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Klepper M, Bosse J, Flores DD, Sanders R. Sibling Support for Transgender and Gender-Diverse Youth: A Scoping Review. J Adolesc Health 2024; 75:543-552. [PMID: 39033456 PMCID: PMC11410513 DOI: 10.1016/j.jadohealth.2024.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 05/03/2024] [Accepted: 05/20/2024] [Indexed: 07/23/2024]
Abstract
Sibling support for transgender and nonbinary (TNB) youth has the potential to improve TNB youths' mental health. A scoping review was conducted to map the knowledge of TNB youths' sibling relationships to create a foundation for the development of sibling-based support interventions for TNB youth. Nine included articles covered two areas: TNB youths' perceptions of sibling support (n = 5) and cisgender siblings' lived experience with a TNB sibling (n = 4). Siblings were perceived to support TNB youth, and their support was associated with less depression, suicidal ideation, and externalizing problems. Siblings of TNB youth lacked knowledge of TNB identities and support for their own understanding and acceptance. Siblings may experience unique stressors around their TNB sibling's changing gender identity. Overall, having a TNB sibling was perceived as a positive experience. None of the studies included intervention with or for siblings of TNB youth. Sibling support can be helpful for TNB youths' mental health. However, cisgender siblings' unique needs are rarely addressed. Providing cisgender siblings with knowledge of TNB identity, a place to process fears and concerns, and skills to navigate situations that may arise in relation to their sibling's gender, has the potential to benefit both siblings.
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Affiliation(s)
- Meredith Klepper
- Johns Hopkins School of Nursing, Johns Hopkins University, Baltimore, Maryland.
| | - Jordon Bosse
- University of Rhode Island College of Nursing, Kingston, Rhode Island
| | | | - Renata Sanders
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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2
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Magnusson K, Glidden E, Mustaquim D, Welder LE, Stokes EK, Beauchamp GA, Greenberg MR, Aldy K, Mazzaccaro RJ, Careyva BA, Sabino JN, Fikse DJ, McLain K, Amaducci AM. Differences in Drug Poisonings Among Those Who Identify as Transgender Compared to Cisgender: An Analysis of the Toxicology Investigators Consortium (ToxIC) Core Registry, United States 2017-2021. Clin Ther 2024:S0149-2918(24)00256-X. [PMID: 39299811 DOI: 10.1016/j.clinthera.2024.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 08/15/2024] [Accepted: 08/20/2024] [Indexed: 09/22/2024]
Abstract
PURPOSE In this manuscript, the abbreviation TG is defined as persons who identify as transgender, GNC is defined as persons who identify as gender nonconforming, and CG is defined as persons who identify as cisgender. TG and GNC (e.g., nonbinary), are those whose gender identity and sex assigned at birth do not align, as opposed to CG. This study describes drug poisonings among TG, GNC, and CG captured in the Toxicology Investigators Consortium (ToxIC) Core Registry during 2017-2021. METHODS Authors conducted a secondary data analysis of medical toxicology physician consultations involving intentional exposures (i.e., use with the knowledge of the exposed person) within the ToxIC Core Registry from 2017 through 2021. Demographic characteristics, exposure intent, and reported drug classes are reported by gender identity and sex assigned at birth. FINDINGS From a total of 15,800 medical toxicology consultations, 213 (1.3%) involved both TG (n = 187, 1.2%) and GNC (n = 26, 0.2%), and 15,587 (98.7%) involved CG. Among TG, 128 (68.8%) were transgender men, 58 (31.2%) transgender women. Sixty-two percent of TG/GNC (n = 132) and 34.8% of CG (n = 5,428) were aged ≤18 years. Reported intent for exposure (i.e., self-harm and misuse/harmful use) differed proportionally across both sexes assigned at birth and gender identity among transgender men and cisgender men. IMPLICATIONS In the ToxIC Core Registry, the consultations varied proportionally by age group across TG/GNC and CG, with more than half of TG/GNC aged ≤18 years. The proportion of consultations also varied by intent across TG/GNC and CG. Further research to delineate differences between TG/GNC and CG could increase knowledge in prevention, assessment, and treatment of drug poisonings in this population.
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Affiliation(s)
| | - Emily Glidden
- National Network of Public Health Institutes (NNPHI), New Orleans, Louisiana; National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Desiree Mustaquim
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Laura E Welder
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Erin K Stokes
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Gillian A Beauchamp
- Lehigh Valley Health Network/ USF Morsani College of Medicine, Allentown, Pennsylvania
| | - Marna R Greenberg
- Lehigh Valley Health Network/ USF Morsani College of Medicine, Allentown, Pennsylvania.
| | - Kim Aldy
- American College of Medical Toxicology (ACMT), Phoenix, Arizona
| | - Richard J Mazzaccaro
- Lehigh Valley Health Network/ USF Morsani College of Medicine, Allentown, Pennsylvania
| | - Beth A Careyva
- Lehigh Valley Health Network/ USF Morsani College of Medicine, Allentown, Pennsylvania
| | - Judith N Sabino
- Lehigh Valley Health Network/ USF Morsani College of Medicine, Allentown, Pennsylvania
| | - Derek J Fikse
- Lehigh Valley Health Network/ USF Morsani College of Medicine, Allentown, Pennsylvania
| | - Katelyn McLain
- Lehigh Valley Health Network/ USF Morsani College of Medicine, Allentown, Pennsylvania
| | - Alexandra M Amaducci
- Lehigh Valley Health Network/ USF Morsani College of Medicine, Allentown, Pennsylvania
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Coyne SM, Christensen Duerden C, Sheppard JA, Ashby S, Van Alfen M, Harris H, Schilaty B, Hunt Q, Shawcroft J, Gale M, Graver H. "I'll Walk with You": LGBTQ+ Individuals and Religious Belonging. JOURNAL OF HOMOSEXUALITY 2024; 71:2571-2593. [PMID: 37782078 DOI: 10.1080/00918369.2023.2246617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
Research on LGBTQ+ individuals, belonging, and religiosity has been mixed. Some studies have illustrated the ways religion can harm LGBTQ+ individuals while others suggest religion has positive impacts. In the current study, we sought to understand this complexity by examining the experiences of LGBTQ+ individuals who have been or currently are affiliated with The Church of Jesus Christ of Latter-day Saints (i.e. Mormon, LDS). A thematic analysis of 100 interviews with LGBTQ+ individuals currently or previously affiliated with the Church revealed various ways they feel belonging or the lack thereof in Latter-day Saint congregations and communities. These include sharing physical space, being invited to and included at events, receiving gifts or acts of service, seeing others' safety signals, hearing accepting and character-affirming language, and having others listen to them and give them voice. With the intent of fostering belonging, we discuss implications of this research for church communities and propose the belonging in practice: LGBTQ+ and religion model.
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Affiliation(s)
- Sarah M Coyne
- School of Family Life, JFSB 2086C, Brigham Young University, Provo, Utah, USA
| | | | - J Andan Sheppard
- School of Family Life, JFSB 2086C, Brigham Young University, Provo, Utah, USA
| | - Sarah Ashby
- School of Family Life, JFSB 2086C, Brigham Young University, Provo, Utah, USA
| | - Megan Van Alfen
- School of Family Life, JFSB 2086C, Brigham Young University, Provo, Utah, USA
| | - Holly Harris
- School of Family Life, JFSB 2086C, Brigham Young University, Provo, Utah, USA
| | - Ben Schilaty
- School of Family Life, JFSB 2086C, Brigham Young University, Provo, Utah, USA
| | - Quintin Hunt
- School of Family Life, JFSB 2086C, Brigham Young University, Provo, Utah, USA
| | - Jane Shawcroft
- School of Family Life, JFSB 2086C, Brigham Young University, Provo, Utah, USA
| | - Megan Gale
- School of Family Life, JFSB 2086C, Brigham Young University, Provo, Utah, USA
| | - Haley Graver
- School of Family Life, JFSB 2086C, Brigham Young University, Provo, Utah, USA
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Topaz E, Perl L, Raphael I, Sheppes T, Erez G, Israeli G, Segev-Becker A, Oren A, Shechner T. Mental health and timing of gender-related events among transgender and gender-diverse children and adolescents seeking gender-affirming consultation and care. Psychiatry Res 2024; 342:116175. [PMID: 39278194 DOI: 10.1016/j.psychres.2024.116175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Revised: 09/02/2024] [Accepted: 09/04/2024] [Indexed: 09/18/2024]
Abstract
Transgender and gender-diverse (TGD) youth encounter unique challenges affecting their mental health, largely related to societal stigma and gender dysphoria. Limited research considers the specific needs of TGD youth. This study examined demographic and developmental factors, including the ages at which gender-related events occur, and their relationship to mental health among TGD youth seeking gender-affirming consultation and care (GACC). We examined the medical records of 674 TGD children and adolescents, comparing demographics, gender-related events, and mental health across gender groups. The total sample comprised 261 patients assigned male at birth, and 413 patients assigned female at birth. Non-binary individuals reported higher rates of psychopathology compared to binary transgender patients, with transgender boys exhibiting higher rates than transgender girls. Seeking GACC at a more advanced pubertal stage and older age was associated with an increased likelihood of psychopathology. Later recollection of first gender incongruence memory was correlated with higher rates of depression and anxiety. Finally, socioeconomic status was linked to GACC healthcare-seeking behaviors. These findings underscore the importance of recognizing the diverse experiences and needs of TGD youth seeking GACC services, highlighting that early identification and access to care may be crucial for improving mental health outcomes.
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Affiliation(s)
- Erez Topaz
- School of Psychological Sciences and the Integrated Brain and Behavior Research Center, University of Haifa, Haifa, Israel.
| | - Liat Perl
- The Institute of Pediatric Endocrinology, Diabetes and Metabolism, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel; Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Ido Raphael
- School of Psychological Sciences and the Integrated Brain and Behavior Research Center, University of Haifa, Haifa, Israel
| | - Tamar Sheppes
- The Institute of Pediatric Endocrinology, Diabetes and Metabolism, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Galit Erez
- Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel; Psychiatry Division, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Galit Israeli
- The Institute of Pediatric Endocrinology, Diabetes and Metabolism, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Anat Segev-Becker
- The Institute of Pediatric Endocrinology, Diabetes and Metabolism, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel; Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Asaf Oren
- The Institute of Pediatric Endocrinology, Diabetes and Metabolism, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel; Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Tomer Shechner
- School of Psychological Sciences and the Integrated Brain and Behavior Research Center, University of Haifa, Haifa, Israel
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5
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Lee J, Kim HH, Budge SL. Psychological Assessment for Gender-Affirming Care in Transgender and Nonbinary Youth: The Companionship Model. Harv Rev Psychiatry 2024; 32:183-192. [PMID: 39265137 DOI: 10.1097/hrp.0000000000000404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/14/2024]
Abstract
ABSTRACT This article introduces The Companionship Model as a template for conducting ethical and affirming assessment sessions for transgender and nonbinary youths (TNBY) and their guardians. The Companionship Model emphasizes proactive clinical companionship as TNBY and their guardians navigate access to gender-affirming care. The model offers specific action steps for establishing a therapeutic alliance and centers TNBY and their guardians' access to resources based on the informed consent/assent process. In this article, we provide sample session questions and illustrative clinical examples.
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Affiliation(s)
- Joonwoo Lee
- From Department of Counseling Psychology, University of Wisconsin-Madison (Mr. Lee and Dr. Budge); Department of Psychiatry, Massachusetts General Hospital, Boston, MA (Dr. Kim)
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McQuillan MT, Cimpian JR, Lebovitz BA, Gill EK. Transgender Adolescent School Climate, Mental Health, and Adult Social Support. JAMA Pediatr 2024:2822795. [PMID: 39186300 PMCID: PMC11348082 DOI: 10.1001/jamapediatrics.2024.3079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 06/28/2024] [Indexed: 08/27/2024]
Abstract
This cross-sectional study describes gender differences in adolescent school climate, health, and social supports, including who depressed or anxious youth seek help from.
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Vicars M, Deppeler M. Please don't gayify!: an autoethnographic account of medicalised relationality for LGBTQI+ safe affirming medical health education and clinical practice. FRONTIERS IN SOCIOLOGY 2024; 9:1438906. [PMID: 39233919 PMCID: PMC11371766 DOI: 10.3389/fsoc.2024.1438906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2024] [Accepted: 07/24/2024] [Indexed: 09/06/2024]
Abstract
In this article, the authors, a cis-gender gay man and an Indigenous non-binary, two-spirit person, narrate their past encounters with health professionals and their experiences pursuing allied health care training as students. Taking an autoethnographic approach, the first author re-narrates how medical practitioners and students engage (or fail to engage) with the LGBTQIA+ community. They draw on gray documentation derived from an interaction with a consulting physician that highlighted a telling lack of knowledge about the LGBTQ+ community, including those with diverse sex characteristics and sexualities/manifesting as unconscious bias. This interaction provided the impetus to speak back to the experience of being reduced to a medical prognosis. The second author questions the hegemonic practices underpinning encounters with the medical model of response in tertiary education. Our remit in this paper is to question how adequately the specific needs of the LGBTQI+ population are being addressed by the medical model and to what extent aspiring clinicians understand how their actions can contribute to gender- and sexuality-based discrimination and stigmatization.
