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Khanijow K, Wright S, Hedian H, Harris C. Hospitalizations and transgender patients in the United States. J Hosp Med 2024; 19:508-512. [PMID: 38623767 DOI: 10.1002/jhm.13368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 03/12/2024] [Accepted: 03/31/2024] [Indexed: 04/17/2024]
Abstract
It is known that transgender people experience health inequalities. Disparities in hospital outcomes impacting transgender individuals have been inadequately explored. We conducted this retrospective cohort study using the National Inpatient Sample (01/2018-12/2019) to compare in-hospital mortality and utilization variables between cisgender and transgender individuals using regression analyses. Approximately two-thirds of hospitalizations for transgender patients (n = 10,245) were for psychiatric diagnoses. Compared to cisgender patients, there were no significant differences in adjusted means differences (aMD) in length of stay (LOS) (aMD = -0.29; p = .16) or total charges (aMD = -$486; p = .56). An additional 4870 transgender patients were admitted for medical diagnoses. Transgender and cisgender individuals had similar adjusted odds ratios (aOR) for in-hospital mortality (aOR = 0.96; p = .88) and total hospital charges (aMD = -$3118; p = .21). However, transgender individuals had longer LOS (aMD = +0.46 days; confidence interval [CI]: 0.15-0.90; p = .04). When comparing mortality and resource utilization between cisgender and transgender individuals, differences were negligible.
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Affiliation(s)
- Keshav Khanijow
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
- Division of Hospital Medicine, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA
| | - Scott Wright
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
- Division of General Internal Medicine, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA
| | - Helene Hedian
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
- Division of General Internal Medicine, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Che Harris
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
- Division of Hospital Medicine, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA
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2
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Gonçalves CC, Waters Z, Quirk SE, Haddad PM, Lin A, Williams LJ, Yung AR. Barriers and facilitators to mental health treatment access and engagement for LGBTQA+ people with psychosis: a scoping review protocol. Syst Rev 2024; 13:143. [PMID: 38816775 PMCID: PMC11137929 DOI: 10.1186/s13643-024-02566-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 05/17/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND The prevalence of psychosis has been shown to be disproportionately high amongst sexual and gender minority individuals. However, there is currently little consideration of the unique needs of this population in mental health treatment, with LGBTQA+ individuals facing barriers in accessing timely and non-stigmatising support for psychotic experiences. This issue deserves attention as delays to help-seeking and poor engagement with treatment predict worsened clinical and functional outcomes for people with psychosis. The present protocol describes the methodology for a scoping review which will aim to identify barriers and facilitators faced by LGBTQA+ individuals across the psychosis spectrum in help-seeking and accessing mental health support. METHODS A comprehensive search strategy will be used to search Medline, PsycINFO, Embase, Scopus, LGBTQ+ Source, and grey literature. Original studies of any design, setting, and publication date will be included if they discuss barriers and facilitators to mental health treatment access and engagement for LGBTQA+ people with experiences of psychosis. Two reviewers will independently screen titles/abstracts and full-text articles for inclusion in the review. Both reviewers will then extract the relevant data according to pre-determined criteria, and study quality will be assessed using the Joanna Briggs Institute (JBI) critical appraisal checklists. Key data from included studies will be synthesised in narrative form according to the Guidance on the Conduct of Narrative Synthesis in Systematic Reviews. DISCUSSION The results of this review will provide a comprehensive account of the current and historical barriers and facilitators to mental healthcare faced by LGBTQA+ people with psychotic symptoms and experiences. It is anticipated that the findings from this review will be relevant to clinical and community services and inform future research. Findings will be disseminated through publication in a peer-reviewed journal and presented at conferences. SCOPING REVIEW REGISTRATION This protocol is registered in Open Science Framework Registries ( https://doi.org/10.17605/OSF.IO/AT6FC ).
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Affiliation(s)
- Cláudia C Gonçalves
- Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC, 3220, Australia.
| | - Zoe Waters
- Telethon Kids Institute, University of Western Australia, Perth, WA, 6009, Australia
| | - Shae E Quirk
- Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC, 3220, Australia
| | - Peter M Haddad
- Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC, 3220, Australia
- University Hospital Geelong, Barwon Health, Geelong, VIC, 3220, Australia
| | - Ashleigh Lin
- School of Population and Global Health, University of Western Australia, Perth, WA, 6009, Australia
| | - Lana J Williams
- Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC, 3220, Australia
| | - Alison R Yung
- Institute for Mental and Physical Health and Clinical Translation, Deakin University, Geelong, VIC, 3220, Australia
- School of Health Sciences, University of Manchester, Manchester, M13 9PL, UK
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Trivedi C, Rizvi A, Mansuri Z, Jain S. Mental health outcomes and suicidality in hospitalized transgender adolescents: A propensity score-matched Cross-sectional analysis of the National inpatient sample 2016-2018. J Psychiatr Res 2024; 172:345-350. [PMID: 38442450 DOI: 10.1016/j.jpsychires.2024.02.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 01/17/2024] [Accepted: 02/20/2024] [Indexed: 03/07/2024]
Abstract
Transgender adolescents have unique mental health needs. This demographic has increased rates of mood disorders, anxiety, and depression compared to their cisgender peers. Large-scale studies focused on mental health outcomes, including suicidality, in the transgender adolescent population remain unknown. This study tries to fill these gaps in the literature. Data for this study was taken from the National Inpatient Sample 2016-2018. Transgender adolescents were identified using the ICD-10 codes related to transsexualism diagnoses. These individuals were compared to adolescents without transsexualism diagnoses. To mitigate imbalances in baseline characteristics, we utilized a 1:2 nearest neighbor propensity score matching with a caliper width of 0.0001, considering variables such as age, year of hospitalization, and psychiatric disorders. Following propensity score matching, the study cohort comprised 2635 transgender and 5270 non-transgender adolescents (Mean age 15.2 years). The transgender group demonstrated a notably higher prevalence of mood disorders (91%) and anxiety disorders (65%). Furthermore, the prevalence of suicidal ideation was significantly higher in the transgender group (52.4% vs. 39.2%, p < 0.001). However, there was no significant difference in the prevalence of suicide attempts between the groups. After controlling for psychiatric comorbidities, age, and gender, the odds ratio for the composite outcome of suicidal ideation or attempt was 1.99 (95% CI 1.58-2.12, p < 0.001). Our study identifies elevated mood and anxiety disorders and suicidality rates in hospitalized transgender adolescents compared to cisgender peers. Mood disorders notably amplify the risk of suicidal attempts. These findings urgently call for targeted mental health interventions and policy changes to serve this vulnerable population in healthcare settings better.
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Affiliation(s)
- Chintan Trivedi
- Department of Psychiatry, Texas Tech University Health Science Center at Odessa/Permian Basin, Odessa, TX, USA.
| | - Abid Rizvi
- Department of Behavioral Medicine & Psychiatry, West Virginia University, 936 Sharpe Hospital Road, Weston, WV, 26452, USA.
| | - Zeeshan Mansuri
- Department of Psychiatry, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Shailesh Jain
- Department of Psychiatry, Texas Tech University Health Science Center at Odessa/Permian Basin, Odessa, TX, USA.
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Trinh MH, Quint M, Coon D, Bhasin S, Tocci B, Reisner SL. Transgender Patients Report Lower Satisfaction with Care Received than Cisgender Patients Receiving Care in an Academic Medical Care System. LGBT Health 2024; 11:202-209. [PMID: 38100315 DOI: 10.1089/lgbt.2023.0034] [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: 12/17/2023] Open
Abstract
Purpose: Transgender and gender diverse (TGD) patients experience challenges in health care settings, including stigma, lack of culturally competent providers, and suboptimal gender-affirming care. However, differences in patient satisfaction between TGD patients compared with cisgender patients have been inadequately studied. This study aimed to assess such differences in patient satisfaction with care received in a large academic medical care system in Boston, Massachusetts. Methods: Routine patient satisfaction surveys were fielded from January to December 2021 and were summarized. Logistic regression models compared low net promoter scores (NPS; ≤6) between gender identity groups (cisgender women, transmasculine and nonbinary/genderqueer people assigned female at birth [AFAB], transfeminine and nonbinary/genderqueer people assigned male at birth) relative to cisgender men, adjusting for age, race, ethnicity, education, inpatient/outpatient service delivery, and distance from medical center. Results: Of 94,810 patients, 246 (0.3%) were TGD and 94,549 (99.7%) were cisgender. The mean age was 58.3 years (standard deviation = 16.6). Of the total sample, 17.0% of patients were people of color, 6.6% were Hispanic/Latinx, 48.6% were college graduates, and 2.6% had received inpatient care. In general, patient satisfaction with health care received was lower for TGD patients than for cisgender patients (7.3% vs. 4.5% reporting low NPS; adjusted odds ratio [aOR] = 1.14; 95% confidence interval [CI] = 0.70-1.85). Transmasculine and nonbinary/genderqueer patients AFAB had elevated odds of low NPS compared with cisgender men (8.8% vs. 3.6%; aOR = 1.71; 95% CI = 1.02-2.89). Conclusion: Future research is warranted to better understand factors driving lower ratings among TGD patients. Health care quality improvement efforts are needed to address gender identity inequities in care.
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Affiliation(s)
- Mai-Han Trinh
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Meg Quint
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Devin Coon
- Center for Transgender Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Shalender Bhasin
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Center for Transgender Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Medicine, and Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Benjamin Tocci
- Office of Patient Experience, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Sari L Reisner
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Center for Transgender Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Medicine, and Brigham and Women's Hospital, Boston, Massachusetts, USA
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Ceccolini CJ, Green JB, Friedman-Yakoobian MS. Gender-affirming care in the assessment and treatment of psychosis risk: Considering minority stress in current practice and future research. Early Interv Psychiatry 2024; 18:207-216. [PMID: 37463844 DOI: 10.1111/eip.13456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 05/30/2023] [Accepted: 07/02/2023] [Indexed: 07/20/2023]
Abstract
INTRODUCTION Although research has documented the marked disparities in rates of psychosis-spectrum diagnoses in various socially marginalized populations, there is limited research addressing the needs of gender expansive individuals in the context of psychosis-spectrum illnesses using a minority stress lens. As clinical high-risk for psychosis (CHR-p) assessment and treatment becomes accessible to increasingly diverse populations, there is a need for clinicians to demonstrate greater clinical competency working with individuals across diverse social backgrounds and identities. METHODS We examined rates of gender expansive (GE) patients seeking evaluation at an urban-based CHR-p clinic and compared the diagnostic profile of GE individuals to cisgender patients. Post-hoc analyses were conducted on clinical variables with significant differences between the cisgender and GE groups. RESULTS The proportion of GE patients seeking evaluation increased from 2017 (9.3%) to 2021 (16.7%). Compared to cisgender youth, GE patients had significantly higher depressive, social anxiety, borderline personality disorder symptoms, higher levels of suicidality and non-suicidal self-injurious behaviour, and lower role functioning. Gender identity was predictive of suicidality controlling for social anxiety, borderline symptoms, and role functioning. CONCLUSIONS We review implications for CHR-p treatment and discuss ways to integrate minority stress theory and gender-affirming practices into coordinated specialty care for CHR-p patients.
