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Coleman TA, Chee K, Chin-See R, Salama R, Sajan M, Narbonne M, Travers R, Coulombe S. Minority Stressors, Social Provisions, and Past-Year Suicidal Ideation and Suicide Attempts in a Sample of Sexual Orientation and Gender Identity/Expression Minority People in Canada. LGBT Health 2024. [PMID: 38557210 DOI: 10.1089/lgbt.2022.0344] [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: 04/04/2024] Open
Abstract
Purpose: Mental health disparities in sexual orientation and/or gender identity and/or expression (SOGIE) minority groups are well-documented, with research consistently showing higher levels of suicidality, even in Canada, considered one of the world's most accepting countries of SOGIE minority groups. Adverse outcomes in these groups are often framed using minority stress theory, with social support frequently studied as an integral buffer to these outcomes. This analysis explores facets of minority stress and social support associated with past-year suicidal ideation and suicide attempts. Methods: A cross-sectional internet survey of SOGIE diverse people in Canada (n = 1542) was conducted. Binary logistic regression calculated bivariate and multivariate factors associated with past-year suicidal ideation and suicide attempts. Backward elimination (retaining sociodemographic factors and self-rated mental health) identified salient minority stress and social support (provisions) factors. Results: Over half (56.72%) of participants had ever thought of dying by suicide, with 24.84% having attempted suicide. During the past year, 26.80% had thought of dying by suicide, with 5.32% having attempted suicide. Victimization events, and guidance (e.g., someone to talk to about important decisions) and attachment (e.g., close relationships providing emotional security) social provision subscales remained salient after backward elimination procedures. Conclusion: Our findings emphasize that a fulsome, multilevel approach considering structural, community, and individual strategies to address overt discrimination, integrating social connections and guidance, is necessary to prevent dying by suicide.
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Affiliation(s)
- Todd A Coleman
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Kenny Chee
- Department of Psychology, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Robert Chin-See
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Ramez Salama
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Maria Sajan
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Macie Narbonne
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Robb Travers
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Simon Coulombe
- Département des relations industrielles, Université Laval, Québec, Québec, Canada
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Harder VS, Lor J, Omland L, Rettew DC. Protective Associations between Supportive Environment and Suicidality among Minority and Majority Adolescents. Arch Suicide Res 2024; 28:629-643. [PMID: 37073782 DOI: 10.1080/13811118.2023.2199808] [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] [Indexed: 04/20/2023]
Abstract
OBJECTIVE To examine the association between supportive environments and adolescent suicidal behavior, especially among marginalized minority groups. METHODS Participants included 12,196 middle and 16,981 high school students who completed the 2019 Vermont Youth Risk Behavior Survey. Multiple logistic regression models were used to assess the association between three protective factors that were part of a supportive environment (feeling like they matter to people in their community, usually eating dinner at home, having a trusted adult) and suicidality (plan or attempt), controlling for key demographics (sex, sexual orientation, gender identity, and race/ethnicity). Moderating effects of demographics were also explored. RESULTS All supportive environment variables were protective of making a suicide plan and making a suicide attempt (ORs < 0.75, p-values < 0.005). Students of minority identities were significantly more likely to make a suicide plan (middle school ORs: 1.34-3.51, p-values < 0.0005; high school ORs: 1.19-3.38, p-values < 0.02) and attempt suicide (middle school ORs: 1.42-3.72, p-values < 0.006; high school ORs: 1.38-3.25, p-values < 0.0005) compared to students with majority demographic characteristics. Generally, the associations between having a supportive environment and suicidality did not vary within sexual orientation, gender identify, or race/ethnicity subgroups, suggesting that these supportive environment factors were more universally protective. However, a few associations were stronger among students in the majority demographic groups. CONCLUSIONS These data suggest that having a supportive environment is protective of suicidality for adolescents from both majority and minority demographic groups.
