Minority stress theory: Application, critique, and continued relevance

"Having providers who are trained and have empathy is life-saving": Improving primary care communication through thematic analysis with ChatGPT and human expertise

In the rapidly evolving field of healthcare research, Artificial Intelligence (AI) and conversational models like ChatGPT (Conversational Generative Pre-trained Transformer) offer promising tools for data analysis. The aim of this study was to: 1) apply ChatGPT methodology alongside human coding to analyze qualitative health services feedback, and 2) examine healthcare experiences among lesbian, gay, bisexual, transgender, and queer (LGBTQ+) patients (N = 41) to inform future intervention. The hybrid approach facilitated the identification of themes related to affirming care practices, provider education, communicative challenges and successes, and environmental cues. While ChatGPT accelerated the coding process, human oversight remained crucial for ensuring data integrity and context accuracy. This hybrid method promises significant improvements in analyzing patient feedback, providing actionable insights that could enhance patient-provider interactions and care for diverse populations. Innovation: This study is the first to combine ChatGPT with human coding for rapid thematic analysis of LGBTQ+ patient primary care experiences.

The Role of Friendship in Mediating and Moderating the Relationship Between Exposure to Gendered Racism and Mental Health among Young Women of Color

Young women of color frequently face discrimination, reflecting the intersecting societal influences of sexism and racism. Although friendships play a significant role in women's lives, there is a lack of research on the role of friendships in navigating exposure to gendered racial discrimination (in-person and social media) and associated mental health. This study investigated the extent to which the content of friendship conversations (i.e., co-rumination against gendered racism, socializing messages related to gendered racial pride and empowerment and oppression awareness) and perceived friendship intimacy and support mediated or moderated the positive association between exposure to gendered racism and mental health. Co-rumination was tested as a mediator, while the other variables were examined as moderators. Online survey data were collected from 339 cisgender women aged 18-24 (M age = 20.90, SD = 1.96; 32.74% Asian, 33.92% Black, and 33.33% Hispanic or Latina; 68.14% identified as straight or heterosexual). Participants described friendship communications and perceived intimacy and support with a same gender and race close friend. Exposure to gendered racial discrimination was significantly associated with depressive and anxiety symptoms and substance use as a coping mechanism. Co-rumination about gendered racism was positively correlated with depressive and anxiety symptoms. Conversely, pride and empowerment socialization was negatively associated with substance use for coping, while oppression awareness socialization was positively correlated with depressive and anxiety symptoms. Structural Equation Modeling Analyses indicated that co-rumination partially mediated the relationship between gendered racism exposure and anxiety symptoms, with other friendship indices not moderating these associations. These findings highlight co-rumination about gendered racism as a risk factor for young women of color and underscore the importance of exploring how the multifaceted nature of friendships is associated with exposure to gendered racism and mental health.

Mapping the gender gradient in posttraumatic stress disorder prevalence: A machine learning approach

The prevalence of posttraumatic stress disorder (PTSD) among women is over twice that of men, but the underlying mechanisms for these differences remain poorly understood. This study introduces a novel approach to examining gender and PTSD, moving beyond the binary group labels of male and female to explore the summative impact of gender-linked sociocultural factors. Using supervised machine learning, we modeled gender from theoretical and empirically selected predictors reflecting the roles, relationships, and institutional facets of gender. This model produced continuous gender scores reflecting the social circumstances typical of male (lower scores) or female (higher scores) individuals. We then examined how well these scores were associated with past-year PTSD among trauma-exposed men and women (N = 23,936) and compared effects to those obtained using binary sex. The results revealed a clear dose-response relationship between the social circumstances typical of female gender and past-year PTSD. Main effects for gender scores, adjusted odds ratio (aOR) = 4.03, 95% CI [2.64, 6.15], were substantially larger than main effects for binary sex, aOR = 2.69, 95% CI [1.96, 3.68], z = 2.30, p = .021, even after accounting for trauma exposure and other risk factors. This study highlights the importance of quantitative approaches that move beyond binary comparisons of male and female to better elucidate sociocultural determinants of traumatic stress.

Exploring Barriers to Compassionate Acts in Individuals with Borderline Personality Disorder: A Critical Literature Review

This critical literature review explores the barriers that individuals with borderline personality disorder face when engaging in compassionate acts, including self-compassion, receiving compassion from others and expressing compassion towards others. Borderline personality disorder is characterised by emotional instability, impulsive behaviours and difficulties in maintaining stable relationships. Although compassionate acts are known to enhance recovery and well-being, individuals with borderline personality disorder often struggle with these behaviours. This review identifies several key barriers, including adverse childhood experiences, stigma and systemic discrimination, known as sanism, and internal challenges such as self-judgement, shame and fear of compassion. By synthesising findings from 29 studies, this review highlights the complex interplay between these factors and their impact on the ability of individuals with borderline personality disorder to engage in compassionate behaviours. The findings emphasise the need for personalised, trauma-informed therapeutic interventions and broader societal changes to foster a more compassionate environment for individuals with borderline personality disorder. Future research should focus on longitudinal studies, inclusion of individuals with lived experiences and exploring diverse sources of compassion to enhance understanding and support recovery in this population.

Self-reported masking in sexual minority and heterosexual autistic adults

Masking can include suppressing or concealing certain behaviors to appear "non-autistic" and is one response to the excess social stressors of being a neurominority in a neurotypical-majority society. It is important to understand how persons who are multiply marginalized (e.g. an autistic person assigned female sex at birth who is bisexual), who experience multiple layers of excess social stressors, may face additional pressures to conceal their authentic selves. Autistic persons may be more likely than neurotypical persons to identify with a sexual minority orientation, such as asexual, bisexual, gay or pansexual. To advance our understanding of how marginalized identities may be associated with masking, we examined self-reported masking using the Camouflaging Autistic Traits Questionnaire in a sample of autistic adults (N = 462). After matching participants for assigned sex at birth and age, and after controlling for these effects in modeling, we found that sexual minority autistic adults reported significantly higher levels of masking relative to heterosexual autistic adults. We situate these findings within literatures on masking, minority stress, and stigma.Lay AbstractMasking can include hiding certain behaviors to appear "non-autistic." Masking is one response to the stress of being autistic in a non-autistic world. Being autistic is only one part of someone's identity, though. Other parts of a person's identity include things like a person's sexual orientation. Autistic people are more likely than non-autistic people to have a sexual orientation other than heterosexual, like asexual, bisexual, gay, or pansexual. People who are both autistic and a sexual minority may experience social stress because of different pressures from society. These different pressures may mean sexual minority autistic adults feel pressured to social camouflage more than heterosexual autistic adults. Thus, we compared masking in sexual minority autistic and heterosexual autistic adults. In the statistical models, we controlled for two other factors that may impact masking: sex assigned at birth and age. We found that sexual minority autistic adults reported significantly higher levels of masking relative to heterosexual autistic adults. We discuss how these findings fit within previous research on masking and minority stress.

A Theoretical Model for Predicting the Derivation of Sexual Satisfaction in Gay Men

This study tests a theoretical model of sexual satisfaction in gay men that incorporates self and self-with-other schemata, identity processes, and sexual communication behaviors. Structural equation modeling based on cross-sectional correlational survey data from 199 gay men in the United Kingdom and Germany examined associations between the self-schema of internalized homonegativity, the self-with-other schema of anxious attachment style, identity resilience, sexual communication behaviors, and sexual satisfaction. The results showed a direct effect of internalized homonegativity, but not of anxious attachment style, on sexual satisfaction. Both internalized homonegativity and anxious attachment style had indirect effects through identity resilience and sexual communication behaviors. Therapeutic interventions to enhance sexual satisfaction in gay men should focus on the identification and management of internalized homonegativity (a self-schema) and anxious attachment style (a self-with-other schema) while also supporting the development of identity resilience and sexual communication skills.

