans and gender non-conforming (TGNC) patients need better care; providers need TGNC focused medical trainings. TGNC health conferences can help, yet these events occur mostly in urban centers. Meanwhile, patients in non-metropolitan areas often face significant discrimination and notably poor access to TGNC care. This study explores the ongoing needs of TGNC patients and their providers following a one-day TGNC health conference in a small town in the American Midwest. Exploratory semi-structured interviews were used to gather in-depth information from TGNC conference attendees (N = 25). Theme analysis methods were used to identify areas of need for future trainings. Providers reported that they needed more exposure to TGNC patients, judgement-free opportunities to learn the basics about TGNC care, and ongoing trainings integrated into their medical school and ongoing education credits. Patients needed better access to care, more informed providers, and safer clinics. They cited lack of specialty care (e.g., mental health, surgery) as particularly problematic in a non-metropolitan setting. TGNC patients, and their providers in non-metropolitan areas, urgently need support. Patients lack specialized care and often possess greater knowledge than their health care teams; providers, in these areas, lack opportunities to work with patients and stay up to date on treatments.
Collapse
Affiliation(s)
- Michelle Teti
- Department of Public Health, University of Missouri, Columbia, MO 65211, USA;
| | - L. A. Bauerband
- Department of Health Sciences, University of Missouri, Columbia, MO 65211, USA;
| | - Tyler W. Myroniuk
- Department of Public Health, University of Missouri, Columbia, MO 65211, USA;
| | - Erica Koegler
- School of Social Work, University of Missouri-St. Louis, St. Louis, MO 63121, USA;
| |
Collapse
|
20
|
Vigny-Pau M, Pang N, Alkhenaini H, Abramovich A. Suicidality and non-suicidal self-injury among transgender populations: A systematic review. JOURNAL OF GAY & LESBIAN MENTAL HEALTH 2021. [DOI: 10.1080/19359705.2021.1955195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Myriam Vigny-Pau
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Nelson Pang
- Institute of Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
| | - Hamad Alkhenaini
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Alex Abramovich
- Institute of Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| |
Collapse
|
21
|
Kia H, MacKinnon KR, Abramovich A, Bonato S. Peer support as a protective factor against suicide in trans populations: A scoping review. Soc Sci Med 2021; 279:114026. [PMID: 34010778 DOI: 10.1016/j.socscimed.2021.114026] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/19/2021] [Accepted: 05/07/2021] [Indexed: 11/19/2022]
Abstract
RATIONALE There is a growing body of research involving transgender (trans) individuals that foregrounds elevated rates of suicidality in trans populations. Although peer support is increasingly studied as a protective factor against suicide among trans persons, the scholarship in this area continues to be limited and has yet to be synthesized and appraised. OBJECTIVE In this paper, we address this existing gap in the literature by presenting the results of a scoping review of the literature examining the significance and function of peer support in mitigating suicide risk in trans populations. METHODS This scoping review is based on an analysis of 34 studies that were included following the execution of a methodical search and selection process. Drawing on scoping review methodology, along with PRISMA-P guidelines, we selected peer-reviewed empirical works, published between 2000 and 2020, which examined relationships between providing, seeking, and/or receiving peer support and suicide risk in trans populations. RESULTS Our findings, which are conceptualized using the minority stress model as a guiding theoretical framework, reveal that while the literature generally substantiates the protective significance of peer support for trans persons, a small body of work also uncovers novel and unanticipated sources of peer support, including social support offered by trans peers online, which are infrequently and inconsistently examined in this body of scholarship. CONCLUSIONS Using our appraisal of the literature, we outline the need for future research to further elucidate the significance and function of peer support in protecting against suicide among trans persons. In particular, we discuss the need for exploratory inquiry to inform a conceptualization and operationalization of peer support that more fully and consistently accounts for how such support (including online and community-based support) is sought, received, and experienced among trans persons in the context of suicide.