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Barboza-Salerno GE, Meshelemiah JCA. Associations between early child adversity and lifetime suicide attempts among gender diverse individuals: A moderated mediation. CHILD ABUSE & NEGLECT 2024; 149:106705. [PMID: 38422580 DOI: 10.1016/j.chiabu.2024.106705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 02/07/2024] [Accepted: 02/13/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND This study examines the effect of adverse childhood experiences (ACEs) on lifetime suicide attempts (LSA) across five gender subgroups (i.e., transgender men, transgender women, transgender non-binary, cisgender men and cisgender women). OBJECTIVE To examine (1) the prevalence of LSA across gender identity subgroups; (2) whether the association between ACEs and LSA is moderated by gender identity subgroup; (3) depressive symptoms, alcohol use disorder, social support, and social well-being as mechanisms linking ACEs with LSA; and (4) the moderating role of gender identity on the four putative mediators. PARTICIPANTS AND SETTINGS We used nationally representative data from a population-based survey of N = 1368 transgender and cisgender individuals collected between 2016 and 2019. METHODS Structural equation modeling was used to explore the indirect effect of depressive symptoms on the relation between ACEs and LSA, and the moderating impact of gender identity. RESULTS LSA was significantly more prevalent among transgender respondents (cisgender man = 5 %; cisgender woman = 9 %; transgender man = 42 %; transgender woman = 33 %; transgender non-binary = 37 %; p < 0.001). Individuals with more ACEs had a greater risk of engaging in LSA regardless of gender identity; however, moderation results showed that the impact of each additional ACE on LSA was stronger for individuals with transgender identities: the likelihood of engaging in LSA was statistically similar for transgender men with no ACEs and cisgender men with all 8 ACEs. Indirect effects of ACEs on LSA via depressive symptoms were also observed, and the mediating effect was moderated by gender identity. CONCLUSIONS By examining the mechanisms linking childhood adversity to LSA, this study demonstrates that not all ACEs impact gender minority subgroups equally.
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Affiliation(s)
- Gia E Barboza-Salerno
- The Ohio State University, College of Public Health & College of Social Work, 352 Cunz Hall, 1841 Neil Avenue, Columbus, OH 43210, United States of America.
| | - Jacquelyn C A Meshelemiah
- The Ohio State University, College of Social Work, 325D Stillman Hall, 1947 North College Road, Columbus, OH 43210, United States of America.
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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: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [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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Fahey KML, Kovacek K, Abramovich A, Dermody SS. Substance use prevalence, patterns, and correlates in transgender and gender diverse youth: A scoping review. Drug Alcohol Depend 2023; 250:110880. [PMID: 37480799 DOI: 10.1016/j.drugalcdep.2023.110880] [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: 01/26/2023] [Revised: 06/24/2023] [Accepted: 06/29/2023] [Indexed: 07/24/2023]
Abstract
Transgender and gender diverse (TGD) adults are at elevated risk of problematic substance use. While understanding substance use disparities in TGD youth is crucial for informing early preventions, there is no known synthesis of prevalence and correlates of substance use in TGD youth. The objectives of this study were to: 1) describe the prevalence and patterns of substance use in TGD youth, 2) identify and evaluate potential correlates of substance use, and 3) report the strengths and limitations of the current literature in recommendation of future steps. A PRISMA-guided systematic search was conducted to identify 55 studies that reported prevalence, patterns, or correlates of substance use in TGD youth aged 10-24 years; were published in the English language; and followed a quantitative design. Fifty-four (98.18%) studies examined prevalence and patterns, 23 (41.82%) examined correlates, and 12 (21.82%) examined moderators and mediators of substance use in TGD youth. Findings suggest TGD youth exhibit a moderate-to-high prevalence of recent substance use, including alcohol (23-31%), binge drinking (11-59%), cigarettes (10-59%), e-cigarettes (17-27%), and marijuana (17-46%). Additionally, results supported that greater victimization experiences, including those related and unrelated to being a gender minority, were associated with increased substance use risk. Few studies examined polysubstance use, resilience, and protective factors, or considered TGD subgroup differences, which we recommend in future research. Further, we recommend improving population-based surveys to better capture gender identity and related experiences.
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Affiliation(s)
| | | | - Alex Abramovich
- University of Toronto, Canada; Centre for Addiction and Mental Health, Canada
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Wong SMY, Ip CH, Hui CLM, Suen YN, Wong CSM, Chang WC, Chan SKW, Lee EHM, Lui SSY, Chan KT, Wong MTH, Chen EYH. Prevalence and correlates of suicidal behaviours in a representative epidemiological youth sample in Hong Kong: the significance of suicide-related rumination, family functioning, and ongoing population-level stressors. Psychol Med 2023; 53:4603-4613. [PMID: 35650661 PMCID: PMC10388322 DOI: 10.1017/s0033291722001519] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 04/28/2022] [Accepted: 05/06/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Young people are most vulnerable to suicidal behaviours but least likely to seek help. A more elaborate study of the intrinsic and extrinsic correlates of suicidal ideation and behaviours particularly amid ongoing population-level stressors and the identification of less stigmatising markers in representative youth populations is essential. METHODS Participants (n = 2540, aged 15-25) were consecutively recruited from an ongoing large-scale household-based epidemiological youth mental health study in Hong Kong between September 2019 and 2021. Lifetime and 12-month prevalence of suicidal ideation, plan, and attempt were assessed, alongside suicide-related rumination, hopelessness and neuroticism, personal and population-level stressors, family functioning, cognitive ability, lifetime non-suicidal self-harm, 12-month major depressive disorder (MDD), and alcohol use. RESULTS The 12-month prevalence of suicidal ideation, ideation-only (no plan or attempt), plan, and attempt was 20.0, 15.4, 4.6, and 1.3%, respectively. Importantly, multivariable logistic regression findings revealed that suicide-related rumination was the only factor associated with all four suicidal outcomes (all p < 0.01). Among those with suicidal ideation (two-stage approach), intrinsic factors, including suicide-related rumination, poorer cognitive ability, and 12-month MDE, were specifically associated with suicide plan, while extrinsic factors, including coronavirus disease 2019 (COVID-19) stressors, poorer family functioning, and personal life stressors, as well as non-suicidal self-harm, were specifically associated with suicide attempt. CONCLUSIONS Suicide-related rumination, population-level COVID-19 stressors, and poorer family functioning may be important less-stigmatising markers for youth suicidal risks. The respective roles played by not only intrinsic but also extrinsic factors in suicide plan and attempt using a two-stage approach should be considered in future preventative intervention work.
