Suicidality and self-harm among sexual minorities in Japan

Sexual Activity as Self-Injury: A Scoping Review

Suicide and other self-injurious behaviors (SIB) are significant causes of morbidity and mortality as well as healthcare costs. Sexual risk behaviors are associated with many SIB, and sexual activities may act as SIB as well. In this scoping review, we consider ways in which sexual activity has been conceptualized as SIB - types of sexual activities as a form of self-injury - and cases in which sexual activities as SIB have been classified as direct or indirect self-injury. We include English-language publications that discuss any aspect of sexual activity as SIB. Database, citation list, and gray literature searches yielded 33 publications. Sexual activities as a form of self-injury included exposure to HIV/AIDS and other sexually transmitted infections, sadomasochistic behaviors undertaken for punishment rather than pleasure, selling sex, injury to the genitals, and sexual encounters with undesired partners or consisting of undesired acts. Twenty-three publications did not categorize sexual activities to self-injure as either direct or indirect self-injury, three publications categorized them as indirect self-injury, and seven publications as direct self-injury. Sexual activity is used to self-injure in a variety of ways and its conceptualization as indirect or direct self-injury remains unclear.

"I Don't Feel at Home in This World" Sexual and Gender Minority Emerging Adults' Self-Perceived Links Between Their Suicidal Thoughts and Sexual Orientation or Gender Identity

OBJECTIVES

To examine whether sexual and gender minority (SGM) emerging adults perceived their SGM status was linked to suicidal ideation, and to explore if their responses fell within tenets of the minority stress framework.

METHOD

Open text (survey) responses of Dutch and Flemish SGM emerging adults (n  =  187) were thematically analysed using the constant comparative comparison method for qualitative analysis.

RESULTS

We identified 8 themes in our qualitative analysis. Two themes fell within the scope of the minority stress framework that has received little attention: (1) concerns about relationships and family planning and (2) feeling different (internal stressor). Two additional themes emerged largely beyond the scope of existing minority stress framework studies on suicidality: (3) SGM-related questioning; (4) negativity in LGBT communities. Four established minority stress framework themes emerged: (5) gender identity stress; (6) victimization; (7) coming-out stress; (8) psychological difficulties linked to SGM status.

CONCLUSION

Suicide prevention needs to focus on supporting SGM emerging adults who worry about feeling "different", or who have concerns over their romantic and family life, on reducing gender minority stress, as well as on caring for those who are victimized due to their sexual or gender identity.

Elevated trauma exposure and mental health burden among men who have sex with men in Vietnam

The purpose of this study was to characterize trauma exposure and mental health burden among men who have sex with men (MSM) in Hanoi, Vietnam. Participants comprise 100 HIV-positive and 98 high-risk, HIV-negative MSM, ranging from 18 to 29 years of age. Data were collected using the Childhood Trauma Questionnaire, Traumatic Events Inventory, Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and PTSD Symptom Scale. A subset of participants (n  =  12) were also interviewed to evaluate community perception of the prevalence, causation, and available treatment options for mental health issues within the MSM community in Vietnam. In our sample, 23.2% reported having experienced moderate-to-severe childhood physical abuse; 18.7% physical neglect; 13.6% emotional abuse; 11.1% emotional neglect; and 26.8% sexual abuse. Such trauma exposure continued into adulthood and manifested most commonly in the form of interpersonal violence. Approximately 37.4% of the sample met the criteria for probable PTSD; 26.8% for moderate-to-severe depression; and 20.2% for moderate-to-severe anxiety. Neither exposure nor mental health burden differed by serostatus. Linear regression revealed that childhood emotional abuse was the only sub-type of trauma significantly associated with depression, anxiety, and PTSD symptoms. The majority of interviewees believed that mental health burden was higher among MSM relative to the general population and attributed this to their vulnerability to interpersonal violence and lack of available coping resources. However, few believed that these mental health issues warranted clinical attention, and only one participant was able to identify a mental health service provider. Our findings suggest that trauma exposure and mental health burden are prevalent among MSM, irrespective of serostatus, and much higher than what has been previously reported among the general population in Vietnam.

