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Song HL, Kong JD, Wang QL, Zhou CX. Gender identity and its impact on attention deficit hyperactivity disorder manifestations: Challenges in diagnosis and assessment. World J Psychiatry 2025; 15:101952. [PMID: 40309590 PMCID: PMC12038685 DOI: 10.5498/wjp.v15.i4.101952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2024] [Revised: 01/12/2025] [Accepted: 02/14/2025] [Indexed: 03/25/2025] Open
Abstract
Attention deficit hyperactivity disorder (ADHD) turns into a common neuro progressional disorder. Although gender identity has obtained increasing attention in ADHD researches, its role in ADHD presentation and treatment response remains underexplored. Our review seeks to mainly delve into the effect of gender identity on ADHD, exploring the unique needs of individuals with various gender identities in the context of ADHD symptoms, diagnostic assessment, and treatment, with the goal of supplying theoretical support and practical recommendations for future research and clinical practice. The primary content includes, specifically: (1) Symptom expression differences: Gender identity significantly affects ADHD symptoms; male-identified individuals commonly perform worse in task orientation and attention stability, while female-identified individuals may demonstrate more variability in attention control and executive functions; (2) Diagnosis and treatment: Clinical practice generally neglects the impact of gender identity on ADHD management, with personalized needs of gender-identified individuals frequently not adequately addressed, potentially, affecting treatment outcomes; and (3) Future research directions: Future studies should further assess how gender identity affects the specific mechanisms of ADHD, conduct researches in multicultural contexts, and engage in long-term follow-up studies to evaluate the long-term impact of gender identity on ADHD progression. Besides, enhanced funding and public education on the relationship between gender identity and ADHD are needed to advance the field.
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Affiliation(s)
- Hao-Lin Song
- College of Graduate Education, Shandong Sport University, Jinan 250000, Shandong Province, China
- School of Management, Sun Yat-sen University, Zhongshan 528400, Guangdong Province, China
| | - Jian-Da Kong
- College of Sports Science, Qufu Normal University, Jining 273100, Shandong Province, China
- College of Sport and Health, Shandong Sport University, Jinan 250000, Shandong Province, China
| | - Qing-Lu Wang
- College of Graduate Education, Shandong Sport University, Jinan 250000, Shandong Province, China
| | - Cai-Xia Zhou
- College of Graduate Education, Shandong Sport University, Jinan 250000, Shandong Province, China
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Bai Y, Cao P, Kim C, Ienciu K, Selvaratnam I, Abramovich A, Jakubiec B, Brennan DJ, Chum A. Gender identity and activity limitations: A national study on transgender and non-binary Canadians. Prev Med 2025; 192:108224. [PMID: 39805546 DOI: 10.1016/j.ypmed.2025.108224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2024] [Revised: 01/07/2025] [Accepted: 01/09/2025] [Indexed: 01/16/2025]
Abstract
INTRODUCTION Activity limitations among transgender and non-binary individuals remain largely unexplored using population-based samples. This study examines the risk of activity limitations across different gender identities in Canada. METHOD Using data from the 2021 Canadian long-form Census, logistic regressions estimated the adjusted odds of reporting activity limitations (seeing, hearing, mobility/dexterity, mental, cognitive, and other) across gender identities. RESULTS Non-binary individuals assigned female at birth (AFAB) had the highest predicted probability of reporting any activity limitations (76.13 %), followed by non-binary individuals assigned male at birth (AMAB) at 61.56 %, transgender men (44.71 %), and transgender women (34.41 %). Cisgender men (19.31 %) and cisgender women (21.98 %) had the lowest probabilities. Mental limitations showed the largest disparity, with 39.4 % of non-binary AFAB individuals affected, compared to 4.9 % of cisgender men. These findings highlight significant disparities in activity limitations across gender identities. CONCLUSION Non-binary and transgender individuals are most at risk for activity limitations. These findings underscore the need for targeted policies to address challenges faced by gender-diverse populations. Future research should investigate the mechanisms behind these disparities. Healthcare policies must prioritize culturally competent, transgender-inclusive care to reduce disparities in activity limitations.
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Affiliation(s)
- Yihong Bai
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada; Department of Epidemiology and Biostatistics, Western University, Toronto, Ontario, Canada
| | - Peiya Cao
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
| | - Chungah Kim
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
| | - Kristine Ienciu
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
| | - Inthuja Selvaratnam
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
| | - Alex Abramovich
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Centre for Addiction and Mental Health (CAMH), Canada
| | | | - David J Brennan
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Antony Chum
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
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Erickson S, Irbahim A, Bowman K, Thompson S, Harrison AJ. A Scoping Review of Interventions Designed to Increase Behavioural Health Service Engagement. Clin Psychol Psychother 2025; 32:e70050. [PMID: 40068819 DOI: 10.1002/cpp.70050] [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: 10/01/2024] [Revised: 02/02/2025] [Accepted: 02/03/2025] [Indexed: 05/13/2025]
Abstract
BACKGROUND A documented underutilization of behavioural health interventions with known efficacy for treating psychological disorders exists. Thus, engagement enhancement approaches (EEAs) exist to help increase individuals' use of behavioural health interventions. EEAs target a range of barriers to treatment; therefore, a wide variety of approaches exist. METHOD To better understand what EEA approaches exist and in which contexts they are most widely implemented, this study conducted a scoping review of existing EEAs to increase treatment engagement in effective interventions for behavioural health disorders. Specifically, the purpose of this review was to characterize EEAs by type, modality, target population, and to examine the intersection of these categories. Additionally, this review examined research rigour and cultural considerations among existing EEAs. RESULTS We found that most of the identified studies targeted individual-level barriers through psychoeducation and awareness campaigns. These primarily focused on adults with substance use disorders or major depressive disorder and occurred in person at a provider location. This review identified several limitations and gaps in the literature regarding EEAs, such a shortage of scientifically rigorous studies that assess these approaches, the lack of cultural adaptations made to EEAs to specifically support minoritized individuals, the narrow focus of targeting individual-level barriers, and the limited scope of target groups. CONCLUSIONS This review offers clinicians and behavioural health researchers information regarding the selection of approaches to increase engagement in accessing behavioural health interventions, as well as suggestions for future research to address disparities and develop solutions to the systemic barriers of the EEAs.
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Affiliation(s)
- Sydney Erickson
- Department of Internal Medicine & Psychiatry, Emory University School of Medicine, Atlanta, USA
| | - Ayah Irbahim
- Burrell College of Osteopathic Medicine, Las Cruces, USA
| | - Karrah Bowman
- Department of Educational Psychology, University of Georgia, Athens, USA
| | - Sadona Thompson
- Department of Educational Psychology, University of Georgia, Athens, USA
| | - Ashley J Harrison
- Department of Educational Psychology, University of Georgia, Athens, USA
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Corman JD, Hughto JMW, Shireman TI, Baker K, Steinle K, Forcier M. Mental Health Changes in US Transgender Adults Beginning Hormone Therapy Via Telehealth: Longitudinal Cohort Study. J Med Internet Res 2025; 27:e64017. [PMID: 39951700 PMCID: PMC11888058 DOI: 10.2196/64017] [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: 07/05/2024] [Revised: 11/08/2024] [Accepted: 01/13/2025] [Indexed: 02/16/2025] Open
Abstract
BACKGROUND Gender-affirming hormone therapy (GAHT) has shown potential for improving mental health outcomes among transgender and gender-diverse adults. How clinical outcomes change among adults receiving GAHT via telehealth across the United States is not well known. OBJECTIVE This study evaluated the relationship between initiating GAHT via a telehealth clinic and changes in depression, anxiety, and suicide ideation over a 3-month period. METHODS This cohort study evaluated the relationship between initiating GAHT via a telehealth clinic and changes in mental health over a 3-month period. Data were collected at baseline and 3 months later among adults who had their first GAHT visit between August and November 2023. The study included adults aged 18 years and older initiating GAHT for the first time, with a final sample of 342 adults across 43 states (192 initiated estrogen and 150 initiated testosterone therapy). The primary outcomes were depression symptoms using the Patient Health Questionnaire-9 (PHQ-9), anxiety symptoms using the General Anxiety Disorder-7 (GAD-7), and suicide ideation in the past 2 weeks. RESULTS Before GAHT initiation, 40% (136/342) of participants reported depression (PHQ-9 ≥10), 36% (120/342) reported anxiety (GAD-7 ≥8), and 25% (91/342) reported suicidal ideation. By follow-up, significant reductions were observed in PHQ-9 (-2.4, 95% CI -3.0 to -1.8) and GAD-7 scores (-1.5, 95% CI -2.0 to -1.0). Among those with elevated symptoms, 40% (48/120) to 42% (56/133) achieved a clinically meaningful response (≥50% reduction in baseline scores), and 27% (36/133) to 28% (33/120) achieved remission (PHQ-9 or GAD-7 score <5). Of those with suicide ideation at baseline, 60% (50/83) had none at follow-up. CONCLUSIONS This study highlights the important relationship between telehealth-delivered GAHT and mental health, emphasizing the importance of accessible and timely care.
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Affiliation(s)
| | | | | | - Kellan Baker
- Whitman-Walker Health, Washington, DC, United States
| | | | - Michelle Forcier
- FOLX Health, Boston, MA, United States
- Brown University, Providence, RI, United States
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Coventry J, Lane R, Osadnik C. Exploring Interactions Between Transgender, Gender-Diverse, and Nonbinary Individuals and Allied Health Professionals in Clinical Practice: A Scoping Review. Transgend Health 2025; 10:22-34. [PMID: 40151171 PMCID: PMC11937776 DOI: 10.1089/trgh.2022.0222] [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: 03/29/2025] Open
Abstract
Transgender, gender diverse, and nonbinary (TGDNB) individuals access allied health care services for various reasons; however, barriers such as fear of discrimination and stigmatization exist. Little is known about the positive or negative features of health care encounters between allied health professionals and TGDNB individuals. This scoping review sought to (1) summarize current evidence describing health care encounters between allied health professionals and TGDNB individuals; (2) identify the extent of clinical practice guidance specific for allied health professionals; and (3) identify recommendations for improving allied health care for TGDNB individuals. A comprehensive search of four electronic databases and two grey literature sources was conducted from January 1, 2000 to September 26, 2021. Relevant data were extracted and summarized narratively, and recommendations were summarized via table. Thirty-five articles were included in this review. Barriers faced by TGDNB individuals in accessing allied health services included previous negative experiences, lack of clinician competence, financial barriers, travel times, lack of understanding of allied health scope and fear of stigmatization, and discrimination. No clinical guidelines were identified specific to allied health; however, eight key recommendations emerged from the synthesis: a need for TGDNB-specific referrals, resources and advocacy, clinician education, awareness and use of patient pronouns, gender neutral environments, inclusive and welcoming environments, gender-inclusive intake forms, confidentiality and privacy, and reduction of stigma and discrimination. Findings suggest that improvements to optimize allied health care experiences of TGDNB individuals are indicated and feasible. Significant scope remains for patient-centered research to improve health care experiences for TGDNB individuals.
