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Obenauf C, Szymanski DM, Owens GP. Moving beyond vulnerability and focusing on resilience: An intersectional posttraumatic growth model for LGBTQ+ people of color. J Clin Psychol 2024. [PMID: 39314121 DOI: 10.1002/jclp.23745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 06/27/2024] [Accepted: 09/09/2024] [Indexed: 09/25/2024]
Abstract
In the context of the legacy of deficit-focused research and application of theoretical models in research on minoritized groups that are underrepresented in the literature, we explored the strengths-based literature among lesbian, gay, bisexual, transgender, and queer (LGBTQ+) people of color to develop a more inclusive and relevant understanding of how posttraumatic growth (PTG) occurs in this population. Our intersectional PTG model is tailored to the experiences of LGBTQ+ people of color that builds upon previous models of PTG, intersectionality theory, and empirical findings of trauma and PTG among LGBTQ+ people of color. Our intersectional PTG model incorporates the unique intrapersonal, interpersonal, institutional, and cultural factors that are unique to this population and contribute to PTG. We challenge the limited scope of Criterion A traumatic events and emphasize empirical findings that support that LGBTQ+ people of color often experience posttraumatic stress after oppression and discrimination. Our model also recognizes the impact of intersecting risk factors, such as gendered racism, that may occur on various levels. Our model acknowledges that LGBTQ+ people of color have often demonstrated PTG in the face of adversity. Intrapersonal factors such as cognitive flexibility, interpersonal factors such as social support, and institutional and cultural factors such as identity-related activism are identified as key contributors to resilience. We discuss practice implications, highlighting that clinicians should recognize limitations of traditional trauma frameworks and adopt culturally sensitive approaches when working with LGBTQ+ people of color. Overall, our model provides a foundation for strengths-based interventions and research, emphasizing resiliency and potential for PTG in this population.
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Affiliation(s)
- Caterina Obenauf
- Department of Psychology, The University of Tennessee, Knoxville, Tennessee, USA
| | - Dawn M Szymanski
- Department of Psychology, The University of Tennessee, Knoxville, Tennessee, USA
| | - Gina P Owens
- Department of Psychology, The University of Tennessee, Knoxville, Tennessee, USA
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2
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McGregor K, Rana V, McKenna JL, Williams CR, Vu A, Boskey ER. Understanding Family Support for Transgender Youth: Impact of Support on Psychosocial Functioning. J Adolesc Health 2024; 75:261-266. [PMID: 38842989 DOI: 10.1016/j.jadohealth.2024.04.006] [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: 10/20/2023] [Revised: 04/03/2024] [Accepted: 04/03/2024] [Indexed: 07/20/2024]
Abstract
PURPOSE This study investigated the association between positive and negative family support and psychosocial outcomes among transgender and gender diverse (TGD) youth. METHODS A retrospective analysis was performed using psychological data collected from 175 TGD youth (aged 13-18 years) at time of hormone readiness assessment within a multispecialty gender clinic between May 2021 and February 2023. As part of this assessment process, TGD youth provided responses to a variety of measures, including the Youth Self-Report and the Family Environment Scale. RESULTS Negative family support scales were more strongly associated with more outcomes than positive support scales. The exclusion and abuse, viewing gender expression as morally wrong, and trying to change gender scales were each associated with significantly higher Youth Self-Report T-scores for internalizing problems (βs = 6.86, 6.26, 5.56, all p < .01), externalizing problems (βs = 4.58, 4.42, 4.19, all p < .02), and total problems (βs = 6.70, 6.45, 5.34, all p < .02). The explicit care and support scale was associated with significantly lower T-scores for externalizing problems (β = -3.54 p = .02) and total problems (β = -3.35, p = .04). Overall support was also associated with higher T-scores in internalizing problems (b = -2.90, p = .02), externalizing problems (β = -2.40, p = .03), and total problems (β = -2.79, p = .03). DISCUSSION Family support plays a critical role in the psychosocial wellbeing of TGD youth. TGD youth reporting positive family support reported fewer mental health concerns, less experiences of nonaffirmation, and lower levels of internalized transphobia. TGD youth reporting negative family support were found to have an increased risk of suicidal ideation.
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Affiliation(s)
- Kerry McGregor
- Boston Children's Hospital, Division of Endocrinology, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Vinisha Rana
- Boston Children's Hospital, Division of Endocrinology, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - John L McKenna
- Boston Children's Hospital, Division of Endocrinology, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Coleen R Williams
- Boston Children's Hospital, Division of Endocrinology, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Ava Vu
- Boston Children's Hospital, Division of Endocrinology, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Elizabeth R Boskey
- Harvard Medical School, Boston, Massachusetts; Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Boston Children's Hospital, Division of Gynecology, Boston, Massachusetts
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Abesamis LEA. Transgender Health Dilemmas: An Intersectional Analysis of the Therapeutic Itineraries of Transgender Communities in the Philippines. JOURNAL OF HOMOSEXUALITY 2024:1-20. [PMID: 38989969 DOI: 10.1080/00918369.2024.2378772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/12/2024]
Abstract
This study leverages an intersectional lens to characterize the therapeutic itineraries of local transgender (trans) communities vis-à-vis salient cisnormative and capitalist structures in Philippine society that produce trans health inequities. Interpretative phenomenological analysis of online interviews with thirteen (13) self-identified trans Filipinos reveals how the inaccessibility of trans-responsive care in the Philippines fosters trans health dilemmas, or the dilemmatic decision-making circumstances and processes that force trans Filipinos to choose between their trans-specific health needs and other needs. Such dilemmas valorize the deprioritization of trans health, disengagement with the health system, and the pursuit of alternative pathways to care oftentimes at the expense of their overall well-being. Addressing these dilemmas entails research, policy, and advocacy work that contend with the implicated structures of domination through systemic interventions initiated in partnership with local trans communities.
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Affiliation(s)
- Luis Emmanuel A Abesamis
- Department of Sociology and Behavioral Sciences, De La Salle University Manila, Manila, Philippines
- Center for Women's and Gender Studies, University of the Philippines, Quezon City, Philippines
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Aggarwal A, Qiao S, O'Leary SD, Schlekat KN, Li X. Measurement Instruments Assessing Multi-Faceted Stigma Regarding Sexual and Gender Minorities: A Systematic Review of Psychometric Properties. AIDS Behav 2024; 28:2054-2077. [PMID: 38441698 DOI: 10.1007/s10461-024-04305-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2024] [Indexed: 06/13/2024]
Abstract
Stigma against sexual and gender minorities (SGM) populations has serious negative health effects for SGM populations. Despite the growing need for accurate stigma measurement in SGM, there are insufficient valid measurement instruments. Moreover, the lack of consistency in construct usage makes comparisons across studies particularly challenging. A critical review and comparative evaluation of the psychometric properties of the various stigma measures for SGM is necessary to advance our understanding regarding stigma measurement against/among SGMs. Based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a comprehensive search was conducted in 4 bibliographic databases (MEDLINE, PsycINFO, CINAHL, and Web of Science) for empirical articles published from 2010 to 2022 that evaluated the psychometrics properties of measurement instruments assessing stigma against SGMs. The screening, extraction, and scoring of the psychometric properties and methodological quality of selected instruments were performed by following the established standards and COSMIN (Consensus-based Standards for the selection of health Measurement Instruments) checklist, respectively. Of the 2031 studies identified, 19 studies were included that reported psychometric properties of 17 measurement instruments. All instruments, except two, were developed for SGMs (n = 15/17). Most instruments included men who have sex with men (MSM) or gay men (n = 11/15), whereas less than half of the instruments assessed stigma among SGM women (n = 6/15). Internal consistency (Cronbach's alpha) and content validity was reported for all instruments (n = 17); construct and structural validity was also reported for majority of the instruments (n = 15 and 10, respectively). However, test-retest reliability and criterion validity was reported for very few instruments (n = 5 each). Based on the COSMIN checklist, we identified the most psychometrically and methodologically robust instruments for each of the five stigma types: combined stigma, enacted stigma, internalized stigma, intersectional stigma, and perceived stigma. For each stigma type, except anticipated stigma, at least one instrument demonstrated strong promise for use in empirical research; however, the selection of instrument depends on the target population and context of the study. Findings indicated a growing use of instruments assessing multiple stigma types. Future studies need to develop intersectional stigma instruments that account for the multiple and intersecting social identities of SGMs. Additionally, most existing instruments would benefit from further psychometric testing, especially on test-retest reliability, criterion validity, adaptability to different LGBTQIA + populations and cultures.
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Affiliation(s)
- Abhishek Aggarwal
- Department of Health Promotion, Education and Behavior, University of South Carolina, Columbia, USA
| | - Shan Qiao
- Department of Health Promotion, Education and Behavior, University of South Carolina, Columbia, USA.
| | - Shannon D O'Leary
- College of Arts and Sciences, University of South Carolina, Columbia, USA
| | - Katrina N Schlekat
- Arnold School of Public Health, University of South Carolina Honors College, Columbia, USA
| | - Xiaoming Li
- Department of Health Promotion, Education and Behavior, University of South Carolina, Columbia, USA
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Carvalho SA, Carvalho F, Fonseca L, Santos G, Castilho P. Beyond the Centrality of Shame: How Self-Concealment and Fear of Receiving Compassion From Others Impact Psychological Suffering in Transgender Adults. JOURNAL OF HOMOSEXUALITY 2024; 71:1373-1391. [PMID: 36043899 DOI: 10.1080/00918369.2022.2114398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Shame-based social interactions are a minority social stressor commonly experienced by transgender individuals. However, few studies have explored the centrality of shame experiences in transgender identity and mental health. Also, the ability to receive care and soothing support may be influenced by intrapersonal shame- and fear-related factors, which may hinder openness, and support and care seeking, thus contributing to psychological distress. This study aims to examine the relationship between central shame experiences, fear of receiving compassion from others, self-concealment, and psychological distress (depression, anxiety, and stress symptoms) in a sample of Portuguese transgender adults. Following a cross-sectional design, data from a convenience sample of 70 self-identified transgender individuals undergoing gender-affirming medical interventions (GAMIs) were analyzed, using SPSS PROCESS, to determine whether the relationship between central shame experiences and psychological suffering occurred indirectly through fear of receiving compassion from others, and self-concealment. Results suggest that fear of receiving compassion from others, but not self-concealment, was the underlying factor between central shame experiences, and depression and anxiety. Results suggest that the centrality of shame experiences and stress symptomatology associate sequentially through fear of compassion and, in turn, through self-concealment. Clinical implications for mental health interventions with transgender individuals undergoing GAMI are discussed.
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Affiliation(s)
- Sérgio A Carvalho
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention (CINEICC), University of Coimbra, Coimbra, Portugal
- HEI-Lab: Digital Human-Environment Interaction Lab, School of Psychology and Life Sciences (EPCV), Lusófona University, Lisbon, Portugal
| | - Frederica Carvalho
- Faculty of Medicine, Institute of Psychological Medicine (IPM), University of Coimbra, Coimbra, Portugal
| | - Lígia Fonseca
- CHUC, Centro de Responsabilidade Integrada de Psiquiatria (CRIP), Coimbra University Hospital, Coimbra, Portugal
| | - Graça Santos
- CHUC, Centro de Responsabilidade Integrada de Psiquiatria (CRIP), Coimbra University Hospital, Coimbra, Portugal
| | - Paula Castilho
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention (CINEICC), University of Coimbra, Coimbra, Portugal
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Brecht A, Bos S, Ries L, Hübner K, Widenka PM, Winter SM, Calvano C. Analyzing body dissatisfaction and gender dysphoria in the context of minority stress among transgender adolescents. Child Adolesc Psychiatry Ment Health 2024; 18:30. [PMID: 38431595 PMCID: PMC10909265 DOI: 10.1186/s13034-024-00718-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 02/05/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND Gender dysphoria among transgender adolescents has predominantly been examined in relation to body dissatisfaction. While in adult transgender samples, body dissatisfaction is higher than in cisgender controls, this has so far rarely been investigated for adolescents. In the context of a cisnormative society, the impact of influences from the social environment on body dissatisfaction and gender dysphoria has been neglected in research. Therefore, this study aimed to (1) provide a detailed analysis of body dissatisfaction among young transgender people and (2) investigate whether body dissatisfaction and gender dysphoria are associated with experiences of minority stress such as trans hostility and poor peer relations (PPR). METHODS The paper presents a cross-sectional study among a sample of transgender adolescents, presenting at a specialized outpatient counseling clinic (N = 99; age M = 15.36, SD = 1.85). First, body dissatisfaction (assessed by the Body-Image-Scale; BIS), was explored and compared to data from a population-based control group of cisgender peers (N = 527; age M = 14.43, SD = 0.97). Second, within a clinic-referred transgender subsample (n = 74), associations between body dissatisfaction and gender dysphoria (measured by Utrecht Gender Dysphoria Scale; UGDS), PPR (measured by the Youth-Self-Report; YSR-R), and trans hostile experiences (assessed in clinical interview) were examined by correlations, t-tests and multivariate regression. RESULTS Transgender adolescents reported more body dissatisfaction than cisgender peers. The dissatisfaction with sex characteristics, non-hormonal reactive body regions and the total score for body dissatisfaction were positively related with gender dysphoria. The majority had experienced trans hostility in the present and/or past (54.1%) and PPR (63.5%). More body dissatisfaction was correlated with more PPR regarding visible body parts i.e., hair, overall appearance and muscles, whilst PPR and gender dysphoria were not associated. Transgender adolescents who experienced trans hostility showed higher gender dysphoria and PPR, but not more body dissatisfaction. In multiple regression, trans hostility predicted gender dysphoria, whilst age and PPR predicted body dissatisfaction. DISCUSSION Experiences of minority-stress differentially interact with body dissatisfaction and gender dysphoria among transgender adolescents. Social correlates of body dissatisfaction and gender dysphoria must be considered when working with young transgender people.
