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Cheung CK, Lee H, Francis-Levin N, Choi E, Geng Y, Thomas BN, Roman VA, Roth ME. Provider preparedness to care for sexual and gender minority adolescent and young adult cancer patients: A scoping review. PEC INNOVATION 2024; 5:100343. [PMID: 39346774 PMCID: PMC11437872 DOI: 10.1016/j.pecinn.2024.100343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 07/30/2024] [Accepted: 09/10/2024] [Indexed: 10/01/2024]
Abstract
Objective The purpose of the current scoping review is to explore knowledge and gaps in the literature on the preparedness of health care providers (HCPs) to deliver cancer care that addresses the needs of sexual and gender minority (SGM) adolescent and young adult (AYA) patients diagnosed with cancer between ages 15-39 years. Methods We conducted two comprehensive searches on OVID MEDLINE, PsycINFO, and CINAHL in February 2022 and June 2024; examined the empirical literature on HCPs who treat SGM AYA cancer patients; characterized existing research; and evaluated each contribution. Results A total of thirteen articles were included in the final review. The reviewed studies varied widely in sample sizes (n = 6 to n = 1253), reflecting different methodological approaches: quantitative cross-sectional (n = 3), qualitative (n = 4), and mixed methods (n = 6). Innovation The current scoping review piloted an innovative Quality Assessment (QA) Tool of Foundational Progress for SGM AYA Research to assess the quality of evidence, providing a new framework for evaluating and guiding future research. Conclusion The existing literature on provider preparedness to care for SGM AYA cancer patients is limited. Future studies are critically needed to improve providers' ability to holistically respond to the unique health care needs and concerns of this population.
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Affiliation(s)
- Christabel K Cheung
- University of Maryland Greenebaum Comprehensive Cancer Center, United States
- University of Maryland School of Social Work, Baltimore, MD, USA
| | - Haelim Lee
- University of Maryland School of Social Work, Baltimore, MD, USA
| | - Nina Francis-Levin
- University of Michigan Division of Metabolism, Endocrinology, and Diabetes, Ann Arbor, MI, USA
| | - Eunju Choi
- University of Texas Department of Nursing and MD Anderson Cancer Center, Houston, TX, USA
| | - Yimin Geng
- Research Medical Library, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Bria N Thomas
- Temple University School of Podiatric Medicine, Philadelphia, PA, USA
| | | | - Michael E Roth
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Fortnum K, Gomersall SR, Ross MH, Woodforde J, Thomas G, Wen YS, Perales F, Stylianou M. 24-Hour Movement Behaviors of LGBTQA+ Young People: A Systematic Review. J Phys Act Health 2024:1-17. [PMID: 39389567 DOI: 10.1123/jpah.2024-0343] [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: 05/10/2024] [Revised: 08/11/2024] [Accepted: 08/18/2024] [Indexed: 10/12/2024]
Abstract
BACKGROUND The movement behaviors of LGBTQA+ young people, who encounter specific health, and other, challenges are not well understood. This systematic review examines the 24-hour movement behaviors of LGBTQA+ young people compared with population estimates of meeting the 24-hour movement guidelines. METHODS Seven electronic databases were searched from inception to January 2024. Observational studies published in English and reporting quantitative data for physical activity, sedentary behavior, or sleep duration for LGBTQA+ individuals <24 years old were included. Data were narratively synthesized for children/adolescents (<18 years) and young adults (18-24 years), guided by the Cochrane Synthesis Without Meta-analysis guidelines. RESULTS Fifty-six studies were included; 46 were of "fair" quality and 37 were conducted in the United States. Physical activity, sedentary behavior, and sleep outcomes were reported in 46, 11, and 14 studies, respectively. Ninety unique LGBTQA+ terms were identified. Based on outcomes reported in ≥1 study, and compared to population estimates, LGBTQA+ young people were less likely to meet aerobic physical activity and strength/resistance training guidelines. LGBTQA+ children/adolescents were less likely to meet the sleep guidelines. Young adults demonstrated similar adherence to sleep guidelines as population estimates. CONCLUSIONS Overall, our results suggest that LGBTQA+ young people have suboptimal 24-hour movement behaviors; in some cases, worse than population estimates. Utilization of more robust measures of exposure and outcome variables is recommended, with a focus on sleep and sedentary behavior.
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Affiliation(s)
- Kathryn Fortnum
- School of Human Movement and Nutrition Sciences, Health and Wellbeing Center for Research Innovation (HWCRI), The University of Queensland, Brisbane, QLD, Australia
| | - Sjaan R Gomersall
- School of Human Movement and Nutrition Sciences, Health and Wellbeing Center for Research Innovation (HWCRI), The University of Queensland, Brisbane, QLD, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Megan H Ross
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - James Woodforde
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, QLD, Australia
| | - George Thomas
- School of Human Movement and Nutrition Sciences, Health and Wellbeing Center for Research Innovation (HWCRI), The University of Queensland, Brisbane, QLD, Australia
| | - Yu-Shu Wen
- School of Human Movement and Nutrition Sciences, Health and Wellbeing Center for Research Innovation (HWCRI), The University of Queensland, Brisbane, QLD, Australia
| | - Francisco Perales
- School of Social Science, The University of Queensland, Brisbane, QLD, Australia
| | - Michalis Stylianou
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, QLD, Australia
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3
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Klinger D, Oehlke SM, Riedl S, Eschbaum K, Zesch HE, Karwautz A, Plener PL, Kothgassner OD. Mental health of non-binary youth: a systematic review and meta-analysis. Child Adolesc Psychiatry Ment Health 2024; 18:126. [PMID: 39385290 PMCID: PMC11465615 DOI: 10.1186/s13034-024-00822-z] [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: 01/14/2024] [Accepted: 09/27/2024] [Indexed: 10/12/2024] Open
Abstract
BACKGROUND Non-binary identities are increasingly recognized within the spectrum of gender diversity, yet there is a dearth of research exploring the mental health challenges specific to this population. Therefore, this systematic review and meta-analysis aimed to comprehensively assess the mental health outcomes of non-binary youth in comparison to their transgender and cisgender peers. METHODS A systematic search was conducted to identify relevant studies across three electronic databases (PubMed, Scopus, Web of Science) covering the period from inception to October 2023. The meta-analysis was performed employing a random-effects model. Inclusion criteria encompassed studies comparing non-binary youth with transgender or cisgender youth, providing data on mental health outcomes such as general mental health, depressive and anxiety symptoms, self-harm and suicidality. RESULTS Twenty-one studies, meeting the inclusion criteria and originating from six different countries, were included in the analysis. The sample encompassed 16,114 non-binary, 11,925 transgender, and 283,278 cisgender youth, with ages ranging from 11 to 25 years. Our meta-analysis revealed that non-binary youth exhibit significantly poorer general mental health compared to both transgender (d = 0.24, 95% CI, 0.05-0.43, p =.013) and cisgender youth (d = 0.48, 95% CI, 0.35-0.61, p <.001), indicating a more impaired general mental health in non-binary youth. Regarding depressive symptoms, when comparing non-binary and cisgender individuals, a moderate and significant effect was observed (d = 0.52, 95% CI, 0.41-0.63, p <.001). For anxiety symptoms, a small but significant effect was observed in the comparison with cisgender individuals (d = 0.44, 95% CI, 0.19-0.68, p =.001). Furthermore, non-binary individuals exhibited lower rates of past-year suicidal ideation than transgender peers (OR = 0.79, 95% CI, 0.65-0.97, p =.023) and higher rates of lifetime suicidal ideation than cisgender youth (OR = 2.14, 95% CI, 1.46-3.13, p <.001). CONCLUSION Non-binary youth face distinct mental health challenges, with poorer general mental health, elevated depressive and anxiety symptoms compared to cisgender, and similar rates of self-harm and suicidal behavior compared to transgender individuals. These findings underscore the urgent need for targeted interventions, including gender-affirming mental health support, to address the specific needs of non-binary youth.
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Affiliation(s)
- Diana Klinger
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria.
- Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria.
| | - Sofia-Marie Oehlke
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Stefan Riedl
- Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
- St. Anna Children's Hospital, Medical University of Vienna, Vienna, Austria
| | - Ken Eschbaum
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Heidi Elisabeth Zesch
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Andreas Karwautz
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Paul L Plener
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Ulm, Germany
| | - Oswald D Kothgassner
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
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Küppers L, Gahr B, Ritz S. Beyond the binary female/male sex classification: The impact of (trans)gender on the identification of human remains. Int J Legal Med 2024:10.1007/s00414-024-03348-3. [PMID: 39375225 DOI: 10.1007/s00414-024-03348-3] [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: 12/12/2023] [Accepted: 09/29/2024] [Indexed: 10/09/2024]
Abstract
In cases of unidentified deceased persons, sex determination is a routine task in forensic medicine. However, the binary biological sex categories 'female' and 'male' may be challenged if it is not clear whether the information in the missing persons databases refers to the biological sex or the (felt and lived) gender. An umbrella term for people who do not identify with their birth sex (which usually is the biological, chromosomal sex) is 'transgender'. In recent decades, the legal and social situation of transgender people has changed in many countries making it easier to live their felt gender more openly. This development highlights the issue of potential challenges in the postmortem identification of transgender individuals. Serious problems in corresponding cases may be rare-but they must be considered and addressed in forensic practice to minimize the risk of delayed or failed identification. The impact of (trans)gender on the identification of human remains was examined by a narrative literature review under special consideration of the prevalences of transgender identities in general populations and in the group of unidentified deceased; possible actions to avoid problems in the postmortem identification of transgender persons in forensic practice are being proposed. One can assume that 1 of 200 people in the United States, the European Union and comparable societies is transgender with an opposite-sex identification, and 2 to 3 of 100 people live outside the typical female/male binary, with numbers increasing. If legally possible, an increasing number of transgender individuals will change their name and gender in civil registration. Transgender individuals are likely to be overrepresented in suicides and in victims of homicides. Although there are no precise data on the prevalence of transgender individuals in the group of unidentified deceased, the remarkably high reported prevalence in the general population and the over-representation of transgender individuals in suicides and homicides suggest that the topic is relevant to forensic practice. An autopsy does not always provide evidence of transgender identity, for example in skeletal remains. Particularly in unsolved cases, the possibility that an unidentified person may have been transgender should be considered. Knowledge and awareness of forensic practitioners on this topic should be strengthened by research and training. Databases and data reporting should be optimized. Recording in antemortem databases should clearly distinguish between 'biological sex' and 'apparent sex /lived gender identity'. When collecting postmortem data, a clear distinction should be made between "chromosomal sex" and "sex based on morphological findings". CLINICAL TRIAL NUMBER: Not applicable (review article).
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Affiliation(s)
- L Küppers
- Institute of Legal Medicine, University Clinic Dusseldorf, Duesseldorf, Germany.
| | - B Gahr
- Institute of Legal Medicine, University Clinic Dusseldorf, Duesseldorf, Germany
| | - S Ritz
- Institute of Legal Medicine, University Clinic Dusseldorf, Duesseldorf, Germany
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5
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Chan RCH, Suen YT, Leung JSY. Gender identity differences in the experiences of family stressors and violence among transgender and non-binary individuals in China. FAMILY PROCESS 2024; 63:1046-1067. [PMID: 38169124 DOI: 10.1111/famp.12958] [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: 10/03/2022] [Revised: 10/30/2023] [Accepted: 11/27/2023] [Indexed: 01/05/2024]
Abstract
Emerging research has demonstrated that transgender and non-binary (TNB) individuals face an elevated risk of experiencing family rejection and violence. However, there remains a significant knowledge gap regarding how TNB individuals manage stressors and their gender identity within the family context, particularly in regions where TNB individuals are highly stigmatized and where legal protections against family violence are lacking. The present study represents one of the first pioneering efforts to provide large-scale quantitative data examining the experiences of family stressors, the management of gender identity and expression, and family violence among TNB individuals in China. A national sample of 1063 TNB individuals in China was involved in the study. They completed questionnaires about their experiences of family stressors and violence. The results indicated that 76.0% of TNB individuals reported having encountered at least one form of violence perpetrated by their family members. Transfeminine individuals were more likely to report experiencing emotional and physical abuse, whereas transmasculine individuals were more likely to be subjected to gender identity and/or expression change efforts. Family stressors, including family non-acceptance and the pressure to marry and reproduce, were positively associated with non-disclosure of gender identity, the suppression of gender expression, and family violence. The findings underscore the substantial burden of family violence borne by TNB individuals in China, which warrants immediate legal, institutional, and social responses. Trans-inclusive family violence prevention and intervention are urgently needed, with a focus on Chinese cultural factors and gender identity differences in violence screening and risk assessment.
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Affiliation(s)
- Randolph C H Chan
- Department of Social Work, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Yiu Tung Suen
- Gender Studies Programme, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Janice Sin Yu Leung
- Gender Studies Programme, The Chinese University of Hong Kong, Shatin, Hong Kong
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6
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Marconi M, Pagano MT, Ristori J, Bonadonna S, Pivonello R, Meriggiola MC, Motta G, Lombardo F, Mosconi M, Oppo A, Cocchetti C, Romani A, Federici S, Bruno L, Verde N, Lami A, Crespi CM, Marinelli L, Giordani L, Matarrese P, Ruocco A, Santangelo C, Contoli B, Masocco M, Minardi V, Chiarotti F, Fisher AD, Pierdominici M. Sociodemographic profile, health-related behaviours and experiences of healthcare access in Italian transgender and gender diverse adult population. J Endocrinol Invest 2024:10.1007/s40618-024-02362-x. [PMID: 38733428 DOI: 10.1007/s40618-024-02362-x] [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: 12/20/2023] [Accepted: 03/09/2024] [Indexed: 05/13/2024]
Abstract
PURPOSE Information on the general health of transgender and gender diverse (TGD) individuals continues to be lacking. To bridge this gap, the National Institute of Health in Italy together with the National Office against Racial Discriminations, clinical centres, and TGD organizations carried out a cross-sectional study to define the sociodemographic profile, health-related behaviours, and experiences of healthcare access in Italian TGD adult population. METHODS A national survey was conducted by Computer-Assisted Web Interviewing (CAWI) technique. Collected data were compared within the TGD subgroups and between TGD people and the Italian general population (IGP). RESULTS TGD respondents were 959: 65% assigned female at birth (AFAB) and 35% assigned male at birth (AMAB). 91.8% and 8.2% were binary and non-binary TGD respondents, respectively. More than 20% of the TGD population reported to be unemployed with the highest rate detectable in AMAB and non-binary people. Cigarette smoking and binge drinking were higher in the TGD population compared with IGP (p < 0.05), affecting TGD subgroups differently. A significant lower percentage of AFAB TGD people reported having had screening for cervical and breast cancer in comparison with AFAB IGP (p < 0.0001, in both cases). Over 40% was the percentage of AFAB and non-binary TGD people accessing healthcare who felt discriminated against because of their gender identity. CONCLUSIONS Our results are a first step towards a better understanding of the health needs of TGD people in Italy in order to plan the best policy choices for a more inclusive public health.
