Mental Health Status of Double Minority Adolescents: Findings from National Cross-Sectional Health Surveys

Wellness in the invisible workforce: a pilot well-being study in black, indigenous, and people of color (BIPOC) women faculty in the pharmacy and pharmaceutical sciences

BACKGROUND

Black, Indigenous, and other People of Color (BIPOC) women faculty are underrepresented in biomedical sciences and higher education. This disparity has been highlighted in previous studies to harm productivity, career progression, and well-being. This pilot study aimed to assess the perceived impact of a longitudinal well-being program for BIPOC women faculty, estimating its effects on well-being, burnout, and self-efficacy.

METHODS

Full-time faculty in pharmacy or pharmaceutical science, identifying as BIPOC women, participated in this pilot repeated cross-sectional study of participants in a Well-Being Initiative, with the first cross-sectional study coming before a pilot intervention and the second cross-sectional coming after the pilot intervention. Cohort 1 engaged in a two-year program, while Cohort 2 participated for one year. Open-text questions assessed program impact on well-being, and inductive coding identified themes. Well-being, burnout, and self-efficacy were measured using the General Well-Being Index (WBI), Maslach Areas of Worklife Survey (AWS), 2-items from the Maslach Burnout Index-Human Services Survey (MBI-HSS), and General Self-Efficacy Survey (GSES). Descriptive statistics were calculated for primary and secondary outcomes.

RESULTS

Sixteen participated in Cohort 1, and 18 participated in Cohort 2. Both cohorts reported a positive impact on well-being and a sense of community as a result of the program. Post-intervention median WBI decreased, and burnout and well-being risk declined (MBI: 24% and 28% point decrease at risk for burnout, WBI: median score 4 to 3 with 20% decreased risk for poor well-being, and median score 3 to 0.5 with a 61% point decrease at risk for poor well-being, for Cohorts 1 and 2, respectively). The AWS community subscale (Cohort 1) median score increased from 2.67 to 3.5, and values subscale (Cohort 2) median score increased 3.17 to 3.67, the largest increases. Cohort 2 exhibited improved self-efficacy (GSES median score change of 30 to 34). Participants reported the sense of community and connection built over the year(s) of the program, the ability to share of experiences from those further along in their career, having a safe space to be authentic with fellow participants, and the various sessions on creating self-care plans and maintaining core values as top themes of how program most benefited their well-being. Lessons learned and opportunities for improvement are addressed.

CONCLUSION

Participants reported many of the key impacts were the program's ability to foster a sense of community and help them develop skills for personal and professional well-being. While higher baseline risks of poor well-being and burnout persist for BIPOC women faculty, positive trends emerged post-intervention. This study contributes to innovative strategies focused on supporting the well-being of BIPOC women faculty and lessons learned may inform and help refine future research.

CLINICAL TRIAL NUMBER

Not applicable.

The glue that binds us: The positive relationships between whanaungatanga (belonging), the wellbeing, and identity pride for takatāpui who are trans and non-binary

ISSUE ADDRESSED

This article explores how belonging can enhance well-being for takatāpui (a traditional Māori term that embraces all Māori with diverse genders, sexualities and sex characteristics) who are trans and non-binary across a range of contexts.

METHODS

We drew data from the 2018 Counting Ourselves, a nationwide community-based survey of trans and non-binary people in Aotearoa (New Zealand) (N = 1178); of which 161 (13.7%) identified as Māori, the Indigenous people of Aotearoa.

RESULTS

Based on generalised regression models, feelings of belonging with friends, takatāpui communities, Māori communities, and work communities were correlated to higher feelings of life satisfaction, life worthwhileness, and identity pride for takatāpui who are trans and non-binary. In Te Ao Maōri (the Māori worldview), such concepts of belonging and relationships are collectively known as whanaungatanga.

CONCLUSIONS

Our findings affirm whanaungatanga as foundational to well-being among trans Māori people, enabling them to locate themselves within nurturing and supportive networks. SO WHAT?: Whanaungatanga is a key policy agenda, alongside other system-level change, that is needed to buffer takatāpui who are trans and non-binary from poverty, stigma, and racism they face. This will require changes to the current policy and practice context. We argue that whanaungatanga, while an important strategy of well-being for trans and non-binary people, must also occur alongside wider system transformations to address transphobia, racism, and cisheteronormativity.