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Affiliation(s)
- Alexandra Brecht
- Department of Education and Psychology, Clinical Child and Adolescent Psychology and Psychotherapy, Freie Universität Berlin, 14195, Berlin, Germany.
- Department of Child and Adolescent Psychiatry, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin and Berlin Insitute of Health, 13353, Berlin, Germany.
| | - Sascha Bos
- Department of Child and Adolescent Psychiatry, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin and Berlin Insitute of Health, 13353, Berlin, Germany
| | - Laura Ries
- Department of Child and Adolescent Psychiatry, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin and Berlin Insitute of Health, 13353, Berlin, Germany
| | - Kerstin Hübner
- Department of Child and Adolescent Psychiatry, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin and Berlin Insitute of Health, 13353, Berlin, Germany
| | - Pia-Marie Widenka
- Klinik für Kinder- und Jugendmedizin, Universität zu Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - Sibylle Maria Winter
- Department of Child and Adolescent Psychiatry, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin and Berlin Insitute of Health, 13353, Berlin, Germany
| | - Claudia Calvano
- Department of Education and Psychology, Clinical Child and Adolescent Psychology and Psychotherapy, Freie Universität Berlin, 14195, Berlin, Germany
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Sadeghi M, Jamali J, Sheybani F. Translation and Evaluation of Psychometric Properties of the Persian 8-Item Internalized Transphobia (IT) Scale in Iranian Transgenders. J Family Reprod Health 2024; 18:44-52. [PMID: 38863843 PMCID: PMC11162881 DOI: 10.18502/jfrh.v18i1.15438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2024] Open
Abstract
Objective Internalized transphobia (IT) is influenced by societal norms and expectations, and it can have significant negative effects on the well-being and mental health of transgender individuals. The aim of this study was to translate and evaluate the psychometric properties of the Persian 8-item IT scale among Iranian transgender individuals in order to enhance the quality and quantity of research in this field. Materials and methods This cross-sectional and methodological study utilized convenience sampling to recruit 119 transgender individuals in Mashhad, the second most populous city in Iran, in 2021. The Persian translation of the IT scale was developed using the backward-forward translation method. Subsequently, various types of validity and reliability were assessed, including content validity using the content validity index (CVI) and content validity ratio (CVR), face validity based on the impact score, construct validity through confirmatory factor analysis (CFA), internal consistency measured by Cronbach's alpha, and test-retest stability analyzed using the intraclass correlation coefficient (ICC). Results The CVR ranged from 0.600 to 1, the CVI ranged from 0.800 to 1, and the impact score exceeded 1.5, indicating the appropriate content and face validity of the 8-item IT scale. The construct validity analysis revealed that the questionnaire is one-dimensional. The internal consistency, as measured by Cronbach's alpha, was 0.917, and the ICC for test-retest stability was 0.871. Conclusion The Persian version of the IT scale demonstrated high and acceptable psychometric properties. The brevity of this scale facilitates its dissemination and utilization in clinical settings.
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Affiliation(s)
- Mohaddeseh Sadeghi
- Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Jamshid Jamali
- Department of Biostatistics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Farshad Sheybani
- Department of Psychiatry, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Mezza F, Mezzalira S, Pizzo R, Maldonato NM, Bochicchio V, Scandurra C. Minority stress and mental health in European transgender and gender diverse people: A systematic review of quantitative studies. Clin Psychol Rev 2024; 107:102358. [PMID: 37995435 DOI: 10.1016/j.cpr.2023.102358] [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: 04/02/2023] [Revised: 11/08/2023] [Accepted: 11/14/2023] [Indexed: 11/25/2023]
Abstract
The current study aimed at systematically reviewing evidence on the relationships between gender minority stress and mental health outcomes among European transgender and gender diverse (TGD) individuals. A systematic search was conducted in PsycINFO, PubMED, Scopus, and Google Scholar. It was based on Boolean operators to combine terms related to minority stress, TGD identities, and mental health. Thirty studies were identified as eligible. The results confirmed that gender minority stress factors are significantly related with mental health problems among European TGD individuals. Distal stressors were identified as strongly associated with poorer mental health, with gender-related discrimination emerging as the most documented risk factor. The significant role of proximal stressors was also highlighted, with some mediation analyses detecting an indirect effect on mental health. However, identity concealment appeared unrelated to mental health outcomes. Resilience-promoting factors buffering the impact of stressors were also identified, including self-esteem, pride, transitioning, and social support. Conversely, data on community connectedness as a source of resilience were inconclusive. The studies reviewed have several limitations, including lack of longitudinal designs, sampling bias, variability in measurement methods, and unaccounted ethnic variables. Research and clinical recommendations in this field are reported.
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Affiliation(s)
- Fabrizio Mezza
- SInAPSi Center, University of Naples Federico II, Via Giulio Cesare Cortese 29, Napoli 80133, Italy
| | - Selene Mezzalira
- Department of Humanistic Studies, University of Calabria, Via Ponte Bucci Cubo 18/C, Rende 87036, Italy.
| | - Rosa Pizzo
- SInAPSi Center, University of Naples Federico II, Via Giulio Cesare Cortese 29, Napoli 80133, Italy
| | - Nelson Mauro Maldonato
- Department of Neuroscience, Reproductive Sciences, and Dentistry, University of Naples Federico II, Via Sergio Pansini 5, Napoli 80133, Italy.
| | - Vincenzo Bochicchio
- Department of Humanistic Studies, University of Calabria, Via Ponte Bucci Cubo 18/C, Rende 87036, Italy.
| | - Cristiano Scandurra
- Department of Neuroscience, Reproductive Sciences, and Dentistry, University of Naples Federico II, Via Sergio Pansini 5, Napoli 80133, Italy.
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Lawrence SE, Watson RJ, Eadeh HM, Brown C, Puhl RM, Eisenberg ME. Bias-based bullying, self-esteem, queer identity pride, and disordered eating behaviors among sexually and gender diverse adolescents. Int J Eat Disord 2024; 57:303-315. [PMID: 37990394 PMCID: PMC10922269 DOI: 10.1002/eat.24092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 10/30/2023] [Accepted: 10/30/2023] [Indexed: 11/23/2023]
Abstract
OBJECTIVE Limited research incorporates an intersectional approach when evaluating disordered eating behaviors among those holding minoritized social positions, such as lesbian, gay, bisexual, queer, questioning, and/or transgender/gender diverse (LGBTQ) adolescents. The current study assessed stigma experiences from peers at school, self-esteem, LGBTQ pride, and overlapping social positions as they relate to disordered eating behaviors among LGBTQ adolescents. METHOD Participants included 11,083 adolescents (Mage = 15.6, SD = 1.3; 34.8% transgender/gender diverse) from a large national survey study of LGBTQ adolescents from 2017. Exhaustive Chi-square Automatic Interaction Detection analysis was used to identify bias-based bullying experiences (i.e., weight-based, identity-based), self-esteem, LGBTQ pride, and overlapping social positions (i.e., gender identity, sexual identity, race/ethnicity, body mass index (BMI) percentile) associated with the highest prevalence of unhealthy weight control behaviors, extreme unhealthy weight control behaviors, and past year binge eating. RESULTS Adolescents in the 28 identified groups with a high prevalence of disordered eating behavior held at least one structurally marginalized social position (e.g., high BMI), bias-based bullying experience, low self-esteem, or low LGBTQ pride in addition to being LGBTQ. Weight-based bullying was a salient risk-factor for disordered eating across social positions. Among adolescents with the same social positions, levels of self-esteem, LGBTQ pride, but no bias-based bullying experience, prevalence estimates of disordered eating were, on average, 23% lower. DISCUSSION LGBTQ adolescents with multiple marginalized social positions and related factors engage in disproportionately high prevalence disordered eating. Findings underscore the importance of addressing intersecting experiences of stigma to reduce disordered eating and promote health equity among adolescents. PUBLIC SIGNIFICANCE Multiply marginalized LGBTQ adolescents, most of whom also reported experiencing bias-based bullying from peers at school, reported disproportionately high prevalence disordered eating. In comparison groups of adolescents with no bias-based bullying experience, prevalence of disordered eating was, on average, 24% lower. Findings underscore the importance of addressing intersecting experiences of stigma to reduce disordered eating and promote health equity among adolescents.
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Affiliation(s)
- Samantha E. Lawrence
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
- School of Social Work, University of Connecticut, Hartford, CT, USA
| | - Ryan J. Watson
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
| | - Hana-May Eadeh
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Camille Brown
- School of Nursing, University of Minnesota, Minneapolis, MN, USA
| | - Rebecca M. Puhl
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
- Rudd Center for Food Policy & Health, University of Connecticut, Hartford, CT, USA
| | - Marla E. Eisenberg
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
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Gold S, Siira M, Willner S, Alcid C, Chen SC, Tangpricha V, Goodman M, Escoffery C, Owen-Smith A, Yeung H. Lived Experience of Acne and Acne Treatment in Transgender Patients. JAMA Dermatol 2024; 160:164-171. [PMID: 38170514 PMCID: PMC10765311 DOI: 10.1001/jamadermatol.2023.5355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 11/02/2023] [Indexed: 01/05/2024]
Abstract
Importance While acne is common in transgender and gender-diverse people and is associated with gender-affirming hormone therapy, little research has examined these factors and their impact in gender minority groups. Objective To examine the lived experiences of acne and acne treatment in transgender and gender-diverse participants. Design, Setting, and Participants This mixed-methods analysis was conducted at a multidisciplinary gender center at a public safety-net hospital and endocrinology and dermatology clinics at a tertiary academic center from January 4, 2021, to April 7, 2022, using semistructured interviews and surveys. Participants were transgender or gender-diverse adults who had received gender-affirming hormone therapy. Data analysis was performed from November 11, 2021, to March 31, 2023. Exposure Current diagnosis of acne. Main Outcomes and Measures Interviews exploring the experience of acne and acne treatment were audio recorded, transcribed verbatim, coded using minority stress theory and the socioecological model, and analyzed using thematic analysis. Themes were triangulated with survey data on gender, self-reported acne severity, skin-specific quality-of-life impact, and treatment experience. Results A total of 32 participants were included in the study (mean [range] age, 32 [18-57] years; 17 transgender men, 11 transgender women, and 4 nonbinary participants). Ten participants (31%) self-rated their skin as currently clear or almost clear, 11 (34%) reported mild acne, and 11 (34%) had moderate to severe acne. Participants described experiences of rejection and bullying related to acne and admitted avoiding social interactions in which they anticipated acne-related discrimination, which led to feelings of depression and anxiety. Acne worsened body appearance dissatisfaction. Transgender women reported acne interfering with feminine gender expression. Transgender men often normalized acne development, sometimes viewing acne positively as an early sign of testosterone action. Most participants tried over-the-counter acne treatments and commonly sought acne treatment advice from physicians, peers, online forums, and social media. Barriers to acne treatments included cost, lack of multidisciplinary care, mistrust toward the health care system, and lack of transgender-specific acne care education. Conclusions and Relevance In this mixed-methods study, transgender and gender-diverse individuals reported experiencing acne-related stigma and facing barriers to acne treatment. Multilevel changes, such as developing strategies to reduce acne stigma, providing transgender-specific acne care education, facilitating multidisciplinary acne care, and expanding transgender-friendly clinical environments, are recommended to reduce the impact of acne in transgender individuals.