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Affiliation(s)
- M Marconi
- Reference Centre for Gender Medicine, Istituto Superiore di Sanità, Rome, Italy
| | - M T Pagano
- Reference Centre for Gender Medicine, Istituto Superiore di Sanità, Rome, Italy
| | - J Ristori
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Florence University Hospital, Florence, Italy
| | - S Bonadonna
- Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - R Pivonello
- Dipartimento Di Medicina Clinica E Chirurgia, Sezione di Endocrinologia, University Federico II, Naples, Italy
| | - M C Meriggiola
- Division of Gynecology and Physiopathology of Human Reproduction, Department of Medical and Surgical Sciences (DIMEC), IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - G Motta
- Division of Endocrinology, Diabetology and Metabolism, Azienda Ospedaliero-Universitaria Città Della Salute E Della Scienza di Torino, University of Turin, Turin, Italy
| | - F Lombardo
- Laboratory of Semiology, Department of Experimental Medicine, Sperm Bank "Loredana Gandini", Sapienza University of Rome, Rome, Italy
| | - M Mosconi
- Gender Identity Development Service, Hospital S. Camillo-Forlanini, Rome, Italy
| | - A Oppo
- Endocrinology Unit, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - C Cocchetti
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Florence University Hospital, Florence, Italy
| | - A Romani
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Florence University Hospital, Florence, Italy
| | - S Federici
- Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - L Bruno
- Dipartimento Di Medicina Clinica E Chirurgia, Sezione di Endocrinologia, University Federico II, Naples, Italy
| | - N Verde
- Dipartimento Di Medicina Clinica E Chirurgia, Sezione di Endocrinologia, University Federico II, Naples, Italy
| | - A Lami
- Division of Gynecology and Physiopathology of Human Reproduction, Department of Medical and Surgical Sciences (DIMEC), IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - C M Crespi
- Division of Endocrinology, Diabetology and Metabolism, Azienda Ospedaliero-Universitaria Città Della Salute E Della Scienza di Torino, University of Turin, Turin, Italy
| | - L Marinelli
- Division of Endocrinology, Diabetology and Metabolism, Azienda Ospedaliero-Universitaria Città Della Salute E Della Scienza di Torino, University of Turin, Turin, Italy
| | - L Giordani
- Reference Centre for Gender Medicine, Istituto Superiore di Sanità, Rome, Italy
| | - P Matarrese
- Reference Centre for Gender Medicine, Istituto Superiore di Sanità, Rome, Italy
| | - A Ruocco
- Reference Centre for Gender Medicine, Istituto Superiore di Sanità, Rome, Italy
| | - C Santangelo
- Reference Centre for Gender Medicine, Istituto Superiore di Sanità, Rome, Italy
| | - B Contoli
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore Di Sanità, Rome, Italy
| | - M Masocco
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore Di Sanità, Rome, Italy
| | - V Minardi
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore Di Sanità, Rome, Italy
| | - F Chiarotti
- Reference Centre for Behavioral Sciences and Mental Health, Istituto Superiore Di Sanità, Rome, Italy
| | - A D Fisher
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Florence University Hospital, Florence, Italy
| | - M Pierdominici
- Reference Centre for Gender Medicine, Istituto Superiore di Sanità, Rome, Italy.
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Gómez-Ibáñez R, Leyva-Moral JM, Cruzado-Reyes A, Platero LR, Granel N, Watson CE. Describing Non-Binary People's Encounters with the Healthcare System: A Qualitative Study in Catalonia (Spain). ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:1957-1967. [PMID: 38565788 PMCID: PMC11106161 DOI: 10.1007/s10508-024-02849-x] [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: 05/08/2023] [Revised: 02/25/2024] [Accepted: 02/29/2024] [Indexed: 04/04/2024]
Abstract
Non-binary people face numerous stressors in their daily lives, including personal, interpersonal, and environmental. These stressors gain strength when such individuals access healthcare services, and discrimination and cisgenderism become the main barrier to obtaining gender-affirming healthcare. This study aimed to describe the experiences of non-binary people regarding the care and medical attention received in Catalonia (Spain). A qualitative phenomenological study was conducted with 21 non-binary people recruited using snowball sampling in 2022. Data were gathered through open-ended interviews and analyzed using thematic analysis. Two main themes were identified, which were further classified into two categories each: Theme 1-This is me composed of the categories, "My Name and My Pronouns" and "One's Chosen Gender," and Theme 2-I do not exist for the health system consisting of "Uneducated Health System in Sexual Health" and "Feeling Like an Outsider for Being Non-Binary." Non-binary people face multiple stressors when accessing the healthcare services that makes them feel invisible, vulnerable, and marginalized. Further widespread implementation of person-centered care is essential to promote the relationship between non-binary people and the healthcare system. In addition, further sexual health training is required for all health professionals.
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Affiliation(s)
- Rebeca Gómez-Ibáñez
- Nursing Department, Faculty of Medicine, Universitat Autònoma de Barcelona, Avinguda de Can Domènech, 08193, Bellaterra, Barcelona, Spain
- Grupo de Investigación Enfermera Sobre Vulnerabilidad y Salud, Nursing Department, Universitat Autónoma de Barcelona, Bellaterra, Barcelona, Spain
| | - Juan M Leyva-Moral
- Nursing Department, Faculty of Medicine, Universitat Autònoma de Barcelona, Avinguda de Can Domènech, 08193, Bellaterra, Barcelona, Spain.
- Grupo de Investigación Enfermera Sobre Vulnerabilidad y Salud, Nursing Department, Universitat Autónoma de Barcelona, Bellaterra, Barcelona, Spain.
| | | | - Lucas R Platero
- Department of Psychology, Rey Juan Carlos University, Madrid, Spain
| | - Nina Granel
- Nursing Department, Faculty of Medicine, Universitat Autònoma de Barcelona, Avinguda de Can Domènech, 08193, Bellaterra, Barcelona, Spain
- Grupo de Investigación Enfermera Sobre Vulnerabilidad y Salud, Nursing Department, Universitat Autónoma de Barcelona, Bellaterra, Barcelona, Spain
| | - Carolina E Watson
- Nursing Department, Faculty of Medicine, Universitat Autònoma de Barcelona, Avinguda de Can Domènech, 08193, Bellaterra, Barcelona, Spain
- Grupo de Investigación Enfermera Sobre Vulnerabilidad y Salud, Nursing Department, Universitat Autónoma de Barcelona, Bellaterra, Barcelona, Spain
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8
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DeGuzman PB, Lyons GR, Azar FN, Kimble A, Huang G, Rheuban K, Gray SH. Impact of Telemedicine on Access to Care for Rural Transgender and Gender-Diverse Youth. J Pediatr 2024; 267:113911. [PMID: 38218369 DOI: 10.1016/j.jpeds.2024.113911] [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: 09/06/2023] [Revised: 01/04/2024] [Accepted: 01/09/2024] [Indexed: 01/15/2024]
Abstract
OBJECTIVE To explore the impact of telemedicine on access to gender-affirming care for rural transgender and gender diverse youth. STUDY DESIGN A retrospective analysis of data drawn from the electronic medical records of a clinic that provides approximately 10 000 adolescent and young adult visits per year and serves patients seeking gender health care. The no-show rate was examined as a proxy for access to care due to anticipated challenges with recruiting a representative sample of a historically marginalized population. Logistic regression with generalized estimating equations was conducted to model the association between the odds of a no-show visit and covariates of interest. RESULTS Telemedicine visits, rural home address, gender health visits, longer travel time, and being younger than 18 years old were associated with lower odds of a no-show in univariate models (n = 17 928 visits). In the adjusted model, the OR of no-shows for gender health visits was 0.56 (95% CI 0.42-0.74), adjusting for rurality, telemedicine, age (< or >18 years), and travel time to the clinic. CONCLUSIONS In this study, telemedicine was associated with reduced no-shows overall, and especially for rural, transgender and gender diverse youth, and patients who hold both identities. Although the no-show rate does not fully capture barriers to access, these findings provide insight into how this vulnerable population may benefit from expanded access to telemedicine for rural individuals whose communities may lack providers with the skills to serve this population.
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Affiliation(s)
- Pamela B DeGuzman
- Department of Family, Community, and Mental Health Systems, University of Virginia School of Nursing, Charlottesville, VA.
| | - Genevieve R Lyons
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA
| | - Francesca N Azar
- Department of Family, Community, and Mental Health Systems, University of Virginia School of Nursing, Charlottesville, VA
| | - April Kimble
- Teen and Adolescent Health Center, UVA Health, Charlottesville, VA
| | - Guoping Huang
- Spatial Sciences Institute, University of Southern California, Los Angeles, CA
| | - Karen Rheuban
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA
| | - Susan H Gray
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA
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9
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Amarante ICJ, Lippman SA, Sevelius JM, Saggese GSR, da Silva AAM, Veras MADSM. Anticipated Stigma and Social Barriers to Communication Between Transgender Women Newly Diagnosed with HIV and Health Care Providers: A Mediation Analysis. LGBT Health 2024; 11:229-238. [PMID: 37910864 PMCID: PMC11001954 DOI: 10.1089/lgbt.2023.0041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023] Open
Abstract
Purpose: We assessed whether anticipated stigma (i.e., fear of public mistreatment due to gender identity) impacts communication between transgender women (TGW) living with HIV and health care providers. Methods: This is a secondary analysis of baseline data from Trans Amigas, a study conducted in Brazil, 2018. The study population consisted of TGW living with HIV, older than 18 years, residing in the São Paulo metropolitan area. We used multivariable logistic regression (α = 0.05), mediation, and bootstrapping for the analysis. Results: One hundred and thirteen participants completed the study. Fear of public mistreatment had an adjusted odds ratio (aOR) of 7.42 (p = 0.003) for difficulty reporting new symptoms to providers. Concerning fear of public mistreatment, we found that unemployment had an aOR of 3.62 (p = 0.036); sex work, an aOR of 2.95 (p = 0.041); and issues related to name change in documents, an aOR of 2.71 (p = 0.033). For the indirect effect on difficulty reporting new symptoms, mediated by fear of public mistreatment, unemployment had an aOR of 1.52 (confidence interval [CI] = 0.88-2.24); sex work, an aOR of 1.48 (CI = 0.81-2.52); and name change issues, an aOR of 1.47 (CI = 0.96-2.43). Conclusions: Anticipated stigma was associated with communication difficulties between TGW living with HIV and providers. Our data suggest that structural factors associated with anticipated stigma could indirectly impact on difficulty reporting new symptoms. These findings indicate the importance of considering social contexts that intersect with individual experiences when analyzing communication barriers between providers and patients, and the need to strengthen social policies for TGW in Brazil. Clinical Trial Registration number: R34MH112177.
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Affiliation(s)
- Isabella Chypriades Junqueira Amarante
- Department of Collective Health, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, São Paulo, Brazil
- Núcleo de Pesquisa em Direitos Humanos e Saúde da População LGBT+ (NUDHES), São Paulo, São Paulo, Brazil
| | - Sheri A Lippman
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Jae M. Sevelius
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Gustavo Santa Roza Saggese
- Núcleo de Pesquisa em Direitos Humanos e Saúde da População LGBT+ (NUDHES), São Paulo, São Paulo, Brazil
| | | | - Maria Amélia de Sousa Mascena Veras
- Department of Collective Health, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, São Paulo, Brazil
- Núcleo de Pesquisa em Direitos Humanos e Saúde da População LGBT+ (NUDHES), São Paulo, São Paulo, Brazil
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10
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Christiano JG, Punekar I, Patel A, McGregor HA, Moskow M, Anson E. Qualitative Assessment of the Experiences of Transgender Individuals Assigned Female at Birth Undergoing Gender-Affirming Mastectomy for the Treatment of Gender Dysphoria. Transgend Health 2024; 9:143-150. [PMID: 38585246 PMCID: PMC10998022 DOI: 10.1089/trgh.2022.0056] [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: 12/14/2022] Open
Abstract
Purpose Evaluation and comparison of outcomes following gender-affirming mastectomy have been hindered by the lack of a validated population- and surgery-specific patient-reported outcome measure (PROM). The purpose of this study was to explore the lived experiences of transgender individuals assigned female at birth (AFAB) from before-to-after gender-affirming mastectomy to identify key qualitative themes that might inform the creation of a quantitative PROM in the future. Methods Identified candidates were transgender men AFAB, 18-65 years of age (mean±standard deviation: 30.3±12.2), who had undergone gender-affirming mastectomy from 2015 through 2017 (n=53). Twelve individuals participated in either focus groups (6) or phone interviews (6), carried out in a semistructured fashion. Verbatim transcriptions were anonymized. Conventional content analysis was used to code all transcripts. Results Content analysis identified six key themes experienced by transgender men undergoing gender-affirming mastectomy. In contrast to their experiences before surgery, participant reported that after surgery they experienced fewer symptoms of gender dysphoria, lower anxiety associated with gender dysphoria, less fear about physical safety, no need to hide a female chest shape, and that they passed as male. Also explored were themes about experiences with the health care team. Conclusion This study presents the first qualitative data based on the lived experiences of transgender individuals AFAB who underwent gender-affirming mastectomy. These qualitative themes should be heavily considered when creating a quantitative PROM that will fully capture the changes transgender individuals AFAB experience from before-to-after gender-affirming mastectomy.
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Affiliation(s)
- Jose G. Christiano
- Division of Plastic Surgery, Department of Surgery, University of Rochester, Rochester, New York, USA
| | - Imran Punekar
- Division of Plastic Surgery, Department of Surgery, University of Rochester, Rochester, New York, USA
| | - Alap Patel
- Division of Plastic Surgery, Department of Surgery, University of Rochester, Rochester, New York, USA
| | | | - Marian Moskow
- University of Rochester School of Nursing, Rochester, New York, USA
| | - Elizabeth Anson
- University of Rochester School of Nursing, Rochester, New York, USA
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11
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Gregory T, Monroy NS, Grace B, Finlay-Jones A, Brushe M, Sincovich A, Heritage B, Boulton Z, Brinkman SA. Mental health profiles and academic achievement in Australian school students. J Sch Psychol 2024; 103:101291. [PMID: 38432734 DOI: 10.1016/j.jsp.2024.101291] [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: 10/04/2022] [Revised: 08/12/2023] [Accepted: 01/25/2024] [Indexed: 03/05/2024]
Abstract
This study explored mental health profiles in Australian school students using indicators of well-being (i.e., optimism, life satisfaction, and happiness) and psychological distress (i.e., sadness and worries). The sample included 75,757 students (ages 8-18 years) who completed the 2019 South Australian Wellbeing and Engagement Collection. Latent profile analysis identified five mental health profiles consisting of (a) complete mental health (23%), (b) good mental health (33%), (c) moderate mental health (27%), (d) symptomatic but content (9%), and (e) troubled (8%). Findings provide partial support for the dual-factor model of mental health. Distal outcomes analysis on a sub-set of students (n = 24,466) found students with a symptomatic but content, moderate mental health, or troubled profile had poorer academic achievement than students with complete mental health. Implications for schools and education systems are discussed, including the need to pair clinical supports for students with psychological distress with population-level preventative health approaches to build psychological well-being.
