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Greydanus DE, Nazeer A, Qayyum Z, Patel DR, Rausch R, Hoang LN, Miller C, Chahin S, Apple RW, Saha G, Prasad Rao G, Javed A. Pediatric suicide: Review of a preventable tragedy. Dis Mon 2024; 70:101725. [PMID: 38480023 DOI: 10.1016/j.disamonth.2024.101725] [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: 09/07/2024]
Abstract
Concepts of suicide are explored in this issue with a focus on suicide in children and adolescents. The epidemiology of pediatric suicide in the United States is reviewed; also, risk and protective factors, as well as prevention strategies, are discussed. Suicide in the pediatric athlete and the potential protective effect of exercise are examined. In addition, this analysis addresses the beneficial role of psychological management as well as current research on pharmacologic treatment and brain stimulation procedures as part of comprehensive pediatric suicide prevention. Though death by suicide in pediatric persons has been and remains a tragic phenomenon, there is much that clinicians, other healthcare professionals, and society itself can accomplish in the prevention of pediatric suicide as well as the management of suicidality in our children and adolescents.
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Affiliation(s)
- Donald E Greydanus
- Department of Pediatric and Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States.
| | - Ahsan Nazeer
- Division of Child and Adolescent Psychiatry, Sidra Medicine/Weill Cornell Medicine, Doha, Qatar
| | - Zheala Qayyum
- Harvard Medical School, Boston, Massachusetts, United States
| | - Dilip R Patel
- Department of Pediatric and Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Rebecca Rausch
- Division of Pediatric Psychology, Department of Pediatric and Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Linh-Nhu Hoang
- Western Michigan University, Kalamazoo, MI, United States
| | - Caroline Miller
- Fielding Graduate University, Santa Barbara, CA, United States
| | - Summer Chahin
- Mott Children's Hospital, University of Michigan, Ann Arbor, MI, United States
| | - Roger W Apple
- Division of Pediatric Psychology, Department of Pediatric and Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Gautam Saha
- Immediate Past President of the SAARC (South Asian Association for Regional Cooperation) Psychiatric Federation (SPF), India
| | - G Prasad Rao
- President, Asian Federation of Psychiatric Association (AFPA), India
| | - Afzal Javed
- Chairman Pakistan Psychiatric Research Centre, Immediate Past President of the World Psychiatric Association (WPA), Pakistan
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Iwatate E, Atem FD, Jones EC, Hughes JL, Yokoo T, Messiah SE. Trends in the relationship between suicide behaviors and obesity among adolescents in the United States from 1999 to 2019. Eur Child Adolesc Psychiatry 2024; 33:725-737. [PMID: 36933151 DOI: 10.1007/s00787-023-02191-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 03/08/2023] [Indexed: 03/19/2023]
Abstract
Previous studies indicate that obesity is a risk factor of suicide behaviors among adolescents. Whether this association has remained consistent during the ongoing obesity epidemic remains unknown. The time trends of the obesity-suicide association were examined using the 1999-2019 biannual Youth Risk Behavior Survey data (n = 161,606). Prevalence odds ratio of suicide behaviors among adolescents with obesity (vs. adolescents with no obesity) for each survey year and time trends using National Cancer Institute Joinpoint regression analysis was calculated. For each year post-baseline, there was a significant increase of prevalence odds ratio of 1.4 (1.2-1.6)-1.6 (1.3-2.0) for suicide ideation, 1.3 (1.1-1.7) -1.7 (1.4-2.0) for plan, and 1.3 (1.0-1.7) -1.9 (1.5-2.4) for an attempt, except for the 2013 survey for attempt (1.19 [0.9-1.6]). Significant positive trends were found from1999 to 2019 for ideation and plan, with biannual %-changes of + 0.92 and + 1.22%, respectively. Adolescents with obesity have consistently higher odds of engaging in suicide behaviors than their peers without obesity since the beginning of the United States obesity epidemic, and this association grew stronger as the obesity epidemic continued.
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Affiliation(s)
- Eriko Iwatate
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas Regional Campus, Trinity Towers, 2777 N Stemmons Fwy, Dallas, TX, 75207, USA.
| | - Folefac D Atem
- Department of Biostatistics and Data Science, School of Public Health, The University of Texas Health Science Center at Houston (UTHealth, Dallas Regional Campus, Dallas, TX, USA
- Center for Pediatric Population Health, Children's Health System of Texas and UTHealth School of Public Health, Dallas, TX, USA
| | - Eric C Jones
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, El Paso Regional Campus, El Paso, TX, USA
| | - Jennifer L Hughes
- Department of Psychiatry and Behavioral Health, College of Medicine and Division of Health Behavior and Health Promotion, College of Public Health, Big Lots Behavioral Health Services, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA
| | - Takeshi Yokoo
- Department of Radiology, University of Texas Southwestern, Dallas, TX, USA
| | - Sarah E Messiah
- Department of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas Regional Campus, Trinity Towers, 2777 N Stemmons Fwy, Dallas, TX, 75207, USA
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Goldbach JT, Schrager SM, Mamey MR, Klemmer C, Holloway IW, Castro CA. Development and Validation of the Military Minority Stress Scale. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6184. [PMID: 37372770 DOI: 10.3390/ijerph20126184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 06/07/2023] [Accepted: 06/15/2023] [Indexed: 06/29/2023]
Abstract
Despite affecting nearly 3% of active-duty service members, little is known about how LGBT-related stress experiences may relate to health outcomes. Thus, the present study sought to create a Military Minority Stress Scale and assess its initial reliability and construct validity in a cross-sectional study of active-duty LGBT service members (N = 248). Associations between 47 candidate items and health outcomes of interest were analyzed to retain those with substantial betas. Item response theory analyzes, reliability testing, invariance testing, and exploratory factor analysis were performed. Construct validity of the final measure was assessed through associations between the sum score of the final measure and the health outcomes. The final 13-item measure demonstrated an excellent reliability (ω = 0.95). Bivariate linear regressions showed significant associations between the sum score of the measure and overall health (β = -0.26, p < 0.001), overall mental health (β = -0.34, p < 0.001), physical health (β = 0.45, p < 0.001), life satisfaction (β = -0.24, p < 0.001), anxiety (β = 0.34, p < 0.001), depressive symptoms (β = 0.37, p < 0.001), suicidality (β = 0.26, p < 0.001), and PTSD (β = 0.42, p < 0.001), respectively. This study provides the first evidence that minority stressors in the military setting can be operationalized and measured. They appear to have a role in the health of LGBT service members and may explain the continued health disparities experienced by this population. Little is known regarding the experiences of LGBT active-duty service members, including experiences of discrimination. Understanding these experiences and their associated health outcomes during military service may therefore help and guide further etiological studies and intervention development.
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Affiliation(s)
- Jeremy T Goldbach
- The Brown School, Washington University in St. Louis, St. Louis, MO 63130, USA
| | - Sheree M Schrager
- Department of Graduate Studies and Research, California State University, Dominguez Hills, Carson, CA 90747, USA
| | | | - Cary Klemmer
- Sexuality, Relationship, Gender Research Collective, University of Michigan, Ann Arbor, MI 48109, USA
| | - Ian W Holloway
- Department of Social Welfare, Luskin School of Public Affairs, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Carl A Castro
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA 90089, USA
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Kar SK, Menon V, Mukherjee S, Bascarane S, Sharma G, Pattnaik JI, Ransing R, Padhy SK, Agarwal V. Suicide reporting of LGBTQI+ population in India: An analysis of online media reports of the past decade. J Public Health (Oxf) 2023; 45:e95-e103. [PMID: 34747474 DOI: 10.1093/pubmed/fdab378] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 09/21/2021] [Accepted: 10/09/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Imbalanced portrayal of suicide by the media can have adverse public health consequences. We aimed to evaluate the psychosocial context, as well as the quality of media reporting, of suicide among lesbian, gay, bisexual, transgender people, queer and intersex (LGBTQI+) population. METHODS A cross-sectional study was conducted to evaluate online news reports discussing the suicide of LGBTQI+ persons published between January 2011 and January 2021. Psychosocial factors associated with suicide were extracted from the reports. Quality of suicide reporting was checked against international as well as locally relevant reporting guidelines. RESULTS A total of 135 suicide reports from five newspapers were analyzed. Multiple psychosocial stressors were reported in 54.5% of the suicides. Social stigma was the most common factor associated with LGBTQI+ suicide. Several breaches of reporting were noted in relation to mentioning the identity (55.6%) and method of suicide (54.3%) in the title of report and inclusion of the deceased's photograph (20.4%). Potentially helpful reporting characteristics, such as including educational information (2.2%), mentioning warning signs (12.6%) and suicide support service details (3.7%), were rarely practiced. Local language news articles displayed more frequent and serious violations compared to English news reports. CONCLUSION Indian media reporting of suicide among LGBTQI+ persons is poorly adherent to reporting guidelines.
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Affiliation(s)
- Sujita Kumar Kar
- Department of Psychiatry, King George's Medical University, Lucknow, Uttar Pradesh 226003, India
| | - Vikas Menon
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry 605006, India
| | - Srijeeta Mukherjee
- Department of Psychiatry, M.K.C.G. Medical College, Brahmapur, Ganjam, Odisha 760004, India
| | - Sharmi Bascarane
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry 605006, India
| | - Ginni Sharma
- Department of Psychiatry, King George's Medical University, Lucknow, Uttar Pradesh 226003, India
| | - Jigyansa Ipsita Pattnaik
- Department of Psychiatry, Kalinga Institute of Medical College (KIMS) KIIT University, Bhubaneswar, Odisha 751024, India
| | - Ramdas Ransing
- Department of Psychiatry, BKL Walalwalkar Rural Medical College, Ratnagiri, Maharashtra 415606, India
| | - Susanta Kumar Padhy
- Department of Psychiatry, All India Institute of Medical Sciences, Bhubaneswar, Odisha 751019, India
| | - Vivek Agarwal
- Department of Psychiatry, King George's Medical University, Lucknow, Uttar Pradesh 226003, India
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Wetmore JB, Jordan AE. Changes in General Health and Mental Health Outcomes in an Urban Population Over a Decade: A Population-Representative Analysis Stratified by Sexual Orientation. LGBT Health 2022; 9:512-519. [PMID: 35877080 PMCID: PMC11391887 DOI: 10.1089/lgbt.2021.0217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: We explored population-level changes in general and mental health outcomes among sexual minority and heterosexual New York City (NYC) adults. Methods: Using the NYC Health and Nutrition Examination Surveys, we analyzed data from 2931 adults surveyed between 2004 and 2014. Sexual minority (LGB+) participants included those who identified as lesbian, gay, bisexual, something else, or not sure. Prevalence estimates of general health, mental health services use, prescription use for a mental/emotional condition, and mental/emotional disability were calculated. Changes in these estimates were compared across survey iterations with two-sided t-tests. Multivariate log binomial regression modeling was also employed. Results: Across the study period, LGB+ adults reported a decrease in fair/poor general health (24%-18%). Compared to 2004, LGB+ adults in 2014 were more likely to use mental health services (15%-27%), take prescription medication for a mental/emotional condition (11%-20%), and have a mental/emotional disability limiting work (5%-10%). Point estimates showed similar changes over time among both LGB+ and heterosexual adults, but some changes were not statistically significant. We also found that bisexual adults utilized mental health services (prevalence ratio [PR] = 2.15; 95% confidence interval [CI]: 1.34-3.44) and medications (PR = 2.92; 95% CI: 1.72-4.96) more than heterosexual adults. Conclusion: Although reporting fair/poor general health decreased, the prevalence of using mental health services, using prescription medication, and having a mental/emotional disability increased for both LGB+ and heterosexual adults in NYC. These findings may be related to greater mental health literacy and awareness or to other population-wide trends.
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Affiliation(s)
- John B Wetmore
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York, New York, New York, USA
| | - Ashly E Jordan
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York, New York, New York, USA
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Querdasi FR, Bacio GA. Suicidal behaviors among Latina adolescents: An ecodevelopmental approach and narrative review. J Adolesc 2021; 93:161-176. [PMID: 34785380 DOI: 10.1016/j.adolescence.2021.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 08/10/2021] [Accepted: 10/31/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION For the past several decades, Latina adolescents have consistently shown high rates of suicidal behaviors (i.e., suicidal ideation, planning, and attempts), higher than Latino adolescents and adolescents of most other ethnic groups. Yet, progress toward establishing evidence-based intervention efforts to address this urgent public health issue has been slow. The purpose of this narrative review is to summarize empirical findings on etiological factors associated with Latina adolescent suicidal behaviors using an ecodevelopmental, gender-specific framework that contextualizes Latina adolescent development. METHODS To be included, peer reviewed empirical manuscripts had to focus on suicidal behaviors (i.e., suicide attempts, suicide plan, and/or suicidal ideation) of adolescents (ages 11-19 or in grades 7-12) who self-identified as either Latina or Hispanic and a girl in the United States. RESULTS A total of 19 studies met review criteria and focused on microsystemic and intrapersonal predictors. Microsystemic predictors included family (i.e., family-adolescent discrepancies in acculturation, family functioning, family-daughter interactions), peer (i.e., victimization, friendships), and school (i.e., functioning, achievement) factors, while intrapersonal predictors were emotional vulnerability, psychosocial functioning, and substance use. CONCLUSIONS Family-related phenomena were the most widely studied. Research on school and peer microsystems was comparatively sparse, and several promising intrapersonal development factors have been underexplored. A notable limitation of existing studies is that samples consisted primarily of U.S.-born adolescents living in urban areas. Additional research is needed to characterize factors on other ecodevelopmental levels, identify resilience processes, and examine within-group diversity among Latina adolescents. Implications for intervention and future directions are discussed.
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Affiliation(s)
- Francesca R Querdasi
- Department of Psychology, Stanford University, 450 Jane Stanford Way, Stanford, CA, 94305, USA.
| | - Guadalupe A Bacio
- Departments of Psychological Science and Intercollegiate Chicana/o-Latina/o Studies, Pomona College, 647 N College Way, Claremont, CA, 91711, USA.