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Affiliation(s)
- Sarah Gold
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - Meron Siira
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - Sigal Willner
- Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Crescent Alcid
- Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Suephy C. Chen
- Department of Dermatology, Duke University School of Medicine and Durham VA Medical Center, Durham, North Carolina
| | - Vin Tangpricha
- Division of Endocrinology, Metabolism, and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Michael Goodman
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Cam Escoffery
- Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Ashli Owen-Smith
- Department of Health Policy and Behavioral Sciences, Georgia State University School of Public Health, Atlanta
| | - Howa Yeung
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
- Clinical Resource Hub, Veterans Administration Veterans Integrated Service Network 7 Southeast Network, Decatur, Georgia
- Associate Editor, JAMA Dermatology
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11
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Loeb TA, Murray SM, Cooney EE, Poteat T, Althoff KN, Cannon CM, Schneider JS, Mayer KH, Haw JS, Wawrzyniak AJ, Radix AE, Malone J, Adams D, Stevenson M, Reisner SL, Wirtz AL. Access to healthcare among transgender women living with and without HIV in the United States: associations with gender minority stress and resilience factors. BMC Public Health 2024; 24:243. [PMID: 38245684 PMCID: PMC10800069 DOI: 10.1186/s12889-024-17764-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 01/13/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Transgender women (TW) experience significant inequities in healthcare access and health disparities compared to cisgender populations. Access to non-transition related healthcare is understudied among TW. We aimed to assess the association between access to care and gender minority stress and resilience factors among TW living with and without HIV in eastern and southern United States. METHODS This study was a cross-sectional analysis of baseline data drawn from a cohort of 1613 adult TW from the LITE Study. The cohort permitted participation through two modes: a site-based, technology-enhanced mode and an exclusively online (remote) mode. Exploratory and confirmatory factor analyses determined measurement models for gender minority stress, resilience, and healthcare access. Structural equation modeling was used to assess the relationships between these constructs. Models were evaluated within the overall sample and separately by mode and HIV status. RESULTS Higher levels of gender minority stress, as measured by anticipated discrimination and non-affirmation were associated with decreased access to healthcare. Among TW living with HIV, higher levels of anticipated discrimination, non-affirmation, and social support were associated with decreased healthcare access. Among TW living without HIV in the site-based mode, resilience was positively associated with positive healthcare experiences and inversely associated with barriers to healthcare access. Among TW living without HIV in the online mode, anticipated discrimination was associated with barriers to healthcare access; resilience was positively associated with positive healthcare experiences and inversely associated with barriers to healthcare access. CONCLUSIONS Gender minority stress was associated with increased barriers to healthcare access among TW in the US, regardless of HIV status. Resilience factors did not mediate this effect. Interventions aiming to increase healthcare access among TW can be aided by efforts to mitigate drivers of gender minority stress and improve patient experiences in healthcare facilities.
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Affiliation(s)
- Talia A Loeb
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, E6014, Baltimore, MD, 21205, USA.
| | - Sarah M Murray
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Erin E Cooney
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Tonia Poteat
- Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Keri N Althoff
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, E6014, Baltimore, MD, 21205, USA
| | | | - Jason S Schneider
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, 1340 Boylston Street, 8th Floor, Boston, MA, 02215, USA
- Beth Israel Deaconess Medical Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - J Sonya Haw
- Division of Endocrinology, Metabolism and Lipids, Emory University School of Medicine, Atlanta, GA, USA
| | - Andrew J Wawrzyniak
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Asa E Radix
- Department of Medicine, Callen-Lorde Community Health Center, New York, NY, USA
| | | | - Dee Adams
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, E6014, Baltimore, MD, 21205, USA
| | - Megan Stevenson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, E6014, Baltimore, MD, 21205, USA
| | - Sari L Reisner
- The Fenway Institute, Fenway Health, 1340 Boylston Street, 8th Floor, Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
- Brigham and Women's Hospital, Boston, MA, USA
- Harvard School of Public Health, Boston, MA, USA
| | - Andrea L Wirtz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, E6014, Baltimore, MD, 21205, USA
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12
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Garcia Nuñez D, Frigerio G, Perler LD, Jäggi T, Schönbucher V, von Känel R. Quality of life and associated factors in Swiss trans people: a cross-sectional study. Front Psychiatry 2024; 14:1233625. [PMID: 38239908 PMCID: PMC10794747 DOI: 10.3389/fpsyt.2023.1233625] [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: 06/02/2023] [Accepted: 12/08/2023] [Indexed: 01/22/2024] Open
Abstract
Background Experiences of stressful life events during transition may have a negative impact on quality of life (QoL) in trans persons. Little attention has been paid to this population in Switzerland, resulting in sparse data on their QoL and associated social factors. Methods 30 participants were recruited during their medical transition treatment and surveyed on their experiences within this time period (13 months after the first medical intervention on average). After performing a diagnostic interview to evaluate their mental health, health-related QoL, psychological distress, self-esteem and the impact of life events that occurred in the last six months on participants were further assessed. Results Approximately 17% of participants had suffered from major depression, 43% reported having had suicidal thoughts or having attempted suicide, and 43% suffered from an anxiety disorder. Psychological distress was twice as high compared to the norm values of the cis population. With regard to QoL, trans individuals showed impairments in the mental domain. Stressful life events were particularly evident on a psychological and social level. Analysis showed a negative correlation between impact of life events and mental QoL and between psychological distress and mental QoL. At the same time, there was a positive correlation between self-esteem and mental QoL. Psychological distress and self-esteem emerged as independent significant predictors of mental QoL. Conclusion This study shows lowered mental QoL and associations of low mental QoL with psychological distress, low self-esteem and stressful life events in trans individuals in Switzerland. The findings concur with the Gender Minority Stress Model and point out that medical transition must not be viewed in isolation but must be embedded in the framework of integrative psychosocial support.
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Affiliation(s)
- David Garcia Nuñez
- Center for Gender Variance, University Hospital Basel, Basel, Switzerland
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Culmannstrasse, Zürich, Switzerland
| | - Giulia Frigerio
- Department of General Surgery, University Hospital Geneva, Rue Gabrielle-Perret-Gentil, Geneva, Switzerland
| | - Laura D. Perler
- Center for Gender Variance, University Hospital Basel, Basel, Switzerland
| | - Tiziana Jäggi
- Department of Psychology, University of Fribourg, Fribourg, Switzerland
| | | | - Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Culmannstrasse, Zürich, Switzerland
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13
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Davidson JD, Neilson EC, Staples JM, Turner RB. Group differences in gender expression discrimination and depressive and anxiety symptoms among transgender and gender-expansive adults: The role of gender identity pride. Bull Menninger Clin 2024; 88:214-238. [PMID: 39226226 DOI: 10.1521/bumc.2024.88.3.214] [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: 09/05/2024]
Abstract
Despite established associations between discrimination and mental health, little research has focused on gender expression discrimination and integrated individual strengths such as transgender and gender-expansive (TGE) identity pride. This study examined the roles of gender expression discrimination and pride in mental health among TGE adults across gender identity, race, and class. A national sample of TGE adults (N = 212) completed online measures assessing gender identity, race, income, gender expression-related discrimination, TGE identity pride, and depression and anxiety symptoms. Gender expression discrimination was positively associated with depressive and anxiety symptoms. Black, Indigenous, People of Color (BIPOC), higher income, transfeminine participants reported more gender expression discrimination. High TGE identity pride buffered the association between gender expression discrimination and depression-most robustly for BIPOC, lower income, transfeminine participants. TGE identity pride may buffer the effects of gender expression discrimination on depression. Intersectionality in case formulation and treatment planning with TGE individuals is vital.
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Affiliation(s)
- Jonathan D Davidson
- Crisis and Residential Recovery Therapist, Pathways, Inc., Ashland, Kentucky
| | - Elizabeth C Neilson
- Director, Community Behavioral Health Clinic, and Assistant Professor, Department of Psychology, Morehead State University, Morehead, Kentucky; Department of Psychology, Eastern Michigan University, Ypsilanti, Michigan
| | - Jennifer M Staples
- Associate Professor, California School of Professional Psychology, Alliant International University, San Diego, California
| | - Rachel B Turner
- Undergraduate research assistant, Department of Psychology, Morehead State University, Morehead, Kentucky
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14
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Sengupta T, Soni T, Bolock AM, Heisey SA, Kuchinski EC, Piper BJ, Joyce JM, Carbe CJ. Knowledge, Attitudes, and Beliefs of Medical Students Toward Transgender Healthcare: A Community-Driven Initiative. Cureus 2023; 15:e49992. [PMID: 38058529 PMCID: PMC10697781 DOI: 10.7759/cureus.49992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2023] [Indexed: 12/08/2023] Open
Abstract
Introduction Transgender patients face substantial systemic healthcare barriers and inadequate care from providers who often demonstrate clinical gaps in the medical needs of the transgender community. Providing interventions in which affirming transgender healthcare is explored, is crucial to delivering competent transgender-patient care and building compassionate physician-patient relationships. The Northeast Pennsylvania (NEPA) Trans Health Conference was established to address the growing need for an educational forum where transgender people could voice their narratives. In this educational intervention study, changes in the knowledge, attitudes, and beliefs about the psychosocial and medical needs of the transgender community in first-year undergraduate medical students were examined pre- and post-trans health conference attendance. Materials and methods In the late spring of both 2018 and 2019, first-year medical students attended the NEPA Trans Health Conference, hosted by the Geisinger Commonwealth School of Medicine (GCSOM). Student knowledge, attitudes, and beliefs, regarding the healthcare needs of the transgender community were evaluated prior to and directly after the conference (intervention). Though the surveys shared thematic similarities, the 2018 and 2019 surveys were different and thus were not used comparatively. Results In 2018, 35.24% of first-year medical students (37/105 participants) completed both the pre- and post-survey. Overall, 62.5% (5/8) of survey items yielded significant differences. In 2019, 25.5%, of first-year medical students (28/110 participants) completed both the pre- and post-survey and 47.6% (9/21) of survey items yielded significant results. Overall, although the majority of first-year medical students displayed positive attitudes toward trans people pre-intervention, the students also demonstrated increased knowledge, empathy, and understanding of the transgender healthcare narrative post-intervention. Conclusion Providing medical students with a humanistic intervention within the medical curriculum that is focused on the transgender person, in addition to their past and present healthcare experiences, offers a bridge between academic content and providing inclusive gender-affirming healthcare to all patients.
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Affiliation(s)
- Tonoya Sengupta
- Department of Medical Education, St. George's University School of Medicine, St. George's, GRD
| | - Tripti Soni
- Department of Psychiatry, University of Maryland Medical Center, Baltimore, USA
| | - Alexa M Bolock
- Department of Radiology, New York-Presbyterian Weill Cornell Medical College, New York, USA
| | - Sarah A Heisey
- Department of Medicine, Prisma Health Greenville Memorial Hospital, Greenville, USA
| | - Elizabeth C Kuchinski
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, USA
| | - Brian J Piper
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, USA
| | - Jennifer M Joyce
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, USA
| | - Christian J Carbe
- Department of Medical Education, Geisinger Commonwealth School of Medicine, Scranton, USA
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15
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Rosser BS, Weideman BC, Rider GN, Jatoi A, Ecklund AM, Wheldon CW, Talley KM, Kulasingam S, Smith MK, Jacobs DR, Mitteldorf D, West W, Alley R, Ross MW. Sexual and Gender Minority Invisibility in Cancer Studies: A Call for Effective Recruitment Methods to Address Cancer Disparities. J Clin Oncol 2023; 41:5093-5098. [PMID: 37725780 PMCID: PMC10666979 DOI: 10.1200/jco.23.00655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 06/09/2023] [Accepted: 07/14/2023] [Indexed: 09/21/2023] Open
Abstract
#LGBTQ+ people with cancer are invisibilized: A call for #intersectional cancer research (link here) #healthequity
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Affiliation(s)
- B.R. Simon Rosser
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Ben C.D. Weideman
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | - G. Nic Rider
- Department of Family Medicine and Community Health, Institute for Sexual and Gender Health, University of Minnesota Medical School, Minneapolis, MN
| | - Aminah Jatoi
- Department of Oncology, Mayo Clinic, Rochester, MN
| | - Alexandra M. Ecklund
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Christopher W. Wheldon
- Department of Social and Behavioural Sciences, College of Public Health, Temple University, Philadelphia, PA
| | - Kristine M.C. Talley
- Adult and Geriatric Health, University of Minnesota School of Nursing, Minneapolis, MN
| | - Shalini Kulasingam
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | - M. Kumi Smith
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | - David R. Jacobs
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | | | - William West
- Department of Writing Studies, University of Minnesota, Minneapolis, MN
| | - Rhea Alley
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Michael W. Ross
- Department of Family Medicine and Community Health, Institute for Sexual and Gender Health, University of Minnesota Medical School, Minneapolis, MN
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16
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Abesamis LEA. Contending with precarity: Digital pathways to sexual and reproductive healthcare among transgender Filipinos during the COVID-19 pandemic. Soc Sci Med 2023; 336:116284. [PMID: 37820496 DOI: 10.1016/j.socscimed.2023.116284] [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: 04/06/2023] [Revised: 08/17/2023] [Accepted: 09/26/2023] [Indexed: 10/13/2023]
Abstract
Stringent lockdowns during the COVID-19 pandemic and the cisnormative framing of sexual and reproductive health (SRH) in the Philippines cultivated precarious access to SRH systems among transgender (trans) communities during the public health crisis. With the shift toward digital health initiatives, this study aimed to explore the experiences of the local trans community in using digital health initiatives (DHIs) to access SRH care and gender-affirming services, information, and providers during the COVID-19 pandemic. Online interviews with 13 self-identified trans Filipinos living in the Philippines during the pandemic were conducted and analyzed using interpretative phenomenological analysis. First, the narratives of trans Filipinos illustrate how DHIs can address discontinuities of care that emerged during the COVID-19 pandemic. However, because of long-standing geographic, economic, and social barriers to trans-responsive healthcare in the Philippines, local trans communities navigate alternative pathways to care established within digital spaces (e.g., social media) by trans individuals and groups. These online communities of care not only connect trans Filipinos to culturally competent and affordable care but also foster a sense of belongingness and support. Taken together, this study underscores the need to go beyond technical access to care to ensure that trans-inclusive and trans-responsive sources and providers of care are made available throughout the healthcare system. As the narratives of trans Filipinos illustrate, the narratives, experiences, and practices within their online communities of care may be the key to actualizing such a healthcare system not only in the Philippines but all over the world.