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Affiliation(s)
- Jessica Coventry
- Department of Physiotherapy, Monash University, Frankston, Australia
| | - Riki Lane
- Department of General Practice, Monash University, Frankston, Australia
- Gender Clinic, Monash Health, Melbourne, Australia
| | - Christian Osadnik
- Department of Physiotherapy, Monash University, Frankston, Australia
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Sternberg KF, Cloutier JG, Ahlers K, Moore C, Koth KA, Soda T, Malhi NK, Verma S, Yeh LC, McLaren JL. Exploring the Intersection of Gender Diversity and Intellectual Disability: A Scoping Review With a Focus on Clinical Care. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2025; 38:e70010. [PMID: 39844579 DOI: 10.1111/jar.70010] [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: 09/22/2023] [Revised: 11/15/2024] [Accepted: 01/06/2025] [Indexed: 01/24/2025]
Abstract
BACKGROUND Little research has been conducted solely exploring gender diversity in people with intellectual disabilities. This review explores the literature, discusses the prevalence, and identifies clinical best practices for people at the intersection of gender diversity and intellectual disability. METHOD A scoping review was conducted utilising PRISMA methodology of the following databases: PubMed, CINAHL Complete (EBSCO), Cochrane Library (Wiley), Dissertations & Theses Global (ProQuest), PsycInfo (EBSCO), Scopus and Web of Science. RESULTS Five hundred seventy five titles and abstracts were screened, 61 full-text articles were reviewed and 17 met inclusion criteria. Four major themes were identified: prevalence, trauma and co-occurring mental health disorders, barriers to care and best practices. CONCLUSION This review highlights the lack of research and provides valuable insight into the experiences of people with gender diversity and intellectual disability. Further research is needed to understand the prevalence and explore the intersection and experience of gender-diverse people with intellectual disabilities.
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Affiliation(s)
- Kady F Sternberg
- Department of Psychiatry, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Joanna G Cloutier
- Health Promotion and Resiliency Intervention Research Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kaitlyn Ahlers
- Department of Psychiatry, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA
| | - Christina Moore
- Department of Psychiatry, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire; Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
| | - Kathleen A Koth
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Takahiro Soda
- Department of Psychiatry, University of Florida, Gainesville, Florida, USA
| | - Narpinder Kaur Malhi
- Department of Psychiatry and Behavioral Health, ChristianaCare, Wilmington, Delaware, USA
| | - Shikha Verma
- Department of Psychiatry, Evolve Treatment Centers, El Segundo, California, USA
| | - Lisa C Yeh
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Jennifer L McLaren
- Department of Psychiatry, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire; Department of Pediatrics, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire; The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, New Hampshire, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
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7
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Stanton AM, Chiu C, Dolotina B, Kirakosian N, King DS, Grasso C, Potter J, Mayer KH, O'Cleirigh C, Batchelder AW. Disparities in depression and anxiety at the intersection of race and gender identity in a large community health sample. Soc Sci Med 2025; 365:117582. [PMID: 39631299 DOI: 10.1016/j.socscimed.2024.117582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 11/04/2024] [Accepted: 11/28/2024] [Indexed: 12/07/2024]
Abstract
BACKGROUND Persons of color experience are disproportionately impacted by poor mental health compared to White individuals, as are gender diverse populations relative to cisgender individuals. Yet, few studies have assessed differences in common mental health disorders at the intersection of race and gender identity. METHODS Using health record data from an urban US community health center in Massachusetts that primarily serves LGBTQIA + communities, we organized patients (N = 29,988) into 24 race and gender identity categories, pairing four race groups (White, Black, Asian, and another race, which was inclusive of Native American/Alaskan, Native Hawaiian, Multiracial, and other) with six gender identity groups (cisgender men and women, transgender men and women, nonbinary individuals assigned male and female at birth [AMAB/AFAB]). We compared the severity of self-reported symptoms of depression and anxiety and the likelihood of meeting diagnostic thresholds across the four race categories within three gender groups (cisgender and transgender men, cisgender and transgender women, nonbinary individuals). RESULTS Depression and anxiety symptom severity differed within men and women; transgender men and women across races had higher severity than cisgender men and women. In nonbinary individuals, symptom severity was high and consistent across the race groups. Differences were observed in the likelihood of meeting clinical thresholds for depression and anxiety across races in men and women, reflecting the pattern described above. Nonbinary participants across races had high likelihood of meeting the thresholds for both diagnoses (29.2%-47.1%). The likelihood of meeting the depression and anxiety thresholds were highest among Black nonbinary AFAB adults (44.4%) and transgender women in the another race category (48.7%), respectively. CONCLUSION In this unique sample, differences in depression and anxiety symptom severity and likely diagnoses suggest disparities among nonbinary individuals across races, as well as among transgender men and women grouped into the another race category and women who identify as Black. Focused mental health strategies tailored to address race and gender identity may be critical to proactively address these disparities.
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Affiliation(s)
- Amelia M Stanton
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA; The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Christopher Chiu
- The Fenway Institute, Fenway Health, Boston, MA, USA; Department of Psychiatry, Boston University, Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Brett Dolotina
- Grossman School of Medicine, New York University, New York, NY, USA
| | - Norik Kirakosian
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
| | - Dana S King
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Chris Grasso
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Jennifer Potter
- The Fenway Institute, Fenway Health, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Conall O'Cleirigh
- The Fenway Institute, Fenway Health, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Abigail W Batchelder
- The Fenway Institute, Fenway Health, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Boston University, Chobanian and Avedisian School of Medicine, Boston, MA, USA.
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Abela D, Patlamazogou L, Lea S. The experiences of oppression among transgender and gender expansive young people in Australia: An interpretative phenomenological study. J Child Adolesc Ment Health 2024:1-26. [PMID: 39558614 DOI: 10.2989/17280583.2024.2393838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2024]
Abstract
Background: Transgender and gender expansive (TGE) people experience poorer mental health outcomes compared to their cisgender counterparts. There is limited research on understanding the experiences of TGE school-aged young people from an Australian perspective. Since each country and state has different cultures, laws, and access to gender-affirming care research considering these differences is imperative.Methods: To address this gap, we used a qualitative design to explore the oppression of Australian TGE young people. Sixteen TGE participants (aged 14-17) completed individual semi-structured interviews. Data were analysed using interpretive phenomenological analysis.Results: Three superordinate themes were identified: (1) oppression within the education system; (2) oppression within the medical and allied health system; and (3) oppression within the family system. The findings highlight the various settings and contexts of oppression young people encounter. We identified what must change for a more equitable society and advocate for the implementation of gender-affirming change.Discussion and conclusion: This study contributes to the dearth of TGE adolescents's experiences and provides practical implications for society, especially in relation to the education, medical, and family systems. The implications include advocacy for more research in Australia and the inclusion of adolescents in policy reform. Limitations of this study and future directions are discussed.
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Affiliation(s)
- Daniel Abela
- School of Educational Psychology and Counselling, Monash University, Victoria, Australia
| | - Lefteris Patlamazogou
- School of Educational Psychology and Counselling, Monash University, Victoria, Australia
| | - Sophie Lea
- School of Educational Psychology and Counselling, Monash University, Victoria, Australia
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Harkness A, Soulliard ZA, Layland EK, Behari K, Rogers BG, Bharat B, Safren SA, Pachankis JE. Implementing LGBTQ-affirmative cognitive-behavioral therapy: implementation strategies across five clinical trials. Implement Sci Commun 2024; 5:124. [PMID: 39501392 PMCID: PMC11539333 DOI: 10.1186/s43058-024-00657-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 10/01/2024] [Indexed: 11/08/2024] Open
Abstract
BACKGROUND LGBTQ-affirmative cognitive-behavioral therapy (CBT) is an evidence-based treatment for reducing transdiagnostic mental and behavioral health concerns among LGBTQ individuals. Preserving the effects of this intervention as it is translated into practice can maximize public health benefits. This study systematically identifies and evaluates implementation strategies for LGBTQ-affirmative CBT. METHODS First, we identified and operationalized implementation strategies used across five trials of LGBTQ-affirmative CBT using the Pragmatic Implementation Reporting Tool. Second, we evaluated the relative importance of these strategies via a quantitative assessment (N = 31 unique trial implementers). Survey responses were analyzed descriptively within each trial. Across all trials, we organized strategies as (1) high priority, (2) moderate priority, and (3) optional (if resources are available) for implementing LGBTQ-affirmative CBT. RESULTS Within each trial, we identified 20 or more implementation strategies that were used, many of which overlapped across trials. We identified nine high priority strategies (e.g., working with clients to engage them in LGBTQ-affirmative CBT), nine moderate priority strategies (e.g., conducting ongoing training in LGBTQ-affirmative CBT), and nine optional/resource dependent strategies (e.g., showing visual indicators of LGBTQ affirmation within the physical spaces where LGBTQ-affirmative CBT is delivered). CONCLUSIONS LGBTQ-affirmative CBT is a complex intervention requiring a package of implementation strategies. Our findings provide guidance for implementers in settings with different levels of resources regarding the highest priority strategies that may be needed to preserve the effectiveness of LGBTQ-affirmative CBT as it is translated into real-world settings.
