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Leal GDC, Júnior JNDBS, Ferreira QR, Ballestero JGDA, Palha PF. Institutional Violence Perpetrated against Transgender Individuals in Health Services: A Systematic Review of Qualitative Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:1106. [PMID: 39200715 PMCID: PMC11355012 DOI: 10.3390/ijerph21081106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2024] [Revised: 08/06/2024] [Accepted: 08/14/2024] [Indexed: 09/02/2024]
Abstract
This review aims to analyze the evidence related to violence perpetrated against transgender individuals in health services based on their narratives. This is a systematic literature review of qualitative studies. A search was carried out in the Scopus, Web of Science, Latin American and Caribbean Literature in Health Sciences (LILACS), Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, and MEDLINE databases using the descriptors "transgender people", "violence", and "health services". The eligibility criteria included original qualitative articles addressing the research question, with fully available text, reporting violence specifically by health workers, involving trans individuals aged 18 and above, and published in Portuguese, English, or Spanish. In addition, studies were included that reported experiences of violence suffered by the trans population, through their narratives, in health services. A total of 3477 studies were found, of which 25 were included for analysis. The results highlighted situations such as refusal of service; resistance to the use of social names and pronouns; barriers to accessing health services; discrimination and stigma; insensitivity of health workers; lack of specialized care and professional preparedness; and a system focused on binarism. The analysis of the studies listed in this review highlights the multiple facets of institutional violence faced by the transgender population in health services. It is evident that the forms of violence often interlink and reinforce each other, creating a hostile environment for the transgender population in health services. Thus, there is an urgent need to create strategies that ensure access to dignified and respectful care for all individuals, regardless of their gender identity.
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Affiliation(s)
- Gilberto da Cruz Leal
- Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto 14040-902, Brazil; (J.N.d.B.S.J.); (Q.R.F.); (J.G.d.A.B.); (P.F.P.)
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2
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Berg L, Pringsheim TM, Lerario M, Martino D. Psychological Factors Associated with Functional Tic-like Behaviours during the COVID-19 Pandemic. Res Child Adolesc Psychopathol 2024; 52:1157-1172. [PMID: 38427218 DOI: 10.1007/s10802-024-01184-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] [Accepted: 02/22/2024] [Indexed: 03/02/2024]
Abstract
Functional tic-like behaviours (FTLB) are a female predominant functional neurological disorder that escalated in incidence during the SARS CoV2 pandemic. This study compared social and adaptive functioning, social media use, pandemic experiences, and psychiatric comorbidities between FTLB (n = 35), Tourette Syndrome (TS) (n = 22), and neurotypical (NT) (n = 25) participants ages 11 to 25 years. The psychiatric comorbidity burden for participants with FTLB was formidable, with frequencies ranging from 1.5 to 10 times higher for major depressive disorder and panic disorder compared to TS and NT participants. Borderline personality disorder (BPD), agoraphobia, social anxiety disorder, and generalized anxiety disorder were also significantly more common in FTLB compared to NT participants. Vulnerable attachment scores, social phobia and social interaction anxiety symptoms were higher in participants with FTLB than NT but not TS. Overall distress tolerance, resilient coping, suggestibility, hours on social media, and exposure to tic and TS content were not significantly different between groups. FTLB participants rated their mental health declined more severely during the pandemic than both TS and NT participants and were more likely to experience trouble sleeping, loneliness, and difficulty affording housing and food than NT participants. Participants with FTLB were significantly more likely to identify as gender minority people than TS and NT, though there were no significant differences based on gender identity in the study variables within the FTLB group. The association and potential pathways explaining how psychiatric disorders may be contributing to FTLB, and why certain groups appear at particular risk are discussed.
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Affiliation(s)
- Lindsay Berg
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - Tamara M Pringsheim
- Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Mathison Centre for Mental Health Research and Education, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | | | - Davide Martino
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada.
- Mathison Centre for Mental Health Research and Education, Calgary, AB, Canada.
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.
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3
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Goldberg AE, Frost RL. "Saying 'I'm not okay' is extremely risky": Postpartum mental health, delayed help-seeking, and fears of the child welfare system among queer parents. FAMILY PROCESS 2024. [PMID: 38922870 DOI: 10.1111/famp.13032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 04/28/2024] [Accepted: 06/02/2024] [Indexed: 06/28/2024]
Abstract
Parent mental health challenges in the postpartum and early parenthood have profound implications for parent, child, and family well-being. Little research has focused on postpartum mental health challenges and barriers to help-seeking among queer birthing people, including members of this community who may be particularly vulnerable to mental health difficulties, such as queer cis women partnered with men, trans/nonbinary parents, and queer parents who are young, low-income, and/or of color. This mixed-methods study of queer parents (n = 99), all of whom were assigned female at birth (AFAB) and gave birth to a child within the past several years, explores parents' postpartum mental health difficulties and perceived barriers to seeking help. Using a structural stigma framework, this study found that participants reported high rates of postpartum mental health difficulties (89%) and reported various barriers to seeking support including fears of discrimination and being deemed "unfit" by providers, which might lead to child welfare system involvement. Young parents and low-income parents were particularly fearful of child welfare system contact and potential child removal. Factors that encouraged help-seeking (e.g., desire to be a good parent; partner pressure to seek help) and implications for family practitioners are discussed.
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Bigalky J, Mackey A, Safaralizadeh T, Petrucka P. Degendering Menstruation: A Scoping Review Exploring the Experiences of Transgender and Non-Binary People. JOURNAL OF HOMOSEXUALITY 2024:1-29. [PMID: 38767881 DOI: 10.1080/00918369.2024.2353057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Menstruation is a biological process experienced by up to 800 million people on any given day. Historically, menstruation has been studied from the female perspective. However, it should be considered that not all who menstruate are women. Therefore, the purpose of this research was to determine the status of evidence on transgender and non-binary individuals' experiences with menstruation. Arksey and O'Malley's (2005) framework for conducting a scoping study was used to guide this review. The authors used five steps of the six-step process to identify the research problem and search strategy, select studies based on defined inclusion and exclusion criteria, extract key information from five selected studies, and chart, summarize, and report the results as themes. The analysis resulted in the identification of four themes: (1) gender dysphoria and the influence on identity; (2) menstrual management and transformation as a turning point; (3) managing menstruation in precarious spaces; and (4) moving toward an open dialogue. Findings suggest a need for awareness of diverse and inclusive menstrual experiences. Inclusive advertising and menstrual products are needed to support transgender and non-binary people and reduce gender dysphoria. Policy initiatives should support the reconceptualization of infrastructure so that bathrooms are safe and comfortable places. Future opportunities for research exploring menstrual management within transgender and non-binary populations with emphasis on global research with diverse cultures and social structures is necessary to address gaps in the existing literature.
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Affiliation(s)
- Jodie Bigalky
- College of Nursing, University of Saskatchewan, Saskatoon
| | - April Mackey
- College of Nursing, University of Saskatchewan, Saskatoon
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Kung KTF. Autistic Traits, Gender Minority Stress, and Mental Health in Transgender and Non-Binary Adults. J Autism Dev Disord 2024; 54:1389-1397. [PMID: 36652125 DOI: 10.1007/s10803-022-05875-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2022] [Indexed: 01/19/2023]
Abstract
The present study investigated the relation between autistic traits and gender minority stress and the relative importance of autistic traits and gender minority stress in predicting mental health outcomes in gender minority adults. An online survey was completed by 90 transgender women, 72 transgender men, 48 non-binary individuals assigned male at birth (AMAB), and 98 non-binary individuals assigned female at birth (AFAB). Autistic traits positively correlated with internalised transphobia in the non-binary groups. In general, higher autistic traits and gender minority stress correlated with poorer mental health outcomes. After controlling for gender minority stress, autistic traits accounted for additional variance of suicidality across gender minority groups, anxiety symptoms in the non-binary groups, and all mental health outcomes in non-binary AFAB.
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Affiliation(s)
- Karson T F Kung
- Department of Psychology, University of Hong Kong, Pokfulam, Hong Kong.
- Gender Development Research Centre, Department of Psychology, University of Cambridge, Cambridge, United Kingdom.
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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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Lerario MP, Rosendale N, Waugh JL, Turban J, Maschi T. Functional Neurological Disorder Among Sexual and Gender Minority People. Neurol Clin 2023; 41:759-781. [PMID: 37775203 DOI: 10.1016/j.ncl.2023.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Abstract
Sexual and gender minority (SGM) people can face unique stressors and structural discrimination that result in higher rates of neuropsychiatric symptoms, such as depression, anxiety, and suicidality. Although more rigorous studies are needed, emerging data suggest a possible higher prevalence of functional neurological disorder and other brain-mind-body conditions in SGM people. Representation and iterative feedback from affected community members is critical to the process of developing affirming environments. More research is needed to explore the relevance of functional neurologic disorder in SGM people within a biopsychosocial framework.
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Affiliation(s)
- Mackenzie P Lerario
- Fordham Graduate School of Social Service, New York, NY, USA; Greenburgh Pride, Greenburgh, NY, USA.
| | - Nicole Rosendale
- Department of Neurology, University of California San Francisco; Weill Institute for Neurosciences, University of California San Francisco
| | - Jeff L Waugh
- Department of Pediatrics, UT Southwestern Medical School, Dallas, TX, USA
| | - Jack Turban
- Division of Child & Adolescent Psychiatry, University of California San Francisco
| | - Tina Maschi
- Fordham Graduate School of Social Service, New York, NY, USA; Greenburgh Pride, Greenburgh, NY, USA
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Abstract
Clients who identify as lesbian, gay, bisexual, transgender, queer/questioning (LGBT+) may experience barriers in health care access and services. LGBT+ clients want a welcoming, inclusive, and affirming encounter with nurses and other health care providers. This concept analysis used a modified Walker and Avant method to clarify the concept of LGBT+ inclusive health care. Antecedents, attributes, and consequences of LGBT+ inclusive health care were identified from the literature. The results of this concept analysis of LGBT+ inclusive health care can inform future research, policy, education, and practice to address the health care needs of this population.