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Affiliation(s)
- Luis Emmanuel A Abesamis
- Department of Sociology and Behavioral Sciences, De La Salle University Manila, Manila, Philippines; Department of Behavioral Sciences, University of the Philippines Manila, Manila, Philippines.
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17
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Lockmiller C. Decoding the Misinformation-Legislation Pipeline: an analysis of Florida Medicaid and the current state of transgender healthcare. J Med Libr Assoc 2023; 111:750-761. [PMID: 37928129 PMCID: PMC10621716 DOI: 10.5195/jmla.2023.1724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023] Open
Abstract
Background The state of evidence-based transgender healthcare in the United States has been put at risk by the spread of misinformation harmful to transgender people. Health science librarians can alleviate the spread of misinformation by identifying and analyzing its flow through systems that affect access to healthcare. Discussion The author developed the theory of the Misinformation - Legislation Pipeline by studying the flow of anti-transgender misinformation from online echo chambers through a peer-reviewed article and into policy enacted to ban medical treatments for transgender people in the state of Florida. The analysis is precluded with a literature review of currently accepted best practices in transgender healthcare, after which, the author analyzes the key report leveraged by Florida's Department of Health in its ban. A critical analysis of the report is followed by a secondary analysis of the key peer-reviewed article upon which the Florida Medicaid authors relied to make the decision. The paper culminates with a summation of the trajectory of anti-transgender misinformation. Conclusion Misinformation plays a key role in producing legislation harmful to transgender people. Health science librarians have a role to play in identifying misinformation as it flows through the Misinformation - Legislation Pipeline and enacting key practices to identify, analyze, and oppose the spread of harmful misinformation.
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Affiliation(s)
- Catherine Lockmiller
- , Health Science Librarian, Cline Library, Northern Arizona University, Flagstaff, AZ
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18
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Hong D, Tang C, Barnhart WR, Cui S, He J. Testing the associations between internalized cisgenderism, self-objectification, body shame, and mental health correlates in the framework of the pantheoretical model of dehumanization: A study in Chinese transgender adults. Body Image 2023; 46:62-72. [PMID: 37244012 DOI: 10.1016/j.bodyim.2023.05.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 05/05/2023] [Accepted: 05/08/2023] [Indexed: 05/29/2023]
Abstract
As an integrated framework informed by the Minority Stress Model and Objectification Theory, the Pantheoretical Model of Dehumanization was proposed to better understand mental health outcomes in transgender individuals. With a sample of 200 Chinese transgender adults, the present study tested the associations and potential mechanisms between internalized cisgenderism, self-objectification, body shame, and mental health correlates in the framework of the Pantheoretical Model of Dehumanization. Correlation and regression analyses were used. Results showed that internalized cisgenderism was positively related to body shame, psychological distress, disordered eating, non-suicidal self-injury (NSSI), suicidal ideation, and suicide attempts. Body shame showed significant indirect effects in the association between internalized cisgenderism and suicide attempts, and in the associations between internalized cisgenderism and psychological distress, disordered eating, and NSSI. In addition, body shame had significant indirect effects in the associations between body surveillance and disordered eating, NSSI, and suicide attempts, and in the association between body surveillance and psychological distress. As the first study testing the associations of core variables in the Pantheoretical Model of Dehumanization in a Chinese transgender sample, the findings largely supported the model in describing meaningful variance in Chinese transgender adults' psychological distress, disordered eating, and self-injurious thoughts and behaviors.
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Affiliation(s)
- Dinan Hong
- School of Humanities and Social Science, The Chinese University of Hong Kong, Shenzhen, Guangdong, China
| | - Chanyuan Tang
- School of Humanities and Social Science, The Chinese University of Hong Kong, Shenzhen, Guangdong, China
| | - Wesley R Barnhart
- Department of Psychology, Bowling Green State University, Bowling Green, OH, USA
| | - Shuqi Cui
- School of Humanities and Social Science, The Chinese University of Hong Kong, Shenzhen, Guangdong, China
| | - Jinbo He
- School of Humanities and Social Science, The Chinese University of Hong Kong, Shenzhen, Guangdong, China.
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19
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Hoover A, Jeffries I, Thomas M, Leston J. Health Care Access and Lived Experience of American Indian/Alaska Native Two Spirit and LGBTQ+ Participants in the Pride and Connectedness Survey, 2020. Public Health Rep 2023; 138:48S-55S. [PMID: 36734193 PMCID: PMC10515980 DOI: 10.1177/00333549231151650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE To better understand health experiences among Two Spirit and lesbian, gay, bisexual, transgender, and queer and questioning (LGBTQ+) American Indian/Alaska Native (AI/AN) people, we examined experiences with access to health care of 223 AI/AN Two Spirit and LGBTQ+ people. METHODS Participants of the Pride and Connectedness 2020 survey, conducted through the Northwest Portland Area Indian Health Board, were asked about barriers to seeking and accessing care through a 10-question scale. We compared cisgender and gender-diverse participant demographic and scale responses to explore potential differences based on gender identity using the Pearson χ2 test of independence and ordinal logistic regression, respectively. RESULTS Both cisgender and gender-diverse participants experienced at least some difficulties accessing health care. Finances, lack of psychologists/other mental health support, and lack of psychological support groups for Two Spirit and LGBTQ+ communities were the top 3 barriers to care experienced by all participants (84%, 82%, and 80%, respectively). Compared with cisgender participants, gender-diverse participants were more likely to report difficulties accessing care for nearly all questions on the 10-question scale and nearly 3 times more likely to report fear of being mistreated within the health care system based on their gender identity (adjusted odds ratio = 2.9; 95% CI, 1.8-4.9; P < .001). CONCLUSIONS Increased access to mental health services and improved health care provider training that focuses on culturally relevant and gender-affirming practices would benefit the health and well-being of AI/AN people who identify as Two Spirit and LGBTQ+.
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Affiliation(s)
- Ashley Hoover
- Northwest Portland Area Indian Health Board, Portland, OR, USA
| | - Itai Jeffries
- Northwest Portland Area Indian Health Board, Portland, OR, USA
| | - Morgan Thomas
- Northwest Portland Area Indian Health Board, Portland, OR, USA
| | - Jessica Leston
- Northwest Portland Area Indian Health Board, Portland, OR, USA
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20
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Williams DY, Hall WJ, Dawes HC, Srivastava A, Radtke SR, Ramon M, Bouchard D, Chen WT, Goldbach JT. Relationships between internalized stigma and depression and suicide risk among queer youth in the United States: a systematic review and meta-analysis. Front Psychiatry 2023; 14:1205581. [PMID: 37547195 PMCID: PMC10399219 DOI: 10.3389/fpsyt.2023.1205581] [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: 04/14/2023] [Accepted: 06/30/2023] [Indexed: 08/08/2023] Open
Abstract
Background Queer youth experience high rates of depression and suicidality. These disparities stem from stigma-based stressors, including internalized stigma (i.e., negative social views that minoritized individuals internalize about their own identity). Given the importance of this factor in understanding mental health disparities among queer youth, we completed a systematic review and meta-analysis examining the relationships between internalized stigma and outcomes of depression and suicide risk (i.e., suicidal ideation, non-suicidal self-injury, and suicidal behavior). Methods We followed the PRISMA standards. Six bibliographic databases were searched for studies in the United States from September 2008 to March 2022. Dual independent screening of search results was performed based on a priori inclusion criteria. Results A total of 22 studies were included for data extraction and review. Most studies examined general internalized homophobia, with few examining internalized biphobia or transphobia. Many studies examined depression as an outcome, few studies examined suicidal ideation or behavior, and no studies examined non-suicidal self-injury. Meta-analyses model results show the association between general internalized queer stigma and depressive symptoms ranged r = 0.19, 95% CI [0.14, 0.25] to r = 0.24, 95% CI [0.19, 0.29], the latter reflecting more uniform measures of depression. The association between internalized transphobia and depressive outcomes was small and positive (r = 0.21, 95% CI [-0.24, 0.67]). General internalized queer stigma and suicidal ideation had a very weak positive association (r = 0.07, 95% CI [-0.27, 0.41]) and an even smaller, weaker positive association with suicide attempt (r = 0.02, 95% CI [0.01, 0.03]). Conclusion Implications for clinical practice, policy, and future research are discussed.
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Affiliation(s)
| | - William J. Hall
- School of Social Work, University of North Carolina, Chapel Hill, NC, United States
| | - Hayden C. Dawes
- School of Social Work, University of North Carolina, Chapel Hill, NC, United States
| | - Ankur Srivastava
- School of Social Work, University of North Carolina, Chapel Hill, NC, United States
| | - Spenser R. Radtke
- School of Social Work, University of North Carolina, Chapel Hill, NC, United States
| | - Magdelene Ramon
- School of Social Work, University of North Carolina, Chapel Hill, NC, United States
| | - D. Bouchard
- School of Social Work, University of North Carolina, Chapel Hill, NC, United States
| | - Wan-Ting Chen
- School of Social Work, University of North Carolina, Chapel Hill, NC, United States
| | - Jeremy T. Goldbach
- Brown School of Social Work at Washington University, St. Louis, MO, United States
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21
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Conn BM, Chen D, Olson-Kennedy J, Chan YM, Ehrensaft D, Garofalo R, Rosenthal SM, Tishelman A, Hidalgo MA. High Internalized Transphobia and Low Gender Identity Pride Are Associated With Depression Symptoms Among Transgender and Gender-Diverse Youth. J Adolesc Health 2023; 72:877-884. [PMID: 37045610 PMCID: PMC10243649 DOI: 10.1016/j.jadohealth.2023.02.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 02/24/2023] [Accepted: 02/26/2023] [Indexed: 04/14/2023]
Abstract
PURPOSE Prior studies have identified a significant relationship between internalized transphobia and poor mental health among transgender and gender-diverse (TGD) adults; however, this relationship has not been extensively examined among youth. Further, little research has sought to explore protective factors, such as identity pride, and their influence on this relationship. We examined the association between internalized transphobia and depression and anxiety symptoms among TGD youth and explored the moderating role of gender identity pride on these associations. METHODS Participants were 315 TGD youth ages 12-20 years (mean = 16; standard deviation = 1.89) seeking gender-affirming hormone treatment at one of four major pediatric hospitals across the United States. At the time of enrollment, participants were naïve to gender-affirming hormone treatment. Participants self-reported mental health, internalized transphobia, and identity pride. Multiple regression models were used with depression and anxiety symptoms as outcomes and age, designated sex at birth, and perceived parental support included as covariates. RESULTS Greater internalized transphobia was associated with greater depressive symptoms, and gender identity pride moderated this relationship, such that greater gender identity pride was associated with fewer depressive symptoms. Greater internalized transphobia was significantly associated with greater anxiety symptoms; no moderation effect was observed for this relationship. DISCUSSION Gender identity pride influenced mental health symptoms for youth experiencing internalized transphobia and represents a potential key protective factor. These results support efforts to further develop, test, and implement clinical inventions to bolster identity pride for TGD youth.
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Affiliation(s)
- Bridgid Mariko Conn
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California; Division of Adolescent and Young Adult Medicine, Children's Hospital Los Angeles, Los Angeles, California.
| | - Diane Chen
- Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Psychiatry and Behavioral Science, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Johanna Olson-Kennedy
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California; Division of Adolescent and Young Adult Medicine, Children's Hospital Los Angeles, Los Angeles, California
| | - Yee-Ming Chan
- Division of Endocrinology, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Diane Ehrensaft
- Child & Adolescent Gender Center, Benioff Children's Hospital, University of California, San Francisco, California; Division of Pediatric Endocrinology, Department of Pediatrics, University of California San Francisco, San Francisco, California
| | - Robert Garofalo
- Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Departments of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Stephen M Rosenthal
- Child & Adolescent Gender Center, Benioff Children's Hospital, University of California, San Francisco, California; Division of Pediatric Endocrinology, Department of Pediatrics, University of California San Francisco, San Francisco, California
| | - Amy Tishelman
- Department of Psychology and Neuroscience, Boston College, Boston, Massachusetts
| | - Marco A Hidalgo
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
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22
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van Bergen DD, Dumon E, Parra LA, Motmans J, Biedermann LC, Gilissen R, Portzky G. "I Don't Feel at Home in This World" Sexual and Gender Minority Emerging Adults' Self-Perceived Links Between Their Suicidal Thoughts and Sexual Orientation or Gender Identity. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2023; 68:461-469. [PMID: 36632009 PMCID: PMC10331255 DOI: 10.1177/07067437221147420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVES To examine whether sexual and gender minority (SGM) emerging adults perceived their SGM status was linked to suicidal ideation, and to explore if their responses fell within tenets of the minority stress framework. METHOD Open text (survey) responses of Dutch and Flemish SGM emerging adults (n = 187) were thematically analysed using the constant comparative comparison method for qualitative analysis. RESULTS We identified 8 themes in our qualitative analysis. Two themes fell within the scope of the minority stress framework that has received little attention: (1) concerns about relationships and family planning and (2) feeling different (internal stressor). Two additional themes emerged largely beyond the scope of existing minority stress framework studies on suicidality: (3) SGM-related questioning; (4) negativity in LGBT communities. Four established minority stress framework themes emerged: (5) gender identity stress; (6) victimization; (7) coming-out stress; (8) psychological difficulties linked to SGM status. CONCLUSION Suicide prevention needs to focus on supporting SGM emerging adults who worry about feeling "different", or who have concerns over their romantic and family life, on reducing gender minority stress, as well as on caring for those who are victimized due to their sexual or gender identity.