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O'Reilly LM, Pettersson E, Donahue K, Quinn PD, Klonsky ED, Lundström S, Larsson H, Lichtenstein P, D'Onofrio BM. Sexual orientation and adolescent suicide attempt and self-harm: a co-twin control study. J Child Psychol Psychiatry 2021; 62:834-841. [PMID: 32924137 DOI: 10.1111/jcpp.13325] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 06/25/2020] [Accepted: 08/06/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Research has demonstrated that individuals who identify as a sexual minority (e.g., gay/lesbian, bisexual) are at increased risk for suicidality-related outcomes. However, previous research is primarily limited by the lack of adjustment for unmeasured (i.e., genetic and environmental) confounding factors and previous psychopathology. METHODS Using the Child and Adolescent Twin Study in Sweden, we employed a co-twin control design to examine the extent to which the association between sexual orientation and adolescent suicide attempt and self-harm (SA/SH) was independent of genetic and environmental factors shared by twins, as well as measured symptoms of childhood psychopathology. RESULTS Adolescents who identified as a sexual minority (i.e., gay/lesbian, bisexual, or other sexual orientation) were at two-fold increased odds for SA/SH (OR, 2.01 [95% confidence interval, 1.63-2.49) compared to heterosexual adolescents. When adjusting for all genetic and shared environmental factors that make twins similar and for measured childhood psychopathology, the association remained positive but attenuated to OR, 1.55 (1.11-2.16). CONCLUSIONS Identifying as a sexual minority was associated with approximately 50% increased odds of SA/SH in adolescence after adjusting for unmeasured genetic and environmental factors shared by twins and for childhood psychopathology. The results support that environmental factors specifically associated with identifying as a sexual minority likely increase risk for SA/SH. Our findings highlight the need to monitor suicidality risk among this group.
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Affiliation(s)
- Lauren M O'Reilly
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA
| | - Erik Pettersson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Kelly Donahue
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Patrick D Quinn
- Department of Applied Health Science, School of Public Health, Indiana University, Bloomington, IN, USA
| | - E David Klonsky
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Sebastian Lundström
- Department of Psychiatry and Neurochemistry, University of Gothenburg, Gothenburg, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Brian M D'Onofrio
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Williams AJ, Jones C, Arcelus J, Townsend E, Lazaridou A, Michail M. A systematic review and meta-analysis of victimisation and mental health prevalence among LGBTQ+ young people with experiences of self-harm and suicide. PLoS One 2021; 16:e0245268. [PMID: 33481862 PMCID: PMC7822285 DOI: 10.1371/journal.pone.0245268] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 12/26/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND LGBTQ+ youth have higher rates of self-harm and suicide than cisgender, heterosexual peers. Less is known about prevalence of risks within these populations. OBJECTIVES The first systematic review and meta-analysis to investigate the prevalence of risks among young people throughout the LGBTQ+ umbrella with experiences across the dimension of self-harm, suicidal ideation and suicide behaviour; and how they may differ between LGBTQ+ umbrella groups. DATA SOURCES MEDLINE, Scopus, EMBASE, PsycINFO, and Web of Science searches were run to identify quantitative research papers (database inception to 31st January, 2020). STUDY ELIGIBILITY CRITERIA Articles included were empirical quantitative studies, which examined risks associated with self-harm, suicidal ideation or suicidal behaviour in LGBTQ+ young people (12-25 years). SYNTHESIS METHODS 2457 articles were identified for screening which was completed by two independent reviewers. 104 studies met inclusion criteria of which 40 had data which could be meta-analysed in a meaningful way. This analysis represents victimisation and mental health difficulties as risks among LGBTQ+ youth with self-harm and suicide experiences. Random-effects modelling was used for the main analyses with planned subgroup analyses. RESULTS Victimisation and mental health were key risk factors across the dimension self-harm and suicide identified through all analyses. A pooled prevalence of 0.36 was indicated for victimisation and 0.39 for mental health difficulties within LGBTQ+ young people with experiences of self-harm or suicide. Odds ratios were calculated which demonstrated particularly high levels of victimisation (3.74) and mental health difficulties (2.67) when compared to cisgender, heterosexual counterparts who also had these experiences. CONCLUSIONS Victimisation and mental health difficulties are highly prevalent among LGBTQ+ youth with experiences of self-harm and suicide. Due to inconsistency of reporting, further risk synthesis is limited. Given the global inclusion of studies, these results can be considered across countries and inform policy and suicide prevention initiatives. PROSPERO REGISTRATION NUMBER CRD42019130037.
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Affiliation(s)
- A. Jess Williams
- School of Psychology, Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom
- School of Psychology, Self-Harm Research Group, University of Nottingham, Nottingham, United Kingdom
| | - Christopher Jones
- School of Psychology, Centre for Applied Psychology, University of Birmingham, Birmingham, United Kingdom
| | - Jon Arcelus
- School of Medicine, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Ellen Townsend
- School of Psychology, Self-Harm Research Group, University of Nottingham, Nottingham, United Kingdom
| | - Aikaterini Lazaridou
- School of Psychology, Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom
| | - Maria Michail
- School of Psychology, Institute for Mental Health, University of Birmingham, Birmingham, United Kingdom
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Qi R, Palmier‐Claus J, Simpson J, Varese F, Bentall R. Sexual minority status and symptoms of psychosis: The role of bullying, discrimination, social support, and drug use - Findings from the Adult Psychiatric Morbidity Survey 2007. Psychol Psychother 2020; 93:503-519. [PMID: 31343817 PMCID: PMC7496804 DOI: 10.1111/papt.12242] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 04/16/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Sexual minorities have an increased risk of psychosis, potentially explained by experiences of social adversity. Sexual minorities may also have a specific risk of paranoid symptoms. The current study aimed to determine whether sexual minorities have increased risk of psychosis, whether they have a specific increased risk of paranoia when compared to auditory verbal hallucinations (AVHs), and whether social adversity such as bullying, recent discrimination, lack of social support, and drug use can explain this risk. METHODS The study used data from the Adult Psychiatric Morbidity Survey 2007 (n = 7,403), exploring both sexual identity and past sexual behaviour. Associations between sexual minority status and probable psychosis, paranoia, and AVH were analysed using logistic regression. Mediation analysis was also conducted using the Karlson-Holm-Breen method, with bullying, recent discrimination, social support, and drug use as mediators assessing pathways between sexual minority status and paranoia/AVH. Socio-demographic confounders were included in analyses. RESULTS Sexual minority status did not significantly predict probable psychosis. Findings generally indicated a specific association between sexual minority status and paranoia when contrasted with AVH. However, sexual behaviour remained significantly associated with AVH in logistic regression models. Bullying, lack of social support, and drug use partially mediated the association between sexual minority status and paranoia. CONCLUSIONS Sexual minority status appears to have a specific association with paranoia symptoms, which may be partially explained by experiences of social adversity. However, the cross-sectional nature of the study limits direct inference about causality of such symptoms. PRACTITIONER POINTS Sexual minority groups may be more likely to experience symptoms of paranoia. It may be important to consider experiences of social adversity such as bullying, lack of social support, and also history of drug use in the context of paranoia within these groups.
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Affiliation(s)
- Robert Qi
- Institute of Health and Life SciencesUniversity of LiverpoolUK
| | - Jasper Palmier‐Claus
- Spectrum Centre for Mental Health ResearchLancaster UniversityUK,Lancashire Care NHS Foundation TrustUK
| | | | - Filippo Varese
- Division of Psychology and Mental HealthUniversity of ManchesterUK,Greater Manchester Mental Health NHS Foundation TrustUK
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Alcohol Use and Suicidality by Sexual Orientation Among U.S. Youth, 2009-2017. Am J Prev Med 2020; 59:394-403. [PMID: 32446749 PMCID: PMC7483808 DOI: 10.1016/j.amepre.2020.03.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 02/07/2020] [Accepted: 03/06/2020] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Alcohol use and suicidality remain serious risks for U.S. youth. Research has established that disparities exist in these outcomes between heterosexual and sexual minority youth. However, research into the associations between alcohol use and suicidality has yet to consider the differential role of sexual orientation. METHODS Using a pooled, diverse sample from the 2009-2017 Youth Risk Behavior Survey, associations of alcohol use and suicidality by sex and sexual orientation, and changes in these outcomes over time, were investigated. Analyses were conducted in 2019. RESULTS Suicidality was highest among nonheterosexuals, who ranged from twofold to sevenfold higher odds to report suicidality across all time points, with the most striking disparities among male sexual minority youth. Rates among all students remained stable or increased over time; notable exceptions included a decrease in suicide attempts among bisexual students. Among all students, current alcohol use was associated with elevated levels of suicidality. For female students, the association between drinking and suicidality did not significantly differ by sexual identity; for male students, it was significant regardless of sexual identity and most pronounced among not sure youth. CONCLUSIONS These results emphasize the need for additional research into the relationship between contemporaneous alcohol use and suicidality, with attention to differences based on sex, sexual orientation, and other factors that may impact these relationships. There is a particular need for research to examine the temporal nature of the association such that evidence-informed, high-impact interventions can be developed to improve suicidality outcomes among sexual minority youth.
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Rehman Z, Lopes B, Jaspal R. Predicting self-harm in an ethnically diverse sample of lesbian, gay and bisexual people in the United Kingdom. Int J Soc Psychiatry 2020; 66:349-360. [PMID: 32122180 PMCID: PMC7488821 DOI: 10.1177/0020764020908889] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Poor mental health is prevalent in lesbian, gay and bisexual (LGB) people due in part to social stigma. The social, psychological and clinical risk factors for self-harm among LGB people are unclear, which limits our ability to predict when and how this will occur and, crucially, how to prevent it. AIMS Drawing on the cognitive-behavioral approach in clinical psychology, this study identifies the predictors of self-harm in LGB people in the United Kingdom. RESULTS Women, lesbians, those with lower income and younger people were more likely to engage in self-harm. Self-harmers exhibited much more discrimination, LGB victimization and, thus, internalized homophobia and depressive symptomatology than non-self-harmers. The structural equation model showed direct effects of age and gender, and indirect effects of income and sexual orientation, on self-harm, through the mediating variables of discrimination, LGB victimization and internalized homophobia. CONCLUSIONS Consistent with the cognitive-behavioral model, the results indicate that exposure to situational stressors can increase the risk of developing a self-hatred and depressive psychological self-schema, resulting in greater risk of self-harm as a maladaptive coping strategy. An integrative clinical intervention for enhancing psychological wellbeing in LGB people is proposed to mitigate the risk of self-harm in this population.
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Affiliation(s)
- Zaqia Rehman
- Faculty of Health & Life Sciences, De Montfort University, Leicester, UK
| | - Barbara Lopes
- CINEICC, Faculdade de Psicologia e de Ciências da Educação, Universidade de Coimbra, Coimbra, Portugal
| | - Rusi Jaspal
- School of Social Sciences, Nottingham Trent University, Nottingham, UK
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12
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Fox KR, Choukas-Bradley S, Salk RH, Marshal MP, Thoma BC. Mental health among sexual and gender minority adolescents: Examining interactions with race and ethnicity. J Consult Clin Psychol 2020; 88:402-415. [PMID: 32150426 PMCID: PMC7148198 DOI: 10.1037/ccp0000486] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Sexual and gender minority (SGM) adolescents report elevated risk for psychopathology. Identifying as a racial/ethnic minority and sexual minority (SM) or gender minority (GM) may lead to greater stress/discrimination and psychopathology. We examined nonsuicidal self-injury, suicide ideation, and suicide attempts (i.e., self-injurious thoughts and behaviors [SITBs]) and depressive symptoms across intersections of sexual orientation, gender, and race/ethnicity. METHOD Study participants consisted of a large (n = 2,948; 59% GM) sample of adolescents aged 14-18 who were recruited online to complete a cross-sectional survey. SGM status, race/ethnicity, and their interactions were used to predict depressive symptoms and SITBs. Associations among race/ethnicity and GM-specific psychosocial factors were assessed. RESULTS SM (B = 3.75) and GM (B = 8.81) participants reported higher depressive symptoms and SITB histories (odds ratios [ORs] from 1.92 to 2.43 and 2.87 to 5.44, respectively). Asian participants were less likely to report nonsuicidal self-injury (OR = 0.45), and Latinx participants were more likely to report suicide attempts (OR = 1.50). Although omnibus tests of interactions were largely insignificant, exploratory analyses revealed fewer depressive symptoms (B = -8.40) and SITBs (ORs from -0.95 to -2.05) among Black SM participants and, at times, Black GM participants. This protective effect may relate to lower self-reported expectations of rejection due to gender. CONCLUSIONS GM participants reported the highest risk for depressive symptoms and SITBs. Contrary to hypotheses, multiple minority identification was not associated with greater psychopathology. Future research, assessing specific sexual and gender identities across diverse samples, is needed to highlight how race affects psychopathology risk across these identities. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Kathryn R. Fox
- University of Pittsburgh School of Medicine, Department of Psychiatry
| | | | - Rachel H. Salk
- University of Pittsburgh School of Medicine, Department of Psychiatry
| | | | - Brian C. Thoma
- University of Pittsburgh School of Medicine, Department of Psychiatry
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13
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Halkitis PN, Maiolatesi AJ, Krause KD. The Health Challenges of Emerging Adult Gay Men: Effecting Change in Health Care. Pediatr Clin North Am 2020; 67:293-308. [PMID: 32122561 PMCID: PMC8690571 DOI: 10.1016/j.pcl.2019.12.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
This article focuses on the health and health care challenges experienced by young and emerging adult gay men. Evidence is provided on the extent to which young and emerging adult gay men are disproportionally burdened by multidimensional health disparities, barriers to health care access, and inadequate provider-patient interactions. Recommendations are provided for health care providers and public health officials working with populations of emerging adult gay men that might have the greatest overall impact on improving this population's well-being and access to competent health care by increasing providers' awareness of the unique needs of young and emerging adult gay men.