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Affiliation(s)
- Christopher J Ceccolini
- Department of Psychiatry, Weill Cornell Medicine, New York, New York, USA
- Department of Psychiatry, NewYork-Presbyterian Hospital, New York, New York, USA
| | - James B Green
- Department of Counseling, Developmental, & Educational Psychology, Boston College, Chestnut Hill, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Massachusetts Mental Health Center, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- CEDAR Clinic, Brookline Center for Community Mental Health, Brookline, Massachusetts, USA
| | - Michelle S Friedman-Yakoobian
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Massachusetts Mental Health Center, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- CEDAR Clinic, Brookline Center for Community Mental Health, Brookline, Massachusetts, USA
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Kim DJ, Hwang NH, Lee JY, Park SH, Lee BI, Yoon ES. An Analysis of the Demographics and Clinical Characteristics of Transgender and Intersex Populations in Korea: A Retrospective Study Using HIRA Database. J Korean Med Sci 2023; 38:e385. [PMID: 38147835 PMCID: PMC10752747 DOI: 10.3346/jkms.2023.38.e385] [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: 07/02/2023] [Accepted: 10/11/2023] [Indexed: 12/28/2023] Open
Abstract
BACKGROUND Transgender and intersex populations have long remained under-documented in South Korea, largely due to the absence of comprehensive epidemiological data. With increasing societal acknowledgment, there's an urgent need to understand the demographics and health challenges faced by these communities. METHODS This retrospective, large-scale data study included people who received the F64 codes from the Korean Health Insurance Review & Assessment Service between January 2007 and December 2021. Demographics, gender-affirmative treatments, and psychiatric related medications were examined. RESULTS Between 2007 and 2021, 8,602 patients were diagnosed with "gender identity disorder" and 45 with "intersex." A steadily increasing annual prevalence was observed, peaking at 986 cases in 2021. The majority (79.8%) were aged between 10 and 30. Nearly half (53.2%) exhibited mental and behavioral disorders. Two-thirds had been prescribed anxiolytics or sedatives either before or after diagnosis. Merely 12.1% received hormone therapy covered by health insurance. CONCLUSION This is the first large-scale study highlighting the demographics and clinical characteristics of the transgender and intersex populations in Korea. The study reveals a consistent growth of these communities over the past 15 years, with a significant proportion under 30 years of age facing mental and behavioral challenges. Findings underscore the need for targeted healthcare interventions, early psychological support, and comprehensive insurance coverage tailored to the specific needs of these individuals in Korea.
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Affiliation(s)
- Dong-Jin Kim
- Department of Plastic and Reconstructive Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Na-Hyun Hwang
- Department of Plastic and Reconstructive Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea.
| | - Ji Yoon Lee
- Department of Biostatistics, Korea University College of Medicine, Seoul, Korea
| | - Seung Ha Park
- Department of Plastic and Reconstructive Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Byung-Il Lee
- Department of Plastic and Reconstructive Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Eul-Sik Yoon
- Department of Plastic and Reconstructive Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
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Britt-Thomas JY, Kridel M, Velez J, Kouame G, Tharrington S, Barrett T, Casanova T. A scoping review of institutional policies and recommendations for trans inpatient mental health care. J Psychiatr Ment Health Nurs 2023; 30:1043-1053. [PMID: 37202857 DOI: 10.1111/jpm.12933] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/30/2023] [Accepted: 05/03/2023] [Indexed: 05/20/2023]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: International guidelines for trans-and-gender-non-conforming (TGNC) exists in outpatient settings. Compared to cisgender and heterosexual people, TGNC individuals are at a higher risk of mental health difficulties and have higher rates of inpatient mental health treatment. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: An international scoping review identifying the lack of guidelines existing for TGNC individuals in inpatient mental health settings. Compared to psychiatrists and psychologists, mental health nursing has the most contact with patients admitted for inpatient psychiatric treatment. The study identifies unaddressed needs in gender affirming policies and outlines preliminary policy recommendations to assist mental health staff in improving TGNC patient quality of care within the United States. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Reforming existing guidelines or creating new guidelines based on the identified themes and gaps to improve the well-being and treatment outcomes of TGNC individuals in inpatient psychiatric settings within the United States. ABSTRACT INTRODUCTION: Access to culturally sensitive care is critical for addressing known mental health disparities among trans-and gender-non-conforming (TGNC) individuals. Although there has been a proliferation of TGNC healthcare guidelines from accrediting bodies, policies have failed to address the needs of TGNC patients in inpatient psychiatric settings. AIM To identify unaddressed needs in policies and policy recommendations for the care of TGNC patients to inform recommendations for change. METHOD A scoping review protocol was developed following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 850 articles were reduced to seven relevant articles with six themes identified via thematic analysis. RESULTS Six themes were identified: lack of consistency in preferred and pronoun use, lack of communication among providers, lack of training in TGNC healthcare, personal bias, lack of formal policies, and housing segregation by sex rather than gender. DISCUSSION The creation of new guidelines or bolstering of existing guidelines to specifically address identified themes and gaps may improve the well-being and treatment outcomes of TGNC individuals in inpatient psychiatric settings. IMPLICATIONS FOR PRACTICE To provide a foundation for future studies to integrate these identified gaps and inform the future development of comprehensive formal policies that generalize TGNC care in inpatient settings.
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Affiliation(s)
- Jessica Y Britt-Thomas
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Matthew Kridel
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Janina Velez
- Clinical Psychology, The Chicago School of Professional Psychology, Washington, DC, USA
| | - Gail Kouame
- Charles M. Baugh Biomedical Library, University of South Alabama, Mobile, Alabama, USA
| | - Shafer Tharrington
- Robert B. Greenblatt, M.D. Library, Augusta University, Augusta, Georgia, USA
| | - Thomas Barrett
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
| | - Tracy Casanova
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
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Termorshuizen F, de Vries AL, Wiepjes CM, Selten JP. The risk of psychosis for transgender individuals: a Dutch national cohort study. Psychol Med 2023; 53:7923-7932. [PMID: 37539460 PMCID: PMC10755224 DOI: 10.1017/s0033291723002088] [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: 11/24/2022] [Revised: 06/15/2023] [Accepted: 07/10/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND The stressful minority position of transgender persons may result in a high risk of psychosis. Conflicting data suggest that the observed risk depends on setting of recruitment. We assessed the relative risk of non-affective psychotic disorder (NAPD) in a large, representative cohort of transgender persons. METHODS This cohort was composed using: data on legal sex change from the Dutch population registry and data on dispensing of cross-sex hormones (route 1), and a registry of insurance claims from mental health care including persons with a diagnosis of gender identity disorder (DSM-IV) or gender dysphoria (DSM-5) (route 2). They were matched by sex at birth, calendar year and country of birth to controls from the general population. Transgender persons (N = 5564) and controls (N = 27 820), aged 16-60 years at 1 January 2011, were followed until the first insurance claim for NAPD in 2011-2019. RESULTS The incidence rate ratio (IRR) of NAPD for transgender persons selected exclusively through route 1 (N = 3859, IRR = 2.00, 95%-CI 1.52-2.63) was increased, but significantly lower than the IRRs for those selected exclusively through route 2 (N = 694, IRR = 22.15, 95%-CI 13.91-35.28) and for those found by both routes (N = 1011, IRR = 5.17, 95%-CI 3.57-7.49; p value for differences in IRR < 0.001). CONCLUSIONS This study supports the social defeat-hypothesis of NAPD. The results also show the presence of a substantial number of transgender persons with severe psychiatric problems who have not (yet) taken steps to gender-affirmative care.
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Affiliation(s)
- Fabian Termorshuizen
- Rivierduinen Institute for Mental Health Care, Sandifortdreef 19, 2333 ZZ Leiden, the Netherlands
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, P.O. Box 616, 6200 MD Maastricht, the Netherlands
| | - Annelou L.C. de Vries
- Department of Child and Adolescent Psychiatry, Center of Expertise on Gender Dysphoria, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, the Netherlands
| | - Chantal M. Wiepjes
- Department of Endocrinology, Center of Expertise on Gender Dysphoria, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, the Netherlands
| | - Jean-Paul Selten
- Rivierduinen Institute for Mental Health Care, Sandifortdreef 19, 2333 ZZ Leiden, the Netherlands
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, P.O. Box 616, 6200 MD Maastricht, the Netherlands
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Will J, Walsh K, Chyten-Brennan J. A comparison of chronic conditions between transgender and cisgender individuals with recent incarceration and in the community in a United States county. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2023; 25:187-198. [PMID: 38681500 PMCID: PMC11044716 DOI: 10.1080/26895269.2023.2280175] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
Background: Transgender individuals are known to be at a higher risk for certain chronic conditions compared to cisgender individuals. Similarly, research also shows justice-involved individuals have a higher risk of chronic conditions compared to non-justice-involved individuals. Aim: This study aims to investigate the differences in chronic disease diagnoses between transgender and cisgender individuals who either utilized healthcare services provided by a US county health system or who were incarcerated in the same county's jail. Method: We leveraged electronic health record data from a United States county health system, including data from the local jail, to evaluate the difference in diagnosis of certain chronic conditions among transgender and cisgender individuals. We also compared individuals who experienced incarceration and those who did not. Results: We found transgender individuals experiencing recent incarceration were more likely to be diagnosed with substance use disorder, HIV/AIDS, and Hepatitis C than cisgender individuals. Transgender individuals not experiencing recent incarceration were more likely to be diagnosed with HIV/AIDS, seizure disorder, major depressive disorder, and bipolar disorder than cisgender individuals. Conclusion: These results highlight how transgender individuals may be disproportionately impacted by certain diseases within and outside carceral settings.
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Affiliation(s)
- John Will
- Custody Health Services, Santa Clara Valley Medical Center, San Jose, California, USA
- New York University Langone Health, New York, New York, USA
| | - Kristin Walsh
- Custody Health Services, Santa Clara Valley Medical Center, San Jose, California, USA
| | - Jules Chyten-Brennan
- Custody Health Services, Santa Clara Valley Medical Center, San Jose, California, USA
- Thundermist Health Center, Woonsocket, Rhode Island, USA
- Department of Family Medicine, Brown University, Providence, Rhode Island, USA
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Reisner SL, Pletta DR, Harris A, Campbell J, Asquith A, Pardee DJ, Deutsch MB, Aguayo-Romero R, Quint M, Keuroghlian AS, Radix A. Exploring gender euphoria in a sample of transgender and gender diverse patients at two U.S. urban community health centers. Psychiatry Res 2023; 329:115541. [PMID: 37857133 DOI: 10.1016/j.psychres.2023.115541] [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: 05/25/2023] [Revised: 10/06/2023] [Accepted: 10/09/2023] [Indexed: 10/21/2023]
Abstract
Transgender and gender diverse (TGD) people are affected by mental health inequities. Gender euphoria-positive emotions or joy in gender-may be associated with positive mental health. Between February 2019-July 2021, we surveyed 2,165 adult TGD patients (median age = 28 years; 29.2 % people of color; 29.6 % nonbinary; 81.0 % taking hormones) evaluating gender euphoria and mental health. Overall, 35.0 % self-reported gender euphoria, 50.9 % gender dysphoria, 23.5 % alcohol misuse, and 44.5 % resilience. Gender euphoria differed by race, gender, insurance, and hormone use, and was associated with reduced gender dysphoria (adjusted Odds Ratio[aOR] = 0.58; 95 % confidence interval [95 %CI] = 0.47-0.72) and alcohol misuse (aOR = 0.75; 95 %CI = 0.60-0.95), and increased resilience (aOR = 1.31; 95 %CI = 1.07-1.61). The construct of gender euphoria may be a promising mental health target.