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Schwartz J, Ginder W. NCHA variable combination as a method to undertake LGBTQ + student subpopulation analyses. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023; 71:1658-1669. [PMID: 34314647 DOI: 10.1080/07448481.2021.1950730] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 04/16/2021] [Accepted: 06/25/2021] [Indexed: 06/13/2023]
Abstract
ObjectiveCombine National Collegiate Health Assessment (NCHA) measures indicating LGBTQ + membership into a single variable in order to analyze health responses of this group as compared to their cisgender, heterosexual (cis-het) peers. Participants: Students at a liberal arts university who completed the Spring 2019 NCHA-II study (n = 1107). Methods: Four different NCHA sexual orientation and gender identification variables were combined, creating a new variable to examine the campus LGBTQ + student sub-sample as a single, complete group. That group was then compared to cis-het students across multiple variables. Results: LGBTQ + students reported statistically significant differences for key variables such as suicide attempts, suicidal ideation, and self-harm, as well as for stressors that impact academic success such as discrimination. Conclusions: This analysis indicates that the challenges campus LGBTQ + students face are much different than their cis-het peers. Support from campus community members is suggested to reduce negative impacts for these students.
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Affiliation(s)
- Joanna Schwartz
- Department of Management, Marketing, and Logistics, Georgia College and State University, Milledgeville, Georgia, USA
| | - Whitney Ginder
- Department of Management, Marketing, and Logistics, Georgia College and State University, Milledgeville, Georgia, USA
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10
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E. Conlin S, P. Douglass R. Feminist Therapy with Gender Questioning Adolescents: Clinical Case Example. WOMEN & THERAPY 2023. [DOI: 10.1080/02703149.2023.2189777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
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11
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Levitt HM, Kehoe KA, Hand AB. Beyond minority stress: Toward a multidimensional psychology of trans/nonbinary gender. Curr Opin Psychol 2023; 49:101515. [PMID: 36525910 DOI: 10.1016/j.copsyc.2022.101515] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/08/2022] [Accepted: 11/09/2022] [Indexed: 11/17/2022]
Abstract
Although research that documents minority stress caused to LGBTQ + people supports needed advocacy, it can concomitantly cause harm to communities by portraying them as depleted and powerless. This review article assesses if and how researchers who study minority stress also center interpersonal functions of gender expression that are agentic for trans/nonbinary (TNB) people. These functions were coded in the qualitative research related to minority stress for TNB people over the last five years. Findings revealed that while most interpersonal functions of gender were described rarely, especially those associated with TNB communities of color, damage-centered perspectives were common. Damage-centered perspectives were common. We charge the field to expand its scope of inquiry, center functionalist and agency-focused research, and to develop a multidimensional psychology of gender.
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Affiliation(s)
- Heidi M Levitt
- University of Massachusetts Boston, 100 Morrissey Blvd, Dept. of Psychology, Boston, MA, 02125, USA.
| | - Kelsey A Kehoe
- University of Massachusetts Boston, 100 Morrissey Blvd, Dept. of Psychology, Boston, MA, 02125, USA
| | - Ally B Hand
- University of Massachusetts Boston, 100 Morrissey Blvd, Dept. of Psychology, Boston, MA, 02125, USA
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Simmons J, Hartman S, Tanabe KO, Hayden ME. Gender-diverse health on campus: Developing a comprehensive, multidisciplinary gender-diverse care team. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023:1-4. [PMID: 36719789 DOI: 10.1080/07448481.2023.2168545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/16/2022] [Accepted: 01/08/2023] [Indexed: 06/18/2023]
Abstract
Objective: To optimize healthcare for gender-diverse students at a large, public university's Student Health and Wellness (SHW) Center. Methods: SHW professionals from medicine, gynecology, health promotion, counseling, psychiatry, and disability services developed a multidisciplinary gender-diverse care team (GDCT) in 2016. The GDCT's team-based design was created to support a diverse student body and provide extra resources to a vulnerable population, ensuring students engage fully in the University. Results: The GDCT has assisted approximately 93 unique students, in-person or by phone with clinical or supportive care. The number of students presenting with questions pertaining to transgender and gender-diverse health care has increased since 2016. Conclusions: Having a comprehensive, multidisciplinary GDCT available within a university SHW provides transgender and gender-diverse students with access to a safe, inclusive, and resource-rich environment to seek care and serves as a potential model for other college health centers.
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Affiliation(s)
- Jessica Simmons
- Division of Student Affairs, Department of Student Health & Wellness, University of Virginia, Charlottesville, Virginia, USA
| | - Stephanie Hartman
- Division of Student Affairs, Department of Student Health & Wellness, University of Virginia, Charlottesville, Virginia, USA
| | - Kawai O Tanabe
- Division of Student Affairs, Department of Student Health & Wellness, University of Virginia, Charlottesville, Virginia, USA
| | - Meredith E Hayden
- Division of Student Affairs, Department of Student Health & Wellness, University of Virginia, Charlottesville, Virginia, USA
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13
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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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Crockett MA, Martínez V, Caviedes P. Barriers and Facilitators to Mental Health Help-Seeking and Experiences with Service Use among LGBT+ University Students in Chile. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16520. [PMID: 36554401 PMCID: PMC9779696 DOI: 10.3390/ijerph192416520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 12/02/2022] [Accepted: 12/07/2022] [Indexed: 06/17/2023]
Abstract
Barriers limiting access to mental health care for lesbian, gay, bisexual, trans, and other sexual and gender minority (LGBT+) university students have not yet been explored in depth. The aim of this study was to explore the barriers and facilitators to mental health help seeking and experiences with service use among LGBT+ university students. Participants were 24 LGBT+ students between 18 and 23 years of age from a university in Chile. Individual semi-structured interviews were conducted and analysed using thematic content analysis. Multiple barriers and facilitators influence mental health help-seeking of LGBT+ students, with some of these barriers being explicitly related to LGBT+ issues (e.g., fear of discrimination or accessing specialised services). Perceived effectiveness of services was closely related to access safe/affirming care. Trans students reported more barriers to help-seeking and negative experiences with professionals than their cisgender peers. Perceptions of university mental health services as safe spaces for LGBT+ students were related to a positive perception of the university regarding LGBT+ issues. Knowing the factors that either hinder or facilitate help-seeking and characterising service use experiences in this population is useful for improving access to mental health services and for the development of policies that promote affirmative care for LGBT+ people.
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Affiliation(s)
- Marcelo A. Crockett
- Escuela de Salud Pública, Facultad de Medicina, Universidad de Chile, Santiago 8380453, Chile
- Millennium Nucleus to Improve the Mental Health of Adolescents and Youths (Imhay), Santiago 8380455, Chile
- Millennium Institute for Research in Depression and Personality (MIDAP), Santiago 7820436, Chile
| | - Vania Martínez
- Millennium Nucleus to Improve the Mental Health of Adolescents and Youths (Imhay), Santiago 8380455, Chile
- Millennium Institute for Research in Depression and Personality (MIDAP), Santiago 7820436, Chile
- Centro de Medicina Reproductiva y Desarrollo Integral del Adolescente (CEMERA), Facultad de Medicina, Universidad de Chile, Santiago 8380455, Chile
| | - Patricio Caviedes
- Millennium Nucleus to Improve the Mental Health of Adolescents and Youths (Imhay), Santiago 8380455, Chile
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Matson TE, Harris AHS, Chen JA, Edmonds AT, Frost MC, Rubinsky AD, Blosnich JR, Williams EC. Influence of a national transgender health care directive on receipt of alcohol-related care among transgender Veteran Health Administration patients with unhealthy alcohol use. J Subst Abuse Treat 2022; 143:108808. [PMID: 35715286 DOI: 10.1016/j.jsat.2022.108808] [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: 08/10/2021] [Revised: 04/16/2022] [Accepted: 05/20/2022] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Transgender persons are vulnerable to under-receipt of recommended health care due to chronic exposure to systemic stressors (e.g., discriminatory laws and health system practices). Scant information exists on receipt of alcohol-related care for transgender populations, and whether structural interventions to reduce transgender discrimination in health care improve receipt of recommended treatment. This study evaluated the effect of the Veteran Health Administration (VA) Transgender Healthcare Directive-a national policy to reduce structural discrimination-on receipt of evidence-based alcohol-related care for transgender VA patients with unhealthy alcohol use. METHODS The study used an interrupted time series with control design to compare monthly receipt of alcohol-related care among transgender patients with unhealthy alcohol use (Alcohol Use Disorders Identification Test Consumption ≥5) documented in their electronic health record before (10/1/2009-5/31/2011) and after (7/1/2011-7/31/2017) implementation of VA's Transgender Healthcare Directive. A propensity-score matched sample of non-transgender patients with unhealthy alcohol use served as a comparison group to control for concurrent secular trends. Mixed effects segmented logistic regression models estimated changes in level and slope (i.e., rate of change) in receipt of any evidence-based alcohol-related care, including brief intervention, specialty addictions treatment, and alcohol use disorder medications. RESULTS The matched sample (mean age = 47.5 [SD = 15.0]; 75% non-Hispanic White race/ethnicity) included 2074 positive alcohol screens completed by 1377 transgender patients and 6,l99 positive alcohol screens completed by 6185 non-transgender patients. Receipt of alcohol-related care increased for transgender patients from 78.5% (95% CI: 71.3%-85.6%) at the start of study to 83.0% (75.9%-90.1%) immediately before the directive and decreased slightly from 81.6% (77.4%-85.9%) immediately after the directive to 80.1% (76.8-85.4) at the end of the study. Changes in level and slope comparing periods before and after the directive were not statistically significant, nor were they statistically significantly different from the matched sample of non-transgender patients. CONCLUSIONS Health systems must urgently employ and evaluate policies to address structural stigma that produces and reproduces disparities in health and health care. Although VA's directive was not associated with increased receipt of alcohol-related care, that receipt of alcohol-related care among transgender patients is comparable to non-transgender patients is promising.
