Families Matter: Social Support and Mental Health Trajectories Among Lesbian, Gay, Bisexual, and Transgender Youth

Transitions in Gender Identity Among Youth: Trajectories of Perceptions of Family Acceptance

PURPOSE

Family acceptance is a crucial protective factor for transgender and gender diverse (TGD) youth well-being. Few studies examine how families react to gender transitions by youth. This study aimed to examine whether families react differently when youth report different gender identities or when youth report gender-nonconforming expressions.

METHODS

Data from 92 TGD youth from a community-based sample participated in up to 4 waves of surveys, 9 months apart (2012-2015). Three gender identity trajectories were identified: (1) youth who consistently identified as TGD (consistent TGD); (2) youth who were initially cisgender (CIS) but later identified as TGD (CIS→TGD); and (3) youth who identified as TGD but later identified as CIS (TGD→CIS). Patterns of family acceptance over time were analyzed using hierarchical linear modeling, including within-person (time-varying) and between-person associations.

RESULTS

Youth who reported consistent TGD identities reported less family acceptance at baseline, and stable and low family acceptance across time; youth who initially identified as CIS and later as TGD reported a pattern of decreasing family acceptance (b = -0.41, p = .004). Current gender nonconformity (but not gender nonconformity in childhood) was associated with lower family acceptance (between-person level: b = -0.22, p = .005; within-person level: b = -0.12, p = .058).

DISCUSSION

In a community-based sample of gender-diverse youth, family acceptance corresponds to gender identity and current gender expression (rather than gender expression earlier in childhood). Interventions should help families of TGD youth, particularly of those whose gender expression is nonconforming, understand gender-diverse identities.

Parenting stress and positive mental health among parents of children with special needs: A moderated serial mediation model

OBJECTIVES

To explore the impact of parenting stress on the mental health of parents of children with special needs, and to analyze the mediating role of family support and resilience, as well as the moderated role of optimism.

METHODS

This study utilized the Parenting Stress Index-Short Form, Family Support Scale, Resilience Scale, Subjective Well-being Scale, and Symptom Checklist-90 to survey 372 parents of children with special needs in Guangdong Province, China.

RESULTS

(1) Parenting stress significantly affected positive mental health (γ = 0.70,p < 0.001). When family support and resilience were included, the direct effect of parenting stress on positive mental health remained significant (γ = 0.45, p < 0.001). (2) Family support and resilience significantly mediated the relationship between parenting stress and positive mental health in a serial manner. (Direct effect =65.35 %, mediating effect =34.65 %). (3) Optimism significantly moderated the mediating effect of family support on positive mental health (γ = 0.13, p < 0.01).

CONCLUSIONS

The study results reveal the mechanisms through which parenting stress impacts the positive mental health of parents of children with special needs, as well as the protective roles of family support, resilience, and optimism. These findings have certain implications for promoting the mental health of parents and families of children with special needs.

Examining the Associations of Family-Related Factors with Hypertension in Sexual Minority Women

Purpose: We examined the association between family-related factors (i.e., sexual identity disclosure to family and family social support) and hypertension (HTN) among sexual minority women (SMW; i.e., lesbian/gay, bisexual, or another sexual identity). Methods: We analyzed data from Waves 3 (2010-2012) and 4 (2017-2019) of the Chicago Health and Life Experiences of Women study. Using multiple logistic regression, we examined the cross-sectional and longitudinal associations of family-related factors with self-reported HTN (diagnosis of HTN at Wave 3 and newly diagnosed HTN at Wave 4) among SMW. We also explored whether race/ethnicity and sexual identity moderated these associations. Analyses were adjusted for relevant covariates (e.g., age, tobacco use). Results: Cross-sectional analyses included 651 SMW with a mean age of 40.2 (±13.8) years, 58% of whom identified as Black/African American or Hispanic. Family social support was inversely associated with the diagnosis of HTN (adjusted odds ratio: 0.85, 95% confidence interval: 0.75-0.97). Longitudinal analyses included 377 SMW (mean age of 38.8 [±13.0] years) with 51% identifying as Black/African American or Hispanic. Family social support was not associated with newly diagnosed HTN. Neither the cross-sectional nor longitudinal associations between sexual identity disclosure to family and HTN were significant. Neither race/ethnicity nor sexual identity were significant moderators. Conclusions: Family social support was associated with lower odds of HTN diagnosis among SMW. Families and clinicians should be educated about the protective role of family social support for sexual minority adults. Further research is needed to identify factors that contribute to HTN disparities observed among these populations.

Suicide Risk and Social Connectedness in Cisgender and Transgender Lesbian, Gay, Bisexual, and Queer/Questioning Youth in the Emergency Department

PURPOSE

Lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) youth are at high suicide risk. Family/peer connectedness may be protective factors; few studies assess social connectedness within cisgender lesbian, gay, bisexual, and queer (cis-LGBQ) and transgender and gender-diverse (TGD) samples. This study aims to identify associations between family/peer connectedness and suicidal thoughts/behaviors (STBs) among cisgender-LGBQ and TGD youth to better inform suicide prevention strategies.

METHODS

This study utilized data from LGBTQ youth aged 12-17 in the Emergency Department Screen for Teens at Risk for Suicide study. Youth completed measures for STBs (Ask Suicide-Screening Questions and Columbia Suicide Severity Rating Scale) and family/peer connectedness ("low," "moderate," and "high"). Logistic regression analyses examined associations between family/peer connectedness and STBs in cis-LGBQ and TGD youth.

RESULTS

53.2% (607/1,140) of cis-LGBQ and 69.7% (99/142) of TGD youth self-reported STBs. For cis-LGBQ youth, the odds of reporting STBs increased when comparing low/moderate versus high family connectedness (p < .001, adjOR = 9.8[6.8-14.2]; p < .001, adjOR = 3.5[2.7-4.7]) and low versus moderate (p < .001, adjOR = 2.8[1.9-4.0]). Regarding cis-LGBQ peer connectedness, the odds of reporting STBs increased when comparing low/moderate versus high (p < .01, adjOR = 1.8[1.2-2.7]; p < .05, adjOR = 1.5[1.1-2.1]), not low versus moderate (p = .4). For TGD youth, the odds of reporting STBs significantly increased when comparing low/moderate versus high family connectedness (p < .001, adjOR = 9.8[3.7-28.2]; p < .001, adjOR = 7.7[2.8-22.8]), not when comparing low versus moderate (p = .7). Peer connectedness levels had no significant associations with TGD youths' STB rates (p = .2, p = .3, p = .8).

DISCUSSION

LGBTQ, especially TGD youth, are at elevated suicide risk. High levels of family connectedness may especially help mitigate suicide risk in TGD youth. Future research should replicate findings in larger TGD samples and adapt LGBTQ-specific, family-based emergency department interventions.