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Affiliation(s)
- Mark Vicars
- Department of Education, Victoria University, Melbourne, VIC, Australia
| | - Mickey Deppeler
- Department of Education, Victoria University, Melbourne, VIC, Australia
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8
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Locke ER, Highland KB, Thornton JA, Sunderland KW, Funk W, Pav V, Brydum R, Larson NS, Schvey NA, Roberts CM, Klein DA. Time to Gender-Affirming Hormone Therapy Among US Military-Affiliated Adolescents and Young Adults. JAMA Pediatr 2024:2822490. [PMID: 39158896 PMCID: PMC11334009 DOI: 10.1001/jamapediatrics.2024.2835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 06/12/2024] [Indexed: 08/20/2024]
Abstract
Importance Use of exogenous sex steroid hormones, when indicated, may improve outcomes in adolescents and young adults with gender incongruence. Little is known about factors associated with the time from diagnosis of gender dysphoria to initiation of gender-affirming hormone therapy. Identification of inequities in time to treatment may have clinical, policy, and research implications. Objective To evaluate factors associated with time to initiation of gender-affirming hormone therapy after a diagnosis of gender dysphoria in adolescents and young adults receiving care within the US Military Health System. Design, Setting, and Participants This retrospective cohort study used TRICARE Prime billing and pharmacy data contained in the Military Health System Data Repository. Patients aged 14 to 22 years, excluding service members and their spouses, who received a diagnosis of gender dysphoria between September 1, 2016, and December 31, 2021, were included. The data were analyzed between August 30 and October 12, 2023. Exposures Included patient characteristics were race and ethnicity, age group, first sex assigned in the medical record, and TRICARE Prime sponsor military rank and service at the time of diagnosis. Health care and contextual characteristics included the year of diagnosis and the primary system in which the patient received health care. Main Outcomes and Measures The primary outcome was the time between initial diagnosis of gender dysphoria to the first prescription for gender-affirming hormone medication within a 2-year period. A Poisson generalized additive model was used to evaluate this primary outcome. Adjusted probability estimates were calculated per specified reference categories. Results Of the 3066 patients included (median [IQR] age, 17 [15-19] years; 2259 with first assigned gender marker of female [74%]), an unadjusted survival model accounting for censoring indicated that 37% (95% CI, 35%-39%) initiated therapy by 2 years. Age-adjusted curves indicated that the proportion initiating therapy by 2 years increased by age category (aged 14-16 years, 25%; aged 17-18 years, 39%; aged 19-22 years, 55%). Incidence rate ratios (IRRs) and 2-year adjusted probabilities indicated that longer times to hormone initiation were experienced by adolescents aged 14 to 16 years (IRR, 0.36; 95% CI, 0.30-0.44) and 17 to 18 years (IRR, 0.66; 95% CI, 0.54-0.79) compared with young adults aged 19 to 22 years and Black compared with White adolescents (IRR, 0.73; 95% CI, 0.54-0.99). Senior officer compared with junior enlisted insurance sponsor rank (IRR, 1.93; 95% CI, 1.04-3.55) and civilian compared with military health care setting (IRR, 1.21; 95% CI, 1.02-1.43) was associated with shorter time to hormone initiation. Conclusions and Relevance In this cohort study, most adolescents and young adults with a diagnosis of gender dysphoria receiving health care through the US military did not initiate exogenous sex steroid hormone therapy within 2 years of diagnosis. Inequities in time to treatment indicate the need to identify and reduce barriers to care.
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Affiliation(s)
- Evan R. Locke
- Department of Family Medicine, David Grant Medical Center, Travis Air Force Base, California
| | - Krista B. Highland
- Department of Anesthesiology, Uniformed Services University, Bethesda, Maryland
| | - Jennifer A. Thornton
- Clinical Investigation Facility, David Grant Medical Center, Travis Air Force Base, California
- Ripple Effect, Rockville, Maryland
| | - Kevin W. Sunderland
- Clinical Investigation Facility, David Grant Medical Center, Travis Air Force Base, California
- Ripple Effect, Rockville, Maryland
| | - Wendy Funk
- Kennell and Associates, Falls Church, Virginia
| | - Veronika Pav
- Kennell and Associates, Falls Church, Virginia
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Rick Brydum
- Kennell and Associates, Falls Church, Virginia
| | - Noelle S. Larson
- Department of Pediatrics, Uniformed Services University, Bethesda, Maryland
- Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Natasha A. Schvey
- Department of Medical and Clinical Psychology, Uniformed Services University, Bethesda, Maryland
| | | | - David A. Klein
- Department of Family Medicine, David Grant Medical Center, Travis Air Force Base, California
- Department of Pediatrics, Uniformed Services University, Bethesda, Maryland
- Department of Family Medicine, Uniformed Services University, Bethesda, Maryland
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9
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O'Shea J, Jenkins R, Nicholls D, Downs J, Hudson LD. Prevalence, severity and risk factors for mental disorders among sexual and gender minority young people: a systematic review of systematic reviews and meta-analyses. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02552-1. [PMID: 39141104 DOI: 10.1007/s00787-024-02552-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 08/01/2024] [Indexed: 08/15/2024]
Abstract
Evidence suggests heightened prevalence and severity of mental disorders among sexual minority (SM) and gender minority (GM) young people. Several risk factors have been associated with these disparities. A systematic review of systematic reviews and meta-analysis was conducted to provide a comprehensive overview of the literature and to determine the field's current position. MEDLINE, PsycInfo, Scopus and Web of Science were searched in March 2022 and updated January 2024. Eligibility criteria were systematic reviews or meta-analyses assessing contemporaneous prevalence, severity and/or risk factors of mental disorders among SM or GM young people aged 25 and under. 42 reviews were included, all of which were low quality. The prevalence of depression among SM was 26% (95% CI 21-32%), and among GM was 46% (95% CI 36-56%). Greater depression severity was found among SM compared to heterosexual young people, with a significant albeit small effect size (Hedges' g = 0.38, 95% CI = 0.25 to 0.50); effect sizes were similar when separating by gender. GM also reported greater symptom severity compared to cisgender young people. Other mental disorders were more prevalent compared to those reported in the general population, and of greater severity compared to heterosexual/cisgender young people. Several proximal and distal risk factors were focused upon within the systematic reviews identified. Past systematic reviews consistently indicate a heightened risk of mental disorders among SM and GM young people. Services need to be aware of these disparities and adapt their care accordingly.
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Affiliation(s)
- Jonathan O'Shea
- Population, Policy and Practice Department, Great Ormond Street UCL Institute of Child Health, London, UK. jonathan.o'
| | - Rebecca Jenkins
- Hull York Medical School, University of York, University Road, Heslington, York, UK
| | - Dasha Nicholls
- Division of Psychiatry, Department of Brain Sciences, Imperial College London, London, UK
| | - James Downs
- Independent Researcher and Expert by Experience, Cardiff, UK
| | - Lee D Hudson
- Population, Policy and Practice Department, Great Ormond Street UCL Institute of Child Health, London, UK
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10
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Hidalgo MA, Chen D, Tishelman AC, Olson-Kennedy J, Chan YM, Garofalo R, Petras H, Rosenthal SM, Ehrensaft D. Childhood Gender Diversity and Mental Health: Protocol for the Longitudinal, Observational Gender Journey Project. JMIR Res Protoc 2024; 13:e55558. [PMID: 39121472 PMCID: PMC11344181 DOI: 10.2196/55558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 04/18/2024] [Accepted: 06/14/2024] [Indexed: 08/11/2024] Open
Abstract
BACKGROUND Prepubertal transgender, nonbinary, and gender-diverse (TGD) children (ie, those asserting gender identity, expressing gender-role behavior outside of culturally defined norms for their sex registered at birth, or both) are presenting in greater numbers to pediatric gender clinics across the United States and abroad. A large subset of TGD children experiences gender dysphoria, that is, distress that arises from the incongruence between gender identity and sex registered at birth. A lack of consensus exists regarding care for prepubertal TGD children due, in part, to a dearth of empirical research on longitudinal developmental trajectories of gender identity, role behavior, and gender dysphoria (when present). OBJECTIVE The objective of this National Institutes of Health-funded study is to provide evidence to inform clinical care for prepubertal TGD children by establishing a US longitudinal cohort (N=248) of prepubertal TGD children and their caregivers that is followed prospectively at 6-month intervals across 18 months. METHODS At each timepoint, clinical and behavioral data are collected via web-based visit from child and caregiver reporters. Latent class analysis, among other methods, is used to identify subgroups and longitudinally characterize the gender identity and gender-role behavior of TGD children. These models will define longitudinal patterns of gender identity stability and characterize the relationship between TGD classes and mental and behavioral health outcomes, including the moderating role of social gender transition (when present), on these associations. RESULTS Baseline data collection (N=248) is complete, and the identification of TGD subgroups based on gender identity and expression using latent class analysis is anticipated in 2024. The completion of all 4 waves of data collection is anticipated in July 2024, coinciding with the start of a no-cost study extension period. We anticipate longitudinal analyses to be completed by winter 2024. CONCLUSIONS Through a longitudinal observational design, this research involving prepubertal TGD children and their caregivers aims to provide empirical knowledge on gender development in a US sample of TGD children, their mental health symptomology and functioning over time, and how family initiated social gender transition may predict or alleviate mental health symptoms or diagnoses. The research findings have promise for clinicians and families aiming to ensure the best developmental outcome for these children as they develop into adolescents. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/55558.
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Affiliation(s)
- Marco A Hidalgo
- Internal Medicine-Pediatrics and Preventive Medicine Section, Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, United States
- Gender Health Program, UCLA Health, University of California Los Angeles, Los Angeles, CA, United States
| | - Diane Chen
- Gender & Sex Development Program, Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Amy C Tishelman
- Department of Psychology and Neuroscience, Boston College, Chestnut Hill, MA, United States
| | - Johanna Olson-Kennedy
- Center for Transyouth Health and Development, Division of Adolescent and Young Adult Medicine, Children's Hospital Los Angeles, Los Angeles, CA, United States
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Yee-Ming Chan
- Division of Endocrinology, Department of Pediatrics, Boston Children's Hospital, Boston, MA, United States
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Robert Garofalo
- Gender & Sex Development Program, Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Hanno Petras
- National Capital Region Center, Pacific Institute for Research and Evaluation, Beltsville, MD, United States
| | - Stephen M Rosenthal
- Child and Adolescent Gender Center, Benioff Children's Hospital, University of California San Francisco, San Francisco, CA, United States
- Department of Pediatrics, Division of Pediatric Endocrinology, University of California San Francisco, San Francisco, CA, United States
| | - Diane Ehrensaft
- Child and Adolescent Gender Center, Benioff Children's Hospital, University of California San Francisco, San Francisco, CA, United States
- Department of Pediatrics, Division of Pediatric Endocrinology, University of California San Francisco, San Francisco, CA, United States
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11
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Lucas R, Geierstanger S, Soleimanpour S. Mental Health Needs, Barriers, and Receipt of Care Among Transgender and Nonbinary Adolescents. J Adolesc Health 2024; 75:267-274. [PMID: 38739056 DOI: 10.1016/j.jadohealth.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 02/02/2024] [Accepted: 03/19/2024] [Indexed: 05/14/2024]
Abstract
PURPOSE Transgender and nonbinary youth disproportionately experience adverse mental health outcomes compared to cisgender youth. This study examined differences in their mental health needs and supports, barriers to care, and receipt of mental health care. METHODS This study examined cross-sectional data from 43,339 adolescents who completed the California Healthy Kids Survey, 4% (n = 1,876) of whom identified as transgender and/or nonbinary. Chi-square test and t-test were used to compare mental health needs and supports, resilience, and barriers to and receipt of care experienced by transgender and nonbinary youth compared to cisgender youth. RESULTS Transgender and nonbinary youth were significantly more likely to experience chronic sadness/hopelessness (74% vs. 35%) and consider suicide (53% vs. 14%) and less likely to report resilience factors (school connectedness: mean score 3.12 vs. 3.52). Transgender and nonbinary youth were significantly less likely to be willing to talk to teachers/adults from school (12% vs. 18%) or parents/family members (21% vs. 43%), but more willing to talk to counselors (25% vs. 19%) regarding mental health concerns. Transgender and nonbinary youth were significantly more likely to select being afraid (48% vs. 20%), not knowing how to get help (44% vs. 30%), or concern their parents would find out (61% vs. 36%) as barriers to seeking mental health care, yet reported slightly higher odds of receiving care when needed (odds ratio: 1.2). DISCUSSION Transgender and nonbinary youth are more likely to report mental health concerns and barriers to seeking care than cisgender youth. Increasing access to care is critical for this population.