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Affiliation(s)
- Theresa E Matson
- Health Services Research & Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA 98108, USA; Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA 98195, USA; Kaiser Permanente Washington Health Research Institute, Seattle, WA 98101, USA.
| | - Alex H S Harris
- Center for Innovation to Implementation, Veterans Affairs (VA) Palo Alto Healthcare System, Menlo Park, CA 94304, USA; Department of Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA.
| | - Jessica A Chen
- Health Services Research & Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA 98108, USA; Department of Psychiatry and Behavioral Science, University of Washington, Seattle, WA 98195, USA.
| | - Amy T Edmonds
- Health Services Research & Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA 98108, USA; Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA 98195, USA.
| | - Madeline C Frost
- Health Services Research & Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA 98108, USA; Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA 98195, USA.
| | - Anna D Rubinsky
- Health Services Research & Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA 98108, USA; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA 94158, USA.
| | - John R Blosnich
- Suzanne Dworak-Peck School of Social Work, University of Southern California, 669 W. 34(th) St., Los Angeles, CA 90089, USA; Health Services Research & Development (HSR&D) Center for Health Equity Research and Promotion, Veterans Affairs (VA) Pittsburgh Healthcare System, Pittsburgh, PA 15219, USA.
| | - Emily C Williams
- Health Services Research & Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA 98108, USA; Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA 98195, USA.
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16
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Cotler J, Katz BZ, Torres C, Jason LA. College student symptoms as assessed by a student health survey. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2022; 70:1953-1958. [PMID: 33258726 PMCID: PMC9562335 DOI: 10.1080/07448481.2020.1845705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 08/20/2020] [Accepted: 10/18/2020] [Indexed: 06/12/2023]
Abstract
ObjectiveWe sought to identify the general health of college students.ParticipantsA total of 4402 university freshmen and sophomores were recruited to report their general health through an online questionnaire.MethodsResponses from the DePaul Symptom Questionnaire were analyzed. We then conducted latent class analyses to evaluate 54 different symptoms among participants.ResultsA four class solution was identified, consisting of a group of asymptomatic students (35.65%), a second group of students reporting mild fatigue and sleep symptoms (38.87%), a third group reporting moderate sleep and fatigue symptoms (20.36%), and a group reporting moderate and severe complaints on the majority of symptoms (5.11%). Female students had 2.07 times the relative risk of the severe symptom class of men. Indigenous students have 2.88 times the relative risk of occupying the severe symptom class than non-indigenous students.ConclusionsThe results suggest that about 5% of college students have varied symptoms of a moderate to severe degree. Future research is needed to better assess whether there are biological associations with these self-report findings, as well as to determine longer-term implications of these symptoms.
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Affiliation(s)
- Joseph Cotler
- Department of Psychology, DePaul University, Chicago, Illinois, USA
| | - Ben Z Katz
- Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Chelsea Torres
- Department of Psychology, DePaul University, Chicago, Illinois, USA
| | - Leonard A Jason
- Department of Psychology, DePaul University, Chicago, Illinois, USA
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Whaibeh E, Vogt EL, Mahmoud H. Addressing the Behavioral Health Needs of Sexual and Gender Minorities During the COVID-19 Pandemic: a Review of the Expanding Role of Digital Health Technologies. Curr Psychiatry Rep 2022; 24:387-397. [PMID: 35841471 DOI: 10.1007/s11920-022-01352-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/16/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW To review the role of digital health technologies in behavioral health treatment and promotion for sexual and gender minorities (SGM). RECENT FINDINGS Digital technologies have advantages and limitations at multiple levels in addressing SGM's behavioral health needs. For patients, digital technologies improve convenience and may reduce stigma; however, privacy concerns in the home may limit their utilization. Providers also benefit from the convenience of these technologies; however, not all providers are comfortable delivering virtual care to SGM. For society, digital technologies reduce transportation-related costs and increase access to healthcare in an increasingly hostile political climate for SGM; however, these advantages are limited by technological access and anti-SGM policies. Digital technologies can improve the behavioral health of SGM at the patient, provider, and systemic levels. Further efforts are necessary to standardize provider training, improve SUD-specific care delivery, and increase quality and accessibility of these technologies.
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Affiliation(s)
- Emile Whaibeh
- Department of Public Health, University of Balamand, Beirut, Lebanon.,École Doctorale Sciences Et Santé, Saint Joseph University, Beirut, Lebanon
| | - Emily L Vogt
- University of Michigan Medical School, Ann Arbor, MI, USA.
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18
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Neri J, Iudici A, Faccio E. Mental health practitioners' narratives about gender transition and the role of diagnosis: A qualitative study in the Italian context. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e2678-e2689. [PMID: 35016261 DOI: 10.1111/hsc.13711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 11/29/2021] [Accepted: 12/17/2021] [Indexed: 06/14/2023]
Abstract
In many European Countries, a diagnosis is needed to access the gender transition process, which has sparked debate about whether gender variance should be equated with a psychodiagnosis. This study explores mental health practitioners' perspectives about the implications of using the diagnosis for gatekeeping purposes. Semi-structured interviews were conducted with 11 Italian mental health specialists. The personal positions and interpretative repertoires emerging from the interviews centred on three thematic areas: the diagnosis, the practitioner's role, and the clinical relationship. In relation to the development of health promotion policies, findings underscore the importance of exercising reflexivity, adhering to theory and national and/or international guidelines, and analysing people's needs to ensure that the clinical setting is an affirmative space, especially for non-binary people.
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Affiliation(s)
- Jessica Neri
- Department of Philosophy, Sociology, Education and Applied Psychology, University of Padua, Padua, Italy
| | - Antonio Iudici
- Department of Philosophy, Sociology, Education and Applied Psychology, University of Padua, Padua, Italy
| | - Elena Faccio
- Department of Philosophy, Sociology, Education and Applied Psychology, University of Padua, Padua, Italy
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19
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Knowledge Management-Based Mental Health Service Model: Sustainable Application during College Students’ Education. SUSTAINABILITY 2022. [DOI: 10.3390/su14159008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
In order to meet the dynamic mental health needs of college students, it is important to promote quality mental health services and to improve the development view of college students’ mental health. This paper uses a knowledge management method to construct college students’ developmental mental health service model. The model is informed by knowledge management, which comprehensively considers service-related components, namely, resources, content, approach, process, personnel, and objects. Furthermore, knowledge management constructs the system structure of the model and expands the research ideas and contents of the service resource pool. Moreover, knowledge management supports the platform, core technology system, and service process in the model. Finally, using Suzhou University as an example, this study examines the implementation and application of the service model to test the effectiveness of the knowledge management method. Thus, this study provides theoretical and methodological support for the construction, implementation, and application of a sustainable mental health service model for college students.
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20
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Panchal Z, Piper C, Whitmore C, Davies RD. Providing supportive transgender mental health care: A systemized narrative review of patient experiences, preferences, and outcomes. JOURNAL OF GAY & LESBIAN MENTAL HEALTH 2022. [DOI: 10.1080/19359705.2021.1899094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Zoë Panchal
- University of Colorado School of Medicine, Aurora, CO, USA
| | - Christi Piper
- University of Colorado Anschutz Medical Campus Strauss Health Sciences Library, Aurora, CO, USA
| | | | - Robert D. Davies
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA
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21
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Mollitt PC. Exploring cisgender therapists' attitudes towards, and experience of, working with trans people in the United Kingdom. COUNSELLING & PSYCHOTHERAPY RESEARCH 2022. [DOI: 10.1002/capr.12559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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22
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Norris M, Borneskog C. The Cisnormative Blindspot Explained: Healthcare Experiences of Trans Men and Non-Binary Persons and the accessibility to inclusive sexual & reproductive Healthcare, an integrative review. SEXUAL & REPRODUCTIVE HEALTHCARE 2022; 32:100733. [PMID: 35576736 DOI: 10.1016/j.srhc.2022.100733] [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: 10/14/2021] [Revised: 03/15/2022] [Accepted: 04/27/2022] [Indexed: 01/11/2023]
Abstract
Trans men and non-binary persons assigned female at birth (AFAB) often encounter resistance and reluctance pertaining to their healthcare needs. As a result of patriarchal-based decision-making and cis-heteronormative ideologies, the trans and gender diverse (TGD) population is routinely left out of representation in research, education, and healthcare. The aim of this integrative literature review is to describe the experiences of trans men and non-binary persons AFAB in healthcare interactions and their sexual and reproductive healthcare needs. A total of 32 articles were analyzed, synthesized, and reconceptualized through joint inductive and deductive analysis with a transfeminist and intersectional lens. From these papers, two broader concepts emerged with five sub-concepts that portrayed underlying barriers to care (primed with fear, onus of self-advocacy, and call for competence) and internalized ideologies (pregnancy incompatibility and presumptive care). A multidisciplinary approach is essential to employ in implementation efforts involving improved standards of care and in achieving desired family planning. As this is not as linear as addressing a knowledge gap, but one of deeper set intrinsic ideologies, instruction on the necessary impact of continued education and peer learning within the context of in-group dynamics can help the efficiency of designated change agents within the healthcare systems themselves.
