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Aggarwal A, Qiao S, O'Leary SD, Schlekat KN, Li X. Measurement Instruments Assessing Multi-Faceted Stigma Regarding Sexual and Gender Minorities: A Systematic Review of Psychometric Properties. AIDS Behav 2024; 28:2054-2077. [PMID: 38441698 DOI: 10.1007/s10461-024-04305-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2024] [Indexed: 06/13/2024]
Abstract
Stigma against sexual and gender minorities (SGM) populations has serious negative health effects for SGM populations. Despite the growing need for accurate stigma measurement in SGM, there are insufficient valid measurement instruments. Moreover, the lack of consistency in construct usage makes comparisons across studies particularly challenging. A critical review and comparative evaluation of the psychometric properties of the various stigma measures for SGM is necessary to advance our understanding regarding stigma measurement against/among SGMs. Based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a comprehensive search was conducted in 4 bibliographic databases (MEDLINE, PsycINFO, CINAHL, and Web of Science) for empirical articles published from 2010 to 2022 that evaluated the psychometrics properties of measurement instruments assessing stigma against SGMs. The screening, extraction, and scoring of the psychometric properties and methodological quality of selected instruments were performed by following the established standards and COSMIN (Consensus-based Standards for the selection of health Measurement Instruments) checklist, respectively. Of the 2031 studies identified, 19 studies were included that reported psychometric properties of 17 measurement instruments. All instruments, except two, were developed for SGMs (n = 15/17). Most instruments included men who have sex with men (MSM) or gay men (n = 11/15), whereas less than half of the instruments assessed stigma among SGM women (n = 6/15). Internal consistency (Cronbach's alpha) and content validity was reported for all instruments (n = 17); construct and structural validity was also reported for majority of the instruments (n = 15 and 10, respectively). However, test-retest reliability and criterion validity was reported for very few instruments (n = 5 each). Based on the COSMIN checklist, we identified the most psychometrically and methodologically robust instruments for each of the five stigma types: combined stigma, enacted stigma, internalized stigma, intersectional stigma, and perceived stigma. For each stigma type, except anticipated stigma, at least one instrument demonstrated strong promise for use in empirical research; however, the selection of instrument depends on the target population and context of the study. Findings indicated a growing use of instruments assessing multiple stigma types. Future studies need to develop intersectional stigma instruments that account for the multiple and intersecting social identities of SGMs. Additionally, most existing instruments would benefit from further psychometric testing, especially on test-retest reliability, criterion validity, adaptability to different LGBTQIA + populations and cultures.
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Affiliation(s)
- Abhishek Aggarwal
- Department of Health Promotion, Education and Behavior, University of South Carolina, Columbia, USA
| | - Shan Qiao
- Department of Health Promotion, Education and Behavior, University of South Carolina, Columbia, USA.
| | - Shannon D O'Leary
- College of Arts and Sciences, University of South Carolina, Columbia, USA
| | - Katrina N Schlekat
- Arnold School of Public Health, University of South Carolina Honors College, Columbia, USA
| | - Xiaoming Li
- Department of Health Promotion, Education and Behavior, University of South Carolina, Columbia, USA
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Kumaraguru M, Chellappa LR, I MA, Jayaraman S. Association Between Perceived Stress and Salivary Biomarkers of Allostatic Load Among Gender Minorities in Chennai: An Observational Cross-Sectional Study. Cureus 2023; 15:e46065. [PMID: 37900445 PMCID: PMC10604589 DOI: 10.7759/cureus.46065] [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: 07/27/2023] [Accepted: 09/27/2023] [Indexed: 10/31/2023] Open
Abstract
Background Transgender individuals in India experience immense psychosocial stressors, stigma, and violence. In response to stress, the body exhibits adaptive responses that necessitate the production of organic chemicals ensuing in the detection of blood serum and saliva. There are currently no laboratory tests that are confirmatory for the diagnosis of stress and facilitate necessary treatment to be carried out in a timely manner. Thus, potential salivary biomarkers could be a helpful tool in overseeing the efficacy of pharmacological treatment prescribed by a psychiatrist. Aim This study aimed to assess the correlation between perceived stress and salivary stress biomarker levels in transgender and gender nonconforming (TGNC) individuals in Chennai, India. Methodology Twenty-two TGNC individuals and 22 age-matched controls in Chennai were administered the Perceived Stress Scale-10 questionnaire. Following this, their saliva samples were collected using the passive drool technique and subjected to sandwich enzyme-linked immunosorbent assay (ELISA) technique for measuring salivary cortisol, salivary tumor necrosis factor-alpha (TNF-alpha), and salivary C-reactive protein (CRP). Independent t-test was used to compare salivary stress biomarker levels between the TGNC and age-matched control groups. Pearson's correlation test was done to correlate perceived stress and salivary stress biomarker levels in the TGNC group. Results Significant difference was seen between the TGNC and control groups with respect to salivary cortisol and salivary TNF-alpha levels, with the levels being higher in the TGNC group. A significant positive correlation was seen between perceived stress and salivary cortisol and between perceived stress and salivary TNF-alpha levels. Conclusion There is a significant correlation between perceived stress and salivary biomarkers of stress among TGNC people in Chennai.