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Affiliation(s)
- Ruby Lucas
- Department of Epidemiology, University of Washington, Seattle, Washington; School of Medicine, Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California.
| | - Sara Geierstanger
- School of Medicine, Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California
| | - Samira Soleimanpour
- School of Medicine, Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California
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12
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McGregor K, Rana V, McKenna JL, Williams CR, Vu A, Boskey ER. Understanding Family Support for Transgender Youth: Impact of Support on Psychosocial Functioning. J Adolesc Health 2024; 75:261-266. [PMID: 38842989 DOI: 10.1016/j.jadohealth.2024.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 04/03/2024] [Accepted: 04/03/2024] [Indexed: 07/20/2024]
Abstract
PURPOSE This study investigated the association between positive and negative family support and psychosocial outcomes among transgender and gender diverse (TGD) youth. METHODS A retrospective analysis was performed using psychological data collected from 175 TGD youth (aged 13-18 years) at time of hormone readiness assessment within a multispecialty gender clinic between May 2021 and February 2023. As part of this assessment process, TGD youth provided responses to a variety of measures, including the Youth Self-Report and the Family Environment Scale. RESULTS Negative family support scales were more strongly associated with more outcomes than positive support scales. The exclusion and abuse, viewing gender expression as morally wrong, and trying to change gender scales were each associated with significantly higher Youth Self-Report T-scores for internalizing problems (βs = 6.86, 6.26, 5.56, all p < .01), externalizing problems (βs = 4.58, 4.42, 4.19, all p < .02), and total problems (βs = 6.70, 6.45, 5.34, all p < .02). The explicit care and support scale was associated with significantly lower T-scores for externalizing problems (β = -3.54 p = .02) and total problems (β = -3.35, p = .04). Overall support was also associated with higher T-scores in internalizing problems (b = -2.90, p = .02), externalizing problems (β = -2.40, p = .03), and total problems (β = -2.79, p = .03). DISCUSSION Family support plays a critical role in the psychosocial wellbeing of TGD youth. TGD youth reporting positive family support reported fewer mental health concerns, less experiences of nonaffirmation, and lower levels of internalized transphobia. TGD youth reporting negative family support were found to have an increased risk of suicidal ideation.
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Affiliation(s)
- Kerry McGregor
- Boston Children's Hospital, Division of Endocrinology, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Vinisha Rana
- Boston Children's Hospital, Division of Endocrinology, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - John L McKenna
- Boston Children's Hospital, Division of Endocrinology, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Coleen R Williams
- Boston Children's Hospital, Division of Endocrinology, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Ava Vu
- Boston Children's Hospital, Division of Endocrinology, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
| | - Elizabeth R Boskey
- Harvard Medical School, Boston, Massachusetts; Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Boston Children's Hospital, Division of Gynecology, Boston, Massachusetts
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13
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Stelmar J, Victor R, Yuan N, Smith SM, Mallavarapu S, Sandhu S, Garcia MM. Endocrine, gender dysphoria, and sexual function benefits of gender-affirming bilateral orchiectomy: patient outcomes and surgical technique. Sex Med 2024; 12:qfae048. [PMID: 39211910 PMCID: PMC11359165 DOI: 10.1093/sexmed/qfae048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 06/08/2024] [Accepted: 07/31/2024] [Indexed: 09/04/2024] Open
Abstract
Background Gender-affirming bilateral orchiectomy (GABO) may be completed as either a standalone procedure (sGABO) or at the same time as gender-affirming vaginoplasty (vGABO). GABO is postulated to decrease gender-affirming hormone therapy (GAHT) dosages and reduce gender dysphoria, but these phenomena are not empirically described in the medical literature. Aim The primary aim of this study was to describe changes in GAHT dosages after sGABO and vGABO. A secondary aim was to assess sGABO patients' preoperative decision-making priorities and postoperative satisfaction. Methods A retrospective chart review identified 204 patients who completed GABO as either a standalone procedure (64% of patients) or at the same time as vaginoplasty (36%). Patient demographic data, surgical outcomes, and pre- and postoperative GAHT dosage data were recorded. Patients completed an opinion questionnaire to assessed decision-making priorities, as well as postoperative satisfaction and changes in quality-of-life measures. Outcomes Primary outcomes included pre- and postoperative dosages of estradiol, progesterone, and spironolactone. Secondary outcomes included sGABO patient priorities, satisfaction with sGABO, changes in quality-of-life measures between sGABO and vGABO patients, and sGABO recommendations to future patients. Results The sGABO and vGABO patients experienced a statistically significant dosage reduction in all three GAHT assessed: estradiol, progesterone, and spironolactone (P < .05). All patients discontinued spironolactone postoperatively. Zero complications related to GABO were recorded for patients in either group. The patient questionnaire revealed that sGABO patients prioritize decreasing endogenous testosterone and reducing their GAHT as most important in their decision to undergo sGABO prior to vaginoplasty. A majority of sGABO patients reported improvement in all nine quality-of-life indices. None of the sGABO patients would recommend against sGABO to a friend who is waiting for vaginoplasty. Clinical Implications For patients who are interested in vaginoplasty, sGABO may serve as a more immediate, low-risk, intermediary step that comes with the benefits of GABO, including significant GAHT medication reduction and gender dysphoria relief. Strengths and Limitations This study offers a comprehensive evaluation of the impact of GABO on patients, combining empirical data with subjective patient feedback. Limitations include the retrospective design and the use of unvalidated survey questions. Conclusion Prevaginoplasty GABO is a viable option to more immediately alleviate gender dysphoria and reduce GAHT medications for patients who are interested in gender-affirming vaginoplasty.
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Affiliation(s)
- Jenna Stelmar
- Cedars-Sinai Transgender Surgery & Health Program, Los Angeles, CA 90211, United States
- Department of Urology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, United States
- UC San Diego School of Medicine, La Jolla, CA 92037, United States
| | - Robert Victor
- Cedars-Sinai Transgender Surgery & Health Program, Los Angeles, CA 90211, United States
- Department of Urology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, United States
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA 94305, United States
| | - Nance Yuan
- Cedars-Sinai Transgender Surgery & Health Program, Los Angeles, CA 90211, United States
- Department of Urology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, United States
| | - Shannon M Smith
- Cedars-Sinai Transgender Surgery & Health Program, Los Angeles, CA 90211, United States
- Department of Urology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, United States
| | - Samhita Mallavarapu
- Cedars-Sinai Transgender Surgery & Health Program, Los Angeles, CA 90211, United States
- Department of Urology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, United States
| | - Sandeep Sandhu
- Cedars-Sinai Transgender Surgery & Health Program, Los Angeles, CA 90211, United States
- Department of Urology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, United States
| | - Maurice M Garcia
- Cedars-Sinai Transgender Surgery & Health Program, Los Angeles, CA 90211, United States
- Department of Urology, Cedars-Sinai Medical Center, Los Angeles, CA 90048, United States
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Carter B, Payne M, Rees P, Sohn SY, Brown J, Kalk NJ. A multi-school study in England, to assess problematic smartphone usage and anxiety and depression. Acta Paediatr 2024. [PMID: 39084660 DOI: 10.1111/apa.17317] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 05/04/2024] [Accepted: 05/28/2024] [Indexed: 08/02/2024]
Abstract
AIM To assess the association between problematic smartphone usage and anxiety and depression in adolescents. METHODS A cross-sectional study in five schools in the UK were included. The primary outcome was moderate anxiety (GAD-7 ≥10) symptoms and secondary outcomes were moderate depression symptoms (PHQ-9 ≥10) and insomnia. Problematic smartphone usage was assessed using screentime and the Smartphone Addiction Scale. A multi-level logistic regression was fitted and adjusted Odds Ratio (aOR) with 95% confidence intervals (95% CI) reported. A mediation analysis was conducted. RESULTS Of the five included schools, 657 adolescents aged 16-18 years were enrolled. The median age was 17.5 years (17-18 [IQR]) and 508 (77.3%) were female. Of these 188 (28.6%) exhibited moderate anxiety and 226 (34.4%) moderate depression symptoms. Almost two thirds (421, 64.1%) have tried to cut down their smartphone use and 81 (12.5%) wanted help to reduce use. Problematic smartphone use was associated with increased anxiety (aOR = 2.03, 95% CI 1.28-3.23); depression (aOR = 2.96, 95% CI 1.80-4.86); and insomnia (aOR = 1.64, 95% CI 1.08-2.50). Screentime was not associated with anxiety (β = 0.99, 95% CI 0.91-1.08); or depression (β = 0.98, 95% CI 0.89-1.07). Problematic smartphone use had a significant direct, indirect and total effect on both anxiety and depression. CONCLUSION Problematic smartphone usage was associated with anxiety and depression, independent of screentime. Interventions are needed to reduce problematic use.
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Affiliation(s)
- Ben Carter
- Department of Biostatistics and Health informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Mollie Payne
- Department of Biostatistics and Health informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Philippa Rees
- Population Policy Practice, University College London, Great Ormond Street Institute of Child Health, London, UK
| | - Sei Yon Sohn
- Department of Biostatistics and Health informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Addictions, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - June Brown
- Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Nicola J Kalk
- Department of Addictions, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
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15
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Price MN, Lee WY, Hobbs JN, DeChants JP, Davis CK. Middle and High School LGBTQ Students Report What Makes School LGBTQ-Affirming Across Race/Ethnicity and Gender Identity, a Topic Modeling Method. THE JOURNAL OF SCHOOL HEALTH 2024; 94:601-609. [PMID: 38697805 DOI: 10.1111/josh.13460] [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: 04/03/2023] [Revised: 04/05/2024] [Accepted: 04/05/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND Affirming spaces have been associated with improved mental health outcomes for lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ) adolescents. METHODS With data from adolescents currently enrolled in middle or high school across the United States, this study used topic modeling methods to examine students' reports of what they were looking for in LGBTQ-affirming schools and, separately, the association of LGBTQ-affirming schools with suicide risk reduction. RESULTS Topic models demonstrated consistent themes in how students determined that their school was affirming, such as LGBTQ clubs, teachers requesting pronouns, pride flags, and accepting peers. Students of color uniquely looked for actionable responses in addressing LGBTQ issues. Transgender and nonbinary students required explicit mention of support for transgender issues. Quantitatively, LGBTQ students who reported that their school was LGBTQ-affirming had 20% lower odds of attempting suicide in the past year (adjusted odds ratio = 0.80). CONCLUSIONS These findings suggest that schools must be safe for all youth and implementing policies that make LGBTQ students feel seen and supported in their identities is a protective factor for mental health. IMPLICATIONS School policies must ensure that youth have access to supportive people, symbols of support, and LGBTQ clubs and that they are also salient to LGBTQ students of color and transgender and nonbinary students.
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Affiliation(s)
| | | | - J N Hobbs
- The Trevor Project, West Hollywood, CA
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16
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Eitel KB, Hodax JK. Evaluation and medical care of intersex and gender diverse youth. Pediatr Radiol 2024; 54:1352-1362. [PMID: 38782777 DOI: 10.1007/s00247-024-05948-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 05/03/2024] [Accepted: 05/07/2024] [Indexed: 05/25/2024]
Abstract
While there is considerable overlap in the treatment of patients with intersex traits and differences in sex development (I/DSD) with transgender and gender diverse (TGD) youth, the initial medical evaluation varies significantly. I/DSD youth often present due to differences in genitalia development in infancy or pubertal development in adolescence, and this leads to comprehensive biochemical, radiologic, and genetic evaluation. TGD youth, however, tend to have typical development noted at birth and during puberty, but present with a gender identity that does not align with their sex assigned at birth and do not require evaluation for underlying pathology. For both I/DSD and TGD youth, the mainstays of treatment are to better align one's physical appearance to their gender identity. This review discusses the non-medical and medical interventions utilized in gender affirming care. A multidisciplinary team of mental health providers, pediatric medical providers, and surgeons is recommended for providing gender affirming care to both I/DSD youth and TGD youth and their families. Radiologists have an important role in initial evaluation of I/DSD youth and in ongoing monitoring of growth and bone mineral density during puberty induction in I/DSD and TGD youth.
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Affiliation(s)
- Kelsey B Eitel
- Division of Endocrinology, Department of Pediatrics, Seattle Children's Hospital, University of Washington, 4800 Sand Point Way NE, M/S OC.7.920, PO Box 5371, Seattle, 98105, WA, USA
| | - Juanita K Hodax
- Division of Endocrinology, Department of Pediatrics, Seattle Children's Hospital, University of Washington, 4800 Sand Point Way NE, M/S OC.7.920, PO Box 5371, Seattle, 98105, WA, USA.
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17
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McCoy M, Menashe S, Wright JN, Zavaletta V. Understanding sex and gender: concepts and terminology for gender affirming care. Pediatr Radiol 2024; 54:1345-1351. [PMID: 38842615 DOI: 10.1007/s00247-024-05959-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 05/16/2024] [Accepted: 05/18/2024] [Indexed: 06/07/2024]
Abstract
Lesbian, gay, bisexual, trans, queer, intersex, asexual, and other diverse individuals (LGBTQIA+) people face lower healthcare utilization rates due to discrimination, poor experiences in healthcare, and barriers to accessing care. There is an increasing need to improve care and reduce health care disparities for the LGBTQIA+ population. The medical community can begin by educating themselves on LGBTQIA+ terminology, using inclusive language and developing cultural competence in clinical settings. In order to achieve this, it is first important to understand that sex and gender are distinct and that both sex and gender exist on continuums. This article will build on this understanding by introducing basic and widely accepted terminology that will provide a foundation for providing care to LGBTQIA+ populations. By thoughtfully incorporating this knowledge into our research and clinical practice, the radiology community will enhance the healthcare experiences of all patients.
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Affiliation(s)
| | - Sarah Menashe
- Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | - Jason N Wright
- Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | - Vaz Zavaletta
- Children's Hospital of Colorado, University of Colorado School of Medicine, 13123 East 16th Avenue, Box 125, Aurora, Denver, CO, 80045, USA.