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Affiliation(s)
- Stephanie M. Y. Wong
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Charlie H. Ip
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Christy L. M. Hui
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Y. N. Suen
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Corine S. M. Wong
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - W. C. Chang
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
| | - Sherry K. W. Chan
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
| | - Edwin H. M. Lee
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Simon S. Y. Lui
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - K. T. Chan
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Michael T. H. Wong
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Eric Y. H. Chen
- Department of Psychiatry, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
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Abstract
Transgender and gender diverse (TGD) children and adolescents are an increasingly visible yet highly stigmatized group. These youth experience more psychological distress than not only their cisgender, heterosexual peers but also their cisgender, sexual minority peers. In this review, we document these mental health disparities and discuss potential explanations for them using a minority stress framework. We also discuss factors that may increase and decrease TGD youth's vulnerability to psychological distress. Further, we review interventions, including gender-affirming medical care, that may improve mental health in TGD youth. We conclude by discussing limitations of current research and suggestions for the future.
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Affiliation(s)
- Natalie M Wittlin
- Department of Psychology, Princeton University, Princeton, New Jersey, USA;
| | - Laura E Kuper
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Department of Endocrinology, Children's Health Systems of Texas, Dallas, Texas, USA
| | - Kristina R Olson
- Department of Psychology, Princeton University, Princeton, New Jersey, USA;
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Keum BT. Impact of Online Racism on Suicide Ideation Through Interpersonal Factors Among Racial Minority Emerging Adults: The Role of Perceived Burdensomeness and Thwarted Belongingness. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:4537-4561. [PMID: 35942944 PMCID: PMC9900690 DOI: 10.1177/08862605221117247] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
While a growing number of studies have documented significant links between online racism (e.g., racist interactions, contents on racial violence) and comorbid factors (e.g., depression) associated with suicide risk, no studies have examined whether online racism predicts suicide ideation and if interpersonal factors can help explain this link. Thus, the current study examined the direct relationship between online racism and suicide ideation among racial minority emerging adults, and the indirect relationships via the interpersonal factors (perceived burdensomeness and thwarted belongingness). Using data from a convenience sample of 338 racial minority emerging adults, we conducted a path analysis with online racism predicting suicide ideation through thwarted belongingness and perceived burdensomeness. Online racism significantly predicted suicide ideation via perceived burdensomeness but not thwarted belongingness. Post hoc multi-group analysis found that this pathway was consistent across Black, Asian, and Latinx groups but was completely mediated for the Asian group. The findings suggest that online racism can increase feelings of being a burden to society, which can trigger thoughts of suicide. This process may be particularly salient among Asian individuals. Implications for future research are discussed.
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Keum BT, Wong MJ, Salim-Eissa R. Gendered racial microaggressions, internalized racism, and suicidal ideation among emerging adult Asian American women. Int J Soc Psychiatry 2023; 69:342-350. [PMID: 35411802 PMCID: PMC9983054 DOI: 10.1177/00207640221089536] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Despite suicide being the leading cause of death among emerging adult Asian American women (AAW), little is known about the risk factors. AIM We tested whether gendered racial microaggressions stress (GRMS) would be associated with AAW's suicidal ideation, and whether internalized racism (self-negativity, IRSN; weakness stereotypes, IRWS; and appearance bias, IRAB) would exacerbate this link based on self-devaluating implications of internalized racism. METHOD Using a sample of 309 AAW (Mage = 20.00, SD = 6.26), we conducted a moderated logistic regression with GRMS predicting suicidal ideation (endorsement or no endorsement) and the three internalized racism factors (IRSN, IRWS, and IRAB) as moderators. RESULTS GRMS significantly predicted suicidal ideation with a threefold increase in the odds of suicidal ideation. Only IRSN significantly exacerbated this link at low to mean levels. CONCLUSION Gendered racial microaggressions is likely a risk factor for suicidal ideation among AAW, particularly for those who internalize negative images of themselves as Asian individuals.