Analysis of Faculty Gender and Race in Scholarly Achievements in Academic Neurology

Background: Intersection of gender and race and/or ethnicity in academic medicine is understudied; we aim to understand these factors in relation to scholarly achievements for neurology faculty. Methods: Faculty from 19 US neurology departments completed a survey (2021-2022) to report rank, leadership positions, publications, funded projects, awards, and speaker invitations. Regression analyses examined effects of gender, race, and their intersectionality on these achievements. Women, Black/Indigenous/People of Color (BIPOC), and BIPOC women were comparator groups. Results: Four hundred sixty-two faculty responded: 55% women, 43% men; 31% BIPOC, 63% White; 21% BIPOC women, 12% BIPOC men, 36% White women, 31% White men. Men and White faculty are more likely to be full professors than women and BIPOC faculty. The number of leadership positions, funded projects, awards, and speaker invitations are significantly greater in White compared to BIPOC faculty. Relative to BIPOC women, the number of leadership positions is significantly higher among BIPOC men, White women, and White men. Publication numbers for BIPOC men are lower, number of funded projects and speaker invitations for White women are higher, and number of awards among White men and White women is higher compared to BIPOC women. Discussion: Our study highlights that inequities in academic rank, award number, funded projects, speakership invitations, and leadership roles disproportionately impacted BIPOC women. More studies are needed to evaluate gender and race and/or ethnicity intersectionality effects on faculty achievements, reasons for inequities, recognition, and potential solutions.

Asian Rainbow Youth in New Zealand: Protective Factors

PURPOSE

To explore the impacts of double minority status (ethnic and sexual/gender minority) and protective factors associated with the emotional wellbeing and mental health of Asian Rainbow (sexual/gender minority) youth in New Zealand.

METHODS

The data were extracted from the Youth19 Rangatahi survey, which surveyed 7,374 students from 45 mainstream secondary schools. The comparison groups were Asian non-Rainbow youth and Pākehā (New Zealand European) Rainbow youth. A secondary analysis was performed examining the associations between postulated protective factors and the emotional wellbeing and mental health outcomes of Asian Rainbow youth.

RESULTS

Asian Rainbow youth had higher odds of depressive symptoms, anxiety, and suicidal thoughts and attempts and lower odds of good emotional wellbeing compared to Asian non-Rainbow youth. However, Asian Rainbow youth had lower odds of anxiety compared to Pākehā Rainbow youth. Among Asian Rainbow youth, family acceptance and feeling safe at school were associated with higher odds of good emotional wellbeing, and lower odds of depressive symptoms, anxiety, and suicidal thoughts. Several other protective factors were also associated with 1 or more (but not all) of the emotional wellbeing and mental health indicators.

DISCUSSION

This study suggests that family acceptance and feeling safe at school may serve as important buffers mitigating risks of adverse emotional wellbeing experienced by Asian Rainbow youth.

Psychological Distress and Suicidality Among Transgender Young Adults in the United States

PURPOSE

Transgender young adults (TYA) are burdened by adverse mental health outcomes. Guided by intersectionality and minority stress frameworks, we compared prevalence of psychological distress and suicidality among TYA of different social identities to inform future interventions.

METHODS

In this secondary data analysis of 12,738 TYA, ages 18-25 years, from the 2015 United States Transgender Survey, we developed multivariable regression models examining associations between social identities and psychological distress and suicidality, adjusting for relevant covariates. Self-reported identities were used as proxies for minority stress resulting from structural oppressions related to gender binarism, transmisogyny, heterosexism, and racism.

RESULTS

Overall, 53% met criteria for serious psychological distress, and 66% reported suicidal ideation. Statistically higher odds of serious psychological distress and suicidal ideation and plan were found for TYA assigned male compared to assigned female at birth (adjusted odds ratios [aORs] = 1.14-1.50). Nonbinary TYA assigned male at birth also had lower odds of all outcomes compared to all other TYA (aORs = 0.6-0.7). Compared to White TYA, Latiné/x TYA were more likely to experience serious psychological distress (aOR = 1.19, 95% confidence interval: 1.02, 1.39) and multiracial TYA were more likely to report suicide plan(s) and attempt(s) (aORs = 1.25-1.30). Finally, compared to heterosexual TYA, bisexual/pansexual TYA were more likely to report suicide plan(s) (aOR = 1.28, 95% confidence intervals: 1.04, 1.52), and all sexual minority TYA were more likely to report serious psychological distress and suicidal ideation (aORs = 1.31-2.00).

DISCUSSION

Results highlight complex associations between intersectional minority stress and mental health outcomes among TYA. Associations between identities and mental health morbidity highlight an urgent need for targeted mental health interventions.