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18
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Wong WI, Shi SY, van der Miesen AIR, Ngan CL, Lei HC, VanderLaan DP. Observations on Gender Variance in Chinese Community Children Measured by the Gender Identity Questionnaire for Children. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:2461-2471. [PMID: 38806754 DOI: 10.1007/s10508-024-02889-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 05/01/2024] [Accepted: 05/02/2024] [Indexed: 05/30/2024]
Abstract
Few studies have examined how gender variance (GV), broadly defined as gender identity and behaviors (e.g., activities and preferences) that do not correspond with culturally defined gender norms, manifests in community samples, particularly in children and outside Western contexts. We present data based on the Gender Identity Questionnaire for Children (GIQC; Johnson et al., 2004) among 461 Chinese community children (4-12 years old) to gauge how well the GIQC serves as a measure of GV and the prevalence of GV. We examined the descriptive scores of GV, its relationship to a gender-typing measure that has been validated in Chinese children (the Child Play Behavior and Activity Questionnaire, CPBAQ), the scores on the GIQC of children whose gender is incongruent with birth-assigned sex, and the binned category distributions (from gender-variant to gender-conforming) in comparison to a Canadian community sample (van der Miesen et al., 2018). The Chinese children on average scored toward the gender-conforming end and children assigned female at birth showed more GV than children assigned male at birth. More importantly, the GIQC appears to be a reliable and sensitive measure of GV in the Chinese sample. GIQC scores correlated significantly with CPBAQ scores and showed a very similar reliability coefficient, gender difference effect size, and bin distribution pattern as the Canadian reference sample. Also, children reported as gender/sex incongruent had the most gender-variant GIQC scores. Although clinically gender-referred Chinese children are required to establish culturally specific cutoff points, these findings provide initial evidence for the characteristics of GV, the applicability of the GIQC as a measure of GV in Chinese community children, and the comparisons of GIQC categories between Chinese and Canadian community samples.
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Affiliation(s)
- Wang Ivy Wong
- Gender Studies Programme and Department of Psychology, The Chinese University of Hong Kong, 248, 2/F, Sino Building, Shatin, New Territories, Hong Kong.
| | - Sylvia Yun Shi
- Gender Studies Programme and Department of Psychology, The Chinese University of Hong Kong, 248, 2/F, Sino Building, Shatin, New Territories, Hong Kong
| | - Anna I R van der Miesen
- Department of Child and Adolescent Psychiatry, Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, The Netherlands
| | - Cho Lam Ngan
- Department of Psychiatry, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Hoi Ching Lei
- Caritas Medical Centre and Kwai Chung Hospital, Hong Kong Hospital Authority, Ma Tau Wai, Hong Kong
| | - Doug P VanderLaan
- Department of Psychology, University of Toronto Mississauga, Mississauga, ON, Canada
- Child and Youth Psychiatry, Centre for Addiction and Mental Health, Toronto, ON, Canada
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Rodgers RF, Gordon AR, Burke NL, Ciao A. Parents and caregivers as key players in the prevention and identification of body image concerns and eating disorders among early adolescents. Eat Disord 2024:1-24. [PMID: 38913912 DOI: 10.1080/10640266.2024.2366546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
Early adolescence (ages 11-14 years) is a key period for the emergence of body image and eating concerns, and early identification and access to treatment are imperative for positive outcomes. Despite research identifying this critical developmental period, few prevention resources are available for early adolescents. Parents are key players for this age group and important socializing agents. As such, they are well positioned to help youth access resources or support where needed. However, programs to position and involve parents as interventionists are lacking. Our aims are two-fold. First, we review the evidence for the effectiveness of parents as body image interventionists and the existing data regarding parental needs. Second, we provide directions for future research and outline a framework for empowering parents as interventionists, identifying key domains in which parents may play a role in addressing body image and eating concerns among early adolescents. Based on the extent literature, these domains include facilitating engagement with or co-utilizing intervention content to decrease body image and eating concerns in at-risk children, which may also help to increase parents' effectiveness in their efforts to support youth. In addition, parents may deliver content to decrease or reverse risk-factors and early symptoms, or disrupt the early disorder phase of illness. To date, parents constitute an underutilized resource in eating disorder and disordered eating prevention, and efforts should be made to increase the evidence-based strategies to leverage their relationship with at-risk children.
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Affiliation(s)
- Rachel F Rodgers
- APPEAR, Department of Applied Psychology, Northeastern University, Boston, Massachusetts, USA
- Department of Psychiatric Emergency & Acute Care, Lapeyronie Hospital, CHRU Montpellier, Montpellier, France
| | - Allegra R Gordon
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts, USA
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Natasha L Burke
- Department of Psychology, Fordham University, Bronx, New York, USA
| | - Anna Ciao
- Department of Psychology, Western Washington University, Bellingham, Washington, USA
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20
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Betsi G, Goulia P, Sandhu S, Xekouki P. Puberty suppression in adolescents with gender dysphoria: an emerging issue with multiple implications. Front Endocrinol (Lausanne) 2024; 15:1309904. [PMID: 38988996 PMCID: PMC11235884 DOI: 10.3389/fendo.2024.1309904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 05/17/2024] [Indexed: 07/12/2024] Open
Abstract
Controversy exists over puberty suppression (PS) in adolescents with gender dysphoria (GD). PS is preferentially achieved with GnRH analogues. By preventing the development of secondary sex characteristics, PS may improve psychological functioning, well-being, quality of life, emotional and behavioral (especially internalizing) problems and depressive symptoms, thus decreasing suicidality. PS can also extend the diagnostic period and give transgender adolescents time to explore their gender identity. GnRHa may also decrease the need for feminization/masculinization surgery. However, 2-year treatment with GnRHa may result in bone mass accrual retardation (decrease in BMD/BMAD z-scores), growth velocity deceleration (decrease in height SDS), increase in fat mass, temporary pause in oocyte/sperm maturation. The most common side effects of GnRHa are hot flashes, mood fluctuations, fatigue and headache. They are usually mild and rarely lead to GnRHa discontinuation. Based on current scientific evidence, PS could be recommended to adolescents who meet the diagnostic criteria of gender incongruence (by DSM-5 and/or ICD-11) and have long-lasting intense GD, which aggravates with puberty onset. Before initiating PS, possible mental issues should be addressed and informed consent (by the adolescent/caregiver) should be given, after counseling on probable reproductive effects of GnRHa. GnRHa can only be started after the adolescent has entered Tanner stage 2. Nevertheless, published studies are inadequate in number, small in size, uncontrolled and relatively short-term, so that it is difficult to draw safe conclusions on efficacy and safety of GnRHa. Large long-term randomized controlled trials are needed to expand knowledge on this controversial issue and elucidate the benefit and risks of PS.
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Affiliation(s)
- Grigoria Betsi
- Endocrinology and Diabetes Clinic, University Hospital of Heraklion, University of Crete School of Medicine, Heraklion, Greece
| | - Panagiota Goulia
- Department of Psychiatry, Cambridgeshire and Peterborough National Health Service (NHS) Foundation Trust, Cambridge, United Kingdom
| | - Sophia Sandhu
- General Practice, Bridge Street Medical Practice, Cambridge, United Kingdom
| | - Paraskevi Xekouki
- Endocrinology and Diabetes Clinic, University Hospital of Heraklion, University of Crete School of Medicine, Heraklion, Greece
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Horton C, Pearce R, Veale J, Oakes-Monger TC, Pang KC, Pullen Sansfaçon A, Quinney S. Child rights in trans healthcare - a call to action. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2024; 25:313-320. [PMID: 39055631 PMCID: PMC11268223 DOI: 10.1080/26895269.2024.2360359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
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22
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Kidd KM, Didden E, Harman H, Sequeira GM, Faeder M, Inwards-Breland DJ, Voss RV, Katz-Wise SL. Parents of Gender Diverse Youth: Support Sought, Received, and Still Needed. J Adolesc Health 2024; 74:1078-1087. [PMID: 37715763 PMCID: PMC10947309 DOI: 10.1016/j.jadohealth.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 07/14/2023] [Accepted: 08/01/2023] [Indexed: 09/18/2023]
Abstract
PURPOSE Gender diverse youth (GDY) have improved mental health when affirmed by parents, but little is known about the support parents of GDY seek, receive, and still need. This qualitative study explored experiences of parents of GDY to better understand their support needs. METHODS Parents of GDY submitted videos and were interviewed about their journey supporting their GDY. Data collection continued until thematic saturation was reached. Audio recordings from videos and interviews were transcribed and analyzed via an inductive thematic analysis using the rigorous and accelerated data reduction technique. RESULTS In total, 25 parents of GDY (mean age 15 years, range 6-21 years) from 12 states provided video recordings and interviews; 36% were People of Color and 28% were fathers. We identified four themes and 12 subthemes. Theme 1: support through education included acknowledging ignorance about gender diversity and remedying ignorance. Theme 2: engaging community noted that support was multilayered and based around the family unit and pre-existing community. Theme 3: expanding community included acknowledgement that seeking new community was important for many to reduce feelings of isolation. It also highlighted that "safe spaces" for parents of GDY were not always safe for those of other marginalized groups, particularly People of Color. Theme 4: support in healthcare spaces centered experiences navigating medical and mental healthcare for GDY and feeling supported and unsupported in those spaces. DISCUSSION Parents identified numerous ways they sought, received, and needed support to understand and affirm their GDY. These findings will aid development of targeted support interventions for parents of GDY. Further research is needed to evaluate the impact of these interventions on GDY health.
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Affiliation(s)
- Kacie M Kidd
- Department of Pediatrics, Division of Adolescent Medicine, West Virginia University School of Medicine, WVU Medicine Children's Hospital, Morgantown, West Virginia.
| | - El Didden
- West Virginia University School of Medicine, WVU Medicine Children's Hospital, Morgantown, West Virginia
| | - Hayley Harman
- West Virginia University School of Medicine, WVU Medicine Children's Hospital, Morgantown, West Virginia
| | - Gina M Sequeira
- Department of Pediatrics, Division of Adolescent Medicine, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, Washington
| | - Morgan Faeder
- Department of Psychiatry, University of Pittsburgh School of Medicine, UPMC Western Psychiatric Hospital, Pittsburgh, Pennsylvania
| | | | - Raina V Voss
- Department of Pediatrics, Divison of Adolescent and Young Adult Medicine, Northwestern University Feinburg School of Medicine, Lurie Children's Hospital, Chicago, Illinois
| | - Sabra L Katz-Wise
- Harvard TH Chan School of Public Health, Boston Children's Hospital, Boston, Massachusetts
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23
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Sequeira GM, Kidd KM, Slekar A, Kahn NF, Costello LM, Negrin I, Huzurbazar S, Narumanchi J. Comfort Providing Gender-Affirming Care and Preferences for Consultative Support Among Rural Pediatric Primary Care Providers. Telemed J E Health 2024; 30:e1798-e1804. [PMID: 38512469 PMCID: PMC11296152 DOI: 10.1089/tmj.2023.0537] [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: 10/16/2023] [Revised: 01/22/2024] [Accepted: 01/25/2024] [Indexed: 03/23/2024] Open
Abstract
Objective: To examine how specialist-to-pediatric primary care provider (PPCP) consultative support may impact PPCP comfort in providing gender-affirming care. Methods: PPCPs in West Virginia completed an electronic survey. T-tests compared comfort providing gender-affirming care and rank-sum tests compared the practicality of four consultative support modalities by time in practice and specialty. Results: Of 51 participants, 47.1% had been in practice for <10 years and 59.6% were trained in pediatrics. PPCPs with <10 years in practice and those trained in pediatrics were more comfortable providing gender-affirming care than those in practice >10 years and those trained in family medicine. PPCPs felt that telemedicine was more practical than tele-education, although they reported all consultative support modalities would increase comfort providing this care. Conclusions: Access to consultative support can increase PPCP comfort providing gender-affirming care, although certain modalities may be more effective for PPCPs with varying levels of experience and specialty training.
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Affiliation(s)
- Gina M. Sequeira
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - Kacie M. Kidd
- Department of Pediatrics, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Alana Slekar
- West Virginia University, Morgantown, West Virginia, USA
| | - Nicole F. Kahn
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - Lisa M. Costello
- Department of Pediatrics, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Isabela Negrin
- Department of Pediatrics, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Snehalata Huzurbazar
- Department of Biostatistics, West Virginia University School of Public Health, Morgantown, West Virginia, USA
| | - Janani Narumanchi
- Department of Pediatrics, University of Tennessee School of Medicine, Memphis, Tennessee, USA
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24
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Ravindranath O, Perica MI, Parr AC, Ojha A, McKeon SD, Montano G, Ullendorff N, Luna B, Edmiston EK. Adolescent neurocognitive development and decision-making abilities regarding gender-affirming care. Dev Cogn Neurosci 2024; 67:101351. [PMID: 38383174 PMCID: PMC11247355 DOI: 10.1016/j.dcn.2024.101351] [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: 05/17/2023] [Revised: 01/10/2024] [Accepted: 01/26/2024] [Indexed: 02/23/2024] Open
Abstract
Recently, politicians and legislative bodies have cited neurodevelopmental literature to argue that brain immaturity undermines decision-making regarding gender-affirming care (GAC) in youth. Here, we review this literature as it applies to adolescents' ability to make decisions regarding GAC. The research shows that while adolescence is a time of peak risk-taking behavior that may lead to impulsive decisions, neurocognitive systems supporting adult-level decisions are available given deliberative processes that minimize influence of short-term rewards and peers. Since GAC decisions occur over an extended period and with support from adult caregivers and clinicians, adolescents can engage adult-level decision-making in this context. We also weigh the benefits of providing GAC access during adolescence and consider the significant costs of blocking or delaying GAC. Transgender and non-binary (TNB) adolescents face significant mental health challenges, many of which are mitigated by GAC access. Further, initiating the GAC process during adolescence, which we define as beginning at pubertal onset, leads to better long-term mental health outcomes than waiting until adulthood. Taken together, existing research indicates that many adolescents can make informed decisions regarding gender-affirming care, and that this care is critical for the well-being of TNB youth. We highlight relevant considerations for policy makers, researchers, and clinicians.