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Affiliation(s)
- Megan Norris
- Dalarna University, School of Health and Welfare, Högskolegatan 2, 791 31 Falun, Sweden.
| | - Catrin Borneskog
- Dalarna University, School of Health and Welfare, Högskolegatan 2, 791 31 Falun, Sweden.
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23
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Mirabella M, Piras I, Fortunato A, Fisher AD, Lingiardi V, Mosconi M, Ristori J, Speranza AM, Giovanardi G. Gender Identity and Non-Binary Presentations in Adolescents Attending Two Specialized Services in Italy. J Sex Med 2022; 19:1035-1048. [PMID: 35370103 DOI: 10.1016/j.jsxm.2022.03.215] [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: 11/05/2021] [Revised: 02/11/2022] [Accepted: 03/02/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Recently, the variability and heterogeneity of gender presentations in transgender youths have gained significant attention worldwide. Alongside this, specialized gender services have reported an increase in referrals of youths reporting non-binary identities. In Italy, studies investigating gender identity and expression in gender non-conforming youths are lacking, as are data regarding the non-binary population. AIM The present study aimed at dimensionally exploring how transgender and non-binary Italian adolescents identify and express their gender. OUTCOMES Gender expression in trans binary youths and non-binary youths. METHODS The Gender Diversity Questionnaire (GDQ; Twist & de Graaf, 2019) was used to investigate gender identity, gender fluidity, and gender expression in a sample of 125 adolescent patients from the Gender Identity Development Service (SAIFIP) in Rome and the Gender Incongruence Unit of the Careggi Hospital in Florence, between April 2019-June 2021. RESULTS The majority of participants (74.4%) identified as trans* binary and the remaining (25.6%) participants identified as non-binary. Trans binary participants reported a stable gender identity, whereas non-binary participants reported a more fluid gender identity across time and contexts. Almost all participants rated external appearance as important to their gender expression, yet trans binary participants attributed more importance to the body in this respect. Body discomfort and pubertal stage emerged as the most influential factors in participants' experiences of gender. Participants who were assigned male at birth expressed significantly more desire for puberty blockers, whereas those who were assigned female at birth had a stronger desire to engage in breast/chest surgery. Non-binary participants sought different medical interventions relative to trans binary participants. CLINICAL IMPLICATIONS These results may be useful for clinicians working with transgender youths as they provide awareness regarding the features of young people who identify within and outside of binary constructions of gender. STRENGTHS & LIMITATIONS This study provides useful data in gaining insight into understanding the variety of experiences and challenges of gender non-conforming youths. However as the sample was recruited from specialized services, it may not represent the entire gender non-conforming population in Italy. CONCLUSION The results describe the range of gender identities and expressions among gender non-conforming youths attending gender specialized services in Italy, thereby improving our understanding of the variety of identities experienced and the specific medical needs of both trans binary and non-binary adolescents. Mirabella M, Piras I, Fortunato A, et al. Gender Identity and Non-Binary Presentations in Adolescents Attending Two Specialized Services in Italy. J Sex Med 2022;19:1035-1048.
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Affiliation(s)
- Marta Mirabella
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy.
| | - Irene Piras
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
| | - Alexandro Fortunato
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
| | - Alessandra D Fisher
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Florence University Hospital, Florence, Italy
| | - Vittorio Lingiardi
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
| | - Maddalena Mosconi
- Gender Identity Development Service, Hospital S. Camillo-Forlanini, Rome, Italy
| | - Jiska Ristori
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Florence University Hospital, Florence, Italy
| | - Anna Maria Speranza
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
| | - Guido Giovanardi
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
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Kennis M, Duecker F, T'Sjoen G, Sack AT, Dewitte M. Sexual Self-Concept Discrepancies Mediate the Relation between Gender Dysphoria Sexual Esteem and Sexual Attitudes in Binary Transgender Individuals. JOURNAL OF SEX RESEARCH 2022; 59:524-536. [PMID: 34279141 DOI: 10.1080/00224499.2021.1951643] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Sexual responding in transgender people has typically been investigated from a medical and functional perspective. Aligning with the biopsychosocial model, it is however equally important to consider psychological aspects of sexuality in this population. We propose that the Sexual Self-Concept (SSC) theory offers a valuable framework to understand (sexual) wellbeing in transgender people, while Self-Concept Discrepancy (SCD) theory could offer an explanation of the mechanisms underlying negative SSCs related to gender dysphoria. We investigated differences in SSC (consisting of sexual esteem, sexual attitudes, and sexual self-efficacy) in 197 binary transgender and 205 cisgender individuals using an online survey and explored the mediating role of actual/ideal self-discrepancies in explaining the relation between gender dysphoria and SSC. Transgender and cisgender individuals differed significantly in seven out of eight components related to sexual esteem and sexual attitudes. Actual/ideal self-discrepancies mediated the relationship between gender dysphoria and the SSC in transgender individuals for the sexual esteem components related to body perception, conduct, and attractiveness, as well as for sexual anxiety. We found no relation between gender dysphoria and the other SSC components in this group. We conclude that SSC discrepancies could be a valuable treatment target to improve transgender individuals' sexual esteem and sexual attitudes.
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Affiliation(s)
- Mathilde Kennis
- Department of Clinical Psychological Science, Maastricht University
- Department of Cognitive Neuroscience, Maastricht University
- Maastricht Brain Imaging Center, Maastricht University
| | - Felix Duecker
- Department of Cognitive Neuroscience, Maastricht University
- Maastricht Brain Imaging Center, Maastricht University
| | - Guy T'Sjoen
- Department of Endocrinology, Ghent University Hospital
- Center for Sexology and Gender, Ghent University Hospital
| | - Alexander T Sack
- Department of Cognitive Neuroscience, Maastricht University
- Maastricht Brain Imaging Center, Maastricht University
- Department of Psychiatry and Neuropsychology, Maastricht University
- Center for Integrative Neuroscience, Maastricht University
| | - Marieke Dewitte
- Department of Clinical Psychological Science, Maastricht University
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25
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Simone M, Hazzard VM, Askew A, Tebbe EA, Lipson SK, Pisetsky EM. Variability in Eating Disorder Risk and Diagnosis in Transgender and Gender Diverse College Students. Ann Epidemiol 2022; 70:53-60. [PMID: 35472489 DOI: 10.1016/j.annepidem.2022.04.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/15/2022] [Accepted: 04/15/2022] [Indexed: 11/01/2022]
Abstract
PURPOSE To examine differences in elevated eating disorder risk and self-reported eating disorder diagnosis across subgroups of transgender and gender diverse (TGD) college students. METHODS Data from 5057 TGD college students participating in the national Healthy Minds Study between 2014-2019 were analyzed. Chi-square tests and logistic regression analyses examined heterogeneity in prevalence and odds of elevated eating disorder risk, as measured by the SCOFF, and self-reported eating disorder diagnosis by gender, as well as by intersecting gender and sexual orientation identities. RESULTS Genderqueer/non-conforming college students reported the highest prevalence of elevated eating disorder risk (38.8%) relative to gender expansive students. Genderqueer/non-conforming (11.1%), gender expansive (12.3%), and trans men/transmasculine students (10.5%) reported higher prevalence of a self-reported eating disorder diagnosis relative to trans women/transfeminine students (6.3%). Heterosexual or straight trans men had lower odds of eating disorder risk and self-reported diagnosis relative to trans men with a minoritized sexual orientation. CONCLUSIONS Genderqueer/non-conforming college students may be at heightened eating disorder risk. Moreover, a heterosexual/straight sexual orientation was associated with lower odds of elevated eating disorder risk and self-reported eating disorder diagnoses among trans men and genderqueer/non-conforming college students, but this finding did not hold for other groups. College campuses should aim to reduce eating disorder risk among TGD students.
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Affiliation(s)
- Melissa Simone
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA, 55454
| | - Vivienne M Hazzard
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA, 55454
| | - Autumn Askew
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA, 92182
| | - Elliot A Tebbe
- School of Nursing, University of Wisconsin-Madison, Madison, WI, 53705
| | - Sarah K Lipson
- Department of Health Law Policy and Management, Boston University School of Public Health, Boston, MA, USA, 02118
| | - Emily M Pisetsky
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical School, Minneapolis, MN, USA, 55454
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26
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Özdemir RC, Erenoğlu R. Attitudes of nursing students towards LGBT individuals and the affecting factors. Perspect Psychiatr Care 2022; 58:239-247. [PMID: 34455595 DOI: 10.1111/ppc.12941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/16/2021] [Accepted: 08/15/2021] [Indexed: 12/28/2022] Open
Abstract
PURPOSE To determine the attitudes of nursing students towards LGBT (lesbian, gay, bisexual, and transgender) individuals and the affecting factors. DESIGN AND METHOD The universe of the research consisted of 500 students. The data collection tools used were "Demographic Data Form" and "Attitude towards Lesbians and Gay Men Scale (ATLG)." FINDINGS Students' attitudes towards LGBT individuals are at a medium level. Male participants had more negative attitudes towards LGBT individuals. PRACTICAL IMPLICATIONS Nurses should provide services within the framework of professional values. In this context, vulnerable groups should be handled carefully. Awareness should be created among nurses.