An ecological analysis of hope amongst Asian rainbow young people in Aotearoa New Zealand

Rainbow research tends to prioritise gender and sexuality experiences over the racialised experiences of Asian rainbow young people. Informed by an intersectional lens, we employed a hope-based ecological framework to examine how multiple overlapping axes of oppression (e.g. cisgenderism, heterosexism and racism) shape the aspirations of these youth. We drew on the voices of Asian participants from the 2021 Aotearoa New Zealand Identify Survey, who had responded to an open-text question on their hopes for rainbow young people (n = 217; age range = 14 to 26). The content analysis identified seven prominent categories of hope across three ecological levels (macro exo and meso). These categories were societies: 1) break away from cisheterosexist expectations; 2) confront racism and intersection with cisheterosexism; 3) promote rainbow-inclusive education; 4) ban sexual orientation and gender identity change efforts; 5) improve access to culturally safe health care; 6) dismantle white-dominated rainbow spaces; and 7) provide more rainbow-inclusive family support. These hopes were constructed amidst the desire to challenge unacceptance and exclusion by the wider society for not adhering to white cisheterosexist expectations. The study provides critical insights for community organisations, education settings, and government to consider in addressing the diverse needs of Asian rainbow young people.

An intersectional approach to exploring lived realities and harnessing the creativity of ethnic minority youth for health gains: protocol for a multiphase mixed method study

BACKGROUND

Understanding the diversity and multiplicity of identities experienced by youth in Aotearoa (Te reo Māori name of the country) New Zealand (NZ) is vital to promoting their wellbeing. Ethnic minority youth (EMY) in NZ (defined as those identifying with Asian, Middle Eastern, Latin American and African ethnic origins) have been historically under-studied and under-counted, despite reporting high levels of discrimination, a major determinant of mental health and wellbeing and potentially a proxy for other inequities. In this paper, we describe the protocol for a multi-year study that examines, using an intersectional approach, how multiple marginalised identities impact mental and emotional wellbeing of EMY.

METHODS

This is a multiphase, multi-method study designed to capture the diversity of lived realities of EMY who self-identify with one or more additional marginalised intersecting identity (the population referred here as EMYi). Phase 1 (Descriptive study) will involve secondary analyses of national surveys to examine the prevalence and relationships between discrimination and wellbeing of EMYi. Phase 2 (Study on public discourse) will analyse data from media narratives, complemented by interviews with stakeholders to explore discourses around EMYi. Phase 3 (Study on lived experience) will examine lived experiences of EMYi to discuss challenges and sources of resilience, and how these are influenced by public discourse. Phase 4 (Co-design phase) will use a creative approach that is youth-centered and participatory, and will involve EMYi, creative mentors and health service, policy and community stakeholders as research partners and advisors. It will employ participatory generative creative methods to explore strengths-based solutions to discriminatory experiences.

DISCUSSION

This study will explore the implications of public discourse, racism and multiple forms of marginalisation on the wellbeing of EMYi. It is expected to provide evidence on the impacts of marginalisation on their mental and emotional wellbeing and inform responsive health practice and policy. Using established research tools and innovative creative means, it will enable EMYi to propose their own strength-based solutions. Further, population-based empirical research on intersectionality and health is still nascent, and even more scarce in relation to youth. This study will present the possibility of expanding its applicability in public health research focused on under-served communities.

“Being Trans Intersects with My Cultural Identity”: Social Determinants of Mental Health Among Asian Transgender People

Purpose

While studies on the relationship between social determinants and mental health among transgender people in Asia are increasing, there is a paucity of research on Asian transgender people living in Western countries. This study aimed to examine how social positions (gender, ethnicity, and migrant status) and social determinants of mental health were inter-related for Asian transgender people in Aotearoa/New Zealand.

Methods

We analyzed both quantitative and qualitative data from Asian participants (n=49) who responded to the 2018 Counting Ourselves: Aotearoa New Zealand Trans and Non-Binary Health Survey.

Results

Overall, 35% reported a very high psychological distress level. There were high levels of unmet needs for gender-affirming care, and participants reported a range of negative experiences at health care settings. About two-fifths had been discriminated because of their transgender (42%) or Asian (39%) identities. Fewer than half of participants felt that their family members were supportive of them being transgender (44%), and most reported they had supportive friends (73%). More than two-thirds of participants (68%) had a strong sense of belongingness to the transgender community and 35% reported this for the Asian community. Qualitative findings revealed specific challenges that participants experienced; these included barriers to accessing health care due to their migrant status and language barriers, influences of Asian cultures on mental health experiences, and rejection by family and people in Asian communities.

Conclusion

Our study provides evidence for health care providers, researchers, and policy makers to employ a culturally appropriate lens to improve knowledge about the intersectional experiences of being Asian and transgender.