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Affiliation(s)
- Audrey Harkness
- School of Nursing and Health Studies, University of Miami, Coral Gables, FL, USA.
| | | | - Eric K Layland
- Department of Human Development and Family Sciences, University of Delaware, Newark, DE, USA
| | - Kriti Behari
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Brooke G Rogers
- Department of Psychiatry, Chobanian & Avedisian School of Medicine Department of Psychiatry, Boston University, Boston Medical Center, Boston, MA, USA
| | - Bharat Bharat
- Psychology Department, University of Miami, Coral Gables, FL, USA
| | - Steven A Safren
- Psychology Department, University of Miami, Coral Gables, FL, USA
| | - John E Pachankis
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
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10
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Tse S, Chee K, Coleman TA, Coulombe S, Travers R. Exploring LGBT2Q+ Intracategorical Factors in Mental Health Service Utilization: Differences in Gender Modalities, Sexual Orientations, and Ethnoracial Groups in Canada. Community Ment Health J 2024; 60:1434-1447. [PMID: 38850503 DOI: 10.1007/s10597-024-01299-y] [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: 10/20/2023] [Accepted: 05/19/2024] [Indexed: 06/10/2024]
Abstract
LGBT2Q+ (lesbian, gay, bisexual, transgender, Two-Spirit, queer, plus) Canadians face minority stressors that lead to higher mental health inequalities such as worse self-reported mental health and increased risk of mental health issues when compared to their heterosexual/straight and cisgender counterparts. However, there are within-group (intracategorical) differences within a community as large as LGBT2Q+ peoples. Guided by the Andersen Model of Healthcare Utilization, we sought to explore intracategorical differences in LGBT2Q+ Canadian predisposing, enabling, and need factors in mental health service utilization within the past year. Using data from the 2020 LGBT2Q+ Health Survey (N = 1542), modified Poisson logistic regression found that more polysexual respondents and trans/gender-diverse respondents were more likely to have utilized mental health services within the past year than their gay, lesbian, and cis male counterparts. As well, compared to White respondents, Indigenous respondents were more likely to have utilized mental health services, while other racialized respondents were associated with less utilization. Backwards elimination of Andersen model of healthcare utilization factors predicting mental health service utilization retained two predisposing factors (ethnoracial groups and gender modality) and two need factors (self-reporting living with a mood disorder and self-reporting living with an anxiety disorder). Results suggest that polysexual, trans and gender-diverse, and racialized LGBT2Q+ peoples have an increased need for mental health services due to increased specific minority stressors that cisgender, White, monosexual peoples do not face. Implications for healthcare providers are discussed on how to improve service provision to LGBT2Q+ peoples.
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Affiliation(s)
- Samson Tse
- Department of Psychology, Wilfrid Laurier University, Waterloo, ON, Canada.
| | - Kenny Chee
- Faculty of Social Works, University of Toronto, Toronto, ON, Canada
| | - Todd A Coleman
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, ON, Canada
| | - Simon Coulombe
- Department of Industrial Relations, Université Laval, Québec, QC, Canada
| | - Robb Travers
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, ON, Canada
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11
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Holmes LG, Xuan Z, Quinn E, Caplan R, Sanchez A, Wharmby P, Holingue C, Levy S, Rothman EF. Alcohol Use Patterns Among Underage Autistic and Non-Autistic Youth. J Autism Dev Disord 2024; 54:3808-3822. [PMID: 37751088 PMCID: PMC11253551 DOI: 10.1007/s10803-023-06086-4] [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] [Accepted: 07/30/2023] [Indexed: 09/27/2023]
Abstract
PURPOSE We explored factors predicting repeated or hazardous alcohol use among autistic and non-autistic U.S. youth ages 16 to 20 years. METHODS Autistic (n = 94) and non-autistic (n = 92) youth completed an online survey. By design, half of each group reported past-year alcohol use. We compared drinking patterns for autistic and non-autistic youth, and within each group between abstinent or infrequent drinkers (0-1 drinking episodes in past year) versus those who drank 2 + times in past year. RESULTS Autistic (vs. non-autistic) youth who drank did so less frequently and consumed fewer drinks per occasion. However, 15% of autistic youth who drank in the past year reported heavy episodic drinking and 9.3% screened positive for AUDIT-C hazardous drinking. For autistic youth only, a diagnosis of depression, bullying or exclusion histories were positively associated with drinking 2 + times in the past year. Autistic youth who put more effort into masking autistic traits were less likely to report drinking 2 + times in the past year. As compared to non-autistic youth, autistic participants were less likely to drink for social reasons, to conform, or to enhance experiences, but drank to cope at similar rates. CONCLUSION Repeated and hazardous underage alcohol occur among autistic youth. Targeted prevention programs designed to address the specific drinking profiles of autistic youth are needed.
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Affiliation(s)
| | - Ziming Xuan
- Boston University School of Public Health, Boston, USA
| | - Emily Quinn
- Boston University School of Public Health, Boston, USA
| | - Reid Caplan
- Silberman School of Social Work, CUNY Hunter College, New York, USA
| | - Amelia Sanchez
- Silberman School of Social Work, CUNY Hunter College, New York, USA
| | - Peter Wharmby
- Silberman School of Social Work, CUNY Hunter College, New York, USA
| | - Calliope Holingue
- Center for Autism and Related Disorders, Department of Mental Health, Kennedy Krieger Institute, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Sharon Levy
- Adolescent Substance Use and Addiction Program, Boston Children's Hospital, Harvard Medical School, Boston, USA
| | - Emily F Rothman
- Department of Occupational Therapy, Boston University, Boston, USA
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12
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Mereish EH. Oppression-Based Stress and Alcohol Inequities Among Sexual and Gender Minority People: An Intersectional Multilevel Framework. Alcohol Res 2024; 44:05. [PMID: 39246430 PMCID: PMC11379061 DOI: 10.35946/arcr.v44.1.05] [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: 09/10/2024] Open
Abstract
PURPOSE Sexual and gender minority (SGM) people are at heightened risk for alcohol use, hazardous drinking, and alcohol use disorder compared to heterosexual and cisgender individuals. This paper: (a) presents an oppression framework that integrates intersectionality, stress, stigma, and addiction-based theories to examine the complex and nuanced ways oppression-based stress (e.g., minority stress) leads to sexual orientation and gender identity inequities in alcohol use; (b) conducts a narrative review that summarizes recent and novel advancements in the literature on the impact of oppression-based stressors on alcohol use outcomes across structural, interpersonal, and intrapersonal domains among SGM people; and (c) provides future research and intervention directions for the alcohol field. SEARCH METHODS A select review of the literature was conducted on July 10, 2023, using multiple electronic databases (i.e., PsycInfo, PubMed, Web of Science) and focusing on studies that had examined the associations between oppression-based stressors and alcohol use outcomes across structural, interpersonal, and intrapersonal levels. Search terms focused on alcohol consumption; SGM people, particularly SGM people of color; and oppression-based stress. Cross-sectional studies that focused on heterosexism-based and anti-bisexual oppression-based stressors at the interpersonal or intrapersonal levels and alcohol use outcomes were excluded as they have been included in prior reviews of the literature. SEARCH RESULTS The initial and combined search across the databases resulted in 3,205 articles. Of those, the narrative review included 50 peer-reviewed articles that focused on the following four areas of the literature on the associations between oppression-based stressors and alcohol use outcomes: (1) experimental, longitudinal, and experience sampling studies of heterosexism- and anti-bisexual oppression-based stressors (22 articles); (2) any studies of cissexism-based stressors (12 articles); (3) any studies of intersectional oppression among SGM people of color (seven articles, one article overlapped with the first category and another overlapped with the fourth category); and (4) any studies of structural oppression (11 articles). DISCUSSION AND CONCLUSIONS Results of this narrative review indicate that mounting evidence implicates oppression-based stress in inequities in alcohol use, hazardous drinking, and alcohol use disorder in SGM populations. This reflects SGM people's embodiment of oppression and injustice at the structural, interpersonal, and intrapersonal levels. Given some inconsistent and mixed patterns of findings, future research needs greater specificity in drinking inclusion criteria, robust and well-validated measures, more attention to culturally and developmentally relevant moderating and mediating mechanisms across the lifespan, application of sophisticated methodologies, and integration of intersectional and addiction frameworks.
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Affiliation(s)
- Ethan H Mereish
- Lavender Lab, Department of Psychology, University of Maryland, College Park, Maryland
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13
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Johnson KC, LeBlanc AJ, Dolezal C, Singh AA, Bockting WO. Invalidation and Mental Health among Nonbinary Individuals. PSYCHOLOGY OF SEXUAL ORIENTATION AND GENDER DIVERSITY 2024; 11:413-424. [PMID: 39600541 PMCID: PMC11588289 DOI: 10.1037/sgd0000621] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2024]
Abstract
This study examines the experience of a unique minority stressor, gender identity invalidation (henceforth referred to as invalidation), which is defined as the refusal to accept someone's gender identity as real or valid, among transgender and nonbinary (TNB) individuals. Data are drawn from a large and diverse sample of TNB adults who participated in a quantitative survey concerning transgender identity, minority stress, and mental health (N = 302). Invalidation was assessed using a novel 17-item scale that ascertains the extent to which respondents experienced invalidation across different social contexts. On average, TNB adults in this sample report low levels of invalidation, although a minority experience it at relatively high levels. Experiences of invalidation were significantly higher among nonbinary participants when compared with their binary trans peers. A series of multivariate regression models that control for sociodemographic factors (sex assigned at birth, race/ethnicity, education, age, and income) and well-established indicators of minority stress (felt stigma, enacted stigma) suggest that nonbinary gender identity is independently associated with poor mental health (assessed with the Global Severity Index), and that this association is mediated by invalidation. These findings suggest that invalidation, which is largely unexamined in existing research, merits greater attention as a particularly salient minority stressor influencing mental health among gender diverse populations, nonbinary populations in particular.
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14
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Thompson HM, Feasley K, Ortiz R, Reyes K, Seanior A, Karnik NS. An Implementation of a Community-Engaged, Group-Level Mental Health Pilot for Black and Latina Transgender Women. Health Promot Pract 2024; 25:895-906. [PMID: 37171050 DOI: 10.1177/15248399231172191] [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] [Indexed: 05/13/2023]
Abstract
The primary aim is to assess the implementation of an eight-session, group therapy pilot for Black and Latina transgender women in Chicago in terms of implementation outcomes regarding intervention effectiveness, acceptability, appropriateness, and feasibility. The Exploration Preparation Implementation Sustainment (EPIS) framework guided implementation processes, including community engagement as an implementation strategy, and an implementation taxonomy was used to evaluate outcomes of acceptability, appropriateness, and feasibility, in addition to intervention effectiveness regarding anxiety and community connectedness. Two rounds of the pilot were completed in 2020, during the COVID-19 pandemic, at a community-based organization serving LGBTQ+ (lesbian, gay, bisexual, transgender, queer/questioning) youth on Chicago's West Side. Participants (N = 14) completed a baseline and postintervention assessment and evaluations after each of eight intervention modules. Descriptive statistics show improvement across measures of anxiety and community connectedness, and high mean scores across domains of acceptability, appropriateness, and feasibility. Pilot findings indicate intervention effectiveness, acceptability, appropriateness, and feasibility to address mental health and social support of Black and Latina transgender women. Additional resources are needed for transgender community-engaged mental health programs and research to establish core and adaptable intervention elements, scaled-up evidence for clinical effectiveness, and, most importantly, to improve mental health outcomes and the sustainability of such interventions.