Collapse
Affiliation(s)
- Hannah Kia
- School of Social Work, The University of British Columbia, Vancouver, Canada.
| | | | - Alex Abramovich
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
| | - Sarah Bonato
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
| |
Collapse
|
22
|
Noonan EJ, Weingartner LA, Combs RM, Bohnert C, Shaw MA, Sawning S. Perspectives of Transgender and Genderqueer Standardized Patients. TEACHING AND LEARNING IN MEDICINE 2021; 33:116-128. [PMID: 32894026 DOI: 10.1080/10401334.2020.1811096] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Phenomenon: Disparities in health and healthcare for gender minorities (GMs) such as transgender people are significant, and medical educators have a responsibility to ensure trainees master the clinical skills required to provide them with quality care. We implemented a standardized patient (SP) scenario designed to measure students' ability to provide gender-affirming care and sought to understand the experiences and perceptions of the GMs who served as SPs in this case. Our key research question was: how do GM SPs describe the experience of serving as an SP on a gender-affirming care clinical case? Approach: Semi-structured focus groups were conducted with GM SPs (n = 10) to understand their experiences and gauge their perceptions of portraying a patient seeking gender-affirming care. The patient they portrayed matched their own gender identity. Focus groups were transcribed verbatim and analyzed using inductive thematic analysis. Findings: We developed three primary themes in our analysis: personal connection, gap identification, and insight into medical education. The SPs reported a personal connection to this case, enabling them to give nuanced feedback, confront bias they encountered, and foster connection to their broader community. They were able to identify specific gaps related to communication skills, assumptions, and knowledge about gender identity and gender-affirming care. They gained valuable insight into medical education such as the complexity of learning clinical skills and roadblocks to inclusive simulation. Insights: By sharing the perspectives of GMs in patient simulation, this study demonstrates that GMs can also benefit from engagement with medical education, as the SPs in our study described hope, empowerment, and engagement as positive aspects of participation. This study also shows that GMs' lived experiences seeking medical care were instrumental in their ability to note gaps, which provides valuable insight for other institutions attempting to improve students' GM clinical skills. Further, GM SPs' perspectives are valuable to provide a rationale and guidance to other schools implementing gender-affirming education. Efforts to create and implement gender-affirming care curriculum should include GMs in order to build partnerships and prioritize the voices and agency of GMs.
Collapse
Affiliation(s)
- Emily J Noonan
- School of Medicine, University of Louisville, Louisville, Kentucky, USA
| | | | - Ryan M Combs
- Health Promotion and Behavioral Sciences, School of Public Health and Information Sciences, University of Louisville, Louisville, Kentucky, USA
| | - Carrie Bohnert
- School of Medicine, University of Louisville, Louisville, Kentucky, USA
| | - M Ann Shaw
- School of Medicine, University of Louisville, Louisville, Kentucky, USA
| | - Susan Sawning
- School of Medicine, University of Louisville, Louisville, Kentucky, USA
| |
Collapse
|
23
|
Renner J, Blaszcyk W, Täuber L, Dekker A, Briken P, Nieder TO. Barriers to Accessing Health Care in Rural Regions by Transgender, Non-Binary, and Gender Diverse People: A Case-Based Scoping Review. Front Endocrinol (Lausanne) 2021; 12:717821. [PMID: 34867775 PMCID: PMC8637736 DOI: 10.3389/fendo.2021.717821] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 09/02/2021] [Indexed: 01/22/2023] Open
Abstract
Research shows an overrepresentation of trans people in vulnerable socioeconomic situations, primarily due to experiences of discrimination. At the same time, rural or suburban living areas often lack specialized trans-related health care, which a majority of trans people rely on to some extent. Taken together, the lack of both socioeconomic resources and access to trans-related health care can exacerbate health-related distress and impairment for trans people. We illustrate this problem using case vignettes of trans people from rural and suburban areas in (Northern) Germany. They are currently participating in an e-health intervention and randomized controlled trial (RCT) called i2TransHealth, whose case vignettes provided the impetus for the scoping review. The scoping review analyzes the impact of place of residence and its intersection with barriers to accessing trans-related health care. PubMed and Web of Science Data bases were searched for relevant studies using a search strategy related to trans people and remote, rural, or suburban residences. 33 studies were selected after full-text screening and supplemented via reference list checks and study team expertise by 12 articles addressing the living conditions of remotely living trans people and describing requirements for trans-related health care. The literature on trans people living remotely reveals intersections of trans mental health with age, race, gender expression, geographic location, community size, socioeconomic status, discrimination experiences, and attitudes towards health care providers. Several structural health care barriers are identified. The role of health care professionals (HCPs) for remotely living trans people is discussed. There is no need assuming that rural life for trans people is inevitably worse for health and well-being than urban life. Nevertheless, some clear barriers and health disparities exist for trans people in remote settings. Empowering trans groups and diversity-sensitive education of remote communities in private and institutional settings are needed for respectful inclusion of trans people. Facilitating access to trans-related health care, such as through video-based e-health programs with HCPs, can improve both the health and socioeconomic situation of trans people.