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Affiliation(s)
- Brian TaeHyuk Keum
- Department of Social Welfare, University of California, Los Angeles, USA
| | - Michele J Wong
- Department of Social Welfare, University of California, Los Angeles, USA
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10
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Lovejoy C, Fitzgerald L, Mutch A. Understanding access to healthcare for gender diverse young people: a critical review of the literature. CULTURE, HEALTH & SEXUALITY 2023; 25:18-32. [PMID: 35000558 DOI: 10.1080/13691058.2021.2017486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 12/08/2021] [Indexed: 06/14/2023]
Abstract
Gender diverse young people face well-documented physical, mental and sexual health disparities compared to the general population. Differential access to healthcare is a key driver of these inequities and literature highlights high unmet healthcare need among members of this group. Healthcare access has been described through a model that defines five dimensions of health services: approachability; acceptability; availability and accommodation; affordability; and appropriateness; and five abilities of health service consumers that interact with these dimensions: the abilities to perceive, seek, reach, pay and engage. This comprehensive literature review examined barriers to and facilitators of healthcare access among gender diverse young people using the lens provided by this model as it relates to dimensions of access at the health service level and/or the abilities of health service users. We advocate expansion of this model to incorporate demand- and supply-side barriers and facilitators of access, and important structural factors including the gender binary health system framework, intersectionality and stigma. Findings highlight the need for improvements to healthcare provider education and the participatory redesign of health services with a focus on intersectionality, individually-tailored service provision and healthcare that is responsive to the unique needs of gender diverse young people.
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Affiliation(s)
- Charlotte Lovejoy
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Lisa Fitzgerald
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Allyson Mutch
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Australia
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11
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Randall AB, van der Star A, Pennesi JL, Siegel JA, Blashill AJ. Gender identity-based disparities in self-injurious thoughts and behaviors among pre-teens in the United States. Suicide Life Threat Behav 2022; 53:241-249. [PMID: 36562588 DOI: 10.1111/sltb.12937] [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: 08/08/2022] [Revised: 09/26/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Transgender individuals are at heightened risk for self-injurious thoughts and behaviors (SITBs). Evidence suggests that middle childhood-aged transgender individuals experience elevated rates of non-suicidal self-injury (NSSI) and passive suicidal ideation (SI), compared to cisgender children. Little is known about gender identity-based disparities in SI more broadly and suicidal behavior (SB) in children aged 9 and 10. The aim of this study was to examine gender identity-based disparities in SITBs among children in middle childhood (pre-teens) in a US-based sample. METHODS Using data from the 3.0 baseline release of the Adolescent Brain Cognitive Development (ABCD) study, logistic regression models, unadjusted and adjusted for covariates, were performed to examine gender identity-based disparities in SITBs. RESULTS In a model adjusted for birth sex, race/ethnicity, and household income, transgender children were at significantly higher odds for current (adjusted odds ratio [AOR] = 6.34) but not lifetime NSSI compared with cisgender children. Transgender children were at significantly higher odds for current and lifetime SI (AOR = 13.03; AOR = 5.39, respectively) and SB (AOR = 14.21; AOR = 12.64, respectively) compared with cisgender children. CONCLUSIONS Gender identity-based disparities in SITBs may be present as early as age 9 and 10, demonstrating the need for SITB prevention and intervention efforts specific to transgender children.
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Affiliation(s)
- Alyson B Randall
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - Arjan van der Star
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - Jamie-Lee Pennesi
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - Jaclyn A Siegel
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - Aaron J Blashill
- Department of Psychology, San Diego State University, San Diego, California, USA.,San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California
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12
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Lett E, Abrams MP, Moberg E, Benson GP, Perlson JE. Syndemic relationship of depressive symptoms, substance use, and suicidality in transgender youth: a cross-sectional study using the U.S. youth risk behavior surveillance system. Soc Psychiatry Psychiatr Epidemiol 2022; 57:2293-2304. [PMID: 35962805 DOI: 10.1007/s00127-022-02348-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 08/02/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Syndemics are co-occurring epidemics that cluster within populations due to shared socio-structural factors and are often in populations with intersecting forms of vulnerability. Suicide, depression, and substance use all disproportionately affect transgender and gender diverse (TGD) youth. In this study, we test a syndemic model of the relationship between these three mental health conditions in the context of economic deprivation and interpersonal discrimination. METHODS We used data on substance use, depressive symptoms, suicidality, and social-structural factors from 2680 TGD youth captured in the 2017 and 2019 survey waves of the Youth Risk Behavior Surveillance System. We used a latent class analysis (LCA) to identify groups with distinct patterns of self-reported substance use and depressive symptoms, and regression models to characterize the relationship between substance-use, depressive symptoms, class membership, social-structural factors, and suicidality. RESULTS A three-class LCA solution identified a subset of student respondents in a "high use" latent class characterized by high self-reported substance use frequency and depressive symptoms compared with other classes. Online bullying (aOR: 1.58; 95% CI: 1.28-1.95) and housing insecurity (aOR: 8.78; 95% CI: 4.35-17.71) were associated with increased odds of "high use" class membership relative to the "no use" class membership. "High use" class membership was associated with increased odds of suicidal ideation (aOR: 2.26; 95% CI: 1.75-2.94), plans (aOR: 2.59; 95% CI: 2.01-3.36), and attempts (aOR: 6.85; 95% CI: 3.17-15.68). CONCLUSION The co-occurrence of substance use and depressive symptoms is associated with socio-structural factors and may drive risk for suicidality among TGD youth. Meaningful suicide prevention efforts that address disproportionate risk in this population must be attentive to and mitigate the shared determinants of mood symptoms and substance use behavior.