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Affiliation(s)
- Hale M Thompson
- Rush University Medical Center, Chicago, IL, USA
- Howard Brown Health, Chicago, IL, USA
| | | | - Reyna Ortiz
- TaskForce Community and Prevention Services, Chicago, IL, USA
| | - Karen Reyes
- Rush University Medical Center, Chicago, IL, USA
| | | | - Niranjan S Karnik
- Rush University Medical Center, Chicago, IL, USA
- University of Illinois at Chicago, Chicago, IL, USA
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15
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Lucas R, Geierstanger S, Soleimanpour S. Mental Health Needs, Barriers, and Receipt of Care Among Transgender and Nonbinary Adolescents. J Adolesc Health 2024; 75:267-274. [PMID: 38739056 DOI: 10.1016/j.jadohealth.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 02/02/2024] [Accepted: 03/19/2024] [Indexed: 05/14/2024]
Abstract
PURPOSE Transgender and nonbinary youth disproportionately experience adverse mental health outcomes compared to cisgender youth. This study examined differences in their mental health needs and supports, barriers to care, and receipt of mental health care. METHODS This study examined cross-sectional data from 43,339 adolescents who completed the California Healthy Kids Survey, 4% (n = 1,876) of whom identified as transgender and/or nonbinary. Chi-square test and t-test were used to compare mental health needs and supports, resilience, and barriers to and receipt of care experienced by transgender and nonbinary youth compared to cisgender youth. RESULTS Transgender and nonbinary youth were significantly more likely to experience chronic sadness/hopelessness (74% vs. 35%) and consider suicide (53% vs. 14%) and less likely to report resilience factors (school connectedness: mean score 3.12 vs. 3.52). Transgender and nonbinary youth were significantly less likely to be willing to talk to teachers/adults from school (12% vs. 18%) or parents/family members (21% vs. 43%), but more willing to talk to counselors (25% vs. 19%) regarding mental health concerns. Transgender and nonbinary youth were significantly more likely to select being afraid (48% vs. 20%), not knowing how to get help (44% vs. 30%), or concern their parents would find out (61% vs. 36%) as barriers to seeking mental health care, yet reported slightly higher odds of receiving care when needed (odds ratio: 1.2). DISCUSSION Transgender and nonbinary youth are more likely to report mental health concerns and barriers to seeking care than cisgender youth. Increasing access to care is critical for this population.
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Affiliation(s)
- Ruby Lucas
- Department of Epidemiology, University of Washington, Seattle, Washington; School of Medicine, Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California.
| | - Sara Geierstanger
- School of Medicine, Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California
| | - Samira Soleimanpour
- School of Medicine, Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California
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16
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Rosati F, Lorusso MM, Pistella J, Anzani A, Di Giannantonio B, Mirabella M, Baiocco R. Nonbinary people living in a binary world: Minority stress in public and gendered places. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2024; 26:360-377. [PMID: 40276003 PMCID: PMC12016279 DOI: 10.1080/26895269.2024.2338152] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/26/2025]
Abstract
Introduction Nonbinary gender identities are widely erased and invalidated in Western societies, due to binary normativity. The segregation by binary gender of public spaces and sports categories may cause unique sources of stress for nonbinary people, manifesting at a structural and interpersonal level. Utilizing the nonbinary minority stress framework this study explores how the dichotomous gender division of public restrooms, store dressing rooms, locker rooms, and sports categories is associated with distal and proximal dimensions of minority stress. Methods The study was conducted in Italy and involved 40 nonbinary individuals aged 19 to 36 years in a semi-structured interview. The research team comprised a diverse range of positionalities, including trans, nonbinary, queer, bisexual, lesbian, and cisgender heterosexual-allied researchers. Results Through reflexive thematic analysis combining deductive and inductive orientations, themes were organized in two macro-areas representing distal and proximal stressors. Distal stressors encompassed experiences of bullying, harassment, discrimination, social intrusiveness and control, non-affirmation, invalidation, and the burden of powerlessness. Proximal stressors included internalized invalidation, avoidance coping, negative expectations, disclosure negotiation, and gender dysphoria. Conclusion and discussion Findings showed that intrusiveness, control, non-affirmation, and social invalidation represent pervasive elements in the daily experiences of nonbinary individuals, contributing to the internalization of negative emotions referred to the self, including discomfort, shame, and a sense of social inadequacy. Nonbinary individuals may prioritize the comfort of others in social interactions, negotiating the disclosure of their identity to prevent others from feeling uneasy in their presence. Implications for clinical interventions, policy, and future research are discussed.
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Affiliation(s)
- Fau Rosati
- Department of Developmental and Social Psychology, Sapienza University of Rome, Italy
| | | | - Jessica Pistella
- Department of Developmental and Social Psychology, Sapienza University of Rome, Italy
| | | | - Bianca Di Giannantonio
- Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
| | - Marta Mirabella
- Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza University of Rome, Italy
| | - Roberto Baiocco
- Department of Developmental and Social Psychology, Sapienza University of Rome, Italy
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17
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Davidson JD, Neilson EC, Staples JM, Turner RB. Group differences in gender expression discrimination and depressive and anxiety symptoms among transgender and gender-expansive adults: The role of gender identity pride. Bull Menninger Clin 2024; 88:214-238. [PMID: 39226226 DOI: 10.1521/bumc.2024.88.3.214] [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: 09/05/2024]
Abstract
Despite established associations between discrimination and mental health, little research has focused on gender expression discrimination and integrated individual strengths such as transgender and gender-expansive (TGE) identity pride. This study examined the roles of gender expression discrimination and pride in mental health among TGE adults across gender identity, race, and class. A national sample of TGE adults (N = 212) completed online measures assessing gender identity, race, income, gender expression-related discrimination, TGE identity pride, and depression and anxiety symptoms. Gender expression discrimination was positively associated with depressive and anxiety symptoms. Black, Indigenous, People of Color (BIPOC), higher income, transfeminine participants reported more gender expression discrimination. High TGE identity pride buffered the association between gender expression discrimination and depression-most robustly for BIPOC, lower income, transfeminine participants. TGE identity pride may buffer the effects of gender expression discrimination on depression. Intersectionality in case formulation and treatment planning with TGE individuals is vital.
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Affiliation(s)
- Jonathan D Davidson
- Crisis and Residential Recovery Therapist, Pathways, Inc., Ashland, Kentucky
| | - Elizabeth C Neilson
- Director, Community Behavioral Health Clinic, and Assistant Professor, Department of Psychology, Morehead State University, Morehead, Kentucky; Department of Psychology, Eastern Michigan University, Ypsilanti, Michigan
| | - Jennifer M Staples
- Associate Professor, California School of Professional Psychology, Alliant International University, San Diego, California
| | - Rachel B Turner
- Undergraduate research assistant, Department of Psychology, Morehead State University, Morehead, Kentucky
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18
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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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19
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Tran GM, Lachowsky N, Urbanoski KA, Scheim AI, Bauer GR. Correlates of hazardous alcohol drinking among trans and non-binary people in Canada: A community-based cross-sectional study. Drug Alcohol Depend 2023; 250:110872. [PMID: 37406573 DOI: 10.1016/j.drugalcdep.2023.110872] [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: 02/16/2023] [Revised: 05/30/2023] [Accepted: 06/20/2023] [Indexed: 07/07/2023]
Abstract
PURPOSE Transgender and non-binary people (TGNB) have a higher rate of heavy episodic drinking than cisgender people; however, extant knowledge about predictors of hazardous alcohol drinking (HAD) among different TGNB groups is limited. This study examined predictors of HAD in a national sample of TGNB people in Canada. METHODS Logistic regression models were fit to examine the effects of 1) minority stressors and 2) stress-buffering factors on the likelihood of HAD, stratified by gender, among 2324 TGNB individuals from the Trans PULSE Canada survey, a cross-sectional survey conducted in 2019 among trans and non-binary people aged 14+ in Canada. RESULTS Almost 17% of participants reported past-year HAD. Lifetime day-to-day and lifetime major discrimination were associated with higher odds of HAD in the full sample [(AOR=1.37, 95% CI: 1.30, 1.44) and (AOR=1.69, 95% CI: 1.55, 1.86) respectively], and across all gender groups. Social support was associated with lower odds of HAD in trans men, non-binary people assigned female at birth (NB-AFAB), and non-binary people assigned male at birth (NB-AMAB) groups, but with higher odds of HAD in the trans women group. Misgendering was associated with lower odds of HAD in trans men and NB-AFAB, but higher odds of HAD in trans women and NB-AMAB. Mixed effects of gender distress, gender positivity, and gender-affirming medical care were also reported across groups. CONCLUSION The study provided a more detailed understanding of the predictors of HAD across four TGNB groups. Public health interventions should focus on structural discrimination and social support for TGNB people.
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Affiliation(s)
- Gioi Minh Tran
- School of Public Health and Social Policy, University of Victoria, 3800 Finnerty Road, Victoria, BC V8P 5C2, Canada; Center for Community Health Promotion, Suite 313-314, Block E1, Trung Tu Diplomatic Compound, Dong Da, Hanoi, Viet Nam.