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Affiliation(s)
- Rana Can Özdemir
- Department of Medical History and Ethics, Faculty of Medicine, Antalya Akdeniz University, Antalya, Turkey
| | - Rabiye Erenoğlu
- Department of Gynaecology and Obstetrics, Department of Nursing, Faculty Of Health Sciences, Hatay Mustafa Kemal University, Antakya, Hatay, Turkey
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27
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Clark KD, Luong S, Lunn MR, Flowers E, Bahalkeh E, Lubensky ME, Capriotti MR, Obedin-Maliver J, Flentje A. Healthcare Mistreatment, State-Level Policy Protections, and Healthcare Avoidance Among Gender Minority People. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2022; 19:1717-1730. [PMID: 36458212 PMCID: PMC9701649 DOI: 10.1007/s13178-022-00748-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/17/2022] [Indexed: 05/07/2023]
Abstract
INTRODUCTION This study examined whether past experiences of mistreatment in healthcare were associated with greater healthcare avoidance due to anticipated mistreatment among gender minority (GM) people. We evaluated whether state-level healthcare policy protections moderated this relationship. METHODS Data from the 2018 Annual Questionnaire of The PRIDE Study, a national longitudinal study on sexual and gender minority people's health, were used in these analyses. Logistic regression modeling tested relationships between lifetime healthcare mistreatment due to gender identity or expression and past-year healthcare avoidance due to anticipated mistreatment among GM participants. Interactions between lifetime healthcare mistreatment and state-level healthcare policy protections and their relationship with past-year healthcare avoidance were tested. RESULTS Participants reporting any lifetime healthcare mistreatment had greater odds of past-year healthcare avoidance due to anticipated mistreatment among gender expansive people (n = 1290, OR = 4.71 [CI]: 3.57-6.20), transfeminine people (n = 263, OR = 10.32 [CI]: 4.72-22.59), and transmasculine people (n = 471, OR = 3.90 [CI]: 2.50-6.13). Presence of state-level healthcare policy protections did not moderate this relationship in any study groups. CONCLUSIONS For GM people, reporting lifetime healthcare mistreatment was associated with healthcare avoidance due to anticipated mistreatment. State-level healthcare policy protections were not a moderating factor in this relationship. Efforts to evaluate the implementation and enforcement of state-level policies are needed. Continued efforts to understand instances of and to diminish healthcare mistreatment of GM people are recommended. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s13178-022-00748-1.
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Affiliation(s)
- Kristen D. Clark
- Department of Nursing, University of New Hampshire, Durham, NH USA
| | - Sean Luong
- Department of Community Health Systems, School of Nursing, University of California San Francisco, San Francisco, CA USA
| | - Mitchell R. Lunn
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA USA
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, CA USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA USA
| | - Elena Flowers
- Department of Physiological Nursing, School of Nursing, University of California San Francisco, San Francisco, CA USA
| | - Esmaeil Bahalkeh
- Department of Health Management & Policy, University of New Hampshire, Durham, NH USA
| | - Micah E. Lubensky
- Department of Community Health Systems, School of Nursing, University of California San Francisco, San Francisco, CA USA
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA USA
| | | | - Juno Obedin-Maliver
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA USA
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA USA
| | - Annesa Flentje
- Department of Community Health Systems, School of Nursing, University of California San Francisco, San Francisco, CA USA
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA USA
- Department of Psychiatry, School of Medicine, Alliance Health Project, University of California San Francisco, San Francisco, CA USA
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Lehmann K, Rosato M, McKenna H, Leavey G. Dramaturgical Accounts of Transgender Individuals: Impression Management in the Presentation of Self to Specialist Gender Services. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:3539-3549. [PMID: 34741248 PMCID: PMC8604840 DOI: 10.1007/s10508-021-02028-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 04/17/2021] [Accepted: 04/20/2021] [Indexed: 06/10/2023]
Abstract
Demand for gender dysphoria (GD) treatment has increased markedly over the past decade. Access to gender-affirming treatments is challenging for most people. For dysphoric individuals, much is at stake. Little is known about the specific needs, challenges, and coping strategies of this hard-to-reach group. We examined the experiences of treatment-seeking adolescents and adults using in-depth unstructured interviews with 26 people attending specialist gender services and 14 transgender people not referred to services. Patients with gender dysphoria distrust clinical services and describe considerable anxiety in sustaining their impression management strategies to obtain treatment. An authentic presentation is regarded by some participants, especially non-binary individuals, as inauthentic and emotionally difficult to maintain. Impression management strategies have partial success in accessing services. The presentation of "idealized" selves may result in unmet mental health needs of patients, and the receipt of interventions incongruent with their authentic selves.
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Affiliation(s)
- Katrin Lehmann
- Bamford Centre for Mental Health and Wellbeing, Ulster University, Cromore Road, Coleraine, Northern Ireland, BT52 1SA, UK.
| | - Michael Rosato
- Bamford Centre for Mental Health and Wellbeing, Ulster University, Cromore Road, Coleraine, Northern Ireland, BT52 1SA, UK
| | - Hugh McKenna
- Institute of Nursing and Health Research, Ulster University, Newtownabbey, Northern Ireland, UK
| | - Gerard Leavey
- Bamford Centre for Mental Health and Wellbeing, Ulster University, Cromore Road, Coleraine, Northern Ireland, BT52 1SA, UK
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Access to Mental Health and Substance Use Resources for 2SLGBTQ+ Youth during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111315. [PMID: 34769836 PMCID: PMC8582808 DOI: 10.3390/ijerph182111315] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/23/2021] [Accepted: 10/25/2021] [Indexed: 11/16/2022]
Abstract
Previous research has established that gender and sexual minority (2SLGBTQ+) youth experience worse mental health and substance use outcomes than their heterosexual and cisgender counterparts. Research suggests that mental health and substance use concerns have been exacerbated by the COVID-19 pandemic. The current study used self-reported online survey responses from 1404 Canadian 2SLGBTQ+ youth which included, but were not limited to, questions regarding previous mental health experiences, diagnoses, and substance use. Additional questions assessed whether participants had expressed a need for mental health and/or substance use resources since the beginning of the COVID-19 pandemic (March 2020) and whether they had experienced barriers when accessing this care. Bivariate and multinomial logistic regression analyses were conducted to determine associations between variables and expressing a need for resources as well as experiencing barriers to accessing these resources. Bivariate analyses revealed multiple sociodemographic, mental health, and substance use variables significantly associated with both expressing a need for and experiencing barriers to care. Multinomial regression analysis revealed gender identity, sexual orientation, ethnicity, and level of educational attainment to be significantly correlated with both cases. This study supports growing research on the mental health-related harms that have been experienced during the COVID-19 pandemic and could be used to inform tailored intervention plans for the 2SLGBTQ+ youth population.
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Silva C, Fung A, Irvine MA, Ziabakhsh S, Hursh BE. Usability of Virtual Visits for the Routine Clinical Care of Trans Youth during the COVID-19 Pandemic: Youth and Caregiver Perspectives. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:11321. [PMID: 34769838 PMCID: PMC8583569 DOI: 10.3390/ijerph182111321] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/21/2021] [Accepted: 10/22/2021] [Indexed: 11/17/2022]
Abstract
We evaluated families' perspectives on the usability of virtual visits for routine gender care for trans youth during the COVID-19 pandemic. An online survey, which included a validated telehealth usability questionnaire, was sent to families who had a virtual Gender Clinic visit between March and August 2020. A total of 87 participants completed the survey (28 trans youth, 59 caregivers). Overall, usability was rated highly, with mean scores between "quite a bit" and "completely" in all categories (usefulness, ease of use, interface and interaction quality, reliability, and satisfaction). Caregivers reported higher usability scores compared to trans youth [mean (SD) 3.43 (0.80) vs. 3.12 (0.93), p = 0.01]. All families felt that virtual visits provided for their healthcare needs. A total of 100% of youth and caregivers described virtual appointments as safer or as safe as in-person visits. A total of 94% of participants would like virtual visits after the pandemic; families would choose a mean of two virtual and one yearly in-person visit with a multidisciplinary team. Overall, virtual gender visits for trans youth had impressive usability. Participants perceived virtual visits to be safe. For the future, a combination of virtual and in-person multidisciplinary visits is the most desired model.
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Affiliation(s)
- Carolina Silva
- Department of Pediatrics, Division of Endocrinology, British Columbia Children’s Hospital and University of British Columbia, 4480 Oak Street, Vancouver, BC V6H 3V4, Canada; (C.S.); (A.F.)
| | - Alex Fung
- Department of Pediatrics, Division of Endocrinology, British Columbia Children’s Hospital and University of British Columbia, 4480 Oak Street, Vancouver, BC V6H 3V4, Canada; (C.S.); (A.F.)
| | - Michael A. Irvine
- Biostatistics Core, Clinical Research Support Unit, BC Children’s Research Institute, 938 W 28th Ave, Vancouver, BC V5Z 4H4, Canada;
| | - Shabnam Ziabakhsh
- Women’s Health Research Institute, BC Women’s Hospital and Health Centre, 4500 Oak Street, Vancouver, BC V6H 3N1, Canada;
| | - Brenden E. Hursh
- Department of Pediatrics, Division of Endocrinology, British Columbia Children’s Hospital and University of British Columbia, 4480 Oak Street, Vancouver, BC V6H 3V4, Canada; (C.S.); (A.F.)