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Affiliation(s)
- Elle Lett
- Perelman School of Medicine, University of Pennsylvania, Blockley Hall, Philadelphia, PA, 19146, USA. .,Center for Applied Transgender Studies, Chicago, IL, USA.
| | - Matthew P Abrams
- Center for Emergency Care Policy and Research, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Penn Medicine Center for Digital Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Emery Moberg
- Unaffiliated Recent College Graduate, Los Angeles, CA, USA
| | - G Perusi Benson
- Department of Psychology, North Carolina State University, Raleigh, NC, USA
| | - Jacob E Perlson
- Department of Psychiatry, Columbia University, New York, NY, USA
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13
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Shah TN, Parodi KB, Holt MK, Green JG, Katz-Wise SL, Kraus AD, Kim GS, Ji Y. A Qualitative Exploration of How Transgender and Non-binary Adolescents Define and Identify Supports. JOURNAL OF ADOLESCENT RESEARCH 2022. [DOI: 10.1177/07435584221123123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This qualitative study explored how 249 transgender and non-binary (TNB) adolescents (ages 14–18) described salient supports in their lives, and ways in which key social-ecological contexts could better support TNB adolescents’ wellbeing. Participants were recruited through social media, and completed online surveys; all study procedures were approved by the Boston University Institutional Review Board. Most (84.7%) participants identified as White, and as sexual minorities (96.4%). Modified consensual qualitative research (CQR-M) methods were used to examine TNB adolescents’ responses to two questions: “In your life, which people, if any, would you describe as most supportive, and why?” and “What can individuals/groups within families, schools, and communities do to best support the well-being of transgender and non-binary adolescents?” Results indicated that the most common source of support for TNB participants was peers, followed by family members. Participants also highlighted the centrality of supportive environments that offer access to resources, as well as support derived through policies and practices that reduce stigma. Collectively, results have implications for how individuals and systems can foster wellbeing among TNB adolescents.
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Affiliation(s)
| | | | | | | | | | | | | | - Yujie Ji
- Tufts University, Medford, MA, USA
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14
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Valente PK, Dworkin JD, Dolezal C, Singh AA, LeBlanc AJ, Bockting WO. Prospective relationships between stigma, mental health, and resilience in a multi-city cohort of transgender and nonbinary individuals in the United States, 2016-2019. Soc Psychiatry Psychiatr Epidemiol 2022; 57:1445-1456. [PMID: 35312828 DOI: 10.1007/s00127-022-02270-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 03/08/2022] [Indexed: 02/06/2023]
Abstract
PURPOSE Gender-based stigma is a fundamental cause of mental health disparities among transgender and non-binary (TGNB) individuals, while resilience factors may be protective. We examined prospective relationships between gender-based enacted stigma, psychological distress, and resilience factors among TGNB individuals. METHODS Between 2016 and 2017, we enrolled 330 TGNB individuals in three metropolitan areas in the U.S. in a prospective cohort study focused on gender identity development, risk, and resilience across the lifespan. Using multilevel regression, we examined prospective associations between enacted gender-based stigma and psychological distress (measured by the Global Severity Index/BSI-18), and examined transgender pride and social support as moderators, adjusting for age, sex assigned at birth, race/ethnicity, education, and income. RESULTS Our sample was diverse in age (M = 34.4, range 16-87) and race/ethnicity (56.4% non-White). Over 2 years of follow-up, there was a decrease in reported gender-based stigma (b = - 0.61, p < 0.001) and transgender pride (b = - 0.14, p = 0.003), increase in social support (b = 0.21, p < 0.001), and no change in psychological distress. In adjusted analyses, gender-based stigma was positively associated with psychological distress (b = 1.10, p < 0.001) and social support was negatively associated with psychological distress (b = - 2.60, p < 0.001). Transgender pride moderated the relationship between stigma and psychological distress (p < 0.01), such that the association was stronger for lower levels of transgender pride. CONCLUSIONS Our study provides longitudinal evidence for the deleterious role of gender-based stigma among TGNB individuals. Future interventions should consider fostering transgender pride and social support to promote mental health and mitigate negative effects of gender-based stigma.