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Affiliation(s)
- Diana D. van Bergen
- Department of Pedagogics and Education, University of Groningen, Groningen, the Netherlands
| | - Eva Dumon
- Unit for Suicide Research, Flemish Centre of Expertise in Suicide Prevention, Ghent University, Ghent, Flanders, Belgium
| | - Luis A. Parra
- Department of Systems, Populations, and Leadership, University of Michigan School of Nursing, Ann Arbor, Michigan, USA
| | - Joz Motmans
- Transgender Infopunt, Ghent University Hospital, and Centre for Research on Culture and Gender, Ghent University, Ghent, Belgium
| | | | - Renske Gilissen
- 113 Suicide Prevention the Netherlands, Amsterdam, the Netherlands
| | - Gwendolyn Portzky
- Unit for Suicide Research, Flemish Centre of Expertise in Suicide Prevention, Ghent University, Ghent, Flanders, Belgium
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McGregor K, McKenna JL, Barrera EP, Williams CR, Hartman-Munick SM, Guss CE. Disordered eating and considerations for the transgender community: a review of the literature and clinical guidance for assessment and treatment. J Eat Disord 2023; 11:75. [PMID: 37189185 DOI: 10.1186/s40337-023-00793-0] [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: 11/14/2022] [Accepted: 04/21/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND It has been well established that individuals who identify as lesbian, gay, bisexual, transgender, and queer are at increased risk for mental health pathology, including eating disorders/disordered eating behaviors (ED/DEB). However, less is understood about the unique experiences of transgender and gender diverse (TGD) people who struggle with ED/DEB. AIMS The purpose of this literature review is to examine the literature regarding the unique risk factors for TGD individuals who experience ED/DEB through a lens informed by the minority stress model. Additionally, guidance around the assessment and clinical management of eating disorders for TGD individuals will be presented. RESULTS TGD people are at increased risk for developing ED/DEB due to a number of factors including: gender dysphoria, minority stress, the desire to pass, and barriers to gender affirming care. CONCLUSION While guidance around assessment and treatment of ED/DEB for TGD individuals is still limited, adhering to a gender affirmative care model is essential.
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Affiliation(s)
- Kerry McGregor
- Gender Multispecialty Service, Boston Children's Hospital, Boston, MA, USA.
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| | - John L McKenna
- Gender Multispecialty Service, Boston Children's Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Ellis P Barrera
- Gender Multispecialty Service, Boston Children's Hospital, Boston, MA, USA
| | - Coleen R Williams
- Gender Multispecialty Service, Boston Children's Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Sydney M Hartman-Munick
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
- UMass Memorial Children's Medical Center/UMass Chan Medical School, Worcester, MA, USA
| | - Carly E Guss
- Gender Multispecialty Service, Boston Children's Hospital, Boston, MA, USA
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
- Division of Pediatrics, Harvard Medical School, Boston, MA, USA
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24
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Cascalheira CJ, Choi NY. Transgender Dehumanization and Mental Health: Microaggressions, Sexual Objectification, and Shame. COUNSELING PSYCHOLOGIST 2023; 51:532-559. [PMID: 37091226 PMCID: PMC10118059 DOI: 10.1177/00110000231156161] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Using structural equation modeling in a national, nonprobabilistic sample of 292 transgender women and men, this project extends the pantheoretical dehumanization framework by testing direct and indirect relations between dehumanization (i.e., a higher-order construct from experiences of transgender microaggressions and sexual objectification), internalization processes (i.e., internalized transnegativity, self-objectification), shame, and general mental health. The model explained 55% of the variance in general mental health. Direct relations between dehumanization and all internalization processes were positive and significant. Internalized transnegativity and shame were significant, negative, direct predictors of mental health, but neither dehumanization nor self-objectification was a significant direct predictor of transgender mental health. Both self-objectification and internalized transnegativity directly predicted more feelings of shame. However, only shame yielded a significant indirect pathway from dehumanization to mental health. The indirect relations from self-objectification and internalized transnegativity to mental health through shame were significant. Research, advocacy, and clinical implications are discussed.
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Mereish EH, Peters JR, Brick LAD, Killam MA, Yen S. A daily diary study of minority stressors, suicidal ideation, nonsuicidal self-injury ideation, and affective mechanisms among sexual and gender minority youth. JOURNAL OF PSYCHOPATHOLOGY AND CLINICAL SCIENCE 2023; 132:372-384. [PMID: 36996184 PMCID: PMC10164073 DOI: 10.1037/abn0000813] [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] [Indexed: 04/01/2023]
Abstract
Sexual and gender minority youth (SGMY) are at greater risk than their heterosexual and cisgender counterparts for suicidal thoughts and behaviors (STB) and nonsuicidal self-injury (NSSI). Unique stressors (i.e., minority stressors) specific to SGMY's stigmatized identities such as discrimination or concealment of one's identity are posited to explain these disparities. However, there is limited research examining the associations among minority stressors, affective mediating processes, and STB and NSSI in SGMY's daily lives. We conducted a 28-day daily diary study to test the mediating effects of daily negative and positive affect and emotion dysregulation between minority stressors and STB and NSSI among SGMY who were recruited from clinical and community settings. Participants were 92 SGMY, aged 12-19 years old (M = 16.45; SD = 1.81; 64% cisgender; 69% White). Results indicated that on days SGMY experienced external and internalized minority stressors, they reported greater intensity of suicidal and nonsuicidal self-injurious ideation and affective distress (i.e., greater negative affect, lower positive affect, and more emotion dysregulation). Greater affective reactivity processes were associated with greater suicidal and nonsuicidal self-injurious ideation intensity on the same day. Most of the within-person associations between external and internalized minority stressors and ideation intensity were mediated by heightened negative affect and emotion dysregulation but not lower positive affect. Our results provide the first evidence of these associations among SGMY, advance the minority stress model, and have implications for clinical interventions as we identified modifiable affective mechanisms. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Ethan H Mereish
- Lavender Lab, Department of Psychology, University of Maryland
| | - Jessica R Peters
- Department of Psychiatry and Human Behavior, Warren Alpert Brown Medical School, Brown University
| | - Leslie A D Brick
- Department of Psychiatry and Human Behavior, Warren Alpert Brown Medical School, Brown University
| | - Matthew A Killam
- Beth Israel Deaconess Medical Center, Department of Psychiatry, Harvard Medical School
| | - Shirley Yen
- Department of Psychiatry and Human Behavior, Warren Alpert Brown Medical School, Brown University
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26
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Kamran R, Jackman L, Chan C, Suk Y, Jacklin C, Deck E, Wietek N, Stepney M, Harrison C, Jain A, Rodrigues J. Implementation of Patient-Reported Outcome Measures for Gender-Affirming Care Worldwide: A Systematic Review. JAMA Netw Open 2023; 6:e236425. [PMID: 37010869 PMCID: PMC10071345 DOI: 10.1001/jamanetworkopen.2023.6425] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 02/12/2023] [Indexed: 04/04/2023] Open
Abstract
Importance Gender-affirming care is a key clinical area that can benefit from implementation of patient-reported outcome measures (PROMs). Identifying barriers to and enablers of PROM implementation is needed to develop an evidence-based implementation strategy. Objective To identify (1) PROMs previously implemented for gender-affirming care and constructs measured, (2) how patients completed PROMs and how results were reported and used, and (3) barriers to and enablers of PROM implementation. Evidence Review In this systematic review, PubMed, Embase, MEDLINE, PsycINFO, CINAHL, and Web of Science were searched from inception to October 25, 2021, and updated on December 16, 2022. Gray literature was searched through gray literature database, online search engine, and targeted website searching. Inclusion criteria were (1) original articles of (2) a formally developed PROM or ad hoc instrument administered for gender-affirming care to (3) patients accessing gender-affirming care. The Critical Appraisal Skills Programme tool was used to evaluate quality of included studies. This review was registered on PROSPERO (CRD42021233080). Findings In total, 286 studies were included, representing 85 395 transgender and nonbinary patients from more than 30 countries. A total of 205 different PROMs were used in gender-affirming care. No studies described using an implementation science theory, model, or framework to support PROM deployment. Key barriers to PROM implementation included issues with evidence strength and quality of the PROM, engaging participants, and PROM complexity. Key enablers of PROM implementation included using PROMs validated for gender-affirming care, implementing PROMs able to be deployed online or in person, implementing PROMs that are shorter and reduce patient burden, engaging key stakeholders and participants as part of developing an implementation plan, and organizational climate. Conclusions and Relevance In this systematic review of barriers to and enablers of PROM implementation in gender-affirming care, PROM implementation was inconsistent and did not follow evidence-based approaches in implementation science. There was also a lack of patient input in creating implementation strategies, suggesting a need for patient-centered approaches to PROM implementation. Frameworks created from these results can be used to develop evidence-based PROM implementation initiatives for gender-affirming care and have potential generalizability for other clinical areas interested in implementing PROMs.
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Affiliation(s)
- Rakhshan Kamran
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Liam Jackman
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Cynthia Chan
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Yujin Suk
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, Ontario, Canada
| | | | - Eve Deck
- Department of Family Medicine, Western University, London, Ontario, Canada
| | - Nina Wietek
- Nuffield Department of Women’s and Reproductive Health, University of Oxford, Oxford, United Kingdom
| | - Melissa Stepney
- Centre for Academic Primary Care, University of Bristol, Bristol, United Kingdom
| | - Conrad Harrison
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Abhilash Jain
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Jeremy Rodrigues
- Warwick Clinical Trials Unit, University of Warwick, Coventry, United Kingdom
- Department of Plastic Surgery, Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, Aylesbury, United Kingdom
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Wall CSJ, Patev AJ, Benotsch EG. Trans broken arm syndrome: A mixed-methods exploration of gender-related medical misattribution and invasive questioning. Soc Sci Med 2023; 320:115748. [PMID: 36736052 DOI: 10.1016/j.socscimed.2023.115748] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 01/23/2023] [Accepted: 01/27/2023] [Indexed: 01/31/2023]
Abstract
RATIONALE Gender-related medical misattribution and invasive questioning (GRMMIQ), colloquially known as "trans broken arm syndrome," is a form of medical discrimination faced by transgender and gender diverse (TGD) patients wherein a provider incorrectly assumes that a medical condition results from a patient's gender identity or medical transition. This phenomenon may take one of two forms: (1) the incorrect and explicit misattribution of gender identity or medical transition as being the cause of an acute complaint, or (2) invasive and unnecessary questions regarding a patient's gender identity or gender transition status. OBJECTIVE Using mixed-methods procedures, this study aims to explore the incidence, some common correlates, and manifestations of GRMMIQ. METHODS American TGD participants (N = 147), recruited through an online recruitment platform, completed questions assessing their experiences in the healthcare system including lifetime incidence of GRMMIQ, outness to healthcare providers, and additional experiences of gender-related discrimination in a medical setting. Participants who indicated experiences of GRMMIQ were asked open-ended questions about one such experience. RESULTS Nearly one-third of participants reported experiencing GRMMIQ. Experiences were associated with outness to acute care providers and other types of gender-related discrimination in healthcare settings. Analysis of qualitative data revealed four primary themes: (1) assumptions of disordered thinking and being, (2) hyperfocus on aspects of medical transition, (3) cultural ignorance and incompetence, and (4) dismissiveness of the patient. CONCLUSION Together, these results enhance the understanding of an underexplored aspect of medical discrimination faced by TGD individuals while highlighting commonalities across different experiences.
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Affiliation(s)
- Catherine S J Wall
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA.
| | - Alison J Patev
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA.
| | - Eric G Benotsch
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA.
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Sessions L, Pipkin A, Smith A, Shearn C. Compassion and Gender Diversity: Evaluation of an Online Compassion-Focused Therapy Group in a Gender Service. PSYCHOLOGY & SEXUALITY 2023. [DOI: 10.1080/19419899.2023.2181097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Affiliation(s)
- Lucy Sessions
- Department of Neuroscience, Psychology and Behaviour, University of Leicester
| | - Alastair Pipkin
- Northamptonshire Gender Service, Northamptonshire Healthcare NHS Foundation Trust
| | - Aimee Smith
- Northamptonshire Gender Service, Northamptonshire Healthcare NHS Foundation Trust
| | - Christina Shearn
- Department of Neuroscience, Psychology and Behaviour, University of Leicester
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29
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Mezzalira S, Scandurra C, Mezza F, Miscioscia M, Innamorati M, Bochicchio V. Gender Felt Pressure, Affective Domains, and Mental Health Outcomes among Transgender and Gender Diverse (TGD) Children and Adolescents: A Systematic Review with Developmental and Clinical Implications. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:ijerph20010785. [PMID: 36613106 PMCID: PMC9819455 DOI: 10.3390/ijerph20010785] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 12/28/2022] [Accepted: 12/28/2022] [Indexed: 05/04/2023]
Abstract
Although capable of mobilizing significant resilience factors to face stigma and discrimination, transgender and gender diverse (TGD) children and adolescents tend to suffer from more adverse mental health outcomes compared to their cisgender counterparts. The minority stressors that this population faces are mainly due to the gender-based pressure to conform to their assigned gender. This systematic review was aimed at assessing the potential mental health issues that affect the TGD population. The literature search was conducted in three databases; namely, Scopus, PubMed, and Web of Science, based on the PRISMA guidelines. The 33 articles included in the systematic review pointed out how TGD children and adolescents experience high levels of anxiety and depression, as well as other emotional and behavioral problems, such as eating disorders and substance use. Resilience factors have been also pointed out, which aid this population in facing these negative mental health outcomes. The literature review highlighted that, on the one hand, TGD individuals appear to exhibit high levels of resilience; nonetheless, health disparities exist for TGD individuals compared with the general population, which are mainly attributable to the societal gender pressure to conform to their assigned gender. Considerations for research and clinical practice are provided.