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Affiliation(s)
- Sari L Reisner
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; The Fenway Institute, Fenway Health, Boston, MA, USA.
| | - David R Pletta
- The Fenway Institute, Fenway Health, Boston, MA, USA; Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Alexander Harris
- Medical Research Division, Callen-Lorde Community Health Center, New York City, NY, USA
| | | | | | - Dana J Pardee
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Madeline B Deutsch
- Family and Community Medicine, University of California San Francsico, San Francisco, CA, USA
| | - Rodrigo Aguayo-Romero
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA; The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Meg Quint
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, MA, USA
| | - Alex S Keuroghlian
- The Fenway Institute, Fenway Health, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Asa Radix
- Medical Research Division, Callen-Lorde Community Health Center, New York City, NY, USA
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Ansari MI, Sperry SD, Leontieva L, Megna JL. Psychological Testing in a Complex Case: Psychosis in Co-occurring PTSD, Gender Dysphoria, and Bipolar Disorder. Cureus 2023; 15:e49626. [PMID: 38161909 PMCID: PMC10755637 DOI: 10.7759/cureus.49626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2023] [Indexed: 01/03/2024] Open
Abstract
This case report investigates the concurrent presence of post-traumatic stress disorder (PTSD) and bipolar disorder (BD) in the transgender population. We present a case involving a 21-year-old female-to-male transgender individual (preferred pronouns - they/them). The patient had a history of psychosis, trauma, gender dysphoria (GD), inconsistent hormone (testosterone) treatments, and a self-attributed diagnosis of "associative identity disorder" with 21 distinct "identities." They had two emergency admissions in quick succession, both characterized by analogous symptoms. Contributing factors included a recent discontinuation of antipsychotic medications and a history of cannabis use. Their family history included BD in the patient's mother and schizophrenia in their paternal grandfather. The differential diagnoses considered were brief psychosis, BD, PTSD, and substance-induced mania/psychosis. A notable improvement in the patient's clinical presentation was observed during their hospital stay. Their therapeutic regimen comprised olanzapine, hydroxyzine, topiramate, trazodone, and lithium carbonate extended-release. Additionally, the patient underwent psychological testing. This progress solidified the primary diagnosis as PTSD coexisting with BD, manifesting episodes of mania and psychosis. This report highlights the critical role of psychological evaluations in assessing symptoms in patients with multiple psychiatric co-morbidities. Our findings emphasize the importance of a comprehensive, multidisciplinary approach for accurate diagnosis and efficacious treatment of such intricate cases.
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Affiliation(s)
- Maliha I Ansari
- Psychiatry and Behavioral Sciences, State University of New York Upstate Medical University, Syracuse, USA
| | - Susan D Sperry
- Psychology, State University of New York Upstate Medical University, Syracuse, USA
| | - Luba Leontieva
- Psychiatry, State University of New York Upstate Medical University, Syracuse, USA
| | - James L Megna
- Psychiatry and Behavioral Sciences, State University of New York Upstate Medical University, Syracuse, USA
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12
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Peters JR, Stumper A, Schmalenberger KM, Taubman AJ, Eisenlohr-Moul TA. Improving rigor through gender inclusivity in reproductive psychiatric science. COMPREHENSIVE PSYCHONEUROENDOCRINOLOGY 2023; 16:100194. [PMID: 37560411 PMCID: PMC10407113 DOI: 10.1016/j.cpnec.2023.100194] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 07/15/2023] [Accepted: 07/16/2023] [Indexed: 08/11/2023] Open
Abstract
Accurately defining the individuals that research involves and generalizes to is critical for rigorous and reproducible science. In reproductive psychiatry, which historically focuses on the impact of the menstrual cycle, pregnancy, and menopause on mental health, this means moving beyond characterizing samples and relevant populations as "women" in favor of language that precisely identifies the physiological characteristics pertinent to the research being conducted and accurately reflects the varied genders represented in those populations. Concrete recommendations are provided for precise use of sex and gender terminology and gender inclusivity throughout the scientific process, including study conceptualization, etiquette in research environments, recruitment, methods, and dissemination. Recommendations are discussed in depth and presented in a checklist format for ease of use by research teams. Suggested items for assessing gender and relevant sex-related physiology in the context of reproductive psychiatry are also provided.
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Affiliation(s)
- Jessica R. Peters
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Box G-BH, Providence, RI, 02912, USA
| | - Allison Stumper
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Box G-BH, Providence, RI, 02912, USA
| | - Katja M. Schmalenberger
- Department of Psychiatry, University of Illinois at Chicago, 912 S. Wood Street, M/C 913, Chicago, IL 60612, USA
| | - Andy J. Taubman
- Youth Pride Inc, 743 Westminster St, Providence, RI 02903, USA
| | - Tory A. Eisenlohr-Moul
- Department of Psychiatry, University of Illinois at Chicago, 912 S. Wood Street, M/C 913, Chicago, IL 60612, USA
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13
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Adepalli N, Cumby J, Campbell N, Pavlova B, Alda M, Cahill LE, Uher R. Developmental Trajectory of Body Weight in Youths at Risk for Major Mood Disorders. JAMA Netw Open 2023; 6:e2338540. [PMID: 37856119 PMCID: PMC10587790 DOI: 10.1001/jamanetworkopen.2023.38540] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 09/06/2023] [Indexed: 10/20/2023] Open
Abstract
Importance Mood disorders are associated with increased body weight, especially in females, but it remains unknown when the weight increase starts. Objectives To examine sex-specific weight trajectories associated with familial mood disorder risk and determine the age at which youth at familial risk for mood disorders begin to diverge in weight from controls. Design, Setting, and Participants This community-based, single-center, acceleration cohort study of youth at familial risk for mood disorders and controls with yearly follow-ups (mean [SD], 5 [2.1] years) from January 1, 2014, to December 31, 2022, assessed 394 unaffected female and male offspring (aged 3 to 20 years) of parents with or without a mood disorder. Parents with mood (depressive or bipolar) disorders were recruited through adult mental health services. Parents of control participants were matched on age and socioeconomic factors and recruited through acquaintance referrals or schools. Exposures The youth in the familial mood risk group had at least 1 parent with a major mood disorder, whereas control youth did not have a parent with a mood disorder. Main Outcomes and Measures Body mass indexes (BMIs) were calculated as weight in kilograms divided by height in meters squared from measured weight and height at annual assessments and then converted to age- and sex-adjusted z scores (zBMIs). Repeated-measure regressions examined the association between zBMI and age in youth at familial risk of mood disorders and controls while accounting for sex. Sensitivity analyses accounted for socioeconomic status, prematurity, and birth weight. Results Of 394 participants (mean [SD] age, 11.5 [3.6] years; 203 [51.5%] female), youths at familial risk for mood disorders showed overall no difference in body weight (β = 0.12; 95% CI, 0.01-0.24) from controls. A sex-specific difference was detected, with females at familial risk showing a rapid peripubertal increase in body weight, leading to significantly increased zBMIs at 12 years and older compared with controls (β = 0.57; 95% CI, 0.31-0.82) independent of socioeconomic status, prematurity, or birth weight. Males did not differ from controls at any age. Conclusions and Relevance In this cohort study, females with a family history of mood disorders were prone to weight gain starting around puberty and predating mood disorder onset. Early interventions aiming to prevent adverse mental and physical outcomes in this vulnerable group need to start in childhood.
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Affiliation(s)
- Nitya Adepalli
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Jill Cumby
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Niamh Campbell
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Barbara Pavlova
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Martin Alda
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Leah E. Cahill
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Rudolf Uher
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
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Nolan CJ, Roepke TA, Perreault ML. Beyond the Binary: Gender Inclusivity in Schizophrenia Research. Biol Psychiatry 2023; 94:543-549. [PMID: 37003472 DOI: 10.1016/j.biopsych.2023.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/24/2023] [Accepted: 03/20/2023] [Indexed: 04/03/2023]
Abstract
Schizophrenia is a severe neuropsychiatric disorder with significant differences in the incidence and symptomology between cisgender men and women. In recent years, considerably more attention has been on the inclusion of sex and gender in schizophrenia research. However, the majority of this research has failed to consider gender outside of the socially constructed binary of men and women. As a result, little is known about schizophrenia in transgender and gender-nonconforming populations. In this review, we present evidence showing that transgender and gender-nonconforming individuals have elevated risk of developing schizophrenia, and we discuss minority stress theory and other potential factors that may contribute to this risk. The need for inclusion of transgender and gender-nonconforming communities in schizophrenia research is emphasized, alongside a discussion on considerations and challenges associated with this type of research. Finally, we offer specific strategies to make research on schizophrenia, and research on other neuropsychiatric disorders, more inclusive of those populations that do not fall within the socially constructed gender binary. If we are to succeed in the development of more personalized therapeutic approaches for all, a better understanding of the variability of the human brain is needed.
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Affiliation(s)
- Caitlin J Nolan
- Department of Biomedical Sciences, University of Guelph, Guelph, Ontario, Canada
| | - Troy A Roepke
- Department of Animal Sciences, School of Environmental and Biological Sciences, Rutgers, The State University of New Jersey, New Brunswick, New Jersey
| | - Melissa L Perreault
- Department of Biomedical Sciences, University of Guelph, Guelph, Ontario, Canada.
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15
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Berry CE, Fazilat AZ, Churukian AA, Abbas DB, Griffin M, Downer M, Januszyk M, Momeni A, Morrison SD, Wan DC. Quality Assessment of Online Resources for Gender-affirming Surgery. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5306. [PMID: 37817924 PMCID: PMC10561794 DOI: 10.1097/gox.0000000000005306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 08/11/2023] [Indexed: 10/12/2023]
Abstract
Background As visibility of the transgender patient population and utilization of online resources increases, it is imperative that web-based gender-affirming surgery (GAS) materials for patients are readable, accessible, and of high quality. Methods A search trends analysis was performed to determine frequency of GAS-related searches over time. The top 100 most common results for GAS-related terms were analyzed using six readability formulas. Accessibility of patient-facing GAS sources was determined by categorizing types of search results. Frequency of article types was compared in low- and high-population dense areas. Quality was assigned to GAS web-based sources using the DISCERN score. Results Search engine trend data demonstrates increasing occurrence of searches related to GAS. Readability scores of the top 100 online sources for GAS were discovered to exceed recommended levels for patient proficiency. Availability of patient-facing online information related to GAS was found to be 60%, followed by information provided by insurance companies (17%). Differences in availability of online resources in varying dense cities were found to be minimal. The average quality of sources determined by the DISCERN score was found to be 3, indicating "potential important shortcomings." Conclusions Despite increasing demand for web-based GAS information, the readability of online resources related to GAS was found to be significantly greater than the grade level of proficiency recommended for patients. A high number of nonpatient-facing search results appear in response to GAS search terms. Quality sources are still difficult for patients to find, as search results have a high incidence of low-quality resources.
