Intimate Partner Violence in Transgender and Nonbinary Relationships: Actor-Partner Associations with Relationship Satisfaction, Dyadic Coping, and Partner Support

Purpose: Transgender and nonbinary (TNB) adults experience disproportionate levels of intimate partner violence (IPV) compared with cisgender populations. Most research with TNB samples has focused on individual and demographic risk factors associated with IPV. Scarce research with TNB samples has evaluated how relational factors correlate with IPV victimization, which would be more consistent with dyadic models of IPV. The current study assessed associations between relational factors and psychological and physical victimization among TNB adults and their significant others. Methods: The sample included 112 dyads (total N = 224; mean [M] relationship length = 8.2 years; M age = 35) comprising a TNB adult and their significant other. Given our dyadic sample, we used actor-partner interdependence models to assess actor (i.e., intrapersonal) and partner (i.e., cross-partner) associations between relational factors (e.g., relationship satisfaction, dyadic coping, and partner social support) and IPV victimization among TNB individuals and their partners. Results: We identified numerous actor-partner effects across dyadic coping subscales and measures of partner support on TNB adult reports of IPV victimization. Actor effects were also significant for relationship satisfaction on both TNB and their partner's reports of IPV victimization. Conclusion: Results provide some of the first evidence of relational factors in association with IPV victimization among TNB adults and their intimate partners. These findings have clinical implications for identifying TNB individuals at risk for IPV in their relationships.

Mentalizing stigma: Reflective functioning as a protective factor against depression and anxiety in transgender and gender-nonconforming people

OBJECTIVE

The current study examined the role of internalized transphobia (IT) as a mediator between gender-related rejection and mental health, and reflective functioning (or mentalization) as a resilience factor moderating the relationship between both rejection and IT with mental health.

METHOD

This online study included 203 Italian transgender and gender-nonconforming (TGNC) individuals ranged in age from 18 to 66 years old (M = 30.70; standard deviation = 10.79). Moderated-mediation analysis was performed using a structural equation modeling approach.

RESULTS

Both rejection and IT were positively associated with mental health, and IT mediated the relationship between rejection and mental health. Mentalization moderated the relationship between rejection and IT with mental health. The indirect effect of rejection on mental health through IT was moderated by mentalization.

CONCLUSIONS

Findings highlight psychological paths that may inform individual- and group-level mentalization-based interventions to reduce minority stress in TGNC individuals.

Studying the Longest 'Legal' U.S. Same-Sex Couples: A Case of Lessons Learned

We review methodological opportunities and lessons learned in conducting a longitudinal, prospective study of same-sex couples with civil unions, recruited from a population-based sample, who were compared with same-sex couples in their friendship circle who did not have civil unions, and heterosexual married siblings and their spouse. At Time 1 (2002), Vermont was the only U.S. state to provide legal recognition similar to marriage to same-sex couples; couples came from other U.S. states and other countries to obtain a civil union. At Time 2 (2005), only one U.S. state had legalized same-sex marriage, and at Time 3 (2013) about half of U.S. states had legalized same-sex marriage, some within weeks of the onset of the Time 3 study. Opportunities included sampling legalized same-sex relationships from a population; the use of heterosexual married couples and same-sex couples not in legalized relationships as comparison samples from within the same social network; comparisons between sexual minority and heterosexual women and men with and without children; improvements in statistical methods for non-independence of data and missing data; and the use of mixed methodologies. Lessons learned included obtaining funding, locating participants over time as technologies changed, and on-going shifts in marriage laws during the study.

Gender confirming medical interventions and eating disorder symptoms among transgender individuals

OBJECTIVE

Studies indicate that transgender individuals may be at risk of developing eating disorder symptoms (EDS). Elevated risk may be attributed to body dissatisfaction and/or societal reactions to nonconforming gender expression, such as nonaffirmation of a person's gender identity (e.g., using incorrect pronouns). Limited research suggests that gender-confirming medical interventions (GCMIs) may prevent or reduce EDS among transgender people.

METHOD

Participants included 154 transfeminine spectrum (TFS) and 288 transmasculine spectrum (TMS) individuals who completed the Trans Health Survey. Serial multiple mediation analyses controlling for age, education, and income were used to examine whether body satisfaction and nonaffirmation mediate any found relationships between various GCMIs (genital surgery, chest surgery, hormone use, hysterectomy, and hair removal) and EDS.