The Relationship Between Parental and Caregiver Support and Suicide Among LGBTQ+ Youth of Color

PURPOSE

This study examines the relationship between parental/caregiver support and suicide risk among LGBTQ+ youth, with a focus on transgender, nonbinary, or gender questioning (TGNBQ) youth of color.

METHODS

Data from 28,524 LGBTQ+ young people aged 13-24 years were collected through a 2022 national online survey. Parental/caregiver support and acceptance were assessed through participants' self-reported experiences of LGBTQ+ supportive actions taken by their parents/caregivers related to their LGBTQ+ identities. Suicide risk was evaluated based on self-reported suicide consideration and attempts over the past year.

RESULTS

Seventy three percent of White LGBTQ+ youth reported acceptance for their sexual orientation, compared to 65% of LGBTQ+ youth of color (χ2 = 174.12, p < .001). White TGNBQ youth reported a higher rate of gender identity acceptance (55%) from parents/caregivers compared to TGNBQ youth of color (47%; χ2 = 63.83; p < .001). For LGBTQ+ youth of color, sexual orientation acceptance was associated with 33% lower odds of attempting suicide in the past year (adjusted odds ratio = 0.67, 95% confidence interval = 0.58-0.75, p < .001). Acceptance for gender identity among TGNB youth of color was linked to 36% lower odds of a past-year suicide attempt (adjusted odds ratio = 0.64, 95% confidence interval = 0.55-0.75, p < .001).

DISCUSSION

The study underscores the protective role of parental/caregiver acceptance against suicidal attempts, emphasizing the need for acceptance across diverse family dynamics. These findings call for culturally competent interventions and policies that enhance parental/caregiver support, recognizing the intersectional challenges faced by LGBTQ+ youth.

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.

Social networks and loneliness differ between LGBTIA and cis-heterosexual persons: results from a two-wave survey in Germany

Current research suggests LGBTIA persons to be lonelier than cis-heterosexual persons. While they rely more on friends than on family as support network, their social network and weekly contact to family and friends, as well as the association between the social network and loneliness have not been fully explored yet. The aim of this analysis was to examine differences in the social network between LGBTIA and cis-heterosexual persons in Germany, and how these differences affect loneliness. Data was collected through an online survey conducted in two independent waves in March/April 2020 and in January/February 2021. Linear regression analyses were performed to examine the influence of the social network on loneliness. Of 6784 participants, 5442 identified as LGBTIA. Weekly contact to family was lower in the LGBTIA group than in cis-heterosexuals. LGBTIA were less likely to be in a relationship. Identifying as LGBTIA increased social and emotional loneliness. Differences in social network partly explained the risk for social loneliness of LGBTIA persons and, to a lower degree, the risk for emotional loneliness. We encourage health care professionals to inquire about sexual orientation, gender identity, and relationship status to raise awareness for feelings of loneliness and related health problems.

Definitions and Measurement Tools for Assessing Parental Reactions to LGB People Coming Out: A Critical Review

Parental responses to young people's coming out as lesbian, gay or bisexual (LGB) are a crucial experience in identity formation and subsequent mental health outcomes. However, how parents react to coming out varies and remains relatively imprecise in the literature. The aim of the present critical review was to explore and discuss the different definitions and measurement tools used in studies assessing perceived parental reactions to the coming out of LGB people aged 18 years and over. Following PRISMA guidelines, a review of 14 selected articles was carried out to examine the different tools used. Then, based on this selection of articles, a review of the different proposed definitions of parental reactions was carried out. Analysis revealed that the Perceived Parental Reactions Scale emerged as the most widely used and most appropriate international scale for capturing the diversity of perceived parental reactions. Then, parental responses were often addressed in a dichotomous manner, focusing primarily on acceptance or rejection. Future studies will need to consider a more nuanced approach to understanding parental reactions to coming out.

Outness, Acceptance, and Victimization: A Longitudinal Study of Depressive Symptoms and Suicidality of Lesbian, Gay, and Bisexual and Transgender and Gender Diverse Youth

PURPOSE

LGBTQ+ youth are at higher risk for poorer mental health. Studies are typically cross-sectional and categorize cisgender lesbian, gay, and bisexual (LGB) and transgender and gender diverse (TGD) youth as a combined group (i.e., LGBTQ+). There is a need for longitudinal studies that examine differences between LGB and TGD youth for a better understanding of their mental health needs.

METHODS

Data come from a 4-wave longitudinal community-based study collected between 2011 and 2015. Hierarchical Linear Models examined trajectories of depressive symptoms and suicidality, comparing LGB and TGD youth. Between-person and within-person associations were examined, accounting for cumulative experiences of victimization, outness to family, and family acceptance in association with depressive symptoms and suicidality.

RESULTS

The study included a diverse sample of 543 LGB and 118 TGD youth. Although TGD youth had, overall, higher levels of depression and suicidality, both LGB and TGD youth experienced improvement in mental health. Youth who were more out and accepted in family were less depressed and suicidal than youth who were less out and accepted in family. Within individuals, when youth become more out and accepted in family, they concurrently reported less depressive symptoms. The accumulation of victimization experiences was associated with higher levels of depression and suicidality, and more depression for youth across time.

DISCUSSION

TGD youth face higher stigmatization than LGB youth, contributing to poorer mental health and disparities. Findings suggest that both LGB and TGD youth develop resilience despite victimization, and many find support within their families to cope with stigma.

Loneliness and Social and Emotional Support Among Sexual and Gender Minority Caregivers

Importance

Sexual and gender minority (SGM) adults in the US are more likely than their non-SGM counterparts to provide informal care to their family members and/or friends. Caregiving can impose substantial physical, mental, and social connection issues on caregivers.

Objective

To examine the associations among loneliness, lack of social and emotional support, sexual orientation, gender identity, and informal caregiving status.

Design, Setting, and Participants

This population-based, cross-sectional study used data from the 2022 Behavioral Risk Factor Surveillance System collected from noninstitutionalized US civilian residents aged 18 years or older. Data analysis was conducted from June to July 2024.

Main Outcomes and Measures

The primary dependent variables included self-reported dichotomized (yes vs no) loneliness and lack of social and emotional support. The primary independent variables were sexual orientation (straight, gay or lesbian, bisexual, or something else), gender identity (cisgender and transgender), and informal caregiving status (yes vs no). A binomial distribution and log link function were used to derive adjusted prevalence ratios (APRs) and their respective 95% CIs for each outcome measure.