Discrimination and Mental Health Among Black and Latino People Living with HIV: Understanding the Role of Religion and Spirituality

Despite significant advances in HIV care and treatment, Black and Latino people living with HIV (PWH) still face substantial health disparities due to discrimination and systemic inequities, which adversely affect their mental health. Given the profound significance of religion and spirituality in Black and Latino communities, the effects of religiosity on the relationship between discrimination and mental health should be examined. This study examined religiosity as a moderator between discrimination and mental health among Black and Latino PWH. Using data from the All of Us Research Program collected from 2016 to 2022, we analyzed electronic health records and survey responses from 902 participants, employing descriptive statistics, Chi-squared test, principal component analysis, and binary logistic regression. Results showed significant associations between education, employment, income, discrimination, religiosity, and mental health. Compared with no or low religiosity, those with high religiosity had significant higher odds of good mental health (aOR:2.35, 95% CI:1.16-4.75). Those who experienced discrimination had 59% lower odds of good mental health compared to those who did not report experiences of discrimination (aOR:0.41, 95% CI:0.20-0.83). There was no significant interaction effect of religiosity on the relationship between discrimination and mental health. While religiosity positively influences mental health, it does not mitigate the detrimental effects of compounded discrimination that Black and Latino PWH face. Continued collaborations between religious and spiritual leaders, researchers, and community members is needed to understand better the relationship between these factors and to identify strategies to maximize the protective effect of religiosity.

Inclusive Inflammatory Bowel Disease Care for Sexual and Gender Minorities: An Urgent Need in Uncertain Times

This editorial provides commentary on recent research on the relationship between gender- and sexual-orientation-related minority stress and inflammatory bowel disease outcomes, explores future directions for research in this area, and provides specific recommendations for LGBTQ + affirming GI care.

Cross-sectional and prospective associations between self-compassion and sexual distress in couples coping with sexual interest/arousal disorder

BACKGROUND

When an individual in a relationship is coping with low desire/arousal, both partners experience difficulties, including higher levels of sexual distress. Effective emotional regulation strategies, such as self-compassion, could have individual and interpersonal benefits for couples with sexual interest/arousal disorder (SIAD).

AIM

Using a dyadic design, we examined the role of self-compassion in the sexual distress of couples coping with SIAD, accounting for overall relationship satisfaction. The associations were analyzed cross-sectionally and prospectively. We also explored the moderating roles of having at least one member identify as sexually or gender diverse within the couple in the potential associations between self-compassion and sexual distress.

METHODS

Individuals with SIAD and their partners (N = 263 couples) completed online measures at baseline and 6 months later.

OUTCOMES

Individuals with SIAD and their partners completed the Sexual Distress Scale-Short Form and the Couples Satisfaction Index.

RESULTS

Controlling for relationship satisfaction, when individuals coping with SIAD and their partners reported greater self-compassion at baseline, they also reported lower sexual distress. For partners only, greater self-compassion was associated with the person with SIAD's lower levels of sexual distress at baseline. No statistically significant prospective associations were found between levels of self-compassion and sexual distress 6 months later. Belonging to a sexually diverse couple was a significant moderator of the cross-sectional associations between partners' level of self-compassion and their own level of sexual distress at baseline, such that the link between greater self-compassion and lower sexual distress was observed only in partners belonging to a sexually diverse couple. Belonging to a gender diverse couple did not moderate any of the associations.

CLINICAL IMPLICATIONS

Findings indicate that self-compassion could be a promising tool to reduce sexual distress in couples coping with SIAD.

STRENGTHS & LIMITATIONS

Strengths of this study include the large, diverse sample of couples coping with SIAD, the use of a cross-sectional and prospective design, and the examination of the moderating role of belonging to a gender or sexually diverse couple. However, the possible lack of statistical power to measure moderation based on belonging to a gender diverse couple and the recall bias due to the use of self-report questionnaires should be considered when interpreting the results.

CONCLUSION

Greater self-compassion is associated with lower sexual distress in both partners of couples coping with SIAD. Self-compassion may be particularly beneficial for partners of individuals with SIAD belonging to a sexually diverse couple.

Experiences and narratives of mandatory psychological assessment in Trans and Nonbinary people: An Italian qualitative analysis

BACKGROUND

This study adopts a qualitative methodological framework to investigate the overall experiences of institutional gender affirmation pathway (GAP) with a focus on the narratives of mandatory psychological assessment in Trans and Nonbinary (TNB) people in Italy, who face daily discrimination, social prejudice, episodes of violence, and victimization. In the Italian context, psychological assessment is a prerequisite to receive a diagnosis of gender dysphoria, which is essential to access hormone therapy, surgical interventions, and legal change of name and gender marker.

METHODS

The study employed a qualitative methodological design, since it allows a deep and flexible exploration of participants' experiences and perspectives. Specifically, the data collection technique consisted of semi-structured interviews with N = 21 participants. The corpus of data was analyzed consistently with thematic analysis and reflexive thematic analytic approach, for identifying, analysing and reporting patterns in data, allowing the corpus of data to be examined in terms of their principal themes, using both theory-driven (top-down) and bottom-up analytical strategies.

RESULTS

Through the reflexive thematic approach, we generated two themes, further divided into sub-themes. The first theme is "Being trans + in our society" and it is composed by the following sub-themes: "personal experiences of identity affirmation"; "minority stress and transphobia"; "supportive familiar and working contexts", "institutional gender affirmation process"; "resilience and self-determination". The second theme, "Experiences of mandatory psychological assessment" is divided in: "disrespectful experiences"; "affirming and supportive interactions"; "to take better care". The results highlight how TNB individuals often experience significant stress related to their minority status and face discrimination in healthcare settings. Furthermore, there is a lack of individualization in the approach by healthcare providers and a shortage of knowledge about gender sensible topics among them. This study therefore highlights an insufficient provision of effective psychological support and the need to adopt more inclusive approaches, dismantling the pathologizing dimension of the diagnostic process for TNB people.

CONCLUSIONS

It is therefore crucial to promote awareness programs on gender identity issues to foster a more welcoming and informed environment in healthcare settings.

TRIAL REGISTRATION

The study has been approved by the Ethics Committee of the University of Padua with unique number D120DC6FDC5DF2694CF281D76B2CDB41 and protocol number 5003.

The increased risk of cyberbullying and its negative impact on mental health among sexual minority college students compared to their peers

BACKGROUNDS

This study explores the relationship between cyberbullying, mental health, and sexual minority groups, focusing on the specific impact of cyberbullying on these individuals' mental wellbeing. Previous research has indicated that sexual minorities face higher levels of cyberbullying on social media. Therefore, this study aims to gain deeper insights into the mental health consequences and potential mitigating factors for this vulnerable population.

METHODS

We employed a questionnaire survey method and convenience sampling to collect data. Participants' psychosocial traits were assessed using established scales measuring stress, anxiety, depression, cyberbullying, loneliness, and sleep quality. Data analysis included Propensity Score Matching (PSM) and causal mediation analysis.

RESULTS

Of the participants, 204 identified as belonging to sexual minority groups, constituting 7.1% of the overall sample. The correlation results indicated that individuals in the sexual minority group experienced higher levels of cyberbullying (r = 0.276, p < 0.001). Cyberbullying was found to partially mediate the relationship between sexual minority status and several mental health issues, including depressive symptoms (0.32, 95% CI 0.19-0.53; P < 0.001), anxiety symptoms (0.52, 95% CI 0.30-0.88; P < 0.001), and loneliness (0.40, 95% CI 0.23-0.69; P < 0.001). Additionally, cyberbullying fully mediated the relationship between sexual minority status and both stress and sleep quality.

CONCLUSION

These findings highlight that cyberbullying serves as a significant mediator in the mental health challenges faced by sexual minorities.

Race and Anti-Racist Online Coping as Moderators of College Adjustment Associated with Exposure to Social Media Racism among Asian, Black, and Hispanic/Latine Students

With the rise of social media, racism in the digital landscape has become ubiquitous potentially impacting the academic adjustment of college students of color. The role of anti-racist online coping strategies, such as seeking resources, support, and actively managing social networks in mitigating the negative effects of online racism has been understudied. Racial group differences and anti-racist online coping were examined as moderators between online discrimination and college adjustment among Asian, Black and Hispanic/Latine college students. The sample consisted of 772 emerging adults of color (Mage = 20.37, SD = 1.56, 44.8% women; 32.4% Asian, 35% Black, 32.6% Hispanic/Latine). Overall, average and high coping levels moderated the association between discrimination and college adjustment, but the protective effect varied by race and domain of adjustment. Across educational, relational and psychological dimensions of adjustment, protective effects of anti-racist online coping were stronger among Asian students, partially effective for Black students, and least effective for Hispanic/Latine students, and psychological adjustment was most vulnerable. These findings underscore the importance of understanding how students of color experience and take part in the digital landscape and providing institutional supports that help students effectively utilize anti-racist online strategies to mitigate the adverse effects of social media racism on their adjustment to college.