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Affiliation(s)
- Pablo K Valente
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, 4th Floor, Providence, RI, 02912, USA
| | - Jordan D Dworkin
- Division of Gender, Sexuality, and Health, New York State Psychiatric Institute/Columbia Psychiatry, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Curtis Dolezal
- Division of Gender, Sexuality, and Health, New York State Psychiatric Institute/Columbia Psychiatry, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA
| | - Anneliese A Singh
- Tulane University School of Social Work, 127 Elk Place, New Orleans, LA, 70112, USA
| | - Allen J LeBlanc
- Health Equity Institute, San Francisco State University, 1600 Holloway Ave, San Francisco, CA, 94132, USA
| | - Walter O Bockting
- Division of Gender, Sexuality, and Health, New York State Psychiatric Institute/Columbia Psychiatry, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA.
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15
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Gonzales G, Deal C. Health Risk Factors and Outcomes Among Gender Minority High School Students in 15 US States. JAMA 2022; 327:1498-1500. [PMID: 35438737 PMCID: PMC9020206 DOI: 10.1001/jama.2022.3087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
This study uses state data sets from the 2017 and 2019 Youth Risk Behavior Survey to assess health risk factors and health outcomes by gender identity among a large, population-based sample of gender minority adolescents.
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Affiliation(s)
- Gilbert Gonzales
- Department of Medicine, Health, and Society, Vanderbilt University, Nashville, Tennessee
| | - Cameron Deal
- Program for Public Policy Studies, Vanderbilt University, Nashville, Tennessee
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16
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Biggs M. Suicide by Clinic-Referred Transgender Adolescents in the United Kingdom. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:685-690. [PMID: 35043256 PMCID: PMC8888486 DOI: 10.1007/s10508-022-02287-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 01/05/2022] [Accepted: 01/05/2022] [Indexed: 05/25/2023]
Affiliation(s)
- Michael Biggs
- Department of Sociology and St Cross College, University of Oxford, 42 Park End Street, Oxford, OX1 1JD, UK.
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17
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Phillip A, Pellechi A, DeSilva R, Semler K, Makani R. A Plausible Explanation of Increased Suicidal Behaviors Among Transgender Youth Based on the Interpersonal Theory of Suicide (IPTS): Case Series and Literature Review. J Psychiatr Pract 2022; 28:3-13. [PMID: 34989340 DOI: 10.1097/pra.0000000000000604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Growing data on suicidal behavior among members of the lesbian, gay, bisexual, transgender, queer, questioning, and other sexual/gender minority (LGBTQ+) communities, particularly in the transgender subgroup, demonstrate that there is a stark elevation in suicidality compared with rates in their cisgender counterparts. Among the available theories of suicide, the interpersonal theory of suicide (IPTS) is a plausible explanation for the increased suicidal behaviors among transgender youths. OBJECTIVE The objective of this study was to examine the pathologic basis of treatment-resistant suicidality in transgender youth despite favorable environments using the theoretical framework of the IPTS, supported by a literature review and case series. METHODS We conducted a literature review using PubMed and PsycInfo with key words suicidal ideation, suicidality, transgender, transgender youth, gender dysphoria, and interpersonal theory of suicide. Seventy-eight articles were retrieved, which were then narrowed down to 30 articles after non-English articles and irrelevant topics were excluded. The clinical presentations of 5 transgender youths, 11 to 17 years of age, were found to be correlated with relevant reports in the research literature, implying a plausible rationale for elevated rates of suicide. All patients and families supplied verbal consent for these case reports to be published. RESULTS Reasons for suicidal behavior among the patients included thwarted belongingness and perceived burdensomeness leading to perpetual suicidal behavior. The presence in these cases of the following contributing factors in the IPTS-thwarted belongingness, perceived burdensomeness, and acquired capability for suicide-suggests that such a basis exists. Perceived burdensomeness appears to have a greater correlation with developing suicidal behavior than thwarted belongingness alone, but the presence of both demonstrates the highest risk of suicidality in transgender youth. Transgender children and adolescents are at extremely high risk of suicidal behavior, but little research has been devoted to the etiology and plausible explanations for this elevated risk, despite growing awareness of and support for the problem. This review suggests further research is required on the triadic factor interactions of the IPTS model that could help us to better understand and intervene with this high-risk population.