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Affiliation(s)
- Orma Ravindranath
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA; Center for Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, PA, USA.
| | - Maria I Perica
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ashley C Parr
- Center for Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, PA, USA; Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Amar Ojha
- Center for Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, PA, USA; Center for Neuroscience, University of Pittsburgh, Pittsburgh, PA, USA
| | - Shane D McKeon
- Center for Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, PA, USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Gerald Montano
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Naomi Ullendorff
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Beatriz Luna
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA; Center for Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, PA, USA; Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA; Center for Neuroscience, University of Pittsburgh, Pittsburgh, PA, USA
| | - E Kale Edmiston
- Department of Psychiatry, University of Massachusetts Chan School of Medicine, USA
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25
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Tarantino MR, Tham RL, Quint MR, Kremen J, Kane K, Rangel-Gomez M, Boskey E, Xu R, Reisner SL. "We Followed their Lead": Exploring Relational Change and Support among Caregivers of Transgender and Gender Diverse Youth. SSM. QUALITATIVE RESEARCH IN HEALTH 2024; 5:100429. [PMID: 38778873 PMCID: PMC11108063 DOI: 10.1016/j.ssmqr.2024.100429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
Transgender and gender diverse youth and young adults (TGDY) experience higher mental health morbidity, including self-harm, suicide ideation, and suicide attempts, as compared to cisgender peers. Support from family members is associated with improved mental health outcomes for TGDY. However, little is known about the process that caregivers who consider themselves supportive undergo and how caregiver-youth relationships evolve through a TGDY's gender journey. Through a reflexive thematic analysis of 14 interviews conducted with caregivers of TGDY from April-July 2022, we sought to understand how caregivers who considered themselves supportive of TGDY navigated shifting relationships with themselves, their children, and their communities. Applying theories of Ambiguous Loss and Thriving Through Relationships, findings coalesced around several themes including reflecting on change, re-negotiating interpersonal relationships, and educating through relationships. The gender journeys of TGDY required caregivers to navigate relationships with self (feeling loss and wrestling with worry for their child), negotiate relationships with others (disclosing to extended family and social networks), and educate themselves and others through relationships (connecting through personal narratives from other families, parents supporting parents, learning to advocate for their child). The process of caregivers learning to support their children was facilitated through profound intrapersonal and interpersonal reflection, connection, and community. Understanding this process is important to inform educational interventions and programs that help caregivers learn to support and advocate effectively for TGDY.
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Affiliation(s)
- Mari R. Tarantino
- Department of Human Development and Family Science, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | - Regina L. Tham
- Department of Urology, Boston Children’s Hospital, Boston, MA, USA
| | - Meg R. Quint
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
- Stanford Medical School, Stanford, CA, USA
| | - Jessica Kremen
- University of California San Francisco, San Francisco, CA, USA
| | - Kaiden Kane
- Department of Urology, Boston Children’s Hospital, Boston, MA, USA
| | - Mauricio Rangel-Gomez
- Behavioral Science & Integrative Neuroscience Research Branch, Division of Neuroscience and Basic Behavioral Science, National Institute of Mental Health, Rockville, MD, USA
| | - Elizabeth Boskey
- Department of Surgery, Harvard Medical School, Boston, MA, USA
- Division of Gynecology, Boston Children’s Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Rena Xu
- Department of Urology, Boston Children’s Hospital, Boston, MA, USA
- Department of Surgery, Harvard Medical School, Boston, MA, USA
| | - Sari L. Reisner
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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26
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Ogrizek A, Ghanimeh C, Moro MR. Parental dysphoria: A new terminology for parents facing parental regret? Int J Soc Psychiatry 2024; 70:832-833. [PMID: 37990554 DOI: 10.1177/00207640231212873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Affiliation(s)
- Anaïs Ogrizek
- Department of Psychiatry, Martinique University Hospital, Fort-de-France
- AP-HP, Cochin Hospital, Maison de Solenn, Paris, France
- CESP-UVSQ, DevPsy, INSERM, Université Paris-Saclay, Villejuif, France
| | | | - Marie Rose Moro
- AP-HP, Cochin Hospital, Maison de Solenn, Paris, France
- CESP-UVSQ, DevPsy, INSERM, Université Paris-Saclay, Villejuif, France
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27
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González-Mendiondo L, Mayor A, Moyano N. The Role of Healthcare Professionals in the Transition Process: A Qualitative Study of Families of Trans Children and Adolescents. Healthcare (Basel) 2024; 12:974. [PMID: 38786386 PMCID: PMC11121463 DOI: 10.3390/healthcare12100974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 04/21/2024] [Accepted: 05/07/2024] [Indexed: 05/25/2024] Open
Abstract
The aim of this study was to explore the role that healthcare professionals, such as pediatricians, psychologists, psychiatrists and sexologists, play in supporting trans children and adolescents in their transition processes. To this end, 22 life stories written by parents of trans children and adolescents who had undergone social transition were collected, and a qualitative analysis was carried out using MAXQDA software. For this purpose, three key periods were considered in the stories: before, during and after the transition. Among other aspects, the stories highlight a major lack of understanding on the part of the professionals who should support trans children and adolescents, and their families, in their transition processes. Parents described the attitude of those professionals who actively listened to their children's needs and were cooperative as positive, even if they do not have the necessary training. The need for specific training in diversity is one of the main conclusions of this study.
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Affiliation(s)
| | - Aingeru Mayor
- Departamento de e Lenguajes y Sistemas Informáticos, Universidad del País Vasco, 48940 San Sebastián, Spain;
| | - Nieves Moyano
- Departamento de Psicología Evolutiva y de la Educación, Universidad de Jaén, 23071 Jaén, Spain
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28
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Steininger J, Knaus S, Kaufmann U, Ott J, Riedl S. Treatment trajectories of gender incongruent Austrian youth seeking gender-affirming hormone therapy. Front Endocrinol (Lausanne) 2024; 15:1258495. [PMID: 38774227 PMCID: PMC11106449 DOI: 10.3389/fendo.2024.1258495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 04/22/2024] [Indexed: 05/24/2024] Open
Abstract
Objective The aim of this study was to describe the treatment trajectories of Austrian children and adolescents with gender incongruence seeking gender-affirming medical care. Methods Patients who presented with gender incongruence at the pediatric outpatient clinic for differences in sex development at a large university hospital in Austria from January 2008 to December 2022 were included in a retrospective chart review, and analyzed regarding referral numbers, patient characteristics, treatment trajectories, fertility preservation, and legal gender marker changes. Results Of 310 eligible patients, 230 (74.2%) were assigned female at birth (AFAB), and 80 (25.8%) were assigned male at birth (AMAB). The number of referrals increased steeply from 2008 to 2018, whereafter it stabilized at around 50 per year. At the time of initial presentation, the median age of patients was 15.6 years (IQR 14.3-16.8). AMAB individuals tended to be younger (median 14.9 years, IQR 13.9-16.8) than AFAB individuals (median 15.8 years, IQR 14.4-16.8; p= 0.012). 207 (66,8%) completed the assessment process and were eligible for gender affirming medical treatment (GAMT). Of those, 89% (186/207) commenced gender affirming hormone therapy in the pediatric outpatient clinic (79/186 received GnRHa monotherapy, 91/186 GnRHa and sex steroids, and 16/186 sex steroid monotherapy). Of the 54 AMAB individuals receiving GAMT, 6 (11.1%) completed fertility preservation prior to therapy initiation. Only 1/132 AFAB adolescents receiving GAMT completed fertility preservation. Chest masculinization surgery was performed in 22 cases (16.7%), and breast augmentation in two cases (3.7%) between the ages of 16 and 18. Changes in legal gender marker were common, with 205 individuals (66.1%) having changed their legal gender marker. Conclusion This is the first time that treatment trajectories, fertility preservation rates, and changes of legal gender marker have been described in Austrian adolescents with gender incongruence seeking GAMT. The majority received GAMT and changed their legal gender marker, while gender affirming surgery rates were low, and utilization of fertility preservation treatment options was rare.
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Affiliation(s)
- Jojo Steininger
- Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
- Division of Gynecological Endocrinology and Reproductive Medicine, Department of Gynecology and Obstetrics, Medical University of Vienna, Vienna, Austria
| | - Sarah Knaus
- Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Ulrike Kaufmann
- Division of Gynecological Endocrinology and Reproductive Medicine, Department of Gynecology and Obstetrics, Medical University of Vienna, Vienna, Austria
| | - Johannes Ott
- Division of Gynecological Endocrinology and Reproductive Medicine, Department of Gynecology and Obstetrics, Medical University of Vienna, Vienna, Austria
| | - Stefan Riedl
- Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
- Department of Pediatrics, St. Anna Kinderspital, Medical University of Vienna, Vienna, Austria
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29
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Moser CN, Fornander MJ, Roberts CM, Egan AM, Robertson G. Body Mass Index Categories of Transgender and Gender Diverse Youth: Clinical Associations and Predictors. Child Obes 2024; 20:279-288. [PMID: 37389851 DOI: 10.1089/chi.2023.0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
Background: Transgender/gender diverse (TGD) youth are at risk for weight-related problems. We describe factors associated with their body mass index (BMI) category. Methods: Chart review of 228 TGD patients, 12-20 years (u = 15.7, standard deviation 1.3), 72% female assigned at birth. BMI percentile was calculated using CDC growth charts. We examined bivariate relationships of 18 clinically derived factors, utilizing analysis of variance (ANOVA) for continuous variables and chi-squared/Fisher's exact test for categorical variables. Nonparametric Classification and Regression Tree (CART) analyses were used to predict BMI category. Results: Almost half (49.6%) of TGD youth presenting for their initial visit for pediatric gender-affirming care fell in the healthy weight range, 4.4% in the underweight range, 16.7% in the overweight range, and 29.4% in the obese range. Self-described weight, weight management intentions, unhealthy weight management, prescription of psychiatric medications, and medications associated with weight gain were associated with BMI category. Use of psychiatric medications (54.8%) and medications associated with weight gain (39.5%) was associated with BMI in the overweight/obese categories. Youth with obesity most often reported unhealthy weight management. In CART models, self-described weight was the strongest predictor of BMI category. Conclusion: TGD youth have high rates of underweight and overweight/obesity. Unhealthy BMI should be treated as part of gender-affirming care. Self-described body weight is associated with weight category. More than half of TGD youth were prescribed psychiatric medications; those with overweight and obesity were more likely prescribed psychiatric and medications with associated weight gain. Youth with obesity were most likely to use unhealthy weight management.
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Affiliation(s)
- Christine N Moser
- Division of Developmental and Behavioral Health, Children's Mercy Kansas City, Overland Park, KS, USA
| | - Mirae J Fornander
- Division of Developmental and Behavioral Health, Children's Mercy Kansas City, Overland Park, KS, USA
| | - Christina M Roberts
- Division of Adolescent Medicine, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Anna M Egan
- Division of Developmental and Behavioral Health, Children's Mercy Kansas City, Overland Park, KS, USA
| | - Gail Robertson
- Division of Developmental and Behavioral Health, Children's Mercy Kansas City, Overland Park, KS, USA
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30
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Pickstone-Taylor SD, Davids EL, de Bever GN, de Vries PJ. Demographic and mental health profile of youth in a gender service: An African case series. S Afr J Psychiatr 2024; 30:2160. [PMID: 38726329 PMCID: PMC11079370 DOI: 10.4102/sajpsychiatry.v30i0.2160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 02/07/2024] [Indexed: 05/12/2024] Open
Abstract
Background Despite a massive global increase in research on gender-diverse youth, there have been no studies in Africa on gender-diverse children and adolescents presenting to health services. Aim This study aimed to present the first African findings of the demographic and mental health profile of youth who have presented at a gender service in South Africa. Setting A specialist mental health outpatient service, consisting of psychiatry, psychology and nursing input, for gender-diverse child and adolescent patients in the Western Cape. Methods All consenting youth seen at a gender service, consisting of psychiatry, psychology and nursing input, in state and by the same clinician in private practice between January 2012 and May 2019 were participants of a retrospective, sequential case series study. Data of interest, including gender identity and sexuality, mental health history and social information, were extracted from the psychiatry files of participants. Results Thirty-nine participants were part of the registry and qualified for the study: 72% self-identified as white, 15% as coloured and 13% as black African. The rate of co-occurring psychopathology was high (64%) and included high rates of autism, particularly in trans males (26%), suicidal ideation in 31% and a history of suicide attempt(s) in 10%. Conclusions This first study describing gender-diverse youth seeking support relating to their gender identity in Africa showed they had remarkable similarities to those studied internationally. Contribution Establishing that transgender youth of all major racial groups in the province with similar demographic profiles to other parts of the world are presenting to services in South Africa and in need of mental health support and interventions.