| | - Nathan Lachowsky
- School of Public Health and Social Policy, University of Victoria, 3800 Finnerty Road, Victoria, BC V8P 5C2, Canada; Canadian Institute for Substance Use Research, University of Victoria, Technology Enterprise Facility Room 273, 2300 McKenzie Avenue, Victoria, BCV8P 5C2, Canada
| | - Karen A Urbanoski
- School of Public Health and Social Policy, University of Victoria, 3800 Finnerty Road, Victoria, BC V8P 5C2, Canada; Canadian Institute for Substance Use Research, University of Victoria, Technology Enterprise Facility Room 273, 2300 McKenzie Avenue, Victoria, BCV8P 5C2, Canada
| | - Ayden I Scheim
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, 3215 Market Street, Philadelphia, PA19104, United States; Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Canada; Li Ka Shing Knowledge Institute, Unity Health Toronto, Canada
| | - Greta R Bauer
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Canada; Institute for Sexual and Gender Health, University of Minnesota Medical School, 1300 South 2nd Street, Minneapolis, MN55455, United States
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20
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Mehta SD, Otieno FO, Kimani J, Wahome E, Okal D, Roy A, van der Elst E, Graham SM, Sanders EJ, Bailey RC. Transgender women in Kenya experience greater stigma, depressive symptoms, alcohol and drug use and risky sexual practices than cis-gendered men who have sex with men. BMC Public Health 2023; 23:1493. [PMID: 37542212 PMCID: PMC10403860 DOI: 10.1186/s12889-023-16348-6] [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: 11/28/2022] [Accepted: 07/18/2023] [Indexed: 08/06/2023] Open
Abstract
BACKGROUND Worldwide, sexual and gender minority individuals have disproportionate burden of HIV. There are limited quantitative data from sub-Saharan Africa on the intersection of risks experienced by transgender women (TGW) in comparison to cis-men who have sex with men (MSM). This analysis addresses this gap by comparing reported stigma, psychosocial measures of health, and sexual risk practices between TGW and cis-MSM in Kenya. METHODS We analyzed data from the baseline visit of an ongoing prospective cohort study taking place in three diverse metropolitan areas. Eligible participants were HIV-negative, assigned male at birth, ages 18-29 years, and reported anal intercourse in the past 3 months with a man or TGW. Data collected by audio computer assisted self-interview included sociodemographic measures, and sexual practices occurring in the past 3 months. Multivariable regressions assessed differences between TGW and cis-MSM in selected sexual practices, depressive symptoms, alcohol and drug use, and stigma. RESULTS From September, 2019, through May, 2021, 838 participants were enrolled: 108 (12.9%) TGW and 730 (87.1%) cis-MSM. Adjusting for sociodemographic variables, TGW were more likely than cis-MSM to report: receptive anal intercourse (RAI; adjusted prevalence ratio [aPR] = 1.59, 95% CI: 1.32 - 1.92), engaging in group sex (aPR = 1.15, 95% CI: 1.04 - 1.27), 4 or more male sex partners (aPR = 3.31, 95% CI: 2.52 - 4.35), and 3 or more paying male sex partners (aPR = 1.58, 95% CI: 1.04 - 2.39). TGW were also more likely to report moderate to severe depressive symptoms (aPR = 1.42, 95% CI: 1.01 - 1.55), and had similar alcohol and drug abuse scores as cis-MSM. In sensitivity analysis, similar to TGW, male-identifying individuals taking feminizing gender affirming therapy had an increased likelihood of reporting RAI and group sex, and greater numbers of male sex partners and paying male sex partners relative to cis-MSM. CONCLUSIONS Across three metropolitan areas in Kenya, TGW were more likely to report depressive symptoms and increased sexual risk taking. We identified a need for research that better characterizes the range of gender identities. Our analysis affirms the need for programmatic gender-affirming interventions specific to transgender populations in Kenya and elsewhere in Africa.
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Affiliation(s)
- Supriya D Mehta
- Division of Epidemiology & Biostatistics, University of Illinois Chicago School of Public Health, 1750 W. Harrison Street, Jelke 1121, Chicago, IL, 60612, USA.
- Division of Infectious Disease Medicine, Rush University College of Medicine, Chicago, USA.
| | | | - Joshua Kimani
- Partners for Health and Development in Africa, Nairobi, Kenya
- University of Manitoba, Winnipeg, Canada
| | - Elizabeth Wahome
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Duncan Okal
- Nyanza Reproductive Health Society, Kisumu, Kenya
| | - Abhishikta Roy
- Division of Epidemiology & Biostatistics, University of Illinois Chicago School of Public Health, 1750 W. Harrison Street, Jelke 1121, Chicago, IL, 60612, USA
| | - Elise van der Elst
- Global Health Department, University of Amsterdam, Amsterdam, The Netherlands
| | - Susan M Graham
- Departments of Global Health, Medicine, and Epidemiology, University of Washington, School of Medicine, Seattle, WA, USA
| | - Eduard J Sanders
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
- Global Health Department, University of Amsterdam, Amsterdam, The Netherlands
- University of Oxford, Oxford, UK
- Aurum Institute, Johannesburg, South Africa
| | - Robert C Bailey
- Division of Epidemiology & Biostatistics, University of Illinois Chicago School of Public Health, 1750 W. Harrison Street, Jelke 1121, Chicago, IL, 60612, USA
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21
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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: 0.5] [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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22
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Stults CB, Gao S, Brandt SA, Taber JL, Lynn SG, Kaczetow W, Lee G, Cruise A, Krause KD. Intimate Partner Violence and Mental Health Among Transgender and Gender Diverse Young Adults. JOURNAL OF FAMILY VIOLENCE 2023:1-15. [PMID: 37358980 PMCID: PMC10220337 DOI: 10.1007/s10896-023-00579-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/18/2023] [Indexed: 06/28/2023]
Abstract
Purpose Research indicates that multiple forms of intimate partner violence (IPV) may be prevalent among transgender and gender diverse (TGD) people, including general forms of IPV (psychological, physical, sexual), as well as identity-specific forms (transgender-related IPV (T-IPV), identity abuse (IA)). Studies also suggest that IPV is associated with negative mental health outcomes in TGD populations, including depression, anxiety, and posttraumatic stress disorder (PTSD). However, little is known about IPV and its association with mental health among TGD young adults. This is noteworthy, as this is a key developmental period for many TGD individuals. Methods Thus, the present study sought (1) to estimate the lifetime and past-year prevalence of several forms of general and identity-specific IPV among a sample of (N = 200) TGD young adults in New York City and (2) to assess the associations between IPV with recent symptoms of depression, anxiety, and PTSD. To address the study aims, a cross-sectional quantitative survey was conducted between July 2019 and March 2020. Results Regarding lifetime IPV, IA was most prevalent (57.0%), followed by sexual (40.0%), physical (38.5%), T-IPV (35.5%), and psychological IPV (32.5%). Regarding past-year IPV, psychological IPV was most common (29.0%), followed by IA (27.5%), physical (20.0%), T-IPV (14.0%), and sexual IPV (12.5%). Results of hierarchical regression models indicate that lifetime IA was related to depression, anxiety, and PTSD, while past-year T-IPV was only associated with depression. Conclusions Taken together, these findings suggest that IPV is highly prevalent among TGD young adults and that IPV - especially identity-specific forms - warrants additional attention from researchers, healthcare professionals, and policymakers, as it may place this population at risk for negative mental health outcomes.
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Affiliation(s)
- Christopher B. Stults
- Department of Psychology, Baruch College, City University of New York, 55 Lexington Ave, New York, NY 10010 USA
- Department of Psychology, The Graduate Center, City University of New York, New York, USA
| | - Stan Gao
- Department of Psychology, Baruch College, City University of New York, 55 Lexington Ave, New York, NY 10010 USA
| | | | - Jamie L. Taber
- Department of Psychology, Baruch College, City University of New York, 55 Lexington Ave, New York, NY 10010 USA
- Department of Psychology, The Graduate Center, City University of New York, New York, USA
| | - Savannah G. Lynn
- Department of Psychology, Baruch College, City University of New York, 55 Lexington Ave, New York, NY 10010 USA
| | - Walter Kaczetow
- Department of Psychology, The Graduate Center, City University of New York, New York, USA
| | - Gabin Lee
- Department of Psychology, Baruch College, City University of New York, 55 Lexington Ave, New York, NY 10010 USA
| | - Andrew Cruise
- Department of Psychology, Baruch College, City University of New York, 55 Lexington Ave, New York, NY 10010 USA
| | - Kristen D. Krause
- Department of Urban-Global Public Health, School of Public Health, Rutgers University, Newark, USA
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23
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Lampis J, De Simone S, Lasio D, Serri F. The Role of Family Support and Dyadic Adjustment on the Psychological Well-being of Transgender Individuals: An Exploratory Study. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2023:1-17. [PMID: 37363352 PMCID: PMC10166461 DOI: 10.1007/s13178-023-00817-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/06/2023] [Indexed: 06/28/2023]
Abstract
Introduction This study aimed to measure dyadic adjustment, social support, and psychological well-being. Methods A research protocol composed of the Dyadic Adjustment Scale, the Outcome Questionnaire 45.2, and the Multidimensional Scale of Perceived Social Support was administered to a sample of 109 Italian transgender individuals. Results Higher levels of global psychological distress, symptom severity, and interpersonal relationship distress were associated with lower levels of family support and dyadic adjustment. In addition, transgender women and younger transgender individuals reported higher levels of interpersonal relationship distress. Conclusions The results indicate that the support and acceptance of one's partner and family of origin play a crucial role in promoting well-being. It represents an important protective factor with respect to negative psychological health outcomes. Policy Implications The findings emphasize the need to develop specific clinical and social practices for transgender individuals and their families. Building family and partner-centered policies and programs is particularly important to enable transgender individuals to avoid paying the emotional and psychological costs associated with rejection and non-acceptance.
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Affiliation(s)
- Jessica Lampis
- Department of Education, Psychology, Philosophy, University of Cagliari, Via Is Mirrionis, 1, 09123 Cagliari, Italy
| | - Silvia De Simone
- Department of Education, Psychology, Philosophy, University of Cagliari, Via Is Mirrionis, 1, 09123 Cagliari, Italy
| | - Diego Lasio
- Department of Education, Psychology, Philosophy, University of Cagliari, Via Is Mirrionis, 1, 09123 Cagliari, Italy
| | - Francesco Serri
- Department of Education, Psychology, Philosophy, University of Cagliari, Via Is Mirrionis, 1, 09123 Cagliari, Italy
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24
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Kirakosian N, Stanton AM, McKetchnie SM, King D, Dolotina B, O'Cleirigh C, Grasso C, Potter J, Mayer KH, Batchelder AW. Suicidal Ideation Disparities Among Transgender and Gender Diverse Compared to Cisgender Community Health Patients. J Gen Intern Med 2023; 38:1357-1365. [PMID: 36650322 PMCID: PMC9844943 DOI: 10.1007/s11606-022-07996-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 12/23/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Transgender and gender diverse (TGD) individuals experience more severe psychological distress and may be at higher risk for suicide compared to cisgender individuals. The existing literature largely consists of small-sample studies that do not assess subgroup differences. OBJECTIVE To examine rates of self-reported suicidal ideation among four TGD groups compared to cisgender individuals. DESIGN Data were extracted from the electronic health records of patients receiving primary care at a community health center specializing in sexual and gender minority health. A logistic regression was used to examine the relationship between sociodemographic variables and the presence of current suicidal ideation. PARTICIPANTS 29,988 patients receiving care at a community health center in Northeastern US between 2015 and 2018. MAIN MEASURES Demographic questionnaire, 9-item Patient Health Questionnaire KEY RESULTS: Younger age, sexual and gender minority identity, and public/grants-based insurance were associated with significantly higher odds of suicidal ideation. Relative to cisgender men, transgender men (OR=2.08; 95% CI=1.29-3.36; p=.003), transgender women (OR=3.08; 95% CI=2.05-4.63; p<.001), nonbinary (NB) individuals assigned male at birth (AMAB; OR=3.55; 95% CI=1.86-6.77; p<001), and NB individuals assigned female at birth (AFAB; OR=2.49; 95% CI=1.52-4.07; p<001) all endorsed significantly higher odds of current suicidal ideation, controlling for age, race, ethnicity, sexual orientation, and insurance status. Larger proportions of transgender women (23.6%) and NB AMAB individuals (26.7%) reported suicidal ideation not only compared to cisgender men (6.1%) and women (6.6%), but also compared to transgender men (17.4%; χ2[5, n=25,959]=906.454, p<0.001). CONCLUSIONS TGD patients were at significantly increased risk of suicidal ideation, even after accounting for age, race, ethnicity, sexual orientation, and insurance status. Findings suggest distinct risk profiles by assigned sex at birth. Consistent assessment of and intervention for suicidal ideation should be prioritized in settings that serve TGD patients.