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Affiliation(s)
- Mahalakshmi Kumaraguru
- Department of Public Health Dentistry, Saveetha Dental College & Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Lalitha Rani Chellappa
- Department of Public Health Dentistry, Saveetha Dental College & Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Meignana Arumugham I
- Department of Public Health Dentistry, Saveetha Dental College & Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Selvaraj Jayaraman
- Department of Biochemistry, Saveetha Dental College & Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
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Herrmann WJ, Oeser P, Buspavanich P, Lech S, Berger M, Gellert P. Loneliness and depressive symptoms differ by sexual orientation and gender identity during physical distancing measures in response to COVID-19 pandemic in Germany. Appl Psychol Health Well Being 2022; 15:80-96. [PMID: 35666060 PMCID: PMC9348355 DOI: 10.1111/aphw.12376] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 05/14/2022] [Indexed: 11/28/2022]
Abstract
During the COVID-19 pandemic, physical distancing measures to prevent transmission of the virus have been implemented. The effect of physical distancing measures on loneliness especially for vulnerable groups remained unclear. Thus, we aimed to investigate loneliness in relation with depressive symptoms among lesbian, gay, bisexual, trans, inter, asexual, and queer (LGBT) persons compared with cis-heterosexual persons during the pandemic. We conducted an online survey during the first two waves of the COVID-19 pandemic in Germany. The survey contained self-categorizations regarding sexual orientation and gender identity, questions on loneliness, social contacts, depressive symptoms, and healthcare. Descriptive and regression analysis and propensity score matching across cohorts was conducted using R; 2641 participants took part in first wave of the survey and 4143 participants in the second wave. The proportion of lonely people was higher in the second wave compared with the first wave. LGBT persons were more lonely than cis-heterosexual persons. In both waves, being LGBT was associated with depressive symptoms, but loneliness mediated the effect, even when adjusting for social contacts. Psychologists and other practitioners should be aware that LGBT clients might have an increased risk for loneliness and depressive symptoms and of the potential burden of the pandemic measures.
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Affiliation(s)
- Wolfram J. Herrmann
- Institute of General PracticeCharité ‐ Universitätsmedizin BerlinBerlinGermany,Münster School of HealthFH MünsterMünsterGermany
| | - Philip Oeser
- Institute of General PracticeCharité ‐ Universitätsmedizin BerlinBerlinGermany
| | - Pichit Buspavanich
- Gender in Medicine (GiM)Charité ‐ Universitätsmedizin BerlinBerlinGermany,Department of Psychiatry, Psychotherapy and PsychosomaticsBrandenburg Medical School Theodor FontaneNeuruppinGermany,Department of Psychiatry and PsychotherapyCharité ‐ Universitätsmedizin BerlinBerlinGermany,Institute of Sexology and Sexual MedicineCharité – Universitätsmedizin BerlinBerlinGermany,Faculty of Health Sciences BrandenburgJoint Faculty of the University of Potsdam, Brandenburg University of Technology Cottbus‐Senftenberg and Brandenburg Medical SchoolPotsdamGermany
| | - Sonia Lech
- Department of Psychiatry, Psychotherapy and PsychosomaticsBrandenburg Medical School Theodor FontaneNeuruppinGermany,Department of Psychiatry and PsychotherapyCharité ‐ Universitätsmedizin BerlinBerlinGermany,Institute of Medical Sociology and Rehabilitation ScienceCharité ‐ Universitätsmedizin BerlinBerlinGermany
| | - Maximilian Berger
- Department of Psychiatry, Psychotherapy and PsychosomaticsBrandenburg Medical School Theodor FontaneNeuruppinGermany,Department of Psychiatry and PsychotherapyCharité ‐ Universitätsmedizin BerlinBerlinGermany
| | - Paul Gellert
- Institute of Medical Sociology and Rehabilitation ScienceCharité ‐ Universitätsmedizin BerlinBerlinGermany