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Affiliation(s)
- Tess Gregory
- Telethon Kids Institute, The University of Western Australia, Ground Floor, 108 North Terrace, Adelaide, South Australia 5000, Australia; School of Public Health, The University of Adelaide, Level 4, 50 Rundle Mall, Rundle Mall Plaza, Adelaide, South Australia 5005, Australia.
| | - Neida Sechague Monroy
- Telethon Kids Institute, The University of Western Australia, Ground Floor, 108 North Terrace, Adelaide, South Australia 5000, Australia
| | - Blair Grace
- Telethon Kids Institute, The University of Western Australia, Ground Floor, 108 North Terrace, Adelaide, South Australia 5000, Australia
| | - Amy Finlay-Jones
- Telethon Kids Institute, The University of Western Australia, Ground Floor, 108 North Terrace, Adelaide, South Australia 5000, Australia
| | - Mary Brushe
- Telethon Kids Institute, The University of Western Australia, Ground Floor, 108 North Terrace, Adelaide, South Australia 5000, Australia
| | - Alanna Sincovich
- Telethon Kids Institute, The University of Western Australia, Ground Floor, 108 North Terrace, Adelaide, South Australia 5000, Australia
| | - Brody Heritage
- Telethon Kids Institute, The University of Western Australia, Ground Floor, 108 North Terrace, Adelaide, South Australia 5000, Australia
| | - Zara Boulton
- Telethon Kids Institute, The University of Western Australia, Ground Floor, 108 North Terrace, Adelaide, South Australia 5000, Australia
| | - Sally A Brinkman
- Telethon Kids Institute, The University of Western Australia, Ground Floor, 108 North Terrace, Adelaide, South Australia 5000, Australia; School of Public Health, The University of Adelaide, Level 4, 50 Rundle Mall, Rundle Mall Plaza, Adelaide, South Australia 5005, Australia
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12
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Servais J, Vanhoutte B, Aguirre-Sánchez-Beato S, Aujoulat I, Kraus C, T'Sjoen G, Tricas-Sauras S, Godin I. Integrating perspectives of transgender and gender-diverse youth, family members, and professionals to support their health and wellbeing - a mixed-method study protocol. Arch Public Health 2024; 82:40. [PMID: 38500212 PMCID: PMC10949725 DOI: 10.1186/s13690-024-01270-z] [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: 12/17/2023] [Accepted: 03/11/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND The current literature highlights a strong link between the poor health outcomes of transgender and gender diverse (TGD) individuals and their negative experiences in various areas of life. Most of these publications rely on adults' memories, lacking a focus on the current experiences and needs of young transgender and gender-diverse individuals. Furthermore, previous studies on support for these young people often solely consider the perspectives of TGD adults or professionals and rarely involve parents' viewpoints. METHODS This study will use a mixed sequential method with a participatory approach. Firstly, the qualitative phase will explore the difficulties and needs of TGD (15-20 years old) and of the families and professionals who support them. Results from this part will be used to develop the questionnaire for the quantitative phase, with the help of a community board. Secondly, based on participatory epidemiological research, the quantitative phase will use an intersectional perspective to measure the impact of individual and structural factors on the quality of life and well-being of transgender and gender-diverse young people. Finally, a co-creation phase will be undertaken to formulate recommendations based on the results of the first two phases. DISCUSSION This research aims at better understanding the influence of gender identity on the quality of life and health of TGD young people and their families and to identify protective and risk factors that affect their vulnerabilities. ETHICS AND DISSEMINATION This study has been approved by the Ethics Committee of the Erasme Faculty Hospital (CCB B4062023000140). As this research is participatory and part of a PhD dissertation, we aim to disseminate the results through our partners' networks and structures locally, and internationally through conferences and peer-reviewed journals.
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Affiliation(s)
- Julie Servais
- School of Public Health, Université Libre de Bruxelles, CP 596, Route de Lennik, 808, Brussels, 1070, Belgium.
| | - Bram Vanhoutte
- School of Public Health, Université Libre de Bruxelles, CP 596, Route de Lennik, 808, Brussels, 1070, Belgium
| | - Sara Aguirre-Sánchez-Beato
- Faculty of Psychology and Education, Université Libre de Bruxelles, CP 122, Avenue F.D. Roosevelt, 50, Brussels, 1050, Belgium
| | - Isabelle Aujoulat
- Health and Society Research Institute - UCLouvain, Clos Chapelle-Aux-Champs 30/B1.30.15, Woluwe-Saint-Lambert, 1200, Belgium
| | - Cynthia Kraus
- Faculty of Social and Political Sciences - UNIL, CH-1015, Lausanne, Switzerland
| | - Guy T'Sjoen
- Faculty of Medicine and Health Sciences, Ghent University Hospital, C. Heymanslaan 10, Ghent, 9000, Belgium
| | - Sandra Tricas-Sauras
- School of Public Health, Université Libre de Bruxelles, CP 596, Route de Lennik, 808, Brussels, 1070, Belgium
| | - Isabelle Godin
- School of Public Health, Université Libre de Bruxelles, CP 596, Route de Lennik, 808, Brussels, 1070, Belgium
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13
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Mezza F, Mezzalira S, Pizzo R, Maldonato NM, Bochicchio V, Scandurra C. Minority stress and mental health in European transgender and gender diverse people: A systematic review of quantitative studies. Clin Psychol Rev 2024; 107:102358. [PMID: 37995435 DOI: 10.1016/j.cpr.2023.102358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 11/08/2023] [Accepted: 11/14/2023] [Indexed: 11/25/2023]
Abstract
The current study aimed at systematically reviewing evidence on the relationships between gender minority stress and mental health outcomes among European transgender and gender diverse (TGD) individuals. A systematic search was conducted in PsycINFO, PubMED, Scopus, and Google Scholar. It was based on Boolean operators to combine terms related to minority stress, TGD identities, and mental health. Thirty studies were identified as eligible. The results confirmed that gender minority stress factors are significantly related with mental health problems among European TGD individuals. Distal stressors were identified as strongly associated with poorer mental health, with gender-related discrimination emerging as the most documented risk factor. The significant role of proximal stressors was also highlighted, with some mediation analyses detecting an indirect effect on mental health. However, identity concealment appeared unrelated to mental health outcomes. Resilience-promoting factors buffering the impact of stressors were also identified, including self-esteem, pride, transitioning, and social support. Conversely, data on community connectedness as a source of resilience were inconclusive. The studies reviewed have several limitations, including lack of longitudinal designs, sampling bias, variability in measurement methods, and unaccounted ethnic variables. Research and clinical recommendations in this field are reported.
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Affiliation(s)
- Fabrizio Mezza
- SInAPSi Center, University of Naples Federico II, Via Giulio Cesare Cortese 29, Napoli 80133, Italy
| | - Selene Mezzalira
- Department of Humanistic Studies, University of Calabria, Via Ponte Bucci Cubo 18/C, Rende 87036, Italy.
| | - Rosa Pizzo
- SInAPSi Center, University of Naples Federico II, Via Giulio Cesare Cortese 29, Napoli 80133, Italy
| | - Nelson Mauro Maldonato
- Department of Neuroscience, Reproductive Sciences, and Dentistry, University of Naples Federico II, Via Sergio Pansini 5, Napoli 80133, Italy.
| | - Vincenzo Bochicchio
- Department of Humanistic Studies, University of Calabria, Via Ponte Bucci Cubo 18/C, Rende 87036, Italy.
| | - Cristiano Scandurra
- Department of Neuroscience, Reproductive Sciences, and Dentistry, University of Naples Federico II, Via Sergio Pansini 5, Napoli 80133, Italy.
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Ceolin C, Scala A, Dall'Agnol M, Ziliotto C, Delbarba A, Facondo P, Citron A, Vescovi B, Pasqualini S, Giannini S, Camozzi V, Cappelli C, Bertocco A, De Rui M, Coin A, Sergi G, Ferlin A, Garolla A. Bone health and body composition in transgender adults before gender-affirming hormonal therapy: data from the COMET study. J Endocrinol Invest 2024; 47:401-410. [PMID: 37450195 PMCID: PMC10859333 DOI: 10.1007/s40618-023-02156-7] [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: 04/28/2023] [Accepted: 07/05/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE Preliminary data suggested that bone mineral density (BMD) in transgender adults before initiating gender-affirming hormone therapy (GAHT) is lower when compared to cisgender controls. In this study, we analyzed bone metabolism in a sample of transgender adults before GAHT, and its possible correlation with biochemical profile, body composition and lifestyle habits (i.e., tobacco smoke and physical activity). METHODS Medical data, smoking habits, phospho-calcic and hormonal blood tests and densitometric parameters were collected in a sample of 125 transgender adults, 78 Assigned Females At Birth (AFAB) and 47 Assigned Males At Birth (AMAB) before GAHT initiation and 146 cisgender controls (57 females and 89 males) matched by sex assigned at birth and age. 55 transgender and 46 cisgender controls also underwent a complete body composition evaluation and assessment of physical activity using the International Physical Activity Questionnaire (IPAQ). RESULTS 14.3% of transgender and 6.2% of cisgender sample, respectively, had z-score values < -2 (p = 0.04). We observed only lower vitamin D values in transgender sample regarding biochemical/hormonal profile. AFAB transgender people had more total fat mass, while AMAB transgender individuals had reduced total lean mass as compared to cisgender people (53.94 ± 7.74 vs 58.38 ± 6.91, p < 0.05). AFAB transgender adults were more likely to be active smokers and tend to spend more time indoor. Fat Mass Index (FMI) was correlated with lumbar and femur BMD both in transgender individuals, while no correlations were found between lean mass parameters and BMD in AMAB transgender people. CONCLUSIONS Body composition and lifestyle factors could contribute to low BMD in transgender adults before GAHT.
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Affiliation(s)
- C Ceolin
- Geriatrics Division, Department of Medicine (DIMED), University of Padua, Padua, Italy.
- Regional Reference Center for Gender Incongruence, Padua, Veneto Region, Italy.
| | - A Scala
- Unit of Andrology and Reproductive Medicine, Department of Medicine (DIMED), University of Padua, Padua, Italy
- Regional Reference Center for Gender Incongruence, Padua, Veneto Region, Italy
| | - M Dall'Agnol
- Geriatrics Division, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - C Ziliotto
- Geriatrics Division, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - A Delbarba
- Unit of Endocrinology and Metabolism, University of Brescia and ASST Spedali Civili, Brescia, Italy
| | - P Facondo
- Unit of Endocrinology and Metabolism, University of Brescia and ASST Spedali Civili, Brescia, Italy
| | - A Citron
- Geriatrics Division, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - B Vescovi
- Unit of Andrology and Reproductive Medicine, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - S Pasqualini
- Unit of Andrology and Reproductive Medicine, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - S Giannini
- Clinica Medica 1, Department of Medicine, University of Padua, Padua, Italy
- Regional Reference Center for Gender Incongruence, Padua, Veneto Region, Italy
| | - V Camozzi
- Endocrinology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy
- Regional Reference Center for Gender Incongruence, Padua, Veneto Region, Italy
| | - C Cappelli
- Unit of Endocrinology and Metabolism, University of Brescia and ASST Spedali Civili, Brescia, Italy
| | - A Bertocco
- Geriatrics Division, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - M De Rui
- Geriatrics Division, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - A Coin
- Geriatrics Division, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - G Sergi
- Geriatrics Division, Department of Medicine (DIMED), University of Padua, Padua, Italy
- Regional Reference Center for Gender Incongruence, Padua, Veneto Region, Italy
| | - A Ferlin
- Unit of Andrology and Reproductive Medicine, Department of Medicine (DIMED), University of Padua, Padua, Italy
- Regional Reference Center for Gender Incongruence, Padua, Veneto Region, Italy
| | - A Garolla
- Unit of Andrology and Reproductive Medicine, Department of Medicine (DIMED), University of Padua, Padua, Italy
- Regional Reference Center for Gender Incongruence, Padua, Veneto Region, Italy
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15
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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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16
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Wang C, Butler G, Szczepanowski MRJ, Betancourt MT, Roberts KC. Physical activity, organized sport participation and active transportation to school among Canadian youth by gender identity and sexual attraction. Health Promot Chronic Dis Prev Can 2024; 44:47-55. [PMID: 38353939 PMCID: PMC11013025 DOI: 10.24095/hpcdp.44.2.02] [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: 02/16/2024]
Abstract
INTRODUCTION Regular physical activity is associated with a wide range of health benefits in youth. While previous studies have identified disparities in physical activity among youth by gender identity and sexual attraction, these have seldom been explored in Canadian youth. METHODS Data from the 2019 Canadian Health Survey on Children and Youth were used to assess prevalence of and time spent in organized sports participation, total physical activity and active transportation by gender identity (non-cisgender vs. cisgender) among youth aged 12 to 17, and by sexual attraction (nonheterosexual attraction vs. heterosexual attraction) among youth aged 15 to 17. RESULTS There was no difference in average minutes of total physical activity per week between non-cisgender and cisgender Canadian youth. Non-cisgender youth (which represent 0.5% of the population) averaged significantly fewer minutes of organized sports per week than their cisgender counterparts. There was some evidence of increased active transportation to school among non-cisgender youth, but insufficient power to detect significant differences. Canadian youth reporting any nonheterosexual attraction (which represent 21.2% of the population, including mostly heterosexual youth) were less likely to be regularly physically active and participate in organized sports than youth reporting exclusive heterosexual attraction. Differences were larger among males than females. Males reporting nonheterosexual attraction were more likely to use active transportation to get to school than their heterosexual counterparts. CONCLUSION Non-cisgender youth and youth reporting nonheterosexual attraction tended to participate less in organized sports than their counterparts, but may have engaged in more active transportation. Mitigating the barriers associated with sport participation could increase physical activity among these groups.
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Affiliation(s)
- Chinchin Wang
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ontario, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Quebec, Canada
- Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Montréal, Quebec, Canada
| | - Gregory Butler
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - McKenna R J Szczepanowski
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ontario, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Marisol T Betancourt
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Karen C Roberts
- Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ontario, Canada
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von der Warth R, Körner M, Farin-Glattacker E. Health literacy of trans and gender diverse individuals -a cross sectional survey in Germany. BMC Public Health 2024; 24:324. [PMID: 38287341 PMCID: PMC10826089 DOI: 10.1186/s12889-024-17823-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 01/19/2024] [Indexed: 01/31/2024] Open
Abstract
INTRODUCTION To date, there has been little research on the general health literacy of trans and gender diverse individuals, even though previous research undermines the importance of good health literacy in this sample. The aim of the article is therefore to describe the general health literacy of trans and gender diverse individuals based on a German survey. METHODS In September 2022, a survey study was conducted in which health literacy was recorded using HLS-EU-16. Data will be presented descriptively; gender differences will be explored using a Χ2- test and a univariate analysis of variance (ANOVA). RESULTS Out of N = 223 participants, n = 129 individuals (57.8%) identified as non-binary; n = 49 (22.0%) identified themselves as male, while n = 45 (20.2%) identified as female. Mean age was 28.03 years. Overall, 26.4% of all the participants showed an inadequate health literacy, as proposed by the HLS-EU-16. In trend, health-related task related to media use were more often perceived as easy compared to the German general population. CONCLUSION Individuals, who identify as trans and gender diverse may have a general health literacy below average compared to the German general population. However, tasks related to media use were perceived as easy, which might be a good starting point for health literacy related interventions. TRIAL REGISTRATION DRKS00026249, Date of registration: 15/03/2022.