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Affiliation(s)
- Charlotte E. Berry
- From Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Alexander Z. Fazilat
- From Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Andrew A. Churukian
- From Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Darren B. Abbas
- From Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Michelle Griffin
- From Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Mauricio Downer
- From Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Micheal Januszyk
- From Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Arash Momeni
- From Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Shane D. Morrison
- From Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, Calif
- Harborview Medical Center, Division of Plastic Surgery, University of Washington at Harborview, Seattle, Wash
| | - Derrick C. Wan
- From Hagey Laboratory for Pediatric Regenerative Medicine, Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, Calif
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16
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Curtis A, Swaringen S, Janssen A. Complex Psychiatric Histories and Transgender and Gender Diverse Youth. Child Adolesc Psychiatr Clin N Am 2023; 32:731-745. [PMID: 37739631 DOI: 10.1016/j.chc.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/24/2023]
Abstract
Transgender and gender diverse (TGD) individuals face higher rates of stressors driving disproportionate health risks. Although psychiatric conditions are important to consider in the context of greater health-promoting efforts for TGD youth, any mental health concerns may or may not be related to gender identity or associated dysphoria. Nevertheless, it is essential to consider the impact of complex mental health factors on decisional capacity and gender care discussions. Psychiatric care of TGD youth includes stratifying risk factors through a minority stress lens, balancing acute needs with patient and caregiver priorities, and bolstering resilience using affirming care principles.
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Affiliation(s)
- Amy Curtis
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine. Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA 98105, USA.
| | - Shanna Swaringen
- Division of Psychiatry and Behavioral Health, The Ohio State University College of Medicine. Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
| | - Aron Janssen
- The Pritzker Department of Psychiatry and Behavioral Health, Associate Professor of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, 446 E Ontario, Chicago, IL 60611, USA. https://twitter.com/LGBTDoc
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17
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Gould WA, MacKinnon KR, Lam JSH, Enxuga G, Abramovich A, Ross LE. Detransition Narratives Trouble the Simple Attribution of Madness in Transantagonistic Contexts: A Qualitative Analysis of 16 Canadians' Experiences. Cult Med Psychiatry 2023:10.1007/s11013-023-09838-0. [PMID: 37737532 DOI: 10.1007/s11013-023-09838-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/28/2023] [Indexed: 09/23/2023]
Abstract
Emerging evidence suggests that transgender individuals are more likely than cisgender peers to receive a diagnosis with a primary mental disorder. Attributions of madness, though, may serve the social function of dismissing and discrediting transgender individual's self-perceptions. The narratives of individuals who stop or reverse an initial gender transition who also identify as living with mental health conditions can sometimes amplify these socio-political discourses about transgender people. Through a critical mental health lens, this article presents a qualitative analysis of 16 individuals who stopped or reversed a gender transition and who also reported a primary mental health condition. Semi-structured, virtual interviews were conducted with people living in Canada. Applying constructivist grounded theory methodology, and following an iterative, inductive approach to analysis, we used the constant comparative method to analyse these 16 in-depth interviews. Results show rich complexity such that participants narrated madness in nuanced and complex ways while disrupting biased attitudes that madness discredited their thoughts and feelings, including prior gender dysphoria. Instead, participants incorporated madness into expanding self-awareness and narrated their thoughts and feelings as valid and worthy. Future research must consider provider's perspectives, though, in treating mad individuals who detransitioned, since alternate gender-affirming care models may better support the identification and wellness of care-seeking individuals who may be identified (in the past, present, or future) as mad.
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Affiliation(s)
- Wren Ariel Gould
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- School of Social Work, York University, Toronto, ON, Canada
| | - Kinnon R MacKinnon
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
- School of Social Work, York University, Toronto, ON, Canada.
| | - June Sing Hong Lam
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Institute for Evaluative Clinical Sciences (ICES), Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health, General and Health Systems Psychiatry Division, Toronto, ON, Canada
| | - Gabriel Enxuga
- School of Social Work, York University, Toronto, ON, Canada
| | - Alex Abramovich
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, Toronto, ON, Canada
| | - Lori E Ross
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Health Systems & Health Equity Research Group, Centre for Addiction and Mental Health, Toronto, ON, Canada
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18
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Hochheimer M, Glick JL, Garrison-Desany H, Huhn AS. Transgender individuals are at higher risk for suicidal ideation and preparation than cisgender individuals in substance use treatment. Front Psychiatry 2023; 14:1225673. [PMID: 37779622 PMCID: PMC10535091 DOI: 10.3389/fpsyt.2023.1225673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 08/14/2023] [Indexed: 10/03/2023] Open
Abstract
Introduction This study describes the differences and similarities in mental health, substance use, and substance use treatment outcomes between people presenting for SUD treatment who identified as transgender and those who identified as cisgender men or women. Methods We compared 64 individuals who self-identified as transgender and presented for SUD treatment to samples of cisgender men and women (separately) matched based on propensity scores which were created based on sociodemographic factors known to influence both the nature of substance use and patterns of treatment engagement including age, education, race, stable housing, and employment status. Comparisons were made using χ2 tests and t-tests in over 150 variables collected at treatment intake regarding physical and mental health, substance use patterns, events that led to treatment, reasons for seeking treatment, and treatment outcomes. Results The transgender sample endorsed six of the seven suicide-related items more often than at least one of the cisgender-matched samples. Furthermore, the transgender sample remained in treatment significantly longer (M = 32.3, SD = 22.2) than the cisgender male sample (M = 19.5, SD = 26.1, t = 2.17, p = 0.03). Discussion This study is a first step into understanding gender minority population experiences during SUD treatment. While there was no significant difference between the cisgender and transgender samples on most variables, there was an elevated prevalence of suicidal ideation and behaviors in the transgender sample, which warrants further investigation.
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Affiliation(s)
- Martin Hochheimer
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Jennifer L. Glick
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Henri Garrison-Desany
- Department of Social and Behavioral Science, Harvard University T.H. Chan School of Public Health, Boston, MA, United States
| | - Andrew S. Huhn
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
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19
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Matouk KM, Schulman JK, Case JAC. Mental Health Disparities in Sexual Minority and Transgender Women: Implications and Considerations for Treatment. Psychiatr Clin North Am 2023; 46:583-595. [PMID: 37500252 DOI: 10.1016/j.psc.2023.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Minority stress theory offers an explanation of how discrimination, marginalization, harassment, and violence against sexual minority and transgender women are connected to mental health disparities. Particularly, these groups are vulnerable to body image issues, disordered eating, higher rates of mood and anxiety disorders, suicide and nonsuicidal self-injury, and substance use. Discrimination is also experienced within clinical settings, which may lead this population to postpone or avoid treatment. Clinicians play a crucial role in reducing barriers to health care by developing cultural competency and ensuring safe and affirming spaces within their practice.
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Affiliation(s)
- Kareen M Matouk
- Department of Psychiatry, Columbia University Irving Medical Center, 710 West 168th Street, 12th Floor, New York, NY 10032, USA.
| | - Julie K Schulman
- Department of Psychiatry, Columbia University Irving Medical Center, 5141 Broadway, 3 River East, New York, NY 10034, USA
| | - Julia A C Case
- Department of Psychiatry, Columbia University Irving Medical Center, 710 West 168th Street, 12th Floor, New York, NY 10032, USA
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20
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Martin D, Lynch S, Becker TD, Shanker P, Staudenmaier P, Leong A, Rice T. Difference in Psychiatric Hospital Admissions Between Cisgender and Transgender and Gender Nonconforming Youth, Before and During the Start of the COVID-19 Pandemic. Child Psychiatry Hum Dev 2023:10.1007/s10578-023-01571-4. [PMID: 37464154 DOI: 10.1007/s10578-023-01571-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/07/2023] [Indexed: 07/20/2023]
Abstract
This retrospective study of 1101 children and adolescents examines differences in psychiatric admissions between cisgender and transgender/gender nonconforming (TGNC) youth between June 2018 and November 2021. Sociodemographic and clinical characteristics for each admission were extracted from medical records. We compared proportion of total admissions and clinical characteristics between cisgender and TGNC youth, during specified time frames of pre-COVID-19, during quarantine, and post-quarantine. During quarantine, 294 (89.9%) youth identified as cisgender and 33 (10.1%) youth identified as TGNC. Post-quarantine, 205 (88.4%) youth identified as cisgender and 27 (11.6%) identified as TGNC. TGNC patients had more history of mood disorders (p < 0.001), self-injurious behavior (p < 0.001), and suicide attempt (p = 0.007), whereas cisgender patients had more history of Attention-deficit/Hyperactivity Disorder (ADHD) (p = 0.011) and violence (p < 0.001) across each time frame of the study. TGNC patients were more likely to be admitted due to suicidal ideation (p = 0.003), whereas cisgender patients were more often admitted for aggression (p < 0.001). There was no change across COVID-19 time periods in terms of any psychiatric history variable among patients identifying as TGNC. The proportion of admitted youth identifying as TGNC increased by 8.1% from pre-COVID-19 to post-quarantine (p < 0.001). These findings suggest that TGNC youth might be particularly vulnerable to mental health crises when faced with pandemic-related stressors. Further research on the vulnerabilities of TGNC youth during sudden and extreme social changes and how this can impact their mental health is necessary, as global pandemics could and are anticipated to repeat.
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Affiliation(s)
- Dalton Martin
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, Mount Sinai Morningside, New York, NY, USA.
| | - Sean Lynch
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY, USA
| | - Timothy D Becker
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, NY, USA
- Department of Psychiatry, New York-Presbyterian Hospital, New York, NY, USA
| | - Parul Shanker
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY, USA
| | - Paige Staudenmaier
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY, USA
| | - Alicia Leong
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Timothy Rice
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, Mount Sinai Morningside, New York, NY, USA
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21
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Dell NA, Vaughn MG, Huang J, Mancini M, Maynard BR. Correlates of Homelessness Among Adults with Personality Disorder. Psychiatr Q 2023:10.1007/s11126-023-10027-w. [PMID: 37227676 DOI: 10.1007/s11126-023-10027-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/25/2023] [Indexed: 05/26/2023]
Abstract
Although personality disorders (PDs) are more common among persons experiencing homelessness than the general population, few studies have investigated the risk of experiencing homelessness among persons with PDs. This study seeks to identify the demographic, socioeconomic, and behavioral health correlates of past-year homelessness among persons with antisocial, borderline, and schizotypal PDs. Nationally representative data of the civilian, noninstitutionalized population of the United States was used to identify correlates of homelessness. Descriptive statistics and bivariate associations between variables and homeless status were summarized prior to conducting several multivariate logistic regression models to identify correlates of homelessness. Main findings revealed positive associations between poverty, relationship dysfunction, and lifetime suicide attempt with homelessness. In the antisocial PD (ASPD) and borderline PD (BPD) models, comorbid BPD and ASPD, respectively, were associated with higher odds of past-year homelessness. Findings underscore the importance of poverty, interpersonal difficulties, and behavioral health comorbidities on homelessness among persons with ASPD, BPD, and schizotypal PD. Strategies to promote economic security, stable relationships, and interpersonal functioning may buffer against the effects of economic volatility and other systemic factors that could contribute to homelessness and persons with PD.