Mental health support experiences of rainbow rangatahi youth in Aotearoa New Zealand: results from a co-designed online survey

A substantial body of research documents high rates of mental health problems in rainbow communities, however little is known about the experiences of rainbow young people who access mental health support in New Zealand. Here, we present analysis of quantitative survey data from 955 rainbow and takatāpui rangatahi (aged 14-24) collected in collaboration with rainbow community organisations. We find that rainbow rangatahi report mixed experiences in mental health settings and commonly worry about discrimination and lack of knowledge on the part of mental health professionals. We also report significant differences in mental health support experiences based on a range of demographic variables, including gender, intersex status, age, location, and ethnicity. Finally, we consider a range of actions mental health professionals can take to improve service provision, and how these findings can improve the quality of mental health support for Aotearoa's rainbow rangatahi.

Creating an inclusive community for BIPOC faculty: women of color in academia

Institutions of higher education are increasingly diverse with more women and people of color hired, but there remains much work to be done to ensure that underrepresented faculty feel supported in their careers, evaluated fairly for tenure and/or promotion, and made to feel appreciated and valued in their institutions. This perspective paper will review how interpersonal and institutional prejudice disadvantage women of color in academia in aspects of their professional responsibilities including teaching, mentoring students, research, and service. The combination of these challenges explains why women of color are not rewarded in the same way and do not advance as quickly in their academic careers compared to white men. After considering the subtle and direct ways that biases cause harm to women of color, we present recommendations to better support women of color in faculty roles with the goal of combating prejudice pertaining to both racial/ethnic and gender biases.

Mental health of people of diverse genders and sexualities in Aotearoa/New Zealand: Findings from the New Zealand Mental Health Monitor

ISSUES ADDRESSED

To examine the mental health inequities, and social exclusion and isolation and protective factor differences between people of diverse genders and sexualities (lesbian/gay, bisexual, gender diverse and takatāpui) and cisgender and heterosexual people in Aotearoa/New Zealand.

METHODS

We employed data from the pooled probability sample of 2016 and 2018 New Zealand Mental Health Monitor. The sample comprised of 2938 people at least 15 years old, of which 93 had diverse gender and sexuality identities. Generalised linear models were used to test for differences in mental health (current and lifetime mental distress, depression, anxiety, self-harm and suicide), social exclusion and isolation, and friend and family support for people of diverse genders and sexualities. We also conducted exploratory linear regression analyses to examine whether mental health difficulties were associated with social exclusion and isolation and friend/family support.

RESULTS

People of diverse genders and sexualities had high rates of mental health difficulties across all variables we examined. For example, people identifying as diverse genders and sexualities had three times the risk of considering self-harm and suicide than their cisgender and heterosexual counterparts (22% vs 5%; RR = 3.12). People of diverse genders and sexualities also scored an average of 6.08 points higher on the 27-point PHQ-9 depression scale when they had experienced social isolation, and 4.01 points higher when they experienced social exclusion.

CONCLUSION

Our results are consistent with current literature on the large mental health inequities faced by people of diverse genders and sexualities. SO WHAT?: Policy makers and health care providers in Aotearoa/New Zealand should consider the negative mental health consequences of social exclusion and isolation for people of diverse genders and sexualities.

Gender Minority Stress: A Critical Review

Past studies that compare cisgender to transgender (or trans) and gender diverse people have found a higher prevalence of mental health problems among the latter groups. This article uses Testa's gender minority stress framework, which is an expansion of minority stress theory, to assess minority stressors that are specific to the experiences of trans and gender diverse people. The concept of cisnormativity, an ideology that positions cisgender identities as a norm, is used in relation to the gender minority stress framework to describe the marginalizing nature of social environments for trans and gender diverse people. This article provides a critical review that integrates and expands on past theoretical perspectives on gender minority stressors and protective factors. Specifically, this article demonstrates the relevance of cultural and ethnic backgrounds to complement the application of intersectionality in research on health disparities experienced by trans and gender diverse people.

Identity negotiation processes among Black and Latinx sexual minority young adult mental health service users

The transition to adulthood presents particular challenges for Black and Latinx sexual minorities in need of mental health services. Identity formation and marginalization during this developmental period can interfere with help-seeking and lead to health disparities. Identity-specific psychosocial supports are needed to assist young adults to successfully navigate these challenges, but research on identity processes, help-seeking, and service-utilization among sexual minority young people of color is very limited. To better understand how multiple minority young people navigate their identities in the context of using, or choosing not to use, mental health services, this study qualitatively explored the experiences of 31 emerging adults. Through in-depth interviews, analyses revealed that young adults negotiated social identity norms about mental health help-seeking by separating from unhelpful norms, managing stigmatized aspects of identity, integrating helpful identity alternatives, and forming individualized perspectives on help-seeking that allowed them to maintain important connections to their minority group identities. Findings are discussed in relation to previous research on ethnic and sexual minority identity development and service utilization. Practice and research recommendations for increasing knowledge, improving help-seeking, and promoting resilience around young adults' intersectional identities are offered.