RESULTS

For TFS individuals, the nonaffirmation to body satisfaction path mediated relationships between all GCMIs and EDS, although body satisfaction alone accounted for more of the indirect effects than this path for chest surgery. For TMS individuals, relationships between all GCMIs and EDS were mediated by the nonaffirmation to body satisfaction path.

CONCLUSION

Findings support the hypothesis that GCMIs reduce experiences of nonaffirmation, which increases body satisfaction and thus decreases EDS. Among TFS participants, the relationship between chest surgery and lower levels of EDS was mediated most strongly by body satisfaction alone, suggesting that satisfaction with one's body may result in lower EDS even if affirmation from the external world is unchanged. Implications of these findings for intervention, policy, and legal efforts are discussed, and future research recommendations are provided. (PsycINFO Database Record

Breaking up is hard to do: Women's experience of dissolving their same-sex relationship

While prior research has compared same-sex to heterosexual relationships, very little attention has been paid to the unique experiences of women dissolving same-sex relationships, especially in the context of shifting legal and social policies. The current study examined the experience of 20 women who dissolved their same-sex relationship between 2002 and 2014. Participants were drawn from a longitudinal sample of same-sex and heterosexual couples and were interviewed using a semi-structured protocol. Interviews focused on three primary research questions: reasons for dissolution, emotional reactions, and role of legal status. While reasons for dissolution largely mirrored literature on women in heterosexual relationships, emotional reactions and the role of legal status were both influenced by sexual minority-specific factors related to minority stress and the recent societal changes pertaining to legal relationship recognition. Results are interpreted in a framework of minority stress and the ongoing legacy of institutional discrimination experienced by women in same-sex relationships.

Accuracy and Bias in Perceptions of Conflict Style Among Same-Sex and Heterosexual Couples

Intimates form stable impressions of their romantic partner's conflict style, which may influence interactions during conflicts and shape expectancies regarding future disagreements. Despite a large body of work comparing relationship outcomes among heterosexual and same-sex couples, research has yet to examine how the validity of these perceptions vary as a function of gender and sexual orientation. The present study examines perceptual accuracy and bias in perceptions of conflict style among same-sex female (N_dyads=215), same-sex male (N_dyads=113), and heterosexual (N_dyads=93) couples. Although members of same-sex and heterosexual couples exhibited some similarity in accuracy and bias in perceptions, a number of compelling differences suggest that the gender and the sexual orientation of a couple shape perceptions of partner conflict style.

Same-Sex Couples' Decisions and Experiences of Marriage in the Context of Minority Stress: Interviews From a Population-Based Longitudinal Study

In the emerging context of marriage equality, it is important to explore the reasons for and experience of marriage for long-term same-sex couples, including the role of minority stress. In Wave 3 of the population-based, longitudinal CUPPLES Study we interviewed 21 long-term same-sex couples (14 female, 7 male) who resided in 12 different states and who were legally married. Couple members ranged in age from 37 to 84 and reported being together as a couple from 15 to 41 years. Seven couples lived in states that did not recognize their marriage at the time of the interview. Legal protection and social validation emerged as the two primary domains that captured couples' lived experiences of marriage. Minority stress experiences emerged in the narratives in the context of couples' long-term commitment, the availability of civil marriage, and couples' participation in activist efforts on behalf of marriage equality for themselves and others.

Brothers and Sisters of Lesbians, Gay Men, and Bisexuals as a Demographic Comparison Group

This study provides an innovative methodology to study social issues across sexual orientations. Lesbians, gay men, and bisexualwomen and men (LGB) were recruited via LGB periodicals and organizations, and they in turn recruited their siblings. Results of female participants indicate that lesbians are more highly educated, have occupations with greater status, are less religious, and are more geographically mobile than are heterosexual women. Heterosexual women are more similar to census data in terms of marriage, children, religion, and homemaker status. Gay men have moved to large cities and are more highly educated than are heterosexual men. In general, bisexual women are more comparable demographically to lesbians, whereas bisexual men are more similar to heterosexual men. Limiting the sample to paired comparisons between lesbian-heterosexual sisters and gay-heterosexual brothers generally yielded similar means on demographic variables.