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Affiliation(s)
- Perry N. Halkitis
- Center for Health, Identity, Behavior & Prevention Studies, Rutgers School of Public Health, One Riverfront Plaza, Newark, NJ 07102, USA,Department of Biostatistics, Rutgers School of Public Health, 683 Hoes Lane West, Piscataway, NJ 08854, USA,Department of Urban-Global Health, Rutgers School of Public Health, 683 Hoes Lane West, Piscataway, NJ 08854, USA,Corresponding author. Departments of Biostatistics, Epidemiology and Urban-Global Health, School of Public Health, Rutgers University, 683 Hoes Lane West, Piscataway, NJ 08854.
| | - Anthony J. Maiolatesi
- Center for Health, Identity, Behavior & Prevention Studies, Rutgers School of Public Health, One Riverfront Plaza, Newark, NJ 07102, USA,Department of Social and Behavioral Sciences, Yale School of Public Health, 60 College Street, New Haven, CT 06510, USA,Center for Interdisciplinary Research on AIDS, Yale University, 135 College Street, New Haven, CT 06510, USA
| | - Kristen D. Krause
- Center for Health, Identity, Behavior & Prevention Studies, Rutgers School of Public Health, One Riverfront Plaza, Newark, NJ 07102, USA,Department of Health Behavior, Society, and Policy, Rutgers School of Public Health, 683 Hoes Lane West, Piscataway, NJ 08854, USA
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14
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Liu RT, Sheehan AE, Walsh RFL, Sanzari CM, Cheek SM, Hernandez EM. Prevalence and correlates of non-suicidal self-injury among lesbian, gay, bisexual, and transgender individuals: A systematic review and meta-analysis. Clin Psychol Rev 2019; 74:101783. [PMID: 31734440 PMCID: PMC6896220 DOI: 10.1016/j.cpr.2019.101783] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 10/01/2019] [Accepted: 11/06/2019] [Indexed: 01/17/2023]
Abstract
The current review presents a meta-analysis of the existing empirical literature on the prevalence of non-suicidal self-injury (NSSI) among lesbian, gay, bisexual, and transgender (LGBT) individuals, as well as on correlates of NSSI within sexual and gender minority populations. Eligible publications (n = 51) were identified through a systematic search of PsycINFO, MEDLINE, and Embase, supplemented by a search of references of prior reviews on this topic. NSSI prevalence rates were quite elevated among sexual (29.68% lifetime) and gender (46.65% lifetime) minority individuals compared to heterosexual and/or cisgender peers (14.57% lifetime), with transgender (46.65% lifetime) and bisexual (41.47% lifetime) individuals being at greatest risk. Even among these group findings, sexual minority youth emerged as an especially vulnerable population. Moreover, current evidence suggests these rates and differences between LGBT and heterosexual and/or cisgender peers have not declined over time. These findings may in some measure be due to the existence of LGBT-specific risk correlates combined with general risk correlates being more severe among sexual and gender minority populations. Additional research, particularly employing a longitudinal design, is needed in this area to advance efforts to reduce risk for NSSI among sexual and gender minority individuals.
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Affiliation(s)
- Richard T Liu
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, United States.
| | - Ana E Sheehan
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, United States
| | - Rachel F L Walsh
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, United States
| | - Christina M Sanzari
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, United States
| | - Shayna M Cheek
- Department of Psychology and Neuroscience, Duke University, United States
| | - Evelyn M Hernandez
- Department of Psychiatry, University of Pittsburgh School of Medicine, United States
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15
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Agnew-Brune CB, Balaji AB, Mustanski B, Newcomb ME, Prachand N, Braunstein SL, Brady KA, Hoots BE, Smith JS, Paz-Bailey G, Broz D. Mental health, social support, and HIV-related sexual risk behaviors among HIV-negative adolescent sexual minority males: three U.S. cities, 2015. AIDS Behav 2019; 23:3419-3426. [PMID: 31065922 DOI: 10.1007/s10461-019-02525-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We examined the association between mental health issues, social support, and HIV among adolescent sexual minority males (SMM), who are disproportionally affected by HIV. National HIV Behavioral Surveillance among Young Men Who Have Sex with Men (NHBS-YMSM) data among SMM aged 13-18 years were collected in three cities (Chicago, New York City, and Philadelphia). Separate log-linked Poisson regression models were used to estimate associations between mental health issues and social support (general and family), and 3 HIV-related sexual risk behavior outcomes: past-year condomless anal intercourse (CAI) with a male partner, past-year sex with ≥ 4 partners, and first vaginal or anal sex before age 13. Of 547 adolescent SMM, 22% reported ever attempting suicide and 10% reported past-month suicidal ideation. The majority (52%) reported depression and anxiety. Thirty-nine percent reported CAI, 29% reported ≥ 4 sex partners and 22% reported first sex before age 13. Ever attempting suicide, suicidal ideation, and depression and anxiety were associated with CAI. Separately, ever attempting suicide and lack of family support were associated with ≥ 4 sex partners. None of the mental health or support measures were associated with having sex before age 13. General social support was not associated with any sexual risk behaviors. Mental health issues are common among adolescent SMM and associated with sexual risk behaviors. Including mental health support in comprehensive HIV prevention for adolescent SMM could potentially reduce HIV risk in this population.
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Affiliation(s)
- Christine B Agnew-Brune
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd., Mailstop E-46, Atlanta, GA, USA.
| | - Alexandra B Balaji
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd., Mailstop E-46, Atlanta, GA, USA
| | - Brian Mustanski
- Department of Medical Social Science, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Michael E Newcomb
- Department of Medical Social Science, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Nik Prachand
- Chicago Department of Public Health, Chicago, IL, USA
| | | | | | - Brooke E Hoots
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd., Mailstop E-46, Atlanta, GA, USA
| | - Justin S Smith
- Behavioral Sciences and Health Education, Rollins School of Public Health at Emory University, Atlanta, GA, USA
| | - Gabriela Paz-Bailey
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd., Mailstop E-46, Atlanta, GA, USA
| | - Dita Broz
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd., Mailstop E-46, Atlanta, GA, USA
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16
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Clarke S, Allerhand LA, Berk MS. Recent advances in understanding and managing self-harm in adolescents. F1000Res 2019; 8:F1000 Faculty Rev-1794. [PMID: 31681470 PMCID: PMC6816451 DOI: 10.12688/f1000research.19868.1] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/18/2019] [Indexed: 12/28/2022] Open
Abstract
Adolescent suicide is a serious public health problem, and non-suicidal self-injury (NSSI) is both highly comorbid with suicidality among adolescents and a significant predictor of suicide attempts (SAs) in adolescents. We will clarify extant definitions related to suicidality and NSSI and the important similarities and differences between these constructs. We will also review several significant risk factors for suicidality, evidence-based and evidence-informed safety management strategies, and evidence-based treatment for adolescent self-harming behaviors. Currently, dialectical behavior therapy (DBT) for adolescents is the first and only treatment meeting the threshold of a well-established treatment for self-harming adolescents at high risk for suicide. Areas in need of future study include processes underlying the association between NSSI and SAs, clarification of warning signs and risk factors that are both sensitive and specific enough to accurately predict who is at imminent risk for suicide, and further efforts to sustain the effects of DBT post-treatment. DBT is a time- and labor-intensive treatment that requires extensive training for therapists and a significant time commitment for families (generally 6 months). It will therefore be helpful to assess whether other less-intensive treatment options can be established as evidence-based treatment for suicidal adolescents.
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Affiliation(s)
- Stephanie Clarke
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA, 94305-5719, USA
| | - Lauren A. Allerhand
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA, 94305-5719, USA
| | - Michele S. Berk
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA, 94305-5719, USA
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17
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Pospos S, Tal I, Iglewicz A, Newton IG, Tai-Seale M, Downs N, Jong P, Lee D, Davidson JE, Lee SY, Rubanovich CK, Ho EV, Sanchez C, Zisook S. Gender differences among medical students, house staff, and faculty physicians at high risk for suicide: A HEAR report. Depress Anxiety 2019; 36:902-920. [PMID: 31102314 DOI: 10.1002/da.22909] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 03/30/2019] [Accepted: 04/13/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In comparison with the general population, physicians, and physicians-in-training are at greater risk for suicide. Although key gender differences in suicide risk factors and behaviors have been identified in the general population, the extent to which these differences apply to physicians and physicians-in-training is unclear. Here, we aimed to identify gender differences in risk factors, clinical presentation, and help-seeking behaviors of medical students, house staff, and physician faculty at high risk for suicide. METHODS We explored gender differences among 450 physicians and trainees meeting criteria for high suicide risk on anonymous online questionnaires completed between 2009 and 2017. RESULTS High-risk female trainees and physicians had higher mean Patient Health Questionnaire-9 (PHQ-9) scores compared with the males (11.1, standard deviation [SD] 5.1 vs. 9.8, SD 4.7) and were more likely to endorse feeling worried (73.8% vs. 61.2%), irritable (60.4% vs. 49.4%), and stressed (79.6% vs. 70%). High-risk male trainees and physicians were more likely than females to endorse suicidal thoughts (31.2% vs. 22.1%), intense anger (24.3% vs. 16.1%), drinking too much (31.2% vs. 22.3%), and recreational drug or prescription medication use without clinically appropriate follow-up (9.4% vs. 4.3%). There were no gender differences in help-seeking behaviors. CONCLUSIONS This is the first study to report gender differences among risk factors, presentation, and help-seeking behaviors of physicians, and trainees at high risk for suicide. Our findings are mostly consistent with those of the general population and show that only a minority of at-risk men and women in healthcare sought treatment, highlighting the importance of intervention and suicide prevention in this population.
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Affiliation(s)
- Sarah Pospos
- Psychiatry, University of California San Diego, La Jolla, California, USA
| | - Ilanit Tal
- Psychiatry, Veterans Affairs San Diego Healthcare System, La Jolla, California, USA
| | - Alana Iglewicz
- Psychiatry, University of California San Diego, La Jolla, California, USA.,Psychiatry, Veterans Affairs San Diego Healthcare System, La Jolla, California, USA
| | - Isabel G Newton
- Radiology, Veterans Affairs San Diego Healthcare System, La Jolla, California, San Diego.,Radiology, University of California San Diego, La Jolla, California, San Diego
| | - Ming Tai-Seale
- Family and Preventive Medicine, University of California San Diego, La Jolla, California, San Diego
| | - Nancy Downs
- Psychiatry, University of California San Diego, La Jolla, California, USA
| | - Pamela Jong
- Internal Medicine, Veterans Affairs San Diego Healthcare System, La Jolla, California, San Diego.,Internal Medicine, University of California San Diego, La Jolla, California, USA
| | - Daniel Lee
- Anesthesiology, University of California San Diego, La Jolla, California, USA
| | - Judy E Davidson
- Psychiatry, University of California San Diego, La Jolla, California, USA
| | - Soo Y Lee
- Undergraduate Student, University of California San Diego, La Jolla, California, USA
| | - Caryn Kseniya Rubanovich
- Joint Doctoral Program in Clinical Psychology, University of California San Diego and San Diego State University, La Jolla, California, USA
| | - Emily V Ho
- Medical Student, University od California San Diego, La Jolla, California, USA
| | - Courtney Sanchez
- Psychiatry, University of California San Diego, La Jolla, California, USA
| | - Sidney Zisook
- Psychiatry, University of California San Diego, La Jolla, California, USA.,Psychiatry, Veterans Affairs San Diego Healthcare System, La Jolla, California, USA
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18
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Gulbas L, Szlyk H, Zayas LH. Evaluating the Interpersonal-Psychological Theory of Suicide among Latina Adolescents using Qualitative Comparative Analysis. QUALITATIVE PSYCHOLOGY 2019; 6:297-311. [PMID: 32051834 PMCID: PMC7015267 DOI: 10.1037/qup0000131] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The Interpersonal-Psychological Theory of Suicide (IPTS) has emerged as an empirically supported theory of suicide risk, yet few studies have utilized IPTS to examine the suicidal behaviors of Latina adolescents. In this study, we explore the cultural and developmental appropriateness, as well as the explanatory fit, of IPTS within a sample of Latina adolescents. Data for this project were drawn from qualitative interviews conducted with Latina adolescents with (n=30) and without (n=30) histories of attempted suicide. We employed a deductive qualitative approach to define and compare core constructs of IPTS (perceived burdensomeness, thwarted belongingness, and acquired capability), and then use qualitative comparative analysis to evaluate how core constructs were linked with the occurrence of a suicide attempt. Consistent with IPTS, perceived burdensomeness, thwarted belongingness, and acquired capability were present in 20 of the 30 adolescents who had attempted suicide, and absent in 22 of the 30 adolescents with no lifetime history of suicidal behaviors. Notably, alternative combinations of IPTS constructs were found in 10 cases of adolescents who attempted suicide, suggesting a need to adjust IPTS to fit the developmental and cultural contexts of Latina teens. Although our results suggest predominantly positive support for IPTS, participants varied in terms of how their experiences resonated with the conceptual definitions put forward by the theory. Ultimately, our findings point to the ways in which developmental tensions are exacerbated by broader sociocultural dynamics, contributing to a broader understanding of suicide risk among ethnic minority adolescents.
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Affiliation(s)
- Lauren Gulbas
- University of Texas at Austin, Carolina Hausmann-Stabile, Bryn Mawr College
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19
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Liu RT. Temporal Trends in the Prevalence of Nonsuicidal Self-injury Among Sexual Minority and Heterosexual Youth From 2005 Through 2017. JAMA Pediatr 2019; 173:790-791. [PMID: 31157883 PMCID: PMC6547150 DOI: 10.1001/jamapediatrics.2019.1433] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
This study examines Youth Risk Behavior Surveillance System data to determine the rate of nonsuicidal self-injury in heterosexual and sexual minority youth from 2005 to 2017.
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Affiliation(s)
- Richard T. Liu
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island
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20
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Johnson B, Leibowitz S, Chavez A, Herbert SE. Risk Versus Resiliency: Addressing Depression in Lesbian, Gay, Bisexual, and Transgender Youth. Child Adolesc Psychiatr Clin N Am 2019; 28:509-521. [PMID: 31076124 DOI: 10.1016/j.chc.2019.02.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Lesbian, gay, bisexual, and transgender (LGBT) youth have unique risk factors that predispose them to depression at higher rates than their non-LGBT peers. Family rejection, bullying, and lack of societal acceptance can contribute to negative health outcomes. Additionally, youth with gender dysphoria may need or benefit from medical interventions. LGBT youth also have the same risk factors as non-LGBT youth, requiring clinicians to decipher risk factors associated with sexual and gender minority identity status, general risk factors, and relationships among them. Assessment of these risk factors and implementation of targeted interventions are important when treating depression in LGBT youth.