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Affiliation(s)
- Norik Kirakosian
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Amelia M Stanton
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Samantha M McKetchnie
- School of Social Work, Boston College, Newton, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Dana King
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Brett Dolotina
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Conall O'Cleirigh
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Chris Grasso
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Jennifer Potter
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Abigail W Batchelder
- The Fenway Institute, Fenway Health, Boston, MA, USA.
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
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25
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King WM, Gamarel KE, Iwamoto M, Suico S, Nemoto T, Operario D. Structural Needs, Substance Use, and Mental Health Among Transgender and Nonbinary Young Adults in the San Francisco Bay Area: Findings from the Phoenix Study. J Urban Health 2023; 100:190-203. [PMID: 36595118 PMCID: PMC9918689 DOI: 10.1007/s11524-022-00700-z] [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] [Accepted: 11/09/2022] [Indexed: 01/04/2023]
Abstract
Transgender and nonbinary (trans) young adults report high rates of substance use and adverse mental health outcomes; however, few studies have examined how social, economic, and legal factors may contribute to health inequities in this population. Guided by the structural vulnerability framework, this study sought to explore structural needs and whether these needs were associated with substance use and mental health outcomes among trans young adults. Between 2019 and 2021, 215 trans young adults aged 18-29 from San Francisco Bay Area were recruited into a longitudinal study. Baseline data were used to examine bivariate and multivariable associations between structural needs and substance use and mental health outcomes. There were bivariate differences in the number of structural needs by education, income source, incarceration history, and ethnicity, and the number of unmet structural needs was associated with education and income source. After adjusting for sociodemographics, the number of structural needs was associated with daily marijuana use (AOR 1.29, 95% CI: 1.10-1.49) and suicidal ideation (AOR 1.24, 95% CI: 1.06-1.45), and the number of unmet structural needs was associated with daily marijuana use (AOR 1.30, 95% CI: 1. 10-1.55) and depressive symptoms (β 2.00, 95% CI: 1.00-3.00). Additionally, both numbers of structural needs and unmet structural needs mediated the relationship between income source (traditional employment vs. other income only) and depressive symptoms (TIE β 2.51, 95% CI: 0.99-4.04; β 1.37, 95% CI: 0.23-2.52, respectively). Findings highlight a need for multisector efforts to address structural vulnerabilities among trans young adults.
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Affiliation(s)
- Wesley M King
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
| | - Kristi E Gamarel
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | | | | | | | - Don Operario
- Department of Behavioral, Social, and Health Education Sciences, Emory University, Atlanta, GA, USA
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26
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Rogers EM, Krajewski AT, Shuster SM. The Disproportionate Mental Health Burden Among Incarcerated Transgender and Gender Diverse People. JOURNAL OF CORRECTIONAL HEALTH CARE 2023; 29:39-46. [PMID: 36577007 DOI: 10.1089/jchc.21.10.0109] [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: 12/30/2022]
Abstract
This article examines the distribution of self-reported mental health conditions and clinical contact among incarcerated transgender and gender diverse (TGD) individuals compared to cisgender women and men. Data are derived from the 2016 Survey of Prison Inmates. Results indicate that TGD respondents report more mental health symptoms, conditions, and clinical contact than their cisgender counterparts. The findings have important implications for the mental health disadvantages experienced by TGD people currently in prison.
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Affiliation(s)
- Ethan M Rogers
- Public Policy Center, University of Iowa, Iowa City, Iowa, USA
| | - Andrew T Krajewski
- School of Economic, Political and Policy Sciences, University of Texas-Dallas, Dallas, Texas, USA
| | - Stef M Shuster
- Lyman Briggs College and Department of Sociology, Michigan State University, East Lansing, Michigan, USA
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27
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Bilsky SA, Olson EK, Luber MJ, Petell JA, Friedman HP. An initial examination of the associations between appearance-related safety behaviors, socioemotional, and body dysmorphia symptoms during adolescence. J Adolesc 2022; 94:939-954. [PMID: 35821622 DOI: 10.1002/jad.12074] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 06/28/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Adolescence is characterized by the onset of a relatively specific set of socioemotional disorders (i.e., depression, generalized anxiety disorder, social anxiety disorder, and eating disorders) as well as body dysmorphia symptoms. Appearance-related concerns are a central feature of these disorders. Emerging evidence in adults suggests that appearance-related safety behaviors may play an instrumental role in the onset and maintenance of a number of disorders. To date, no work has examined appearance-related safety behaviors during adolescence. The present study examined the extent to which appearance-related safety behaviors may be associated with socioemotional and body dysmorphia symptoms during adolescence. METHODS Adolescents between the ages of 13 and 17 years old (N = 387, Mage = 14.82 years, 31.3% identified as male, 47.0% identified as female, and 19.1% identified as nonbinary/third gender, 2.6% declined to report gender identity) completed measures assessing negative affect, anxiety-relevant safety behavior use, cognitive reappraisal, expressive suppression, appearance-related safety behaviors, body dysmorphia symptoms, and socioemotional symptoms. Structural Equation Modeling was used to test hypotheses. RESULTS The results of this study suggest that appearance-related safety behaviors evidenced associations with latent factors corresponding to affective (i.e., depression, generalized anxiety disorder, social anxiety), eating disorders, and body dysmorphia symptoms after controlling for previously established vulnerability factors. CONCLUSIONS These findings demonstrate that appearance-related safety behaviors may evidence transdiagnostic associations with socioemotional symptoms and body dysmorphia symptoms during adolescence.
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Affiliation(s)
- Sarah A Bilsky
- Department of Psychology, University of Mississippi, Oxford, Mississippi, USA
| | - Emily K Olson
- Department of Psychology, University of Mississippi, Oxford, Mississippi, USA
| | - Maxwell J Luber
- Department of Psychology, University of Mississippi, Oxford, Mississippi, USA
| | - Jennifer A Petell
- Department of Psychology, University of Mississippi, Oxford, Mississippi, USA
| | - Hannah P Friedman
- Department of Psychology, University of Mississippi, Oxford, Mississippi, USA
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28
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Blakeman JR, Fillman VM. An Analysis of the Use of the Terms Sex and Gender in Research Reported in Nursing Journals. ANS Adv Nurs Sci 2022; 45:E110-E126. [PMID: 34879022 DOI: 10.1097/ans.0000000000000402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Accurately measuring and reporting the demographic characteristics of research participants are imperative to provide consumers of research with an understanding of who was included in a study. While researchers often, incorrectly, use the variables sex and gender interchangeably, these 2 variables are different. We conducted a content analysis of 239 randomly selected research articles, with the purpose of describing how researchers have used sex and gender in studies published in nursing journals and identifying opportunities for improved clarity and precision in measuring these 2 variables. We found that significant improvement is needed in the way these variables are used/reported.
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Affiliation(s)
- John R Blakeman
- Mennonite College of Nursing, Illinois State University, Normal
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29
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Evelyn S, Clancy EM, Klettke B, Tatnell R. A Phenomenological Investigation into Cyberbullying as Experienced by People Identifying as Transgender or Gender Diverse. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:6560. [PMID: 35682144 PMCID: PMC9180504 DOI: 10.3390/ijerph19116560] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 05/24/2022] [Accepted: 05/25/2022] [Indexed: 02/01/2023]
Abstract
Cyberbullying can present a serious risk for adolescents and young adults, with severe effects on victims including adverse mental health outcomes and increased risk of suicide. Transgender and gender diverse (TGD) individuals are significantly more likely to experience cyberbullying. However, little is presently known about the lived cyberbullying experiences of TGD adults despite the prevalence of cyberbullying experienced by the TGD community. TGD participants (n = 66, M = 24 years) were recruited through snowball sampling and completed an online questionnaire as part of a larger study, which included qualitative questions regarding cyberbullying. Participants reported that cyberbullying was experienced predominantly on social media sites and was largely anonymous. The content was often physically and sexually threatening and heavily transphobic. Additionally, some cyberbullying experienced by TGD individuals was perpetrated by other TGD individuals and focused on the identity policing and gatekeeping of TGD spaces. Participants reported cyberbullying evoked negative emotions, and they often responded by either arguing with or blocking the perpetrators, thereby demonstrating resilience. Some participants sought social support in response to cyberbullying, which acted as a protective factor. Findings reveal specific harms associated with cyberbullying as experienced by TGD individuals and highlight the need for further research and targeted support.
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Affiliation(s)
| | - Elizabeth M. Clancy
- School of Psychology, Deakin University, Geelong 3216, Australia; (S.E.); (B.K.); (R.T.)
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30
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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: 44] [Impact Index Per Article: 14.7] [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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31
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Silveri G, Schimmenti S, Prina E, Gios L, Mirandola M, Converti M, Fiorillo A, Pinna F, Ventriglio A, Galeazzi GM, Sherriff N, Zeeman L, Amaddeo F, Paribello P, Pinna F, Giallanella D, Gaggiano C, Ventriglio A, Converti M, Fiorillo A, Galeazzi GM, Marchi M, Arcolin E, Fiore G, Mirandola M, Schimmenti S, Silveri G, Prina E, Amaddeo F, Bragazzi NL. Barriers in care pathways and unmet mental health needs in LGBTIQ + communities. Int Rev Psychiatry 2022; 34:215-229. [PMID: 36151825 DOI: 10.1080/09540261.2022.2075256] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Lesbian, gay, bisexual, transgender, intersex, queer people and minority gender identities and sexualities (LGBTIQ+) are often stigmatized and experience discrimination in health care settings, leading to poorer mental health outcomes and unmet needs compared to heterosexual and cisgendered peers. It is thus imperative that mental health providers consider and address structural challenges in order to reduce mental health inequalities of this population. This narrative review assessed the barriers that may prevent access to care and the pathways for care in LGBTIQ + communities. PubMed, PsycInfo, Embase, and Scopus were searched for papers published between December 2021 and February 2022. A total of 107 papers were included with studies reflecting five themes: (1) Unmet mental health needs; (2) Young people; (3) Substance abuse and addiction; (4) Barriers and pathways to care; and (5) Interventions. Findings demonstrate that LGBTIQ + people experience stigmatization and higher rates of substance misuse and mental ill health, which may lead to barriers in accessing health care services, and fewer tailored interventions being provided. These findings have implications for policy, health care screening, and how specialist services are structured. Substantial gaps in the evidence-base exist, and future research should examine how mental health care providers can challenge social issues that maintain discriminatory and stigmatizing practices, and support LGBTIQ + individuals to sustain their resilience.