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Affiliation(s)
- Simon D Pickstone-Taylor
- Department of Psychiatry, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Eugene L Davids
- Department of Psychiatry, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Graham N de Bever
- Department of Psychiatry, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Petrus J de Vries
- Department of Psychiatry, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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31
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Etxebarria-Perez-de-Nanclares O, Vizcarra Morales MT, López-Vélez AL, Gamito Gómez R. Trans narratives on school experiences-This is how we feel. Front Psychol 2024; 15:1373508. [PMID: 38680278 PMCID: PMC11055463 DOI: 10.3389/fpsyg.2024.1373508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 03/27/2024] [Indexed: 05/01/2024] Open
Abstract
Introduction The school environment remains unsafe for many trans people, where they are victims of discrimination, aggression, and bullying, resulting in socioemotional and physical harm to trans individuals. Intersectionality and minority stress are contributing factors in this already challenging education environment. In many cases, the voices of trans people are not heard or listened to at school; therefore, this study aims to listen to their school experiences in order to identify key areas for improvement. Method This study implemented a narrative research approach where six in-depth interviews were completed with trans participants from the Basque Country, Europe, and the United States of America that focused on five dimensions: being a trans, the role of school, lack of teacher education and training, segregation by gender, and socioemotional wellbeing. The transcriptions of these interviews were coded using Nvivo software in categorical systems in a deductive and inductive way. Results The results clearly showed that the binary society has a negative impact on trans people. In addition, the educational environment is still hostile for most of them, in which the lack of teacher training and gender identity content in the curriculum has a negative impact on trans people and their experiences at school. Discussion The findings support the idea that socially ingrained binarism is detrimental to all those who step outside the norm. It can also be said that the earlier the transition is made, the better the effect (clinical as well as socioemotional) on their personal lives. For this early transition to occur, it is necessary to have access to information from an early age.
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Affiliation(s)
- Olatz Etxebarria-Perez-de-Nanclares
- Psychodidactics Doctoral Program, Psychology of Education and Specific Didactic, Faculty of Education and Sport, University of the Basque Country, Vitoria-Gasteiz, Spain
| | - Maria Teresa Vizcarra Morales
- Didactics of Musical, Plastic and Body Expression, Faculty of Education and Sport, University of the Basque Country, Vitoria-Gasteiz, Spain
| | - Ana Luisa López-Vélez
- Department of School Didactics and Organization, Faculty of Education and Sport, University of the Basque Country, Vitoria-Gasteiz, Spain
| | - Rakel Gamito Gómez
- Department of School Didactics and Organization, Faculty of Education and Sport, University of the Basque Country, Vitoria-Gasteiz, Spain
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32
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Miller GH, Marquez-Velarde G, Suárez MI, Glass C. Support Saves Lives: Exploring the Relationship Between Age of Transition, Family Support, and Retrospective K-12 Educational Experiences in Transgender Suicidality. Transgend Health 2024; 9:118-127. [PMID: 38585247 PMCID: PMC10998011 DOI: 10.1089/trgh.2022.0073] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Purpose The purpose of this study is to test the association between protective and risk factors, including age of transition, K-12 experiences, and family support, on suicidality among transgender and gender nonbinary/gender queer (TNB) adults. Methods Our analysis relies on data from the 2015 United States Transgender Survey. We used separate logistic regression models to predict lifetime suicidal ideation and suicide attempt among 19,121 survey respondents. Results Negative K-12 experiences significantly predict higher likelihood of both suicidal ideation and suicide attempt for transgender people, regardless of age of transition, and after controlling for a host of covariates. The age a transgender person begins to live full time in a gender different from the one assigned at birth has little association with suicidality. However, supportive families act as a buffer against suicidal ideation, and unsupportive families significantly predict higher likelihood of suicide attempt for transgender people when controlling for numerous covariates. Conclusion Our findings underscore the importance of supportive environments for TNB adolescents. Interventions that strengthen interpersonal relationships and local environments will reduce suicidality among TNB youth. Importantly, recent anti-trans legislation may interfere with the ability of teachers and families to provide needed supports and will likely have deleterious effects on the mental health of TNB individuals.
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Affiliation(s)
- Gabe H. Miller
- Department of Sociology and African American Studies Program, Mississippi State University, Mississippi State, Mississippi, USA
- Department of Sociology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Mario I. Suárez
- Department of School of Teacher Education and Leadership, Utah State University, Logan, Utah, USA
| | - Christy Glass
- Department of Sociology and Anthropology, Utah State University, Logan, Utah, USA
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33
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Heffernan ME, Bendelow A, Macy ML, Voss RV, Leininger J, Menker CG, Casale M, Smith TL, Davis MM. Parent Awareness of and Attitudes Toward Gender-Affirming Pediatric Health Care: A Cross-Sectional Survey. J Adolesc Health 2024; 74:808-813. [PMID: 38127016 DOI: 10.1016/j.jadohealth.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 11/09/2023] [Accepted: 11/15/2023] [Indexed: 12/23/2023]
Abstract
PURPOSE We aimed to characterize parent attitudes toward gender-affirming healthcare for transgender youth, from a general parent sample in a diverse urban setting. METHODS We surveyed Chicago parents through the Voices of Child Health in Chicago Parent Panel Survey via web and phone in English and Spanish from May-July 2022. We used both probability-based and nonprobability-based sampling, with calibration weights for the nonprobability sample. Parents responded about their awareness of a debate about and support for autonomy in gender-affirming healthcare for transgender youth and provided demographic information. We used descriptive analyses and logistic regression to examine predictors of awareness and support. Data were weighted to be representative of Chicago's parent population. RESULTS Surveys were completed by 1,059 parents. The survey completion rate for the probability sample was 43.1% (a completion rate was not available for the nonprobability sample from online, opt-in surveys). Most parents were unaware of the debate about gender-affirming healthcare (56.0%). More than two-thirds of parents (68.9%) support decisions about gender-affirming healthcare being left to children, their parents, and their doctor. Parents who were aware of the debate were more likely to support gender-affirming healthcare (83.7%) than parents who were not aware (57.2%, p < .0001). Parents who were aware of the debate had higher odds of supporting gender-affirming care for youth (adjusted odds ratio = 3.00, 95% confidence interval: 1.93-4.66) in a multivariable logistic regression model. DISCUSSION Broad parent support for gender-affirming healthcare for transgender youth is an important perspective to consider in policy discussions at state and federal levels.
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Affiliation(s)
- Marie E Heffernan
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Mary Ann & J. Milburn Smith Child Health Outcomes, Research, and Evaluation Center, Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Anne Bendelow
- Data Analytics and Reporting, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Michelle L Macy
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Mary Ann & J. Milburn Smith Child Health Outcomes, Research, and Evaluation Center, Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Raina V Voss
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Jennifer Leininger
- Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Carly G Menker
- Mary Ann & J. Milburn Smith Child Health Outcomes, Research, and Evaluation Center, Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Mia Casale
- Data Analytics and Reporting, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Tracie L Smith
- Data Analytics and Reporting, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Matthew M Davis
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Mary Ann & J. Milburn Smith Child Health Outcomes, Research, and Evaluation Center, Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Departments of Medicine, Medical Social Sciences, and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Narita Z, DeVylder J, Yamasaki S, Ando S, Endo K, Miyashita M, Yamaguchi S, Usami S, Stanyon D, Knowles G, Hiraiwa-Hasegawa M, Furukawa TA, Kasai K, Nishida A. Uncovering associations between gender nonconformity, psychosocial factors, and mental health in adolescents: a birth cohort study. Psychol Med 2024; 54:921-930. [PMID: 37721216 DOI: 10.1017/s0033291723002623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
BACKGROUND Little information is available on the association between gender nonconformity during adolescence and subsequent mental health. While the distress related to gender nonconformity may be socially produced rather than attributed to individual-level factors, further research is needed to better understand the role of psychosocial factors in this context. METHOD We analyzed data from the Tokyo Teen Cohort, obtained through random sampling of adolescents born between 2002 and 2004. We used inverse probability weighting to examine the association of gender nonconformity at ages 12 and 14 as a time-varying variable with subsequent mental health at age 16, while accounting for time-fixed and time-varying confounders. Furthermore, we used a weighting approach to investigate the mediating role of modifiable psychosocial factors in this association, addressing exposure-mediator and mediator-mediator interactions. RESULTS A total of 3171 participants were analyzed. Persistent gender nonconforming behavior at ages 12 and 14 was associated with subsequent depression (β = 2.02, 95% confidence interval [CI] 0.85 to 3.19) and psychotic experiences (β = 0.33, 95% CI 0.14 to 0.52) at age 16. The results remained robust in sensitivity analyses. Approximately 30% of the association between gender nonconformity and depression was consistently mediated by a set of psychosocial factors, namely loneliness, bullying victimization, and relationships with mother, father, and friends. CONCLUSIONS Persistent gender nonconformity during adolescence is associated with subsequent mental health. Psychosocial factors play a vital mediating role in this association, highlighting the essential need for social intervention and change to reduce stigmatization and ameliorate mental health challenges.
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Grants
- JP16H06395, 16H06398, 16H06399, 16K21720, 16K15566, 16H03745, 17H05931, 20H03951, 20H01777, JP20H03596, JP21H05171 and JP21H05173 Japan Society for the Promotion of Science
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Affiliation(s)
- Zui Narita
- Department of Behavioral Medicine, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Jordan DeVylder
- Graduate School of Social Service, Fordham University, New York, USA
- Unit for Mental Health Promotion, Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Syudo Yamasaki
- Unit for Mental Health Promotion, Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Shuntaro Ando
- Unit for Mental Health Promotion, Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kaori Endo
- Unit for Mental Health Promotion, Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Mitsuhiro Miyashita
- Unit for Mental Health Promotion, Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Satoshi Yamaguchi
- Unit for Mental Health Promotion, Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Satoshi Usami
- Graduate School of Education, The University of Tokyo, Tokyo, Japan
- Center for Research and Development on Transition from Secondary to Higher Education, The University of Tokyo, Tokyo, Japan
| | - Daniel Stanyon
- Unit for Mental Health Promotion, Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Gemma Knowles
- Unit for Mental Health Promotion, Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
- Economic and Social Research Council (ESRC) Center for Society and Mental Health, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Mariko Hiraiwa-Hasegawa
- School of Advanced Science, SOKENDAI (Graduate University for Advanced Studies), Kanagawa, Japan
| | - Toshiaki A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Kyoto, Japan
| | - Kiyoto Kasai
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- The International Research Center for Neurointelligence (WPI-IRCN), University of Tokyo Institutes of Advanced Study (UTIAS), Tokyo, Japan
| | - Atsushi Nishida
- Unit for Mental Health Promotion, Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
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Brecht A, Bos S, Ries L, Hübner K, Widenka PM, Winter SM, Calvano C. Analyzing body dissatisfaction and gender dysphoria in the context of minority stress among transgender adolescents. Child Adolesc Psychiatry Ment Health 2024; 18:30. [PMID: 38431595 PMCID: PMC10909265 DOI: 10.1186/s13034-024-00718-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 02/05/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND Gender dysphoria among transgender adolescents has predominantly been examined in relation to body dissatisfaction. While in adult transgender samples, body dissatisfaction is higher than in cisgender controls, this has so far rarely been investigated for adolescents. In the context of a cisnormative society, the impact of influences from the social environment on body dissatisfaction and gender dysphoria has been neglected in research. Therefore, this study aimed to (1) provide a detailed analysis of body dissatisfaction among young transgender people and (2) investigate whether body dissatisfaction and gender dysphoria are associated with experiences of minority stress such as trans hostility and poor peer relations (PPR). METHODS The paper presents a cross-sectional study among a sample of transgender adolescents, presenting at a specialized outpatient counseling clinic (N = 99; age M = 15.36, SD = 1.85). First, body dissatisfaction (assessed by the Body-Image-Scale; BIS), was explored and compared to data from a population-based control group of cisgender peers (N = 527; age M = 14.43, SD = 0.97). Second, within a clinic-referred transgender subsample (n = 74), associations between body dissatisfaction and gender dysphoria (measured by Utrecht Gender Dysphoria Scale; UGDS), PPR (measured by the Youth-Self-Report; YSR-R), and trans hostile experiences (assessed in clinical interview) were examined by correlations, t-tests and multivariate regression. RESULTS Transgender adolescents reported more body dissatisfaction than cisgender peers. The dissatisfaction with sex characteristics, non-hormonal reactive body regions and the total score for body dissatisfaction were positively related with gender dysphoria. The majority had experienced trans hostility in the present and/or past (54.1%) and PPR (63.5%). More body dissatisfaction was correlated with more PPR regarding visible body parts i.e., hair, overall appearance and muscles, whilst PPR and gender dysphoria were not associated. Transgender adolescents who experienced trans hostility showed higher gender dysphoria and PPR, but not more body dissatisfaction. In multiple regression, trans hostility predicted gender dysphoria, whilst age and PPR predicted body dissatisfaction. DISCUSSION Experiences of minority-stress differentially interact with body dissatisfaction and gender dysphoria among transgender adolescents. Social correlates of body dissatisfaction and gender dysphoria must be considered when working with young transgender people.