Factors Associated with Academic Achievement for Sexual and Gender Minority and Heterosexual Cisgender Students: Implications from a Nationally Representative Study

Research on sexual and gender minority student achievement indicates that such students report lowered achievement relative to other students. Increased victimization and less school belonging, amongst other factors, have been identified as contributing to these inequalities. However, supportive schooling structures and caregiver support may support their achievement. A nationally representative survey of secondary school students was used to identify specific factors that support achievement for sexual minority (n = 485), gender minority (n = 298), and heterosexual cisgender (where one's sex assigned at birth "matches" a binary gender identity, i.e., a male assigned at birth identifies as a boy/man, n = 7064) students in New Zealand. While reported victimization did not affect achievement for sexual and gender minority students, school belonging, and teacher expectations of success, emerged as significant factors. Differences emerged between sexual minority and gender minority achievement factors, suggesting a range of detailed policy implications and recommendations.

Navigating double marginalisation: migrant Chinese sexual and gender minority young people's views on mental health challenges and supports

Sexual and/or gender minority young people who are also members of an ethnic minority can experience unique challenges. Limited research draws directly on the mental health experiences of these 'double minority' youth. This study focused on Chinese sexual/gender minority youth in New Zealand. It sought to explore features they found challenging for, or supportive of, their mental health and wellbeing. Semi-structured interviews were conducted with 11 Chinese sexual/gender minority participants aged between 19 and 29 years old and residing in Auckland, New Zealand. An inductive approach to qualitative data analysis was used. Two major domains of findings emerged. Firstly, participants described mental health challenges linked to racism, sexism, cis-heteronormativity and challenges in relation to intersecting identities. Secondly, Chinese culture and community connections, family and peer support and role models seemed to facilitate resiliency. However, the fear of 'losing face', unwillingness to disclose distress when unwell and mental health service providers' lack of cultural and linguistic competency were described as barriers to effective mental health support. In conclusion, Chinese and sexual/gender minority identities were integral parts of participants' sense of self, and this was associated with their mental health and wellbeing. Further research is required to explore ways to reduce barriers and promote resiliency.

How LGBT+ Young People Use the Internet in Relation to Their Mental Health and Envisage the Use of e-Therapy: Exploratory Study

Background

Lesbian, gay, bisexual, and transgender (LGBT) youth and other young people diverse in terms of their sexuality and gender (LGBT+) are at an elevated risk of mental health problems such as depression. Factors such as isolation and stigma mean that accessing mental health services can be particularly challenging for LGBT+ young people, and previous studies have highlighted that many prefer to access psychological support on the Web. Research from New Zealand has demonstrated promising effectiveness and acceptability for an LGBT+ focused, serious game–based, computerized cognitive behavioral therapy program, Rainbow Smart, Positive, Active, Realistic, X-factor thoughts (SPARX). However, there has been limited research conducted in the area of electronic therapy (e-therapy) for LGBT+ people.

Objective

This study aimed to explore how and why LGBT+ young people use the internet to support their mental health. This study also sought to explore LGBT+ young people’s and professionals’ views about e-therapies, drawing on the example of Rainbow SPARX.

Methods

A total of 3 focus groups and 5 semistructured interviews were conducted with 21 LGBT+ young people (aged 15-22 years) and 6 professionals (4 health and social care practitioners and 2 National Health Service commissioners) in England and Wales. A general inductive approach was used to analyze data.

Results

LGBT+ youth participants considered that the use of the internet was ubiquitous, and it was valuable for support and information. However, they also thought that internet use could be problematic, and they highlighted certain internet safety and personal security considerations. They drew on a range of gaming experiences and expectations to inform their feedback about Rainbow SPARX. Their responses focused on the need for this e-therapy program to be updated and refined. LGBT+ young people experienced challenges related to stigma and mistreatment, and they suggested that strategies addressing their common challenges should be included in e-therapy content. Professional study participants also emphasized the need to update and refine Rainbow SPARX. Moreover, professionals highlighted some of the issues associated with e-therapies needing to demonstrate effectiveness and challenges associated with health service commissioning processes.

Conclusions

LGBT+ young people use the internet to obtain support and access information, including information related to their mental health. They are interested in LGBT-specific e-therapies; however, these must be in a contemporary format, engaging, and adequately acknowledge the experiences of LGBT+ young people.