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Affiliation(s)
- Nathaniel A Dell
- School of Social Work, Saint Louis University, Saint Louis, MO, USA.
| | - Michael G Vaughn
- School of Social Work, Saint Louis University, Saint Louis, MO, USA
| | - Jin Huang
- School of Social Work, Saint Louis University, Saint Louis, MO, USA
| | - Michael Mancini
- School of Social Work, Saint Louis University, Saint Louis, MO, USA
| | - Brandy R Maynard
- School of Social Work, Saint Louis University, Saint Louis, MO, USA
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22
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Rivas-Grajales AM, Barbour T, Camprodon JA, Kritzer MD. The Impact of Sex Hormones on Transcranial Magnetic Stimulation Measures of Cortical Excitability: A Systematic Review and Considerations for Clinical Practice. Harv Rev Psychiatry 2023; 31:114-123. [PMID: 37171472 PMCID: PMC10264142 DOI: 10.1097/hrp.0000000000000366] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
ABSTRACT Repetitive transcranial magnetic stimulation (rTMS) has emerged as a promising alternative for the treatment of major depressive disorder (MDD), although its clinical effectiveness varies substantially. The effects of sex hormone fluctuations on cortical excitability have been identified as potential factors that can explain this variability. However, data on how sex hormone changes affect clinical response to rTMS is limited. To address this gap, we reviewed the literature examining the effects of sex hormones and hormonal treatments on transcranial magnetic stimulation (TMS) measures of cortical excitability. Results show that variations of endogenous estrogen, testosterone, and progesterone have modulatory effects on TMS-derived measures of cortical excitability. Specifically, higher levels of estrogen and testosterone were associated with greater cortical excitability, while higher progesterone was associated with lower cortical excitability. This highlights the importance of additional investigation into the effects of hormonal changes on rTMS outcomes and circuit-specific physiological variables. These results call for TMS clinicians to consider performing more frequent motor threshold (MT) assessments in patients receiving high doses of estrogen, testosterone, and progesterone in cases such as in vitro fertilization, hormone replacement therapy, and gender-affirming hormonal treatments. It may also be important to consider physiological hormonal fluctuations and their impact on depressive symptoms and the MT when treating female patients with rTMS.
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Affiliation(s)
- Ana Maria Rivas-Grajales
- From the Department of Psychiatry, Boston Medical Center, Boston University School of Medicine, Boston, MA (Dr. Rivas-Grajales); Department of Psychiatry, Division of Behavioral Neurology and Neuropsychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA (Drs. Barbour, Camprodon, Kritzer); Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA (Drs. Camprodon, Kritzer)
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Chumakov EM, Ashenbrenner YV, Petrova NN, Ventriglio A, Azarova LA, Limankin OV. Mental health, minority stress and discrimination against transgender people: a cross-sectional survey in Russia. Int Rev Psychiatry 2023; 35:331-338. [PMID: 37267033 DOI: 10.1080/09540261.2023.2182668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 02/16/2023] [Indexed: 06/03/2023]
Abstract
Mental health needs of transgender people in Russia remain unmet and stigmatised as in many other countries around the globe. The aim of this study was to assess the stressors and perceived need for mental health care among transgender people in Russia. A structured online survey was conducted in November 2019. A total of 588 transgender adults (mean age: 24.0 ± 6.7) was included in the final analysis. An overwhelming majority of respondents (95.1%) reported stress in their lives. Financial burden (73.5%), relationships with relatives (59.4%), and intimate relationships (37.9%) were among the most frequently reported sources of stress. Most of respondents (71.8%) indicated that the psychological distress they perceived interfered with their ability to lead a fulfilling social life. More than half of the respondents (52.4%) had visited a mental health professional prior to their gender transition. Virtually half of them (49%) reported problems related to seeking mental healthcare attributed to stigma. Over one third (37.8%) reported taking non-prescription or off-label medications to improve their well-being or mood. Our study confirmed high rates of psychiatric problems in this vulnerable group and problems in help-seeking. The article also discusses the challenges of providing psychiatric care to transgender people in Russia.
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Affiliation(s)
- Egor M Chumakov
- Department of Psychiatry and Addiction, St. Petersburg State University, St. Petersburg, Russia
- Day in-Patient Clinic, St. Petersburg Psychiatric Hospital No 1 named after P.P. Kaschenko, St. Petersburg, Russia
| | - Yulia V Ashenbrenner
- Day in-Patient Clinic, St. Petersburg Psychiatric Hospital No 1 named after P.P. Kaschenko, St. Petersburg, Russia
| | - Nataliia N Petrova
- Department of Psychiatry and Addiction, St. Petersburg State University, St. Petersburg, Russia
| | - Antonio Ventriglio
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Larisa A Azarova
- Day in-Patient Clinic, St. Petersburg Psychiatric Hospital No 1 named after P.P. Kaschenko, St. Petersburg, Russia
| | - Oleg V Limankin
- Day in-Patient Clinic, St. Petersburg Psychiatric Hospital No 1 named after P.P. Kaschenko, St. Petersburg, Russia
- Department of Psychotherapy, Medical Psychology and Sexology, North-Western State Medical University named after I.I. Mechnikov, St. Petersburg, Russia
- Department of Social Psychiatry and Psychology, St. Petersburg Institute of Postgraduate Improvement of Physicians-experts of the Ministry of Labour and Social Protection, St. Petersburg, Russia
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Kemp AJ, Zhang M, Wang Y, Leontieva LV, Sperry SD. Psychosis With Religious Delusions in a Reportedly Intersex Transgender Person. Cureus 2023; 15:e38192. [PMID: 37252535 PMCID: PMC10223858 DOI: 10.7759/cureus.38192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2023] [Indexed: 05/31/2023] Open
Abstract
There is limited research on mental illness in intersex and transgender individuals. This case report describes psychosis in a self-identified intersex transgender individual with a past psychiatric history of schizoaffective disorder. The patient and collateral information reported colpocleisis as a newborn, was assigned and raised as a male, then transitioned to a female. When the patient discussed her experiences as a transgender person, she would become significantly more psychotic with disorganized speech and grandiose Christian delusions. A psychological assessment including a projective test was completed to better understand the patient's psychotic symptoms along with her views of self, others, and the world. This case explores how the psychotic process interacts with gender dysphoria in a predominantly cisnormative, Christian society, with discussions of psychological defenses and psychodynamic theory.
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Affiliation(s)
- Allyson J Kemp
- Psychiatry, State University of New York Upstate Medical University, Syracuse, USA
| | - Mengpin Zhang
- Psychology, State University of New York Upstate Medical University, Syracuse, USA
| | - You Wang
- Psychiatry, State University of New York Upstate Medical University, Syracuse, USA
| | - Luba V Leontieva
- Psychiatry, State University of New York Upstate Medical University, Syracuse, USA
| | - Susan D Sperry
- Psychology, State University of New York Upstate Medical University, Syracuse, USA
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Parra LA, Spahr CM, Goldbach JT, Bray BC, Kipke MD, Slavich GM. Greater lifetime stressor exposure is associated with poorer mental health among sexual minority people of color. J Clin Psychol 2023; 79:1130-1155. [PMID: 36459589 PMCID: PMC10010942 DOI: 10.1002/jclp.23463] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 07/25/2022] [Accepted: 11/04/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND Research has shown that sexual minority people of color experience pervasive and sometimes severe life stressors that increase their risk of experiencing mental health problems, and that can contribute to lifelong health disparities. However, no studies in this population have investigated stressor exposure occurring over the entire lifespan. Moreover, it remains unknown whether these stressor-health effects differ based on the timing or types of stressors experienced. PURPOSE The purpose of this study is to examine how cumulative lifetime stressor exposure is associated with mental health among Black, Latinx, and biracial Black-Latinx sexual minority persons. METHOD Participants were 285 ethnic/racial minority young adults (Mage = 25.18 years old, SD = 1.94, age range = 19-29 years), who completed the Stress and Adversity Inventory for Adults to assess for retrospective reports of lifetime stressor count and severity. The Brief Symptom Inventory was used to assess participants' symptoms of anxiety, depression, and somatization, which were the main outcomes. Most participants identified as cisgender male (94.7%) and gay (74.2%), with the remaining participants identifying as transgender or genderqueer/nonbinary for gender and bisexual/pansexual, queer, or another sexual orientation. RESULTS Multiple regression analyses indicated that experiencing more-and more severe-stressors across the lifespan was related to greater anxiety, depressive, and somatization symptoms. These effects were robust while controlling for race/ethnicity, sexual orientation, education, and employment status, and they differed based on stressor exposure timing, type, primary life domain, and core social-psychological characteristic. CONCLUSION Greater cumulative lifetime stressor exposure is related to poorer mental health among sexual minority people of color. Screening for lifetime stressors may thus help identify at-risk persons and provide an opportunity to intervene to help mitigate or prevent mental health disparities in multiply stigmatized adults.
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Affiliation(s)
- Luis A. Parra
- School of Nursing, University of Michigan, Ann Arbor, MI USA
| | - Chandler M. Spahr
- Department of Psychology, University of California, Riverside, CA, USA
| | | | - Bethany C. Bray
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago, IL, USA
| | - Michele D. Kipke
- Children’s Hospital Los Angeles, Los Angeles, CA, USA
- Departments of Pediatrics and Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - George M. Slavich
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
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Progovac AM, Mullin BO, Yang X, Kibugi L(T, Mwizerwa D, Hatfield LA, Schuster MA, McDowell A, Cook BL. Despite Higher Rates of Minimally Recommended Depression Treatment, Transgender and Gender Diverse Medicare Beneficiaries with Depression Have Poorer Mental Health Outcomes: Analysis of 2009–2016 Medicare Data. Transgend Health 2023. [DOI: 10.1089/trgh.2022.0146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
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27
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Jackson D. Suicide-Related Outcomes Following Gender-Affirming Treatment: A Review. Cureus 2023; 15:e36425. [PMID: 36950718 PMCID: PMC10027312 DOI: 10.7759/cureus.36425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2023] [Indexed: 03/24/2023] Open
Abstract
Gender-affirming treatment remains a topic of controversy; of particular concern is whether gender-affirming treatment reduces suicidality. A narrative review was undertaken evaluating suicide-related outcomes following gender-affirming surgery, hormones, and/or puberty blockers. Of the 23 studies that met the inclusion criteria, the majority indicated a reduction in suicidality following gender-affirming treatment; however, the literature to date suffers from a lack of methodological rigor that increases the risk of type I error. There is a need for continued research in suicidality outcomes following gender-affirming treatment that adequately controls for the presence of psychiatric comorbidity and treatment, substance use, and other suicide risk-enhancing and reducing factors. There is also a need for future systematic reviews given the inherent limitations of a narrative review. There may be implications on the informed consent process of gender-affirming treatment given the current lack of methodological robustness of the literature reviewed.
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Affiliation(s)
- Daniel Jackson
- Psychiatry and Behavioral Sciences, Norton College of Medicine, Upstate Medical University, Syracuse, USA
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Mental health and substance use risks and resiliencies in a U.S. sample of transgender and gender diverse adults. Soc Psychiatry Psychiatr Epidemiol 2022; 57:2305-2318. [PMID: 36112161 DOI: 10.1007/s00127-022-02359-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 09/02/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE Victimization contributes to mental and behavioral health inequities among transgender and gender diverse (TGD) people, but few studies have simultaneously examined health-promoting resiliencies. We sought to identify classes of risk and resilience among TGD adults, assess characteristics associated with these classes, and examine their relationship with mental health and substance use outcomes. METHODS Cross-sectional data were from the 2015 US Transgender Survey, a non-probability study including 26,957 TGD adults. Using latent class analysis, we classified patterns of vulnerability and resilience based on risk (past-year denial of equal treatment, verbal harassment, physical attack, bathroom-related discrimination; lifetime sexual assault, intimate partner violence) and protective (activism; family, work, classmate support) factors. Regression models were fit to (1) determine the association between sociodemographic and gender affirmation characteristics and latent classes; (2) model associations between latent classes and mental health (current serious psychological distress, past-year and lifetime suicidal thoughts and attempts, and lifetime gender identity/transition-related counseling) and substance use (current binge alcohol use, smoking, illicit drug use; past-year drug/alcohol treatment) outcomes. RESULTS Three latent classes were identified: high risks, with activism involvement ("risk-activism," 35%); low risks, with not being out about one's TGD identity ("not-out," 25%); and low risks, with high family support ("family-support," 40%). Gender affirmation and sociodemographic characteristics, such as race/ethnicity and sexual orientation, were associated with latent classes. Risk-activism class membership was associated with higher odds of negative mental health and substance use outcomes, while the family-support class had lower odds of these outcomes. CONCLUSIONS Interventions leveraging family support, and policy protections from discrimination and victimization, may promote TGD mental and behavioral health.