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Affiliation(s)
- Alexandra Brecht
- Department of Education and Psychology, Clinical Child and Adolescent Psychology and Psychotherapy, Freie Universität Berlin, 14195, Berlin, Germany.
- Department of Child and Adolescent Psychiatry, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin and Berlin Insitute of Health, 13353, Berlin, Germany.
| | - Sascha Bos
- Department of Child and Adolescent Psychiatry, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin and Berlin Insitute of Health, 13353, Berlin, Germany
| | - Laura Ries
- Department of Child and Adolescent Psychiatry, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin and Berlin Insitute of Health, 13353, Berlin, Germany
| | - Kerstin Hübner
- Department of Child and Adolescent Psychiatry, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin and Berlin Insitute of Health, 13353, Berlin, Germany
| | - Pia-Marie Widenka
- Klinik für Kinder- und Jugendmedizin, Universität zu Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - Sibylle Maria Winter
- Department of Child and Adolescent Psychiatry, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt Universität zu Berlin and Berlin Insitute of Health, 13353, Berlin, Germany
| | - Claudia Calvano
- Department of Education and Psychology, Clinical Child and Adolescent Psychology and Psychotherapy, Freie Universität Berlin, 14195, Berlin, Germany
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36
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Roosevelt LK, Kattari L, Yingling C. Affirming Care for Transgender and Gender-Diverse Youth. MCN Am J Matern Child Nurs 2024; 49:66-73. [PMID: 38112665 DOI: 10.1097/nmc.0000000000000981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
ABSTRACT Nurses play a critical role in providing gender-affirming care for transgender and gender-diverse youth. With heightened debate about the clinical care for transgender and gender-diverse youth in the national and global spotlight, now more than ever before nurses must equip themselves with the knowledge and the evidence spanning more than 4 decades that support the clinical use of gender-affirming care for youth and young adults. By exploring gender development and gender-affirming care approaches through the lifespan perspective, this review provides an up-to-date discussion about best practices and clinical implications for providing equitable care for transgender and gender-diverse youth from birth to childhood and through adolescence developmental phases. A transgender and gender-diverse youth's future willingness to access health care is dependent on how positive their interactions are with their care team at this sensitive moment in their life. Nurses must not let political rhetoric impede their practice and ethical guidelines to provide competent, skilled, and unbiased care. Knowledgeable, informed, and empowered nurses can provide life-saving care to transgender and gender-diverse youth and their families.
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Kahn NF, Asante PG, Guler J, Reyes V, Anan Y, Bocek K, Kidd KM, Richardson LP, Christakis DA, Pratt W, Sequeira GM. Caregiver perspectives on receiving gender-affirming care with their transgender and gender diverse adolescents via telemedicine. LGBTQ+ FAMILY : AN INTERDISCIPLINARY JOURNAL 2024; 20:190-200. [PMID: 38721330 PMCID: PMC11075659 DOI: 10.1080/27703371.2024.2317139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
Telemedicine may help improve access to gender-affirming care for transgender and gender diverse (TGD) adolescents. Parents or guardians (i.e., caregivers) of TGD adolescents play a critical role in supporting TGD adolescents in accessing this care. The purpose of this study was to explore caregivers' perspectives regarding their adolescent receiving pediatric gender-affirming care via telemedicine to help providers and health systems optimize this modality for future care delivery. Caregivers (n=18) of TGD adolescents ages 14-17 participated in semi-structured, individual interviews that were transcribed and analyzed qualitatively. Caregivers cited participating in visits from their home environment, decreased anxiety, COVID safety, ability to have more family members attend, no transportation demands, and effective delivery of care as advantages of telemedicine. Disadvantages included dysphoria or discomfort with self-image, impersonal provider-patient interactions, video teleconferencing fatigue, difficulty with portal navigation, connectivity issues, and lack of privacy. Caregivers largely deferred to their child's preference regarding the choice of visit modality, but many reported a preference for the first to be conducted in-person, and follow-up and less complex visits via telemedicine. Health systems should consider these perspectives as they adapt telemedicine infrastructure to better meet the needs of patients and their families.
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Affiliation(s)
- Nicole F Kahn
- Seattle Children's Hospital and Research Institute, Seattle, Washington, USA
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Peter G Asante
- Seattle Children's Hospital and Research Institute, Seattle, Washington, USA
| | - Jessy Guler
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Valentino Reyes
- Seattle Children's Hospital and Research Institute, Seattle, Washington, USA
| | - Yomna Anan
- Seattle Children's Hospital and Research Institute, Seattle, Washington, USA
| | - Kevin Bocek
- Seattle Children's Hospital and Research Institute, Seattle, Washington, USA
| | - Kacie M Kidd
- Department of Pediatrics, West Virginia University, Morgantown, West Virginia, USA
| | - Laura P Richardson
- Seattle Children's Hospital and Research Institute, Seattle, Washington, USA
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Dimitri A Christakis
- Seattle Children's Hospital and Research Institute, Seattle, Washington, USA
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Wanda Pratt
- The Information School, University of Washington, Seattle, Washington, USA
| | - Gina M Sequeira
- Seattle Children's Hospital and Research Institute, Seattle, Washington, USA
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
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38
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González-González F, Fernández-Agis I. Patterns and practices of parenting transgender children: A brief Comparative study. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2024; 25:63-73. [PMID: 38328585 PMCID: PMC10846449 DOI: 10.1080/26895269.2023.2269911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
The practices of parents raising children with trans* life experiences influence their subsequent social adjustment. The aim of the study was to identify potential differences in parenting patterns and practices between two groups, one comprising families with transgender children and the other group comprising families with cisgender children. Twenty-eight adults and 15 children and adolescents from Bogotá, Colombia, participated. We performed descriptive, nonparametric comparative, and Bayesian comparative analyses for independent samples. We used a frequentist inferential comparative method with the Mann-Whitney U test with an effect size based on rank-biserial correlation, which revealed no statistically significant difference values. Bayesian comparisons showed minimal evidence in favor of the null hypothesis in all comparisons performed, except for the Behavioral Control or Regulation variable. The main finding of this study suggests that parents of children with trans* life experiences may not be addressing their specific needs, which could lead to a lack of understanding of their situation and support in their transition process.
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Burnett O, Sequeira GM, Rodanthe RS, Kidd KM. Nine Ways Parents Can Support Their Gender Diverse Children. Transgend Health 2024; 9:98-103. [PMID: 38312457 PMCID: PMC10835157 DOI: 10.1089/trgh.2022.0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Parental support is associated with improved mental health outcomes for gender diverse youth (GDY). Parents often seek guidance from pediatric providers, but few studies explore what actions make GDY feel supported. Using a qualitative analysis of open-ended survey responses, we aimed to identify ways in which GDY want to be supported by their parents or caregivers. Nine key themes were identified, including using affirming language at home and other settings as desired by GDY, seeking education, and aiding in accessing affirming items and care. Findings from this study can help pediatric medical and mental health providers help parents to support their GDY.
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Affiliation(s)
- Oliver Burnett
- Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
| | - Gina M Sequeira
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | | | - Kacie M Kidd
- Department of Pediatrics, West Virginia University School of Medicine, Morgantown, West Virginia, USA
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40
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Williams CR, McGregor K, Feld A, Boskey ER. Understanding Their Experiences: Psychosocial Functioning of Nonbinary and Binary Youth at the Time of Hormone Readiness Assessment. LGBT Health 2024; 11:164-169. [PMID: 37815823 DOI: 10.1089/lgbt.2023.0056] [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: 10/11/2023] Open
Abstract
Purpose: The unique psychosocial experiences of nonbinary individuals across the lifespan are understudied compared with those of binary transgender individuals. This study examined the psychosocial stressors faced by nonbinary youth compared with their binary transgender counterparts at the time of gender-affirming hormone (GAH) readiness assessment. Methods: This study compared the psychosocial functioning of nonbinary youth with their binary transgender peers, ages 14-18, utilizing the Youth Self Report (YSR) at the time of GAH readiness assessment. Clinically relevant subscale scores of the YSR were analyzed. Results: Data from 479 binary and 55 nonbinary individuals were analyzed for this study. Analysis found that nonbinary youth reported substantially more psychosocial distress in the form of total problems (β = 2.86, 95% confidence interval [CI] [0.15-5.56]), internalizing problems (β = 4.57, 95% CI [1.55-7.59]), depression (β = 4.52, 95% CI [1.70-7.33]), and self-harm (odds ratio 2.65, 95% CI [1.26-5.56]) than their binary transgender peers. Conclusion: Nonbinary youth experienced higher psychosocial distress compared with their binary transgender counterparts. Future research is needed to better understand the possible health disparities experienced by nonbinary people across their lifespan so that their psychosocial needs can be better met.
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Affiliation(s)
- Coleen R Williams
- Gender Multispecialty Service, Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Psychology, Harvard Medical School, Boston, Massachusetts, USA
| | - Kerry McGregor
- Gender Multispecialty Service, Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Psychology, Harvard Medical School, Boston, Massachusetts, USA
| | - Amalia Feld
- Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Elizabeth R Boskey
- Division of Gynecology, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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Oh JW, Park S, Lim S, Lee ES. Age of first experience of gender incongruence among transgender and non-binary individuals. Obstet Gynecol Sci 2024; 67:132-141. [PMID: 38044615 DOI: 10.5468/ogs.23229] [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] [Received: 09/14/2023] [Accepted: 10/31/2023] [Indexed: 12/05/2023] Open
Abstract
OBJECTIVE Gender incongruence (GI) is a condition in which an individual's gender identity, role, and expression differ from their assigned sex. This study aimed to evaluate when GI first arises in transgender and non-binary individuals seeking hormone therapy and their years living untreated in South Korea. METHODS This retrospective study analyzed GI patients seeking gender-affirming hormone therapy (GAHT) or surgery between 2015 and 2021. The recorded data included gender identity, legal transition status, age of onset of GI, age at the initiation of therapy, and total therapy duration. RESULTS In total, 337 patients were enrolled, including 149 (44.2%) transgender men, 153 (45.4%) transgender women, and 35 (10.4%) non-binary individuals. The mean age of onset of GI was 10.6 years (standard deviation, 5.1). Of the total patients, 29% had an onset of GI before age 6 years (preschool), 61% before age 12 (elementary-school), and 87% before age 15 (middle-school). Patients lived with GI for almost 14 years before GAHT initiation at a median age of 23.0 years. 90% of transgender men, 82.3% of transgender women, and 85% of non-binary patients disclosed their gender identities to their families. Regarding social transition, 31.5% of transgender men, 16.3% of transgender women, and none of the non-binary patients (P<0.005) changed their legal gender markers. CONCLUSION Many transgender and non-binary individuals experience GI early in life. These findings emphasized the need for early evaluation, timely gender-affirming care, and more accessible legal processes for gender marker changes in South Korea, aiming to enhance the safety and well-being of these individuals.
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Affiliation(s)
- Jeong-Won Oh
- Department of Obstetrics and Gynecology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Sohee Park
- Department of Obstetrics and Gynecology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Seongyun Lim
- Department of Obstetrics and Gynecology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Eun Sil Lee
- Department of Obstetrics and Gynecology, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
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Das HK, Govindappa L. Anxiety, depression and social support of LGBTIQ during COVID-19 in Kerala, India. Int J Soc Psychiatry 2023; 69:1971-1978. [PMID: 37353961 PMCID: PMC10291211 DOI: 10.1177/00207640231183913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/25/2023]
Abstract
BACKGROUND It is reported that the marginalised and underprivileged sections suffer bitter consequences in the event of calamities and pandemics. The present study aims at assessing the level of anxiety, depression and social support of the LGBTIQ communities during the COVID-19. Since the 'LGBTIQ' community is an integral part of society, it is necessary to study these psychological dimensions in the face of multiple waves of the pandemic in the country. AIM The study aims to measure the anxiety, depression and social support of LGBTIQ during COVID-19 in Kerala. METHOD The study followed descriptive research design and using snowball sampling, total of 106 respondents were interviewed from the urban and rural areas of Kerala. The researchers used the 'DASS21' to assess anxiety and depression and the Multidimensional Scale of Perceived Social Support to assess social support. RESULTS Approximately half (44.3%) of the participants were experiencing severe or extremely severe levels of depression. At the same time, many of them had episodes of anxiety disorder at much higher levels (41.5%) than the other members of society. Perceived social support was negatively correlated with depression, anxiety and stress, while depression, anxiety and stress showed a positive correlation with each other. CONCLUSION Common mental health problems such as anxiety, depression and stress were largely prevalent in the LGBTIQ community during COVID-19, who found the social support inadequate and suffered from other social and economic problems. There is a need to address these issues among this population.
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Affiliation(s)
| | - Lakshmana Govindappa
- Department of Social Work, School of Social and Behavioral Science, Central University of Karnataka, Kalaburagi, Karnataka, India
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Okuzono SS, Wilson J, Slopen N. Resilience in development: Neighborhood context, experiences of discrimination, and children's mental health. Dev Psychopathol 2023; 35:2551-2559. [PMID: 37641977 DOI: 10.1017/s0954579423001025] [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: 08/31/2023]
Abstract
An understanding of child psychopathology and resilience requires attention to the nested and interconnected systems and contexts that shape children's experiences and health outcomes. In this study, we draw on data from the National Survey of Children's Health, 2016 to 2021 (n = 182,375 children, ages 3- to 17 years) to examine associations between community social capital and neighborhood resources and children's internalizing and externalizing problems, and whether these associations were moderated by experiences of racial discrimination. Study outcomes were caregiver-report of current internalizing and externalizing problems. Using logistic regression models adjusted for sociodemographic characteristics of the child and household, higher levels of community social capital were associated with a lower risk of children's depression, anxiety, and behaviors. Notably, we observed similar associations between neighborhood resources and child mental health for depression only. In models stratified by the child's experience of racial/ethnic discrimination, the protective benefits of community social capital were specific to those children who did not experience racial discrimination. Our results illustrate heterogeneous associations between community social capital and children's mental health that differ based on interpersonal experiences of racial/ethnic discrimination, illustrating the importance of a multilevel framework to promote child wellbeing.