Suicidal Ideation and Suicide Attempts Among Lesbian, Gay, Bisexual, Pansexual, Queer, and Asexual Youth: Differential Impacts of Sexual Orientation, Verbal, Physical, or Sexual Harassment or Assault, Conversion Practices, Family or Household Religiosity, and School Experience

Purpose: This article examines factors associated with suicidal ideation and suicide attempts in the past 12 months among lesbian, gay, bisexual, pansexual, queer, asexual, or other non-heterosexual identifying youth (LGBQA+). Methods: A national Australian cross-sectional online survey was conducted involving 4370 cisgender LGBQA+ participants aged 14-21 years from September to October 2019. Multivariable logistic regression analyses were performed to examine significant factors associated with suicidal ideation and suicide attempts in the past 12 months. Research ethics approval for the WTI4 study was granted by the La Trobe University Human Research Ethics Committee and the ACON Research Ethics Review Committee. Results: Overall, 56.4% of participants reported suicidal ideation and 8.9% a suicide attempt in the past 12 months. Multivariable regression results show that participants aged younger than 18 years, lesbian (compared with gay) identifying, those living in rural or remote locations (compared with inner city), those reporting any verbal, physical, or sexual harassment or assault based on sexual orientation or gender identity, or who had a religious family or household, or had experienced conversion practices in the past 12 months reported higher levels of suicidal ideation or suicide attempts. Those who reported feeling part of their school reported lower levels of suicidal ideation and suicide attempts. Conclusion: High levels of suicidal ideation and suicide attempts among young LGBQA+ people in Australia highlight a need for the ongoing inclusion of LGBQA+ youth as a priority population for suicide prevention. The findings illustrate key factors associated with a greater risk of suicidality among young LGBQA+ people. These findings can be used to inform the provision of tailored support services, including culturally safe suicide prevention programs and efforts to address stigma, discrimination, and conversion practices.

Additional Value of Peer Informants in Psychological Autopsy Studies of Youth Suicides

In this study, we examined the feasibility and added value of including peer informants in a psychological autopsy study of youth suicides. Peer semi-structured interview data from 16 cases were analyzed qualitatively and compared to parent data. Results show that peers added information to parents' narratives in general and particularly on social relationships, bullying, school experiences, social media, and family relations. Peers also provided additional information on the presence of certain issues (such as social media contagion) as well as on the emotional impact from certain adverse events that seemed to have functioned as precipitating factors. We conclude that including peers in psychological autopsy studies of youth suicides is feasible and of added value but that more research is desirable. The results initially can be used in the design of psychological autopsies so that the maximum amount of information about each suicide will be learned.

Exploring Cross-Sectional Predictors of Suicide Ideation, Attempt, and Risk in Gender Incongruent Adults in India

INTRODUCTION

Suicide rates and suicidal tendencies among gender incongruent persons are higher compared to the general population. Yet little is known about the factors that are relevant for suicide-related outcomes among Indian gender incongruent individuals.

MATERIALS AND METHODS

Within a large sample of gender incongruent adults (n=120), we examined the contribution of demographic (age, assigned sex, gender identity, relationship, and addiction status) and socio-economic variables (education, profession, income, social support) in the prediction of three suicide-related outcomes: past-year suicidal thought, history of suicidal attempt and a composite measure of the two.

RESULTS

Of the entire sample, 25.8% (n=31) reported a past suicide attempt, with 18.3% (n = 22) reporting one attempt, 2.5% (n = 3) reporting two attempts, 1.7% (n = 2) reporting three attempts and 2.5% (n=3) reporting four to six attempts. The age at which the first suicide attempt occurs is mostly between 16 to 18 years. 19.26% (n = 21) reported that although they had not attempted suicide, they had given serious thought to killing themselves in the last year. A Chi-square test was conducted to ascertain each demographic variable and socio-economic marker. However, none of these proposed predictors correlated with suicide-related outcomes in our cohort.

CONCLUSIONS

The gender incongruent community is highly susceptible to suicidal behavior. Gender identity may be the risk factor for that behavior. Further study with larger population needs to identify other relevant risk factors, including gender-related victimization and mental health conditions as risk factors.