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Hydock DS. Sex Hormone Suppression and Physical Activity: Possible Implications for Transgender Individuals. Transgend Health 2022; 7:43-51. [PMID: 36644022 PMCID: PMC9829143 DOI: 10.1089/trgh.2020.0073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Purpose Transgender individuals tend to be less physically active than cisgender individuals, and the primary focus of these physical activity barriers have been psychosocial in nature. Very little attention has been given to the role that changes in the sex hormone milieu (such as that occurring during gender-affirming hormone therapy) play on physical activity. The purpose of this study was to explore the effects of sex hormone suppression using a gonadotropin-releasing hormone agonist (GnRHa) on physical activity levels and patterns. Methods Female and male rats received 4 weeks of sex hormone suppression using the GnRHa goserelin acetate (GA) or received a placebo as a control (CON). Animals were then allowed free access to voluntary running wheels, and activity was recorded throughout the treatment period. Results Female rats receiving GA (F GA) had a significantly lower total wheel running distance than female CON (F CON, 53±11 km vs. 113±28 km, respectively, p=0.042), and male rats receiving GA (M GA) had a significantly lower total wheel running distance when compared with male CON (M CON, 31±7 km vs. 69±18 km, respectively, p=0.037). Differences in daily wheel running distances were first observed at day 18 between F GA and F CON (p=0.037) and at day 2 between M GA and M CON (p=0.021). Conclusion Reduced sex hormone availability reduced wheel running activity in female and male rats. Understanding the role that sex hormone manipulation has on physical activity may be an important consideration in promoting physical activity in transgender individuals receiving treatments that reduce sex hormone availability.
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Affiliation(s)
- David S. Hydock
- School of Sport and Exercise Science, University of Northern Colorado, Greeley, Colorado, USA.,Address correspondence to: David S. Hydock, PhD, School of Sport and Exercise Science, University of Northern Colorado, Gunter 2590, Box 39, 501 20th Street, Greeley, CO 80639, USA,
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Zhou SJ, Wang LL, Qi M, Yang XJ, Gao L, Zhang SY, Zhang LG, Yang R, Chen JX. Depression, Anxiety, and Suicidal Ideation in Chinese University Students During the COVID-19 Pandemic. Front Psychol 2021; 12:669833. [PMID: 34421725 PMCID: PMC8375404 DOI: 10.3389/fpsyg.2021.669833] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 07/19/2021] [Indexed: 12/23/2022] Open
Abstract
Coronavirus disease-2019 (COVID-19) pandemic has seriously threatened the global public health security and caused a series of mental health problem. Current research focuses mainly on mental health status and related factors in the COVID-19 pandemic among Chinese university students. Data from 11133 participants was obtained through an online survey. The Patient Health Question-9 (PHQ-9) was used to assess depressive symptoms, the Social Support Rate Scale (SSRS) was used to assess social support. We also used 7-item Generalized Anxiety Disorder Scale (GAD-7) to assess anxiety symptoms. Totally, 37.0% of the subjects were experiencing depressive symptoms, 24.9% anxiety symptoms, 20.9% comorbid depressive and anxiety symptoms, and 7.3% suicidal ideation. Multivariable logistic regression analysis revealed an increased presence of mental health problems in female students, graduate students, and those with personal COVID-19 exposure. Awareness of COVID-19, living with family were protective factors that reduced anxiety and depression symptoms. In addition, male, personal COVID-19 exposure, depressive and anxiety symptoms were risk factors for suicidal ideation. Social support, COVID-19 preventive and control measures, prediction of COVID-19 trends, living with family and graduate students are protective factors for reducing suicidal ideation.