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Affiliation(s)
- Brandon Johnson
- Mount Sinai St. Luke's Hospital, Icahn School of Medicine at Mount Sinai, 411 West 114th Street, 2nd Floor, New York, NY 10025, USA.
| | - Scott Leibowitz
- THRIVE Gender Development Program, Nationwide Children's Hospital, The Ohio State University College of Medicine, 555 South 18th Street, Columbus, OH 43205, USA
| | - Alexis Chavez
- Department of Psychiatry, University of Colorado, Anschutz, 13001 East 17th Place, Building 500, 2E, Aurora, CO 80045, USA
| | - Sarah E Herbert
- Department of Psychiatry and Behavioral Sciences, Morehouse School of Medicine, Atlanta, GA, USA
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21
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Perales F, Campbell A, O'Flaherty M. Sexual Orientation and Adolescent Time Use: How Sexual Minority Youth Spend Their Time. Child Dev 2019; 91:983-1000. [DOI: 10.1111/cdev.13245] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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22
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Studen-Pavlovich D, Vieira AM. The Dynamics of Change. Pediatr Dent 2019. [DOI: 10.1016/b978-0-323-60826-8.00037-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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23
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Heiden-Rootes K, Wiegand A, Thomas D, Moore RM, Ross KA. A National Survey on Depression, Internalized Homophobia, College Religiosity, and Climate of Acceptance on College Campuses for Sexual Minority Adults. JOURNAL OF HOMOSEXUALITY 2018; 67:435-451. [PMID: 30517821 DOI: 10.1080/00918369.2018.1550329] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Sexual minority persons have an increased risk for negative mental health outcomes in adulthood. This seems to largely be due to experiences of stigma in social settings. This study sought to understand the relationship between attending a religiously conservative college, internalized homophobia (a measure of sexual stigma), and depressive symptoms for sexual minority adults. Sexual minority adult participants (n = 384) from across the U.S. were recruited and completed a Web-based, anonymous survey. A mediation model predicting depression through college religious conservatism, college acceptance of sexual minority identities, and internalized homophobia was tested using path analysis. Results revealed an indirect effect of increased religious conservatism of a college predicted higher depression through lower college acceptance and higher internalized homophobia. Implications for the mental health of sexual minority adults and future research are examined.
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Affiliation(s)
- Katie Heiden-Rootes
- Department of Family & Community Medicine, Medical Family Therapy Program, Saint Louis University, St. Louis, Missouri, USA
| | - Ashley Wiegand
- Department of Family & Community Medicine, Medical Family Therapy Program, Saint Louis University, St. Louis, Missouri, USA
| | - Danielle Thomas
- Department of Family & Community Medicine, Medical Family Therapy Program, Saint Louis University, St. Louis, Missouri, USA
| | - Rachel M Moore
- Department of Family & Community Medicine, Medical Family Therapy Program, Saint Louis University, St. Louis, Missouri, USA
| | - Kristin A Ross
- Department of Family & Community Medicine, Medical Family Therapy Program, Saint Louis University, St. Louis, Missouri, USA
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24
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Gondim R, Teles F, Barroso U. Sexual orientation of 46, XX patients with congenital adrenal hyperplasia: a descriptive review. J Pediatr Urol 2018; 14:486-493. [PMID: 30322770 DOI: 10.1016/j.jpurol.2018.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 08/01/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Congenital adrenal hyperplasia (CAH) consists of a group of diseases characterized by an enzyme deficiency, particularly 21-hydroxylase deficiency. The condition may present in the simple virilizing form or in the salt-wasting form, with varying degrees of genital ambiguity. The non-heterosexual orientation is used in gender studies fields and includes bisexual, homosexual, Lesbians, gays, bissexuals, transgender, intersex, and others. OBJECTIVE The objective of this study was to evaluate the frequency of non-heterosexual orientation in patients with CAH, in an attempt to identify biological factors possibly associated with this occurrence. METHODS This was a descriptive review of observational studies on the sexual orientation of patients with CAH published between 1985 and 2016, as listed in PubMed. RESULTS Various studies have been performed to establish the relationship between CAH and non-heterosexual orientation. Non-heterosexual orientation is more prevalent in patients with more advanced Prader stages and those with the null and I2-splice genotype. CONCLUSION The prevalence of homosexuality and bisexuality is greater in patients with CAH in relation to the general population.
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Affiliation(s)
- R Gondim
- Postgraduate Program in Medicine and Human Health, Bahiana School of Medicine and the Department of Urology, Federal University of Bahia, Salvador, Bahia, Brazil
| | - F Teles
- Postgraduate Program in Medicine and Human Health, Bahiana School of Medicine and the Department of Urology, Federal University of Bahia, Salvador, Bahia, Brazil
| | - U Barroso
- Postgraduate Program in Medicine and Human Health, Bahiana School of Medicine and the Department of Urology, Federal University of Bahia, Salvador, Bahia, Brazil.
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25
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Nam B, Wilcox HC, Hilimire M, DeVylder JE. Perceived need for care and mental health service utilization among college students with suicidal ideation. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2018; 66:713-719. [PMID: 29384469 DOI: 10.1080/07448481.2018.1434779] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 12/09/2017] [Accepted: 01/28/2018] [Indexed: 06/07/2023]
Abstract
OBJECTIVE This study aimed to identify correlates of service utilization and perceived need for care among college students with suicidal ideation. PARTICIPANTS Respondents were recruited from introductory psychology courses at an undergraduate college during the Fall 2014 semester. METHODS Independent correlates of (1) mental health service utilization, (2) self-perceived need, and (3) other-perceived need for mental health services among college students (N = 190) with suicidal ideation were identified. RESULTS Service utilization was associated with need for care as perceived by others. Perceived need for care by others was associated with suicidal ideation intensity and suicide attempt history. Perceived need by the respondents themselves was correlated with depression severity, sex, and race but was not independently associated with actual service utilization. CONCLUSIONS Perceived need by others was the sole significant correlate of service utilization, suggesting it is an important target for public health interventions aimed at facilitating pathways into mental health treatment.
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Affiliation(s)
- Boyoung Nam
- a School of Social Work, University of Maryland , Baltimore , Maryland , USA
| | - Holly C Wilcox
- b Department of Mental Health , Johns Hopkins Schools of Medicine and Bloomberg School of Public Health, Johns Hopkins University , Baltimore , Maryland , USA
| | - Matthew Hilimire
- c Department of Psychology , The College of William & Mary , Williamsburg , Virginia , USA
| | - Jordan E DeVylder
- a School of Social Work, University of Maryland , Baltimore , Maryland , USA
- d Graduate School of Social Service , Fordham University , New York , New York , USA
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26
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Lapinski J, Covas T, Perkins JM, Russell K, Adkins D, Coffigny MC, Hull S. Best Practices in Transgender Health: A Clinician's Guide. Prim Care 2018; 45:687-703. [PMID: 30401350 DOI: 10.1016/j.pop.2018.07.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Providing culturally competent and medically knowledgeable care to the transgender community is increasingly falling within the realms of practice for primary care providers. The purpose of this article is to provide an overview of best practices as they relate to transgender care. This article is by no means a comprehensive guide, but rather a starting point for clinicians as they provide high-quality care to their transgender patients.
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Affiliation(s)
- Jessica Lapinski
- Department of Community and Family Medicine, Duke University Health System, Duke University, 2100 Erwin Road, Durham, NC 27710, USA.
| | - Tiffany Covas
- Department of Community and Family Medicine, Duke University Health System, 2100 Erwin Road, Durham, NC 27710, USA
| | - Jennifer M Perkins
- Division of Diabetes, Endocrinology, and Metabolism, Department of Medicine, Duke University Health System, 2100 Erwin Road, Durham, NC 27710, USA
| | - Kristen Russell
- Department of Case Management, Duke Child and Adolescent Gender Care, Duke University Health System, 2100 Erwin Road, Durham, NC 27710, USA
| | - Deanna Adkins
- Duke Child and Adolescent Gender Care, Duke University Health System, 2100 Erwin Road, Durham, NC 27710, USA
| | | | - Sharon Hull
- Department of Community and Family Medicine, Duke University School of Medicine, 2100 Erwin Road, Durham, NC 27710, USA
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O'Hanlan KA, Gordon JC, Sullivan MW. Biological origins of sexual orientation and gender identity: Impact on health. Gynecol Oncol 2018; 149:33-42. [PMID: 29605047 DOI: 10.1016/j.ygyno.2017.11.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 10/30/2017] [Accepted: 11/07/2017] [Indexed: 01/19/2023]
Abstract
Gynecologic Oncologists are sometimes consulted to care for patients who present with diverse gender identities or sexual orientations. Clinicians can create more helpful relationships with their patients if they understand the etiologies of these diverse expressions of sexual humanity. Multidisciplinary evidence reveals that a sexually dimorphic spectrum of somatic and neurologic anatomy, traits and abilities, including sexual orientation and gender identity, are conferred together during the first half of pregnancy due to genetics, epigenetics and the diversity of timing and function of sex chromosomes, sex-determining protein secretion, gonadal hormone secretion, receptor levels, adrenal function, maternally ingested dietary hormones, fetal health, and many other factors. Multiple layers of evidence confirm that sexual orientation and gender identity are as biological, innate and immutable as the other traits conferred during that critical time in gestation. Negative social responses to diverse orientations or gender identities have caused marginalization of these individuals with resultant alienation from medical care, reduced self-care and reduced access to medical care. The increased risks for many diseases, including gynecologic cancers are reviewed. Gynecologic Oncologists can potentially create more effective healthcare relationships with their patients if they have this information.
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Affiliation(s)
- Katherine A O'Hanlan
- Laparoscopic Institute for Gynecology and Oncology (LIGO), 4370 Alpine Rd. Suite 104, Portola Valley, CA 94028, United States.
| | - Jennifer C Gordon
- University of Tennessee Health Sciences Center, Memphis, TN, United States.
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Miranda-Mendizábal A, Castellví P, Parés-Badell O, Almenara J, Alonso I, Blasco MJ, Cebrià A, Gabilondo A, Gili M, Lagares C, Piqueras JA, Roca M, Rodríguez-Marín J, Rodríguez-Jiménez T, Soto-Sanz V, Vilagut G, Alonso J. Sexual orientation and suicidal behaviour in adolescents and young adults: systematic review and meta-analysis. Br J Psychiatry 2017; 211:77-87. [PMID: 28254960 DOI: 10.1192/bjp.bp.116.196345] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 11/21/2016] [Accepted: 11/27/2016] [Indexed: 11/23/2022]
Abstract
BackgroundResearch suggests that lesbian, gay and bisexual (LGB) adolescents have a higher risk of suicidal behaviours than their heterosexual peers, but little is known about specific risk factors.AimsTo assess sexual orientation as a risk factor for suicidal behaviours, and to identify other risk factors among LGB adolescents and young adults.MethodA systematic search was made of six databases up to June 2015, including a grey literature search. Population-based longitudinal studies considering non-clinical populations aged 12-26 years and assessing being LGB as a risk factor for suicidal behaviour compared with being heterosexual, or evaluating risk factors for suicidal behaviour within LGB populations, were included. Random effect models were used in meta-analysis.ResultsSexual orientation was significantly associated with suicide attempts in adolescents and youths (OR = 2.26, 95% CI 1.60-3.20). Gay or bisexual men were more likely to report suicide attempts compared with heterosexual men (OR = 2.21, 95% CI 1.21-4.04). Based on two studies, a non-significant positive association was found between depression and suicide attempts in LGB groups.ConclusionsSexual orientation is associated with a higher risk of suicide attempt in young people. Further research is needed to assess completed suicide, and specific risk factors affecting the LGB population.