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18
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de Graaf NM, Steensma TD, Carmichael P, VanderLaan DP, Aitken M, Cohen-Kettenis PT, de Vries ALC, Kreukels BPC, Wasserman L, Wood H, Zucker KJ. Suicidality in clinic-referred transgender adolescents. Eur Child Adolesc Psychiatry 2022; 31:67-83. [PMID: 33165650 DOI: 10.1007/s00787-020-01663-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 10/11/2020] [Indexed: 12/20/2022]
Abstract
Gender and sexually diverse adolescents have been reported to be at an elevated risk for suicidal thoughts and behaviors. For transgender adolescents, there has been variation in source of ascertainment and how suicidality was measured, including the time-frame (e.g., past 6 months, lifetime). In studies of clinic-referred samples of transgender adolescents, none utilized any type of comparison or control group. The present study examined suicidality in transgender adolescents (M age, 15.99 years) seen at specialty clinics in Toronto, Canada, Amsterdam, the Netherlands, and London, UK (total N = 2771). Suicidality was measured using two items from the Child Behavior Checklist (CBCL) and the Youth Self-Report (YSR). The CBCL/YSR referred and non-referred standardization samples from both the U.S. and the Netherlands were used for comparative purposes. Multiple linear regression analyses showed that there was significant between-clinic variation in suicidality on both the CBCL and the YSR; in addition, suicidality was consistently higher among birth-assigned females and strongly associated with degree of general behavioral and emotional problems. Compared to the U.S. and Dutch CBCL/YSR standardization samples, the relative risk of suicidality was somewhat higher than referred adolescents but substantially higher than non-referred adolescents. The results were discussed in relation to both gender identity specific and more general risk factors for suicidality.
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Affiliation(s)
- Nastasja M de Graaf
- Gender Identity Development Service, The Tavistock and Portman NHS Trust, London, England
- Department of Medical Psychology, Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, the Netherlands
| | - Thomas D Steensma
- Department of Medical Psychology, Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, the Netherlands
| | - Polly Carmichael
- Gender Identity Development Service, The Tavistock and Portman NHS Trust, London, England
| | - Doug P VanderLaan
- Department of Psychology, University of Toronto Mississauga, Mississauga, ON, Canada
- Child and Youth Psychiatry, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Madison Aitken
- Child and Youth Psychiatry, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Peggy T Cohen-Kettenis
- Department of Medical Psychology, Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, the Netherlands
| | - Annelou L C de Vries
- Department of Medical Psychology, Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, the Netherlands
| | - Baudewijntje P C Kreukels
- Department of Medical Psychology, Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, the Netherlands
| | - Lori Wasserman
- Reproductive Life Stages Program, Women's College Hospital, Toronto, ON, Canada
| | - Hayley Wood
- Psychological Services, Toronto Board of Education, Toronto, ON, Canada
| | - Kenneth J Zucker
- Department of Psychiatry, University of Toronto, 250 College St., Toronto, ON, M5T 1R8, Canada.
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19
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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
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20
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Burke TA, Bettis AH, Barnicle SC, Wang SB, Fox KR. Disclosure of Self-Injurious Thoughts and Behaviors Across Sexual and Gender Identities. Pediatrics 2021; 148:peds.2021-050255. [PMID: 34521728 PMCID: PMC9115868 DOI: 10.1542/peds.2021-050255] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/01/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Evidence suggests that sexual minority (SM) and gender minority (GM) youth are more likely to experience self-injurious thoughts and behaviors (SITBs) than heterosexual and cisgender youth. A major barrier to identifying and treating SITBs is nondisclosure. In this study, we explored differences in SITB disclosure patterns between SM and GM youth and their heterosexual and cisgender peers. In this study, we further examined the association between discrimination experiences and SITB disclosure. METHODS Adolescents (N = 931) completed questionnaires assessing demographics, SITBs, disclosure history, disclosure barriers, future intentions to disclose SITBs, and discrimination history. RESULTS Few differences in SITB disclosure patterns emerged between SM and GM youth and heterosexual and cisgender youth (P > .05). SM and GM youth endorsed greater rates of fear of disclosure to and worrying parents, two parent-related barriers ([Formula: see text] = 8.11, P = .017; [Formula: see text] = 7.25, P = .027). GM youth reported greater discrimination experiences than SM youth (F = 6.17, P = .002); discrimination experiences impacted their willingness to disclose future SITBs more so than their SM and heterosexual and cisgender peers (F = 11.58, P < .001). Among the full sample, more discrimination experiences were associated with lower previous disclosure honesty to therapists and pediatricians (r = -0.09 to -0.10, P < .05). Among SM and GM youth, discrimination experiences were associated with lesser odds of disclosing suicide attempts in the future (r = -0.12, P < .05). CONCLUSIONS Minority stress experiences may interfere with SITB disclosure, particularly among GM youth. Targeted interventions should be considered to reduce minority stress and support disclosure.