Results

The analytic sample included 43 693 US adults (23 223 [51.6%] female at birth). In multivariable regression analyses adjusting for sociodemographic and health factors, among caregivers only, and compared with straight individuals, loneliness was significantly more likely among lesbian or gay individuals (APR, 1.30; 95% CI, 1.11-1.51), bisexual individuals (APR, 1.26; 95% CI, 1.12-1.43), and those who identify as something else (APR, 1.26; 95% CI, 1.09-1.46). Similarly, for noncaregivers, lesbian or gay individuals (APR, 1.34; 95% CI, 1.15-1.57), bisexual individuals (APR, 1.47; 95% CI, 1.34-1.61), and individuals identifying as something else (APR, 1.41; 95% CI, 1.25-1.58) experienced significantly higher risk of loneliness than straight noncaregivers. Transgender caregivers were more likely than cisgender caregivers to report loneliness (APR, 1.34; 95% CI, 1.24-1.46). In terms of lack of social and emotional support, bisexual caregivers (APR, 1.21; 95% CI, 1.00-1.48) and caregivers identifying as something else (APR, 1.34; 95% CI, 1.09-1.66) were significantly more likely than straight caregivers to report a lack of social and emotional support. Similarly, both bisexual noncaregivers (APR, 1.44; 95% CI, 1.28-1.63) and noncaregivers identifying as something else (APR, 1.38; 95% CI, 1.18-1.61) experienced a significantly higher risk of lacking support compared with straight noncaregivers.

Conclusions and Relevance

In this cross-sectional study of social connections, SGM adults experienced significantly higher levels of loneliness compared with straight adults, irrespective of caregiving status. Furthermore, caregiving exacerbated these disparities across SGM subgroups. Patterns of lack of social and emotional support mirrored those of loneliness across different SGM and caregiving subpopulations, with nuances emerging upon adjustment for individual characteristics.

Open worlds: An examination of digital accounts of gender and sexual identity development through the use of tabletop role-playing games among LGBTQ2S+ youth and young adults

Gender and sexual identity development (GSID) are formative tasks of adolescence and young adulthood. For LGBTQ2S+ individuals, these processes may be complicated by issues of safety, support, and access to resources. A potential avenue for identity experimentation is tabletop role-playing games (TRPGs), cooperative narrative games wherein players adopt fictional personas and describe their actions within a fantasy setting arbitrated by a facilitator. Previous studies provide indications of the significance of TRPGs to GSID but have generally been limited to small sample sizes and/or specific demographic subgroups that lack a specific inclusion of LGBTQ2S+ youth within their samples. The current study sought to address these gaps and investigate the role of TRPGs to GSID among LGBTQ2S+ individuals during adolescence and young adulthood by generating and analyzing a digital ethnography composed of anonymous online public posts ( N = 211) across four social media platforms authored by current self-identified LGBTQ2S+ youth and young adults, or self-identified LGBTQ2S+ adults retroactively reflecting on their youth and/or young adulthood ( N = 199). Thematic analysis revealed a range of themes highlighting the significance of TRPGs to GSID organized under five overarching categories: (a) Identity Expression, Exploration, and Experimentation through Role-Play; (b) Navigating Safety and Visibility; (c) Enactment and Embodiment of Possibility through Fantasy; (d) Agency, Power, and Resistance; and (e) Personal Significance and Impact to Life and Well-Being.

The experiences of oppression among transgender and gender expansive young people in Australia: An interpretative phenomenological study

Background: Transgender and gender expansive (TGE) people experience poorer mental health outcomes compared to their cisgender counterparts. There is limited research on understanding the experiences of TGE school-aged young people from an Australian perspective. Since each country and state has different cultures, laws, and access to gender-affirming care research considering these differences is imperative.Methods: To address this gap, we used a qualitative design to explore the oppression of Australian TGE young people. Sixteen TGE participants (aged 14-17) completed individual semi-structured interviews. Data were analysed using interpretive phenomenological analysis.Results: Three superordinate themes were identified: (1) oppression within the education system; (2) oppression within the medical and allied health system; and (3) oppression within the family system. The findings highlight the various settings and contexts of oppression young people encounter. We identified what must change for a more equitable society and advocate for the implementation of gender-affirming change.Discussion and conclusion: This study contributes to the dearth of TGE adolescents's experiences and provides practical implications for society, especially in relation to the education, medical, and family systems. The implications include advocacy for more research in Australia and the inclusion of adolescents in policy reform. Limitations of this study and future directions are discussed.

Religiosity, perceived family support, and gender disclosure of LGBTQ + medical students in Thailand

BACKGROUND

The well-being of LGBTQ + medical students can be influenced by religiosity, family support, and the disclosure of their gender identity or sexual orientation. These factors have frequently been overlooked and warrant further consideration in creating a supportive environment for all students.

METHODS

This multicenter study investigated two main outcomes including the differences in religiosity and perceived family support between LGBTQ + and non-LGBTQ + medical students in Thailand, and the gender disclosure to family among LGBTQ + medical students. It was conducted among students from five medical schools across Thailand, using online questionnaires during the academic year 2021-2022. Data were collected on demographic characteristics, religiosity, gender identity/sexual orientation disclosure to family, and perceived family support. Comparisons between groups were conducted using chi-square test and Wilcoxon rank-sum test.

RESULTS

Of the 1,322 participants, 31.2% identified themselves as LGBTQ+, among whom 81.8% were Buddhists. The proportion of non-religious LGBTQ + students was significantly higher (vs. non-LGBTQ+; 15.0% vs. 8.4%, respectively; p = 0.001). However, there was no statistical difference in religiosity between LGBTQ + and non-LGBTQ + students as well as between LGBTQ + subgroups. Although, 74% of LGBTQ + students reported good family support, significantly more LGBTQ + students perceived poor family support (vs. non-LGBTQ+, 7.0% vs. 4.7%; p = 0.002). Regarding the disclosure of gender identity or sexual orientation to the family, the majority of LGBTQ + individuals indicated either a non-disclosure or uncertainty. There were significant associations between perceived family support and the likelihood of disclosing one's identity to family members, as better perceived support was associated with higher disclosure rates.

CONCLUSIONS

No statistically significant difference in religiosity was found between LGBTQ + and non-LGBTQ + students. The majority of LGBTQ + medical students reported receiving good family support; however, among those who perceived their family's support to be lacking, there was a greater tendency to conceal their gender identity from their families. For future studies, it is crucial to investigate whether this concealment extends to other spheres of their lives and to assess the potential impact on their well-being, including mental health and quality of life.

LGBT Myanmar Migrants in Thailand: Unveiling Diverse Forms of Abuse, Healthy and Unhealthy Coping Strategies

This study investigates the challenges faced by LGBT Myanmar migrants in Thailand, including discrimination and abuse due to their gender identity or sexual orientation, and their coping strategies. Through qualitative interviews with 20 self-identified LGBT Myanmar migrants aged over 18 years who experienced discrimination or abuse in Thailand, the findings underscore the presence of a segment within the Myanmar LGBT migrant community in Thailand subject to discrimination and violence across diverse settings, including workplaces, public areas, and even within their homes. Additionally, the research identified healthy coping strategies like self-soothing thoughts, relaxation activities, and seeking support, contrasted with unhealthy coping strategies such as negative self-talk, rumination, and suppressing one's identity, leading to harmful behaviors and even suicidality. The experiences of severe discrimination and violence among LGBT migrants help this study advocate for policy interventions, such as extending the coverage of the Gender Equality Act to encompass LGBT migrants and implementing mental health support services as a form of secondary prevention. Given the significant contribution of LGBT migrants to various sectors of Thailand's workforce, these measures are essential. However, the existing legislation concerning gender equality in Thailand inadequately addresses the specific concerns of this demographic group.