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Affiliation(s)
- A Miranda-Mendizábal
- A. Miranda-Mendizábal, MD, MPH, Health Services Research Group, Institut Hospital del Mar d'Investigacións Mèdiques (IMIM) and Department of Health and Experimental Sciences, Pompeu Fabra University (UPF), Barcelona; P. Castellví, PhD, Health Services Research Group, IMIM and Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona; O. Parés-Badell, MD, MPH, Health Services Research Group, IMIM, Barcelona; J. Almenara, MD, PhD, Faculty of Nursing and Physiotherapy, University of Cádiz; I. Alonso, PhD, Morales Meseguer Hospital, Murcia; M. J. Blasco, MSc, Health Services Research Group, IMIM, Department of Health and Experimental Sciences, UPF, and CIBERESP, Barcelona; A. Cebrià, PhD, Department of Mental Health, Corporació Sanitaria Parc Taulí, Sabadell; A. Gabilondo, MD, PhD, Outpatient Mental Health Care Network, Osakidetza-Basque Health Service, and Mental Health and Psychiatric Care Research Unit, BioDonosti Health Research Institute; M. Gili, PhD, Institut Universitari d'Investigació en Ciències de la Salut (IUNICS-IDISPA), University of Balearic Islands, Palma de Mallorca; C. Lagares, PhD, Department of Statistics and Operative Research, University of Cádiz; J. A. Piqueras, PhD, Department of Health Psychology, Miguel Hernandez University of Elche; M. Roca, MD, PhD, IUNICS-IDISPA and Network of Preventive Activities and Health Promotion, University of Balearic Islands, Palma de Mallorca; J. Rodríguez-Marín, PhD, T. Rodríguez-Jiménez, PhD, v. Soto-Sanz, BSc, Department of Health Psychology, Miguel Hernandez University of Elche; G. Vilagut, Health Services Research Group, IMIM, and CIBERESP, Barcelona; Jordi Alonso, MD, PhD, Health Services Research Group, IMIM, Department of Health and Experimental Sciences, UPF, and CIBERESP, Barcelona, Spain
| | - P Castellví
- A. Miranda-Mendizábal, MD, MPH, Health Services Research Group, Institut Hospital del Mar d'Investigacións Mèdiques (IMIM) and Department of Health and Experimental Sciences, Pompeu Fabra University (UPF), Barcelona; P. Castellví, PhD, Health Services Research Group, IMIM and Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona; O. Parés-Badell, MD, MPH, Health Services Research Group, IMIM, Barcelona; J. Almenara, MD, PhD, Faculty of Nursing and Physiotherapy, University of Cádiz; I. Alonso, PhD, Morales Meseguer Hospital, Murcia; M. J. Blasco, MSc, Health Services Research Group, IMIM, Department of Health and Experimental Sciences, UPF, and CIBERESP, Barcelona; A. Cebrià, PhD, Department of Mental Health, Corporació Sanitaria Parc Taulí, Sabadell; A. Gabilondo, MD, PhD, Outpatient Mental Health Care Network, Osakidetza-Basque Health Service, and Mental Health and Psychiatric Care Research Unit, BioDonosti Health Research Institute; M. Gili, PhD, Institut Universitari d'Investigació en Ciències de la Salut (IUNICS-IDISPA), University of Balearic Islands, Palma de Mallorca; C. Lagares, PhD, Department of Statistics and Operative Research, University of Cádiz; J. A. Piqueras, PhD, Department of Health Psychology, Miguel Hernandez University of Elche; M. Roca, MD, PhD, IUNICS-IDISPA and Network of Preventive Activities and Health Promotion, University of Balearic Islands, Palma de Mallorca; J. Rodríguez-Marín, PhD, T. Rodríguez-Jiménez, PhD, v. Soto-Sanz, BSc, Department of Health Psychology, Miguel Hernandez University of Elche; G. Vilagut, Health Services Research Group, IMIM, and CIBERESP, Barcelona; Jordi Alonso, MD, PhD, Health Services Research Group, IMIM, Department of Health and Experimental Sciences, UPF, and CIBERESP, Barcelona, Spain
| | - O Parés-Badell
- A. Miranda-Mendizábal, MD, MPH, Health Services Research Group, Institut Hospital del Mar d'Investigacións Mèdiques (IMIM) and Department of Health and Experimental Sciences, Pompeu Fabra University (UPF), Barcelona; P. Castellví, PhD, Health Services Research Group, IMIM and Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona; O. Parés-Badell, MD, MPH, Health Services Research Group, IMIM, Barcelona; J. Almenara, MD, PhD, Faculty of Nursing and Physiotherapy, University of Cádiz; I. Alonso, PhD, Morales Meseguer Hospital, Murcia; M. J. Blasco, MSc, Health Services Research Group, IMIM, Department of Health and Experimental Sciences, UPF, and CIBERESP, Barcelona; A. Cebrià, PhD, Department of Mental Health, Corporació Sanitaria Parc Taulí, Sabadell; A. Gabilondo, MD, PhD, Outpatient Mental Health Care Network, Osakidetza-Basque Health Service, and Mental Health and Psychiatric Care Research Unit, BioDonosti Health Research Institute; M. Gili, PhD, Institut Universitari d'Investigació en Ciències de la Salut (IUNICS-IDISPA), University of Balearic Islands, Palma de Mallorca; C. Lagares, PhD, Department of Statistics and Operative Research, University of Cádiz; J. A. Piqueras, PhD, Department of Health Psychology, Miguel Hernandez University of Elche; M. Roca, MD, PhD, IUNICS-IDISPA and Network of Preventive Activities and Health Promotion, University of Balearic Islands, Palma de Mallorca; J. Rodríguez-Marín, PhD, T. Rodríguez-Jiménez, PhD, v. Soto-Sanz, BSc, Department of Health Psychology, Miguel Hernandez University of Elche; G. Vilagut, Health Services Research Group, IMIM, and CIBERESP, Barcelona; Jordi Alonso, MD, PhD, Health Services Research Group, IMIM, Department of Health and Experimental Sciences, UPF, and CIBERESP, Barcelona, Spain
| | - J Almenara
- A. Miranda-Mendizábal, MD, MPH, Health Services Research Group, Institut Hospital del Mar d'Investigacións Mèdiques (IMIM) and Department of Health and Experimental Sciences, Pompeu Fabra University (UPF), Barcelona; P. Castellví, PhD, Health Services Research Group, IMIM and Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona; O. Parés-Badell, MD, MPH, Health Services Research Group, IMIM, Barcelona; J. Almenara, MD, PhD, Faculty of Nursing and Physiotherapy, University of Cádiz; I. Alonso, PhD, Morales Meseguer Hospital, Murcia; M. J. Blasco, MSc, Health Services Research Group, IMIM, Department of Health and Experimental Sciences, UPF, and CIBERESP, Barcelona; A. Cebrià, PhD, Department of Mental Health, Corporació Sanitaria Parc Taulí, Sabadell; A. Gabilondo, MD, PhD, Outpatient Mental Health Care Network, Osakidetza-Basque Health Service, and Mental Health and Psychiatric Care Research Unit, BioDonosti Health Research Institute; M. Gili, PhD, Institut Universitari d'Investigació en Ciències de la Salut (IUNICS-IDISPA), University of Balearic Islands, Palma de Mallorca; C. Lagares, PhD, Department of Statistics and Operative Research, University of Cádiz; J. A. Piqueras, PhD, Department of Health Psychology, Miguel Hernandez University of Elche; M. Roca, MD, PhD, IUNICS-IDISPA and Network of Preventive Activities and Health Promotion, University of Balearic Islands, Palma de Mallorca; J. Rodríguez-Marín, PhD, T. Rodríguez-Jiménez, PhD, v. Soto-Sanz, BSc, Department of Health Psychology, Miguel Hernandez University of Elche; G. Vilagut, Health Services Research Group, IMIM, and CIBERESP, Barcelona; Jordi Alonso, MD, PhD, Health Services Research Group, IMIM, Department of Health and Experimental Sciences, UPF, and CIBERESP, Barcelona, Spain
| | - I Alonso
- A. Miranda-Mendizábal, MD, MPH, Health Services Research Group, Institut Hospital del Mar d'Investigacións Mèdiques (IMIM) and Department of Health and Experimental Sciences, Pompeu Fabra University (UPF), Barcelona; P. Castellví, PhD, Health Services Research Group, IMIM and Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona; O. Parés-Badell, MD, MPH, Health Services Research Group, IMIM, Barcelona; J. Almenara, MD, PhD, Faculty of Nursing and Physiotherapy, University of Cádiz; I. Alonso, PhD, Morales Meseguer Hospital, Murcia; M. J. Blasco, MSc, Health Services Research Group, IMIM, Department of Health and Experimental Sciences, UPF, and CIBERESP, Barcelona; A. Cebrià, PhD, Department of Mental Health, Corporació Sanitaria Parc Taulí, Sabadell; A. Gabilondo, MD, PhD, Outpatient Mental Health Care Network, Osakidetza-Basque Health Service, and Mental Health and Psychiatric Care Research Unit, BioDonosti Health Research Institute; M. Gili, PhD, Institut Universitari d'Investigació en Ciències de la Salut (IUNICS-IDISPA), University of Balearic Islands, Palma de Mallorca; C. Lagares, PhD, Department of Statistics and Operative Research, University of Cádiz; J. A. Piqueras, PhD, Department of Health Psychology, Miguel Hernandez University of Elche; M. Roca, MD, PhD, IUNICS-IDISPA and Network of Preventive Activities and Health Promotion, University of Balearic Islands, Palma de Mallorca; J. Rodríguez-Marín, PhD, T. Rodríguez-Jiménez, PhD, v. Soto-Sanz, BSc, Department of Health Psychology, Miguel Hernandez University of Elche; G. Vilagut, Health Services Research Group, IMIM, and CIBERESP, Barcelona; Jordi Alonso, MD, PhD, Health Services Research Group, IMIM, Department of Health and Experimental Sciences, UPF, and CIBERESP, Barcelona, Spain
| | - M J Blasco
- A. Miranda-Mendizábal, MD, MPH, Health Services Research Group, Institut Hospital del Mar d'Investigacións Mèdiques (IMIM) and Department of Health and Experimental Sciences, Pompeu Fabra University (UPF), Barcelona; P. Castellví, PhD, Health Services Research Group, IMIM and Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona; O. Parés-Badell, MD, MPH, Health Services Research Group, IMIM, Barcelona; J. Almenara, MD, PhD, Faculty of Nursing and Physiotherapy, University of Cádiz; I. Alonso, PhD, Morales Meseguer Hospital, Murcia; M. J. Blasco, MSc, Health Services Research Group, IMIM, Department of Health and Experimental Sciences, UPF, and CIBERESP, Barcelona; A. Cebrià, PhD, Department of Mental Health, Corporació Sanitaria Parc Taulí, Sabadell; A. Gabilondo, MD, PhD, Outpatient Mental Health Care Network, Osakidetza-Basque Health Service, and Mental Health and Psychiatric Care Research Unit, BioDonosti Health Research Institute; M. Gili, PhD, Institut Universitari d'Investigació en Ciències de la Salut (IUNICS-IDISPA), University of Balearic Islands, Palma de Mallorca; C. Lagares, PhD, Department of Statistics and Operative Research, University of Cádiz; J. A. Piqueras, PhD, Department of Health Psychology, Miguel Hernandez University of Elche; M. Roca, MD, PhD, IUNICS-IDISPA and Network of Preventive Activities and Health Promotion, University of Balearic Islands, Palma de Mallorca; J. Rodríguez-Marín, PhD, T. Rodríguez-Jiménez, PhD, v. Soto-Sanz, BSc, Department of Health Psychology, Miguel Hernandez University of Elche; G. Vilagut, Health Services Research Group, IMIM, and CIBERESP, Barcelona; Jordi Alonso, MD, PhD, Health Services Research Group, IMIM, Department of Health and Experimental Sciences, UPF, and CIBERESP, Barcelona, Spain
| | - A Cebrià
- A. Miranda-Mendizábal, MD, MPH, Health Services Research Group, Institut Hospital del Mar d'Investigacións Mèdiques (IMIM) and Department of Health and Experimental Sciences, Pompeu Fabra University (UPF), Barcelona; P. Castellví, PhD, Health Services Research Group, IMIM and Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona; O. Parés-Badell, MD, MPH, Health Services Research Group, IMIM, Barcelona; J. Almenara, MD, PhD, Faculty of Nursing and Physiotherapy, University of Cádiz; I. Alonso, PhD, Morales Meseguer Hospital, Murcia; M. J. Blasco, MSc, Health Services Research Group, IMIM, Department of Health and Experimental Sciences, UPF, and CIBERESP, Barcelona; A. Cebrià, PhD, Department of Mental Health, Corporació Sanitaria Parc Taulí, Sabadell; A. Gabilondo, MD, PhD, Outpatient Mental Health Care Network, Osakidetza-Basque Health Service, and Mental Health and Psychiatric Care Research Unit, BioDonosti Health Research Institute; M. Gili, PhD, Institut Universitari d'Investigació en Ciències de la Salut (IUNICS-IDISPA), University of Balearic Islands, Palma de Mallorca; C. Lagares, PhD, Department of Statistics and Operative Research, University of Cádiz; J. A. Piqueras, PhD, Department of Health Psychology, Miguel Hernandez University of Elche; M. Roca, MD, PhD, IUNICS-IDISPA and Network of Preventive Activities and Health Promotion, University of Balearic Islands, Palma de Mallorca; J. Rodríguez-Marín, PhD, T. Rodríguez-Jiménez, PhD, v. Soto-Sanz, BSc, Department of Health Psychology, Miguel Hernandez University of Elche; G. Vilagut, Health Services Research Group, IMIM, and CIBERESP, Barcelona; Jordi Alonso, MD, PhD, Health Services Research Group, IMIM, Department of Health and Experimental Sciences, UPF, and CIBERESP, Barcelona, Spain
| | - A Gabilondo
- A. Miranda-Mendizábal, MD, MPH, Health Services Research Group, Institut Hospital del Mar d'Investigacións Mèdiques (IMIM) and Department of Health and Experimental Sciences, Pompeu Fabra University (UPF), Barcelona; P. Castellví, PhD, Health Services Research Group, IMIM and Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona; O. Parés-Badell, MD, MPH, Health Services Research Group, IMIM, Barcelona; J. Almenara, MD, PhD, Faculty of Nursing and Physiotherapy, University of Cádiz; I. Alonso, PhD, Morales Meseguer Hospital, Murcia; M. J. Blasco, MSc, Health Services Research Group, IMIM, Department of Health and Experimental Sciences, UPF, and CIBERESP, Barcelona; A. Cebrià, PhD, Department of Mental Health, Corporació Sanitaria Parc Taulí, Sabadell; A. Gabilondo, MD, PhD, Outpatient Mental Health Care Network, Osakidetza-Basque Health Service, and Mental Health and Psychiatric Care Research Unit, BioDonosti Health Research Institute; M. Gili, PhD, Institut Universitari d'Investigació en Ciències de la Salut (IUNICS-IDISPA), University of Balearic Islands, Palma de Mallorca; C. Lagares, PhD, Department of Statistics and Operative Research, University of Cádiz; J. A. Piqueras, PhD, Department of Health Psychology, Miguel Hernandez University of Elche; M. Roca, MD, PhD, IUNICS-IDISPA and Network of Preventive Activities and Health Promotion, University of Balearic Islands, Palma de Mallorca; J. Rodríguez-Marín, PhD, T. Rodríguez-Jiménez, PhD, v. Soto-Sanz, BSc, Department of Health Psychology, Miguel Hernandez University of Elche; G. Vilagut, Health Services Research Group, IMIM, and CIBERESP, Barcelona; Jordi Alonso, MD, PhD, Health Services Research Group, IMIM, Department of Health and Experimental Sciences, UPF, and CIBERESP, Barcelona, Spain
| | - M Gili
- A. Miranda-Mendizábal, MD, MPH, Health Services Research Group, Institut Hospital del Mar d'Investigacións Mèdiques (IMIM) and Department of Health and Experimental Sciences, Pompeu Fabra University (UPF), Barcelona; P. Castellví, PhD, Health Services Research Group, IMIM and Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona; O. Parés-Badell, MD, MPH, Health Services Research Group, IMIM, Barcelona; J. Almenara, MD, PhD, Faculty of Nursing and Physiotherapy, University of Cádiz; I. Alonso, PhD, Morales Meseguer Hospital, Murcia; M. J. Blasco, MSc, Health Services Research Group, IMIM, Department of Health and Experimental Sciences, UPF, and CIBERESP, Barcelona; A. Cebrià, PhD, Department of Mental Health, Corporació Sanitaria Parc Taulí, Sabadell; A. Gabilondo, MD, PhD, Outpatient Mental Health Care Network, Osakidetza-Basque Health Service, and Mental Health and Psychiatric Care Research Unit, BioDonosti Health Research Institute; M. Gili, PhD, Institut Universitari d'Investigació en Ciències de la Salut (IUNICS-IDISPA), University of Balearic Islands, Palma de Mallorca; C. Lagares, PhD, Department of Statistics and Operative Research, University of Cádiz; J. A. Piqueras, PhD, Department of Health Psychology, Miguel Hernandez University of Elche; M. Roca, MD, PhD, IUNICS-IDISPA and Network of Preventive Activities and Health Promotion, University of Balearic Islands, Palma de Mallorca; J. Rodríguez-Marín, PhD, T. Rodríguez-Jiménez, PhD, v. Soto-Sanz, BSc, Department of Health Psychology, Miguel Hernandez University of Elche; G. Vilagut, Health Services Research Group, IMIM, and CIBERESP, Barcelona; Jordi Alonso, MD, PhD, Health Services Research Group, IMIM, Department of Health and Experimental Sciences, UPF, and CIBERESP, Barcelona, Spain