Internalized Sexual Stigma, Sexual Orientation Disclosure, and Patient Experience Among Gay Men and Lesbian Women in Taiwan: A Cross-Sectional Survey

Purpose: Previous research has found that stigma, discrimination, and depression are associated with the sexual minority population's medical experiences. However, there is still a lack of relevant research results in Taiwan. This study investigated the health-seeking experiences and influencing factors of gay men and lesbian women in Taiwan. Methods: We recruited gay men and lesbian women through lesbian, gay, bisexual, and transgender (LGBT)-friendly websites and associations between November 2019 and June 2020. Surveys included the demographics, medical visiting experiences, Measure of Internalized Sexual Stigma, Patient Health Questionnaire-9, and Daily Heterosexist Experiences Questionnaire. Results: There were 270 participants, including 188 gay men and 82 lesbian women. Most respondents refused to disclose their sexual orientation to health care providers; some feared seeking medical care and preferred seeking LGBT-friendly health care services. Compared with lesbian women, gay men had higher levels of internalized sexual stigma, victimization, vigilance, and experiences of medical staff denying services. Discrimination, depressive severity, and internalized sexual stigma affected the medical visit experience. Conclusion: In Taiwan, the health care experiences of gay men and lesbian women are affected by discrimination, internalized sexual stigma, and severe depression, while facing challenges of fear of seeking medical care or reluctance to disclose their sexual orientation.

Mental Telehealth Utilization Patterns Among High School Students from Racial and Ethnic Minority Backgrounds Affected by Violence and Substance Use

BACKGROUND

Recent data show high school students from racial and ethnic minority (REM) backgrounds in the United States confront a twofold challenge, marked by the highest rates of firearm-related homicides since 1994 and increased youth substance use. The pandemic increased online and telehealth usage opportunities for at-risk REM youth. Therefore, this study investigated (1) the frequency and prevalence of co-occurring youth violence and substance use among REM adolescents, (2) racial/ethnic, age, and natal sex (as gender data was not collected) differences in patterns and trends in co-occurring youth violence and substance use among REM adolescents, and (3) the relationship between these syndemic issues and REM adolescent mental telehealth use during the pandemic.

METHODS

Data was sourced from a nationally representative sample of U.S. 9th-12th students (n = 3241) who completed the CDC's 2021 Adolescent and Behavioral Experiences Survey (ABES). Using univariate (frequency distribution), bivariate (Pearson's chi-squared test), and multivariate logistic regression models, we examined seven violence victimization outcomes, four violence perpetration outcomes, two family violence outcomes, and six substance use outcomes and their associations with telehealth use for mental health (dependent variable) among REM adolescents.

RESULTS

This sample was primarily female (50.7%), Black or African American (48.3%), Hispanic or Latinx (20.6%), and identified as straight or heterosexual (69.5%). The study found significant sex-based differences in violence perpetration/victimization, substance use, and telehealth use for mental health. In general, mental telehealth use was significantly associated with substance use among REM adolescents (cigarette smoking, vaping, alcohol, marijuana, prescription meds, and illicit drug use) (p-value = .001). Mental telehealth use was also significantly associated with all peer and family violence outcomes (p < 0.001). Controlling for covariates, gun carrying was associated with 4.8 times higher odds of using mental telehealth. Students in a physical fight or carrying a weapon (gun, knife, or club) on school property had 2.45 times and 8.09 times the odds of utilizing mental telehealth. Bullied students were 2.5 times more likely to use mental telehealth (p-value < 0.05). Illicit drug use (cocaine, heroin, methamphetamines, and ecstasy) was associated with a higher likelihood of mental telehealth use (AOR = 1.3, p-value = .05).

CONCLUSION

Our results suggest crucial insights for shaping violence and substance use prevention strategies, with implications for the future of online and telehealth behavioral services. Mental telehealth help-seeking emerges as a crucial avenue for supporting adolescents affected by violence and substance use, especially when they face obstacles to accessing traditional services. It can work in tandem with in-person services to address these challenges.

Family as a Pathway to Suicidal Behaviors Through Depression Symptoms and Internalized Homophobia

Research consistently highlights how systemic and social factors can adversely impact mental health, and the potential buffering effects of family support, yet raced sexual minorities are vastly underrepresented among these studies. As rates of suicide increase among Black people and remain high among men and those in gender and sexually diverse communities, this study sought to examine to relationships between family dynamics and suicidality among young Black men who have sex with men (MSM) in young adulthood. We used an online survey to conduct a logistic regression to examine family factors (family support, open family communication, other adult support, and other adult value), depression symptoms, and internalized homophobia on suicide attempts. The conceptualization of the study's design and interpretation of the results were informed by minority stress theory and the phenomenological variant of ecological systems theory. The results indicate that higher levels of family support and open family communication were associated with lower levels of suicidality. Implications for future research and applications for healthcare providers and human services professionals who support young Black MSM in emerging adulthood are discussed.

Supporting filipino LGBTQ+ youth: development of evidence-informed self-help materials

Self-stigma and minority stress necessitate programmes and interventions that consider and respond to how LGBTQ+ individuals evaluate, cope with, and seek support in relation to these stressors and their sources. Self-help materials are potentially useful in supporting the development of skills and knowledge that may help LGBTQ+ youth cope with minority stress and self-stigma. This study developed 54 online self-help resources for Filipino LGBTQ+ youth. The developed materials were evaluated by twenty-four respondents representative of LGBTQ+ youth and advocates, content experts, and community partners to obtain quantitative and qualitative feedback. The self-help materials were rated positively indicating that the materials were attractive, understandable, acceptable, believable, relatable, relevant, and motivational to a considerable extent. The materials developed may prove helpful in providing Filipino LGBTQ+ youth with evidence-informed, contextually grounded self-help resources to support and promote their mental health.

Medical Mistrust: A Concept Analysis

Background: The term "medical mistrust" has increased in literary usage within the last ten years, but the term has not yet been fully conceptualized. This article analyzes the usage of the term "medical mistrust" in the extant literature in order to articulate its antecedents, attributes, and consequences. The aim of this article is to provide a preliminary conceptual definition and conceptual figure for medical mistrust. Methods: Walker and Avant's method of conceptual analysis was used to extract concept attributes, antecedents, and consequences and define empirical referents. The databases PubMed, CINAHL, Scopus, and PSYCinfo and the Google search engine were used. Results: Medical mistrust is a social determinant of health fueled by a fear of harm and exploitation and is experienced at both the interpersonal, intergenerational, and institutional levels, reinforced by structural racism and systemic inequalities. Medical mistrust is antedated by historical trauma, socioeconomic disparities, medical gaslighting, traumatic medical experiences, maladaptive health beliefs and behaviors, and individual minority identities and is transmitted intergenerationally and culturally. The consequences of medical mistrust include the underutilization of health services, delays in diagnosis and care, poor treatment adherence, poor health outcomes, negative psychological effects, and an increase in the uptake of medical misinformation and maladaptive health behaviors. Conclusions: The findings of this concept analysis have important implications for healthcare providers, healthcare systems, and researchers, as well as healthcare policy makers.

Capturing sexual orientation and gender identity information in electronic medical records to inform the person-centred care of sexual and gender minority people

BACKGROUND

The healthcare disparities of sexual and gender minority (SGM) people are globally recognised. Research from the United States has advocated for sexual orientation and gender identity (SOGI) information capture via the electronic medical record (EMR) to support the generation of knowledge regarding SGM people's healthcare needs and the appropriate care for this population. In November 2022, The Royal Melbourne Hospital (RMH) enabled the SOGI capture EMR functionality. The purpose of this study is to understand how SOGI capture can inform the person-centred care of SGM people by way of interviews with SGM patients and RMH staff. It quantitatively describes RMH SOGI capture throughout the study period to provide additional insights.