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Baguso GN, Santiago-Rodriguez E, Gyamerah AO, Wilson EC, Chung C, McFarland W, Wesson P. Mental Distress and Use of Stimulants: Analysis of a Longitudinal Cohort of Transgender Women. LGBT Health 2022; 10:228-236. [PMID: 36301245 PMCID: PMC10079245 DOI: 10.1089/lgbt.2021.0192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: The purpose of our study was to examine the effects of mental distress (depression, anxiety, and post-traumatic stress disorder [PTSD]), incarceration, and hate crime on stimulant use (methamphetamine, crack, and cocaine) among transgender women. Methods: We conducted a secondary analysis of longitudinal data collected from 2016 to 2018 with 429 transgender women in the San Francisco Bay Area. Generalized estimating equation log-binomial regressions were used to calculate relative risks of stimulant use associated with mental distress, incarceration, and hate crime. Results: At baseline, transgender women experienced transphobic hate crime (46.4%), incarceration (53.0%), mental distress (69.2%), and stimulant use (28.4%). Transgender women who used stimulants reported lower education (45.1%, χ2 = 14.3, p = 0.001) and significantly more had been incarcerated (62.3%, χ2 = 5.9, p = 0.015), and reported diagnoses of depression (67.8%, χ2 = 6.1, p = 0.014), anxiety (62.8%, χ2 = 4.3, p = 0.039), and PTSD (43.8%, χ2 = 6.7, p = 0.010). Longitudinal multivariate analysis found that depression (adjusted relative risk [aRR] = 1.46, 95% confidence interval [CI] 1.09-1.95), anxiety (aRR = 1.42, 95% CI = 1.05-1.93), and PTSD (aRR = 1.38, 95% CI = 1.02-1.87) were associated with methamphetamine use but not with crack or cocaine use. Incarceration was associated with methamphetamine use and crack use, whereas experiencing hate crime was associated with crack use. Conclusions: Mental distress, incarceration, and hate crime were key exposures of stimulant use among transgender women. Intervention targets for reducing stimulant use should consider working upstream by addressing underlying stressors impacting mental health for transgender women, including laws to protect transgender women from hate crime and to reduce their disproportionate representation in the criminal justice system.
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Affiliation(s)
- Glenda N Baguso
- Division of Prevention Science, Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, California
| | - Edda Santiago-Rodriguez
- Division of Prevention Science, Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, California
| | - Akua O Gyamerah
- Division of Prevention Science, Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, California
| | - Erin C Wilson
- San Francisco Department of Public Health, Center for Public Health Research, San Francisco, California
| | | | - Willi McFarland
- San Francisco Department of Public Health, Center for Public Health Research, San Francisco, California
| | - Paul Wesson
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
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Strenth CR, Pagels P, SoRelle JA, Gonzalez L, Day PG, Gimpel NE, Levy Kamugisha EI, Moore RM, Arnold EM. Predictors of mood or anxiety problems among transgender individuals seeking hormone therapy. Fam Pract 2022; 40:273-281. [PMID: 36250448 DOI: 10.1093/fampra/cmac111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Mental health needs of transgender individuals can be complex with individual, social, and medical factors impacting symptoms. This study examines predictors of mood or anxiety problems among transgender individuals seeking hormone therapy (HT). METHODS A retrospective chart review was conducted at 2 clinics providing gender-affirming HT. Cross-sectional data from initial patient encounters (N = 311) were used in this study. Bivariate correlations and multiple logistic regression analyses were carried out. RESULTS Transgender women (TW) were 2.2 times more likely to have mood or anxiety problems while transgender men (TM) were 2.6 times more likely as the number of medical comorbidities increased. For both TW and TM, White race significantly increased the likelihood of mood or anxiety problems. Neither previous nor current HT were associated with mood or anxiety problems for TW and TM. However, receiving multiple gender-affirming procedures decreased the likelihood of mood or anxiety problems for TM. CONCLUSIONS Gender-affirming care and addressing comorbidities can be important aspects of mental health needs for transgender individuals.
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Affiliation(s)
- Chance R Strenth
- Department of Family and Community Medicine, UT Southwestern Medical Center, Dallas, TX, United States
| | - Patti Pagels
- Department of Family and Community Medicine, UT Southwestern Medical Center, Dallas, TX, United States
| | - Jeffrey A SoRelle
- Department of Pathology, UT Southwestern Medical Center, Dallas, TX, United States
| | - Leo Gonzalez
- Department of Family and Community Medicine, UT Southwestern Medical Center, Dallas, TX, United States
| | - Philip G Day
- Family Medicine and Community Health, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Nora E Gimpel
- Department of Family and Community Medicine, UT Southwestern Medical Center, Dallas, TX, United States
| | - Emily I Levy Kamugisha
- Department of Family and Community Medicine, UT Southwestern Medical Center, Dallas, TX, United States
| | - Rachel M Moore
- Department of Family and Community Medicine, UT Southwestern Medical Center, Dallas, TX, United States
| | - Elizabeth Mayfield Arnold
- Department of Family and Community Medicine, UT Southwestern Medical Center, Dallas, TX, United States
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Kramper S, Brydon C, Carmichael KP, Chaddock HM, Gorczyca K, Witte T. "The Damage Happens … You Just Try Not to Dwell on It": Experiences of Discrimination by Gender and Sexual Minority Veterinary Professionals and Students in the US and the UK. JOURNAL OF VETERINARY MEDICAL EDUCATION 2022; 50:e20220047. [PMID: 36170353 DOI: 10.3138/jvme-2022-0047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Data collected in a 2016 survey of veterinary students and professionals from the United States and the United Kingdom who identified as lesbian, gay, bisexual, transgender, queer, questioning, and asexual (LGBTQ+) indicated that 34.5% (152/440) had experienced difficulties related to their sexual orientation or gender identity at school or work. This study's objective was to examine narrative responses collected in the 2016 survey and utilize content analysis to explore the research questions: What are the concerns of the LGBTQ+ veterinary population, and how do they attempt to resolve difficulties at work and school? To address these questions, we developed two taxonomies that cataloged (a) the difficulties reported by veterinary professionals and students in the 2016 survey sample and (b) the outcomes of their attempts to resolve these difficulties. The themes related to difficulties that occurred most frequently were exposure to homophobic or transphobic language (n = 69; 45.4%), outness/staying in the closet (45, 29.6%), and negative emotional outcomes (32, 21.2%). The most common themes that described the outcomes of their attempts to resolve those difficulties were unresolved (n = 41, 27.0%), changed jobs or graduated (22, 14.5%), and found self-acceptance of acceptance from others (21, 13.8%). Our findings can inform the efforts of schools and colleges of veterinary medicine, professional organizations, and workplaces in targeting improvements to support LGBTQ+ students and professionals and the development of measures tailored to this population.
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Goetz TG, Adams N. The Transgender and Gender Diverse and Attention Deficit Hyperactivity Disorder Nexus: A Systematic Review. JOURNAL OF GAY & LESBIAN MENTAL HEALTH 2022; 28:2-19. [PMID: 38577478 PMCID: PMC10989732 DOI: 10.1080/19359705.2022.2109119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 07/31/2022] [Indexed: 10/15/2022]
Abstract
Introduction Prior work suggests an increased prevalence of Attention Deficit Hyperactivity Disorder (ADHD) among transgender and/or gender diverse (TGD) individuals. This systematic review summarizes primary literature on TGD/ADHD experience. Methods Texts from databases, reference lists, and referral were screened per PRISMA guidelines, with author consensus. Results Since 2014, 17 articles have been published on the TGD/ADHD nexus. Gender-affirming care specialists authored 65%. 71% reported prevalence, per medical records. Only case reports discussed implications. None avoided deficit-framing, nor included explicit TGD/ADHD authorship. Conclusions The paucity of literature and lack of explicit TGD/ADHD community involvement are striking; each warrants increased attention.
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Affiliation(s)
- Teddy G Goetz
- University of Pennsylvania, Department of Psychiatry, Philadelphia, PA, USA
| | - Noah Adams
- Ontario Institute for Studies in Education, University of Toronto, Toronto, Canada
- Center for Applied Transgender Studies, Chicago, IL USA
- Transgender Professional Association for Transgender Health
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Lam JSH, Abramovich A, Victor JC, Zaheer J, Kurdyak P. Characteristics of Transgender Individuals With Emergency Department Visits and Hospitalizations for Mental Health. Psychiatr Serv 2022; 73:722-729. [PMID: 34875849 DOI: 10.1176/appi.ps.202100306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Transgender individuals experience significant oppression resulting in mental health disparities. Factors associated with their need for acute mental health care are unknown. This study compared characteristics of transgender individuals who presented for acute mental health care with population-based comparison samples. METHODS This cross-sectional study examined transgender individuals who had a mental health-related emergency department (ED) visit (N=728) or hospitalization (N=454). Transgender individuals were identified, and their data were linked with health administrative data. The transgender ED and hospitalization samples were each compared with two samples: all individuals in Ontario who had an ED visit or hospitalization (unmatched) and individuals matched on age, region of residence, and mental health care utilization history. Individuals' sociodemographic and clinical factors were compared. RESULTS After matching, transgender individuals in the ED sample were more likely than those in the comparison group to be in the lowest neighborhood income quintile (37% versus 27%) and the highest residential instability quintile (47% versus 38%) and to be diagnosed as having a mood (26% versus 19%) or personality disorder (4% versus 1%). Transgender individuals in the hospitalization sample were more likely to be in the lowest neighborhood income quintile (36% versus 27%) and the highest residential instability quintile (45% versus 35%) and to be diagnosed as having a mood (40% versus 35%) or personality disorder (5% versus 2%). CONCLUSIONS Transgender individuals who accessed acute mental health care had unique sociodemographic and clinical factors associated with their presentation that persisted after matching. More research into the factors associated with their acute care presentation is warranted, including how experiences of marginalization play a role.