Relationship Quality and Domestic Violence in Women's Same-Sex Relationships: The Role of Minority Stress

Despite a large body of literature addressing relationship quality and domestic violence in women's same-sex relationships, few studies have empirically examined how stress specific to living as a lesbian or bisexual woman might correlate with these relationship variables. Degree of outness, internalized homophobia, lifetime and recent experiences of discrimination, butch/femme identity, relationship quality, and lifetime and recent experiences of domestic violence were assessed in a sample of 272 predominantly European American lesbian and bisexual women. Lesbian and bisexual women were found to be comparable on most relationship variables. In bivariate analyses, minority stress variables (internalized homophobia and discrimination) were associated with lower relationship quality and both domestic violence perpetration and victimization. Outness and butch/femme identity were largely unrelated to relationship variables. Path analysis revealed that relationship quality fully mediated the relationship between internalized homophobia and recent domestic violence.

Racial/ethnic differences in identity and mental health outcomes among young sexual minority women

Previous research suggests that sexual minorities are at greater risk for trauma exposure, mental health problems, and substance use. To date, few studies have examined racial/ethnic differences among sexual minorities in relation to health-related behaviors and outcomes. Furthermore, studies of racial/ethnic differences among young adult sexual minority women (SMW) are virtually nonexistent. The current study adds to the previous literature by exploring differences in trauma exposure, sexual identity, mental health, and substance use in a nonprobability national sample of young adult SMW. A total of 967 self- identified lesbian and bisexual women were recruited via the Internet using social networking sites to participate in a larger longitudinal study on young women's health behaviors. The present study included 730 (76%) White, 108 (10%) African American, 91 (9%) Latina, and 38 (4%) Asian women ages 18 to 25 years. Results revealed differences in socioeconomic variables, degree of outness to family, childhood sexual assault, and forcible rape, but not overall lifetime trauma exposure. Among mental health and health-related behavior variables, few differences between groups emerged. Our findings indicate that both researchers and clinicians should turn their attention to processes of resilience among young SMW, particularly young SMW of color.

Current intimate relationship status, depression, and alcohol use among bisexual women: The mediating roles of bisexual-specific minority stressors

Current intimate relationship characteristics, including gender and number of partner(s), may affect one's visibility as a bisexual individual and the minority stressors they experience, which may in turn influence their health. The current study tested four hypotheses: 1) minority stressors vary by current intimate relationship status; 2) higher minority stressors are associated with higher depressive symptoms and alcohol-related outcomes; 3) depressive symptoms and alcohol-related outcomes vary by current intimate relationship status; and 4) minority stressors will mediate differences in these outcomes. Participants included 470 self-identified bisexual women (65% Caucasian, mean age: 21) from a sample of sexual minority women recruited from different geographic regions in the United States through advertisements on social networking sites and Craigslist. Participants completed a 45 minute survey. Respondents with single partners were first grouped by partner gender (male partner: n=282; female partner: n=56). Second, women were grouped by partner gender/number (single female/male partner: n = 338; women with multiple female and male partners: n=132). Women with single male partners and women with multiple male and female partners exhibited elevated experienced bi-negativity and differences in outness (H1). Experienced and internalized bi-negativity were associated with health outcomes, but not outness (H2). Differences in outcomes emerged by partner number and partner number/gender (H3); these differences were mediated by experienced bi-negativity (H4). These results suggest that experiences of discrimination may underlie differences in health related to bisexual women's relationship structure and highlight the importance of evaluating women's relational context as well as sexual identification in understanding health risk behaviors.

Windsor and Perry: reactions of siblings in same-sex and heterosexual couples

The U.S. Supreme Court decisions in U.S. v. Windsor (570 U.S. 307) and Hollingsworth v. Perry (570 U.S. 399) created a focal point for public discussion of marriage equality for same-sex couples. This article reports the results of an exploratory study of the reactions of individuals currently or previously in same-sex couple relationships and a heterosexual sibling who is currently or previously married (N = 371) to the Supreme Court decisions. Thematic content analysis was used to explore participants' responses to an open-ended question on a survey. Reactions of individuals from same-sex couples revealed the following themes: (1) longitudinal perspectives on the advancement of rights for same-sex couples; (2) emotional responses celebrating the decisions or expressing relief; (3) affirmation of their relationship or rights; (4) practical consequences of the extension of rights; and (5) minority stress related to anticipation of future prejudice or discrimination. Themes in the heterosexual siblings' responses were (1) ally support; (2) flat support without emotion or elaboration; (3) indifference to or ignorance about the decisions; and (4) disapproval of the decisions. These themes are compared and discussed in light of prior research on reactions to marriage restriction debates and marriage (in)equality and family relationships.