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Affiliation(s)
- Rieka von der Warth
- Section of Health Care Research and Rehabilitation Research, Institute of Medical Biometry and Statistics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 49, 79106, Freiburg, Germany.
| | - Mirjam Körner
- Institute of Medical Psychology and Medical Sociology, University of Freiburg, Freiburg, Germany
| | - Erik Farin-Glattacker
- Section of Health Care Research and Rehabilitation Research, Institute of Medical Biometry and Statistics, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 49, 79106, Freiburg, Germany
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Marcus R, Trujillo L, Olansky E, Cha S, Hershow RB, Baugher AR, Sionean C, Lee K. Transgender Women Experiencing Homelessness - National HIV Behavioral Surveillance Among Transgender Women, Seven Urban Areas, United States, 2019-2020. MMWR Suppl 2024; 73:40-50. [PMID: 38261599 PMCID: PMC10826682 DOI: 10.15585/mmwr.su7301a5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024] Open
Abstract
Transgender women experience high prevalence of homelessness, which can affect their likelihood of acquiring HIV infection and can lead to poor medical outcomes. CDC analyzed data from the National HIV Behavioral Surveillance Among Transgender Women to identify whether personal characteristics and social factors affecting transgender women were associated with duration of homelessness during the past 12 months. Longer duration and chronic homelessness might indicate greater unmet needs, which increases their likelihood for acquiring HIV infection. Ordinal logistic regression was conducted to calculate adjusted prevalence odds ratios and 95% CIs for transgender women from seven urban areas in the United States experiencing homelessness 30-365 nights, 1-29 nights, and zero nights during the past 12 months. Among 1,566 transgender women, 9% reported 1-29 nights homeless and 31% reported 30-365 nights homeless during the past 12 months. Among participants who reported physical intimate partner violence or forced sex, 50% and 47%, respectively, reported experiencing 30-365 nights homeless. Furthermore, 55% who had been evicted or denied housing because of their gender identity and 58% who had been incarcerated during the past year experienced 30-365 nights homeless. The odds of transgender women experiencing longer duration of homelessness was associated with being younger and having a disability; higher psychological distress scores were associated with longer duration of homelessness. Analysis of social determinants of health found transgender women experiencing longer homelessness to be less educated, living below the Federal poverty level, and having lower social support. Therefore, focusing on HIV prevention and interventions addressing housing instability to reduce the duration of homelessness among transgender women is important. Further, integrating housing services with behavioral health services and clinical care, specifically designed for transgender women, could reduce HIV acquisition risk and improve HIV infection outcomes.
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Affiliation(s)
| | | | | | | | | | | | | | | | - National HIV Behavioral Surveillance Among Transgender Women Study Group
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, CDC, Atlanta, Georgia; Social & Scientific Systems, Inc., Silver Spring, Maryland
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Herrmann L, Barkmann C, Bindt C, Fahrenkrug S, Breu F, Grebe J, Becker-Hebly I. Binary and Non-binary Gender Identities, Internalizing Problems, and Treatment Wishes Among Adolescents Referred to a Gender Identity Clinic in Germany. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:91-106. [PMID: 37563319 PMCID: PMC10794330 DOI: 10.1007/s10508-023-02674-8] [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: 04/27/2022] [Revised: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 08/12/2023]
Abstract
Clinical research on transgender and gender-nonconforming (TGNC) adolescents has focused on binary individuals or often not differentiated among gender identities. Recent studies suggest that a considerable proportion of TGNC adolescents identify as non-binary and that these youth report more internalizing problems as well as different transition-related medical treatment wishes than binary adolescents. However, the results are inconclusive, and data for the German-speaking area are lacking. Therefore, the present study aimed to assess the percentage of binary and non-binary gender identities in a German sample of clinically referred TGNC adolescents and examine associations of gender identity with internalizing problems and transition-related medical treatment wishes. The sample consisted of 369 adolescents (11-18 years, Mage = 15.43; 305 birth-assigned female, 64 birth-assigned male) who attended the Hamburg Gender Identity Service for children and adolescents (Hamburg GIS) between 2013 and 2019. Gender identity and treatment wishes were assessed using study-specific items and internalizing problems using the Youth Self-Report. In total, 90% (n = 332) of the sample identified as binary and 10% (n = 37) as non-binary. Having a non-binary gender identity was significantly associated with more internalizing problems and with wishing for no transition-related medical treatment or only puberty-suppressing hormones. The results underscore that non-binary adolescents represent a specifically vulnerable subgroup within TGNC adolescents with unique mental health needs and treatment wishes. Future research should differentiate among various gender identities. In clinical practice, it is crucial to create an inclusive space for non-binary youth and provide mental health care if needed.
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Affiliation(s)
- Lena Herrmann
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, W29, 20246, Hamburg, Germany.
| | - Claus Barkmann
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, W29, 20246, Hamburg, Germany
| | - Carola Bindt
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, W29, 20246, Hamburg, Germany
| | - Saskia Fahrenkrug
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, W29, 20246, Hamburg, Germany
| | - Franziska Breu
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, W29, 20246, Hamburg, Germany
| | - Jörn Grebe
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, W29, 20246, Hamburg, Germany
| | - Inga Becker-Hebly
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, W29, 20246, Hamburg, Germany
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20
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Kidd KM, Mitchell K, Sequeira G, Mann MJ, Smith ML, Benton B, Kristjansson AL. Social Support for Rural Gender Diverse Youth Compared to Cisgender Peers. J Adolesc Health 2023; 73:1132-1137. [PMID: 37715765 PMCID: PMC10841152 DOI: 10.1016/j.jadohealth.2023.07.016] [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: 11/20/2022] [Revised: 06/15/2023] [Accepted: 07/07/2023] [Indexed: 09/18/2023]
Abstract
PURPOSE Gender diverse youth (GDY) experience higher rates of mental health concerns than their cisgender peers, but these can be ameliorated by feeling support from family, school, and community. Little is known about how youth perceptions of support vary by gender identity, especially for younger adolescents and those living in rural areas. METHODS Youth ages 12-19 years completed anonymous surveys including measures of perceived support and a two-step gender identity question. GDY (n = 206) were further categorized into binary and nonbinary gender identities. An additional 500 randomly selected cisgender youth were included for comparison. Multivariate analyses of variance with Tukey post hoc tests were employed to test GDY group differences while accounting for the interaction between scaled measures. RESULTS Cisgender youth had the highest perceived support across all support measures while youth who shared both binary and nonbinary aspects of their gender identity had the lowest rates of perceived support. The F tests for between-subject effects were statistically significant (p <.001) for all six support measures, and multivariate group testing was statistically significant with Wilks' λ 6.38(18,1621.17) = 0.82; p <.001. DISCUSSION Despite research demonstrating a strong association between perceived support and improved mental health outcomes, GDY in our sample had lower rates of perceived support at the family, school, and community levels. GDY with both binary and nonbinary gender identities had the lowest levels of perceived support. Further research is needed to see if this finding is consistent in other populations and to develop targeted interventions to improve perceived support for this population.
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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.
| | - Kylerra Mitchell
- West Virginia University School of Medicine, Morgantown, West Virginia
| | - Gina Sequeira
- Department of Pediatrics, Division of Adolescent Medicine, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, Washington
| | - Michael J Mann
- Department of Public Health and Population Science, Boise State University, Boise, Idaho
| | - Megan L Smith
- Department of Public Health and Population Science, Boise State University, Boise, Idaho
| | - Brandon Benton
- West Virginia University School of Medicine, Morgantown, West Virginia
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21
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Nayar KR, Vinu S, Bhat LD, Kandaswamy S. Right Versus Wrong: A Qualitative Appraisal With Respect to Pandemic Trajectories of Transgender Population in Kerala, India. JOURNAL OF BIOETHICAL INQUIRY 2023; 20:639-646. [PMID: 38150121 DOI: 10.1007/s11673-023-10290-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 07/20/2023] [Indexed: 12/28/2023]
Abstract
The transgender population generally faces rights violations and discrimination in their day-to-day lives, which was exacerbated during the recent pandemic. This necessitates close scrutiny from an ethics perspective. Following directives from a 2014 Supreme Court judgement, Kerala became the first Indian state to implement a comprehensive policy to enforce the constitutional rights of transgender people. Despite such positive actions, a basic social tendency not to respect gender diversity has led to discrimination and marginalization. This was very evident during the pandemic. In this empirical work, we have documented the lives of the transgender community during the pandemic wherein they share experiences related to livelihood, interaction with the healthcare system, and acceptance in society vis-à-vis the pandemic. Simply providing third-gender status will not help the gender-marginalized community to grow to their fullest potential and have a better lifestyle on par with others in mainstream society.
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Affiliation(s)
| | - S Vinu
- Global Institute of Public Health, Trivandrum, 695024, India
| | - Lekha D Bhat
- Department of Epidemiology and Public Health, Central University of Tamil Nadu, Thiruvarur, 610005, India.
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22
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Castellanos-López I, González-Rodríguez LG, Bermejo LM, Cuadrado-Soto E, López-Sobaler AM. [Nutritional problems in cis and trans women]. NUTR HOSP 2023; 40:33-36. [PMID: 37929906 DOI: 10.20960/nh.04952] [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: 11/07/2023] Open
Abstract
Introduction Women deserve special attention due to the different requirements they have in comparison with men. In the same way, transgender women need individualized attention. Transgender women are at greater risk of suffering heart attacks or ischemic accidents, among other diseases, and are also at greater risk of developing eating disorders, poorer weight control and poorer perception of their image. Hormone therapy for gender reaffirmation in trans women modifies their body composition, and may also increase the risk of suffering from some pathologies. The nutritional needs of cisgender women are different from those of men, and trans women also have special needs, which may depend on whether or not they follow hormone therapy. Dietary studies, although scarce, suggest that transgender women have poor dietary habits and lifestyle. It is necessary to deepen the study of the nutritional situation of the female group, considering its diversity, and to develop standards and references appropriate to each case that allow better attention to the needs of these groups.
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Affiliation(s)
- Isabel Castellanos-López
- Departamento de Nutrición y Ciencia de los Alimentos. Facultad de Farmacia. Universidad Complutense de Madrid
| | | | - Laura M Bermejo
- Departamento de Nutrición y Ciencia de los Alimentos. Facultad de Farmacia. Universidad Complutense de Madrid. Grupo de Investigación VALORNUT-UCM (920030). IdISSC
| | | | - Ana M López-Sobaler
- Departamento de Nutrición y Ciencia de los Alimentos. Facultad de Farmacia. Universidad Complutense de Madrid. Grupo de Investigación VALORNUT-UCM (920030). IdISSC
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23
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Skuban-Eiseler T, Orzechowski M, Steger F. Why do transgender individuals experience discrimination in healthcare and thereby limited access to healthcare? An interview study exploring the perspective of German transgender individuals. Int J Equity Health 2023; 22:211. [PMID: 37817187 PMCID: PMC10566060 DOI: 10.1186/s12939-023-02023-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 09/25/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND Transgender individuals experience limited access to healthcare. This results not least from experiences of discrimination to which they are exposed in the health system. These contribute to transgender individuals having poorer health than cis individuals, i.e. individuals whose sex assigned at birth is in line with their gender identity. It is an ethical duty to take effective measures to minimize inequalities in medical care. At best, such measures should also be assessed as appropriate from the perspective of those affected in order to be accepted and thus effective. It is therefore important to know whether measures touch on the subjectively assumed reasons for experiences of discrimination. Hence, to be able to take appropriate measures, it is important to identify the reasons that transgender individuals see as causal for their experiences of discrimination in healthcare. METHODS We conducted semi-structured interviews with 14 German transgender individuals and asked them about their own experiences of discrimination in healthcare and their assumptions on the reasons for discrimination. We analyzed the responses using the method of structured qualitative content analysis. RESULTS 13 transgender individuals reported experiences of discrimination in healthcare. These emanated from different professional groups and took place in trans-specific as well as general medical settings. We were able to identify a total of 12 reasons that transgender individuals see as causal for their experiences of discrimination: (1) internalized trans-hostility and "protection" of cis individuals, (2) lack of knowledge/uncertainties regarding transition, (3) "protection" of a binary worldview, (4) binary worldview in medicine, (5) structural deficits, (6) asymmetric interactions with specialists, (7) current political debate, (8) view of transgender individuals as a "burden for society", (9) objectification, (10) homophobia, (11) misogyny/androcentrism and (12) discrimination as reaction to discrimination. CONCLUSIONS German transgender individuals have a very differentiated picture regarding their subjective reasons for experiencing discrimination in healthcare. Overall, disrespect regarding gender identity and a confrontation with foreignness seems to be seen as the decisive factor. Thus, it is not enough to focus only on measures that aim to remedy the information deficit on the part of medical providers. Measures must be taken that can create a granting and respectful attitude towards transgender individuals.
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Affiliation(s)
- Tobias Skuban-Eiseler
- Institute of the History, Philosophy and Ethics of Medicine, Faculty of Medicine, Ulm University, Ulm, Germany.
- kbo-Isar-Amper-Klinikum Region München, München-Haar, Germany.
| | - Marcin Orzechowski
- Institute of the History, Philosophy and Ethics of Medicine, Faculty of Medicine, Ulm University, Ulm, Germany
| | - Florian Steger
- Institute of the History, Philosophy and Ethics of Medicine, Faculty of Medicine, Ulm University, Ulm, Germany
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24
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Gibbs V, Hudson J, Pellicano E. The Extent and Nature of Autistic People's Violence Experiences During Adulthood: A Cross-sectional Study of Victimisation. J Autism Dev Disord 2023; 53:3509-3524. [PMID: 35821545 PMCID: PMC10465381 DOI: 10.1007/s10803-022-05647-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2022] [Indexed: 10/17/2022]
Abstract
This study investigated the extent and nature of violence experiences reported by autistic adults. Autistic (n = 118) and non-autistic (n = 110) adults completed a questionnaire about their experiences of sexual harassment, stalking and harassment, sexual violence and physical violence since the age of 15. Autistic adults reported higher rates of all violence types, multiple forms of violence and repeated instances of the same type of violence. Typical gender differences in the patterns of violence (more physical violence reported by men and more sexual violence reported by women) were apparent in the non-autistic but not the autistic group. Findings add to the limited research in this area and highlight the need to identify risk and protective factors. Policy and practice implications are also discussed.