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Affiliation(s)
- Giada Silveri
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Simone Schimmenti
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Eleonora Prina
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, 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
| | | | - Andrea Fiorillo
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Federica Pinna
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Antonio Ventriglio
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Gian Maria Galeazzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Department of integrated activity of Mental Health and Pathological Dependencies, USL-IRCSS company of Reggio Emilia, Reggio Emilia, Italy
| | - Nigel Sherriff
- School of Sport and Health Sciences, University of Brighton, Brighton, UK.,Centre for Transforming Sexuality and Gender, University of Brighton, Brighton, UK
| | - Laetitia Zeeman
- School of Sport and Health Sciences, University of Brighton, Brighton, UK.,Centre for Transforming Sexuality and Gender, University of Brighton, Brighton, UK
| | - Francesco Amaddeo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | | | - Pasquale Paribello
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Federica Pinna
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Daniela Giallanella
- Department of Clinical and Experimental, University di Foggia, Foggia, Italy
| | - Costanza Gaggiano
- Department of Clinical and Experimental, University di Foggia, Foggia, Italy
| | - Antonio Ventriglio
- Department of Clinical and Experimental, University di Foggia, Foggia, Italy
| | | | - Andrea Fiorillo
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Gian Maria Galeazzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Mattia Marchi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Elisa Arcolin
- Department of Mental Health and Drug Abuse, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Gianluca Fiore
- Department of Mental Health and Drug Abuse, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Massimo Mirandola
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Simone Schimmenti
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Giada Silveri
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Eleonora Prina
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Francesco Amaddeo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Nicola Luigi Bragazzi
- Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, Ontario, Canada
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32
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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: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 06/21/2022] [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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Joshi N, Vinu V, Jois SN, Begum F, Salagame KK. The Need, Feasibility and Willingness to Explore "Meditation on Twin Hearts" as a Self-administered Tool for Mental Health Management among Transgender Women: An Exploratory Survey. Community Ment Health J 2022; 58:666-672. [PMID: 34255215 PMCID: PMC8276206 DOI: 10.1007/s10597-021-00869-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 06/27/2021] [Indexed: 11/30/2022]
Abstract
Hijras are the transgender community and have been socio-economically marginalized and hence their mental healthcare needs to be addressed. This was a descriptive, qualitative study, conducted in Mysore, India to examine the mental health status of 33 transgender women (TGW) and their response to the "Meditation on Twin Hearts (MTH)" intervention. Assessment of anxiety, depression and suicidality was carried out before the meditative session followed by a single session of MTH. Their feedback on meditation experience was collected, coded, and transformed into quantitative data. Among total participants, 39.4% of TGW exhibited severe anxiety, 21.2% has severe depression and 75.8% of them were at suicidal risk. Depression was positively correlated with anxiety and suicidal behavior. Most participants reported MTH was useful with signs of improvements in mental state. Thus, a single session of MTH has shown good signs of improvement in mental state among TGW.
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Affiliation(s)
- Neha Joshi
- Public Health Research Institute of India, Mysuru, India
| | - V. Vinu
- World Pranic Healing Foundation-India Research Center, Mysuru, India
| | - Srikanth N. Jois
- World Pranic Healing Foundation-India Research Center, Mysuru, India
| | - Fazila Begum
- Public Health Research Institute of India, Mysuru, India
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Cotaina M, Peraire M, Boscá M, Echeverria I, Benito A, Haro G. Substance Use in the Transgender Population: A Meta-Analysis. Brain Sci 2022; 12:366. [PMID: 35326322 PMCID: PMC8945921 DOI: 10.3390/brainsci12030366] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/03/2022] [Accepted: 03/08/2022] [Indexed: 02/06/2023] Open
Abstract
(1) Background: This meta-analysis aimed to assess the relationship between identifying as transgender and substance use. (2) Methods: We searched for relevant studies in PubMed, Scopus, the Web of Science, and PsycINFO on 21 July 2021. (3) Results: Twenty studies comparing transgender and cisgender people were included in this work, accounting for a total of 2,376,951 participants (18,329 of whom were transgender). These articles included data on current tobacco use, current tobacco use disorder, current alcohol use, current alcohol use disorder, lifetime substance (all) use, current substance use (excluding tobacco and alcohol), current use of specific substances (excluding tobacco and alcohol and including cocaine, amphetamines, methamphetamines, ecstasy, stimulants, heroin, opiates, cannabis, marijuana, LSD, hallucinogens, steroids, inhalants, sedatives, Ritalin or Adderall, diet pills, cold medicine, prescription medications, polysubstance, other club drugs, and other illegal drugs), and current substance use disorder (excluding tobacco and alcohol). We used the ORs and their 95% CIs to state the association between identifying as transgender and those variables. The control reference category used in all cases was cisgender. We employed a random-effects model. Transgender people were more likely to use tobacco (odds ratio (OR) = 1.65; 95% CI [1.37, 1.98]), have used substances throughout their lives (OR = 1.48; 95% CI [1.30, 1.68]), and present current use of specific substances (OR = 1.79; 95% CI [1.54, 2.07]). When current alcohol and substance use in general and tobacco, alcohol, and substance use disorders specifically were considered, the likelihood did not differ from that of cisgender people. (4) Conclusions: The presence of substance use disorders did not differ between transgender and cisgender people. Considering this population as consumers or as addicted may be a prejudice that perpetuates stigma. Nonetheless, transgender people were more likely to use tobacco and other substances, but not alcohol. Hypothetically, this might be an emotional regulation strategy, a maladaptive mechanism for coping with traumatic experiences, or could respond to minority stress, produced by stigma, prejudice, discrimination, and harassment. It is of particular importance to implement policies against discrimination and stigmatisation and to adapt prevention and treatment services so that they are inclusive of the 2SLGBTQIA+ community.
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Affiliation(s)
- Miriam Cotaina
- TXP Research Group, Universidad Cardenal Herrera-CEU, CEU Universities, 12006 Castellon de la plana, Spain; (M.C.); (M.P.); (I.E.); (G.H.)
- Department of Mental Health, Consorcio Hospitalario Provincial de Castellón, 12002 Castellon de la plana, Spain;
| | - Marc Peraire
- TXP Research Group, Universidad Cardenal Herrera-CEU, CEU Universities, 12006 Castellon de la plana, Spain; (M.C.); (M.P.); (I.E.); (G.H.)
- Department of Mental Health, Consorcio Hospitalario Provincial de Castellón, 12002 Castellon de la plana, Spain;
| | - Mireia Boscá
- Department of Mental Health, Consorcio Hospitalario Provincial de Castellón, 12002 Castellon de la plana, Spain;
| | - Iván Echeverria
- TXP Research Group, Universidad Cardenal Herrera-CEU, CEU Universities, 12006 Castellon de la plana, Spain; (M.C.); (M.P.); (I.E.); (G.H.)
- Department of Mental Health, Consorcio Hospitalario Provincial de Castellón, 12002 Castellon de la plana, Spain;
| | - Ana Benito
- TXP Research Group, Universidad Cardenal Herrera-CEU, CEU Universities, 12006 Castellon de la plana, Spain; (M.C.); (M.P.); (I.E.); (G.H.)
- Torrente Mental Health Unit, Hospital General de Valencia, 46900 Torrente, Spain
| | - Gonzalo Haro
- TXP Research Group, Universidad Cardenal Herrera-CEU, CEU Universities, 12006 Castellon de la plana, Spain; (M.C.); (M.P.); (I.E.); (G.H.)
- Department of Mental Health, Consorcio Hospitalario Provincial de Castellón, 12002 Castellon de la plana, Spain;
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Pachankis JE, Soulliard ZA, Morris F, Seager van Dyk I. A Model for Adapting Evidence-Based Interventions to Be LGBQ-Affirmative: Putting Minority Stress Principles and Case Conceptualization into Clinical Research and Practice. COGNITIVE AND BEHAVIORAL PRACTICE 2022. [DOI: 10.1016/j.cbpra.2021.11.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Carlson KJ, Irwin JA, Dowdall JR, Figy SC, Amoura NJ. Integrated Comprehensive Care for Transcare and Gender Diverse Clinic Patients: An Assessment of Physical, Mental, and Social Needs. Cureus 2021; 13:e20544. [PMID: 35070571 PMCID: PMC8765569 DOI: 10.7759/cureus.20544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2021] [Indexed: 11/05/2022] Open
Abstract
Introduction There is a large body of research reporting the healthcare needs of groups identifying as lesbian, gay, bisexual, transgender, and/or queer (LGBTQ); however, a gap exists in the research literature because many epidemiological studies focus on sexual orientation rather than gender identify/incongruence. To address the lack of specific data from transgender and gender diverse (TGD) individuals, our organization designed and deployed a survey to assess the gender-affirming physical, mental, and social care needs of current patients. Methods A group of subspecialty physicians currently working with TGD patients created a list of questions and requested feedback from medical professionals familiar with the healthcare needs of this population. In addition, patients reviewed the survey for content and clarity. The final 68-item survey was distributed in April 2020 to patients or patients' representatives with an email address on file at the Nebraska Medicine Transgender Care Clinic (NMTCC). Participants were asked to respond to questions regarding their gender identity, their transition-related medical decisions, and their interest in services. Results Invitations were sent to 690 patients and 168 surveys were completed (response rate: 24.3%). Over 90% (n = 153) of the participants were patients and 9% (n = 15) answered survey questions on the patient’s behalf. A majority (77.2%) had started the medical transition (hormones or puberty blockers) in the past four years. Nearly half (46.4%) identified as trans women, 43.4% identified as trans men, and 10.2% indicated they were nonbinary or gender expansive. Participants' sex assigned at birth was 50.9% female and 46.1% male. Most patients (n = 149; 92%) reported currently receiving hormone treatment within the Nebraska Medicine healthcare system. Results indicated the highest level of clinical services interest was primary care (38.4%), gender-affirming surgery (73.5%), voice therapy (49.0%), and hair removal (37.5%). In addition, participants were very likely to participate in support groups with "people of similar gender identity" (32.9%), with "others around my age" (28.6%), and "including a mix of ages and identities" (26.9%). Discussion This study suggests that our TGD patients would utilize integrated services to access a variety of clinical and non-clinical services. Ongoing community engagement and direct feedback from patients are critical to the success and growth of our gender-affirming care clinic. The results of this study will inform the planning and further evolution of a program designed to build trust and address health inequities for TGD individuals throughout the region.