COPING AS A MEDIATOR OF INTERNALIZED HOMOPHOBIA AND PSYCHOLOGICAL DISTRESS AMONG YOUNG ADULT SEXUAL MINORITY WOMEN

Sexual minorities have higher rates of depression and anxiety than their heterosexual counterparts. This elevated risk of psychological distress has generally been hypothesized to be a result of the effects of discrimination including internalized negative beliefs about sexual minorities. However, little research has examined the role of various types of coping in mediating between internalized homophobia and mental health. We tested the direct relationship between internalized homophobia and psychological distress and evaluated general and sexual minority-specific coping strategies as potential mediators using structural equation modeling. Data are from a national sample of 1,099 young adult sexual minority women who were on average 20.86 (SD= 2.12) years old, participating in a study on mental health and substance use. The model demonstrated acceptable fit, χ² (83) = 402.9, p <.001, CFI=.94, TLI=.92, SRMR= .07, and RMSEA=.06, accounting for 73% of variance in psychological distress. Greater use of maladaptive coping and less use of sexual minority-specific coping were associated with higher psychological distress. Although maladaptive coping mediated the relationship between internalized homophobia and psychological distress, sexual minority-specific coping did not. Our findings support previous studies that have demonstrated the impact of internalized homophobia on psychological distress as well as the role of coping as a protective/risk factor in this relationship.

The Daily Heterosexist Experiences Questionnaire: Measuring Minority Stress Among Lesbian, Gay, Bisexual, and Transgender Adults

The authors conducted a three-phase, mixed-methods study to develop a self-report measure assessing the unique aspects of minority stress for lesbian, gay, bisexual, and transgender adults. The Daily Heterosexist Experiences Questionnaire has 50 items and nine subscales with acceptable internal reliability, and construct and concurrent validity. Mean sexual orientation and gender differences were found.

Understanding sexual orientation health disparities in smoking: a population-based analysis

Lesbian, gay, and bisexual populations are at elevated risk for tobacco use compared to their heterosexual peers. However, there is little research examining reasons for this disparity. Drawing on prior literature regarding psychosocial variables associated with both sexual orientation and smoking, the authors tested a path model of risk and protective factors to help explain sexual orientation differences in smoking using data from the Washington State Behavioral Risk Factor Surveillance System from 2003 to 2007. The authors estimated separate models for men and women, comparing lesbians or gays and bisexuals to heterosexuals. Results indicated that the explanatory variables accounted for most of the variance in this relationship, with both risk-enhancing and risk-reducing pathways. Mental health, life dissatisfaction, alcohol use, exposure to tobacco marketing, and single relationship status were risk enhancers for most LGB participants. Health-care access and income level were risk enhancers for bisexual participants only. Neither emotional support nor attitudes and knowledge about tobacco use helped explain the relationship between sexual orientation and smoking. These findings have significant implications for tobacco prevention and control efforts in this high-risk population.

Sexual revictimization and mental health: a comparison of lesbians, gay men, and heterosexual women

Childhood sexual abuse (CSA) has several deleterious effects on health and well-being, including increased risk for rape in adulthood. Such revictimization experiences are linked to negative mental health outcomes. The vast majority of literature on prevalence and impact of sexual revictimization has focused on heterosexual women. In an effort to extend this research to lesbians and gay men, who are known to face higher rates of both CSA and adult rape, we conducted a study (N = 871) comparing adult lesbians, gay men, and heterosexual women on prevalence and mental health correlates of sexual revictimization. Results indicated that CSA is associated with elevated rates of adult rape for all three groups. In addition, revictimization showed comparable associations with mental health variables for all three groups. Participants with both CSA and adult rape had higher levels of psychological distress, suicidality, alcohol use, and self-harm behaviors relative to those with only one type of victimization and those with no victimization, and those with any victimization were more likely to report recent use of drugs compared to those with no victimization.