Latin Transgender and Gender-Diverse Individuals' Perceptions of Well-Being During the COVID-19 Pandemic

Latin transgender and gender-diverse (LTGGD) individuals experienced the public health measures mandated during the COVID-19 pandemic in unique ways. Intersecting ethnic and gender-identifying frameworks contributes to differing access, support, and well-being observations. The aim of this study was to examine emerging adult LTGGD individuals' perceptions of their health and well-being experiences during the COVID-19 pandemic in South Florida. Interviews were conducted with nine self-identifying LTGGD individuals. Using a thematic analysis, a total of three major themes were identified as shaping the participants' experiences and perceptions of health during COVID-19, including (a) healthcare interactions, (b) challenges, and (c) opportunities. Some of the participants were mixed in their perceptions of their well-being during the COVID-19 pandemic; negative concerns included the inability to access general and transgender/gender-diverse specific health services. However, others note that they were happy that the pandemic allowed them to avoid contexts where they regularly experienced microaggressions due to their identities. Additionally, various participants were able to use this time of isolation to identify providers with greater knowledge about LTGGD health needs. These findings highlight the importance of providing culturally competent and humility-centered skills to healthcare providers and others supporting the LTGGD population's well-being.

Exploring the Role of Social Support and Sexual Functioning: A Study of Chemsex and Sober Sex in Men Who Have Sex with Men

Research on chemsex, the intentional use of certain drugs in sexual contexts by gay men and other men who have sex with men (MSM), has been growing in recent years although, even today, much of it focuses on drug use and its consequences, rather than on the sexual and social experiences of users. This study aimed to explore the influence of social support and sexual functioning on the frequency of chemsex and sober sex. A sample of 160 MSM WAS recruited through social media and NGOs. Through regression analysis, it was found that lower perceived social support and greater number of routes of drug administration predicted a higher frequency of chemsex practice. On the other hand, higher perceived social support, higher levels of desire and arousal, and fewer routes of drug administration predicted a higher frequency of engaging in sober sex. This study provides empirical evidence that both social support and sexual functioning are key elements in chemsex and have an impact on both the frequency of chemsex and sober sex. Given the importance of these elements, we suggest that interventions should be framed holistically. Nevertheless, not all chemsex is problematic and it is a free choice in sexuality.

Familias con Orgullo: Pilot Study of a Family Intervention for Latinx Sexual Minority Youth to Prevent Drug Use, Sexual Risk Behavior, and Depressive Symptoms

Families are key in the healthy development of Latinx sexual minority youth (Latinx SMY), a group that experiences behavioral, mental, and sexual health disparities. Despite this, there are no family-based interventions for Latinx SMY and their families to prevent drug use, sexual risk behaviors, and depressive symptoms. The purpose of this pilot study was to evaluate the preliminary impact (i.e., estimated effect sizes) of Familias con Orgullo (FcO) and examine its feasibility and acceptability among 30 Latinx SMY and their parents. Parents and adolescents were randomized to FcO or a control condition and assessed pre/post-intervention. Feasibility was measured based on session completion and effect sizes. Focus groups were conducted to evaluate intervention acceptability. Findings showed promising effects favoring FcO on parent-adolescent communication (d = 0.46) and parental involvement (d = 0.34). There were also promising effects favoring FcO on suicidal thoughts (OR = 0.75) and depression symptoms (OR = 0.69). Finally, 100% of the adolescents in FcO either continued to remain drug-free or transitioned from current use to no use (from baseline to post-intervention) compared to 74% in the control. Effect sizes for condomless sex, parental monitoring, and positive parenting were small. Session completion (above 80%) and focus group findings indicated strong feasibility and acceptability. FcO holds promise for reducing drug use and depressive symptoms and improving family functioning among Latinx SMY.

The Role of Family Support in Moderating Mental Health Outcomes for LGBTQ+ Youth in Primary Care

Importance

Lesbian, gay, bisexual, transgender, queer, and/or questioning (LGBTQ+) youth face worse mental health outcomes than non-LGBTQ+ peers. Family support may mitigate this, but sparse evidence demonstrates this in clinical settings.

Objectives

To compare depression and suicide risk between LGBTQ+ and non-LGBTQ+ youth in primary care settings and to investigate whether family support mitigates these negative mental health outcomes.

Design, Setting, and Participants

This cross-sectional study uses data from well care visits completed by adolescents aged 13 to 19 years from February 2022 through May 2023, including the Patient Health Questionnaire-9 Modified for Teens (PHQ-9-M) and the Adolescent Health Questionnaire (AHQ; an electronic screener assessing identity, behaviors, and guardian support), at 32 urban or suburban care clinics in Pennsylvania and New Jersey.

Exposures

The primary exposure was self-reported LGBTQ+ status. Family support moderators included parental discussion of adolescent strengths and listening to feelings. Race and ethnicity (determined via parent or guardian report at visit check-in), sex, payer, language, age, and geography were covariates.

Main Outcomes and Measures

PHQ-9-M-derived mental health outcomes, including total score, recent suicidal ideation, and past suicide attempt.

Results

The sample included 60 626 adolescents; among them, 9936 (16.4%) were LGBTQ+, 15 387 (25.5%) were Black, and 30 296 (50.0%) were assigned female sex at birth. LGBTQ+ youth, compared with non-LGBTQ+ youth, had significantly higher median (IQR) PHQ-9-M scores (5 [2-9] vs 1 [0-3]; P < .001) and prevalence of suicidal ideation (1568 [15.8%] vs 1723 [3.4%]; P < .001). Fewer LGBTQ+ youth endorsed parental support than non-LGBTQ+ youth (discussion of strengths, 8535 [85.9%] vs 47 003 [92.7%]; P < .001; and listening to feelings, 7930 [79.8%] vs 47 177 [93.1%]; P < .001). In linear regression adjusted for demographic characteristics and parental discussion of strengths, LGBTQ+ status was associated with a higher PHQ-9-M score (mean difference, 3.3 points; 95% CI, 3.2-3.3 points). In logistic regression, LGBTQ+ youth had increased adjusted odds of suicidal ideation (adjusted odds ratio, 4.3; 95% CI, 4.0-4.7) and prior suicide attempt (adjusted odds ratio, 4.4; 95% CI, 4.0-4.7). Parental support significantly moderated the association of LGBTQ+ status with PHQ-9-M score and suicidal ideation, with greater protection against these outcomes for LGBTQ+ vs non-LGBTQ+ youth.