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Affiliation(s)
- Sakurako S Okuzono
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Joseph Wilson
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Natalie Slopen
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Center on the Developing Child, Cambridge, MA, USA
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Mahfouda S, Maybery M, Moore J, Perry Y, Strauss P, Zepf F, Lin A. Gender non-conformity in childhood and adolescence and mental health through to adulthood: a longitudinal cohort study, 1995-2018. Psychol Med 2023; 53:7756-7765. [PMID: 37403583 DOI: 10.1017/s0033291723001721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Abstract
BACKGROUND Few studies have examined associations between gender non-conformity (GNC) in childhood or adolescence and mental health outcomes later in life. This study examined associations between (1) GNC and mental health over multiple time points in childhood and adolescence, and (2) GNC in childhood and/or adolescence and mental health in adulthood. METHOD Second generation participants from the Raine Study, a longitudinal cohort from Perth, Western Australia. Data were collected between 1995 and 2018, comprising seven waves: ages 5 (N = 2236), 8 (N = 2140), 10 (N = 2048), 14 (N = 1864), 17 (N = 1726), 22 (N = 1236) and 27 (N = 1190) years. History of GNC, v. absence of this history, was based on responses to item 110 from the Child Behaviour Checklist (CBCL)/Youth Self Report (YSR) ('wishes to be of opposite sex'). The CBCL/YSR were used to measure internalising and externalising symptoms. Items 18 ('deliberate self-harm [DSH] or attempts suicide') and 91 ('talks/thinks about killing self') were used as measures of suicidal ideation (SI) and DSH. For adults, Depression, Anxiety and Stress Subscales and Kessler Psychological Distress Scale assessed mental health. RESULTS Child and adolescent GNC was associated with elevated internalising and externalising behaviours and increased odds of DSH. A history of GNC was also associated with vulnerability for severe psychological distress in adulthood in some symptom scales. CONCLUSION GNC over the child and adolescent period is associated with significant emotional and behavioural difficulties, and psychological distress. A history of GNC in childhood and/or adolescence also predicts poorer mental health in adulthood on multiple symptom domains.
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Affiliation(s)
| | | | - Julia Moore
- Perth Children's Hospital, Nedlands, Australia
| | - Yael Perry
- Telethon Kids Institute, Nedlands, Australia
| | | | - Florian Zepf
- Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
- German Center for Mental Health (DZPG)
- Center for Intervention and Research on adaptive and maladaptive brain Circuits underlying mental health (C-I-R-C), Jena-Magdeburg-Halle, Germany
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Lenne E, Sun CJ, Klawetter S. An Examination of Power in a Triadic Model of Parent-Child-Pediatrician Relationships Related to Early Childhood Gender Development. JOURNAL OF FAMILY THEORY & REVIEW 2023; 15:662-676. [PMID: 38351982 PMCID: PMC10861221 DOI: 10.1111/jftr.12527] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/12/2023] [Indexed: 02/16/2024]
Abstract
In this paper, the authors introduce the Triadic Model of Pediatric Care, an innovative conceptual framework for pediatric practice with transgender and gender diverse children. The Triadic Model of Pediatric Care consists of three experts-pediatricians, primary caregiver(s), and children-who each possess unique insights, knowledge, and decision-making power. This model guides pediatricians to provide gender-affirming care that acknowledges children as experts of their own experience and worthy of bodily autonomy, while also working to ensure primary caregiver(s) have the information and support necessary to provide a safe and nurturing developmental environment for their child. The authors provide a recommendation for how the Triadic Model of Pediatric Care might be applied in a pediatric healthcare setting and conclude with a summary of the model's implications, limitations, and future directions.
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Affiliation(s)
- Eline Lenne
- School of Social Work, Portland State University, Portland, OR, USA
| | - Christina J. Sun
- College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Abstract
Increasing numbers of youth are identifying as transgender or gender diverse (TGD), meaning their gender identity or expression do not conform to culturally defined expectations for their designated sex at birth. The mental health needs of TGD youth are diverse, and to effectively address these needs requires knowledgeable general pediatric providers, who often are families' first resource for education and support around gender diversity. To help general pediatric providers work more effectively with TGD youth, we describe the role of mental health providers working with TGD youth and how best to support TGD youth's access to gender-affirming mental health and medical interventions. [Pediatr Ann. 2023;52(12):e456-e461.].
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Linsenmeyer W, Heiden-Rootes K, Drallmeier T, Rahman R, Buxbaum E, Walcott K, Rosen W, Gombos BE. The power to help or harm: student perceptions of transgender health education using a qualitative approach. BMC MEDICAL EDUCATION 2023; 23:836. [PMID: 37936098 PMCID: PMC10629163 DOI: 10.1186/s12909-023-04761-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 10/10/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND Lack of transgender health education among health professional education programs is a limitation to providing gender-affirming care. Educational interventions have advanced in the past decade using a variety of pedagogical approaches. Although evidence supports that educational interventions can significantly improve student knowledge, comfort levels, preparedness, and clinical skills, few studies have addressed student perceptions of or receptiveness towards transgender health education. The study purpose was to explore student perceptions of transgender health education using a qualitative approach. METHODS We utilized a basic qualitative design to explore student perceptions of transgender health education at a Catholic, Jesuit institution. Participants were medical students (n = 182), medical family therapy students (n = 8), speech, language and hearing sciences students (n = 44), and dietetic interns (n = 30) who participated in an Interprofessional Transgender Health Education Day (ITHED) in partnership with transgender educators and activists. Participants completed an online discussion assignment using eight discussion prompts specific to the ITHED sessions. Data were analyzed using the constant comparative method and triangulated across four medical and allied health programs. RESULTS A total of 263 participants provided 362 responses across eight discussion prompts. Three major themes resulted: (1) The Power to Help or Harm, (2) The Responsibility to Provide Health Care, and (3) A Posture of Humility: Listen and Learn. Each theme was supported by three to four subthemes. CONCLUSIONS Health professional students were highly receptive towards transgender health education delivered by transgender community members. First-person accounts from session facilitators of both positive and negative experiences in healthcare were particularly effective at illustrating the power of providers to help or harm transgender patients. Reflection and constructive dialogue offers students an opportunity to better understand the lived experiences of transgender patients and explore their identities as healthcare providers at the intersection of their religious and cultural beliefs.
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Affiliation(s)
- Whitney Linsenmeyer
- Department of Nutrition and Dietetics, Saint Louis University, 3437 Caroline Street, Room 3076, St. Louis, MO, 63105, USA.
| | - Katie Heiden-Rootes
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1008 S. Spring Avenue, 3rd Floor, St. Louis, MO, 63110, USA
| | - Theresa Drallmeier
- Department of Family and Community Medicine, Saint Louis University School of Medicine, 1008 S. Spring Avenue, 3rd Floor, St. Louis, MO, 63110, USA
| | - Rabia Rahman
- Department of Nutrition and Dietetics, Saint Louis University, 3437 Caroline Street, Room 3076, St. Louis, MO, 63105, USA
| | - Emily Buxbaum
- Department of Speech, Language & Hearing Sciences, Saint Louis University, 3750 Lindell Blvd., Suite 23, St. Louis, MO, 63108, USA
| | - Katherine Walcott
- Department of Nutrition and Dietetics, Saint Louis University, 3437 Caroline Street, Room 3076, St. Louis, MO, 63105, USA
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Vandermorris A, Metzger DL. Une approche d'affirmation pour les soins aux jeunes transgenres et de diverses identités de genre. Paediatr Child Health 2023; 28:449-461. [PMID: 37885605 PMCID: PMC10599493 DOI: 10.1093/pch/pxad046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 02/17/2023] [Indexed: 10/28/2023] Open
Abstract
Un nombre croissant de jeunes s'identifient comme transgenres ou de diverses identités de genre. De nombreux pédiatres et dispensateurs de soins de première ligne accueilleront cette population dans leur pratique, dans le cadre de soins liés au genre ou de soins de santé généraux. Le présent document de principes se veut une ressource pour orienter les pédiatres et les dispensateurs de soins de première ligne à adopter une approche d'affirmation pour la prestation des soins réguliers à tous les jeunes. De plus, il contient de l'information visant à aider les dispensateurs à répondre aux demandes de conseils des jeunes transgenres et de diverses identités de genre et de leur famille au sujet des possibilités de transition médicale et d'orientation vers des services spécialisés s'ils le désirent et le jugent pertinent. Enfin, on anticipe que la demande de soins d'affirmation de genre continue d'augmenter, et certains dispensateurs de soins peuvent souhaiter acquérir les connaissances et les habiletés nécessaires pour amorcer les inhibiteurs d'hormones et les hormones d'affirmation de genre chez les adolescents. Le présent document ne contient pas de directives cliniques, mais de l'information fondamentale au sujet des divers éléments possibles des soins d'affirmation de genre, tout en reconnaissant que les besoins et les objectifs d'adolescents particuliers n'incluent pas automatiquement de telles interventions. D'autres ressources permettant d'acquérir les compétences nécessaires pour offrir des interventions d'affirmation de genre sont également proposées.
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Affiliation(s)
- Ashley Vandermorris
- Société canadienne de pédiatrie, comité de la santé de l'adolescent, Ottawa (Ontario)Canada
| | - Daniel L Metzger
- Société canadienne de pédiatrie, comité de la santé de l'adolescent, Ottawa (Ontario)Canada
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So RJ, Davis A, Akst LM, Hillel AT, Best SR. Factors Associated With Loss of Follow-Up in Transgender Patients Receiving Vocal Therapy. Laryngoscope 2023; 133:3061-3067. [PMID: 37161908 DOI: 10.1002/lary.30727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 03/29/2023] [Accepted: 04/18/2023] [Indexed: 05/11/2023]
Abstract
OBJECTIVES Optimal vocal care for transgender patients necessitates regular follow-up. Factors associated with loss of follow-up in voice patients have never been investigated. In this study, we report a case series of transgender patients seeking vocal care at our institution and compare those who were and were not lost to follow-up. METHODS Charts of transgender patients diagnosed with gender dysphoria who sought vocal care at our institution from January 2018 through May 2022 were reviewed. A chronological timeline of each patient's care at our vocal clinic was recorded. Loss of follow-up was defined as instances in which patients were not yet satisfied with their vocal outcomes and expressed interest in scheduling a subsequent visit but had not yet done so. Logistic regressions were performed to identify factors associated with loss of follow-up. RESULTS Of 73 patients identified, 59 (80.8%) were assigned male at birth, and 72 (98.6%) were non-Hispanic White. Loss of follow-up occurred in 35 (47.9%) patients. Patients who received vocal surgery were significantly less likely to be lost to follow-up (OR: 0.16 (0.03, 0.79); p = 0.03). The availability of telemedicine options for vocal care was protective against loss of follow-up (OR: 0.09 (0.02, 0.44); p = 0.003). Patients who received other non-voice gender-affirming treatments concomitant to their vocal care were more likely to be lost to follow-up (OR: 4.44 (1.35, 14.59); p = 0.01). CONCLUSION Loss of follow-up in transgender patients receiving vocal care is common. Providing telemedicine options and encouraging patients to complete vocal care prior to or after receiving other non-voice gender-affirming treatments may help increase rates of follow-up. LEVEL OF EVIDENCE 4 Laryngoscope, 133:3061-3067, 2023.
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Affiliation(s)
- Raymond J So
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Ashley Davis
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Lee M Akst
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Alexander T Hillel
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Simon R Best
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
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Sequeira S, Carmel T, Tervo-Clemmens B, Edmiston EK. Future Directions in the Mental Health of Transgender Youth: Towards a Social-Affective Developmental Model of Health Disparity. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2023; 52:866-876. [PMID: 37910433 DOI: 10.1080/15374416.2023.2272972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
Mental health disparities in transgender and gender diverse (TGD) youth are well-documented. These disparities are often studied in the context of minority stress theory, and most of this research focuses on experiences of trauma and discrimination TGD youth experience after coming out. However, TGD youth may be targets of violence and victimization due to perceived gender nonconformity before coming out. In this Future Directions, we integrate research on attachment, developmental trauma, and effects of racism and homophobia on mental health to propose a social-affective developmental framework for TGD youth. We provide a clinical vignette to highlight limitations in current approaches to mental health assessment in TGD youth and to illustrate how using a social-affective developmental framework can improve clinical assessment and treatment approaches and deepen our understanding of mental health disparities in TGD people.
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Affiliation(s)
| | - Tamar Carmel
- Department of Psychiatry, Veterans Affairs Richmond
| | | | - E Kale Edmiston
- Department of Psychiatry, University of Massachusetts Chan School of Medicine
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