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Markovic L, McDermott DT, Stefanac S, Seiler-Ramadas R, Iabloncsik D, Smith L, Yang L, Kirchheiner K, Crevenna R, Grabovac I. Experiences and Interactions with the Healthcare System in Transgender and Non-Binary Patients in Austria: An Exploratory Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18136895. [PMID: 34199049 PMCID: PMC8297154 DOI: 10.3390/ijerph18136895] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 06/15/2021] [Accepted: 06/24/2021] [Indexed: 11/16/2022]
Abstract
Medical care of transgender and non-binary (TNB) patients if often a complex interdisciplinary effort involving a variety of healthcare workers (HCWs) and services. Physicians not only act as gatekeepers to routine or transitioning therapies but are also HCWs with the most intimate and time-intensive patient interaction, which influences TNB patients' experiences and health behaviors and healthcare utilization. The aim of this study was to investigate the physician-patient relationship in a sample of TNB individuals within the Austrian healthcare system, and explore its associations with sociodemographic, health-, and identity-related characteristics. A cross-sectional study utilizing an 56-item online questionnaire, including the Patient-Doctor Relationship Questionnaire 9 (PDRQ-9), was carried out between June and October 2020. The study involved TNB individuals 18 or older, residing in Austria, and previously or currently undergoing medical transition. In total, 91 participants took part, of whom 33.0% and 25.3% self-identified as trans men and trans women, respectively, and 41.8% as non-binary. Among participants, 82.7% reported being in the process of medical transitioning, 58.1% perceived physicians as the most problematic HCWs, and 60.5% stated having never or rarely been taken seriously in medical settings. Non-binary participants showed significantly lower PDRQ-9 scores, reflecting a worse patient-physician relationship compared to trans male participants. TNB patients in Austria often report negative experiences based on their gender identity. Physicians should be aware of these interactions and reflect potentially harmful behavioral patterns in order to establish unbiased and trustful relations.
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Affiliation(s)
- Lovro Markovic
- Department of Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna, 1090 Vienna, Austria; (L.M.); (R.S.-R.); (D.I.); (I.G.)
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, 1090 Vienna, Austria;
| | - Daragh T. McDermott
- NTU Psychology, School of Social Sciences, Nottingham Trent University, Nottingham NG1 4FQ, UK;
| | - Sinisa Stefanac
- Institute of Outcomes Research, Centre for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, 1090 Vienna, Austria
- Correspondence:
| | - Radhika Seiler-Ramadas
- Department of Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna, 1090 Vienna, Austria; (L.M.); (R.S.-R.); (D.I.); (I.G.)
| | - Darina Iabloncsik
- Department of Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna, 1090 Vienna, Austria; (L.M.); (R.S.-R.); (D.I.); (I.G.)
| | - Lee Smith
- Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge CB1 1PT, UK;
| | - Lin Yang
- Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Calgary, AB T2S 3C3, Canada;
- Departments of Oncology and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Kathrin Kirchheiner
- Department of Radiation Oncology, Medical University of Vienna, 1090 Vienna, Austria;
| | - Richard Crevenna
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, 1090 Vienna, Austria;
| | - Igor Grabovac
- Department of Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna, 1090 Vienna, Austria; (L.M.); (R.S.-R.); (D.I.); (I.G.)
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Sanfacon K, Leffers A, Miller C, Stabbe O, DeWindt L, Wagner K, Kushalnagar P. Cross-Sectional Analysis of Medical Conditions in the U.S. Deaf Transgender Community. Transgend Health 2021; 6:132-138. [PMID: 34164578 PMCID: PMC8215402 DOI: 10.1089/trgh.2020.0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: This first U.S.-based, descriptive study of transgender Deaf adults looks to contribute to the gap in research regarding those who lie at the intersection of Deaf and transgender identities. The study objective is to identify characteristics that associate with medical conditions, including depression and anxiety disorders, among Deaf transgender adults. Methods: We gathered self-reported data from 74 Deaf transgender adults who used American Sign Language. Modified Poisson regression with robust standard errors was used to calculate relative risk estimates of having a medical condition among nonbinary individuals compared with gender binary individuals. Results: The sample lifetime prevalence for medical conditions in the Deaf transgender sample were as follows: 48.6% for depression/anxiety disorders, 28.8% for hypertension, 20.3% for lung conditions, 16.2% for arthritis/rheumatism, 12.3% for diabetes, 7.0% for cirrhosis/liver/kidney problems, 5.5% for heart conditions, and 2.7% for cancer. In cross-tabulation analysis across binary and nonbinary subsamples, the lifetime prevalence was significantly different only for depression and anxiety disorder with higher percentage in the nonbinary subsample. After adjusting for covariates in a regression model, identification as nonbinary increased a Deaf person's risk for being diagnosed with depression or anxiety disorder by 80% (95% confidence interval, 1.11-2.90) relative to Deaf people who self-identified as a binary gender. Conclusion: Study findings suggest that the Deaf transgender community is at risk for developing mental and physical health conditions.
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Affiliation(s)
- Keith Sanfacon
- Physical Education and Recreation, Gallaudet University, Washington, District of Columbia, USA
| | - Alex Leffers
- LGBTQA Resource Center, and Gallaudet University, Washington, District of Columbia, USA
| | - Cara Miller
- Department of Psychology, Gallaudet University, Washington, District of Columbia, USA
| | | | - Lori DeWindt
- Deaf Wellness Center, University of Rochester Medical Center, Rochester, New York, USA
| | - Kathryn Wagner
- Department of Psychology, Gallaudet University, Washington, District of Columbia, USA
| | - Poorna Kushalnagar
- Department of Psychology, Gallaudet University, Washington, District of Columbia, USA
- Center for Deaf Health Equity, Gallaudet University, Washington, District of Columbia, USA
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Vann DM, Riggs DW, Green HJ. Implementing a brief E-training opportunity for mental health practitioners working with non-binary clients. AUSTRALIAN PSYCHOLOGIST 2021. [DOI: 10.1080/00050067.2021.1921556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Damian M. Vann
- Menzies Health Institute Qld, Griffith University, Gold Coast, Australia
- School of Applied Psychology, Griffith University, Gold Coast, Australia
| | - Damien W. Riggs
- College of Education, Psychology, & Social Work, Flinders University, Adelaide, Australia
| | - Heather J. Green
- Menzies Health Institute Qld, Griffith University, Gold Coast, Australia
- School of Applied Psychology, Griffith University, Gold Coast, Australia
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Trans and gender diverse people's experiences and evaluations with general and trans-specific healthcare services: a cross-sectional survey. Int J Impot Res 2021; 33:679-686. [PMID: 33854204 DOI: 10.1038/s41443-021-00432-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 03/15/2021] [Accepted: 03/29/2021] [Indexed: 11/09/2022]
Abstract
Research into access to and experiences with healthcare services of gender-diverse and trans individuals remains scarce. In this paper, self-reported experiences with general and trans-specific healthcare services were analyzed for differences between gender-diverse people, trans men, and trans women, using data from a five-country survey. More than half of all respondents indicated they had delayed general healthcare services at least once because of their gender identity, mostly out of fear of being treated badly. Almost one in four participants felt personally discriminated against in general healthcare services within the previous year. Gender-diverse people had significantly less experiences with seeking trans-specific healthcare. Additional effects were found for different socio-demographic variables (age; sex assigned at birth; educational level; socioeconomic status; and belonging to an ethnic, sexual, and/or disability minority). Gender-diverse people gave significantly worse evaluations of trans-specific healthcare services (in general as well as for specific types of trans-specific healthcare). The findings highlight the need for healthcare providers in creating inclusive healthcare settings, with attention for gender-diverse clients and those belonging to precarious minority groups due to their level of education or sexual, disability, and/or ethnic background.
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Nieder TO, Mayer TK, Hinz S, Fahrenkrug S, Herrmann L, Becker-Hebly I. Individual Treatment Progress Predicts Satisfaction With Transition-Related Care for Youth With Gender Dysphoria: A Prospective Clinical Cohort Study. J Sex Med 2021; 18:632-645. [PMID: 33642235 DOI: 10.1016/j.jsxm.2020.12.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 11/26/2020] [Accepted: 12/22/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND The number of adolescents presenting with gender dysphoria (GD) in healthcare services has increased significantly, yet specialized services offering transition-related care (TRC) for trans youth is lacking. AIM To investigate satisfaction with TRC, regret, and reasons for (dis)satisfaction with transition-related medical interventions (TRMIs) in trans adolescents who had presented to the Hamburg Gender Identity Service for children and adolescents (Hamburg GIS). METHODS Data were collected from a clinical cohort sample of 75 adolescents and young adults diagnosed with GD (81% assigned female at birth) aged 11 to 21 years (M = 17.4) at baseline and follow-up (on a spectrum of ongoing care, on average 2 years after initial consultation). To determine progress of the youth's medical transitions, an individual treatment progress score (ITPS) was calculated based on number of desired vs received TRMIs. OUTCOMES Main outcome measures were satisfaction with TRC at the time of follow-up, ITPS, social support, reasons for regret and termination of TRC, and (dis)satisfaction with TRMIs. RESULTS Participants underwent different stages of TRMIs, such as gender-affirming hormone treatment or surgeries, and showed overall high satisfaction with TRC received at the Hamburg GIS. Regression analysis indicated that a higher ITPS (an advanced transition treatment stage) was predictive of higher satisfaction with TRC. Sex assigned at birth, age, and time since initial consultation at the clinic showed no significant effects for satisfaction with TRC, while degree of social support showed a trend. No adolescents regretted undergoing treatment at follow-up. Additional analysis of free-text answers highlighted satisfaction mostly with the physical results of TRMI. CLINICAL IMPLICATIONS Because youth were more satisfied with TRC when their individual transition (ITPS) was more progressed, treatment should start in a timely manner to avoid distress from puberty or long waiting lists. STRENGTHS AND LIMITATIONS This study is one of the first to report on treatment satisfaction among youth with GD from Europe. The ITPS allowed for a more detailed evaluation of TRMI wishes and experiences in relation to satisfaction with TRC and may close a gap in research on these treatments in adolescent populations. However, all participants were from the same clinic, and strict treatment eligibility criteria may have excluded certain trans adolescents from the study. Low identification rates with non-binary identities prevented comparisons between non-binary and binary genders. CONCLUSION The study highlights the role of TRMI and individual treatment or transition progress for youth's overall high satisfaction with TRC received at the Hamburg GIS. Nieder TO, Mayer TK, Hinz S, et al. Individual Treatment Progress Predicts Satisfaction With Transition-Related Care for Youth With Gender Dysphoria: A Prospective Clinical Cohort Study. J Sex Med 2021;18:632-645.