METHODS

This study uses an embedded mixed-methods design: qualitative data are primary and quantitative data are supplementary. SOGI capture uptake at RMH informed the recruitment of SGM patients (n = 11) and RMH staff (n = 13). Participants were engaged in in-depth semi-structured interviews that were then reflexively thematically analysed. SOGI capture throughout the study period (8th November 2022 to 23rd September 2024) was quantitatively described via frequency and percentage and then analysed in relation to the qualitative results to provide additional insights.

RESULTS

Interviewed participants considered SOGI capture a significant step toward providing person-centred care for SGM people. However, participants shared problems in SGM healthcare and expressed that for SOGI capture to benefit SGM patients, staff must be aware of not only SOGI capture but also SGM healthcare issues. Other recommendations for SOGI capture included patient informed consent; patient preferences accurately captured; and mandatory SOGI questions to normalise this process. During the study period 272,672 patients were admitted to RMH, of which there were 2,174 (0.8%) SGM SOGI captures; 2,000 (0.7%) captured a gender identity that was not 'male' or 'female' and 1,113 captured a sexual orientation that was not 'straight' or 'not reported' (0.4%). These numbers demonstrate SGM patients' minority status and signal the need for more staff and patient awareness of SOGI capture and mandatory SOGI questions to increase the representation and knowledge of this population and ultimately improve its care provision. A diversity of identifiers for this population was captured (10 sexual orientation identifiers and 14 gender identity identifiers) which demonstrate the significance of recognising SGM patient preferences.

CONCLUSION

This study presented an in-depth exploration of how SOGI capture can inform the person-centred care of SGM people if staff are aware of SGM healthcare issues, and if SOGI capture is done according to patient preference and consent and is normalised through mandatory questions. Insights and recommendations generated from this study can inform local and international policies and processes in the implementation of SOGI capture such that it can inform person-centred care for SGM people.

Barriers and Solutions to Cancer Screening in Gender Minority Populations

Gender minority groups, comprising individuals whose gender identity and/or expression differ from their sex assigned at birth, experience significant health disparities in the United States and abroad. Members of this popula.

Racial and Ethnic Disparities in Referral Rejection From Postacute Care Facilities Among People With Opioid Use Disorder in Massachusetts

OBJECTIVES

The aim of the study was to examine the association between Black, White, and Hispanic or Latino race and ethnicity and referral rejection from private postacute care facilities among hospitalized individuals with opioid use disorder (OUD).

METHODS

In this retrospective cohort study, we linked electronic postacute care referrals from Boston Medical Center in 2018 to electronic medical record data, which we used to ascertain OUD status and race and ethnicity. Using multivariable logistic regression, we examined the association between Black, White, and Hispanic or Latino race and ethnicity and referral rejection, adjusting for individual-level characteristics including medication for opioid use disorder treatment type and for facility-level factors using facility random effects.

RESULTS

We identified 159 hospitalizations from 141 individuals with OUD referred to private postacute medical care, corresponding to 1272 referrals to 244 facilities. Hospitalizations comprised 53 (33%) non-Hispanic Black, 28 (18%) Hispanic or Latino, and 78 (49%) non-Hispanic White individuals. In adjusted analyses, referrals for non-Hispanic Black individuals had significantly higher odds of rejection compared to referrals for non-Hispanic White individuals (adjusted odds ratio 1.83, 95% confidence interval [1.24, 2.69], P = 0.002). There were no significant differences between referrals for Hispanic or Latino individuals and non-Hispanic White individuals (adjusted odds ratio 1.11, 95% confidence interval [0.67, 1.84], P = 0.69).

CONCLUSIONS

Among people with OUD referred to private postacute care in Massachusetts, non-Hispanic Black individuals were more likely to be rejected compared to non-Hispanic White individuals, demonstrating racism in postacute care admissions. Efforts to address discrimination against people with OUD in postacute care admissions must also address racial equity.

An Integrative Model of Alcohol-Facilitated Intimate Partner Aggression Perpetration in Sexual and Gender Diverse Couples

OBJECTIVE

Sexual and gender diverse (SGD) individuals are at heightened risk for intimate partner aggression (IPA) perpetration relative to their heterosexual and cisgender peers. Alcohol is a well-established cause of IPA perpetration in cisgender, heterosexual couples; however, minimal research has investigated the alcohol-IPA perpetration link in SGD couples. The relative lack of work in this area is a major barrier to addressing this health disparity. SGD individuals experience unique stressors related to their and/or their partner's intersecting minoritized identities that are crucial to understanding alcohol-IPA etiology and informing culturally affirming intervention programming.

METHOD

We advance prior work by members of the authorship team to propose an integrative theoretical model that invokes (a) the I3 Model to organize risk and resilience factors at the individual and dyadic level and (b) alcohol myopia theory to explain the mechanism by which proximal alcohol use facilitates IPA as a function of individual differences in those factors.

RESULTS

This integrative model provides a framework to understand how the confluence of stigma, minority stressors, proximal alcohol use, and other factors contribute to IPA perpetration in SGD couples.

CONCLUSIONS

Application of this integrative model has the potential to facilitate more rigorous research (e.g., intensive longitudinal designs, dyadic analysis) focused on putative risk and resilience factors across the social ecology. Further, the model provides guidance for intervention development by identifying how individual (e.g., minority stress), relationship (e.g., relationship functioning), and structural factors (e.g., SGD stigma) interactively contribute to alcohol-facilitated IPA perpetration.

Gender dysphoria in adolescence: examining the rapid-onset hypothesis

The sharp rise in the number of predominantly natal female adolescents experiencing gender dysphoria and seeking treatment in specialized clinics has sparked a contentious and polarized debate among both the scientific community and the public sphere. Few explanations have been offered for these recent developments. One proposal that has generated considerable attention is the notion of "rapid-onset" gender dysphoria, which is assumed to apply to a subset of adolescents and young adults. First introduced by Lisa Littman in a 2018 study of parental reports, it describes a subset of youth, primarily natal females, with no childhood indicators of gender dysphoria but with a sudden emergence of gender dysphoria symptoms during puberty or after its completion. For them, identifying as transgender is assumed to serve as a maladaptive coping mechanism for underlying mental health issues and is linked to social influences from peer groups and through social media. The purpose of this article is to analyze this theory and its associated hypotheses against the existing evidence base and to discuss its potential implications for future research and the advancement of treatment paradigms.

Developing guidelines on EFT for same-sex/gender relationships: Recommendations from a Delphi study

Emotionally focused therapy (EFT) is one of few empirically supported treatments for relationship distress. While evidence-based approaches are critical for ensuring safe and effective treatment, EFT has not been adapted for use with same-sex/same-gender (SS/SG) relationships. This study used the Delphi method to generate consensus on treatment guidelines for using EFT with SS/SG relationships. Forty therapists with clinical expertise in EFT for SS/SG relationships were recruited. Data were collected in three phases. In phase one, participants responded to open-ended questions regarding how EFT should be adapted for SS/SG relationships. Phases two and three involved participants rating the importance of the recommended guidelines. Data were analyzed using thematic analysis and descriptive statistics. The final recommendations included 49 guidelines on EFT for SS/SG relationships. The data reflected modifications to therapists' foundational knowledge and development, practice set up and orientation, and the three stages and nine steps of EFT.

Cigarette and E-Cigarette Use Among LGBT+ Youths and Young Adults According to Strength of State-Level LGBT+ Equality Protections

Objectives. To examine whether the state-level LGBT+ (lesbian, gay, bisexual, transgender, and other identities) legal protections where LGBT+ youths and young adults reside are associated with cigarette and e-cigarette use. Methods. We drew LGBT+ respondents (aged 15-31 years; n = 1255) from a national, probability-based survey conducted from August to December 2023. We scored each state for LGBT+ equality on a scale from restrictive to protective based on the Movement Advancement Project's 2023 policy environment. Using weighted logistic regression models, we examined the relationship between current (past 30-day) cigarette and e-cigarette use and state LGBT+ equality protections, controlling for demographics and state tobacco control expenditure. Results. LGBT+ individuals in protective policy states had 65% lower odds (odds ratio [OR] = 0.35; 95% confidence interval [CI] = 0.16, 0.78) of current cigarette use, and 56% lower odds (OR = 0.44; 95% CI = 0.25, 0.79) of current e-cigarette use compared with those in restrictive policy states. Conclusions. LGBT+ individuals living in protective policy environments had lower odds of current cigarette and e-cigarette use, consistent with theoretical relationships between stress, discrimination, and harmful health behaviors. Public Health Implications. Protective policies may alleviate tobacco use disparities among the LGBT+ community. (Am J Public Health. Published online ahead of print February 27, 2025:e1-e9. https://doi.org/10.2105/AJPH.2025.308008).