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The influence of sex, gender, age, and ethnicity on psychosocial factors and substance use throughout phases of the COVID-19 pandemic. PLoS One 2021; 16:e0259676. [PMID: 34807908 PMCID: PMC8608308 DOI: 10.1371/journal.pone.0259676] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 10/24/2021] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES The SARS-CoV-2 (COVID-19) pandemic has had profound physical and mental health effects on populations around the world. Limited empirical research has used a gender-based lens to evaluate the mental health impacts of the pandemic, overlooking the impact of public health measures on marginalized groups, such as women, and the gender diverse community. This study used a gender-based analysis to determine the prevalence of psychosocial symptoms and substance use (alcohol and cannabis use in particular) by age, ethnicity, income, rurality, education level, Indigenous status, and sexual orientation. METHODS Participants in the study were recruited from previously established cohorts as a part of the COVID-19 Rapid Evidence Study of a Provincial Population-Based Cohort for Gender and Sex (RESPPONSE) study. Those who agreed to participate were asked to self-report symptoms of depression, anxiety, pandemic stress, loneliness, alcohol use, and cannabis use across five phases of the pandemic as well as retrospectively before the pandemic. RESULTS For all psychosocial outcomes, there was a significant effect of time with all five phases of the pandemic being associated with more symptoms of depression, anxiety, stress, and loneliness relative to pre-COVID levels (p < .0001). Gender was significantly associated with all outcomes (p < .0001) with men exhibiting lower scores (i.e., fewer symptoms) than women and gender diverse participants, and women exhibiting lower scores than the gender diverse group. Other significant predictors were age (younger populations experiencing more symptoms, p < .0001), ethnicity (Chinese/Taiwanese individuals experiencing fewer symptoms, p = .005), and Indigenous status (Indigenous individuals experiencing more symptoms, p < .0001). Alcohol use and cannabis use increased relative to pre-pandemic levels, and women reported a greater increase in cannabis use than men (p < .0001). CONCLUSIONS Our findings highlight the need for policy makers and leaders to prioritize women, gender-diverse individuals, and young people when tailoring public health measures for future pandemics.
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D’Angelo AB, Argenio K, Westmoreland DA, Appenroth MN, Grov C. Health and Access to Gender-Affirming Care During COVID-19: Experiences of transmasculine individuals and men assigned female sex at birth. Am J Mens Health 2021; 15:15579883211062681. [PMID: 34861796 PMCID: PMC8646200 DOI: 10.1177/15579883211062681] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 10/29/2021] [Accepted: 11/03/2021] [Indexed: 01/26/2023] Open
Abstract
Since the onset of the COVID-19 pandemic, global research has suggested that the pandemic has negatively affected lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ) populations, including by limiting health care access. There is little research on the impact of COVID-19 among transmasculine persons and men assigned female sex at birth (AFAB) in the United States, who face unique health care challenges outside of the pandemic context. Between May and June of 2020, 20 transmasculine individuals and AFAB men who have sex with men participated in semi-structured interviews about their experiences during the early months of the COVID-19 pandemic. Participants were asked how the pandemic affected their access to health care, overall health, and well-being. Interviews were analyzed using an inductive, thematic approach. Participants reported reduced access to in-person health care, which in some cases meant overdue hormone-related bloodwork and unmet health care needs. Most participants reported that they were able to maintain their testosterone regimen, although some were concerned about future access, citing anxiety about potential shortages. Three participants reported canceled or deferred gender-affirming procedures, which they were uncertain would be rescheduled soon. Participants generally reported that the expansion of telehealth improved access to care, particularly for gender-affirming psychotherapy that was otherwise inaccessible or inconvenient prior to the pandemic. Other salient themes include the pandemic's impact on health behaviors and daily routines. Although the COVID-19 pandemic created new challenges for maintaining health, it also expanded access to gender-affirming health care, largely through the expansion of telehealth. Our findings provide new insights for supporting the health of transmasculine individuals and AFAB men.
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Affiliation(s)
- Alexa B. D’Angelo
- The City University of New York Graduate School of Public Health and Health Policy, New York, NY, USA
- The City University of New York Institute for Implementation Science in Population Health, New York, NY, USA
| | - Kira Argenio
- The City University of New York Graduate School of Public Health and Health Policy, New York, NY, USA
| | - Drew A. Westmoreland
- The City University of New York Graduate School of Public Health and Health Policy, New York, NY, USA
- The City University of New York Institute for Implementation Science in Population Health, New York, NY, USA
| | - Max N. Appenroth
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christian Grov
- The City University of New York Graduate School of Public Health and Health Policy, New York, NY, USA
- The City University of New York Institute for Implementation Science in Population Health, New York, NY, USA
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McGuire FH, Carl A, Woodcock L, Frey L, Dake E, Matthews DD, Russell KJ, Adkins D. Differences in Patient and Parent Informant Reports of Depression and Anxiety Symptoms in a Clinical Sample of Transgender and Gender Diverse Youth. LGBT Health 2021; 8:404-411. [PMID: 34388043 DOI: 10.1089/lgbt.2020.0478] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Purpose: We assessed characteristics of patients at a pediatric gender clinic and investigated if reports of mental health concerns provided by transgender and gender diverse (TGD) youth patients differed from reports provided by a parent informant on their behalf. Methods: This cross-sectional study included 259 TGD patients 8 to 22 years of age attending a pediatric gender clinic in the southeast United States from 2015 to 2020. Pearson correlations and paired sample t-tests compared patient-reported mental health concerns at patient intake with those provided by a parent informant. Clinical symptom severity was assessed with standardized T-scores. Level 2 Patient-Reported Outcomes Measurement Information System (PROMIS) Emotional Distress-Depression Scale and Level 2 PROMIS Emotional Distress-Anxiety Scale assessed depression and anxiety symptoms of patients. Diagnostic and Statistical Manual of Mental Disorders Fifth Edition Parent/Guardian-Rated Level 1 Cross-Cutting Symptom Measure was used with parents. Results: Patients had a mean age of 14.9 at first visit, with most identifying as White (85.5%), non-Hispanic (91.1%), and as a boy or man (63.6%). Half had moderate-to-severe depression (51.2%) or anxiety (47.9%) symptoms. There was a moderate, positive correlation between patient-reported and parent-reported depression symptoms, with no correlation for anxiety symptoms. Informant type differences were statistically significant (patients reporting greater depression and anxiety symptoms). Conclusions: TGD youth patients reported more severe depression and anxiety symptoms compared with parent informants. Despite moderate agreement on depression symptoms, parents did not accurately detect their child's anxiety symptoms. These discrepancies highlight a need for interventions which increase parental recognition of child mental health status.
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Affiliation(s)
- F Hunter McGuire
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Alexandra Carl
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Lindsay Woodcock
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Lauren Frey
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Emily Dake
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Derrick D Matthews
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Kristen J Russell
- Clinical Social Work Division, Department of Case Management, Duke University Medical Center, Durham, North Carolina, USA
| | - Deanna Adkins
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
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Coakley KE, Le H, Silva SR, Wilks A. Anxiety is associated with appetitive traits in university students during the COVID-19 pandemic. Nutr J 2021; 20:45. [PMID: 33985515 PMCID: PMC8118620 DOI: 10.1186/s12937-021-00701-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 04/27/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND COVID-19 has impacted mental health globally, however, associations between anxiety and appetitive traits during the pandemic are unreported. This study evaluated anxiety symptom severity and associations with appetitive traits in students at a large public University in the U.S. during the pandemic. METHODS Current undergraduate and graduate/professional students completed a cross-sectional survey in fall 2020. Demographic information, anxiety symptoms in the past 2 weeks assessed by the Generalized Anxiety Disorder Scale (GAD-7), and appetitive traits assessed by the Adult Eating Behavior Questionnaire (AEBQ) were evaluated. Mean scores for eight AEBQ scales (four food approach and four food avoidance traits) were calculated. Differences in mean scores were examined between participants with moderate to severe anxiety symptoms (GAD-7 score ≥ 10) and those with mild to no anxiety symptoms (GAD-7 score < 10) via independent samples t-tests and effect sizes. Associations between GAD-7 score and individual appetitive traits were also examined, adjusting for age and gender. RESULTS Of the 1243 students who completed the survey (57% undergraduates; mean age = 26.5 years), 51.9% reported moderate to severe anxiety symptoms. Groups experiencing the highest degree of moderate to severe anxiety symptoms included transgender, gender fluid, and other-gendered participants (73.6%); the youngest age group [18-20 years (62%)]; undergraduate students (60.7%); and Hispanic/Latinx participants (57.7%). Participants with moderate to severe anxiety symptoms had higher scores for most food approach and avoidance traits but lower scores for enjoyment of food than those with mild to no anxiety symptoms. Effect sizes were largest for hunger and emotional over-eating (Cohen's d = 0.31 and 0.30, respectively). Adjusting for age and gender, GAD-7 score was significantly and positively associated with hunger, emotional over-eating, food and satiety responsiveness, and food fussiness and negatively associated with enjoyment of food. CONCLUSIONS Over half of students at a U.S. University reported moderate to severe anxiety symptoms during COVID-19. More severe anxiety symptoms were associated with increased hunger, emotional over-eating, and food and satiety responsiveness and decreased enjoyment of food. Universities must consider strategies to address anxiety, particularly in younger students; transgender, gender fluid, and students of other genders; and across race/ethnicities keeping in mind associations with appetitive traits.
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Affiliation(s)
- Kathryn E Coakley
- College of Education & Human Sciences, University of New Mexico, Albuquerque, NM, 87131, USA.
| | - Huyen Le
- College of Education & Human Sciences, University of New Mexico, Albuquerque, NM, 87131, USA
| | - Spirit Rae Silva
- College of Education & Human Sciences, University of New Mexico, Albuquerque, NM, 87131, USA
| | - Aspen Wilks
- College of Education & Human Sciences, University of New Mexico, Albuquerque, NM, 87131, USA
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