Measuring multiple minority stress: the LGBT People of Color Microaggressions Scale

Lesbian, gay, and bisexual individuals who are also racial/ethnic minorities (LGBT-POC) are a multiply marginalized population subject to microaggressions associated with both racism and heterosexism. To date, research on this population has been hampered by the lack of a measurement tool to assess the unique experiences associated with the intersection of these oppressions. To address this gap in the literature, we conducted a three-phase, mixed method empirical study to assess microaggressions among LGBT-POC. The LGBT People of Color Microaggressions Scale is an 18-item self-report scale assessing the unique types of microaggressions experienced by ethnic minority LGBT adults. The measure includes three subscales: (a) Racism in LGBT communities, (b) Heterosexism in Racial/Ethnic Minority Communities, and (c) Racism in Dating and Close Relationships, that are theoretically consistent with prior literature on racial/ethnic minority LGBTs and have strong psychometric properties including internal consistency and construct validity in terms of correlations with measures of psychological distress and LGBT-identity variables. Men scored higher on the LGBT-PCMS than women, lesbians and gay men scored higher than bisexual women and men, and Asian Americans scored higher than African Americans and Latina/os.

Disparities in health-related quality of life: a comparison of lesbians and bisexual women

OBJECTIVES

We investigated the association of health-related quality of life (HRQOL) with sexual orientation among lesbians and bisexual women and compared the predictors of HRQOL between the 2 groups.

METHODS

We used multivariate logistic regression to analyze Washington State Behavioral Risk Factor Surveillance System population-based data (2003 to 2007) in a sample of 1496 lesbians and bisexual women and examined determinants of HRQOL among lesbians and bisexual women.

RESULTS

For lesbians and bisexual women, frequent mental distress and poor general health were associated with poverty and lack of exercise; poor general health was associated with obesity and mental distress. Bisexual women showed a higher likelihood of frequent mental distress and poor general health than did lesbians. The odds of mental distress were higher for bisexual women living in urban areas as compared with nonurban areas. Lesbians had an elevated risk of poor general health and mental distress during midlife.

CONCLUSIONS

Despite the standard practice of collapsing sexual minority women into a single group, lesbian and bisexual women in this study emerge as distinct groups that merit specific attention. Bisexual women are at elevated risk for poor HRQOL.

Childhood abuse and mental health indicators among ethnically diverse lesbian, gay, and bisexual adults

OBJECTIVE

Prior research has established that lesbian, gay, and bisexual (LGB) people experience higher rates of childhood abuse than heterosexuals. However, there has been little research on the mental health impact of these experiences or how race/ethnicity might influence prevalence and mental health impact of childhood abuse in this population. The study's objective was to examine the relationships between race/ethnicity, childhood abuse, and mental health indicators in a national sample of LGB adults.

METHOD

Participants were recruited via the Internet through snowball and targeted sampling methods. Six hundred and sixty-nine LGB adults, 21% of whom were people of color, participated in an online survey. Participants completed the Childhood Trauma Questionnaire-Short Form, the Center for Epidemiologic Studies Depression Scale, the Patient Health Questionnaire Generalized Anxiety Disorder Scale, the Posttraumatic Stress Disorder (PTSD) Checklist-Civilian Version, and the Perceived Stress Scale-Short Form.

RESULTS

Latina/o and Asian American participants reported the highest levels of physical abuse (p < .01), and Latina/o and African American participants reported the highest levels of sexual abuse (p < .01). Childhood emotional abuse was the strongest predictor of psychopathology symptoms for all participants (ps < .01). Relative to White participants, emotional abuse showed a stronger relationship with PTSD and anxiety symptoms for African American participants (ps < .01), and physical abuse showed a stronger relationship with PTSD and anxiety symptoms for Latina/o participants (ps < .05).

CONCLUSIONS

Race/ethnicity may be an important factor when examining childhood abuse and mental health correlates among LGB populations.