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Affiliation(s)
- Vicki Gibbs
- Macquarie School of Education, Macquarie University, Sydney, Australia.
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25
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Cascalheira CJ, Nelson J, Flinn RE, Zhao Y, Helminen EC, Scheer JR, Stone AL. High-risk polysubstance use among LGBTQ+ people who use drugs in the United States: An application of syndemic theory. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 118:104103. [PMID: 37413908 PMCID: PMC10528101 DOI: 10.1016/j.drugpo.2023.104103] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 04/16/2023] [Accepted: 06/13/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND Compared to heterosexual and cisgender people, lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) people are more likely to develop problems with high-risk polysubstance use. According to syndemic theory, this disparity in high-risk polysubstance use is produced by the LGBTQ+ community's increased vulnerability to experiencing psychosocial (e.g., discrimination, unwanted sex) and structural (e.g., food insecurity, homelessness) conditions, greater likelihood of coping with concurrent health problems (e.g., human immunodeficiency virus [HIV]), and decreased opportunities to develop protective factors (e.g., social support, resilience). METHODS Data from 306 LGBTQ+ participants living in the United States (U.S.) with a lifetime history of alcohol and drug use were analyzed; 21.2% reported lifetime problems with 10 different drugs. Bootstrapped hierarchical multiple regression was used to test demographic correlates and syndemic predictors of high-risk polysubstance use. One-way ANOVA and post-hoc comparison tests were used to test subgroup differences by gender. RESULTS Results indicated that income, food insecurity, sexual orientation-based discrimination, and social support were associated with high-risk polysubstance use, explaining 43.9% of the variance of high-risk polysubstance use. Age, race, unwanted sex, gender identity-based discrimination, and resilience were not significant. Group comparison tests revealed that, compared to nonbinary people and cisgender sexual minority men and women, transgender individuals experienced significantly higher levels of high-risk polysubstance use and sexual orientation-based discrimination but significantly lower levels of homelessness and social support. CONCLUSION This study provided further evidence for conceptualizing polysubstance use as an adverse outcome of syndemic conditions. Harm reduction strategies, anti-discrimination laws, and gender-affirming residential treatment options should be considered in U.S. drug policy. Clinical implications include targeting syndemic conditions to reduce high-risk polysubstance use among LGBTQ+ people who use drugs.
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Affiliation(s)
- Cory J Cascalheira
- Department of Counseling and Educational Psychology, New Mexico State University, Las Cruces, NM, USA; Department of Psychology, Syracuse University, Syracuse, NY, USA.
| | - Jessie Nelson
- Department of Counseling and Educational Psychology, New Mexico State University, Las Cruces, NM, USA
| | - Ryan E Flinn
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Yuxuan Zhao
- Department of Counseling and Educational Psychology, New Mexico State University, Las Cruces, NM, USA
| | - Emily C Helminen
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Jillian R Scheer
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Amy L Stone
- Department of Sociology and Anthropology, Trinity University, San Antonio, TX, USA
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26
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Kidd JD, Tettamanti NA, Kaczmarkiewicz R, Corbeil TE, Dworkin JD, Jackman KB, Hughes TL, Bockting WO, Meyer IH. Prevalence of substance use and mental health problems among transgender and cisgender U.S. adults: Results from a national probability sample. Psychiatry Res 2023; 326:115339. [PMID: 37429172 PMCID: PMC10528335 DOI: 10.1016/j.psychres.2023.115339] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/30/2023] [Accepted: 07/06/2023] [Indexed: 07/12/2023]
Abstract
Transgender individuals experience numerous health disparities relative to cisgender individuals. However, most transgender-health studies have focused on convenience samples with limited generalizability. This study utilized data from the 2016-2018 TransPop Study, the first national probability sample of transgender adults (n=274) with a cisgender comparison sample (n=1162). Using multivariable logistic regression, adjusted for demographics, we compared the prevalence of hazardous drinking, problematic drug use, serious psychological distress, suicidality, and non-suicidal self-injury between transgender and cisgender individuals and among transgender men (n=78), transgender women (n=120), and transgender nonbinary individuals (n=76). Among transgender individuals, 28.2% (95%CI 21.2-35.2) and 31.2% (95%CI 23.8-38.7) reported hazardous drinking and problematic drug use, respectively; 44.4% (95% CI 35.8-53.0) reported recent suicidal ideation, 6.9% (95% CI 2.3-11.5) reported a recent suicide attempt, and 21.4% (95% CI 14.5%-28.4%) reported recent non-suicidal self-injury. In their lifetime, 81.3% (95%CI 75.1-87.5) of transgender respondents had suicidal ideation, 42.0% (95%CI 34.2-49.8) had attempted suicide, and 56.0% (95% CI 48.2-63.8) reported non-suicidal self-injury. Most (81.5%; 95%CI 75.5-87.5) had utilized formal mental health care and 25.5% (95%CI 18.5-32.4) had sought informal mental health support. There were no differences in alcohol or drug-use outcomes between transgender and cisgender adults. Compared to cisgender adults, transgender adults had higher odds of serious psychological distress (aOR=3.1; 95%CI 1.7-5.7), suicidal ideation (recent: aOR=5.1, 95%CI 2.7-9.6); lifetime: aOR=6.7, 95%CI 3.8-11.7), lifetime suicide attempts (aOR=4.4, 95%CI 2.4-8.0), and non-suicidal self-injury (recent: aOR=13.0, 95%CI 4.8-35.1); lifetime: aOR=7.6, 95%CI 4.1-14.3). Transgender nonbinary adults had the highest odds for all outcomes, including substance use outcomes. Findings from these national probability samples support those of earlier convenience-sample studies showing mental health disparities among transgender adults relative to cisgender adults, with nonbinary individuals at highest risk. These findings also highlight variations in risk across sub-groups of transgender individuals.
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Affiliation(s)
- Jeremy D Kidd
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA.
| | | | | | | | - Jordan D Dworkin
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA
| | - Kasey B Jackman
- Columbia University School of Nursing, New York, NY, USA; New York Presbyterian Hospital, New York, NY, USA
| | - Tonda L Hughes
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA; Columbia University School of Nursing, New York, NY, USA
| | - Walter O Bockting
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA; New York State Psychiatric Institute, New York, NY, USA; Columbia University School of Nursing, New York, NY, USA
| | - Ilan H Meyer
- Williams Institute for Sexual Orientation Law and Public Policy, University of California - Los Angeles, Los Angeles, CA, USA
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27
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Kinney MK, Victor BG, Fortenberry JD. Conceptualizations of wellbeing among nonbinary individuals in the Midwestern United States: a photovoice study. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2023; 25:483-503. [PMID: 39055637 PMCID: PMC11268229 DOI: 10.1080/26895269.2023.2232351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
Background: Traditionally, gender has been viewed through an essentialist lens with fixed biology-based traits or polarized gender norms between women and men. As awareness of gender diversity grows, increasingly more people are coming out as nonbinary - or not exclusively a man or woman. Little has been explored regarding experiences unique to nonbinary individuals, particularly beyond a focus on adverse risks and outcomes to understand their wellbeing. This article discusses gendered experiences and the construction of wellbeing among nonbinary individuals. Aim: The purpose of this study was to conceptualize wellbeing as a complex multidimensional phenomenon through nonbinary individuals' perspectives. Methods: A virtual PhotoVoice study was conducted with 17 nonbinary adults in the Midwestern United States who participated in online group discussions and in-depth semi-structured interviews, which were analyzed with thematic analysis. Results: The analysis identified five core dimensions of nonbinary wellbeing: 1) Security, 2) Mental and physical health, 3) Autonomy, 4) Belonging, and 5) Gender positivity. Exemplary definitions of wellbeing are also presented. Discussion: Understanding how nonbinary individuals thrive challenges the framing of gender diverse experiences in adversity and presents a more holistic portrayal that community members and allies can strive toward. This study contributes an intersectional understanding of wellbeing in relation to identities of race, culture, age, disability, neurodiversity, and sociopolitical geographical context. The findings of this study can aid in practice, advocacy, and research to bolster the wellbeing of nonbinary people.
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Affiliation(s)
- M. Killian Kinney
- Claire Argow Social Work Program, Pacific University, Forest Grove, Oregon, USA
| | - Bryan G. Victor
- School of Social Work, Wayne State University, Detroit, Michigan, USA
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28
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Martin D, Lynch S, Becker TD, Shanker P, Staudenmaier P, Leong A, Rice T. Difference in Psychiatric Hospital Admissions Between Cisgender and Transgender and Gender Nonconforming Youth, Before and During the Start of the COVID-19 Pandemic. Child Psychiatry Hum Dev 2023:10.1007/s10578-023-01571-4. [PMID: 37464154 DOI: 10.1007/s10578-023-01571-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/07/2023] [Indexed: 07/20/2023]
Abstract
This retrospective study of 1101 children and adolescents examines differences in psychiatric admissions between cisgender and transgender/gender nonconforming (TGNC) youth between June 2018 and November 2021. Sociodemographic and clinical characteristics for each admission were extracted from medical records. We compared proportion of total admissions and clinical characteristics between cisgender and TGNC youth, during specified time frames of pre-COVID-19, during quarantine, and post-quarantine. During quarantine, 294 (89.9%) youth identified as cisgender and 33 (10.1%) youth identified as TGNC. Post-quarantine, 205 (88.4%) youth identified as cisgender and 27 (11.6%) identified as TGNC. TGNC patients had more history of mood disorders (p < 0.001), self-injurious behavior (p < 0.001), and suicide attempt (p = 0.007), whereas cisgender patients had more history of Attention-deficit/Hyperactivity Disorder (ADHD) (p = 0.011) and violence (p < 0.001) across each time frame of the study. TGNC patients were more likely to be admitted due to suicidal ideation (p = 0.003), whereas cisgender patients were more often admitted for aggression (p < 0.001). There was no change across COVID-19 time periods in terms of any psychiatric history variable among patients identifying as TGNC. The proportion of admitted youth identifying as TGNC increased by 8.1% from pre-COVID-19 to post-quarantine (p < 0.001). These findings suggest that TGNC youth might be particularly vulnerable to mental health crises when faced with pandemic-related stressors. Further research on the vulnerabilities of TGNC youth during sudden and extreme social changes and how this can impact their mental health is necessary, as global pandemics could and are anticipated to repeat.
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Affiliation(s)
- Dalton Martin
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, Mount Sinai Morningside, New York, NY, USA.
| | - Sean Lynch
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY, USA
| | - Timothy D Becker
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, NY, USA
- Department of Psychiatry, New York-Presbyterian Hospital, New York, NY, USA
| | - Parul Shanker
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY, USA
| | - Paige Staudenmaier
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY, USA
| | - Alicia Leong
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Timothy Rice
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, Mount Sinai Morningside, New York, NY, USA
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29
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Coyne SM, Weinstein E, Sheppard JA, James S, Gale M, Van Alfen M, Ririe N, Monson C, Ashby S, Weston A, Banks K. Analysis of Social Media Use, Mental Health, and Gender Identity Among US Youths. JAMA Netw Open 2023; 6:e2324389. [PMID: 37486631 PMCID: PMC10366700 DOI: 10.1001/jamanetworkopen.2023.24389] [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: 07/25/2023] Open
Abstract
Importance Mental health among children and adolescents is a critical public health issue, and transgender and gender nonbinary youths are at an even greater risk. Social media has been consistently associated with youth mental health, but little is known about how gender identity interacts with this association. Objective To use a risk and resilience approach to examine the association between social media use and mental health among transgender, gender nonbinary, and cisgender youths. Design, Setting, and Participants This cross-sectional study analyzed data collected from an online survey between May and August 2021. Participants included a random sample of US youths; eligibility requirements included being aged 10 to 17 years and residing in the US. Statistical analysis was performed from February to April 2022. Main Outcomes and Measures Social media use (time, type of use, favorite site, social comparisons, mindfulness, taking intentional breaks, cleaning and curating feeds, problematic use, and media literacy programs at their school) and mental health (depression, emotional problems, conduct problems, and body image) as main outcomes. Results Participants included 1231 youths aged 10 to 17 years from a national quota sample from the United States; 675 (54.8%) identified as cisgender female, 479 (38.9%) as cisgender male, and 77 (6.3%) as transgender, gender nonbinary, or other; 4 (0.3%) identified as American Indian or Alaska Native, 111 (9.0%) as Asian, 185 (15.0%) as Black, 186 (15.1%) as Hispanic or Latinx, 1 (0.1%) as Pacific Islander, 703 (57.1%) as White, and 41 (3.3%) as mixed and/or another race or ethnicity. Gender identity moderated both the strength and the direction of multiple associations between social media practices and mental health: active social media use (eg, emotional problems: B = 1.82; 95% CI, 0.16 to 3.49; P = .03), cleaning and/or curating social media feeds (eg, depression: B = -0.91; 95% CI, -1.98 to -0.09; P = .03), and taking intentional breaks (eg, depression: B = 1.03; 95% CI, 0.14 to 1.92; P = .02). Conclusions and Relevance In this cross-sectional study of gender identity, social media, and mental health, gender identity was associated with youths' experiences of social media in ways that may have distinct implications for mental health. These results suggest that research about social media effects on youths should attend to gender identity; directing children and adolescents to spend less time on social media may backfire for those transgender and gender nonbinary youths who are intentional about creating safe spaces on social media that may not exist in their offline world.
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Affiliation(s)
- Sarah M Coyne
- School of Family Life, Brigham Young University, Provo, Utah
| | - Emily Weinstein
- Harvard Graduate School of Education, Cambridge, Massachusetts
| | | | - Spencer James
- School of Family Life, Brigham Young University, Provo, Utah
| | - Megan Gale
- School of Family Life, Brigham Young University, Provo, Utah
| | - Megan Van Alfen
- School of Family Life, Brigham Young University, Provo, Utah
| | - Nora Ririe
- School of Family Life, Brigham Young University, Provo, Utah
| | - Cameron Monson
- School of Family Life, Brigham Young University, Provo, Utah
| | - Sarah Ashby
- School of Family Life, Brigham Young University, Provo, Utah
| | - Allison Weston
- School of Family Life, Brigham Young University, Provo, Utah
| | - Kennedy Banks
- School of Family Life, Brigham Young University, Provo, Utah
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Holland MR, Kahlor LA. A Google Trends Analysis of Interest in Nonbinary Identities. CYBERPSYCHOLOGY, BEHAVIOR AND SOCIAL NETWORKING 2023. [PMID: 37140556 DOI: 10.1089/cyber.2022.0304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Emerging research on stigma suggests that society's mistreatment of nonbinary individuals can, in part, be attributed to public uncertainty and a lack of knowledge about nonbinary identities. In response to this, this study drew upon the theoretical framework of uncertainty management to explore research questions related to nonbinary identity and information behaviors by investigating uncertainty management as evidenced by longitudinal Google Trends data related to nonbinary gender identities. If individuals were found to be engaging in information seeking, the result of this behavior may be that they become less likely to hold stigmatizing attitudes toward nonbinary people, and ultimately be less likely to engage in discrimination toward them. Results indicated that indeed there has been an increase in search volume interest related to nonbinary identities in the past decade. The study concludes by presenting the need for further research to clarify the nature of the relationship between stigma and information seeking, as well as presenting a quandary for researchers regarding the desire for more detailed demographic data, as balanced with concerns for privacy.