Pensamento suicida entre a população transgênero: um estudo epidemiológico

RESUMO Objetivo Analisar a prevalência de pensamentos suicidas em pacientes de um ambulatório de transgêneros no Distrito Federal, bem como as variáveis associadas a esses eventos. Métodos Estudo epidemiológico de corte transversal, realizado a partir de uma revisão dos prontuários dos pacientes atendidos no ambulatório de transgêneros do Hospital Dia, no Distrito Federal, no período de agosto de 2017 a setembro de 2018. Os dados foram tabulados pelo programa Excel 2016 e depois analisados pelo Pacote Estatístico para as Ciências Sociais (SPSS). Resultados Neste estudo, observamos fatores intervenientes e variáveis que influenciam o desenvolvimento do comportamento suicida, com uma correlação entre fatores de risco modificáveis e não modificáveis. Os achados deste estudo corroboram a literatura internacional sobre comportamento suicida e as variáveis que podem estar relacionadas a esse fato. Conclusão Questões sociodemográficas, de habitação e psiquiátricas compõem esses fatores, demonstrando possíveis relações com a ideação suicida. Assim, é possível mostrar situações de intervenção e elaboração de estratégias e políticas que possam melhorar a qualidade de vida desses indivíduos e reduzir as taxas de comportamento suicida.

"I Never Saw a Future": Childhood Trauma and Suicidality Among Sexual Minority Women

While a significant health concern for sexual minority women, there is little qualitative research investigating their experiences of childhood trauma and suicidality. In this study, we used photovoice methods and an intersectionality framework. Drawing on qualitative interviews, we inductively derived three themes (a) Traumatized and discredited, (b) Cascading marginality, estrangement, and suicidality, (c) Reconstruction and reclaiming resilience. In Traumatized and discredited, we describe the sense of abandonment flowing from childhood trauma heightened by a lack of protection and neglect on the part of parents/guardians. The lack of support to deal with childhood trauma and the layering effects of marginality characterizes the theme Cascading marginality, estrangement, and suicidality. In the third theme, we discuss strategies for reconstruction and reclaiming resilience as participants worked to overcome these challenging experiences. Our study findings offer guidance to suicide prevention counseling programs for sexual minority women and affirm actions to address health inequities.

Experiences of transmasculine spectrum people who report nonsuicidal self-injury: A qualitative investigation

Transgender populations experience mental and physical health disparities compared to nontransgender populations, including nonsuicidal self-injury (NSSI). Guided by the minority stress theory and Nock's model of NSSI, this study explored perspectives of transmasculine spectrum people (i.e., people with a gender identity that is man, male, transgender man, genderqueer, or nonbinary and who were assigned female at birth) who engage in NSSI. Qualitative interviews were conducted with transmasculine spectrum people (N = 18) who reported a history of NSSI. Their mean age was 24.9 years old (SD = 5.43, range = 17-38). Participants reported that NSSI was influenced by a variety of factors including stress from gender nonconformity in childhood and adolescence. Stigma related to minority status and identity as well as proximal minority stress processes of concealment and expectations of rejection were identified as contributing to NSSI. Transgender identity development tasks such as coming out and identity exploration also appeared to affect NSSI. Finding a community of peers who engage in NSSI was helpful in mitigating social isolation, but at times reinforced NSSI. We discuss clinical implications at the individual and family levels. Interventions to reduce NSSI among transmasculine-spectrum people should include facilitating connections with gender minority peers and providing individual support and family interventions to facilitate transgender identity development. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Suicide and Suicidal Behavior among Transgender Persons

BACKGROUND

Suicide rate and suicidal tendencies among transgender persons are considerably high compared to general population. Hence, this review is an attempt to understand the issues around the suicide and suicidal behavior among transgender persons.

METHODOLOGY

The literature search conducted using three sources, i.e., electronic databases (PubMed, ProQuest, Google Scholar, PsycInfo), manual search (library catalog), and gray literature (consultation with experts).

RESULTS

The suicide attempt rate among transgender persons ranges from 32% to 50% across the countries. Gender-based victimization, discrimination, bullying, violence, being rejected by the family, friends, and community; harassment by intimate partner, family members, police and public; discrimination and ill treatment at health-care system are the major risk factors that influence the suicidal behavior among transgender persons.