| | - C Lagares
- A. Miranda-Mendizábal, MD, MPH, Health Services Research Group, Institut Hospital del Mar d'Investigacións Mèdiques (IMIM) and Department of Health and Experimental Sciences, Pompeu Fabra University (UPF), Barcelona; P. Castellví, PhD, Health Services Research Group, IMIM and Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona; O. Parés-Badell, MD, MPH, Health Services Research Group, IMIM, Barcelona; J. Almenara, MD, PhD, Faculty of Nursing and Physiotherapy, University of Cádiz; I. Alonso, PhD, Morales Meseguer Hospital, Murcia; M. J. Blasco, MSc, Health Services Research Group, IMIM, Department of Health and Experimental Sciences, UPF, and CIBERESP, Barcelona; A. Cebrià, PhD, Department of Mental Health, Corporació Sanitaria Parc Taulí, Sabadell; A. Gabilondo, MD, PhD, Outpatient Mental Health Care Network, Osakidetza-Basque Health Service, and Mental Health and Psychiatric Care Research Unit, BioDonosti Health Research Institute; M. Gili, PhD, Institut Universitari d'Investigació en Ciències de la Salut (IUNICS-IDISPA), University of Balearic Islands, Palma de Mallorca; C. Lagares, PhD, Department of Statistics and Operative Research, University of Cádiz; J. A. Piqueras, PhD, Department of Health Psychology, Miguel Hernandez University of Elche; M. Roca, MD, PhD, IUNICS-IDISPA and Network of Preventive Activities and Health Promotion, University of Balearic Islands, Palma de Mallorca; J. Rodríguez-Marín, PhD, T. Rodríguez-Jiménez, PhD, v. Soto-Sanz, BSc, Department of Health Psychology, Miguel Hernandez University of Elche; G. Vilagut, Health Services Research Group, IMIM, and CIBERESP, Barcelona; Jordi Alonso, MD, PhD, Health Services Research Group, IMIM, Department of Health and Experimental Sciences, UPF, and CIBERESP, Barcelona, Spain
| | - J A Piqueras
- A. Miranda-Mendizábal, MD, MPH, Health Services Research Group, Institut Hospital del Mar d'Investigacións Mèdiques (IMIM) and Department of Health and Experimental Sciences, Pompeu Fabra University (UPF), Barcelona; P. Castellví, PhD, Health Services Research Group, IMIM and Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona; O. Parés-Badell, MD, MPH, Health Services Research Group, IMIM, Barcelona; J. Almenara, MD, PhD, Faculty of Nursing and Physiotherapy, University of Cádiz; I. Alonso, PhD, Morales Meseguer Hospital, Murcia; M. J. Blasco, MSc, Health Services Research Group, IMIM, Department of Health and Experimental Sciences, UPF, and CIBERESP, Barcelona; A. Cebrià, PhD, Department of Mental Health, Corporació Sanitaria Parc Taulí, Sabadell; A. Gabilondo, MD, PhD, Outpatient Mental Health Care Network, Osakidetza-Basque Health Service, and Mental Health and Psychiatric Care Research Unit, BioDonosti Health Research Institute; M. Gili, PhD, Institut Universitari d'Investigació en Ciències de la Salut (IUNICS-IDISPA), University of Balearic Islands, Palma de Mallorca; C. Lagares, PhD, Department of Statistics and Operative Research, University of Cádiz; J. A. Piqueras, PhD, Department of Health Psychology, Miguel Hernandez University of Elche; M. Roca, MD, PhD, IUNICS-IDISPA and Network of Preventive Activities and Health Promotion, University of Balearic Islands, Palma de Mallorca; J. Rodríguez-Marín, PhD, T. Rodríguez-Jiménez, PhD, v. Soto-Sanz, BSc, Department of Health Psychology, Miguel Hernandez University of Elche; G. Vilagut, Health Services Research Group, IMIM, and CIBERESP, Barcelona; Jordi Alonso, MD, PhD, Health Services Research Group, IMIM, Department of Health and Experimental Sciences, UPF, and CIBERESP, Barcelona, Spain
| | - M Roca
- A. Miranda-Mendizábal, MD, MPH, Health Services Research Group, Institut Hospital del Mar d'Investigacións Mèdiques (IMIM) and Department of Health and Experimental Sciences, Pompeu Fabra University (UPF), Barcelona; P. Castellví, PhD, Health Services Research Group, IMIM and Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona; O. Parés-Badell, MD, MPH, Health Services Research Group, IMIM, Barcelona; J. Almenara, MD, PhD, Faculty of Nursing and Physiotherapy, University of Cádiz; I. Alonso, PhD, Morales Meseguer Hospital, Murcia; M. J. Blasco, MSc, Health Services Research Group, IMIM, Department of Health and Experimental Sciences, UPF, and CIBERESP, Barcelona; A. Cebrià, PhD, Department of Mental Health, Corporació Sanitaria Parc Taulí, Sabadell; A. Gabilondo, MD, PhD, Outpatient Mental Health Care Network, Osakidetza-Basque Health Service, and Mental Health and Psychiatric Care Research Unit, BioDonosti Health Research Institute; M. Gili, PhD, Institut Universitari d'Investigació en Ciències de la Salut (IUNICS-IDISPA), University of Balearic Islands, Palma de Mallorca; C. Lagares, PhD, Department of Statistics and Operative Research, University of Cádiz; J. A. Piqueras, PhD, Department of Health Psychology, Miguel Hernandez University of Elche; M. Roca, MD, PhD, IUNICS-IDISPA and Network of Preventive Activities and Health Promotion, University of Balearic Islands, Palma de Mallorca; J. Rodríguez-Marín, PhD, T. Rodríguez-Jiménez, PhD, v. Soto-Sanz, BSc, Department of Health Psychology, Miguel Hernandez University of Elche; G. Vilagut, Health Services Research Group, IMIM, and CIBERESP, Barcelona; Jordi Alonso, MD, PhD, Health Services Research Group, IMIM, Department of Health and Experimental Sciences, UPF, and CIBERESP, Barcelona, Spain
| | - J Rodríguez-Marín
- A. Miranda-Mendizábal, MD, MPH, Health Services Research Group, Institut Hospital del Mar d'Investigacións Mèdiques (IMIM) and Department of Health and Experimental Sciences, Pompeu Fabra University (UPF), Barcelona; P. Castellví, PhD, Health Services Research Group, IMIM and Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona; O. Parés-Badell, MD, MPH, Health Services Research Group, IMIM, Barcelona; J. Almenara, MD, PhD, Faculty of Nursing and Physiotherapy, University of Cádiz; I. Alonso, PhD, Morales Meseguer Hospital, Murcia; M. J. Blasco, MSc, Health Services Research Group, IMIM, Department of Health and Experimental Sciences, UPF, and CIBERESP, Barcelona; A. Cebrià, PhD, Department of Mental Health, Corporació Sanitaria Parc Taulí, Sabadell; A. Gabilondo, MD, PhD, Outpatient Mental Health Care Network, Osakidetza-Basque Health Service, and Mental Health and Psychiatric Care Research Unit, BioDonosti Health Research Institute; M. Gili, PhD, Institut Universitari d'Investigació en Ciències de la Salut (IUNICS-IDISPA), University of Balearic Islands, Palma de Mallorca; C. Lagares, PhD, Department of Statistics and Operative Research, University of Cádiz; J. A. Piqueras, PhD, Department of Health Psychology, Miguel Hernandez University of Elche; M. Roca, MD, PhD, IUNICS-IDISPA and Network of Preventive Activities and Health Promotion, University of Balearic Islands, Palma de Mallorca; J. Rodríguez-Marín, PhD, T. Rodríguez-Jiménez, PhD, v. Soto-Sanz, BSc, Department of Health Psychology, Miguel Hernandez University of Elche; G. Vilagut, Health Services Research Group, IMIM, and CIBERESP, Barcelona; Jordi Alonso, MD, PhD, Health Services Research Group, IMIM, Department of Health and Experimental Sciences, UPF, and CIBERESP, Barcelona, Spain
| | - T Rodríguez-Jiménez
- A. Miranda-Mendizábal, MD, MPH, Health Services Research Group, Institut Hospital del Mar d'Investigacións Mèdiques (IMIM) and Department of Health and Experimental Sciences, Pompeu Fabra University (UPF), Barcelona; P. Castellví, PhD, Health Services Research Group, IMIM and Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona; O. Parés-Badell, MD, MPH, Health Services Research Group, IMIM, Barcelona; J. Almenara, MD, PhD, Faculty of Nursing and Physiotherapy, University of Cádiz; I. Alonso, PhD, Morales Meseguer Hospital, Murcia; M. J. Blasco, MSc, Health Services Research Group, IMIM, Department of Health and Experimental Sciences, UPF, and CIBERESP, Barcelona; A. Cebrià, PhD, Department of Mental Health, Corporació Sanitaria Parc Taulí, Sabadell; A. Gabilondo, MD, PhD, Outpatient Mental Health Care Network, Osakidetza-Basque Health Service, and Mental Health and Psychiatric Care Research Unit, BioDonosti Health Research Institute; M. Gili, PhD, Institut Universitari d'Investigació en Ciències de la Salut (IUNICS-IDISPA), University of Balearic Islands, Palma de Mallorca; C. Lagares, PhD, Department of Statistics and Operative Research, University of Cádiz; J. A. Piqueras, PhD, Department of Health Psychology, Miguel Hernandez University of Elche; M. Roca, MD, PhD, IUNICS-IDISPA and Network of Preventive Activities and Health Promotion, University of Balearic Islands, Palma de Mallorca; J. Rodríguez-Marín, PhD, T. Rodríguez-Jiménez, PhD, v. Soto-Sanz, BSc, Department of Health Psychology, Miguel Hernandez University of Elche; G. Vilagut, Health Services Research Group, IMIM, and CIBERESP, Barcelona; Jordi Alonso, MD, PhD, Health Services Research Group, IMIM, Department of Health and Experimental Sciences, UPF, and CIBERESP, Barcelona, Spain
| | - V Soto-Sanz
- A. Miranda-Mendizábal, MD, MPH, Health Services Research Group, Institut Hospital del Mar d'Investigacións Mèdiques (IMIM) and Department of Health and Experimental Sciences, Pompeu Fabra University (UPF), Barcelona; P. Castellví, PhD, Health Services Research Group, IMIM and Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona; O. Parés-Badell, MD, MPH, Health Services Research Group, IMIM, Barcelona; J. Almenara, MD, PhD, Faculty of Nursing and Physiotherapy, University of Cádiz; I. Alonso, PhD, Morales Meseguer Hospital, Murcia; M. J. Blasco, MSc, Health Services Research Group, IMIM, Department of Health and Experimental Sciences, UPF, and CIBERESP, Barcelona; A. Cebrià, PhD, Department of Mental Health, Corporació Sanitaria Parc Taulí, Sabadell; A. Gabilondo, MD, PhD, Outpatient Mental Health Care Network, Osakidetza-Basque Health Service, and Mental Health and Psychiatric Care Research Unit, BioDonosti Health Research Institute; M. Gili, PhD, Institut Universitari d'Investigació en Ciències de la Salut (IUNICS-IDISPA), University of Balearic Islands, Palma de Mallorca; C. Lagares, PhD, Department of Statistics and Operative Research, University of Cádiz; J. A. Piqueras, PhD, Department of Health Psychology, Miguel Hernandez University of Elche; M. Roca, MD, PhD, IUNICS-IDISPA and Network of Preventive Activities and Health Promotion, University of Balearic Islands, Palma de Mallorca; J. Rodríguez-Marín, PhD, T. Rodríguez-Jiménez, PhD, v. Soto-Sanz, BSc, Department of Health Psychology, Miguel Hernandez University of Elche; G. Vilagut, Health Services Research Group, IMIM, and CIBERESP, Barcelona; Jordi Alonso, MD, PhD, Health Services Research Group, IMIM, Department of Health and Experimental Sciences, UPF, and CIBERESP, Barcelona, Spain
| | - G Vilagut
- A. Miranda-Mendizábal, MD, MPH, Health Services Research Group, Institut Hospital del Mar d'Investigacións Mèdiques (IMIM) and Department of Health and Experimental Sciences, Pompeu Fabra University (UPF), Barcelona; P. Castellví, PhD, Health Services Research Group, IMIM and Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona; O. Parés-Badell, MD, MPH, Health Services Research Group, IMIM, Barcelona; J. Almenara, MD, PhD, Faculty of Nursing and Physiotherapy, University of Cádiz; I. Alonso, PhD, Morales Meseguer Hospital, Murcia; M. J. Blasco, MSc, Health Services Research Group, IMIM, Department of Health and Experimental Sciences, UPF, and CIBERESP, Barcelona; A. Cebrià, PhD, Department of Mental Health, Corporació Sanitaria Parc Taulí, Sabadell; A. Gabilondo, MD, PhD, Outpatient Mental Health Care Network, Osakidetza-Basque Health Service, and Mental Health and Psychiatric Care Research Unit, BioDonosti Health Research Institute; M. Gili, PhD, Institut Universitari d'Investigació en Ciències de la Salut (IUNICS-IDISPA), University of Balearic Islands, Palma de Mallorca; C. Lagares, PhD, Department of Statistics and Operative Research, University of Cádiz; J. A. Piqueras, PhD, Department of Health Psychology, Miguel Hernandez University of Elche; M. Roca, MD, PhD, IUNICS-IDISPA and Network of Preventive Activities and Health Promotion, University of Balearic Islands, Palma de Mallorca; J. Rodríguez-Marín, PhD, T. Rodríguez-Jiménez, PhD, v. Soto-Sanz, BSc, Department of Health Psychology, Miguel Hernandez University of Elche; G. Vilagut, Health Services Research Group, IMIM, and CIBERESP, Barcelona; Jordi Alonso, MD, PhD, Health Services Research Group, IMIM, Department of Health and Experimental Sciences, UPF, and CIBERESP, Barcelona, Spain
| | - J Alonso
- A. Miranda-Mendizábal, MD, MPH, Health Services Research Group, Institut Hospital del Mar d'Investigacións Mèdiques (IMIM) and Department of Health and Experimental Sciences, Pompeu Fabra University (UPF), Barcelona; P. Castellví, PhD, Health Services Research Group, IMIM and Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona; O. Parés-Badell, MD, MPH, Health Services Research Group, IMIM, Barcelona; J. Almenara, MD, PhD, Faculty of Nursing and Physiotherapy, University of Cádiz; I. Alonso, PhD, Morales Meseguer Hospital, Murcia; M. J. Blasco, MSc, Health Services Research Group, IMIM, Department of Health and Experimental Sciences, UPF, and CIBERESP, Barcelona; A. Cebrià, PhD, Department of Mental Health, Corporació Sanitaria Parc Taulí, Sabadell; A. Gabilondo, MD, PhD, Outpatient Mental Health Care Network, Osakidetza-Basque Health Service, and Mental Health and Psychiatric Care Research Unit, BioDonosti Health Research Institute; M. Gili, PhD, Institut Universitari d'Investigació en Ciències de la Salut (IUNICS-IDISPA), University of Balearic Islands, Palma de Mallorca; C. Lagares, PhD, Department of Statistics and Operative Research, University of Cádiz; J. A. Piqueras, PhD, Department of Health Psychology, Miguel Hernandez University of Elche; M. Roca, MD, PhD, IUNICS-IDISPA and Network of Preventive Activities and Health Promotion, University of Balearic Islands, Palma de Mallorca; J. Rodríguez-Marín, PhD, T. Rodríguez-Jiménez, PhD, v. Soto-Sanz, BSc, Department of Health Psychology, Miguel Hernandez University of Elche; G. Vilagut, Health Services Research Group, IMIM, and CIBERESP, Barcelona; Jordi Alonso, MD, PhD, Health Services Research Group, IMIM, Department of Health and Experimental Sciences, UPF, and CIBERESP, Barcelona, Spain
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Using Hospitalization and Mortality Data to Identify Areas at Risk for Adolescent Suicide. J Adolesc Health 2017; 61:192-197. [PMID: 28483298 DOI: 10.1016/j.jadohealth.2017.02.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 02/17/2017] [Accepted: 02/21/2017] [Indexed: 11/20/2022]
Abstract
PURPOSE The purpose of this study is to use statewide data on inpatient hospitalizations for suicide attempts and suicide mortality to identify communities and school districts at risk for adolescent suicide. METHODS Five years of data (2010-2014) from the Office of the Connecticut Medical Examiner and the Connecticut Hospital Inpatient Discharge Database were analyzed. A mixed-effects Poisson regression model was used to assess whether suicide attempt/mortality rates in the state's 119 school districts were significantly better or worse than expected after adjusting for 10 community-level characteristics. RESULTS Ten districts were at significantly higher risk for suicidal behavior, with suicide mortality/hospitalization rates ranging from 154% to 241% of their expected rates, after accounting for their community characteristics. Four districts were identified as having significantly lower risk for suicide attempts than expected after accounting for community-level advantages and disadvantages. CONCLUSIONS Data capturing hospitalization for suicide attempts and suicide deaths can inform prevention activities by identifying high-risk areas to which resources should be allocated, as well as low-risk areas that may provide insight into the best practices in suicide prevention.