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Affiliation(s)
- Madeleine R Holland
- Department of Communication Studies, The University of Texas at Austin, Austin, Texas, USA
| | - Lee Ann Kahlor
- School of Advertising and Public Relations, The University of Texas at Austin, Austin, Texas, USA
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Anderson KG, Garrison E, Clifton RL, Harper L, Zapolski TCB, Khazvand S, Carson I. Measures of self-reported identity associated with sex and gender: Relations with collegiate drinking. Alcohol Clin Exp Res 2023; 47:501-511. [PMID: 36930036 DOI: 10.1111/acer.15013] [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: 06/27/2022] [Revised: 12/24/2022] [Accepted: 12/31/2022] [Indexed: 03/18/2023]
Abstract
OBJECTIVE Quantitative research has typically relied on categorical measures of sex assigned at birth (SAAB) and gender, with heterogeneous findings in terms of their associations with alcohol-related behavior. This investigation examined continuous indices of self-identification as an alternative to categorical operationalizations in alcohol research. METHOD Eight hundred ninety-three undergraduate students (74.6% cisgender women, 20.3% cisgender men, 3.9% nonbinary, and 1.2% transgender), recruited from the Midwest and Pacific Northwest of the United States, completed online measures of SAAB (male/female), gender (categorical), continuous indices of identification (femaleness, maleness, and bidirectional), and alcohol consumption (Cahalan Indices; Daily Drinking Questionnaire-Revised; Alcohol Use Disorders Identification Test [AUDIT]). RESULTS Novel continuous measures of identification were associated with categorical indices of SAAB and gender as predicted. While none of the self-identification indices (continuous or categorical) predicted current drinking (consumption in the past 30 days), they evidenced relatively consistent, albeit small effects, across quantity-frequency of drinking and AUDIT scores for current drinkers. Higher scores on maleness and bidirectional indices of identification were associated with greater consumption, while greater endorsement of femaleness and being a cisgender woman (vs. a cisgender man) were related to less drinking. CONCLUSIONS Continuous self-reported identification items performed well when describing drinking behavior in college students. The inclusion of dimensional scales of identity broadens our ability to capture differing self-conceptualizations in research.
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Affiliation(s)
| | - Elise Garrison
- Department of Psychology, Reed College, Portland, Oregon, USA
| | - Richelle L Clifton
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA
| | - Leia Harper
- Department of Psychology, Reed College, Portland, Oregon, USA
| | - Tamika C B Zapolski
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA
| | - Shirin Khazvand
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA
| | - Ian Carson
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA
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32
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Jadva V, Guasp A, Bradlow JH, Bower-Brown S, Foley S. Predictors of self-harm and suicide in LGBT youth: The role of gender, socio-economic status, bullying and school experience. J Public Health (Oxf) 2023; 45:102-108. [PMID: 34850220 PMCID: PMC10017085 DOI: 10.1093/pubmed/fdab383] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 08/12/2021] [Accepted: 09/20/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Lesbian, gay and bisexual (LGB) young people's increased risk of self-harm, suicidal attempts and suicide compared with heterosexual youth is well established. The current study sought to examine whether these findings also apply to the trans (T) population and which factors act as additional risk or protective factors. METHODS In a national cross-sectional survey, 3713 LGBT adolescents, aged 11-19 years, reported on their own history of self-harm, suicidal ideation and suicide attempts, as well as their experiences of school and homophobic, biphobic and transphobic bullying. Logistic regressions tested the association between risk and protective factors on self-harm, suicidal ideation and suicide attempts. RESULTS A high proportion of the sample reported self-harm (65.3%), suicidal ideation (73.8%) and suicide attempts (25.7%). Demographic risk factors included identifying as female, non-binary or trans and being from a low-income background. Bullying and online bullying were associated with an increased risk for each outcome, and positive school experience was associated with a reduced risk for each outcome. CONCLUSIONS Consistent with minority stress theory, the study found high rates of mental health problems within LGBT youth. Interventions focused on improving young people's experiences in schools appear useful targets to help improve mental health outcomes.
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Affiliation(s)
- V Jadva
- Address correspondence to V. Jadva, E-mail:
| | - A Guasp
- Stonewall, 192 St John St EC1V 4JY, UK
| | | | - S Bower-Brown
- Centre for Family Research, University of Cambridge, Free School Lane, Cambridge CB2 3RQ, UK
| | - S Foley
- Moray House School of Education and Sport, University of Edinburgh, Edinburgh, UK
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London-Nadeau K, Chadi N, Taylor AB, Chan A, Pullen Sansfaçon A, Chiniara L, Lefebvre C, Saewyc EM. Social Support and Mental Health Among Transgender and Nonbinary Youth in Quebec. LGBT Health 2023; 10:306-314. [PMID: 36787477 DOI: 10.1089/lgbt.2022.0156] [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: 02/16/2023] Open
Abstract
Purpose: Transgender and nonbinary (TNB) youth face elevated levels of discrimination, stigma, mental health disorders, and suicidality when compared with their cisgender counterparts. Family and school support may mitigate some of the effects of the stressors facing TNB youth. This study aimed to better understand the impact of each of these sources of support on TNB youths' mental health and wellbeing. Methods: We used data collected between 2018 and 2019 as part of the Canadian Trans Youth Health Survey, a bilingual online survey to measure social support, physical health, and mental health in a sample of 220 TNB youth aged 14-25 living in Québec, Canada. We examined the relationships among different sources of support, and mental health and wellbeing outcomes using logistic regression. Analyses were conducted on the full sample and according to linguistic groups (French and English). Results: Participants reported high levels of mental health symptoms, self-harm, and suicidality, and mental health symptoms were higher in the English-speaking group (p = 0.005). In models controlling for age, family connectedness was associated with good/excellent self-reported mental health (odds ratio [OR] = 2.62, p = 0.001) and lower odds of having considered suicide (OR = 0.49, p = 0.003) or attempted suicide (OR = 0.43, p = 0.002), whereas school connectedness was associated with higher odds of good/very good/excellent general (OR = 2.42, p = 0.013) and good/excellent mental (OR = 2.45, p = 0.045) health. Conclusion: Family and school support present consistent associations with TNB youths' health and may constitute key areas for intervention for those supporting them.
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Affiliation(s)
- Kira London-Nadeau
- Department of Psychology, Université de Montréal, Montréal, Québec, Canada.,CHU Sainte-Justine Research Center, Montréal, Québec, Canada
| | - Nicholas Chadi
- CHU Sainte-Justine Research Center, Montréal, Québec, Canada.,Division of General Pediatrics, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, Québec, Canada.,Division of Adolescent Medicine, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
| | - Ashley B Taylor
- Stigma and Resilience Among Vulnerable Youth Centre, School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ace Chan
- Stigma and Resilience Among Vulnerable Youth Centre, School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Annie Pullen Sansfaçon
- Canada Research Chair on Transgender Children and their Families, School of Social Work, Université de Montréal, Montréal, Québec, Canada.,School of Social Work, Stellenbosch University, Stellenbosch, South Africa
| | - Lyne Chiniara
- Division of Endocrinology, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
| | - Claire Lefebvre
- Division of General Pediatrics, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
| | - Elizabeth M Saewyc
- Stigma and Resilience Among Vulnerable Youth Centre, School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
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Hodax JK, DiVall S. Gender-affirming endocrine care for youth with a nonbinary gender identity. Ther Adv Endocrinol Metab 2023; 14:20420188231160405. [PMID: 37006780 PMCID: PMC10064168 DOI: 10.1177/20420188231160405] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 02/11/2023] [Indexed: 04/04/2023] Open
Abstract
Nonbinary individuals, or those who identify outside of the traditional gender binary, are currently present in up to 9% of the general population of youth or up to 55% of gender-diverse youth. Despite the high numbers of nonbinary individuals, this population continues to experience barriers to healthcare due to providers' inability to see beyond the transgender binary and lack of competence in providing nonbinary care. In this narrative review, we discuss using embodiment goals to individualize care of nonbinary individuals, and review hormonal and nonhormonal treatment options for gender affirmation. Hormonal treatments include those often used in binary transgender individuals, such as testosterone, estradiol, and anti-androgens, but with adjustments to dosing or timeline to best meet a nonbinary individual's embodiment goals. Less commonly used medications such as selective estrogen receptor antagonists are also discussed. For nonhormonal options, alterations in gender expression such as chest binding, tucking and packing genitalia, and voice training may be beneficial, as well as gender-affirming surgeries. Many of these treatments lack research specific to nonbinary individuals and especially nonbinary youth, and future research is needed to ensure safety and efficacy of gender-affirming care in this population.
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Sports Medicine Physicians Comfort and Competence in Caring for Transgender and Gender Nonconforming Patients and Athletes. Clin J Sport Med 2023; 33:33-44. [PMID: 36111996 DOI: 10.1097/jsm.0000000000001067] [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: 02/21/2022] [Accepted: 07/29/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The purpose of this study was to explore primary care sports medicine physicians' comfort, competence, education, and scope of training in caring for transgender and gender nonconforming (TGNC) patients/athletes. DESIGN Mixed-methods, cross-sectional survey. SETTING Online. PATIENTS OR PARTICIPANTS In total, 4300 e-mails were successfully sent with 252 eligible responses received from the American Medical Society for Sports Medicine members. INDEPENDENT VARIABLES Previous relationships with TGNC persons; previous relationships with TGNC patients/athletes; frequency of care for TGNC patients/athletes. MAIN OUTCOME MEASURES The participants completed a 38-item tool used to assess perceived comfort and competence treating TGNC patients/athletes. Physicians defined "transgender" and described their thoughts on unfair competitive advantage of transgender athletes. RESULTS Most participants had worked with a TGNC patient (70.2%, n = 177), but far fewer worked with a TGNC athlete (n = 26.6%, n = 67). Among the participants who provided a definition of transgender (n = 183), only 28.4% (n = 52) of participants were able to correctly define the term, whereas most were able to partially (57.9%, n = 106) characterize the term. The most common mechanisms identified for learning about TGNC patients were reading peer-reviewed journal articles (44.8%, n = 113) and CME (41.3%, n = 104). Those with previous TGNC friend/family, patient, and athlete relationships had a significantly different level of comfort and competence treating TGNC patients/athletes. CONCLUSIONS Previous care relationships with TGNC strongly influences comfort and perceived competence of primary care sports medicine physicians. Training, from unbiased peer-reviewed sources of data, is critical to improve care for TGNC patients/athletes.
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Johansson C, Kullgren C, Bador K, Kerekes N. Gender non-binary adolescents' somatic and mental health throughout 2020. Front Psychol 2022; 13:993568. [PMID: 36619033 PMCID: PMC9816129 DOI: 10.3389/fpsyg.2022.993568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022] Open
Abstract
Background Non-binary gender adolescents are particularly vulnerable and more likely to be exposed to several socio-psychological difficulties and disorders. It is vital to discover and act on the vulnerabilities they encounter. The present study aims to describe the somatic and mental health, affect state, frequency of risk behaviors, victimization and negative psychosocial factors, as well as the personality profiles of non-binary adolescents. In this study the concept of gender non-binary is used and captured respondents who selected "neither of these" as their gender from the possible options (female/male/neither of these). Materials and methods Data was collected between September 2020 and February 2021 in Sweden, Morocco, Serbia, Vietnam, and the United States. The cross-sectional, retrospective study utilized the electronic version of the Mental and Somatic Health without borders (MeSHe) survey. From the over 5,000 responses of 15-19-year-old adolescents, 58 respondents identified as being non-binary, and built our study population. Their data was analyzed with descriptive statistic methods. Results Close to a fourth of adolescents identifying as non-binary reported the existence of at least one somatic disease. The most prevalent somatic disease was allergies. Almost one-third had suffered from pain either often or all the time in the past 12 months. The highest levels of perceived psychological distress were measured using obsessive-compulsive symptoms, depression, and interpersonal sensitivity. The average level of alcohol and drug use during the past 12 months was low. About 40% of non-binary adolescents reported having experienced physical abuse, and half of them experienced psychological abuse at some point in their lives. Seventeen percent reported living with adults with alcohol-use problems. Non-binary adolescents' personalities were found to be dominated by high scores in Openness, Neuroticism, and Agreeableness. Conclusion This study presents a detailed biopsychosocial picture of a multinational sample of non-binary adolescents. Our study suggests that awareness and support are required from all fields of society, including family, school, healthcare, and educational institutions, for cis-normative culture to progress toward a greater understanding of and respect for gender diversity.
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Affiliation(s)
- Catrin Johansson
- Department of Health Sciences, University West, Trollhättan, Sweden
| | - Carina Kullgren
- Department of Health Sciences, University West, Trollhättan, Sweden
| | - Kourosh Bador
- Agera KBT AB, Gothenburg, Sweden,Center for Holistic Psychiatry Research (CHoPy), Mölndal, Sweden
| | - Nóra Kerekes
- Department of Health Sciences, University West, Trollhättan, Sweden,Center for Holistic Psychiatry Research (CHoPy), Mölndal, Sweden,*Correspondence: Nóra Kerekes,
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Fish JN, Russell ST. The paradox of progress for sexual and gender diverse youth. Curr Opin Psychol 2022; 48:101498. [PMID: 36401907 DOI: 10.1016/j.copsyc.2022.101498] [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: 07/28/2022] [Revised: 09/27/2022] [Accepted: 10/18/2022] [Indexed: 01/28/2023]
Abstract
In this essay, we explore diversity in sexual and gender identities, with a focus on implications of the current politicized moment for lesbian, gay, bisexual, transgender, queer, or questioning youth. As youth come out at younger ages, their personal identity development collides with the adolescence period characterized by peer influence, stigma, and possible victimization. We consider the changing and diverse experiences of coming out in adolescence for sexual and gender diverse youth. The current social and political moment offers possibilities for new identities, yet anti-LGBTQ + legislative and policy actions have crucial implications for health and wellbeing for youth.
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Affiliation(s)
- Jessica N Fish
- Department of Family Science, University of Maryland, 4200 Valley Drive, Suite 2242, College Park, MD 20742, USA
| | - Stephen T Russell
- Department of Human Development and Family Sciences, The University of Texas at Austin, 108 E Dean Keeton St, Austin, TX 78712, USA.