Collapse
|
24
|
Mohatt NV, Kreisel CJ, Hoffberg AS, Mph LW, Beehler SJ. A Systematic Review of Factors Impacting Suicide Risk Among Rural Adults in the United States. J Rural Health 2020; 37:565-575. [PMID: 33210399 DOI: 10.1111/jrh.12532] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE Suicide rates continue to be significantly higher in rural compared to urban communities in the United States, with the suicide rate disparity continuing to grow since 1999. This systematic review synthesizes rural-specific factors related to increased suicide risk. METHODS OVID Medline, EMBASE, OVID PsycINFO, Web of Science, SocINDEX, Cochrane Library, and Google Scholar were searched for articles published after 2003 investigating rural adult suicide in the United States. Selection criteria were: (1) study participants > 18 years old; (2) included rural participants or communities; (3) included suicidal self-directed violence outcomes; (4) within the United States; (5) published after 2003; (6) presented peer-reviewed original data; (7) identified rural-specific risk or protective factors for suicide or barriers to treatment. FINDINGS Of the 1,058 records screened, 34 studies were included. The strength of evidence was relatively stronger for individual level factors including lethal means, alcohol and substance use. CONCLUSIONS Access to firearms is strongly related to elevated rural US suicide rates, with substance use, economic stress, and behavioral health care utilization as additional individual level factors that may contribute to the disparity. At the community level, economic distress and access to care were commonly identified factors. Future research should better quantify how risk factors contribute to rural suicide and examine interdependence across social-ecological levels. Suicide prevention efforts for the rural United States must address access to lethal means, in particular the use of firearms, and navigate limited access to quality behavioral health care.
Collapse
Affiliation(s)
- Nathaniel V Mohatt
- Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center, Aurora, Colorado.,Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, Colorado.,Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Carlee J Kreisel
- Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center, Aurora, Colorado.,Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, Colorado
| | - Adam S Hoffberg
- Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center, Aurora, Colorado
| | - Leah Wendleton Mph
- Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center, Aurora, Colorado
| | - Sarah J Beehler
- Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Rocky Mountain Regional VA Medical Center, Aurora, Colorado.,University of Minnesota Medical School, Duluth Campus, Duluth, Minnesota
| |
Collapse
|
25
|
Differential Experiences of Mental Health among Trans/Gender Diverse Adults in Michigan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186805. [PMID: 32961959 PMCID: PMC7557385 DOI: 10.3390/ijerph17186805] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 09/13/2020] [Accepted: 09/15/2020] [Indexed: 11/17/2022]
Abstract
Transgender and gender diverse individuals experience high rates of health disparities, as compared with their cisgender (non-transgender) counterparts. One area in which these disparities is most grave is that of mental health, with some studies indicating transgender and gender diverse individuals as having a 40% rate of lifetime suicide attempts and similarly high rates of depression, anxiety, and suicidal ideation. These rates vary further within this population, with differential rates seen across sociodemographic factors, including race/ethnicity, gender, sexual orientation, disability status, education level, and income. This study explores mental health experiences across different social identities, using data from the 2018 Michigan Trans Health Survey (N = 659), a community-based participatory action research project collected in Michigan, United States, analyzed using chi-square tests of independence and logistic regressions. Findings indicate incredibly high rates of mental health concerns; 72.2% had been diagnosed with depression in their lifetime and 73.0% had been diagnosed with anxiety in their lifetime. In the past year, 49.9% had had non-suicidal self-injury (NSSI) thoughts, 45.4% had suicidal thoughts, 26.3% engaged in NSSI, and 7.7% had attempted suicide. Bivariate regressions showed some nuanced experiences of rates of mental health diagnoses and experiences, such as greater odds of experiencing all mental health disparities among those with disabilities, and differential odds across gender in regard to ever having a depression diagnosis, non-suicidal self-injury thoughts and engaging in non-suicidal self-injury behavior. This indicates a need for social workers, counselors, therapists, and other human services professionals to act more intentionally and with an intersectional lens when it comes to exploring the mental health of transgender and gender diverse persons.