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Parker EO, McDowell T. Integrating Social Justice into the Practice of CBFT: A Critical Look at Family Schemas. JOURNAL OF MARITAL AND FAMILY THERAPY 2017; 43:502-513. [PMID: 27862056 DOI: 10.1111/jmft.12205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Many families come to therapy struggling with the negative consequence of social inequity. Family therapy modalities have been developed to address these negative consequences and attend to power and social equity (Transformative family therapy: Just families in a just society. Boston, MA: Pearson Education; Socio-emotional relationship therapy. New York, NY: Springer). We argue that many family therapy modalities can be adapted to include social equity (Applying critical social theory in family therapy practice. AFTA Springer Series. New York, NY: Springer Publishing). Specifically, cognitive behavioral family therapy can be used to address the inequality in social systems that negatively affect the family system. We focus on schema formation and suggest an emphasis on societal schemas within the therapy milieu as a tool to help families see how societal inequality can affect the problems faced in family life.
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Abstract
Despite published guidelines on the need to provide comprehensive care to lesbian, gay, bisexual, transgender, and questioning/queer (LGBTQ) youth, there has been limited research related to the deliverance of primary health care to this population. The goals of this study were to learn about LGBTQ youth's experiences with their primary care physicians and to identify areas for improvement. Youth attending 1 of 5 community-based programs completed a written questionnaire and participated in a focus group discussion regarding experiences at primary care visits, including topics discussed, counselling received, and physician communication. Most of the youth did not feel their health care needs were well met. The majority acknowledged poor patient-provider communication, disrespect, and lack of discussions about important topics such as sexual and emotional health. Participants cited concerns about confidentiality and inappropriate comments as barriers to care. Youth expressed a strong desire to have physicians be more aware of their needs and concerns.
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Affiliation(s)
- Barbara K Snyder
- 1 Community Health Programs Health Center, Great Barrington, MA, USA
| | - Gail D Burack
- 2 RutgersRobert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Anna Petrova
- 2 RutgersRobert Wood Johnson Medical School, New Brunswick, NJ, USA
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Meeting the Needs of Sexual and Gender Minority Youth: Formative Research on Potential Digital Health Interventions. J Adolesc Health 2017; 60:541-548. [PMID: 28108088 DOI: 10.1016/j.jadohealth.2016.11.023] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 11/28/2016] [Accepted: 11/29/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE Sexual and gender minority youth (SGMY) have unique risk factors and worse health outcomes than their heterosexual and cisgender counterparts. SGMY's significant online activity represents an opportunity for digital interventions. To help meet the sex education and health needs of SGMY and to understand what they consider important, formative research was conducted to guide and inform the development of new digital health interventions. METHODS Semistructured interviews, in-person focus groups, and online focus groups were conducted with 92 youths (aged 15-19 years) who self-identify as nonheterosexual, noncisgender, questioning, and/or have engaged in same-sex sexual behavior. Data were coded and analyzed using inductive thematic analysis. RESULTS Thematic analysis revealed that SGMYs are often driven online by experiences of isolation, stigmatization, and lack of information and are looking for a supportive, validating community and relevant, accurate information. Gender minority youths felt that they faced a larger number of and more extreme incidences of discrimination than sexual minority youths. Most youths described interpersonal discrimination as having substantial negative effects on their mental health. CONCLUSIONS Any digital intervention for SGMY should focus on mental health and well-being holistically rather than solely on risk behaviors, such as preventing HIV. Interventions should include opportunities for interpersonal connection, foster a sense of belonging, and provide accurate information about sexuality and gender to help facilitate positive identity development. Content and delivery of digital interventions should appeal to diverse sexualities, genders, and other intersecting identities held by SGMY to avoid further alienation.
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Hacia una salud pública con orgullo: equidad en la salud en las personas lesbianas, gais, bisexuales y trans en España. GACETA SANITARIA 2017; 31:175-177. [DOI: 10.1016/j.gaceta.2016.09.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 09/28/2016] [Accepted: 09/29/2016] [Indexed: 11/18/2022]
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Hafeez H, Zeshan M, Tahir MA, Jahan N, Naveed S. Health Care Disparities Among Lesbian, Gay, Bisexual, and Transgender Youth: A Literature Review. Cureus 2017. [PMID: 28638747 PMCID: PMC5478215 DOI: 10.7759/cureus.1184] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
About 3.5% Americans identify themselves as lesbian, gay, or bisexual while 0.3% identify themselves as transgender. The LGBT (lesbian, gay, bisexual, and transgender) community belongs to almost every race, ethnicity, religion, age, and socioeconomic group. The LGBT youth are at a higher risk for substance use, sexually transmitted diseases (STDs), cancers, cardiovascular diseases, obesity, bullying, isolation, rejection, anxiety, depression, and suicide as compared to the general population. LGBT youth receive poor quality of care due to stigma, lack of healthcare providers' awareness, and insensitivity to the unique needs of this community. The main objective of this literature review is to highlight the challenges faced by the LGBT youth and to enhance the awareness among physicians about the existing disparities in order to provide a more comprehensive, evidence-based, and humane medical care to this community.
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Affiliation(s)
| | - Muhammad Zeshan
- Department of Psychiatry, Bronx Lebanon Hospital Icahn School of Medicine at Mount Sinai, Bronx, NY
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Yüksel Ş, Aslantaş Ertekin B, Öztürk M, Bikmaz PS, Oğlağu Z. A Clinically Neglected Topic: Risk of Suicide in Transgender Individuals. Noro Psikiyatr Ars 2017; 54:28-32. [PMID: 28566955 DOI: 10.5152/npa.2016.10075] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 11/13/2015] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The aim of this study was to determine whether adolescence of transgender individuals is characterized by a high risk of suicide. METHODS In total, 141 participants with transgenderism were questioned using a semi-structured interview to determine whether participants had current suicidal thoughts, had a lifetime history of such thoughts, or had attempted suicide. These findings were cross-referenced to the participants' sociodemographic characteristics, and information about their families' general attitudes toward sexuality, gender identity, and commitment to religious views. In total, 101 participants attended group psychotherapy sessions for at least a year. In these sessions, family and partner relationships, occupational problems, financial problems, medical issues, and religious concerns were discussed. RESULTS The incidence of suicide attempts, current suicidal thoughts, and lifetime suicidal thoughts were 29.8%, 9.2%, and 55.3%, respectively. In total, 76.7% of the suicide attempts occurred before the age of 21. CONCLUSION Transsexual individuals present a high risk of suicide, particularly during adolescence. This finding may be considered a sign for taking action to prevent suicide when working with transgender individuals, particularly during adolescence.
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Affiliation(s)
- Şahika Yüksel
- Department of Psychiatry, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | | | - Mine Öztürk
- Clinic of Psychiatry, Balıklı Rum Hospital, İstanbul, Turkey
| | - Pervin Sevda Bikmaz
- Department of Psychology, Haliç University School of Arts and Sciences, İstanbul, Turkey
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Kim GH, Ahn HS, Kim HJ. Type of sexual intercourse experience and suicidal ideation, plans, and attempts among youths: a cross-sectional study in South Korea. BMC Public Health 2016; 16:1229. [PMID: 27923371 PMCID: PMC5142152 DOI: 10.1186/s12889-016-3895-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 11/30/2016] [Indexed: 11/15/2022] Open
Abstract
Background Despite abundant theoretical evidence of higher rates of suicide among lesbian, gay, and bisexual (LGB) youths, little is known about the relationship between suicide and types of sexual intercourse experience in youths. This study examines the association between the type of intercourse experience and suicide risk outcomes (SROs: suicidal ideation, plans for suicide, suicidal attempts) from the Korea Youth Risk Behavior Web-based Survey. Methods We analyzed cross-sectional data from 146,621 students aged 12–17 years for the years 2012 and 2013. We defined lesbian, gay, or bisexual youth as youths who engaged in a type of sexual intercourse (same-sex or both-sex intercourse). A chi-square test and logistic regression analysis were used to evaluate the association between intercourse experience and SROs. Results The results showed that the prevalence of suicidal ideation was higher among youths with same-sex intercourse experience (45.9% for females, 33.7% for males) than among youths with opposite-sex intercourse experience (42.2% for females, 23.8% for males) and those with no experience in intercourse (21.0% for females, 12.7% for males). After adjusting for revealed risk factors that were associated with suicide risks, among males, suicide risks based on intercourse experience seemed to increase in the following order: no experience in sexual intercourse, opposite-sex, same-sex, and then both-sexes sexual intercourse experience. Same- and both-sexes intercourse related SROs are strongly linked to violence (being physically assaulted, threatened, or bullied) and sexually transmitted diseases (STDs), including HIV infection. Those having no sexual intercourse experience showed the least probability of suicide risks among youths. Conclusion The SROs of youths with same-sex or both-sex intercourse experience had strong associations with gender (males), violence, and STDs. Therefore, school educators must continue to advocate for and to implement LGB inclusive policies and programs in order to promote safe and supportive learning environments where all students are protected from health risk behaviors.
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Affiliation(s)
- Geum Hee Kim
- Department of School Health Education, Sanggye High School, 432, Nohaero, Nowon-gu, Seoul, 01761, Korea.,Department of Preventive Medicine, College of Medicine, Korea University, 73, Inchon-ro, Seongbuk-gu, Seoul, 02841, Korea
| | - Hyeong Sik Ahn
- Department of Preventive Medicine, College of Medicine, Korea University, 73, Inchon-ro, Seongbuk-gu, Seoul, 02841, Korea.
| | - Hyun Jung Kim
- Department of Preventive Medicine, College of Medicine, Korea University, 73, Inchon-ro, Seongbuk-gu, Seoul, 02841, Korea
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Trujillo MA, Perrin PB, Sutter M, Tabaac A, Benotsch EG. The buffering role of social support on the associations among discrimination, mental health, and suicidality in a transgender sample. Int J Transgend 2016; 18:39-52. [PMID: 29904324 DOI: 10.1080/15532739.2016.1247405] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION Per the minority stress framework, trans individuals often experience psychological distress given the unique stress engendered by gender identity-related discrimination. Prior research has identified social support as particularly important for psychological distress and has suggested that social support may moderate this relationship. AIMS: The purpose of the current study was to explore the patterns of connections among discrimination, mental health, and suicidal ideation in trans individuals, and whether social support moderates these relationships. METHODS Participants (N = 78) completed measures of these constructs as part of a national online survey. RESULTS A series of simultaneous multiple regressions found that harassment/rejection discrimination was a unique positive predictor of mental health symptoms and suicidal ideation, with depression positively predicting suicidal ideation. A mediational model indicated that the association between harassment/rejection discrimination and suicidal ideation was fully mediated by depression. Three moderated meditational models were run, and one yielded a significant interaction, such that discrimination predicted suicidal ideation most strongly when participants had low social support from a significant other in comparison to moderate or high support. Further, conditional direct effects identified that discrimination led to ideation only for individuals with low support from friends or a significant other but not for those with moderate or high support. CONCLUSIONS Helping trans individuals cope with harassment and rejection, particularly by drawing on social support, may promote better mental health, which could help reduce suicidality in this population.
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Willging CE, Green AE, Ramos MM. Implementing school nursing strategies to reduce LGBTQ adolescent suicide: a randomized cluster trial study protocol. Implement Sci 2016; 11:145. [PMID: 27770819 PMCID: PMC5075193 DOI: 10.1186/s13012-016-0507-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 10/08/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Reducing youth suicide in the United States (U.S.) is a national public health priority, and lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ) youth are at elevated risk. The Centers for Disease Control and Prevention (CDC) endorses six evidence-based (EB) strategies that center on meeting the needs of LGBTQ youth in schools; however, fewer than 6 % of U.S. schools implement all of them. The proposed intervention model, "RLAS" (Implementing School Nursing Strategies to Reduce LGBTQ Adolescent Suicide), builds on the Exploration, Preparation, Implementation, and Sustainment (EPIS) conceptual framework and the Dynamic Adaptation Process (DAP) to implement EB strategies in U.S. high schools. The DAP accounts for the multilevel context of school settings and uses Implementation Resource Teams (IRTs) to facilitate appropriate expertise, advise on acceptable adaptations, and provide data feedback to make schools implementation ready and prepared to sustain changes. METHODS/DESIGN Mixed methods will be used to examine individual, school, and community factors influencing both implementation process and youth outcomes. A cluster randomized controlled trial will assess whether LGBTQ students and their peers in RLAS intervention schools (n = 20) report reductions in suicidality, depression, substance use, bullying, and truancy related to safety concerns compared to those in usual care schools (n = 20). Implementation progress and fidelity for each EB strategy in RLAS intervention schools will be examined using a modified version of the Stages of Implementation Completion checklist. During the implementation and sustainment phases, annual focus groups will be conducted with the 20 IRTs to document their experiences identifying and advancing adaptation supports to facilitate use of EB strategies and their perceptions of the DAP. DISCUSSION The DAP represents a data-informed, collaborative, multiple stakeholder approach to progress from exploration to sustainment and obtain fidelity during the implementation of EB strategies in school settings. This study is designed to address the real-world implications of enabling the use of EB strategies by school nurses with the goal of decreasing suicide and youth risk behaviors among LGBTQ youth. Through its participatory processes to refine and sustain EB strategies in high schools, the RLAS represents a novel contribution to implementation science. TRIAL REGISTRATION ClinicalTrials.gov, NCT02875535.