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Affiliation(s)
- Shuang-Jiang Zhou
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, China
| | - Lei-Lei Wang
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, China
| | - Meng Qi
- Department of Psychology, Chengde Medical University, Chengde, China
| | - Xing-Jie Yang
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, China
| | - Lan Gao
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, China
| | - Suo-Yuan Zhang
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, China
| | - Li-Gang Zhang
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, China
| | - Rui Yang
- Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Jing-Xu Chen
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, China
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Abstract
PURPOSE OF REVIEW I review the recent literature related to the assessment, treatment, and management of transgender individuals who sexually harm. RECENT FINDINGS There are no empirical research studies directly focused on the care of this group of individuals that have only recently been identified as an important sub-population among people who sexually harm. Related empirical research and other important professional literature do exist to inform clinicians regarding treatment guidelines for transgender mental healthcare. Research is needed to determine how best to assess sexual violence recidivism risk and to distinguish unique treatment needs for transgender individuals who sexually harm. Strength-based approaches to the treatment of sexual violence can help organize treatment approaches to assist transgender individuals in avoiding future incidents of sexually harmful behavior.
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Affiliation(s)
- Shan Jumper
- Liberty Healthcare Corporation, Bala Cynwyd, PA, USA.
- Illinois DHS Treatment and Detention Facility, Rushville, IL, USA.
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Becerra MB, Rodriquez EJ, Avina RM, Becerra BJ. Experiences of violence and mental health outcomes among Asian American transgender adults in the United States. PLoS One 2021; 16:e0247812. [PMID: 33662045 PMCID: PMC7932064 DOI: 10.1371/journal.pone.0247812] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 02/15/2021] [Indexed: 11/18/2022] Open
Abstract
PURPOSE We addressed prevalence and factors associated with mental health outcomes (suicidal behavior and psychological distress) among Asian Americans (AA), who identify as transgender, a key group among sexual and gender minorities that is overlooked and understudied. METHODS We used data from 2015 United States Transgender Survey during 2019-2020 with our population as census defined AA. Outcomes included suicidal ideation, suicidal thoughts, and serious psychological distress (SPD). Independent variables included any abuse, partner abuse, bathroom-related abuse, and additional covariates. Adjusted odds ratio and 95% confidence interval (aOR; 95% CI) for each outcome are adjusted for age, marital status, citizenship status, education level, employment status, as well as poverty status. RESULTS Nearly 67% reported experiencing any abuse, 52% reported abuse from romantic/sexual partner(s), while 29% reported harassment/abuse when trying to use bathrooms. Moreover, 82% reported suicidal thoughts, 40% reported suicidal attempts, and 39% had SPD. Results demonstrated that any abuse/violence had higher odds of suicidal thoughts (adjusted odds ratio [aOR] = 2.67, 95% confidence interval (CI):[1.98-3.58], suicidal attempts (aOR = 2.83, 95% CI:[2.18-3.68]), and SPD (aOR = 1.56, 95% CI:[1.20, 2.04]). Abuse from romantic/sexual partners had higher odds of suicidal thoughts (aOR = 2.47, 95% CI:[1.76-3.47]), suicidal attempts (aOR = 2.17, 95% CI:[1.68-2.80]), and SPD (aOR = 2.72, 95% CI:[2.03-3.63]). Experience of harassment/abuse during bathroom use had increased odds of suicidal attempts (aOR = 1.81, 95% CI:[1.41-2.31]). CONCLUSION Exposure to violence is common among AA transgender individuals and related to negative mental health outcomes. Initiatives to reduce exposure to abuse and providing resources for trauma-informed care are imperative to improve health outcomes.
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Affiliation(s)
- Monideepa B. Becerra
- Department of Health Science and Human Ecology, California State University, San Bernardino, California, United States of America
- Center for Health Equity, California State University, San Bernardino, California, United States of America
| | - Erik J. Rodriquez
- Division of Intramural Research, National Heart, Lung, Blood Institute, Bethesda, Maryland, United States of America
| | - Robert M. Avina
- Department of Health Science and Human Ecology, California State University, San Bernardino, California, United States of America
- Center for Health Equity, California State University, San Bernardino, California, United States of America
| | - Benjamin J. Becerra
- Center for Health Equity, California State University, San Bernardino, California, United States of America
- Department of Information and Decision Sciences, California State University, San Bernardino, California, United States of America
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García-Andrade RF, Rendón-Luna BS, Martínez VV, De Meneses EMT, Prieto BR. Transgender Women with Severe Mental Illness and Homelessness: A Retrospective Case Series. ACTA ACUST UNITED AC 2019. [DOI: 10.4236/jss.2019.78030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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