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Affiliation(s)
- Selene Mezzalira
- Department of Humanities, University of Calabria, 87036 Rende, Italy
| | - Cristiano Scandurra
- Department of Neuroscience, Reproductive Sciences, and Dentistry, University of Naples Federico II, 80131 Naples, Italy
| | - Fabrizio Mezza
- SInAPSi Center, University of Naples Federico II, 80133 Naples, Italy
| | - Marina Miscioscia
- Department of Developmental Psychology and Socialization, University of Padua, 35131 Padua, Italy
| | - Marco Innamorati
- Department of History, Cultural Heritage, Education, and Society, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Vincenzo Bochicchio
- Department of Humanities, University of Calabria, 87036 Rende, Italy
- Correspondence:
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30
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Oorthuys AOJ, Ross M, Kreukels BPC, Mullender MG, van de Grift TC. Identifying Coping Strategies Used by Transgender Individuals in Response to Stressors during and after Gender-Affirming Treatments-An Explorative Study. Healthcare (Basel) 2022; 11:healthcare11010089. [PMID: 36611552 PMCID: PMC9818796 DOI: 10.3390/healthcare11010089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 12/09/2022] [Accepted: 12/23/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Gender-affirming treatments are reported to improve mental health significantly. However, a substantial number of transgender individuals report a relapse in, or persistence of, mental health problems following gender-affirming treatments. This is due to multiple stressors occurring during this period, and in general as a consequence of widespread stigma and minority stress. AIM The aim of this pilot study was to identify different coping strategies that transgender individuals use in response to stressors prior to and following gender-affirming treatments, as mediator of mental health. METHODS Qualitative interviews were conducted to better understand the treatment outcomes and healthcare experiences of Dutch transgender individuals who had received gender-affirming treatments. Nineteen participants were included, of which 12 identified as (transgender) male, six as (transgender) female and one as transgender. OUTCOMES Inductive coding and theory-informed thematic analysis were used to assess stressors (ncodes = 335) and coping strategies (ncodes = 869). RESULTS Four stressor domains were identified, including lack of support system, stressors related to transition, and physical and psychosocial stressors post-transition. We identified six adaptive coping strategies of which acceptance, help seeking and adaptive cognitions concerning gender and transition were reported most frequently. Of the seven maladaptive strategies that we identified, social isolation and maladaptive cognitions concerning gender and transition were the most-reported maladaptive coping strategies Clinical implications: The results indicated that transgender individuals may experience significant stress, both transgender-specific and non-specific, prior to and following gender-affirming treatments and, as a result, use many coping strategies to adapt. Increased awareness of stressors and (mal)adaptive coping strategies may help to improve mental healthcare and overall support for transgender individuals. Strengths and Limitations: This is the first (pilot) study to provide insight into the range of stressors that transgender individuals experience during and after gender-affirming treatments, as well as the variety of coping strategies that are used to adapt. However, since this was a pilot study assumptions and generalizations of the evidence should be made cautiously. CONCLUSION Results of this pilot study showed that transgender individuals may undergo significant stress during and after gender-affirming medical treatment related to the treatments and the social experiences that occur during this period, and as a result, use a range of coping strategies to adapt to the stress.
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Affiliation(s)
- Anna O. J. Oorthuys
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Centers, Location VUmc, 1081 HV Amsterdam, The Netherlands
| | - Maeghan Ross
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Centers, Location VUmc, 1081 HV Amsterdam, The Netherlands
- Amsterdam Public Health Institute, 1081 BT Amsterdam, The Netherlands
| | - Baudewijntje P. C. Kreukels
- Amsterdam Public Health Institute, 1081 BT Amsterdam, The Netherlands
- Department of Medical Psychology, Center of Expertise on Gender Dysphoria, Amsterdam University Medical Centers, Location VUmc, 1081 HV Amsterdam, The Netherlands
| | - Margriet G. Mullender
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Centers, Location VUmc, 1081 HV Amsterdam, The Netherlands
- Amsterdam Public Health Institute, 1081 BT Amsterdam, The Netherlands
| | - Tim C. van de Grift
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Centers, Location VUmc, 1081 HV Amsterdam, The Netherlands
- Amsterdam Public Health Institute, 1081 BT Amsterdam, The Netherlands
- Department of Medical Psychology, Center of Expertise on Gender Dysphoria, Amsterdam University Medical Centers, Location VUmc, 1081 HV Amsterdam, The Netherlands
- Correspondence: ; Tel.: +31-204443520
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31
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Seabra D, Gato J, Carreiras D, Petrocchi N, Salvador MDC. Shame-Based Experiences of Homophobic Bullying and Mental Health: The Mediating Role of Self-Compassionate Actions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16866. [PMID: 36554745 PMCID: PMC9778800 DOI: 10.3390/ijerph192416866] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/12/2022] [Accepted: 12/13/2022] [Indexed: 06/17/2023]
Abstract
Homophobic experiences with traumatic characteristics related to shame are more frequent among sexual minority (SM) than heterosexual individuals. Concurrently, SM individuals present higher levels of psychopathology and transdiagnostic processes (e.g., shame) than heterosexual individuals. Self-compassion has been identified as a protective mechanism that counteracts the effects of shame. The current study aimed to analyse which components of self-compassion affect mental health and test the mediating role of self-compassion in the relationship between feelings of shame in traumatic homophobic bullying experiences (THBEs) and psychopathology indicators (depression, anxiety, and social anxiety symptoms). In this study, 190 Portuguese SM individuals (Mage = 28.3, SD = 7.5) completed self-report measures assessing traumatic experiences, self-compassion, and psychopathology. Data were explored with SPSS and AMOS. Regression analyses showed that internal shame felt during THBE and compassionate actions predicted psychopathology outcomes. Mediation analyses revealed that internal shame during a THBE had a significant indirect effect on all psychopathology outcomes through compassionate actions. In other words, internal shame during a THBE was significantly associated with depression, anxiety, and social anxiety, and these relationships were partially mediated by compassionate actions. Our results reinforce the importance of developing compassionate actions towards the self as a possible protective factor for psychopathology among SM individuals.
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Affiliation(s)
- Daniel Seabra
- University of Coimbra, Center for Research in Neuropsychology and Cognitive and Behavioural Intervention (CINEICC), Rua do Colégio Novo, 3000-115 Coimbra, Portugal
| | - Jorge Gato
- Faculty of Psychology and Education Sciences and Center for Psychology, University of Porto, Rua Alfredo Allen, 4200-135 Porto, Portugal
| | - Diogo Carreiras
- University of Coimbra, Center for Research in Neuropsychology and Cognitive and Behavioural Intervention (CINEICC), Rua do Colégio Novo, 3000-115 Coimbra, Portugal
| | - Nicola Petrocchi
- Department of Economics and Social Sciences, John Cabot University, Via della Lungara 233, 00165 Rome, Italy
- Compassionate Mind Italia, Via Marcantonio Colonna 44, 00192 Rome, Italy
| | - Maria do Céu Salvador
- University of Coimbra, Center for Research in Neuropsychology and Cognitive and Behavioural Intervention (CINEICC), Rua do Colégio Novo, 3000-115 Coimbra, Portugal
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Transgender identity: Development, management and affirmation. Curr Opin Psychol 2022; 48:101467. [PMID: 36219930 DOI: 10.1016/j.copsyc.2022.101467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 09/04/2022] [Accepted: 09/08/2022] [Indexed: 01/28/2023]
Abstract
In this review, I discuss recent research on transgender identity development, management and affirmation, situating key topics within a social feedback model of transgender identity. This model foregrounds the dynamic interplay between internal and external influences on transgender identity. Furthermore, issues of intersectionality are highlighted throughout and located within broader socio-political contexts. Collectively, research on topics such as gender euphoria, passing, identity affirmation and social transitions, among others, points to the pivotal role of supportive social relationships and social environments in the healthy development and expression of transgender identities. Future work should prioritize longitudinal studies with careful and rigorous assessment of identity-related constructs in order to further examine these and other topics.
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Urban B, Knutson D, Klooster D, Soper J. Social and contextual influences on eating pathology in transgender and nonbinary adults. Eat Disord 2022; 31:301-319. [PMID: 36325725 DOI: 10.1080/10640266.2022.2135715] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Eating pathology (EP) is reported at alarmingly high rates among transgender and nonbinary (TNB) people. The present study investigates key associations between experiences that are common in TNB populations and EP. TNB individuals located within the United States (N = 212) who self-identified as currently experiencing disordered eating or an eating disorder were recruited from social media outlets and completed an online survey that included measures of EP, discrimination-based trauma symptoms, internalized transphobia, and gender dysphoria. The average age of participants was just over 27 years old (SD = 6.22) and the majority of participants (68.9%) were nonbinary. Data were analyzed using IBM SPSS version 28 and PROCESS 4.0. Discrimination trauma [β = .27, t(211) = 3.90, p < .001] and internalized transphobia [β = .21, t(211) = 3.03, p = .003] were significant predictors of EP in a multiple regression model. Additionally, internalized transphobia partially mediated the association between discrimination trauma and EP. Findings reinforce the need for trauma-informed and multiculturally competent provision of services for TNB populations presenting with eating concerns. Results also highlight the complex role that previously unexplored variables play in the etiology of EP for TNB populations. Implications and clinical recommendations are discussed.
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Affiliation(s)
- Bek Urban
- School of Community Health Sciences, Counseling & Counseling Psychology, Oklahoma State University, Stillwater, Oklahoma, USA
| | - Douglas Knutson
- School of Community Health Sciences, Counseling & Counseling Psychology, Oklahoma State University, Stillwater, Oklahoma, USA
| | - Dannie Klooster
- School of Community Health Sciences, Counseling & Counseling Psychology, Oklahoma State University, Stillwater, Oklahoma, USA
| | - Jules Soper
- School of Community Health Sciences, Counseling & Counseling Psychology, Oklahoma State University, Stillwater, Oklahoma, USA
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Guimaoutdinov N, Tram JM. Experiences of Transgender Identity in a Sample of Primarily White Binary Trans Masculine and Nonbinary Individuals. Transgend Health 2022; 7:521-527. [PMID: 36644122 PMCID: PMC9829130 DOI: 10.1089/trgh.2020.0150] [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: 01/18/2023] Open
Abstract
Purpose This study investigated the differences between binary and nonbinary transgender individuals' experiences of transgender identity through the Transgender Identity Survey (TIS). Method Binary and nonbinary participants in the United States were recruited through social media. Despite efforts to recruit binary trans feminine individuals and People of Color, the participants in this study were primarily White binary trans masculine and nonbinary individuals. Participants completed the TIS and demographic questions online. Results Four independent t-tests were conducted along the TIS subscales of passing, shame, alienation, and pride. We grouped our sample as "binary" and "nonbinary" based on participant-reported gender. After controlling for multiple comparisons, we had four main findings. First, nonbinary individuals possessed significantly less concern about passing (or being perceived) as their affirmed gender than binary individuals. Second, nonbinary individuals possessed significantly less shame than their binary counterparts. Third, we found no significant differences between binary and nonbinary participants with regard to their feelings of alienation from other transgender individuals. Fourth, nonbinary individuals possessed significantly more pride in their transgender status than binary individuals. Conclusion Our findings, which should be interpreted in light of our sample (i.e., predominantly White binary trans masculine and nonbinary people), suggest that the current standard of care (medical transition) for transgender individuals may not account for the needs of the nonbinary community. Furthermore, concepts of passing and shame may be more nuanced for nonbinary people and warrant future research. Transgender individuals experiencing distress associated with their transgender status may benefit from psychological care aimed at building community resources.