Conclusions and Relevance

Compared with non-LGBTQ+ youth, LGBTQ+ youth at primary care visits had more depressive symptoms and higher odds of suicidal ideation and prior suicide attempt. Youth-reported parental support was protective against these outcomes, suggesting potential benefits of family support-focused interventions to mitigate mental health inequities for LGBTQ+ youth.

Sexuality Minority Status, Victimization, Mental Health, and Substance Use

Background: Prior research suggests that sexual minority status is related to victimization, mental health issues, and substance use. However, few studies have sought to connect these relationships in a way supported by theory, and fewer have utilized probability and/or nationally representative samples. Objective: The current study seeks to test the relationships among these variables, guided by general strain theory (GST). Methods: One wave of the National Longitudinal Study of Adolescent to Adult Health dataset (Add Health) (N = 14,121) and path modeling in Mplus are utilized. Results: Models run separately by race/ethnicity suggest that the relationship among these variables largely support expectations from GST, but with some notable differences by race/ethnicity. Conclusion: Results suggest a relationship among these variables that concurs with criminological theorizing. Implications and limitations are discussed.

Surveying Psychological Wellbeing in a Post-Pandemic World: The Role of Family and Social Support for LGBTQ+ and Cisgender Heterosexual Adults in the UK

Studies have emphasized the importance of social support in mitigating the relationship between psychological distress and mental health effects, with family of origin and family of formation providing key sources of social support over the life course. However, LGBTQ+ people may experience family of origin relationships as a source of distress, while partners and friends may buffer the relationship between minority stress and psychological wellbeing. Through our online survey (March-June 2022), which was conducted when the social restrictions of the COVID-19 pandemic were lifted in the UK, we considered the association between psychological wellbeing and sources of social support by sampling n = 1330 LGBTQ+ and cisgender heterosexual adults. LGBTQ+ adults generally experienced poorer psychological wellbeing outcomes than did cisgender heterosexual people. For LGBTQ+ adults, social support from family of origin, a special person, or friends was not associated with depression, anxiety, or stress levels, but social support from family or a special person was positively associated with higher levels of life satisfaction. Our findings indicate the importance of considering negative as well as positive wellbeing.

Psychological distress and mental health care utilization among lesbian, gay, and bisexual survivors of adolescent and young adult cancer

PURPOSE

Survivors of adolescent and young adult (AYA) cancer face significant psychological distress and encounter barriers accessing mental health care. However, limited research exists on psychological health among lesbian, gay, and bisexual (LGB) survivors of AYA cancer, particularly in comparison with heterosexual survivors and LGB individuals without a history of cancer.

METHODS

Using the National Health Interview Survey (2013-2018), we identified LGB survivors of AYA cancer, LGB individuals without a history of cancer, and heterosexual survivors of AYA cancer. Sociodemographic, chronic health conditions, modifiable factors (such as smoking and alcohol use), and psychological outcomes were assessed using chi-square tests. Logistic regression models, adjusted for survey weights, evaluated the odds of psychological distress by cancer status after accounting for covariates. Interactions between variables and cancer status were explored.

RESULTS

The study comprised 145 LGB survivors, 1450 LGB individuals without a history of cancer, and 1450 heterosexual survivors. Compared to heterosexual survivors, LGB survivors were more likely to report severe distress (aOR = 2.26, p = 0.021) and had higher odds of reporting a mental health care visit (aOR = 1.98, p = 0.003). Odds of severe distress (aOR = 1.36, p = 0.36) and reporting a mental health care visit (aOR = 1.27, p = 0.29) were similar between LGB survivors and LGB individuals without a history of cancer. While 47.8% of LGB survivors reported moderate/severe distress, only 29.7% reported a mental health care visit.

CONCLUSION

A history of cancer during the AYA years is associated higher odds of severe psychological distress among LGB survivors compared to heterosexual survivors. However, many LGB survivors with psychological distress have not accessed mental health care.

Modeling perceived parental attitudes and mental well-being in Chinese young LGBTQ+ individuals: Investigation of weekly diary data using dynamic network analysis

Existing literature has reported negative parental attitudes toward LGBTQ+ individuals associated with their LGBTQ+ identity concealment and mental well-being. However, limited research has explored the dynamic network changes using intensive, repeated weekly diary data. This study aimed to model the associations between perceived parental attitude, anxiety, depression, and LGBTQ+ individuals' identity concealment within dynamic network analysis (DNA); 103 LGBTQ+ youth participated in the study. Participants' perceived parental attitudes toward LGBTQ+ identity and LGBTQ+ identity concealment, depression (by the 9-item Patient Health Questionnaire), and anxiety (by the 7-item Generalized Anxiety Disorder Questionnaire) were measured. Each was assessed four times at 1-week intervals for four consecutive weeks. The graphical vector autoregression explored the DNA of the internal relationships among perceived parental attitudes, identity concealment, depression, and anxiety. Findings in the between-subjects network revealed that poor perceived parental attitudes toward sexual and gender minorities were positively associated with depression, anxiety, and identity concealment. The contemporaneous network showed that the "expression" (one's identity concealment) was the direct trigger of "suicide" (one's depressive symptom), indicating depression was initiated earlier and subsequently exacerbated a sequence of other psychiatric reactions. The temporal network indicated that only parents' "general attitude" reduced participants' concealment ("self-disclosure"), which simultaneously stimulated mental benefits.

Exploring the practice principles and beliefs of trans-care providers working with trans and detrans youth: A survey-based analysis

Objective

While research on detransition in young people has helped to develop a data-driven understanding of this new phenomenon, it only became available late 2020. This small-scale exploratory project aims to examine the attitudes and beliefs on the topic of detransition held by trans-care providers working with trans and non-binary youth at a moment when research evidence was limited.

Method

An online survey was circulated between September 1, 2020, and January 31, 2021. A total of 147 professionals participated, of whom 61 completed more than 60% of the online survey. The survey examined how attitudes and beliefs of these 61 participants compare between providers who have or may have followed youth who detransitioned (YDT) (n = 29) and those who have not (n = 22). Descriptive and Mann-Withney U tests using SPSS V 28 were performed. Qualitative data were analised through thematic analysis and used to illustrate quantitative data.

Results

The analysis uncovered slight but significant differences between these two groups of care providers. The results indicate that those who have interacted with YDT are less likely to have adhered to the empirical evidence available at the time of the survey compared to those who have not.

Conclusion

While the reasons for these differences are not entirely clear, the article suggests that media content may have captured the attention of providers who have followed YDT, potentially leading to confirmation bias.

Implications

The latest peer-reviewed evidence has to be more readily accessible to all providers, and providers must critically appraise evidence to ensure that their practices are more data-driven and insure best intervention for all gender-diverse youth.