CONCLUSION

In spite of facing a number of hardships in their day-to-day life, the transgender community holds a number of resiliency factors. Further, this community needs to be supported to strengthen their resiliency factors and draw culturally sensitive and transgender-inclusive suicide prevention strategies and increase protective factors to tackle this high rate of suicidality.

Self-injury among trans individuals and matched controls: prevalence and associated factors

This study aims to determine the prevalence rate of current non-suicidal self-injury (NSSI) among trans individuals, in comparison with a control sample of non-trans adults. It also aims to compare those with current NSSI and those with no history of NSSI in terms of psychological well-being, self-esteem, body dissatisfaction, social support and demographic factors. Participants were 97 adults, diagnosed with transsexualism (ICD-10, F64.0), attending a national gender clinic in the United Kingdom, and a matched control group. Clinical participants were all engaged on the treatment pathway. Participants completed the following self-report measures: Self-Injury Questionnaire - Treatment Related (SIQ-TR), Symptom Checklist 90 Revised (SCL-90-R), Rosenberg Self-Esteem Scale (RSE), Hamburg Body Drawing Scale (HBDS) and Multidimensional Scale of Perceived Social Support (MSPSS). The results showed that the trans participants had a significantly higher prevalence of current NSSI behaviour than the non-trans group, with 19% currently engaging in NSSI. Current NSSI was also significantly more prevalent among trans men than trans women. Compared with both trans and non-trans participants with no history of NSSI, trans participants with current NSSI had significantly higher scores on SCL; significantly lower scores on RSE, HBDS and MSPSS; and were younger in age. The study concludes that trans men, specifically, are more at risk of NSSI than trans women and the general population, even when on the treatment pathway. Those who currently self-injure have greater psychopathology, lower body satisfaction, lower self-esteem, lower social support and tend to be younger, than those who do not engage in NSSI.

Prevalence of sexual victimization and correlates of forced sex in Japanese men who have sex with men

Studies of men who have sex with men (MSM) in diverse geographic and cultural contexts have identified health challenges affecting this population. MSM might be particularly vulnerable to sexual victimization and forced sex. The aim of this research study was to examine prevalence of sexual victimization and correlates of forced sex among Japanese MSM. We recruited a sample of 5,731 Japanese MSM who completed an internet-administered survey. Participants reported on history of different types of sexual victimization, unprotected anal sex, other health risk behaviors, exposure to gay-related teasing and bullying, depression, and suicidality. Over one-fifth of the sample (21.4%) reported experiencing at least one form of sexual victimization, and 8.7% reported a history of forced sex. MSM who had ever experienced forced sex were significantly more likely to report experiencing psychological risks (depression OR = 1.55, 95% CI = 1.28–1.89; attempted suicide OR = 2.25, 95% CI = 1.81–2.81; other forms of bullying OR = 1.38, 95% CI = 1.13–1.68) and other behavioral risks (unprotected anal sex OR = 1.56, 95% CI = 1.29–1.90; sex venue attendance OR = 1.27, 95% CI = 1.04–1.54; methamphetamine use OR = 1.57, 95% CI  = 1.05–1.36), compared to MSM who had not experienced forced sex. Efforts to develop holistic and integrated health services for Japanese MSM are warranted, particularly related to psychosocial determinants of HIV prevention. However, due to cultural factors that emphasize familial and social relations and that stigmatize same-sex behavior, Japanese MSM might experience challenges to seeking social support and health services. Interventions must be provided in safe and non-judgmental settings where Japanese MSM feel comfortable disclosing their health and social support needs.

Qualitative research on suicide in East Asia: a scoping review

BACKGROUND

Suicide is a serious problem in East Asia. Yet, there is a significant lack of research on the topic, particularly using qualitative methodology.

OBJECTIVES

This scoping review reports on findings drawn from 11 qualitative studies, providing up-to-date knowledge and understandings about suicide in East Asian populations.

METHODS

A web-based literature search was performed to identify empirical qualitative research articles addressing suicide in East Asia, published from January 2002 to December 2011.