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Olszewska K, Piotrowski P, Wojciechowski BW. Attitudes Towards Rape and Their Determinants Among Men, Women and Non-Binary People in Poland. SEXUALITY & CULTURE 2022; 27:863-877. [PMID: 36440434 PMCID: PMC9676860 DOI: 10.1007/s12119-022-10042-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 11/05/2022] [Indexed: 05/11/2023]
Abstract
The aim of this paper is to present the results of research on attitudes towards rape conducted in a group of 850 adult Poles, including 505 women, 310 men and 35 non-binary people, and to analyze their selected correlates: rape myth acceptance, right-wing authoritarianism and rape empathy. Non-binary people have only recently been included in research as a distinct group and little information can be found in the literature on the characteristics of their attitudes towards social problems. Therefore particular attention was paid to comparing the attitudes towards rape of non-binary people with those of women and men. In analyzing the results, the authors took into account the current socio-political situation in Poland. The results indicate that attitudes toward sexual aggression are related to the type of gender identification. The most positive attitudes towards rape victims among the groups participating in the research are held by non-binary people. Furthermore, attitudes towards rape are determined by rape myths, right-wing authoritarianism and empathy for victims of rape.
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Affiliation(s)
- Klaudia Olszewska
- Faculty of Management and Social Communication, Jagiellonian University in Krakow, Krakow, Poland
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Qeadan F, Egbert J, Barbeau WA, Madden EF, Venner KL, English K. Sexuality and Gender Identity Inequities in Substance Use Disorder and Its Treatment among American Indian, Alaska Native, and Native Hawaiian College Students. Subst Use Misuse 2022; 57:2085-2093. [PMID: 36305843 DOI: 10.1080/10826084.2022.2136490] [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: 10/31/2022]
Abstract
BACKGROUND The aim of this study was to investigate inequities in substance use disorder (SUD) diagnosis, opioid misuse, marijuana misuse, SUD treatment utilization, and utilization of university mental health services among sexual and gender minority (SGM) American Indian, Alaska Native, and Native Hawaiian (AI/AN/NH) college students. METHODS Data consisting of 8,103 AI/AN/NH students' responses to the American College Health Association's National College Health Assessment survey from fall 2015 through spring 2019 were utilized for this study. Multivariable logistic regression models were used to compare the odds of SUD diagnosis, opioid misuse, and marijuana misuse in SGM AI/AN/NH students to cisgender, heterosexual peers. Unadjusted odds of SUD treatment utilization and utilization of university mental health services were also evaluated. RESULTS Compared to cisgender females, transgender (aOR = 4.43, 95% CI = 2.67-7.34) and gender diverse (aOR = 2.86, 95% CI = 1.61-5.07) students had significantly higher odds of SUD diagnosis. Similarly, significantly higher odds of SUD diagnosis were observed among sexual minorities, including gay/lesbian (aOR = 2.95, 95% CI = 1.71-5.09) and bisexual (aOR = 1.97, 95% CI = 1.30-2.99) students compared to heterosexual peers. Sexual minority students had significantly higher odds of utilizing university mental health services (uOR = 2.43, 95% CI = 1.22-4.84) than heterosexual peers. Odds of opioid misuse and marijuana misuse were also significantly increased among sexual minority students. CONCLUSIONS AI/AN/NH college students who identify as SGM have higher odds of SUD diagnosis, opioid misuse, and marijuana misuse than their cisgender, heterosexual peers. These findings highlight the need to consider tailored programming for SGM AI/AN/NH students in substance use prevention and intervention efforts in U.S. college settings.
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Affiliation(s)
- Fares Qeadan
- Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, Illinois, USA
| | - Jamie Egbert
- Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, Illinois, USA
| | - William A Barbeau
- Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, Illinois, USA
| | - Erin F Madden
- Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Kamilla L Venner
- Department of Psychology, Center on Alcohol, Substance Use and Addictions (CASAA), University of New Mexico, Albuquerque, New Mexico, USA
| | - Kevin English
- Albuquerque Area Southwest Tribal Epidemiology Center, Albuquerque, New Mexico, USA
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Bross LA, Huffman JM, Hagiwara M. Examining the special interest areas of autistic adults with a focus on their employment and mental health outcomes. JOURNAL OF VOCATIONAL REHABILITATION 2022. [DOI: 10.3233/jvr-221218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND: Many individuals with autism spectrum disorder (ASD) have special interest areas (SIAs) which are characterized by significant depth and breadth of knowledge in a particular topic. These interests can continue through adulthood. OBJECTIVE: We conducted this study to develop a better understanding of the relation between SIAs and employment and mental health outcomes of adults with ASD. METHODS: Qualitative and quantitative analyses were used to examine the data with an emphasis on bringing autistic voices to the forefront of the discussion. Seventy-two adults with ASD, ages 18–53, completed an online survey describing their SIA engagement, employment status, and current mental health measured by two standardized assessments. Respondents provided open-ended responses describing their SIA and beliefs regarding SIAs broadly. RESULTS: Open-ended responses indicated adults with ASD have highly diverse SIAs that are rarely utilized in their employment experiences. Hierarchical regressions revealed SIA-related bullying was associated with higher levels of depression, anxiety, and stress. SIA employment was associated with depression such that those who were not currently employed in their SIA reported higher levels of depression. Respondents without support from people in their life related to their SIA reported higher levels of stress. CONCLUSION: SIAs are extremely important in the lives of autistic adults and should be utilized to enhance their employment experiences and overall well-being. Family members, adult service providers, and educational professionals should support and encourage SIAs.
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Affiliation(s)
- Leslie Ann Bross
- Department of Special Education and Child Development, University of North Carolina at Charlotte, Charlotte, NC, USA
| | | | - Mayumi Hagiwara
- Department of Special Education, San Francisco State University, San Francisco, CA, USA
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Zinchuk M, Kustov G, Beghi M, Voinova N, Pashnin E, Beghi E, Avedisova A, Guekht A. Factors Associated with Non-Binary Gender Identity in Psychiatric Inpatients with Suicidal Ideation Assigned Female at Birth: A Case-Control Study. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:3601-3612. [PMID: 36109451 DOI: 10.1007/s10508-022-02424-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 09/03/2022] [Accepted: 09/03/2022] [Indexed: 06/15/2023]
Abstract
The study aimed to investigate factors associated with non-binary gender identity in Russian female psychiatric inpatients with suicidal ideation. This case-control study included 38 female inpatients with non-binary gender identity and a control group-76 cisgender women matched for age (age range 19-35 years, M age, 21.5 years); both groups were psychiatric inpatients with suicidal thoughts. All patients underwent the Self-Injurious Thoughts and Behaviors Interview and completed the brief Reasons for Living Inventory. We also used the WHO Quality of Life Questionnaire (WHOQOL-100) and the Life Style Index (LSI). Non-binary gender identity in inpatients with suicidal ideation was associated with lower educational level, higher unemployment rate, being more socially reticent in preschool, and lifetime sexual experience with both male and female partners. In addition, they were younger at the time of the first suicidal ideation, suicide plan development, and attempt. Non-binary inpatients had lower scores in freedom, physical safety, and security facets of WHOQOL-100 and a higher level of intellectualization on LSI. People with non-binary gender identity face educational, employment, and communication issues. They also have distinct suicidal thoughts and behavioral profiles. These issues and differences mean unique approaches to suicide prevention for a population of inpatients with non-binary gender identity are needed.
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Affiliation(s)
- Mikhail Zinchuk
- Moscow Research and Clinical Center for Neuropsychiatry of the Healthcare Department of Moscow, 43, Donskaya ul., Moscow, 115419, Russian Federation.
| | - Georgii Kustov
- Moscow Research and Clinical Center for Neuropsychiatry of the Healthcare Department of Moscow, 43, Donskaya ul., Moscow, 115419, Russian Federation
| | | | - Nadezhda Voinova
- Moscow Research and Clinical Center for Neuropsychiatry of the Healthcare Department of Moscow, 43, Donskaya ul., Moscow, 115419, Russian Federation
| | - Evgenii Pashnin
- Moscow Research and Clinical Center for Neuropsychiatry of the Healthcare Department of Moscow, 43, Donskaya ul., Moscow, 115419, Russian Federation
| | - Ettore Beghi
- Laboratory of Neurological Disorders, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Alla Avedisova
- Moscow Research and Clinical Center for Neuropsychiatry of the Healthcare Department of Moscow, 43, Donskaya ul., Moscow, 115419, Russian Federation
- Federal Medical Research Centre for Psychiatry and Narcology, Moscow, Russian Federation
| | - Alla Guekht
- Moscow Research and Clinical Center for Neuropsychiatry of the Healthcare Department of Moscow, 43, Donskaya ul., Moscow, 115419, Russian Federation
- Department of Neurology, Neurosurgery and Medical Genetics, Pirogov Russian National Research Medical University, Moscow, Russian Federation
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The association of gender with receptive and distributive needle sharing among individuals who inject drugs. Harm Reduct J 2022; 19:108. [PMID: 36180917 PMCID: PMC9524088 DOI: 10.1186/s12954-022-00689-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 09/13/2022] [Indexed: 11/28/2022] Open
Abstract
Background Injection drug use and needle sharing remains a public health concern due to the associated risk of HIV, HCV and skin and soft tissue infections. Studies have shown gendered differences in the risk environment of injection drug use, but data are currently limited to smaller urban cohorts. Methods To assess the relationship between gender and needle sharing, we analyzed publicly available data from the 2010–2019 National Survey on Drug Use and Health (NSDUH) datasets. Chi-square tests were conducted for descriptive analyses and multivariable logistic regression models were built adjusting for survey year, age, HIV status, and needle source. Results Among the entire sample, 19.8% reported receptive needle sharing, 18.8% reported distributive sharing of their last needle, and 37.0% reported reuse of their own needle during last injection. In comparison with men, women had 34% increased odds (OR 1.34, 95% CI 1.11–1.55) of receptive needle sharing and 67% increased odds (OR 1.67, 95% CI 1.41–1.98) of distributive needle sharing. Reuse of one's own needle did not differ by gender. Conclusions In this nationally representative sample, we found that women are more likely in comparison with men to share needles both through receptive and distributive means. Expansion of interventions, including syringe service programs, to increase access to sterile injection equipment is of great importance.
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de Almeida MM, da Silva LAV, Bastos FI, Guimarães MDC, Coutinho C, de Brito AM, Cavalcante S, Dourado I. Factors associated with symptoms of major depression disorder among transgender women in Northeast Brazil. PLoS One 2022; 17:e0267795. [PMID: 36048808 PMCID: PMC9436078 DOI: 10.1371/journal.pone.0267795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 04/17/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Transgender women (TGW) are one of the most vulnerable groups, including higher prevalence of HIV and mental health disorders, such as anxiety and depression than in the general population. Major Depression Disorder (MDD) is one of the most important mental health conditions due to an increasing trend in prevalence in the general population. This study aims at describing the prevalence of symptoms of MDD (SMDD) and associated factors among TGW in capitals of three States in Northeast Brazil. METHODS TGW n = (864) were selected from the cities of Salvador (n = 166), Recife (n = 350), and Fortaleza (n = 348) using Respondent Driven Sampling methodology. Symptoms of MDD were defined according to the Patient Health Questionnaire-9 scale. Multinomial logistic regression was used to compare those with mild/moderate or moderately severe/severe symptoms of depression with those with no depression, respectively, using complex sample design. Weighted Odds Ratio with 95% confidence interval were estimated. RESULTS 51.1% of the sample was classified as mild/moderate and 18.9% as moderately severe/severe SMDD. Mild/moderate SMDD was associated with a history of sexual violence (OR = 2.06, 95%CI: 1.15-3.68), history of physical violence (OR = 2.09, 95%CI: 1.20-3.67),) and poor self-rated quality of life (OR = 2.14, 95%CI: 1.31-3.49).). Moderately severe/severe SMDD was associated with history of sexual violence (OR = 3.02, 95%CI: 1.17-7.77), history of physical violence (OR = 4.34, 95% CI:1.88-6.96), poor self-rated quality of life (OR = 3.32, 95%CI:1.804-6.12), lack of current social support (OR = 2.53, 95%IC: 1.31-4.88) and lack of family support in childhood (OR = 2.17, 95%IC 1.16-4.05)). CONCLUSIONS Our findings strengthens the evidence of a higher prevalence of SMDD among TGW as compared to the general population. Public health policies and actions that target social determinants of risk and protection for MDD among TGW must be urgently implemented.
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Affiliation(s)
| | - Luís Augusto Vasconcelos da Silva
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
- Institute of Arts, Sciences and Humanities, Federal University of Bahia, Salvador, Brazil
| | | | - Mark Drew Crosland Guimarães
- Department of Preventive and Social Medicine, Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | - Ana Maria de Brito
- Aggeu Magalhães Institute, Oswaldo Cruz Foundation, Recife, Pernambuco, Brazil
| | - Socorro Cavalcante
- Health Department of the State of Ceará and Municipality of Fortaleza, Fortaleza, Brazil
| | - Inês Dourado
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
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Carrillo-Alvarez E, Andrés A, Riera-Romaní J, Novak D, Rodriguez-Monforte M, Costa-Tutusaus L, Guerra-Balic M. The association between social capital indicators and psychological distress in Catalan adolescents. Front Psychol 2022; 13:964689. [PMID: 36059788 PMCID: PMC9428606 DOI: 10.3389/fpsyg.2022.964689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 07/21/2022] [Indexed: 11/13/2022] Open
Abstract
According to the WHO, globally, one in seven adolescents experiences a mental disorder, being in a detrimental situation toward educational achievement, social cohesion, future health and life chances. Calls to identify risk and resilience factors to develop effective preventive actions have been made. Following a systemic approach, we conducted a cross-sectional study on the relationship between social capital and psychological distress in a sample of Catalan adolescents in Barcelona, taking into account a range of other relevant aspects at different levels influencing mental health, including gender, age, migrant status, family background, lifestyle factors, body mass index, and self-rated health. Data were collected through validated questionnaires in December 2016 from 646 of 14- to 18-year-old adolescents from three public and private high schools in Barcelona (Spain). Data analysis included descriptive analysis, a correlational study and logistic regression to obtain the odds ratio for social capital indicators to be associated with psychological distress. Our results suggest that reporting higher levels of family support and higher levels of teacher-student trust reduce the likelihood of suffering psychological distress. Higher levels of neighborhood informal control were associated with mental health, but a possible detrimental effect cannot be ruled out. Being a girl, reporting low self-rated health or higher media use was also associated with higher likelihood of psychological distress. Current results may encourage interventions that focus on social capital as a means to reduce psychological distress and foster well-being in youth.