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Affiliation(s)
- Nikolai Guimaoutdinov
- School of Graduate Psychology, Pacific University College of Health Professions, Hillsboro, Oregon, USA
| | - Jane M. Tram
- School of Graduate Psychology, Pacific University College of Health Professions, Hillsboro, Oregon, USA
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Klein A, Golub SA. Ethical HIV research with transgender and non-binary communities in the United States. J Int AIDS Soc 2022; 25 Suppl 5:e25971. [PMID: 36225134 PMCID: PMC9557013 DOI: 10.1002/jia2.25971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 07/19/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Because transgender individuals experience disproportionately high rates of HIV infection, this population is an increasing focus of epidemiological and implementation science research to combat the epidemic. However, study participants, providers and other advocates have become increasingly concerned about research practices that may alienate, objectify, exploit or even re-traumatize the communities they are designed to benefit. This commentary explores the common pitfalls of HIV research with transgender communities and provides a potential framework for ethical, community-engaged research practice. DISCUSSION We review some of the critical challenges to HIV research with transgender and non-binary communities that limit the potential for such studies to improve practice. For example, scales that measure stigma perceptions/experiences often include activating language, while the consistent focus in research on risk and trauma can often feel judgemental and redundant. Because of limited employment opportunities, some participants may feel undue influence by research stipends; others may perceive their participation as fuelling the larger research economy without providing research jobs to community members. Questions remain regarding optimal strategies for authentic research partnership beyond community advisory boards or focus groups. Transgender and non-binary researchers are under-represented and may be tokenized. Many demonstration projects provide much-needed services that disappear when the research funding is over, and community-based dissemination efforts are often perceived as "too little, too late" to effect change. CONCLUSIONS Based on this review and input from study participants across the United States, we detail six recommendations for ethical HIV research with transgender and non-binary communities, including (1) equitable budgeting with community-based programme partners; (2) representation in the development of both research agenda and methods; (3) integration of research activities into the ongoing work of any clinical or service site, so that individuals' needs as "clients" can continue to be prioritized over their role as "participants;" (4) mindfully considered compensation that values the contributions of community members, but avoids undue influence; (5) transparent, community-focused and timely communication at every stage of the study, including research purpose, data usage, preliminary findings and full-scale results; and (6) planning for sustainability of any programme or services beyond the life of the research project.
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Affiliation(s)
- Augustus Klein
- Hunter Alliance for Research and TranslationHunter CollegeNew York CityNew YorkUSA
| | - Sarit A. Golub
- Hunter Alliance for Research and TranslationHunter CollegeNew York CityNew YorkUSA
- Department of PsychologyHunter CollegeNew York CityNew YorkUSA
- Department of Basic and Applied Social PsychologyThe Graduate Center of the City University of New YorkNew York CityNew YorkUSA
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Price MA, Hollinsaid NL. Future Directions in Mental Health Treatment with Stigmatized Youth. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2022; 51:810-825. [PMID: 36007234 PMCID: PMC9835015 DOI: 10.1080/15374416.2022.2109652] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Stigma refers to societally-deemed inferiority associated with a circumstance, behavior, status, or identity. It manifests internally, interpersonally, and structurally. Decades of research indicate that all forms of stigma are associated with heightened risk for mental health problems (e.g., depression, PTSD, suicidality) in stigmatized youth (i.e., children, adolescents, and young adults with one or more stigmatized identities, such as youth of Color and transgender youth). Notably, studies find that stigmatized youth living in places with high structural stigma - defined as laws/policies and norms/attitudes that hurt stigmatized people - have a harder time accessing mental health treatment and are less able to benefit from it. In order to reduce youth mental health inequities, it is imperative for our field to better understand, and ultimately address, stigma at each of these levels. To facilitate this endeavor, we briefly review research on stigma and youth mental health treatment, with an emphasis on structural stigma, and present three future directions for research in this area: (1) directly addressing stigma in treatment, (2) training therapists in culturally responsive care, and (3) structural interventions. We conclude with recommendations for best practices in broader mental health treatment research.
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Affiliation(s)
- Maggi A. Price
- School of Social Work, Boston College, Boston, MA
- Department of Psychology, Harvard University, Cambridge, MA
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Azul D, Hancock AB, Lundberg T, Nygren U, Dhejne C. Supporting Well-Being in Gender-Diverse People: A Tutorial for Implementing Conceptual and Practical Shifts Toward Culturally Responsive, Person-Centered Care in Speech-Language Pathology. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:1574-1587. [PMID: 35580248 DOI: 10.1044/2022_ajslp-21-00322] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
PURPOSE Gender dysphoria is commonly conceptualized as a mental disorder in gender-diverse people who do not identify with the gender assigned to them at birth. Direct support for well-being tends to be delegated to the field of mental health (MH), whereas speech-language pathology (SLP) practice is charged with modifying gender-diverse people's voice and communication in the belief that well-being will improve as a byproduct. However, with the introduction of the minority stress model, gender dysphoria is now understood as the result of sociocultural processes of stigmatization, pathologization, coping, and resilience, and it is to be addressed by all professions providing transgender health services. The purposes of this tutorial are to examine practices in SLP in light of the current conceptualization of gender dysphoria and guide speech-language pathologists in their role in supporting the well-being of gender-diverse people. METHOD We reviewed the SLP and MH literature in the topic area to compare the two disciplines' conceptualizations and approaches to professional support for gender-diverse people. RESULTS We propose a transdisciplinary, person-centered, and culturally responsive approach to SLP practice that directly attends to minority stress, microaggressions, coping skills, and resilience factors. CONCLUSIONS It is not sufficient for speech-language pathologists to delegate support for well-being in gender-diverse people to MH practitioners. Rather, speech-language pathologists need to be proactive in taking responsibility for supporting their clients' well-being based on each individual clinician's knowledge, skills, and capacity to do so. We recommend addressing barriers and facilitators of gender-diverse people's well-being both within SLP as a professional culture and by adapting the clinician's own professional practice.
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Affiliation(s)
- David Azul
- Rural Department of Allied Health, La Trobe University, Bendigo, Australia
| | - Adrienne B Hancock
- Department of Speech, Language, and Hearing Sciences, The George Washington University, Washington, DC
| | | | - Ulrika 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
| | - Cecilia Dhejne
- Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
- ANOVA, Karolinska University Hospital, Stockholm, Sweden
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Friley LB, Venetis MK. Decision-Making Criteria When Contemplating Disclosure of Transgender Identity to Medical Providers. HEALTH COMMUNICATION 2022; 37:1031-1040. [PMID: 33567931 DOI: 10.1080/10410236.2021.1885774] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
As identified in HealthyPeople 2020, the transgender population faces various barriers in accessing quality health care. One barrier includes the fear of negative response or refusal of treatment after disclosing one's transgender identity. In an effort to address this concern, it is essential to understand the criteria that transgender patients consider when determining if they will disclose their gender identity. The disclosure decision-making model (DD-MM) describes how individuals make decisions to share non-visible, health-relevant information with others. Applying the information assessment component of the DD-MM, the present study investigated the salient information assessment themes that contribute to transgender patients' decisions to disclose or withhold their gender identity from medical providers. The sample (N = 26) included transgender individuals who participated in in-depth interviews and described instances and criteria of disclosure decisions. Results revealed that when gauging stigma, participants consider cultural attitudes, how providers may attribute health concerns to their transgender identity, and if providers will perceive them as "trans enough" to provide access to transition-related care. When transition-related care is not necessary, participants' disclosure decision criteria include thoughts on how providers will perceive their gender expression and whether their transgender identity is salient to the medical interaction. Findings also highlighted opportunities for extending prior theoretical conceptualizations and practical implications for transgender care.
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Affiliation(s)
- L Brooke Friley
- Department of Communication & Media, Texas A&M University-Corpus Christi
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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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Diamond LM, Alley J. Rethinking minority stress: A social safety perspective on the health effects of stigma in sexually-diverse and gender-diverse populations. Neurosci Biobehav Rev 2022; 138:104720. [PMID: 35662651 DOI: 10.1016/j.neubiorev.2022.104720] [Citation(s) in RCA: 70] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/25/2022] [Accepted: 05/30/2022] [Indexed: 12/13/2022]
Abstract
For over two decades, the minority stress model has guided research on the health of sexually-diverse individuals (those who are not exclusively heterosexual) and gender-diverse individuals (those whose gender identity/expression differs from their birth-assigned sex/gender). According to this model, the cumulative stress caused by stigma and social marginalization fosters stress-related health problems. Yet studies linking minority stress to physical health outcomes have yielded mixed results, suggesting that something is missing from our understanding of stigma and health. Social safety may be the missing piece. Social safety refers to reliable social connection, inclusion, and protection, which are core human needs that are imperiled by stigma. The absence of social safety is just as health-consequential for stigmatized individuals as the presence of minority stress, because the chronic threat-vigilance fostered by insufficient safety has negative long-term effects on cognitive, emotional, and immunological functioning, even when exposure to minority stress is low. We argue that insufficient social safety is a primary cause of stigma-related health disparities and a key target for intervention.
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Affiliation(s)
- Lisa M Diamond
- Department of Psychology, University of Utah, Salt Lake City, UT, USA.
| | - Jenna Alley
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
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Horstmann S, Schmechel C, Palm K, Oertelt-Prigione S, Bolte G. The Operationalisation of Sex and Gender in Quantitative Health-Related Research: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:7493. [PMID: 35742742 PMCID: PMC9224188 DOI: 10.3390/ijerph19127493] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 06/13/2022] [Accepted: 06/16/2022] [Indexed: 12/10/2022]
Abstract
Current trends in quantitative health research have highlighted the inadequacy of the usual operationalisation of sex and gender, resulting in a growing demand for more nuanced options. This scoping review provides an overview of recent instruments for the operationalisation of sex and gender in health-related research beyond a concept of mutually exclusive binary categories as male or masculine vs. female or feminine. Our search in three databases (Medline, Scopus and Web of Science) returned 9935 matches, of which 170 were included. From these, we identified 77 different instruments. The number and variety of instruments measuring sex and/or gender in quantitative health-related research increased over time. Most of these instruments were developed with a US-American student population. The majority of instruments focused on the assessment of gender based on a binary understanding, while sex or combinations of sex and gender were less frequently measured. Different populations may require the application of different instruments, and various research questions may ask for different dimensions of sex and gender to be studied. Despite the clear interest in the development of novel sex and/or gender instruments, future research needs to focus on new ways of operationalisation that account for their variability and multiple dimensions.
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Affiliation(s)
- Sophie Horstmann
- Department of Social Epidemiology, Institute of Public Health and Nursing Research, University of Bremen, 28359 Bremen, Germany;
- Health Sciences Bremen, University of Bremen, 28359 Bremen, Germany
| | - Corinna Schmechel
- Gender and Science Research Unit, Institute of History, Humboldt-University of Berlin, 10099 Berlin, Germany; (C.S.); (K.P.)
| | - Kerstin Palm
- Gender and Science Research Unit, Institute of History, Humboldt-University of Berlin, 10099 Berlin, Germany; (C.S.); (K.P.)
| | - Sabine Oertelt-Prigione
- Department of Primary and Community Care, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands;
- Sex- and Gender-Sensitive Medicine Unit, University of Bielefeld, 33615 Bielefeld, Germany
| | - Gabriele Bolte
- Department of Social Epidemiology, Institute of Public Health and Nursing Research, University of Bremen, 28359 Bremen, Germany;
- Health Sciences Bremen, University of Bremen, 28359 Bremen, Germany
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Ybarra ML, Goodman KL, Saewyc E, Scheer JR, Stroem IF. Youth Characteristics Associated With Sexual Violence Perpetration Among Transgender Boys and Girls, Cisgender Boys and Girls, and Nonbinary Youth. JAMA Netw Open 2022; 5:e2215863. [PMID: 35653152 PMCID: PMC9164004 DOI: 10.1001/jamanetworkopen.2022.15863] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 03/25/2022] [Indexed: 11/17/2022] Open
Abstract
Importance Gender minority adults experience higher rates of sexual violence (SV) than cisgender adults. How this disparity extends to youths, including perpetration rates, is unknown. Objective To compare rates of experience and perpetration of SV by gender identity and investigate characteristics associated with odds of perpetration within gender identity categories. Design, Setting, and Participants This cross-sectional study used baseline data from a national online longitudinal survey collected in 2018 to 2020. Eligible participants were youths ages 14 to 16 years who read English and had internet access. Data were analyzed in November 2021 and March 2022. Exposures Youth characteristics included stressors associated with being marginalized (eg, internalized transphobia), general stressors (eg, trauma not associated with experiencing SV), other marginalized statuses (eg, identifying as a girl), factors associated with protection (eg, social support), environmental characteristics (eg, community violence exposure), and risk factors associated with SV (eg, consumption of violent pornography). Main Outcomes and Measures Self-reported rates of experiencing and perpetrating SV, defined as sexual assault, rape, attempted rape, and coercive sex, among cisgender, transgender, and nonbinary youths. Results Among 4193 youths in the sample (mean [SD] age, 14.8 [0.7] years), 3282 participants (78.3%) were cisgender, 329 participants (7.9%) were transgender, and 582 participants (13.9%) were nonbinary. The odds of SV perpetration were not statistically significantly different for transgender boys and girls (odds ratio [OR], 0.90; 95% CI, 0.57-1.41; P = .64) or nonbinary youths (OR, 0.78; 95% CI, 0.54-1.12; P = .18) compared with cisgender boys and girls. By contrast, transgender boys and girls (OR, 2.31; 95% CI, 1.83-2.91; P < .001) and nonbinary youths (OR, 2.37; 95% CI, 1.98-2.83; P < .001) were more than 2-fold as likely as cisgender boys and girls to report experiencing SV. Aggressive behavior was associated with higher odds of SV perpetration for transgender boys and girls (adjusted OR [aOR], 1.87; 95% CI, 0.75-4.65; P = .18) and nonbinary youths (aOR, 1.61; 95% CI, 0.78-3.32; P = .20). Indications of hostile masculinity were associated with higher odds of SV perpetration among cisgender youths (ie, positive attitudes for boys to engage in rape behaviors: aOR per unit increase in score, 1.15; 95% CI, 1.07-1.25; P < .001; sexual dominance: aOR per unit increase in score, 1.03; 95% CI, 1.01-1.04; P < .001) but not among transgender or nonbinary youths. Conclusion and Relevance These findings may suggest an important foundation for the development of inclusive, research-based SV prevention programs and methods for incorporating gender identity effectively into SV research.