Healthy eating, exercise, and weight: impressions of sexual minority women

Obesity is a risk factor for multiple disease outcomes, including cancer and cardiovascular disease. A healthy diet and physically active lifestyle can prevent obesity. Sexual orientation is an important demographic factor that has been suggested to affect engagement in health-related behaviors, and interventions developed for the general population of women are likely to be less effective in assisting sexual minority women to make healthy choices. We conducted seven focus groups with sexual minority women (i.e., lesbians and bisexual women) to explore issues, including barriers and motivations, regarding healthy eating, physical activity, and weight in this population. The participants reported a wide range of levels of engagement in health-related behaviors. While nearly all of the participants reported some awareness of the importance of good dietary choices, the majority reported some confusion about what constitutes a healthy diet. In contrast, the majority of participants seemed clearly aware that regular exercise was important for good health. These data can guide the design of effective intervention strategies to improve health behaviors in sexual minority women.

A pilot study of behavioral activation for veterans with posttraumatic stress disorder

A pilot study was conducted to investigate the feasibility and effectiveness of behavioral activation (BA) therapy for veterans with posttraumatic stress disorder (PTSD). Eleven veterans seeking treatment at a Veterans Administration outpatient PTSD clinic were enrolled in the study protocol, consisting of 16-weekly individual sessions of BA. Nine veterans completed the protocol, one participant completed 15 sessions, and one dropped out after one session. Clinician-rated PTSD symptom severity showed significant pre- to posttreatment improvement and was associated with a moderate effect size. A number of participants also were improved on measures of depression and quality of life, but changes did not reach statistical significance. Findings suggest that BA is a well-tolerated, potentially beneficial intervention for veterans with chronic symptoms of PTSD.

Victimization, substance use, and HIV risk behaviors among gay/bisexual/two-spirit and heterosexual American Indian Men in New York City

OBJECTIVES

secondary aims included describing condom-use attitudes, beliefs about HIV/AIDS in the Indian community, HIV knowledge, HIV status, and preference for and access to HIV prevention services in this population.

METHODS

A survey was mailed to all members of an American Indian community organization in New York City.

RESULTS

The 20 men self-identifying as gay, two-spirit, or bisexual (hereafter, "two-spirit") were more likely to report being victimized and engaging in HIV risk behaviors than the 51 heterosexual respondents, although they reported comparable levels of recent substance use. Overall, victimization was associated with lifetime HIV risk behaviors (even after control for sexual orientation) but not with substance use or unsafe sex in the past 12 months. The percentage of HIV infection was surprisingly high (10% of two-spirit men and 6% of heterosexual men).

CONCLUSIONS

Two-spirit men are a vulnerable population whose victimization must be understood within an appropriate historical and political context.

Victimization over the life span: a comparison of lesbian, gay, bisexual, and heterosexual siblings

Lifetime victimization was examined in a primarily European American sample that comprised 557 lesbian/gay, 163 bisexual, and 525 heterosexual adults. Lesbian, gay, and bisexual (LGB) participants were recruited via LGB e-mail lists, periodicals, and organizations; these participants recruited 1 or more siblings for participation in the study (81% heterosexual, 19% LGB). In hierarchical linear modeling analyses, sexual orientation was a significant predictor of most of the victimization variables. Compared with heterosexual participants, LGB participants reported more childhood psychological and physical abuse by parents or caretakers, more childhood sexual abuse, more partner psychological and physical victimization in adulthood, and more sexual assault experiences in adulthood. Sexual orientation differences in sexual victimization were greater among men than among women.

Mental Health of Lesbian, Gay, Bisexual, and Heterosexual Siblings: Effects of Gender, Sexual Orientation, and Family

Self-identified lesbian, gay male, and bisexual (LGB) individuals were recruited via convenience sampling, and they in turn recruited their siblings (79% heterosexual, 19% LGB). The resulting sample of 533 heterosexual, 558 lesbian or gay male, and 163 bisexual participants was compared on mental health variables and their use of mental health services. Multilevel modeling analyses revealed that sexual orientation predicted suicidal ideation, suicide attempts, self-injurious behavior, use of psychotherapy, and use of psychiatric medications over and above the effects of family adjustment. Sexual orientation was unrelated to current psychological distress, psychiatric hospitalizations, and self-esteem. This is the 1st study to model family effects on the mental health of LGB participants and their siblings.