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Affiliation(s)
- Elena Carrillo-Alvarez
- Global Research on Wellbeing (GRoW) Research Group, Blanquerna School of Health Sciences, Ramon Llull University, Barcelona, Spain
- *Correspondence: Elena Carrillo-Alvarez,
| | - Ana Andrés
- Faculty of Psychology, Education and Sport Sciences Blanquerna, Ramon Llull University, Barcelona, Spain
| | - Jordi Riera-Romaní
- Research Group on Pedagogy, Society and Innovation (PSITIC), Faculty of Psychology, Education and Sport Sciences Blanquerna, Ramon Llull University, Barcelona, Spain
| | - Dario Novak
- Faculty of Kinesiology, University of Zagreb, Zagreb, Croatia
| | - Míriam Rodriguez-Monforte
- Global Research on Wellbeing (GRoW) Research Group, Blanquerna School of Health Sciences, Ramon Llull University, Barcelona, Spain
| | - Lluís Costa-Tutusaus
- Global Research on Wellbeing (GRoW) Research Group, Blanquerna School of Health Sciences, Ramon Llull University, Barcelona, Spain
| | - Myriam Guerra-Balic
- Research Group on Health, Physical Activity and Sport (SAFE), Faculty of Psychology, Education and Sport Sciences Blanquerna, Ramon Llull University, Barcelona, Spain
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Compte EJ, Cattle CJ, Lavender JM, Brown TA, Murray SB, Capriotti MR, Flentje A, Lubensky ME, Obedin-Maliver J, Lunn MR, Nagata JM. Psychometric evaluation of the muscle dysmorphic disorder inventory (MDDI) among gender-expansive people. J Eat Disord 2022; 10:95. [PMID: 35794647 PMCID: PMC9260975 DOI: 10.1186/s40337-022-00618-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 06/24/2022] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Muscle dysmorphia is generally classified as a specific form of body dysmorphic disorder characterized by a pathological drive for muscularity and the preoccupation that one is too small or not sufficiently muscular. The majority of research on the condition has been conducted in cisgender men with a paucity of literature on gender minority people, a population that is at risk for muscle dysmorphia. One of the most widely used measures of muscle dysmorphia symptoms, the Muscle Dysmorphic Disorder Inventory (MDDI), has not been psychometrically validated for use in gender minority samples, the aim of the present study. METHODS We evaluated the psychometric properties of the MDDI in a sample of 1031 gender-expansive individuals (gender minority people whose gender identity differs from that assumed for their sex assigned at birth and is not exclusively binary man or woman) aged 18-74 who were part of The PRIDE Study, a large-scale, U.S., longitudinal cohort study. RESULTS Using a two-step, split-sample exploratory and confirmatory factor analytic approach, we found support for the original three-factor structure of the measure. The subscales showed adequate internal consistency, and convergent validity was supported based on significant associations of the MDDI subscale scores with theoretically related scores on a widely used measure of disordered eating. CONCLUSIONS These findings provided novel support for adequate psychometric properties of the MDDI in a sample of gender-expansive individuals, facilitating the use of this measure in future research on muscle dysmorphia in this understudied and at-risk population.
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Affiliation(s)
- Emilio J Compte
- Eating Behavior Research Center, School of Psychology, Universidad Adolfo Ibáñez, Santiago, Chile
- Research Department, Comenzar de Nuevo Treatment Center, Monterrey, Mexico
| | - Chloe J Cattle
- Department of Pediatrics, University of California, San Francisco, 550 16th Street, 4th Floor, Box 0110, San Francisco, CA, 94158, USA
| | - Jason M Lavender
- Military Cardiovascular Outcomes Research Program (MiCOR), Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- The Metis Foundation, San Antonio, TX, USA
| | - Tiffany A Brown
- Department of Psychological Sciences, Auburn University, Auburn, AL, USA
| | - Stuart B Murray
- Department of Psychiatry and Behavioral Sciences, University of Southern California, Los Angeles, CA, USA
| | - Matthew R Capriotti
- Department of Psychology, San José State University, San Jose, CA, USA
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA, USA
| | - Annesa Flentje
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA, USA
- Department of Community Health Systems, University of California, San Francisco, San Francisco, CA, USA
- Alliance Health Project, Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Micah E Lubensky
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA, USA
- Department of Community Health Systems, University of California, San Francisco, San Francisco, CA, USA
| | - Juno Obedin-Maliver
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA, USA
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Mitchell R Lunn
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, CA, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Jason M Nagata
- Department of Pediatrics, University of California, San Francisco, 550 16th Street, 4th Floor, Box 0110, San Francisco, CA, 94158, USA.
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Sex and gender in treatment response to dialectical behaviour therapy: current knowledge, gaps, and future directions. COGNITIVE BEHAVIOUR THERAPIST 2022. [DOI: 10.1017/s1754470x22000253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Borderline personality disorder (BPD) is a mental health condition characterized by emotion dysregulation, interpersonal impairment, and high suicidality. Dialectical behaviour therapy (DBT) is the most widely studied psychotherapeutic treatment for BPD. To date, the vast majority of DBT research has focused on cisgender women, with a notable lack of systematic investigation of sex and/or gender differences in treatment response. In order to encourage effective, equitable treatment of BPD, further investigation into treatment targets in this population is critical. Here, we employed a systematic strategy to delineate gaps in the DBT literature pertaining to sex and gender differences and propose directions for future research. Findings demonstrate a significant discrepancy in measurement of sex and gender, particularly among gender-diverse individuals. Exploring DBT treatment response across the full spectrum of genders will facilitate the provision of more tailored, impactful care to all individuals who suffer from BPD.
Key learning aims
(1)
To date, DBT treatment literature has focused almost exclusively on cisgender women, with only two of 253 DBT studies in current literature accounting for transgender and gender diverse (TGD) individuals.
(2)
Recognize how gender minority stress may impact the prevalence of BPD among TGD individuals.
(3)
Learn how future research initiatives can be employed to rectify this gap in the DBT literature.
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Mirabella M, Piras I, Fortunato A, Fisher AD, Lingiardi V, Mosconi M, Ristori J, Speranza AM, Giovanardi G. Gender Identity and Non-Binary Presentations in Adolescents Attending Two Specialized Services in Italy. J Sex Med 2022; 19:1035-1048. [PMID: 35370103 DOI: 10.1016/j.jsxm.2022.03.215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 02/11/2022] [Accepted: 03/02/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Recently, the variability and heterogeneity of gender presentations in transgender youths have gained significant attention worldwide. Alongside this, specialized gender services have reported an increase in referrals of youths reporting non-binary identities. In Italy, studies investigating gender identity and expression in gender non-conforming youths are lacking, as are data regarding the non-binary population. AIM The present study aimed at dimensionally exploring how transgender and non-binary Italian adolescents identify and express their gender. OUTCOMES Gender expression in trans binary youths and non-binary youths. METHODS The Gender Diversity Questionnaire (GDQ; Twist & de Graaf, 2019) was used to investigate gender identity, gender fluidity, and gender expression in a sample of 125 adolescent patients from the Gender Identity Development Service (SAIFIP) in Rome and the Gender Incongruence Unit of the Careggi Hospital in Florence, between April 2019-June 2021. RESULTS The majority of participants (74.4%) identified as trans* binary and the remaining (25.6%) participants identified as non-binary. Trans binary participants reported a stable gender identity, whereas non-binary participants reported a more fluid gender identity across time and contexts. Almost all participants rated external appearance as important to their gender expression, yet trans binary participants attributed more importance to the body in this respect. Body discomfort and pubertal stage emerged as the most influential factors in participants' experiences of gender. Participants who were assigned male at birth expressed significantly more desire for puberty blockers, whereas those who were assigned female at birth had a stronger desire to engage in breast/chest surgery. Non-binary participants sought different medical interventions relative to trans binary participants. CLINICAL IMPLICATIONS These results may be useful for clinicians working with transgender youths as they provide awareness regarding the features of young people who identify within and outside of binary constructions of gender. STRENGTHS & LIMITATIONS This study provides useful data in gaining insight into understanding the variety of experiences and challenges of gender non-conforming youths. However as the sample was recruited from specialized services, it may not represent the entire gender non-conforming population in Italy. CONCLUSION The results describe the range of gender identities and expressions among gender non-conforming youths attending gender specialized services in Italy, thereby improving our understanding of the variety of identities experienced and the specific medical needs of both trans binary and non-binary adolescents. Mirabella M, Piras I, Fortunato A, et al. Gender Identity and Non-Binary Presentations in Adolescents Attending Two Specialized Services in Italy. J Sex Med 2022;19:1035-1048.
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Affiliation(s)
- Marta Mirabella
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy.
| | - Irene Piras
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
| | - Alexandro Fortunato
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
| | - Alessandra D Fisher
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Florence University Hospital, Florence, Italy
| | - Vittorio Lingiardi
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
| | - Maddalena Mosconi
- Gender Identity Development Service, Hospital S. Camillo-Forlanini, Rome, Italy
| | - Jiska Ristori
- Andrology, Women's Endocrinology and Gender Incongruence Unit, Florence University Hospital, Florence, Italy
| | - Anna Maria Speranza
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
| | - Guido Giovanardi
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
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Fornander MJ, Roberts T, Egan AM, Moser CN. Weight Status, Medication Use, and Recreational Activities of Treatment-Naïve Transgender Youth. Child Obes 2022; 18:228-236. [PMID: 34762510 DOI: 10.1089/chi.2021.0155] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background: Studies of transgender/gender diverse (TGD) youth indicate a high prevalence of overweight/obesity and concern for unhealthy weight management behavior. This study describes the association of weight status with medication use and recreational activities among treatment-naïve, pediatric TGD patients. Methods: This study is a chart review of 277 patients [aged 9-18 years, 79.1% female sex assigned at birth (SAB), and 86.3% white] seen at a medical center from 2017 to 2020. BMI was calculated by age and SAB using CDC growth charts. BMI percentile (BMI%) and BMI z-score (BMIz) were used to define weight status. Results: By BMI% category, 3.6% patients were in the underweight range (BMI <5%); 50.5% had BMI >85%; and 30.3% had BMI >95%. Overweight and obesity rates were higher than national norms (χ2 = 15.152, p < 0.01). Female SAB participants had higher BMIz values than male SAB participants. Youth who reported watching/listening to media (t = 3.50, p < 0.01) and parent-reported creative arts involvement (t = 1.97, p = 0.05) were associated with higher BMIz values. Conversely, spending time with friends and family was associated with a lower BMIz. Over half of the patients were prescribed medications, and those patients taking medications had higher BMIz values than those not taking medications (t = -1.96, p < 0.05). Female SAB, involvement in sedentary recreational activities, and taking medications to treat gastrointestinal conditions were associated with elevated BMIz. Conclusions: Overweight/obesity is a common problem among TGD youth. TGD youth should be considered a high-risk group and targeted in obesity prevention and treatment efforts. Interventions to decrease sedentary activities and improve connections with friends and family are promising strategies to address overweight and obesity among TGD youth.
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Affiliation(s)
- Mirae J Fornander
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Timothy Roberts
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Anna M Egan
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Christine N Moser
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, MO, USA
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D'hoore L, T'Sjoen G. Gender-affirming hormone therapy: An updated literature review with an eye on the future. J Intern Med 2022; 291:574-592. [PMID: 34982475 DOI: 10.1111/joim.13441] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
In line with increasing numbers of transgender (trans) and gender nonbinary people requesting hormone treatment, the body of available research is expanding. More clinical research groups are presenting data, and the numbers of participants in these studies are rising. Many previous review papers have focused on all available data, as these were scarce, but a more recent literature review is timely. Hormonal regimens have changed over time, and older data may be less relevant for today's practice. In recent literature, we have found that even though mental health problems are more prevalent in trans people compared to cisgender people, less psychological difficulties occur, and life satisfaction increases with gender-affirming hormone treatment (GAHT) for those who feel this is a necessity. With GAHT, body composition and contours change towards the affirmed sex. Studies in bone health are reassuring, but special attention is needed for adolescent and adult trans women, aiming at adequate dosage of hormonal supplementation and stimulating therapy compliance. Existing epidemiological data suggest that the use of (certain) estrogens in trans women induces an increased risk of myocardial infarction and stroke, the reason that lifestyle management can be an integral part of trans health care. The observed cancer risk in trans people does not exceed the known cancer-risk differences between men and women. Now it is time to integrate the mostly reassuring data, to leave the overly cautious approach behind, to not copy the same research questions repeatedly, and to focus on longer follow-up data with larger cohorts.
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Affiliation(s)
- Laurens D'hoore
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium
| | - Guy T'Sjoen
- Department of Endocrinology, Ghent University Hospital, Ghent, Belgium.,Center for Sexology and Gender, Ghent University Hospital, Ghent, Belgium
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50
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Pinna F, Paribello P, Somaini G, Corona A, Ventriglio A, Corrias C, Frau I, Murgia R, El Kacemi S, Galeazzi GM, Mirandola M, Amaddeo F, Crapanzano A, Converti M, Piras P, Suprani F, Manchia M, Fiorillo A, Carpiniello B. Mental health in transgender individuals: a systematic review. Int Rev Psychiatry 2022; 34:292-359. [PMID: 36151828 DOI: 10.1080/09540261.2022.2093629] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Several lines of evidence indicate the prevalence of mental health disorders in Transgender (TG) individuals is higher than that of cisgender individuals or the general population. In this systematic review, we aim to propose a summary of some of the most significant research investigating mental health disorders' prevalence among this population. We performed a double-blind systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting (PRISMA) on PUBMED/MEDLINE and SCOPUS, specifically using peer-reviewed articles examining the mental health status of transgender (TG) individuals. This review did not exclude any research based on publication date. The last search was performed in February 2022. The employed search strategy led to the selection of 165 peer-reviewed articles. The majority of these papers presented a cross-sectional design with self-reported diagnoses and symptoms, signaling a significant prevalence of mental health disorders amongst TG Individuals. Of the reviewed articles, 72 examined the prevalence of mood and anxiety disorders; 8 examined eating disorders; 43 examined the prevalence of suicidal or self-harm ideation or behaviors; 5 papers examined the prevalence of trauma and stress-related disorders; 10 examined the frequency of personality disorders; 44 examined substance use disorders; and 9 papers examined the prevalence of autism spectrum disorder. Finally, 22 studies reported on the prevalence of TG individuals diagnosed with co-morbid mental health disorders or unspecified mental disorders. Our findings coincide with existing research, which indicates TG individuals do experience a higher prevalence of mental health disorders than that of the general population or cisgender individuals. However, further research is needed to address the existing gaps in knowledge.
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Affiliation(s)
- Federica Pinna
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Pasquale Paribello
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Giulia Somaini
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Alice Corona
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Antonio Ventriglio
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Carolina Corrias
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Ilaria Frau
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Roberto Murgia
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Sabrina El Kacemi
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Gian Maria Galeazzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Dipartimento ad attività integrata di Salute Mentale e Dipendenze Patologiche, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Massimo Mirandola
- Department of Diagnostics and Public Health, Infectious Diseases Section, University of Verona, Verona, Italy.,School of Sport and Health Sciences, University of Brighton, Brighton, UK
| | - Francesco Amaddeo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Andrea Crapanzano
- Department of Counseling, San Francisco State University, San Francisco, California, USA
| | - Manlio Converti
- Dipartimento di salute mentale, ASL Napoli 2 Nord, Naples, Italy
| | - Paola Piras
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Federico Suprani
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Mirko Manchia
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy.,Department of Pharmacology, Dalhousie University, Halifax, NS, Canada
| | - Andrea Fiorillo
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Bernardo Carpiniello
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
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