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Affiliation(s)
- June Sing Hong Lam
- Centre for Addiction and Mental Health, Toronto (Lam, Abramovich, Zaheer, Kurdyak); Department of Psychiatry (Lam, Abramovich Zaheer, Kurdyak), Dalla Lana School of Public Health (Abramovich), and Institute of Health Policy, Management and Evaluation (Lam, Victor, Kurdyak), University of Toronto, Toronto;ICES, Toronto (Victor, Kurdyak)
| | - Alex Abramovich
- Centre for Addiction and Mental Health, Toronto (Lam, Abramovich, Zaheer, Kurdyak); Department of Psychiatry (Lam, Abramovich Zaheer, Kurdyak), Dalla Lana School of Public Health (Abramovich), and Institute of Health Policy, Management and Evaluation (Lam, Victor, Kurdyak), University of Toronto, Toronto;ICES, Toronto (Victor, Kurdyak)
| | - J Charles Victor
- Centre for Addiction and Mental Health, Toronto (Lam, Abramovich, Zaheer, Kurdyak); Department of Psychiatry (Lam, Abramovich Zaheer, Kurdyak), Dalla Lana School of Public Health (Abramovich), and Institute of Health Policy, Management and Evaluation (Lam, Victor, Kurdyak), University of Toronto, Toronto;ICES, Toronto (Victor, Kurdyak)
| | - Juveria Zaheer
- Centre for Addiction and Mental Health, Toronto (Lam, Abramovich, Zaheer, Kurdyak); Department of Psychiatry (Lam, Abramovich Zaheer, Kurdyak), Dalla Lana School of Public Health (Abramovich), and Institute of Health Policy, Management and Evaluation (Lam, Victor, Kurdyak), University of Toronto, Toronto;ICES, Toronto (Victor, Kurdyak)
| | - Paul Kurdyak
- Centre for Addiction and Mental Health, Toronto (Lam, Abramovich, Zaheer, Kurdyak); Department of Psychiatry (Lam, Abramovich Zaheer, Kurdyak), Dalla Lana School of Public Health (Abramovich), and Institute of Health Policy, Management and Evaluation (Lam, Victor, Kurdyak), University of Toronto, Toronto;ICES, Toronto (Victor, Kurdyak)
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Pinna F, Paribello P, Somaini G, Corona A, Ventriglio A, Corrias C, Frau I, Murgia R, El Kacemi S, Galeazzi GM, Mirandola M, Amaddeo F, Crapanzano A, Converti M, Piras P, Suprani F, Manchia M, Fiorillo A, Carpiniello B. Mental health in transgender individuals: a systematic review. Int Rev Psychiatry 2022; 34:292-359. [PMID: 36151828 DOI: 10.1080/09540261.2022.2093629] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Several lines of evidence indicate the prevalence of mental health disorders in Transgender (TG) individuals is higher than that of cisgender individuals or the general population. In this systematic review, we aim to propose a summary of some of the most significant research investigating mental health disorders' prevalence among this population. We performed a double-blind systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting (PRISMA) on PUBMED/MEDLINE and SCOPUS, specifically using peer-reviewed articles examining the mental health status of transgender (TG) individuals. This review did not exclude any research based on publication date. The last search was performed in February 2022. The employed search strategy led to the selection of 165 peer-reviewed articles. The majority of these papers presented a cross-sectional design with self-reported diagnoses and symptoms, signaling a significant prevalence of mental health disorders amongst TG Individuals. Of the reviewed articles, 72 examined the prevalence of mood and anxiety disorders; 8 examined eating disorders; 43 examined the prevalence of suicidal or self-harm ideation or behaviors; 5 papers examined the prevalence of trauma and stress-related disorders; 10 examined the frequency of personality disorders; 44 examined substance use disorders; and 9 papers examined the prevalence of autism spectrum disorder. Finally, 22 studies reported on the prevalence of TG individuals diagnosed with co-morbid mental health disorders or unspecified mental disorders. Our findings coincide with existing research, which indicates TG individuals do experience a higher prevalence of mental health disorders than that of the general population or cisgender individuals. However, further research is needed to address the existing gaps in knowledge.
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Affiliation(s)
- Federica Pinna
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Pasquale Paribello
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Giulia Somaini
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Alice Corona
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Antonio Ventriglio
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Carolina Corrias
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Ilaria Frau
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Roberto Murgia
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Sabrina El Kacemi
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Gian Maria Galeazzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Dipartimento ad attività integrata di Salute Mentale e Dipendenze Patologiche, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Massimo Mirandola
- Department of Diagnostics and Public Health, Infectious Diseases Section, University of Verona, Verona, Italy.,School of Sport and Health Sciences, University of Brighton, Brighton, UK
| | - Francesco Amaddeo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Andrea Crapanzano
- Department of Counseling, San Francisco State University, San Francisco, California, USA
| | - Manlio Converti
- Dipartimento di salute mentale, ASL Napoli 2 Nord, Naples, Italy
| | - Paola Piras
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Federico Suprani
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Mirko Manchia
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy.,Department of Pharmacology, Dalhousie University, Halifax, NS, Canada
| | - Andrea Fiorillo
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Bernardo Carpiniello
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
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Aquino NJ, Boskey ER, Staffa SJ, Ganor O, Crest AW, Gemmill KV, Cravero JP, Vlassakova B. A Single Center Case Series of Gender-Affirming Surgeries and the Evolution of a Specialty Anesthesia Team. J Clin Med 2022; 11:jcm11071943. [PMID: 35407551 PMCID: PMC9000168 DOI: 10.3390/jcm11071943] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 03/29/2022] [Accepted: 03/29/2022] [Indexed: 02/01/2023] Open
Abstract
Most minors and young transgender persons wishing to undergo gender-affirming surgery need to seek specialists affiliated with gender affirmation programs in adult hospitals. Research suggests gender affirmation surgery has been established as an effective and medically indicated treatment for gender dysphoria. Although most data on gender-affirming surgeries are from adult populations, there is growing literature establishing their effectiveness in adolescents and young adults. Therefore, it is critical to evaluate the perioperative outcomes for gender-diverse youth to deliver safe and affirming care. The primary objective of this retrospective case series is to examine the perioperative characteristics and outcomes of patients with gender identity disorders (International Classification of Diseases [ICD]-10-code F64) who underwent chest reconstruction (mastectomy) and genital surgery (phalloplasty, metoidioplasty, and vaginoplasty) in a pediatric academic hospital. The secondary aim is to evaluate the value of a specialized anesthesia team for improving clinical outcomes, interdisciplinary communication, and further advancing the transgender perioperative experience. We identified 204 gender affirmation surgical cases, 177 chests/top surgeries, and 27 genital/bottom surgeries. These findings indicate gender-diverse individuals who underwent life-changing surgery at our institution had a median age of 18 years old, with many patients identifying as transmen. Our data suggests that postoperative pain was significant, but adverse events were minimal. The evolution of a specialty anesthesia team and initiatives (anesthesia management guidelines, scheduling, continuity, and education) necessitate direct care coordination and multidisciplinary planning for gender affirmation surgery in transgender youth.
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Affiliation(s)
- Nelson J. Aquino
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA 02115, USA; (S.J.S.); (A.W.C.); (K.V.G.); (J.P.C.); (B.V.)
- Correspondence:
| | - Elizabeth R. Boskey
- Center for Gender Surgery, Boston Children’s Hospital, Boston, MA 02115, USA; (E.R.B.); (O.G.)
| | - Steven J. Staffa
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA 02115, USA; (S.J.S.); (A.W.C.); (K.V.G.); (J.P.C.); (B.V.)
| | - Oren Ganor
- Center for Gender Surgery, Boston Children’s Hospital, Boston, MA 02115, USA; (E.R.B.); (O.G.)
| | - Alyson W. Crest
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA 02115, USA; (S.J.S.); (A.W.C.); (K.V.G.); (J.P.C.); (B.V.)
| | - Kristin V. Gemmill
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA 02115, USA; (S.J.S.); (A.W.C.); (K.V.G.); (J.P.C.); (B.V.)
| | - Joseph P. Cravero
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA 02115, USA; (S.J.S.); (A.W.C.); (K.V.G.); (J.P.C.); (B.V.)
| | - Bistra Vlassakova
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA 02115, USA; (S.J.S.); (A.W.C.); (K.V.G.); (J.P.C.); (B.V.)
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36
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Callegari M, Pettigrew G, MacLean J, Mishra K, Khouri JS, Gupta S. Gender Affirmation Surgery for the Transmasculine Patient. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2022. [DOI: 10.1007/s13669-022-00330-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Barr SM, Roberts D, Thakkar KN. Psychosis in transgender and gender non-conforming individuals: A review of the literature and a call for more research. Psychiatry Res 2021; 306:114272. [PMID: 34808496 DOI: 10.1016/j.psychres.2021.114272] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 11/03/2021] [Indexed: 01/22/2023]
Abstract
Epidemiological studies have described higher rates of psychotic disorder diagnoses in transgender, as compared to cisgender, individuals. With the exception of this work and a small number of published case studies, however, there has been little consideration of gender diversity in psychosis research or clinical care. In this paper, we will review and critically evaluate the limited literature on gender diversity and clinical psychosis and articulate the critical need for more work in this field, more specifically on the following areas and how they bear on clinical care: 1) diagnostic biases; 2) how chronic non-affirmation and bias, gender dysphoria, and other gender minority stressors may operate as trauma and can contribute to clinically significant psychotic symptoms; 3) the potential impact of gender-affirming care, such as hormone therapies, on mental health and barriers for receiving such care in transgender and nonbinary individuals; and 4) culturally-sensitive and gender-affirming approaches for addressing psychosis. Finally, we consider ways in which researchers may engage in ethical, gender-affirming, and accurate approaches to better address gender identity in psychosis research. We hope that such research will aid in the creation of clinical guidelines for understanding, diagnosing, and treating psychosis in gender diverse individuals.
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Affiliation(s)
| | - Dominic Roberts
- Department of Psychology, Michigan State University, United States
| | - Katharine N Thakkar
- Department of Psychology, Michigan State University, United States; Department of Psychiatry and Behavioral Medicine, Michigan State University, United States.
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Guethlein N, Grahlow M, Lewis CA, Bork S, Habel U, Derntl B. Healthcare for Trans*gender People in Germany: Gaps, Challenges, and Perspectives. Front Neurosci 2021; 15:718335. [PMID: 34557067 PMCID: PMC8452951 DOI: 10.3389/fnins.2021.718335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 08/11/2021] [Indexed: 11/13/2022] Open
Abstract
People whose gender does not correspond to the binary gender system, i.e., trans∗gender people, face two main problems when it comes to healthcare in Germany: (1) They often suffer from general psychiatric comorbidities as well as specific and significant mental distress due to gender dysphoria, and (2) the German healthcare system lacks sufficiently educated and clinically experienced medical personnel who are able to provide specialized healthcare. Aside from transition, it often is extremely difficult for trans∗gender people to get access to and be integrated into the medical system. Stigmatization and pathologization in treatment are widespread, as are long waiting times for specialized healthcare providers who are often only accessible to those trans∗gender people willing to travel long distances. Frequently, trans∗gender people face further difficulties and barriers after transition, as some healthcare professionals fail to provide suitable care (e.g., gynecological consultation for transmen). The ICD-11 German Modification (ICD-11-GM), which should be routinely used by 2022, implements a depathologization of trans∗gender people in the medical system. This paper compares the issues related to health and healthcare of trans∗gender people in Germany with those in other European countries. We review the care offered by specialized centers with regard to treatment of and support for trans∗gender people. We conclude with specific proposals that may contribute to establish an improved, up-to-date, gender-sensitive healthcare system.