RESULTS

Three themes were identified within the reviewed studies; (1) influence of cultural beliefs; (2) the role of caregivers; and (3) specific sociological contexts. These themes are interrelated rather than mutually exclusive.

CONCLUSION

The findings drawn from this scoping review reveal specific as well as broad contexts where suicidal ideation and behaviours occur among East Asians. To advance understandings, future studies should focus on comparative and longitudinal research to distil prevailing trends as well as the specificities that reside among particular East Asian subgroups (i.e. gender, sexual identity and generational) as a means to developing culturally sensitive and targeted suicide prevention programs.

Adolescents' and young adults' perception of homosexuality and related factors in three Asian cities

PURPOSE

Adolescents' and young adults' perception of homosexuality plays an important role in the marginalization and stigmatization of the homosexual, thereby influencing his or her health. This article aims to study that perception and to examine its predictors in three Asian cities that are culturally dominated by Confucianism.

METHODS

From May 2006 to January 2007, a cross-sectional survey of 17,016 adolescents and young adults, aged 15-24 years old, in both urban and rural sites of three Asian cities (Hanoi in Vietnam, Shanghai in the mainland of China, and Taipei in Taiwan) was conducted through interview and computer-assisted self-interview for sensitive questions. Chi-square tests and multivariate logistic regression were performed to identify the predictors for their perception of homosexuality.

RESULTS

The percentage of adolescents and young adults who hold a positive view of homosexuality (i.e., thought it was normal and/or acceptable) was low, especially in Hanoi and Shanghai; these figures increased from Hanoi to Shanghai to Taipei for both males and females. Overall, those factors significantly associated with adolescents' and young adults' perception of homosexuality included individuals' demographic characteristics (urban/rural, age, economic status, student status, and educational level), preferred origin of movies/videos, self-identified sexual orientation, sexual and reproductive health knowledge, family values, gender role values, and attitudes toward premarital sex.

CONCLUSIONS

In these three Asian cities composed of populations whose views are largely influenced by Confucianism, adolescents and young adults mainly hold a negative perception of homosexuality. The most common and important predictors for a respondent's perception of homosexuality were his or her knowledge of sexual and reproductive health and how traditional his/her values may be. Greater attention needs to be paid to the popularization of knowledge about sexual and reproductive health including homosexuality-and to efforts aimed at instilling more liberal attitudes to improve adolescents' and young adults' perception of homosexuality. This could then reduce the marginalization and stigmatization of the homosexual, and thus improve his/her health.

Family acceptance in adolescence and the health of LGBT young adults

ISSUE

the role of family acceptance as a protective factor for lesbian, gay, bisexual, and transgender (LGBT) adolescents and young adults has not been established.

METHODS

a quantitative measure with items derived from prior qualitative work retrospectively assessed family accepting behaviors in response to LGBT adolescents' sexual orientation and gender expression and their relationship to mental health, substance abuse, and sexual risk in young adults (N= 245).

FINDINGS

family acceptance predicts greater self-esteem, social support, and general health status; it also protects against depression, substance abuse, and suicidal ideation and behaviors.

CONCLUSIONS

family acceptance of LGBT adolescents is associated with positive young adult mental and physical health. Interventions that promote parental and caregiver acceptance of LGBT adolescents are needed to reduce health disparities.

Women's experiences of their violent behavior in an intimate partner relationship

The purpose of this study was to describe women's perceptions of their violent behavior in a heterosexual partnership. The study followed the traditions of Husserlian descriptive phenomenology and the philosophy of existential phenomenology. Twenty-four volunteer Finnish women, aged 19 to 58 years, with a history of different manifestations of intimate partner violence (IPV) participated in open-ended interviews. The data were analyzed by the method developed by Colaizzi. The findings revealed that some of the women who opposed all violence on ethical grounds did not label their behavior as violent; some others minimized or justified their violent behavior. The findings offer professional insight into women's violent behavior and call for a readjustment in approaches to work in the area. Prevention and early identification of IPV require knowledge of the various manifestations and individual meanings of violence. Helping methods should provide women with the opportunity to talk about their abusive behavior and to confront and address their feelings of guilt, disappointment, and shame.