Navigating Adversity: Ethnoracial Discrimination, Family Support, and Psychotic Symptom Severity in US Latinx People with First Episode Psychosis

INTRODUCTION

Prior research has identified a link between discrimination and psychotic symptoms in community samples, yet less is known about potential protective factors particularly in the context of clinical samples of psychotic illness. The goal of this exploratory study was to examine the relationship between ethnoracial discrimination and symptom severity among U.S. Latinx people experiencing their first episode of psychosis (FEP). We were particularly interested in whether family support quality buffered the negative relationship between discrimination and symptomatology.

METHODS

Data were taken from a longitudinal parent study assessing the effectiveness of a communication campaign on reducing duration of untreated illness among U.S. Latinx communities with FEP. A total of 43 participants with FEP were administered the study measures for the present study at baseline, including self-report survey on perceived discrimination, the Positive and Negative Symptoms Scale clinical interview, and a qualitative interview measuring family support, which was analyzed using deductive methods. Independent samples t-tests and multiple linear regression analyses were conducted.

RESULTS

Endorsement of ethnoracial discrimination was associated with greater positive and general symptoms, but not negative symptoms. Among those endorsing ethnoracial discrimination, family support buffered the association with negative and general symptoms, but not positive symptoms.

CONCLUSION

Family support could be a relevant mechanism to target the negative symptoms of psychosis and general psychopathology among Latinx people with FEP, particularly in the context of racialized stressors.

Exploring Help-Seeking Behaviors among Black Sexual Minority Cisgender Women in Late Adolescence: The Role of Abuse Experiences

Sexual minority youth (e.g., lesbian, queer, bisexual) encounter higher rates of abuse compared to their heterosexual peers. Similarly, Black youth are disproportionately affected by adverse experiences, including abuse. Seeking help after experiencing abuse has been shown to improve both mental and physical health outcomes. There is a lack of research on how the intersection of these identities affects help-seeking behaviors when experiencing different types of abuse. To address this gap, our study analyzed national data from 716 Black cisgender sexual minority women (SMW) aged 18 to 21 (Mage = 19.5) who participated in the Healthy Minds Study and examined the likelihood of seeking formal and informal support based on past year emotional, physical, and sexual abuse experiences. Formal help-seeking was assessed by whether participants received counseling or therapy, and informal help-seeking was defined as seeking support from a non-professional source (e.g., family member, friend, and significant other). We found participants who reported abuse experiences, including physical abuse, sexual abuse, emotional abuse, or combined abuse experiences, were significantly more likely to seek informal support, with odds ratios of 2.20, 1.66, 2.77, and 2.38, respectively. However, there was no difference in formal help-seeking compared to participants without abuse experiences. Specific sources of informal support sought were explored descriptively by participants with and without abuse experiences, showing that participants who experienced abuse primarily sought informal support from friends, family members, significant others, and roommates. This trend was consistent among participants who did not report any abuse experiences. Overall, findings suggest that there were no significant differences in the likelihood of seeking formal support regardless of participants' abuse history. However, those who experienced abuse were significantly more likely to seek informal support compared to those who did not. Findings suggest Black adolescent SMW who have endured abuse may face barriers accessing formal support networks; therefore, targeted interventions are needed.

Gendernauts in the Cistem - How Do Nonbinary People Handle Social Groups and Gender Minority Stress?

This study explores how nonbinary individuals manage minority stress within the predominantly binary society of Switzerland. Utilizing social identity theory and minority stress theory, along with thematic analysis of focus group interviews with 16 nonbinary individuals and 14 social identity maps, the study found three concentric circles of social groups: circle 1 (family, partners, friends), circle 2 (coworkers, LGBTIQA+ communities), and circle 3 (the public, media, Swiss institutions). Participants primarily felt affirmed and supported by circles 1 and 2. They reported feeling less support from circle 3 and engaged in cautious social monitoring to anticipate potential discrimination. They found discrimination from close social groups (circle 1) more distressing than from emotionally distant ones (circle 2 or 3). Our study also examined strategies employed by nonbinary participants, including monitoring others and their trans-friendliness before coming out, educating others, taking actions to make institutions more inclusive, disengaging from invalidating individuals, groups, or institutions, and searching for affirmative environments. However, these coping strategies often entail significant mental workload and exhaustion. We conclude with participant-generated recommendations to enhance nonbinary inclusion in society, politics, and healthcare. The findings underscore the need for broader societal awareness and support to mitigate minority stress experienced by nonbinary individuals.

Psychosocial Determinants of Occupational Health Through the Lenses of Gender Identity and Sexual Orientation

Understanding the determinants of the occupational health of specific populations and their work-related vulnerabilities is important for developing more effective psychosocial interventions. The aims of this study were (1) to explore differences in occupational health between groups of men versus women and heterosexual versus LGBTQIA+ individuals living in Portugal; (2) to assess whether belonging to LGBTQIA+ groups or being a woman predicts worse occupational health; and (3) to evaluate differences in absenteeism frequency and possible predictors based on sexual orientation and gender. This cross-sectional quantitative study involved 577 participants living and working in Portugal (mean age: 41.62 years, SD = 11.41). To assess occupational health, we used the Copenhagen Psychosocial Questionnaire (COPSOQ III-Middle Version). Women and LGBTQIA+ individuals reported poorer occupational health compared to men and heterosexual individuals, although greater discrepancies were observed in LGBTQIA+ individuals, especially in mental health indicators. Gender and sexual orientation were found to have modest but statistically significant effects on occupational health. The absenteeism frequency was higher among women. Our data suggest improvements in terms of women's occupational health in Portugal, but not gender equality, which indicates that there are still points to be improved. These findings also suggest the persistence of stigma related to sexual diversity and its effects on the occupational health of LGBTQIA+ and underscore the need for more inclusive workplace policies in Portugal.

The relationship between gender identity and depressive symptoms in adolescents: a moderated mediation model of self-efficacy and family functioning

BACKGROUND

Gender identity is associated with adolescent depression, but the relationship remains unclear. To further clarify the relationship between gender identity and mental health, this study targets adolescents with significant fluctuations in gender identity, constructs a moderated mediation effect model, examines the relationship between gender identity and depression, and explores the mediating role of self-efficacy and the moderating role of family functioning, to provide scientific references for proposing effective psychological interventions for different gender identity groups.

METHODS

Using whole group convenience sampling method, 2341 students from a school in Changsha, Hunan Province, were selected for the survey, and the Patient Health Questionnaire-9 items, the Family Care Index Scale, the General Self-Efficacy Scale-Schwarzer, and gender identity-related questions were used for the assessment of mental health.

RESULTS

The prevalence of depression was 40.5% among transgender adolescents, which was significantly higher than that of cisgender adolescents (15.6%). At the same time, gender identity, self-efficacy, family functioning, and depression constituted a moderated mediation model, with family functioning moderating the posterior path of this mediation process. Specifically, self-efficacy was progressively less predictive of depression as family functioning increased.

CONCLUSION

Transgender adolescents showed significantly poorer mental health than cisgender adolescents. There was a partial mediating effect of self-efficacy between gender identity and adolescent depression, with family functioning moderating the latter half of this mediation effect. This study advances our understanding of the relationship between depression and self-efficacy or family functioning in adolescents of different gender identities.