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Affiliation(s)
- Nora Guethlein
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Melina Grahlow
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
- Graduate Training Centre of Neuroscience, University of Tübingen, Tübingen, Germany
| | - Carolin A. Lewis
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
- Emotion Neuroimaging Lab, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- International Max Planck Research School on Neuroscience of Communication: Function, Structure, and Plasticity, Leipzig, Germany
| | - Stephan Bork
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Ute Habel
- Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany
- Institute of Neuroscience and Medicine, JARA-Institute Brain Structure Function Relationship (INM 10), Research Center Jülich, Jülich, Germany
| | - Birgit Derntl
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
- LEAD Graduate School and Research Network, University of Tübingen, Tübingen, Germany
- International Max Planck Research School for Cognitive and Systems Neuroscience, University of Tübingen, Tübingen, Germany
- TübingenNeuroCampus, University of Tübingen, Tübingen, Germany
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Chumakov EM, Ashenbrenner YV, Petrova NN, Zastrozhin MS, Azarova LA, Limankin OV. Anxiety and Depression Among Transgender People: Findings from a Cross-Sectional Online Survey in Russia. LGBT Health 2021; 8:412-419. [PMID: 34283658 DOI: 10.1089/lgbt.2020.0464] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Purpose: As we still do not know enough about the mental health concerns of gender minority people in Russia, there is a need to initiate research on these issues. We aimed to examine the frequency of anxiety and depression symptoms in a Russian sample of transgender people. Methods: The study consisted of a structured online survey and was conducted throughout November 2019. The Hospital Anxiety and Depression Scale was used for online screening of anxiety and depression symptoms. A total of 588 transgender adults living in all Federal Districts of Russia (mean age 24.0 ± standard deviation 6.7) was included in the final analysis. Results: It was found that 45.1% (n = 265) and 24.0% (n = 141) of transgender people had clinically significant levels of anxiety and depression, respectively. No statistically significant differences in the prevalence of anxiety and depression were found among those who identified as a transgender man, a transgender woman, or other transgender identities. The anxiety and depression mean scores in the sample were statistically significantly higher than in the general Russian population (p < 0.001). No statistically significant differences were found in the level of depression and anxiety symptoms among respondents in Moscow, St. Petersburg, and other Russian cities. Conclusions: We found high rates of clinical symptoms of depression and anxiety among transgender people, consistent with international research. The study highlights the need for further research on the psychological well-being and mental health of transgender people, and the availability of psychiatric care to transgender people living in Russia.
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Affiliation(s)
- Egor M Chumakov
- Day in-Patient Clinic, St. Petersburg Psychiatric Hospital No 1 named after P.P. Kaschenko, St. Petersburg, Russia.,Department of Psychiatry and Addiction, St. Petersburg State University, St. Petersburg, Russia
| | - Yulia V Ashenbrenner
- Day in-Patient Clinic, St. Petersburg Psychiatric Hospital No 1 named after P.P. Kaschenko, St. Petersburg, Russia
| | - Nataliia N Petrova
- Department of Psychiatry and Addiction, St. Petersburg State University, St. Petersburg, Russia
| | - Michael S Zastrozhin
- Department of Addictology, Moscow Research and Practical Centre on Addictions, Moscow Department of Healthcare, Moscow, Russia.,Department of Addictology, Russian Medical Academy of Continuous Professional Education, Ministry of Health of the Russian Federation, Moscow, Russia
| | - Larisa A Azarova
- Day in-Patient Clinic, St. Petersburg Psychiatric Hospital No 1 named after P.P. Kaschenko, St. Petersburg, Russia
| | - Oleg V Limankin
- Day in-Patient Clinic, St. Petersburg Psychiatric Hospital No 1 named after P.P. Kaschenko, St. Petersburg, Russia.,Department of Psychotherapy, Medical Psychology and Sexology, North-Western State Medical University named after I.I. Mechnikov, St. Petersburg, Russia.,Department of Social Psychiatry and Psychology, St. Petersburg Institute of Postgraduate Improvement of Physicians-Experts of the Ministry of Labour and Social Protection, St. Petersburg, Russia
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40
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Frost MC, Blosnich JR, Lehavot K, Chen JA, Rubinsky AD, Glass JE, Williams EC. Disparities in Documented Drug Use Disorders Between Transgender and Cisgender U.S. Veterans Health Administration Patients. J Addict Med 2021; 15:334-340. [PMID: 33252409 PMCID: PMC8384140 DOI: 10.1097/adm.0000000000000769] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Transgender people-those whose gender identity differs from their sex assigned at birth-are at risk for health disparities resulting from stressors such as discrimination and violence. Transgender people report more drug use than cisgender people; however, it is unclear whether they have higher likelihood of drug use disorders. We examined whether transgender patients have increased likelihood of documented drug use disorders relative to cisgender patients in the national Veterans Health Administration (VA). METHODS Electronic health record data were extracted for VA outpatients from 10/1/09 to 7/31/17. Transgender status and past-year documentation of drug use disorders (any, opioid, amphetamine, cocaine, cannabis, sedative, hallucinogen) were measured using diagnostic codes. Logistic regression models estimated odds ratios for drug use disorders among transgender compared to cisgender patients, adjusted for age, race/ethnicity and year. Effect modification by presence of ≥1 mental health condition was tested using multiplicative interaction. RESULTS Among 8,872,793 patients, 8619 (0.1%) were transgender. Transgender patients were more likely than cisgender patients to have any drug use disorder (Adjusted Odds Ratio [aOR] 1.67, 95% confidence interval [CI] 1.53-1.83), amphetamine (aOR 2.22, 95% CI 1.82-2.70), cocaine (aOR 1.59, 95% CI 1.29-1.95), and cannabis (aOR 1.82, 95% CI 1.62-2.05) use disorders. There was no significant interaction by presence of ≥1 mental health condition. CONCLUSIONS Transgender VA patients may have higher likelihood of certain drug use disorders than cisgender VA patients, particularly amphetamine use disorder. Future research should explore mechanisms underlying disparities and potential barriers to accessing treatment and harm reduction services faced by transgender people.
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Affiliation(s)
- Madeline C. Frost
- Department of Health Services, University of Washington School of Public Health, 1959 NE Pacific St, Seattle, WA 98195
- Health Services Research & Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, 1660 South Columbian Way, Seattle WA 98108
| | - John R. Blosnich
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
- Health Services Research & Development (HSR&D) Center for Health Equity Research and Promotion, Veterans Affairs (VA) Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Keren Lehavot
- Department of Health Services, University of Washington School of Public Health, 1959 NE Pacific St, Seattle, WA 98195
- Health Services Research & Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, 1660 South Columbian Way, Seattle WA 98108
- Department of Psychiatry and Behavioral Science, University of Washington, Seattle, WA, USA
| | - Jessica A. Chen
- Health Services Research & Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, 1660 South Columbian Way, Seattle WA 98108
- Department of Psychiatry and Behavioral Science, University of Washington, Seattle, WA, USA
| | - Anna D. Rubinsky
- Health Services Research & Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, 1660 South Columbian Way, Seattle WA 98108
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Joseph E. Glass
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Seattle, WA 98101
| | - Emily C. Williams
- Department of Health Services, University of Washington School of Public Health, 1959 NE Pacific St, Seattle, WA 98195
- Health Services Research & Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, 1660 South Columbian Way, Seattle WA 98108
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Ruprecht MM, Wang X, Johnson AK, Xu J, Felt D, Ihenacho S, Stonehouse P, Curry CW, DeBroux C, Costa D, Phillips Ii G. Evidence of Social and Structural COVID-19 Disparities by Sexual Orientation, Gender Identity, and Race/Ethnicity in an Urban Environment. J Urban Health 2021; 98:27-40. [PMID: 33259027 PMCID: PMC7706696 DOI: 10.1007/s11524-020-00497-9] [Citation(s) in RCA: 104] [Impact Index Per Article: 34.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/01/2020] [Indexed: 11/22/2022]
Abstract
The ongoing COVID-19 pandemic has had widespread social, psychological, and economic impacts. However, these impacts are not distributed equally: already marginalized populations, specifically racial/ethnic minority groups and sexual and gender minority populations, may be more likely to suffer the effects of COVID-19. The COVID-19 Resiliency Survey was conducted by the city of Chicago to assess the impact of COVID-19 on city residents in the wake of Chicago's initial lockdown, with particular focus on the experiences of minority populations. Chi-square tests of independence were performed to compare COVID-19-related outcomes and impacts on heterosexual vs. sexual minority populations, cisgender vs. gender minority populations, and White vs. racial/ethnic minority subgroups. Marginalized populations experienced significant disparities in COVID-19 exposure, susceptibility, and treatment access, as well as in psychosocial effects of the pandemic. Notably, Black and Latinx populations reported significant difficulties accessing food and supplies (p = 0.002). Healthcare access disparities were also visible, with Black and Latinx respondents reporting significantly lower levels of access to a provider to see if COVID-19 testing would be appropriate (p = 0.013), medical services (p = 0.001), and use of telehealth for mental health services (p = 0.001). Sexual minority respondents reported significantly lower rates of using telehealth for mental health services (p = 0.011), and gender minority respondents reported significantly lower levels of primary care provider access (p = 0.016). There are evident COVID-19 disparities experienced in Chicago especially for Black, Latinx, sexual minority, and gender minority groups. A greater focus must be paid to health equity, including providing increased resources and supplies for affected groups, adapting to inequities in the built environment, and ensuring adequate access to healthcare services to ameliorate the burden of COVID-19 on these marginalized populations.
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Affiliation(s)
- Megan M Ruprecht
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Xinzi Wang
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Amy K Johnson
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jiayi Xu
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Dylan Felt
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Siobhan Ihenacho
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Patrick Stonehouse
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Caleb W Curry
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Catherine DeBroux
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Diogo Costa
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Gregory Phillips Ii
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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42
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Giraldi A. Mental health and gender dysphoria - why does it matter? Acta Psychiatr Scand 2020; 141:483-485. [PMID: 32506572 DOI: 10.1111/acps.13182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/08/2020] [Indexed: 12/29/2022]
Affiliation(s)
- A Giraldi
- Sexological Clinic, Psychiatric Center Copenhagen, Rigshospitalet & Department of Clinical Medicine, Univeristy of Copenhagen, Copenhagen, Denmark
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43
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Shen Y, Lo-Ciganic WH, Segal R, Goodin AJ. Prevalence of substance use disorder and psychiatric comorbidity burden among pregnant women with opioid use disorder in a large administrative database, 2009-2014. J Psychosom Obstet Gynaecol 2020:1-7. [PMID: 32067526 DOI: 10.1080/0167482x.2020.1727882] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 01/30/2020] [Accepted: 02/05/2020] [Indexed: 10/25/2022] Open
Abstract
Objectives: Using data from the Healthcare Cost and Utilization Project (HCUP), we estimated prevalence of individual substance use disorders (SUDs) and psychiatric comorbidities among pregnant women with opioid use disorder (OUD) in the New York State from 2009 to 2014.Methods: In this cross-sectional study, pregnancy outcome and gestational age at delivery were estimated, and OUD diagnosis during pregnancy or at delivery discharge was identified. Prevalence of SUDs and psychiatric comorbidities were then calculated.Results: Among 1,463,302 pregnant women, 8324 (0.57%) were diagnosed with OUD during pregnancy or at delivery. The most frequent SUDs or psychiatric comorbidities among pregnant women with OUD were non-opioid SUD (78.2%), followed by tobacco use disorder (74.9%), generalized anxiety disorder (38.0%), major depressive disorder (36.9%), cannabis use disorder (28.3%) and cocaine use disorder (27.4%).Conclusions: Most pregnant women with OUD were diagnosed with at least one non-opioid SUD and tobacco use disorder. Generalized anxiety disorder and major depressive disorder were also common, suggesting that mental health screenings should be prioritized for pregnant women with OUD.
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Affiliation(s)
- Yun Shen
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Wei-Hsuan Lo-Ciganic
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, FL, USA
| | - Richard Segal
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, FL, USA
| | - Amie J Goodin
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL, USA
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, FL, USA
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