Mitigating the Impact of Religiously Based Family Expectations on Depression Among Sexual and Gender Minorities: The Role of Authenticity

Although it is clear that religious beliefs can motivate family rejection among sexual and gender minorities (SGMs), ultimately harming their mental health, researchers have not examined the direct link between religiously based family expectations and mental health. In the present study, we first developed the Religiously Based Family Expectations Scale. The scale demonstrated good reliability and factor structure. It evidenced convergent and divergent validity with other measures of religiousness and sexual identity, as well as incremental validity in predicting mental health outcomes above and beyond these measures. Next, we examined how religiously based family expectations related to depression in a sample of 534 SGMs with a conservative religious background (raised as part of the Church of Jesus Christ of Latter-day Saints). We found that religiously based family expectations were positively related to depression but that this relationship was moderated by authenticity such that religiously based family expectations exerted a much stronger relationship with depression among SGMs who evidenced less authenticity.

Perceived Social and Emotional Support Among Teenagers: United States, July 2021-December 2022

Objective

This report uses data from the National Health Interview Survey and National Health Interview Survey-Teen to estimate the prevalence of self-reported social and emotional support among teenagers ages 12-17 years, describe differences in health and well-being outcomes by level of support received, and compare teen- and parent-reported estimates for social and emotional support overall and by selected teen and family characteristics.

Methods

The percentage of teenagers who self-reported always or usually receiving social and emotional support by selected demographic characteristics, and potential differences in health outcomes by level of support, were estimated using data from the National Health Interview Survey-Teen collected from July 2021 through December 2022. In addition, data from the same time period from the National Health Interview Survey were used to compare parent-reported estimates of their teenager's social and emotional supports with the teenager's self-reported estimates.

Results

In 2021-2022, 58.5% of teenagers reported always or usually receiving the social and emotional support they needed. Differences were seen by several demographic characteristics including sex, race and Hispanic origin, sexual or gender minority status, highest parental education level, and family income level. Teenagers who always or usually received support were less likely to report poor or fair health, anxiety or depression symptoms, very low life satisfaction, and poor sleep quality. Parents consistently reported higher perceived levels of their teenager's social and emotional support compared with the teenager's self-report.

Intersectional stigma and mental health: Interactions with identity authenticity and SGM community in sexual and gender minoritized young adults of color

OBJECTIVES

Sexual and gender minoritized people (SGM) of color experience stigma unique to their intersection of identities, such as racism from SGM and heterosexism from people of color (POC) in their same racial/ethnic group. SGM POC who experience enacted stigma, like microaggressions, have been found to have poorer mental health outcomes. SGM identity authenticity and connections to the SGM community have been associated with better mental health. We sought to test if intersectional enacted stigma, identity authenticity, community connectedness, and the interactions between enacted stigma and authenticity and community were associated with mental health in assigned female at birth (AFAB) SGM young adults of color.

METHOD

Data come from 341 racial/ethnic minoritized SGM-AFAB (Mage = 21.23, SD = 3.80). Multivariate linear regressions tested main effects of intersectional enacted stigma (heterosexism from POC and racism from SGM) and authenticity and community on mental health, as well as interaction effects on mental health.

RESULTS

SGM-AFAB POC who experienced more heterosexism from POC reported more anxiety and depression symptoms. Greater connection to the SGM community was associated with fewer anxiety and depression symptoms. Heterosexism from POC and community connection interacted such that SGM-AFAB who experienced less heterosexism from POC reported fewer mental health symptoms if they were more connected to the SGM community, but SGM-AFAB who experienced more heterosexism did not benefit from stronger community connection.

CONCLUSIONS

Heterosexism from other POC may put SGM POC at higher exposure for negative mental health outcomes and reduce the mental health benefits of a stronger connection to the SGM community. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Prevalence, severity and risk factors of psychiatric disorders amongst sexual and gender diverse young people during the COVID-19 pandemic: A systematic review

Before the COVID-19 pandemic, the prevalence and severity of psychiatric disorders among sexual and gender diverse (SGD) young people was greater than in their heterosexual/cisgender peers. We systematically reviewed literature examining the prevalence, severity, and risk factors for psychiatric disorders among SGD young people aged 25 and under during the pandemic. Four databases (MEDLINE, PsycInfo, Scopus and Web of Science) were searched. Eligibility criteria were studies assessing prevalence rates, mean symptomology scores and risk factors of psychiatric disorders using contemporaneous screening measures or diagnosis. Thirteen studies of mixed quality were identified. Most studies indicated SGD young people were at high risk of experiencing several psychiatric disorders including depressive and generalised anxiety disorder compared to the general population. This group also experienced more severe symptomology of various psychiatric disorders compared to their heterosexual/cisgender peers. Risk factors included those specific to the pandemic along with factors that led to greater risk before the pandemic. This systematic review has indicated evidence of heightened risk of psychiatric disorders among SGD young people during the COVID-19 pandemic. It is important for clinicians to acknowledge the needs of SGD young people, working with them to co-develop more inclusive care as they deal with the pandemic's fallout.

Mapping the role of sexuality in adolescent mental health and substance use

Individuals who belong to a sexual minority are at greater risk of adverse health and social outcomes. These effects are observed during adolescence when many mental health problems, such as depression, first emerge. Here, we used a network analytic approach to better understand the role that sexual minority status plays in the association between depression, interpersonal difficulties and substance use in a large sample of mid-adolescents. In doing so, we used data from 8017 fourteen year olds from the UK's Millennium Cohort Study, of which 490 self-identified as belonging to a sexual minority. We found that sexual minority status was highly central in the network and connected to multiple adverse outcomes, sometimes directly and sometimes indirectly. The largest single association was between sexual minority status and depression, and this link mediated multiple negative associations with being in a sexual minority. The shortest path to drinking, poor social support and closeness with parents and victimization occurred via depression. The shortest path to smoking and drug use occurred via conduct problems. We also identified three distinct profiles of adverse outcomes among those belonging to a sexual minority, highlighting the heterogeneous nature of this group.

Changes in Gender Dysphoria, Interpersonal Minority Stress, and Mental Health Among Transgender Youth After One Year of Hormone Therapy

PURPOSE

Cross-sectional studies have identified a strong link between interpersonal minority stress and mental health among transgender youth. However, very little is known about how experiences of minority stress change over time and how these changes relate to mental health. Further, few quantitative studies have examined the extent to which changes in gender dysphoria drive the improvements witnessed in mental health following gender-affirming medical treatment.

METHODS

Transgender youth (N = 115; age 12-18) completed measures of interpersonal minority stress (e.g., family and peer support, parent support of gender, victimization), body dissatisfaction, and mental health (e.g., depression, anxiety, psychosocial functioning) at baseline and one year after initiating medical treatment with a multidisciplinary gender-affirming program.