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Affiliation(s)
- Cathleen E Willging
- Behavioral Health Research Center of the Southwest, Pacific Institute for Research and Evaluation, 612 Encino Place NE, Albuquerque, NM, USA.
| | - Amy E Green
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, MC 0812, La Jolla, San Diego, CA, 92093, USA.,Child and Adolescent Services Research Center, 3665 Kearny Villa Road, San Diego, CA, 92123, USA
| | - Mary M Ramos
- Department of Pediatrics, University of New Mexico, MSC10 5590, 1 University of New Mexico, Albuquerque, NM, 87131-0001, USA
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Power E, Coughlan H, Clarke M, Kelleher I, Lynch F, Connor D, Fitzpatrick C, Harley M, Cannon M. Nonsuicidal self-injury, suicidal thoughts and suicide attempts among sexual minority youth in Ireland during their emerging adult years. Early Interv Psychiatry 2016; 10:441-5. [PMID: 25962582 DOI: 10.1111/eip.12249] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 04/12/2015] [Indexed: 11/28/2022]
Abstract
AIM This study aimed to examine whether or not sexual minority youth constitute an at-risk group for nonsuicidal self-injury, suicidal ideation or suicide attempts during their emerging adult years. METHODS Using data from the Challenging Times Study, a population-based study of psychopathology and suicide in Ireland, analyses were conducted to test the associations between sexual minority status and the odds of any lifetime experience of nonsuicidal self-injury, suicidal thoughts or suicide attempts among Irish youth aged 19-24 years. RESULTS Sexual minority youth had 6.6-fold (95% CI 1.7-24.7) increased risk of nonsuicidal self-injury, a 5.0-fold (95% CI 1.3-18.3) increased risk of suicidal ideation, a 7.7-fold (95% CI 1.8-32.0) increased risk of suicide intent and a 6.8-fold (95% CI 1.6-27.6) increased risk of a suicide attempt during their lifetime compared to their heterosexual peers. CONCLUSIONS This study shows that emerging adulthood is a period of risk for suicide and nonsuicidal self-injurious behaviour among sexual minority youth.
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Affiliation(s)
- Emmet Power
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Helen Coughlan
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - Mary Clarke
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland.,Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Ian Kelleher
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland.,Department of Psychiatry, Cluain Mhuire Community Mental Health Service, Dublin, Ireland
| | | | - Dearbhla Connor
- Department of Psychology, James Connolly Memorial Hospital, Dublin, Ireland
| | | | - Michelle Harley
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland.,St. Michael's House, Dublin, Ireland
| | - Mary Cannon
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland.,Beaumont Hospital, Dublin, Ireland
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Reuter TR, Sharp C, Kalpakci AH, Choi HJ, Temple JR. Sexual Orientation and Borderline Personality Disorder Features in a Community Sample of Adolescents. J Pers Disord 2016; 30:694-707. [PMID: 26583589 DOI: 10.1521/pedi_2015_29_224] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Empirical literature demonstrates that sexual minorities are at an increased risk of developing psychopathology, including borderline personality disorder (BPD). The specific link between sexual orientation and BPD has received significantly less attention in youth, and it remains unclear what drives this relation. Given that there are higher rates of psychopathology in both sexual minorities and individuals with BPD, the present study aimed to determine if sexual orientation uniquely contributes to borderline personality pathology, controlling for other psychopathology. An ethnically diverse sample of 835 adolescents completed self-report measures of borderline features, depression, anxiety, and sexual orientation. Sexual minorities scored higher on borderline features compared to heterosexual adolescents. When controlling for depression and anxiety, sexual orientation remained significantly associated with borderline features. The relation between sexual orientation and BPD cannot fully be explained by other psychopathology. Future research is necessary to understand potential mechanisms underlying this relation.
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Affiliation(s)
| | | | | | - Hye J Choi
- University of Texas Medical Branch, Galveston, Texas
| | - Jeff R Temple
- University of Texas Medical Branch, Galveston, Texas
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Hegna K, Rossow I. What's Love Got to Do with It? Substance Use and Social Integration for Young People Categorized by Same-Sex Experience and Attractions. JOURNAL OF DRUG ISSUES 2016. [DOI: 10.1177/002204260703700201] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of the study was to assess whether social integration and substance use differed between three groups of adolescents that were categorized by a combination of sexual experience and attractions: (a) heterosexual orientation and attraction only, (b) same-sex experiences without same-sex attraction, and (c) same-sex attraction. A school based sample of 5,500 Norwegian 16 to 19 year olds (92% response rate) with good population representativity was analyzed. Same-sex experiences included “necking”/“making out,” petting, intercourse, and oral sex. Compared to heterosexual young people, young people reporting same-sex sexual experiences only were more socially integrated into their peer group and consumed more alcohol. Young people reporting same-sex attraction reported poorer social integration into peer networks and good social support, but a stronger sense of loneliness. Use of illegal drugs other than marijuana was more than three times as prevalent compared to that of heterosexual youths, and the gender differences in substance use were small or the opposite of what was expected.
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43
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Montano GT, McCauley HL, Miller E, Chisolm DJ, Marshal MP. Differences in Parental Monitoring Components and Their Associated Health Indicators Between Sexual-Minority and Heterosexual Girls. JOURNAL OF GLBT FAMILY STUDIES 2016; 13:211-235. [PMID: 30872979 PMCID: PMC6413312 DOI: 10.1080/1550428x.2016.1200507] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Our study sought to assess whether parental monitoring and their associations with health behaviors differed for heterosexual girls compared to sexual minority girls (girls who identified as lesbian or bisexual, endorsed same-sex attraction, or had same-sex romantic or sexualpartners). We analyzed three components of parental monitoring-adolescent disclosure, parental solicitation, and parental knowledge-between heterosexual and sexual minority girls.We also tested if the associations between these three constructs and adolescent relationship abuse, suicidality, heavy drinking, binge drinking, anxiety symptoms, and depressive symptoms were different for heterosexual girls compared to sexual minority girls. Sexual minority girls were less likely to disclose accurately to their parents their location and activities and perceived their parents asked less and knew less about their location and activities than did heterosexual girls. Heterosexual girls who reported higher levels of adolescent disclosure were less likely than were sexual minority girls to report suicidality and anxiety symptoms. Additionally, heterosexual girls who reported higher levels of parental knowledge were also less likely than were sexual minority girls to report anxiety and depressive symptoms. These findings suggest that parental monitoring may not be as protective forsexual minority girls as it is for heterosexual girls.
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Affiliation(s)
- Gerald T Montano
- Corresponding Author, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh, School of Medicine Department of Pediatrics, , 3420 Fifth Avenue, Pittsburgh, PA 15213
| | - Heather L McCauley
- Assistant Professor, University of Pittsburgh School of Medicine Department of Pediatrics, , 3420 Fifth Avenue, Pittsburgh, PA 15213
| | - Elizabeth Miller
- Professor, University of Pittsburgh School of Medicine Department of Pediatrics, , 3420 Fifth Avenue, Pittsburgh, PA 15213
| | - Deena J Chisolm
- Associate Professor, The Ohio State University College of Medicine Department of Pediatrics, The Ohio State University College of Public Health, , 700 Children's Drive, Room JW4986, Columbus, OH 43205
| | - Michael P Marshal
- Associate Professor, University of Pittsburgh School of Medicine Department of Psychiatry, University of Pittsburgh School of Medicine Department of Pediatrics, , 3811 O'Hara Strett, Pittsburgh, PA 15213
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The “Something Else” of Sexual Orientation: Measuring Sexual Identities of Older Lesbian and Bisexual Women Using National Health Interview Survey Questions. Womens Health Issues 2016; 26 Suppl 1:S71-80. [DOI: 10.1016/j.whi.2016.03.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 03/25/2016] [Accepted: 03/29/2016] [Indexed: 11/23/2022]
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Goldbach JT, Castro CA. Lesbian, Gay, Bisexual, and Transgender (LGBT) Service Members: Life After Don't Ask, Don't Tell. Curr Psychiatry Rep 2016; 18:56. [PMID: 27086317 DOI: 10.1007/s11920-016-0695-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Lesbian, gay, and bisexual service members can serve openly in the military with the repeal of the Don't Ask, Don't Tell policy. The fate of transgender service members remains uncertain as the policy preventing them from serving in the military remains under review. The health care needs of these populations remain for the most part unknown, with total acceptance and integration in the military yet to be achieved. In this paper, we review the literature on the health care needs of lesbian, gay, bisexual, and transgender (LGBT) service members, relying heavily on what is known about LGBT civilian and veteran populations. Significant research gaps about the health care needs of LGBT service members are identified, along with recommendations for closing those gaps. In addition, recommendations for improving LGBT acceptance and integration within the military are provided.
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Affiliation(s)
- Jeremy T Goldbach
- University of Southern California School of Social Work, 1150 South Olive Street, Suite 1400, Los Angeles, CA, 90015, USA
| | - Carl Andrew Castro
- University of Southern California School of Social Work, 1150 South Olive Street, Suite 1400, Los Angeles, CA, 90015, USA.
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46
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Suicide in married couples in Sweden: Is the risk greater in same-sex couples? Eur J Epidemiol 2016; 31:685-90. [PMID: 27168192 DOI: 10.1007/s10654-016-0154-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 04/27/2016] [Indexed: 10/21/2022]
Abstract
Minority sexual orientation is a predictor of suicide ideation and attempts, though its association with suicide mortality is less clear. We capitalize on Sweden's extensively linked databases, to investigate whether, among married individuals, same-sex marriage is associated with suicide. Using a population-based register design, we analyzed suicide risk among same-sex married women and men (n = 6456), as compared to different-sex married women and men (n = 1181723) in Sweden. We selected all newly partnered or married individuals in the intervening time between 1/1/1996 and 12/31/2009 and followed them with regard to suicide until 12/31/2011. Multivariate Poisson regression was used to calculate adjusted incidence risk ratios (IRR) with 95 % confidence intervals (CI). The risk of suicide was higher among same-sex married individuals as compared to different-sex married individuals (IRR 2.7, 95 % CI 1.5-4.8), after adjustment for time at risk and socioeconomic confounding. Sex-stratified analyses showed a tentatively elevated risk for same-sex married women (IRR 2.5, 95 % CI 0.8-7.7) as compared to different-sex married women. Among same-sex married men the suicide risk was nearly three-fold greater as compared to different-sex married (IRR 2.895 % CI 1.5-5.5). This holds true also after adjustment for HIV status. Even in a country with a comparatively tolerant climate regarding homosexuality such as Sweden, same-sex married individuals evidence a higher risk for suicide than other married individuals.
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47
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McTavish J. Spiritual Accompaniment for Persons with Same-Sex Attraction. Linacre Q 2016. [DOI: 10.1179/0024363915z.000000000144a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Affiliation(s)
- James McTavish
- Local Responsible of the Verbum Dei Missionaries, Manila, Philippines
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48
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Affiliation(s)
- James McTavish
- Local Responsible of the Verbum Dei Missionaries, Manila, Philippines
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49
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Björkenstam C, Kosidou K, Björkenstam E, Dalman C, Andersson G, Cochran S. Self-reported suicide ideation and attempts, and medical care for intentional self-harm in lesbians, gays and bisexuals in Sweden. J Epidemiol Community Health 2016; 70:895-901. [PMID: 26945095 DOI: 10.1136/jech-2015-206884] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 02/19/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND Minority sexual orientation is a robust risk indicator for self-reported suicidal ideation and attempts. However, little is known about patterns of medical care for intentional self-harm in this vulnerable population. We investigate sexual orientation-related differences in self-reported lifetime suicide symptoms and medical care for intentional self-harm between 1969 and 2010, including age at initial treatment and recurrence. METHODS We used data from the Stockholm Public Health Cohort, a population-based sample of 874 lesbians/gays, 841 bisexuals and 67 980 heterosexuals, whose self-administered surveys have been linked to nationwide registers. Estimates of risk for medical care were calculated as incidence rate ratios (IRR) with 95% CIs. RESULTS Both suicidal ideation and attempts were more commonly reported by lesbian/gay and bisexual (LGB) individuals. Adjusting for risk-time and confounding, lesbians (IRR 3.8, 95% CI 2.7 to 5.4) and bisexual women (IRR 5.4, 95% CI 4.4 to 6.6) experienced elevated risk for medical care for intentional self-harm, as compared to heterosexual women. Gay men evidenced higher risk (IRR 2.1, 95% CI 1.3 to 3.4) as compared to heterosexual men. Recurrent medical care was more frequent in LGB individuals, especially in bisexual women and gay men. Lesbian and bisexual women were also younger than heterosexual women when they first received medical care for intentional self-harm. CONCLUSIONS Positive histories of suicidal ideation, attempts and medical care for intentional self-harm, including higher levels of recurrence, are more prevalent among LGB individuals in contrast to heterosexuals. Lesbian/bisexual women evidence an earlier age of onset of treatment. Tailored prevention efforts are urgently needed.
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Affiliation(s)
- Charlotte Björkenstam
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, USA Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden Department of Sociology, Stockholm University, Stockholm, Sweden
| | - Kyriaki Kosidou
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Emma Björkenstam
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden Department of Community Health Sciences, Fielding School of Public Health and California Center for Population Research, University of California Los Angeles, Los Angeles, USA
| | - Christina Dalman
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Gunnar Andersson
- Department of Sociology, Stockholm University, Stockholm, Sweden
| | - Susan Cochran
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, USA
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50
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May AM, Klonsky ED. What Distinguishes Suicide Attempters From Suicide Ideators? A Meta-Analysis of Potential Factors. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2016. [DOI: 10.1111/cpsp.12136] [Citation(s) in RCA: 185] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Alexis M. May
- Department of Psychology; University of British Columbia; Vancouver BC Canada
| | - E. David Klonsky
- Department of Psychology; University of British Columbia; Vancouver BC Canada
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