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Affiliation(s)
- Taylor A. Burke
- Harvard Medical School, Boston, Massachusetts,Massachusetts General Hospital, Boston, Massachusetts
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21
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Voss RV, Simons L. Supporting the Health of Transgender and Gender-Diverse Youth in Primary Care Settings. Prim Care 2021; 48:259-270. [PMID: 33985703 DOI: 10.1016/j.pop.2021.02.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Transgender and gender-diverse youth represent approximately 2% of all youth in the United States. Given that gender diversity usually develops during childhood and adolescence, primary care providers must be equipped to recognize and support youth exploring gender identity or experiencing gender dysphoria. This article provides an overview of gender diversity and reviews strategies for creating a welcoming clinical space, discussing gender during the office visit, providing affirming primary care, and supporting youth and their families during gender identity exploration and gender transition.
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Affiliation(s)
- Raina V Voss
- Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 161b, Chicago, IL 60611, USA; Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Lisa Simons
- Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 161b, Chicago, IL 60611, USA; Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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22
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Michels S, Kovar CL. Transgender and gender-expansive youth: Assisting the nurse in providing culturally competent care for our clients and their families. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2021; 33:157-162. [PMID: 33439549 DOI: 10.1111/jcap.12290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 06/04/2020] [Accepted: 07/12/2020] [Indexed: 11/29/2022]
Abstract
TOPIC Society's blue and pink concept of gender has been under a dramatic and controversial shift over the last 10 years. While the general population has been given some latitude in slowly coming to terms with this new understanding, health care providers, specifically nurses, have been under the microscope to demonstrate a perfect blend of competency and compassion when caring for clients who present outside the gender binary. PURPOSE To clarify the areas of potential impact in the nurse's role and to discuss ways in which they can better equip themselves to promote effective communication and culturally competent care. Thus, we envision heightened empowerment for the nurse to take a more active role in decreasing risks for negative health outcomes such as psychological stress, depression, self-harm, and suicidal ideation in our transgender and gender-expansive youth. SOURCES USED Utilizing PubMed, nationally recognized websites, and current textbooks/pamphlets, a literature review was conducted to ascertain pertinent information related to transgender, gender-expansive youth, and nursing education. Included references were from 2012 to the present. CONCLUSIONS Nurses have a unique and dynamic opportunity to provide support and education for our transgender youth and their families, yet often play a minimal role due to inexperience or lack of resources.
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Affiliation(s)
- Susan Michels
- Department of Family and Community, University of North Carolina Greensboro School of Nursing, Greensboro, North Carolina, USA
| | - Cheryl L Kovar
- Advanced Nursing Practice & Education Department, East Carolina University College of Nursing, Greenville, North Carolina, USA
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23
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Self-Injurious Thoughts and Behaviors Among Sexual and Gender Minority Youth: a Systematic Review of Recent Research. CURRENT SEXUAL HEALTH REPORTS 2020. [DOI: 10.1007/s11930-020-00295-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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24
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Westwater JJ, Riley E, Peterson GM. Using circular questions to explore individual family member experiences of youth gender dysphoria in Australia. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2020; 21:321-336. [PMID: 34993512 PMCID: PMC8726649 DOI: 10.1080/26895269.2020.1777616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Background: The number of young people reporting gender dysphoria is increasing worldwide, with gender dysphoria known to affect everyone in the family in unique ways. Previous research has highlighted the importance of family support and understanding; however, much less is known about individual and collective family member experiences, particularly for siblings under the age of 18 years. Aims: This study sought to identify, describe and interpret individual family member experiences of youth gender dysphoria using semi-structured interviews, incorporating circular questioning, within a whole of family, clinical and wider social context. Methods: Thirty-five individual family members living in Australia (nine young people aged 12-17 years experiencing gender dysphoria, 10 mothers, eight fathers, and eight siblings aged 11-17 years) were interviewed, exploring positive and negative experiences of youth gender dysphoria, within and outside of the family. Family relationships, support and healthcare experiences were also explored. Results: All participants reported a mixture of positive and negative experiences of youth gender dysphoria. Levels of acceptance tended to change with the duration of transition, with most family members adapting with time. Siblings reported mixed experiences within the same family, with some struggling to adapt. Most family members felt that including the whole family in the healthcare of the young person was important, although dependent on individual circumstances and family context. Specialist gender care experiences were unanimously positive, although services were considered difficult to access. Discussion: Family members reported shared and individual positive and negative experiences of youth gender dysphoria across social contexts. Accepting and facilitating gender transition for young people appeared to improve individual and family functioning. Most participants valued a whole of family approach within specialist healthcare. The use of circular questioning in the study helped dispel assumptions and facilitated curiosity for others' experiences in the family.
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Affiliation(s)
| | - Elizabeth Riley
- School of Medicine, University of Tasmania, Hobart, Australia
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