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Affiliation(s)
- T O Nieder
- Institute For Sex Research, Sexual Medicine, and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - T K Mayer
- Institute For Sex Research, Sexual Medicine, and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - S Hinz
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - S Fahrenkrug
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - L Herrmann
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Inga Becker-Hebly
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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Stanton AM, Batchelder AW, Kirakosian N, Scholl J, King D, Grasso C, Potter J, Mayer KH, O’Cleirigh C. Differences in mental health symptom severity and care engagement among transgender and gender diverse individuals: Findings from a large community health center. PLoS One 2021; 16:e0245872. [PMID: 33493207 PMCID: PMC7833136 DOI: 10.1371/journal.pone.0245872] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 12/28/2020] [Indexed: 11/18/2022] Open
Abstract
Mental health disparities among transgender and gender diverse (TGD) populations have been documented. However, few studies have assessed differences in mental health symptom severity, substance use behavior severity, and engagement in care across TGD subgroups. Using data from the electronic health record of a community health center specializing in sexual and gender minority health, we compared the (1) severity of self-reported depression, anxiety, alcohol use, and other substance use symptoms; (2) likelihood of meeting clinical thresholds for these disorders; and (3) number of behavioral health and substance use appointments attended among cisgender, transgender, and non-binary patients. Participants were 29,988 patients aged ≥18 who attended a medical appointment between 2015 and 2018. Depression symptom severity (F = 200.6, p < .001), anxiety symptom severity (F = 102.8, p < .001), alcohol use (F = 58.8, p < .001), and substance use (F = 49.6, p < .001) differed significantly by gender. Relative to cisgender and transgender individuals, non-binary individuals are at elevated risk for depression, anxiety, and substance use disorders. Gender was also associated with differences in the number of behavioral health (χ2 = 51.5, p < .001) and substance use appointments (χ2 = 39.3, p < .001) attended. Engagement in treatment among certain gender groups is poor; cisgender women and non-binary patients assigned male at birth were the least likely to have attended a behavioral health appointment, whereas transgender men and cisgender women had attended the lowest number of substance use appointments. These data demonstrate the importance of (1) assessing gender diversity and (2) addressing the barriers that prevent TGD patients from receiving affirming care.
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Affiliation(s)
- Amelia M. Stanton
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- The Fenway Institute, Fenway Health, Boston, Massachusetts, United States of America
| | - Abigail W. Batchelder
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- The Fenway Institute, Fenway Health, Boston, Massachusetts, United States of America
| | - Norik Kirakosian
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - James Scholl
- The Fenway Institute, Fenway Health, Boston, Massachusetts, United States of America
- Department of Psychiatry, Veterans Affairs Boston Healthcare System, Boston, Massachusetts, United States of America
| | - Dana King
- The Fenway Institute, Fenway Health, Boston, Massachusetts, United States of America
| | - Chris Grasso
- The Fenway Institute, Fenway Health, Boston, Massachusetts, United States of America
| | - Jennifer Potter
- The Fenway Institute, Fenway Health, Boston, Massachusetts, United States of America
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - Kenneth H. Mayer
- Harvard Medical School, Boston, Massachusetts, United States of America
- The Fenway Institute, Fenway Health, Boston, Massachusetts, United States of America
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - Conall O’Cleirigh
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- The Fenway Institute, Fenway Health, Boston, Massachusetts, United States of America
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Hershner S, Jansen EC, Gavidia R, Matlen L, Hoban M, Dunietz GL. Associations Between Transgender Identity, Sleep, Mental Health and Suicidality Among a North American Cohort of College Students. Nat Sci Sleep 2021; 13:383-398. [PMID: 33762860 PMCID: PMC7982442 DOI: 10.2147/nss.s286131] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 01/29/2021] [Indexed: 12/20/2022] Open
Abstract
PURPOSE The purpose of this study is to examine the associations between transgender identity, sleep, and mental health among a North American cohort of cisgender and transgender college students. PARTICIPANTS AND METHODS This cross-sectional study surveyed 221,549 North American college students from the 2016-2017 American College Health Association-National College Health Assessment II. Bivariate and multivariable analysis examined associations among transgender identity and outcomes of insomnia symptoms, daytime sleepiness, sleep disorder diagnoses and treatments. Mental health outcomes included mood symptoms, suicidal behaviors, anxiety and depression diagnoses and treatments. RESULTS Transgender identity was reported by 1.6% (n=3471) of United States (US) and 1.7% (n=717) Canadian students, respectively. Mean age was 22.5 ±6. Transgender college students have an increased prevalence of daytime sleepiness, insomnia symptoms, diagnoses and/or treatment of insomnia and other sleep disorders as compared to cisgender college students. Mental Health symptoms are more prevalent with a 2-fold increase in depression and anxiety and nearly a 4-fold increase in suicide attempts among transgender students. A higher burden of mood symptoms exists among transgender college students in the US in comparison to Canadian students. CONCLUSION Transgender college students have an alarmingly high rate of mood, sleep disturbances and sleep diagnoses, and suicidality. Colleges and universities must provide sufficient resources to address the sleep and mental health needs of transgender students. Institutions must adopt gender affirming policies that promote an inclusive environment. Increased allocation of resources and adoption of policies that enhance the physical and mental health of transgender students could improve sleep, mood, and potentially lower the suicide risk among a population that often experiences health inequities.
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Affiliation(s)
- Shelley Hershner
- Sleep Disorders Center, Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Erica C Jansen
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Ronald Gavidia
- Sleep Disorders Center, Department of Neurology, University of Michigan, Ann Arbor, MI, USA
| | - Lisa Matlen
- Department of Pediatrics; Sleep Disorder Center, University of Michigan, Ann Arbor, MI, USA
| | - Mary Hoban
- American College Health Association, Research Office, Silver Spring, MD, USA
| | - Galit Levi Dunietz
- Sleep Disorders Center, Department of Neurology, University of Michigan, Ann Arbor, MI, USA
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Romano JL. Politics of Prevention: Reflections From the COVID-19 Pandemic. JOURNAL OF PREVENTION AND HEALTH PROMOTION 2020; 1:34-57. [PMID: 38603060 PMCID: PMC7358972 DOI: 10.1177/2632077020938360] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The COVID-19 pandemic from a prevention science perspective, including research topics, is discussed. Political considerations that influence prevention activities, with examples from the pandemic and from more typical prevention initiatives in schools and communities, are presented. The definitions of prevention science and prevention interventions are delineated, and a brief summary of prevention history is given. The relationship between health disparities and COVID-19 is discussed. Two theoretical perspectives that may help to inform effectiveness of COVID-19 prevention measures, health belief model and theory of reasoned action and planned behavior, are summarized. This article emphasizes the importance of adapting prevention applications to the intended recipients, especially ethnic and cultural groups. The need to strengthen prevention training in graduate education and strategies to reform the education to meet accreditation and licensing standards are suggested.
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Cooper K, Russell A, Mandy W, Butler C. The phenomenology of gender dysphoria in adults: A systematic review and meta-synthesis. Clin Psychol Rev 2020; 80:101875. [PMID: 32629301 PMCID: PMC7441311 DOI: 10.1016/j.cpr.2020.101875] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 03/29/2020] [Accepted: 05/31/2020] [Indexed: 12/31/2022]
Abstract
Gender dysphoria is distress due to a discrepancy between one's assigned gender and gender identity. Adults who wish to access gender clinics are assessed to ensure they meet the diagnostic criteria for gender dysphoria. Therefore, the definition of gender dysphoria has a significant impact on the lives of individuals who wish to undergo physical gender transition. This systematic review aimed to identify and synthesize all existing qualitative research literature about the lived experience of gender dysphoria in adults. A pre-planned systematic search identified 1491 papers, with 20 of those meeting full inclusion criteria, and a quality assessment of each paper was conducted. Data pertaining to the lived experience of gender dysphoria were extracted from each paper and a meta-ethnographic synthesis was conducted. Four overarching concepts were identified; distress due to dissonance of assigned and experienced gender; interface of assigned gender, gender identity and society; social consequences of gender identity; internal processing of rejection, and transphobia. A key finding was the reciprocal relationship between an individual's feelings about their gender and societal responses to transgender people. Other subthemes contributing to distress were misgendering, mismatch between gender identity and societal expectations, and hypervigilance for transphobia. A systematic review of all papers on the lived experience of gender dysphoria Twenty papers with 1606 participants were included in a meta-ethnographic synthesis. Distress was due to gender and sex incongruence, as well as social factors. Results give new insights into the relationships between factors causing distress.