Untangling Relational Ties: How Internalized Homonegativity and Adult Attachment Shape Relationship Quality in Lesbian and Gay Couples

INTRODUCTION

Several studies point to an association between minority stress, especially internalized homonegativity and the quality of the couple relationship. However, the dimensions of psychological functioning that might moderate this relationship seem to be scarcely explored. Accordingly, the present study aimed to investigate the association between internalized homonegativity and relationship quality by examining the moderating role of adult attachment (dimensions of anxiety and avoidance) in lesbian and gay (LG) people.

MATERIALS AND METHODS

A total of 674 LG participants who had been in a couple relationship for at least 12 months were included in the study and completed self-report questionnaires.

RESULTS

The results show a direct negative effect of internalized homonegativity on relationship quality. Adult attachment seems to moderate this relationship: on the one hand, the negative relationship between internalized homonegativity and relationship quality is significant at high levels of anxious attachment, but not at low levels. On the other hand, the negative relationship between internalized homonegativity and relationship quality turns out to be significant at low levels of avoidant attachment, but not at high levels.

DISCUSSION

The results suggest that attachment anxiety and avoidance play different roles in the relationship between internalized homonegativity and relationship quality. While high levels of anxious attachment appear to be a risk factor, high levels of avoidant attachment seem to play a protective role. Although future studies are needed to investigate the present preliminary findings further, the results of the present study provide useful clinical and research insights.

Associations between discriminatory experiences and dementia in the Health and Retirement Study

Dramatic racial and ethnic disparities in dementia necessitate research into potential risk factors and points of intervention. Using data from a large sample (n = 13,733) of older US residents participating in the Health and Retirement Study between 2006 and 2016, we investigated relationships between everyday and major discrimination and development of dementia. Data on self-reported everyday and major discrimination were collected via questionnaires. Algorithmic classification of probable dementia status was determined via a battery of cognitive tests. We used logistic regression models, and analyses were stratified by race and ethnicity and sex. We found that overall, more frequent experiences of everyday discrimination were associated with higher odds of developing dementia (odds ratio (OR) = 1.18; 95% confidence interval (CI): 1.10, 1.27; p < 0.001). Estimates stratified by race similarly suggested the positive association between everyday discrimination and odds of dementia onset was highest in non-Hispanic Black participants (OR: 1.30; 95% CI: 1.13, 1.51; p < 0.001). Our results reveal a link between frequency of everyday experiences of discrimination and dementia onset and highlight the role of psychosocial exposures in health and disease. This study underlines the impact that psychosocial stressors can have on cognitive health. Interventions addressing psychosocial risk factors experienced disproportionately by historically marginalized groups may be crucial in the goal to mitigate dementia disparities and achieve dementia equity.

A Syndemic Clustering of Adversities on Suicide Risk among YMSM Living with HIV in Bangkok: A Causal Latent Class Analysis

This study investigated the clustering of psychosocial adversities and their synergistic effect with depression on suicidality in a 12-month prospective cohort (N = 214) of YMSM living with HIV in Bangkok, Thailand. Latent class analysis identified subgroups with distinct combinations of adversities, including bullying, intimate partner violence, substance use, HIV stigma, low social support, histories of sex work, and below-income status. Significant interactive synergism were found as hypothesized, supporting a syndemic effect with qualitatively increasing levels of adversities on suicidality (score range: 3-17) over the 12 months. The interaction between moderate adversity clustering and depression (βow = 2.50, 95% CI: 1.12-3.88) and high adversity clustering and depression (βow = 3.61, 95% CI: 1.12-6.09) indicated that the impact of depression on suicidality was modified by pre-existing adversities. The findings suggest that, while a multi-component intervention addressing psychosocial problems is ideal, effective depression treatment alone could significantly reduce suicidality among YMSM living with HIV.

Minority stress in relation to biological outcomes among sexual and gender minority people: a systematic review and update

Here we present an updated systematic review identifying studies published 2019-2024, since our prior systematic review in 2020, that examine the association between minority stress and a biological outcome among sexual and gender minority (SGM) people. Pubmed, Web of Science, and Embase were queried to identify studies that examined an association between minority stress (including prejudice events and conditions, anticipation of rejection and discrimination, concealment or disclosure of SGM identity(ies), internalized stigma, or structural stigma) and a biological health outcome among SGM people. Included studies were coded for methodological approaches, study population, minority stress measure, biological outcomes, count of overall analyses, and count of analyses where an association was detected. Fifty-nine studies met inclusion criteria and included a total of 391 analyses between an element of minority stress and a biological outcome, among which 38% of analyses detected an association (44% detected this association when study outliers were removed). All elements of minority stress demonstrated associations with outcomes: multicomponent measures, prejudice events and conditions, and structural stigma demonstrated the highest proportion of associations. Associations with minority stress were detected for general physical health, sleep, immune, cardiovascular, metabolic, hormonal, brain health, allostatic load, epigenetic and transcriptional regulation. The highest proportion of associations were detected among sleep, immune, cardiovascular, and hormonal outcomes. These studies evidence associations between minority stress and biological outcomes among gender minority people in addition to evidence among sexual minority people. Future research should consider increasing rigor in methodology and expanding our understanding of moderators and mediators of these relationships.

Stigma and Sexual Dissatisfaction in Middle-Aged and Older Sexual Minorities

High sexual quality and activity predict psychological well-being in heterosexual middle-aged and older adults; however, these associations have not been documented in sexual minorities, who have faced lifelong stigma concerning their sexuality. This paper presents data from two secondary studies that explored the benefits of being sexually active and satisfied and the role of internalized homonegativity in a sample of middle-aged and older sexual minorities. Study 1 was a cross-sectional survey collected on 91 sexually active sexual minorities (ages 40-80) in same-sex relationships. Study 2 was a cross-sectional survey collected on 235 single and partnered sexual minorities (ages 40-90), which included sexually active (N = 101) and inactive (N = 134) participants. In Study 1, sexual satisfaction was associated with higher psychological well-being and dissatisfaction was more prominently associated with lower psychological well-being. In Study 2, we found that the sexually active participants had higher levels of psychological well-being, in addition to corroborating the Study 1 findings. Additionally, we also determined that sexual dissatisfaction was a mediator between internalized homonegativity and psychological well-being. These findings accentuate the benefits of retaining high sexual quality and activity for middle-aged and older sexual minorities. Although there are apparent advantages of being sexually satisfied, the relationship to psychological well-being is stronger and more of a concern for those who are dissatisfied, which is rooted in internalized homonegativity. These results can guide practitioners working with middle-aged and older sexual minorities to help them achieve successful aging trajectories by reducing their internalized homonegativity and promoting higher sexual quality.

Sexual and gender minority youth in Canada: An investigation of disparities in positive mental health

OBJECTIVES

While studies indicate that 2SLGBTQ + youth are more likely to experience negative psychological outcomes compared to their heterosexual and cisgender peers, less is known about the positive mental health (PMH) of 2SLGBTQ + youth in Canada. To fill this gap, we investigated disparities in PMH by self-reported sexual attraction among 15‒17-year-olds and gender modality among 12‒17-year-olds.

METHODS

We analyzed data from youth respondents in the 2019 Canadian Health Survey on Children and Youth. We obtained estimates of average life satisfaction and high self-rated mental health, happiness, autonomy, competence, and relatedness for youth with an exclusively heterosexual attraction and youth with a minority sexual attraction (those exclusively attracted to the same gender, and those attracted to both females and males), and for cisgender and gender minority youth. Regression analyses were conducted to test for disparities on each PMH outcome.

RESULTS

Compared with exclusively heterosexual youth, sexual minority youth reported lower life satisfaction and were less likely to report high self-rated mental health, happiness, autonomy, competence, and relatedness. Significant disparities were more consistently found for youth attracted to both females and males than youth exclusively attracted to the same gender. Gender minority (versus cisgender) youth also reported lower average life satisfaction and were less likely to report high self-rated mental health, happiness, autonomy, competence, and relatedness.

CONCLUSION

Although this study provides evidence for the presence of disparities in PMH, its strength-based focus on PMH also documents the presence of well-being among many sexual and gender minority youth in Canada.