RESULTS

Significant reductions in body dissatisfaction, victimization, depression, and anxiety were found along with improvements in parent gender-related nonaffirmation and psychosocial functioning. Higher levels of baseline family support, parent gender-related acceptance, and lower levels of baseline victimization were associated with better mental health at one-year follow-up. Reductions in body dissatisfaction were also associated with fewer symptoms of depression and better psychosocial functioning and follow-up.

DISCUSSION

Results provide further confirmation of the broad, short-term benefits of gender-affirming hormone therapy and highlight the importance of monitoring youth's experience of dysphoria while receiving treatment. Results also continue to highlight the importance of family support and suggest some forms of minority stress improve over time; however, the relationship between short-term changes in minority stress and mental health may be more complex.

"We Followed their Lead": Exploring Relational Change and Support among Caregivers of Transgender and Gender Diverse Youth

Transgender and gender diverse youth and young adults (TGDY) experience higher mental health morbidity, including self-harm, suicide ideation, and suicide attempts, as compared to cisgender peers. Support from family members is associated with improved mental health outcomes for TGDY. However, little is known about the process that caregivers who consider themselves supportive undergo and how caregiver-youth relationships evolve through a TGDY's gender journey. Through a reflexive thematic analysis of 14 interviews conducted with caregivers of TGDY from April-July 2022, we sought to understand how caregivers who considered themselves supportive of TGDY navigated shifting relationships with themselves, their children, and their communities. Applying theories of Ambiguous Loss and Thriving Through Relationships, findings coalesced around several themes including reflecting on change, re-negotiating interpersonal relationships, and educating through relationships. The gender journeys of TGDY required caregivers to navigate relationships with self (feeling loss and wrestling with worry for their child), negotiate relationships with others (disclosing to extended family and social networks), and educate themselves and others through relationships (connecting through personal narratives from other families, parents supporting parents, learning to advocate for their child). The process of caregivers learning to support their children was facilitated through profound intrapersonal and interpersonal reflection, connection, and community. Understanding this process is important to inform educational interventions and programs that help caregivers learn to support and advocate effectively for TGDY.

Longitudinal Family Functioning and Mental Health in Transgender and Nonbinary Youth and Their Families

This study examined concordance of family members' perspectives of family functioning and mental health across two years in families with transgender and/or nonbinary youth (TNBY). Participants were 89 family members (30 TNBY, age 13-17 years; 44 cisgender caregivers; 15 cisgender siblings, age 14-24 years) from 30 families from the U.S. New England region. Family members completed an online survey every 6-8 months for 5 waves between December 2015 and Feb 2019. Surveys assessed family functioning (quality of communication, satisfaction with family) and the following mental health-related outcomes: depression and anxiety symptoms, non-suicidal self-injury, suicidality, self-esteem, and resilience. Analyses tested concordance of family functioning and mental health across family members. Reports of family functioning changed over time, and family members were not consistently concordant in their reports of family functioning. Caregivers perceived a higher quality family communication than TNBY at all waves and higher than siblings at some waves. Perceptions of family satisfaction did not show a clear pattern between family member types across waves. The greatest concordance of perceived family functioning was between caregivers and siblings and between TNBY and siblings. Across all waves, TNBY reported more severe depression and anxiety symptoms than their caregivers and siblings, and more non-suicidal self-injury than their siblings. Compared to siblings, TNBY reported higher self-esteem, but less resilience. This study highlights opportunities for intervention in clinical work with TNBY and their families. Providers working with families with TNBY should use family systems approaches to support the mental health of all family members.

Examining developmental assets of young Black sexual gender minority males in preventing suicidal behaviors

Black gay and bisexual male adolescents and young adults (BGBMA/YA) are at higher risk for suicidal outcomes given their minoritized and stigmatized identities at the intersection of race and sexual orientation. This study explores key developmental assets, including family support and family communication, and their role in preventing depression symptoms and suicidal outcomes among BGBMA/YA. A cross-sectional survey was administered to participants (N = 400, Mage = 23.46, SD = 2.59) recruited through Amazon M-Turk, community-based organizations, and social media sites. A path analysis was conducted to examine associations among external assets (family support, communication about sex and drugs with parents, open family communication), depression symptoms, and suicidal attempts and plan to die by suicide. About 28 % of respondents reported a suicide attempt in the past 12 months. Depression symptoms and communication about sex and drugs with parents were positively associated with plan to die by suicide. Family support was negatively associated with depression symptoms. Depression symptoms were positively associated with suicide attempts. Family support was indirectly and negatively associated with suicide attempts. Suggestions for future research and policy implications are discussed.

Interpersonal protective factors for LGBTQ+ youth at multiple intersecting social identities and positions

Interpersonal supports are protective against multiple negative health outcomes for youth such as emotional distress and substance use. However, finding interpersonal support may be difficult for youth exposed to intersecting racism, heterosexism, and cisgenderism, who may feel they are "outsiders within" their multiple communities. This study explores disparities in interpersonal supports for youth at different sociodemographic intersections. The 2019 Minnesota Student Survey includes data from 80,456 high school students, including measures of four interpersonal supports: feeling cared about by parents, other adult relatives, friends, and community adults. Exhaustive Chi-square Automatic Interaction Detection analysis was used to examine all interactions among four social identities/positions (racialized/ethnic identity, sexual identity, gender identity, sex assigned at birth) to identify groups who report different rates of caring from each source (Bonferroni adjusted p<.05). In the overall sample, 69.24% perceived the highest level of caring ("very much") from parents, 50.09% from other adult relatives, 39.94% from friends, and 15.03% from community adults. Models identified considerable differences in each source of support. For example, more than 72% of straight, cisgender youth reported their parents cared about them very much, but youth who identified as LGBQ and TGD or gender-questioning were much less likely to report high parent caring (less than 36%) across multiple racialized/ethnic identities and regardless of sex assigned at birth. Findings highlight the importance of better understanding the ways interpersonal support might differ across groups, and underscore a need for intersectionality-tailored interventions to develop protective interpersonal supports for LGBTQ+ youth, rather than one-size-fits-all approaches.

Mapping the Dynamic Complexity of Sexual and Gender Minority Healthcare Disparities: A Systems Thinking Approach

Sexual and gender minority (SGM) populations experience extensive health disparities compared to their straight and cisgender counterparts. The importance of addressing these disparities is paramount, as SGM groups often encounter significant barriers to accessing comprehensive healthcare, including societal stigma, provider bias, and financial constraints. This study utilizes a community-based system dynamics approach to understand and visualize the barriers to and facilitators of healthcare engagement for SGM groups across their life course. It aims to identify core constructs, relationships, and dynamic feedback mechanisms related to the experiences of connection/disconnection with physical, mental, and dental healthcare of SGM individuals. Barriers to access, such as discriminatory practices and the limited availability of SGM-informed healthcare professionals, exacerbate these disparities, underscoring the urgency of developing targeted interventions. System dynamics, a complex systems science (CSS) methodology, was used for this research. Group model building sessions were conducted with diverse SGM groups, including youth, older adults, and trans and gender-expansive community members. Causal loop diagrams were developed according to an iterative process, and a meta-model of their collective experiences was created. The study revealed extensive, dynamic, and shifting structural barriers for SGM community members accessing healthcare. Societal and structural stigma, provider bias, and pathologization were identified as significant barriers throughout their life course. Community-led interventions and SGM-focused holistic healthcare were identified as critical facilitators of SGM healthcare connection. The findings highlight the need for SGM-affirming and culturally responsive healthcare settings. This paper calls for a concerted effort from SGM health researchers to use CSS in developing interventions to reduce SGM health disparities.