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Affiliation(s)
- Michele L. Ybarra
- Center for Innovative Public Health Research, San Clemente, California
| | | | - Elizabeth Saewyc
- Stigma and Resilience Among Vulnerable Youth Centre, School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Ida F. Stroem
- Center for Innovative Public Health Research, San Clemente, California
- Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
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Williams AJ, Arcelus J, Townsend E, Michail M. Feasibility and acceptability of experience sampling among LGBTQ+ young people with self-harmful thoughts and behaviours. Front Psychiatry 2022; 13:916164. [PMID: 36061288 PMCID: PMC9428709 DOI: 10.3389/fpsyt.2022.916164] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 07/20/2022] [Indexed: 11/13/2022] Open
Abstract
This study was the first to determine whether it was feasible and acceptable to use experience sampling methods (ESM) among LGBTQ+ young people, who had current experiences of self-harm. Sixteen LGBTQ+ young people (16-25 years old) took part in the experience sampling study. This included a baseline assessment, a 7-day ESM assessment (participants were sampled six times a day using a phone app), and the option of an interview at the end of the 7-day ESM assessment. Feasibility data was descriptively analysed, with pilot ESM data presented. Qualitative data was thematically analysed to determine the acceptability (barriers and facilitators) of taking part in this study. Study feasibility was assessed by enrolment rate (55.2%), participant retention across assessment period (100%), ESM app feasibility (87.5%), and good adherence to total number of ESM surveys (67.6%). Individual study adherence ranged between 43 and 95.2%. Study acceptability was assessed by participant interviews. Thematic analysis indicated four superordinate themes; (i) Self-reflection and awareness; (ii) Practicalities of ESM surveys; (iii) Daily timeframes; and (iv) Suggestions for future studies. Pilot ESM data demonstrates that there was fluctuation of depressive and anxiety symptoms within- and between- participants over the course of the study, however, greater sample power is needed for full analysis. This study demonstrated that ESM designs are feasible and acceptable among LGBTQ+ young people with current experiences of self-harm. Pilot data indicated that specific experiences and moods are likely to be important to self-harm. These potentially have a temporal influence on self-harm behaviour or ideation, and therefore should be examined in a fully powered sample.
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Affiliation(s)
- A J Williams
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, United Kingdom.,Self-Harm Research Group, School of Psychology, University of Nottingham, Nottingham, United Kingdom.,Informatics, Faculty of Natural, Mathematical and Engineering Sciences, King's College London, London, United Kingdom
| | - Jon Arcelus
- Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom.,Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, Barcelona, Spain
| | - Ellen Townsend
- Self-Harm Research Group, School of Psychology, University of Nottingham, Nottingham, United Kingdom
| | - Maria Michail
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, United Kingdom
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Tabler J, Schmitz RM, Nagata JM, Geist C. Self-perceived gender expression, discrimination, and mental health disparities in adulthood. SSM - MENTAL HEALTH 2021. [DOI: 10.1016/j.ssmmh.2021.100020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Asseervatham RA, Eng S, Eang S, Tuot S, Yi S. Barriers and facilitators of post-violence help-seeking behavior among 21-49-year-old transgender women in Phnom Penh: A qualitative study. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2021; 24:368-380. [PMID: 37901056 PMCID: PMC10601521 DOI: 10.1080/26895269.2021.1985677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
Background: Transgender women are disproportionately affected by gender-based violence (GBV). However, little is known about how they respond to GBV. Aims: This study aims to understand transgender women's response to GBV and identify barriers and facilitators in accessing healthcare and legal aid after experiencing the violence. Methods: We conducted a qualitative study between February to March 2020 in Phnom Penh, Cambodia. Data were collected through in-depth interviews with 20 transgender women aged between 21 and 49 who had experienced GBV or knew a peer who had experienced GBV. Thematic analysis was conducted for the coding process, and an inductive approach was used to develop a coding frame. Results: All participants had experienced at least one form of GBV in their lifetime, and most participants had experienced multiple forms of GBV. However, most of them did not seek any services from healthcare providers, law enforcement officers, or assistance for healthcare and legal aid from non-governmental organizations (NGOs). Participants reported the following barriers to access to GBV services: anticipated stigma, the internalized stigma, which resulted in shame and low self-esteem, a lack of knowledge on NGOs' services that can assist with healthcare and legal aid, the perception that mental health services were unavailable, a lack of social support, enacted stigma by the police, and the perceived healthcare cost. The participants reported social support and knowledge of NGOs' services as facilitators of access to GBV service. Social media and NGO staff were reported to be preferred sources of information. Participants wanted more effective law enforcement services, comprehensive healthcare catered to the unique transgender women's needs, and non-discriminating service providers. Discussion: Interventions to address GBV and improve the health outcomes of transgender women should involve creating an enabling environment for help-seeking with the partnership between NGOs and different sectors and building social support.
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Affiliation(s)
- Rysheila Anne Asseervatham
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health, Singapore, Singapore
| | - Sothearith Eng
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Songheang Eang
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Sovannary Tuot
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Faculty of Social Sciences and Humanities, Royal University of Phnom Penh, Phnom Penh, Cambodia
| | - Siyan Yi
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health, Singapore, Singapore
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
- Center for Global Health Research, Touro University California, Vallejo, California, USA
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Kittiteerasack P, Matthews AK, Park C. Psychometric properties of the Thai version of the Internalized sexual stigma scale for research on lesbian, gay, bisexual, and transgender (LGBT) populations. PSYCHOLOGY & SEXUALITY 2021. [DOI: 10.1080/19419899.2021.2000013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | - Alicia K. Matthews
- College of Nursing, The University of Illinois at Chicago, Illinois, United States
| | - Chang Park
- College of Nursing, The University of Illinois at Chicago, Illinois, United States
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Christian LM, Cole SW, McDade T, Pachankis JE, Morgan E, Strahm AM, Kamp Dush CM. A biopsychosocial framework for understanding sexual and gender minority health: A call for action. Neurosci Biobehav Rev 2021; 129:107-116. [PMID: 34097981 PMCID: PMC8429206 DOI: 10.1016/j.neubiorev.2021.06.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 05/26/2021] [Accepted: 06/01/2021] [Indexed: 12/29/2022]
Abstract
The number of US adults identifying as lesbian, gay, bisexual, transgender, or a different sexual identity has doubled since 2008, and about 40 % of the sexual and gender minority population identify as people of color. Minority stress theory posits that sexual and gender minorities are at particular risk for stress via stigma and discrimination at the structural, interpersonal, and individual levels. This stress, in turn, elevates the risk of adverse health outcomes across several domains. However, there remains a conspicuously limited amount of research on the psychoneuroimmunology of stress among sexual and gender minorities. We developed the Biopsychosocial Minority Stress Framework which posits that sexual minority status leads to unique experiences of minority stress which results in adverse health behavioral factors, elevated psychological distress and sleep disturbance, and immune dysregulation. Moderators in the model include both individual differences and intersectional identities. There is a crucial need to understand the biological-psychological axis of stress among the increasingly visible sexual and gender minority population to increase their health, longevity, and quality of life.
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Affiliation(s)
- Lisa M Christian
- Department of Psychiatry & Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH, USA; The Institute for Behavioral Medicine Research, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
| | - Steve W Cole
- Department of Psychiatry & Biobehavioral Sciences and Medicine, UCLA School of Medicine, Los Angeles, CA, USA
| | - Thomas McDade
- Department of Anthropology, Northwestern University, Evanston, IL, USA; Institute for Policy Research, Northwestern University, Evanston, IL, USA; Child and Brain Development Program, Canadian Institute for Advanced Research, Toronto, ON, Canada
| | - John E Pachankis
- Yale School of Public Health, New Haven, CT, USA; Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, USA
| | - Ethan Morgan
- College of Nursing, The Ohio State University, Columbus, OH, USA
| | - Anna M Strahm
- Department of Psychiatry & Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH, USA; The Institute for Behavioral Medicine Research, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Claire M Kamp Dush
- Minnesota Population Center, University of Minnesota, Minneapolis, MN, USA; Department of Sociology, University of Minnesota, Minneapolis, MN, USA
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Egan JE, Corey SL, Henderson ER, Abebe KZ, Louth-Marquez W, Espelage D, Hunter SC, DeLucas M, Miller E, Morrill BA, Hieftje K, Sang JM, Friedman MS, Coulter RWS. Feasibility of a Web-Accessible Game-Based Intervention Aimed at Improving Help Seeking and Coping Among Sexual and Gender Minority Youth: Results From a Randomized Controlled Trial. J Adolesc Health 2021; 69:604-614. [PMID: 34140199 PMCID: PMC8494066 DOI: 10.1016/j.jadohealth.2021.03.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/15/2021] [Accepted: 03/16/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE To address the gap in interventions for improving sexual and gender minority youth (SGMY; e.g., lesbian, gay, bisexual, and transgender youth) health, we tested the feasibility of a game-based intervention for increasing help-seeking, productive coping skills, resource knowledge/use, and well-being. METHODS We conducted a 2-arm randomized controlled trial testing a theory-based, community-informed, Web-accessible computer role-playing game intervention. Control condition received a list of resources. Primary hypotheses were high levels of implementation success, game demand, and game acceptability. RESULTS We randomized 240 SGMYs aged 14-18 years into the intervention (n = 120) or control (n = 120) conditions. Participants completed baseline (100%), 1-month follow-up (T2; 73.3%), and 2-month follow-up (T3; 64.4%) surveys. Among intervention participants, 55.8% downloaded and played the game. Of those who played, 46.2% reported a desire to play it again, and 50.8% would recommend it. Game acceptability exceeded hypothesized benchmarks, wherein participants reported high positive affect (M = 2.36; 95% confidence interval [CI]: 2.13, 2.58), low negative affect (M = 2.75; 95% CI: 2.55, 2.95), low tension/annoyance (M = 3.18; 95% CI: 2.98, 3.39), and high competence (M = 2.23; 95% CI: 2.04, 2.43) while playing the game. In multivariable intent-to-treat analyses of 38 secondary/tertiary outcomes, intervention participants reported significantly larger reductions than control participants in cyberbullying victimization (T2 b = -.28; 95% CI: -.56, -.01), binge drinking frequency (T2 b = -.39; 95% CI: -.71, -.06), and marijuana use frequency (T3 b = -2.78; 95% CI: -4.49, -1.08). CONCLUSIONS We successfully implemented a Web-accessible game trial with SGMY. The game-based intervention was feasible and acceptable to SGMY, and preliminary results show it improved several health-related behaviors. A larger scale trial is needed to test whether the game-based intervention can reduce health inequities for SGMY.
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Affiliation(s)
- James E Egan
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.
| | - Stephanie L Corey
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Emmett R Henderson
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kaleab Z Abebe
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - William Louth-Marquez
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Dorothy Espelage
- School of Education, University of North Carolina, Chapel Hill, North Carolina
| | - Simon C Hunter
- Department of Psychology, Glasgow Caledonian University, Glasgow, United Kingdom
| | | | - Elizabeth Miller
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | - Jordan M Sang
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Mark S Friedman
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Robert W S Coulter
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
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Evangelista ZM, Lido C, Swingler M, Bohan J. Exploring LGBT+ campus climate in the UK and Philippines: How prejudice and belonging shape inclusion in higher education. EUROPEAN JOURNAL OF SOCIAL PSYCHOLOGY 2021. [DOI: 10.1002/ejsp.2801] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Zyra M. Evangelista
- Postgraduate Researcher Schools of Education & Psychology University of Glasgow
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Towards Making an Invisible Diversity Visible: A Study of Socially Structured Barriers for Purple Collar Employees in the Workplace. SUSTAINABILITY 2021. [DOI: 10.3390/su13169322] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Eunuchs and members of the transgender community are yet to be recognized as an effective human resource and this diversity in the workforce is still invisible. A tiny portion of the transgender community is employed, and they are tagged as purple collar employees. It is generally claimed that coworkers do not accept members of the transgender community in the workplace and are not willing to work with them due to their different personal, social, and work-related characteristics. This study aimed to investigate coworkers’ attitudes towards transgender colleagues and their willingness to work with them in the workplace. We selected the Punjab province of Pakistan as the context for the study where more than five hundred thousand members of the transgender community live. We collected data from 363 randomly selected respondents working in an organization where transgender people also worked. We applied Structural Equation Modeling (SEM) to analyze the data. Our findings revealed that coworkers do not hesitate to work with transgender people merely based on their biological differences. Coworkers’ willingness was more influenced by social attributes (trust and support) and work attributes (knowledge, ability, and motivation) irrespective of gender differences. The study strongly suggests tapping this invisible human resource and mainstreaming this resource to emancipate transgender people from poverty and to bring a productive diversity in the workforce. Government should frame policies to provide all human rights including national identity, health and educational facilities, and organizations should provide transgender people with jobs to properly utilize this untapped human resource.
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