Caregivers' Perspectives on Supporting Sexual and Gender-Diverse Youth in Adolescent Relationship Abuse Prevention

Adolescent relationship abuse (ARA) has significant sequelae and is more prevalent among sexual and gender-diverse youth (SGDY). Increased parental involvement and communication has been linked to decreased prevalence of ARA and associated health risks. Parents of SGDY may have unique needs and experiences regarding communicating with their children about ARA, yet little research has examined this area. This study explored caregivers' current practices around supporting their SGDY in healthy relationship formation and ARA prevention; caregivers' perceptions about ARA among SGDY; and their recommendations for developing ARA prevention-focused interventions for caregivers of SGDY. We conducted 24 semi-structured interviews with caregivers of SGDY aged 12 to 19. Transcripts were analyzed using thematic analysis. Some participants reported having positive, open communication with their SGDY about dating, while others struggled to understand and respond to the unique risks of ARA experienced by their adolescent. Caregivers discussed ways systemic discrimination affects SGDY experiences of relationships and ARA, and distinct dating challenges for gender-diverse youth. When considering caregiver-focused ARA prevention, participants supported a program including ARA education, communication skills building, and caregiver affirmation. Participants encouraged the use of digital and in-person mediums, experienced and relatable facilitators, and SGDY involvement. Caregivers of SGDY had significant strengths and challenges when engaging and communicating with their child around dating and ARA prevention. Caregivers at varying stages of acceptance and understanding believed they could benefit from a comprehensive and inclusive education program on SGDY ARA experiences and how they can support their child in preventing ARA.

LGBTQ+ Adult Sexual Violence Critical Scoping Review: Victimization Risk Factors

Sexual violence experienced by LGBTQ+ adults is a rapidly expanding field of academic study. Therefore, there is a need for a synthesis and critical analysis of the research. The aim of this review was to conduct a critical review of the academic literature on adult LGBTQ+ sexual violence and to provide recommendations for future research. A total of 10,845 papers were identified through a comprehensive scoping review approach and 108 met the criteria for inclusion. The findings are reported across two papers. This second paper reports on the risk factors for victimization: alcohol and other drugs (AOD); homophobia, biphobia, transphobia, and minority stress; "risky" sexual behavior and HIV transmission; and child sexual abuse (CSA). AOD use was seen as a risk factor for sexual violence, yet the causal relationship was not always clear. Minority stress was conceived of as an individual issue with undertones of victim-blaming. "Risky" sexual behavior research, at times, framed LGBTQ+ sex as "risky" and failed to account for the specific needs of LGBTQ+ communities. Research on adult sexual violence risks had a focus on CSA that often neglected broader structural issues. In general, across the studies, there was a focus on individual-level research that analyzed survivor behavior, resulting in victim blaming. This paper advocates for expanding LGBTQ+ sexual violence research beyond just individual risk factors, shifting research away from constructing LGBTQ+ people as "risky," and expanding research to include a more intersectional analysis that goes beyond heteronormative and cisnormative inquiry.

How it affects me: the effects of arguments in public debates on marriage equality for young people in Taiwan

How do arguments in public debates regarding same-sex marriage affect young people? The literature has suggested three possible effects. These debates may affect young people, regardless of their sexual identities, due to the fact that young people widely share a set of values pertaining to human rights and equality (H1). These debates may affect sexual minority individuals more strongly than heterosexual individuals because the arguments used in such debates are targeted at sexual minority individuals (H2). Alternatively, these debates may affect positive and negative outcomes in different ways depending on the nature of the arguments (H3). Two experimental studies (N = 92 and N = 411) were conducted in Taiwan with the goal of testing these three hypotheses. The evidence revealed by these studies largely supported the first hypothesis. The effects observed were similar across young people with different sexual identities and various types of outcomes: reading arguments in support of same-sex marriage increased positive emotions (in both studies) and reduced negative emotions (in Study 2) in comparison with a control condition. Further implications regarding young people's responses to social changes are discussed.

Mental Health Issues Associated With Classic Congenital Adrenal Hyperplasia Due to 21-Hydroxylase Deficiency

CONTEXT

The goal of this review is to move beyond summarizing what is known about psychosexual development in females with classic congenital adrenal hyperplasia (CAH) due to 21-hydroxylase deficiency-commonly studied as a natural experiment to understand prenatal androgen effects in 46,XX individuals. Instead, it will explore the various aspects of the condition that significantly impact the daily lives of both male and female patients and their families, with a particular focus on the implications for psychosocial, educational, and vocational adaptation.

EVIDENCE ACQUISITION

This work represents a selective, yet balanced review of papers highlighting potential threats to positive psychological adaptation in both male and female individuals with CAH.

EVIDENCE SYNTHESIS

This review outlines the effects of both cross-cutting risks (such as challenges related to parenting and healthcare management) and CAH-specific risks (including growth and appearance changes, psychiatric and neurocognitive issues, reduced reproductive function and interest in parenting, and masculinization in girls and women) on psychosocial adaptation. Opportunities for optimizing psychological outcomes of those with CAH are presented.

CONCLUSION

Routine psychosocial screening of patient and family risk and resilience factors is recommended to identify areas of concern applicable to individual patients and families. Such screening should include assessment of both cross-cutting and condition-specific factors. This, in turn, provides a pathway forward for providing quality team-based patient-centered care.

Sexual Fluidity and Suicidal Thoughts and Behaviors in Early and Middle Adulthood: Evidence From the National Longitudinal Study of Adolescent to Adult Health

OBJECTIVE

The present study seeks to explore the relationship between sexual fluidity and suicidal thoughts (STs) and behaviors (STBs) among adults in early and middle adulthood.

METHODS

This study utilized data from Waves IV and V of the National Longitudinal Study of Adolescent to Adult Health (ADD Health). Participants were categorized into four groups: (1) heterosexual at both waves, (2) sexual minority (SM) at Wave IV but heterosexual at Wave V, (3) heterosexual at Wave IV and SM at Wave V, and (4) SM at Wave IV and Wave V.

RESULTS

Hierarchical logistic regression revealed that sexual fluidity between Waves IV and V was associated with STs. Those who were heterosexual-identifying at Wave IV but identified as an SM at Wave V were close to four times as likely to report STs at Wave V than were those who identified as heterosexual at both waves. Those who were an SM at Waves IV and V were almost twice as likely to report STs compared to those who were heterosexual at both waves. Additionally, χ2 results showed that suicide attempts (SAs) and sexual fluidity were associated. Similarly, SA prevalence was highest during periods in which participants identified as SMs.

CONCLUSIONS

Transitioning into a sexually minoritized status is associated with increased risk of STBs, whereas transitioning into a nonminoritized status was not.

Turning the spotlight: Hostile behavior in creative higher education and links to mental health in marginalized groups

Hostile, discriminatory, and violent behavior within the creative industries has attracted considerable public interest and existing inequalities have been discussed broadly. However, few empirical studies have examined experiences of hostile behavior in creative higher education and associated mental health outcomes of early career artists. To address this gap, we conducted a survey among individuals studying at higher education institutions for art and music (N = 611). In our analyses of different types of hostile behaviors and their associations with mental health and professional thriving, we focused on differences and similarities between marginalized and more privileged groups across multiple diversity domains. A substantial percentage of participants reported hostile behaviors in their creative academic environments. Individuals from marginalized groups reported more hostile behaviors, which partially explained their worse mental health and lower professional thriving. These findings indicate a clear need for the creative sector to implement strategies to create safer environments, particularly for early career artists from specific socio-demographic backgrounds. We conclude by suggesting strategies for prevention in this highly competitive industry.

Mental Health Disparities by Sexual Orientation and Gender Identity in the All of Us Research Program

Importance

Limited research explores mental health disparities between individuals in sexual and gender minority (SGM) populations and cisgender heterosexual (non-SGM) populations using national-level data.

Objective

To explore mental health disparities between SGM and non-SGM populations across sexual orientation, sex assigned at birth, and gender identity within the All of Us Research Program.

Design, Setting, and Participants

This cross-sectional study used survey data and linked electronic health records of eligible All of Us Research Program participants from May 31, 2017, to June 30, 2022.

Exposure

Self-identified SGM status.

Main Outcomes and Measures

Prevalence of common mental health conditions identified from linked electronic health records. Logistic regression adjusted for age, race and ethnicity, educational level, income, employment status, and geographic region was used to assess the association between SGM status and mental health conditions.