Culture, trauma, and wellness: a comparison of heterosexual and lesbian, gay, bisexual, and two-spirit native americans

In a community-based sample of urban American Indian and Alaska Native adults, 25 lesbian, gay, bisexual, and two-spirit participants were compared with 154 heterosexual participants with respect to sociodemographic characteristics, Native, cultural participation, trauma, physical and mental health, and substance use. Compared with their heterosexual counterparts, two-spirit participants reported higher rates of childhood physical abuse and more historical trauma in their families, higher levels of psychological symptoms, and more mental health service utilization. Two-spirit participants reported differences in patterns of alcohol use and were more likely to have used illicit drugs other than marijuana. Discussion and recommendations for health promotion interventions and future research are presented in consideration of an "indigenist" health model and the multiple minority status of two-spirit people.

Pioneers in partnership: lesbian and gay male couples in civil unions compared with those not in civil unions and married heterosexual siblings

This study compared 212 lesbians and 123 gay men who had civil unions in Vermont (during the first year legislation made this available) with 166 lesbians and 72 gay men in their friendship network who had not had civil unions, and also with 219 heterosexual married women and 193 heterosexual married men consisting of civil union couples' siblings and their spouses. Married heterosexual couples had been together longer and had more traditional division of labor and child care than did lesbians and gay men in both types of couples. Lesbians in civil unions were more open about their sexual orientation than those not in civil unions, and gay men in civil unions were closer to their family of origin than gay men not in civil unions. This is the first study on same-sex couples with civil unions, and the first to compare lesbians and gay men with their married siblings. At a time of legal changes for same-sex couples, these results indicate that legalized same-sex relationships are related to visibility of same-sex couples to their family and the general public.

Lesbian and Bisexual Women's Experiences of Victimization: Mental Health, Revictimization, and Sexual Identity Development

SUMMARY The prevalence and correlates of a variety of victimization experiences among a large, ethnically diverse national sample of 2,431 lesbian, bisexual, and gay women (LBG) is examined. Most participants (62.3%) report experiencing bias related victimization because they are LBG. Overall, 30.8% of participants report being harshly beaten or physically abused in childhood and 21.2% in adulthood; 39.3% report sexual victimization before the age of sixteen and 36.2% at age sixteen or older. Each type of victimization was significantly related to current psychological distress, and the more types of victimization (sexual or physical, in childhood or adulthood) a participant experienced, the greater her psychological distress. Participants who were victimized in childhood were four times more likely to experience the same type of victimization (sexual or physical) as an adult and about twice as likely to experience the other type of victimization in adulthood. In addition, there were significant differences in history of victimization by race/ethnicity. Native American participants reported the highest rates followed by Latinas, African Americans, Asian Americans, and Whites.

Traumatic victimization in the lives of lesbian and bisexual women

SUMMARY This paper takes a contextual approach to understanding traumatic victimization experiences of lesbian and bisexual women over the life span. Expanding on feminist perspectives on violence against women, the concept of "cultural victimization" is used to explore the role of societal homophobia in shaping the experience of victimization for lesbian and bisexual women. An overview of the existing literature on the prevalence and impact of childhood abuse, domestic violence, sexual assault, and hate crimes among this population is provided. The relationship between sexual identity development and trauma is discussed. This article provides a framework for understanding lesbian and bisexual women's victimization, lends insight to clinicians working with lesbian/bisexual survivors, and provides direction for future research.

Lesbian and bisexual mothers and nonmothers: demographics and the coming-out process

In a large, national sample of 2,431 lesbians and bisexual women, those who had children before coming out, those who had children after coming out, and those who did not have children were compared on demographic factors and milestones in the coming-out process. Differences were found in race/ethnicity, age, prior marriage, income, religion, use of mental health counseling, and reported hate crimes. Results are also presented for lesbians and bisexual women of each ethnic/racial and age group. Controlling for age and income, lesbians and bisexual women who had children before coming out had reached developmental milestones in the coming-out process about 7-12 years later than women who had children after coming out and about 6-8 years later than nonmothers.

Changing hearts, changing minds

ABSTRACT This article is comprised of excerpts from an interview with Dee Mosbacher, MD, PhD, a psychiatric consultant and lesbian ac tivist who has expressed her visions of social change through documentary films. Dee describes the beginnings of her political activism in the social change and women's health movements of the 1960s and 1970s and her evolution as an activist filmmaker over the past two decades. She explores the process of fundraising, the importance of working collabor-atively, her experience balancing activism with her work as a psychiatrist, and the rewards of making films that have an impact on people's lives. She also discusses her visions for the future and provides recommendations for young lesbian activists.