Collapse
|
26
|
Cooper K, Russell A, Mandy W, Butler C. The phenomenology of gender dysphoria in adults: A systematic review and meta-synthesis. Clin Psychol Rev 2020; 80:101875. [PMID: 32629301 PMCID: PMC7441311 DOI: 10.1016/j.cpr.2020.101875] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 03/29/2020] [Accepted: 05/31/2020] [Indexed: 12/31/2022]
Abstract
Gender dysphoria is distress due to a discrepancy between one's assigned gender and gender identity. Adults who wish to access gender clinics are assessed to ensure they meet the diagnostic criteria for gender dysphoria. Therefore, the definition of gender dysphoria has a significant impact on the lives of individuals who wish to undergo physical gender transition. This systematic review aimed to identify and synthesize all existing qualitative research literature about the lived experience of gender dysphoria in adults. A pre-planned systematic search identified 1491 papers, with 20 of those meeting full inclusion criteria, and a quality assessment of each paper was conducted. Data pertaining to the lived experience of gender dysphoria were extracted from each paper and a meta-ethnographic synthesis was conducted. Four overarching concepts were identified; distress due to dissonance of assigned and experienced gender; interface of assigned gender, gender identity and society; social consequences of gender identity; internal processing of rejection, and transphobia. A key finding was the reciprocal relationship between an individual's feelings about their gender and societal responses to transgender people. Other subthemes contributing to distress were misgendering, mismatch between gender identity and societal expectations, and hypervigilance for transphobia. A systematic review of all papers on the lived experience of gender dysphoria Twenty papers with 1606 participants were included in a meta-ethnographic synthesis. Distress was due to gender and sex incongruence, as well as social factors. Results give new insights into the relationships between factors causing distress.
Collapse
Affiliation(s)
- Kate Cooper
- Centre for Applied Autism Research, Department of Psychology, University of Bath, BA2 7AY, UK.
| | - Ailsa Russell
- Centre for Applied Autism Research, Department of Psychology, University of Bath, BA2 7AY, UK
| | - William Mandy
- UCL Research Department of Clinical, Educational, and Health Psychology, Gower Street, London WC1E 6BT, UK
| | | |
Collapse
|
27
|
Teti M, Bauerband LA, Rolbiecki A, Young C. Physical activity and body image: Intertwined health priorities identified by transmasculine young people in a non-metropolitan area. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2020; 21:209-219. [PMID: 33015670 PMCID: PMC7430460 DOI: 10.1080/26895269.2020.1719950] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Background: A dearth of research exists about the health behaviors of transgender young people (TYP). As we seek to learn more about transgender (trans) health, community-based participatory research (CBPR) approaches are crucial for incorporating TYP's needs into the formulation of research questions and development of health behavior programing. Aim: Explore body image and exercise as priorities among TYP. Methods: Trans masculine young adults (N = 16) in a small city in the Midwest took part in semi-structured interviews about their health behaviors and priorities. Theme analysis was used to capture key patterns in participants' responses. Specific analysis steps included initial and more specific coding, analytical memos, organizational matrices and reports, and discussion about results with participants. Results: Participants identified exercise and body image as connected primary health concerns. They discussed these issues in terms of three themes: Body shape as motivation for exercise; Poor body image, stigma and fear as exercise barriers, and; Exercise or lack of, as destructive. Participants wanted to exercise to achieve a certain body shape, not for health or as stress relief. They cited gyms as unwelcoming, however. They also worried about discrimination and did not feel sufficiently comfortable with their bodies to exercise. When they could not exercise, they used harmful behaviors, like restricted eating, to achieve a specific male shape. Conclusions: Using participatory methods allowed us to understand the priorities of a group of Transmasculine young people. Our findings suggest that it is important to continue to explore TYP's body-related motivations for exercise and understand the balance between exercise as a positive health behavior, and a potentially harmful one, in light of TYP's complex body image concerns. Trans friendly gyms and gym policies could promote safe exercise and continued anti trans discrimination work and policy advocacy can promote the safety of TYP in all spaces.
Collapse
Affiliation(s)
- Michelle Teti
- Department of Health Sciences, University of Missouri, Columbia, Missouri, USA
| | - L. A. Bauerband
- Department of Health Sciences, University of Missouri, Columbia, Missouri, USA
| | | | - Cole Young
- Department of Health Sciences, University of Missouri, Columbia, Missouri, USA
| |
Collapse
|
28
|
Lane R. Developing inclusive primary care for trans, gender-diverse and nonbinary people. CMAJ 2019; 191:E61-E62. [PMID: 30665974 PMCID: PMC6336472 DOI: 10.1503/cmaj.190011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Riki Lane
- Southern Academic Primary Care Research Unit, Department of General Practice, Monash University, Notting Hill; Gender Clinic, Monash Health, Hampton East, Australia
| |
Collapse
|