Results

Among 413 457 participants, 269 947 (65.3%) were included in the analysis (median age, 59 [IQR, 43-70] years), with 22 189 (8.2%) self-identified as SGM. Men with cisgender sexual minority identity had higher odds of bipolar disorder (adjusted odds ratio [AOR], 1.87; 95% CI, 1.70-2.56) compared with cisgender heterosexual men. Women with cisgender sexual minority identity had higher odds of bipolar disorder (AOR, 2.09; 95% CI, 1.95-2.25) compared with cisgender heterosexual women. Gender diverse people assigned female sex at birth had higher odds of posttraumatic stress disorder (PTSD) compared with both cisgender heterosexual men (AOR, 3.67; 95% CI, 2.99-4.50) and cisgender heterosexual women (AOR, 2.77; 95% CI, 2.26-3.40). Gender diverse individuals assigned male sex at birth had higher odds of bipolar disorder (AOR, 2.35; 95% CI, 1.66-3.33) compared with cisgender heterosexual men and higher odds of attention-deficit/hyperactivity disorder (AOR, 2.19; 95% CI, 1.48-3.23) compared with cisgender heterosexual women. Transgender men had higher odds of depression (AOR, 2.11; 95% CI, 1.80-2.49) compared with cisgender heterosexual men, while transgender women had higher odds of any personality disorder (AOR, 2.71; 95% CI, 1.84-3.99) compared with cisgender heterosexual women.

Conclusions and Relevance

In this cross-sectional study of participants in the All of Us Research Program, there were significant mental health disparities between participants in SGM and non-SGM groups. These findings underscore the need for tailored mental health interventions to improve the well-being of SGM populations, while noting that the associations do not imply causality but reflect the stigma and minority stress experienced by these individuals.

The Self-Dehumanization Scale: Three Studies on Its Development and Validation

Self-dehumanization, a phenomenon relevant to social psychology, has been somewhat absent from clinical psychology research. Furthermore, measures of self-dehumanization are few, and to our knowledge, no validated and generalizable self-report measure exists. To address this gap, we present a Self-Dehumanization Scale (SDS). This work incorporates evidence from three studies examining the reliability, validity, and factor structure of the SDS in an undergraduate sample, a clinically relevant community sample, and a sample with at least one minoritized identity. The SDS was derived from dehumanization theory and was developed to measure animalistic and mechanistic self-dehumanization. All studies suggested an 8-item SDS, with Study 1 suggesting a single-factor solution with, however, some indication of a two-factor structure, and Studies 2 and 3 affirming a two-factor solution. The SDS, and its respective factors, generally showed discriminant validity from related, yet distinct, measures of self-hate, self-esteem (Study 2), dissociation, and measures of discrimination (in Study 3). Finally, animalistic and mechanistic SDS showed somewhat mixed but promising evidence regarding their associations to minoritized identities and to symptoms of depression, and suicide risk, above and beyond each study's fairly stringent control variables. Thus, self-dehumanization may prove to be a clinically promising leverage point in assessing psychopathology, particularly among minoritized communities.

Multiple chronic diseases and psychological distress among adults in the United States: the intersectionality of chronic diseases, race/ethnicity, immigration, sex, and insurance coverage

PURPOSE

Psychological distress significantly contributes to the burdens of morbidity and mortality in the United States (U.S.), but our understanding is limited with regards to the risk factors associated with psychological distress. We used nationally representative data to examine (1) the comorbidities of chronic diseases and their risks for psychological distress and (2) the ways in which chronic diseases combine with demographic factors such as sex, race/ethnicity, immigration status, and health insurance coverage to affect the patterning of psychological distress.

METHODS

We analyzed the 2005-2018 National Health Survey Interview cross-sectional data on U.S. adults aged ≥ 18 years (n = 351,457). We fitted sequential multivariable logistic regression models.

RESULTS

There was a dose-response relationship between the number of chronic diseases and psychological distress, with increased number of chronic diseases associated with increased psychological distress risk. Females (vs. males) and those without health insurance (vs. insured) were more likely to experience psychological distress. Immigrants (vs. non-immigrants) and racial/ethnic minorities (vs. White individuals) were less likely to experience psychological distress. There were significant interactions between chronic diseases and insurance coverage, immigration status, and race/ethnicity, but the three-way interactions were not statistically significant with psychological distress: chronic disease status vs. immigration status vs. health insurance coverage, and chronic disease vs. race/ethnicity vs. immigration status.

CONCLUSION

The findings suggest a critical need to consider the complex ways in which chronic diseases and psychosocial factors combine to affect psychological distress and their implications for tailoring mental health screening, initiatives to reduce distress, and prevention strategies for effectively addressing health-related disparities in the general population.

Unveiling the cognitive burden: The impact of stigma on distorted thinking among individuals living with hepatitis B

Hepatitis B (HBV) is a prevalent chronic illness affecting approximately 254 million individuals worldwide, with China accounting for nearly one-third of cases. Despite its widespread impact, stigma associated with HBV significantly hinders access to testing, diagnosis, and treatment. This study investigates the relationship between HBV stigma and cognitive distortions among individuals living with HBV by analyzing 35,697 posts from Yiyou Forum, China's largest HBV online community. Utilizing a large language model (LLM) for stigma classification, posts were categorized into stigma-related (S-posts) and non-stigma-related (N-posts). A schema comprising 235 n-grams was employed to identify 12 types of cognitive distortions within these posts. Statistical analyses revealed that S-posts had a prevalence ratio (PR) of 1.824 (95%CI [1.636, 2.074]) for cognitive distortions compared to N-posts, indicating that distorted thinking patterns were approximately 1.8 times more common in stigma-related discussions. Specific distortions such as disqualifying the positive, labeling and mislabeling, mental filtering, and should statements were significantly more prevalent in S-posts. User-level analysis confirmed that individuals engaging in stigma-related posts consistently displayed higher levels of cognitive distortions. These insights underscore the potential of targeted cognitive-behavioral therapy (CBT) interventions to address and mitigate cognitive distortions, thereby alleviating the psychological burden of HBV stigma. Additionally, this study demonstrates the efficacy of advanced computational methods in psychological research.

Does Resilience Mediate the Relationship Between Negative Self-Image and Psychological Distress in Middle-Aged and Older Gay and Bisexual Men?

Aging gay and bisexual men may have negative self-images due to body image dissatisfaction and internalized ageism, resulting in psychological distress. Gay and bisexual men with HIV may be at greater risk for distress because of research linking HIV to accelerated aging. We examined associations between self-image and psychological distress, and potential mediating effects (resilience, fitness engagement), and whether these relationships were moderated by HIV serostatus. We tested our hypotheses with structural equation modeling using data from gay and bisexual men with HIV (n = 525, Mage = 57.6) and without HIV (n = 501, Mage = 62.2). We observed significant positive associations between self-image and distress and significant mediation effects (resilience, fitness engagement) that were moderated by HIV serostatus (resilience was only significant for men with HIV). We conclude that resilience interventions may be beneficial in alleviating distress from negative self-image among aging gay and bisexual men with HIV.

Incorporating Sex-Diverse and Gender-Inclusive Perspectives in Higher Education Biology Courses

Inclusive teaching is teaching in a way that reaches all students in the classroom; this is beneficial for everyone, particularly for those with minoritized identities. Instructors play a critical role in scaffolding how students are exposed to and learn science content in the classroom. In this manuscript, we discuss how biology instructors can make their classrooms more inclusive with regard to sex and gender diversity content. Many topics in biology are based on androcentric, heteronormative, and oppressive framing, even though those lenses are more reflective of our own history and culture than they are of the diversity we see in nature. Here, we summarize information presented in the SICB 2024 workshop titled "Incorporating sex diversity and gender inclusivity in biology undergraduate classrooms" and provide instructors with (a) rationale for why inclusive teaching matters, (b) guidance on how to challenge unscientific views and make their curricula more sex diverse and gender inclusive, and (c) practical and easy-to-implement strategies for discussing "contentious" topics in the classroom. Incorporation of this material will be beneficial for students, for science and medicine, and for accurately representing the diversity found across the tree of life.