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Affiliation(s)
- Kate Cooper
- Centre for Applied Autism Research, Department of Psychology, University of Bath, BA2 7AY, UK.
| | - Ailsa Russell
- Centre for Applied Autism Research, Department of Psychology, University of Bath, BA2 7AY, UK
| | - William Mandy
- UCL Research Department of Clinical, Educational, and Health Psychology, Gower Street, London WC1E 6BT, UK
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Kattari SK, Bakko M, Hecht HK, Kattari L. Correlations between healthcare provider interactions and mental health among transgender and nonbinary adults. SSM Popul Health 2020; 10:100525. [PMID: 31872041 PMCID: PMC6909214 DOI: 10.1016/j.ssmph.2019.100525] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 11/20/2019] [Accepted: 11/28/2019] [Indexed: 01/26/2023] Open
Abstract
Transgender and nonbinary patients have a wide array of experiences when attempting to access healthcare, including discrimination and having to educate providers about trans people. This study examines the mental health factors connected to transgender and nonbinary patients' experience with providers to determine the likelihood of transgender or nonbinary patients receiving respectful care after a provider knows about the patient's gender identity, and patients' experience of having to educate providers about trans people, controlling for sociodemographic factor. Using data from the 2015 United States Trans Survey (N = 27,715), chi-square tests of independence and multivariate logistic regressions were used to explore the odds of transgender or nonbinary individuals having a positive experience with a doctor or healthcare provider. Of the respondents, 24.31% experienced having to educate a provider about trans people when seeking care, and 62.90% experienced a provider knowing they were transgender or nonbinary and treating them with respect. Those experiencing depression and suicidal thoughts were significantly less likely to have had a provider treat them with respect, and significantly more likely to need to educate their providers. Gender, age, disability status, and educational level were significant across both variables; income was significant regarding having to educate a provider. Healthcare providers need ongoing training and education to improve their care of transgender and nonbinary patients, specifically around acknowledging the multiple backgrounds and experiences of such patients, including those related to mental health, gender, race, age, income, educational level, and disability.
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Affiliation(s)
- Shanna K. Kattari
- University of Michigan School of Social Work, 1080 S. University Avenue, Ann Arbor, MI, 48109, USA
| | - Matthew Bakko
- University of Michigan School of Social Work, 1080 S. University Avenue, Ann Arbor, MI, 48109, USA
| | - Hillary K. Hecht
- University of Michigan School of Social Work, 1080 S. University Avenue, Ann Arbor, MI, 48109, USA
| | - Leonardo Kattari
- Michigan State University School of Social Work, 655 Auditorium Road, East Lansing, MI, 48824, USA
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Abstract
In the last decade, mental health issues have come to the foreground in academia. Literature surrounding student mental health continues to grow as universities try to implement wellness services and study the mental health of their students. Studies vary greatly in terms of measurement tools, timeframe, sample demographics, as well as the chosen threshold of symptom severity for diagnosis. This review attempts to summarize, contextualize and synthesize papers that pertain to the challenges faced by academic trainees at the undergraduate, graduate and post-graduate level. The evidence for, and against, the common claim of increasing prevalence of mental health issues among students in recent years is discussed. While some studies support this claim, it is difficult to reach a definitive conclusion due to numerous confounding factors such as increased help-seeking behaviour, greater awareness of mental health issues and weak methodology. The prevalence of depression, anxiety, suicidal and self-injurious behaviour, distress and general mental illness diagnoses are discussed. Other issues known to influence mental health, such as sexual assault and bullying, are briefly addressed. Finally, select studies on a few wellness strategies that may improve mental health of trainees, such as mindfulness, are summarised, along with diverse recommendations for individual students, universities, and academia as a whole.
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Affiliation(s)
- Renee Eleftheriades
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON, Canada
| | - Clare Fiala
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON, Canada
| | - Maria D. Pasic
- Laboratory Medicine and Pathobiology, St. Joseph’s Health Centre, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
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Tucker CM, Roncoroni J, Buki LP. Counseling Psychologists and Behavioral Health: Promoting Mental and Physical Health Outcomes. COUNSELING PSYCHOLOGIST 2020. [DOI: 10.1177/0011000019896784] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
On the occasion of the 50th Anniversary of The Counseling Psychologist, we reflect on the many contributions that counseling psychologists have made and are poised to make in the areas of behavioral health and behavioral health care. We note that psychologists’ engagement in health promotion and prevention of behavioral, mental, and emotional disorders is consistent with counseling psychology values. We provide a concise review of theories that are widely applied in behavioral health contexts and discuss ways in which counseling psychologists may apply these theories to help ameliorate health disparities, empower communities to take control of their own health, and promote social justice. In addition, we highlight the need to create interdisciplinary partnerships to conduct culturally sensitive research on the bi-directional relationship between mental health and physical health. The article ends with wide-ranging implications and recommendations for theory development, research, training, practice, and advocacy.
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Reisner SL, Hughto JMW. Comparing the health of non-binary and binary transgender adults in a statewide non-probability sample. PLoS One 2019; 14:e0221583. [PMID: 31454395 PMCID: PMC6711503 DOI: 10.1371/journal.pone.0221583] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 08/09/2019] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND In the U.S., non-binary refers to transgender people who have a gender identity not aligned with their assigned sex at birth, and who identify outside of the traditional male-female binary, such as genderqueer, genderfluid, or gender nonconforming. Few data are available to characterize the health of non-binary adults. METHODS The current study sought to fill this gap by conducting a secondary analysis of data from a non-probability sample of transgender and/or gender nonconforming adults in Massachusetts (sample mean age 32.6 years, 63% female assigned sex at birth; 79.4% white non-Hispanic/Latinx). Multivariable models were fit to compare non-binary (e.g., genderqueer) vs. binary (e.g., man/trans man, woman/trans woman) respondents across a range of social and health indicators. RESULTS Overall, 40.9% identified their gender identity as non-binary. Non-binary respondents significantly differed from binary respondents on (all p<0.05): demographics (younger age, more female assigned sex at birth); gender affirmation (older age of identity recognition, lower current uptake of and future desires for medical gender affirmation); healthcare utilization (lower rates of being up-to-date in annual wellness visit, less mental healthcare utilization in past year); mental health and substance use (higher past-week depressive distress, higher hazardous alcohol use); social history (more unstably housed, more current students), violence victimization (lower rates of lifetime intimate partner violence), and social support (less family support). CONCLUSION Gender diversity, including whether people endorse a binary or non-binary gender identity, is a prevalent and an important aspect of transgender health. Demographic measures of gender identity that include binary and non-binary response options are recommended to inform future research and clinical care.
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Affiliation(s)
- Sari L. Reisner
- Division of General Pediatrics, Boston Children’s Hospital, Boston, Massachusetts, United States of America
- Pediatrics, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- The Fenway Institute, Fenway Health, Boston, Massachusetts, United States of America
| | - Jaclyn M. W. Hughto
- The Fenway Institute, Fenway Health, Boston, Massachusetts, United States of America
- Departments of Behavioral and Social Sciences and Epidemiology, Brown University School of Public Health, Providence, Rhode Island, United States of America
- Center for Health Equity Research, Brown University, Providence, Rhode Island, United States of America
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Scandurra C, Mezza F, Maldonato NM, Bottone M, Bochicchio V, Valerio P, Vitelli R. Health of Non-binary and Genderqueer People: A Systematic Review. Front Psychol 2019; 10:1453. [PMID: 31293486 PMCID: PMC6603217 DOI: 10.3389/fpsyg.2019.01453] [Citation(s) in RCA: 92] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 06/06/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Non-binary and genderqueer (NBGQ) people are those who do not identify within the gender binary system (male vs. female), not falling exclusively in man/male or woman/female normative categories. A higher proportion of NBGQ people is usually found within young persons. This population is marginalized and, as such, is at risk of stigmatization and of developing negative health outcomes. As literature on the health of NBGQ people is sparse, this study aims at systematically review the limited studies on this field. Methods: The research questions which guided the systematic review were: (1) What are the differences in the health levels between NBGQ and binary transgender (BT) individuals? (2) What are the differences in the health levels between NBGQ and cisgender individuals? (3) Which medical and psychological interventions are most suitable for improving NBGQ health? According to PRISMA guidelines, a systematic search was conducted in PubMed, PsycInfo, Web of Science, and Google Scholar. Results: Eleven studies met the inclusion criteria for the current systematic review. Among them, 9 were focused on the health differences between NBGQ and BT individuals, 4 of the latter and 1 individually were focused on the health differences between NBGQ and cisgender individuals, and 1 was focused on the evaluation of health outcomes related to medical procedures. No studies assessed psychological interventions aimed at improving health in NBGQ individuals. All studies were cross-sectional, did not generally recruit a large sample of NBGQ individuals, and used non-probability sample design. Results related to the difference in health between NBGQ and BT were mixed; indeed, some found a better health status while others a worse one. Results related to the differences in health between NBGQ and cisgender highlighted higher health needs in NBGQ than in BT individuals. The only study analyzing the effects of medical interventions on health found that NBGQ female-assigned at birth individuals improved their quality of life after chest surgery. Conclusions: Although scholars are starting to pay attention to the NBGQ health, research needs to be expanded both in terms of methodology and research contents. Clinical, health-related social policies, and research recommendations in this field are reported.
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Affiliation(s)
- Cristiano Scandurra
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy
| | - Fabrizio Mezza
- Center SInAPSi, University of Naples Federico II, Naples, Italy
| | - Nelson Mauro Maldonato
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy
| | - Mario Bottone
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy
| | | | - Paolo Valerio
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy
| | - Roberto Vitelli
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy
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