Patterns and practices of parenting transgender children: A brief Comparative study

The practices of parents raising children with trans* life experiences influence their subsequent social adjustment. The aim of the study was to identify potential differences in parenting patterns and practices between two groups, one comprising families with transgender children and the other group comprising families with cisgender children. Twenty-eight adults and 15 children and adolescents from Bogotá, Colombia, participated. We performed descriptive, nonparametric comparative, and Bayesian comparative analyses for independent samples. We used a frequentist inferential comparative method with the Mann-Whitney U test with an effect size based on rank-biserial correlation, which revealed no statistically significant difference values. Bayesian comparisons showed minimal evidence in favor of the null hypothesis in all comparisons performed, except for the Behavioral Control or Regulation variable. The main finding of this study suggests that parents of children with trans* life experiences may not be addressing their specific needs, which could lead to a lack of understanding of their situation and support in their transition process.

Sexual Minority Identity Development: Latent Profiles of Developmental Milestones in a National Probability Sample

Sexual identity development milestones mark the ages at which sexual minority people first experience key developmental events including same-sex attraction, self-realization of a sexual minority identity, same-sex sexual behavior and romantic relationships, and sexual identity disclosure. Most studies of milestones use variable-centered, rather than person-centered approaches, potentially obscuring diversity in patterns across milestones. Using data from The Generations Study, the first national probability sample of White, Black, and Latinx sexual minority adults in the United States (n = 1,492), we examined variability in milestone timing and patterning using a latent profile analysis approach. We identified four distinct profiles, characterized by variability in milestone mean ages, pacing, and sequences: an early adolescence profile (22.9%), a middle adolescence profile (33.6%), a late adolescence profile (27.6%), and an adulthood profile (15.9%). Profiles were demographically distinct, varying by birth cohort, sexual identity, race/ethnicity, gender identity, and childhood gender nonconformity. Results suggest developmental and demographic diversity in the emergence of sexual identity development across the life course, with implications for sexual minority health and thriving.

Right Versus Wrong: A Qualitative Appraisal With Respect to Pandemic Trajectories of Transgender Population in Kerala, India

The transgender population generally faces rights violations and discrimination in their day-to-day lives, which was exacerbated during the recent pandemic. This necessitates close scrutiny from an ethics perspective. Following directives from a 2014 Supreme Court judgement, Kerala became the first Indian state to implement a comprehensive policy to enforce the constitutional rights of transgender people. Despite such positive actions, a basic social tendency not to respect gender diversity has led to discrimination and marginalization. This was very evident during the pandemic. In this empirical work, we have documented the lives of the transgender community during the pandemic wherein they share experiences related to livelihood, interaction with the healthcare system, and acceptance in society vis-à-vis the pandemic. Simply providing third-gender status will not help the gender-marginalized community to grow to their fullest potential and have a better lifestyle on par with others in mainstream society.

Unveiling Gender Dysphoria Experiences in Turkish Young Adults: Challenges, Perspectives, and Implications in Health Care Settings

Purpose

Gender dysphoria (GD) emerged as a focal area in child and adolescent development research. While the intricacies of diagnosis and interventions for GD intertwine with diverse socio-cultural challenges, a notable dearth of knowledge exists about the experiences of transgender (TG) individuals during their formative years in Turkey. This study aims to unveil these experiences, shedding light on the challenges, perspectives, and implications in health care settings.

Patients and Methods

Our study encompassed 125 participants: 62 TGs under clinical follow-up, and a control group of 63 cisgender individuals. Surveys tailored to TG participants addressed early GD experiences, gender-typed activity participation, and psychosocial challenges from childhood through adolescence. Additionally, both cohorts contributed to a survey on attitudes towards community-based interventions, allowing for a comparative analysis of their perspectives.

Results

TGs identified their GD around age 10.77. Female-to-male TGs showed more involvement in traditionally male-associated activities, whereas male-to-female engaged more in female-associated domestic role-plays (p<0.001). Over a third (37.09%) faced ostracization or bullying due to GD, 45.16% encountered verbal abuse, and 12.90% reported physical violence. Additionally, 40.32% had undergone treatment for depression and anxiety disorders. Most participants supported awareness initiatives, advocating for open gender expression, and normalizing the experiences of TG youth. Furthermore, 88.71% of TGs emphasized the importance of enhancing the expertise of professional groups, such as medical and mental health practitioners, in GD matters, a sentiment echoed by 68.25% of cisgender participants (p=0.030). While medical interventions were the least favored strategy at 32.80% overall, 46.78% of TGs supported it, compared to 19.05% of controls (p=0.010).

Conclusion

Our study underscores the challenges faced by TG individuals during development. Early recognition, societal awareness, enhanced training in professional healthcare environments, and comprehensive support are crucial for fostering acceptance and reducing adversity among children and adolescents navigating GD.

Understanding the Role of Patient Portals in Fostering Interprofessional Collaboration Within Mental Health Care Settings: Mixed Methods Study

BACKGROUND

Patient portals are web-based systems through which patients can access their personal health information and communicate with their clinicians. The integration of patient portals into mental health care settings has been evolving over the past decade, as cumulated research to date has highlighted the potential role of portals in facilitating positive health outcomes. However, it is currently unknown whether portal use can foster interprofessional collaboration between clinicians and patients or whether the portal is a tool to support an already established collaborative relationship.

OBJECTIVE

This mixed methods study aimed to understand how the use of a patient portal within mental health settings can impact the level of interprofessional collaboration between clinicians and patients.

METHODS

This study was conducted in a large mental health care organization in Ontario, Canada. A convergent mixed methods design was used, where the primary data collection methods included questionnaires and semistructured interviews with patients who had experience using a portal for their mental health care. For the quantitative strand, participants completed the Health Care Communication Questionnaire and the Self-Empowerment subscale of the Mental Health Recovery Measure at 3 time points (baseline, 3 months of use, and 6 months of use) to measure changes in scores over time. For the qualitative strand, semistructured interviews were conducted at the 3-month time point to assess the elements of interprofessional collaboration associated with the portal.

RESULTS

For the quantitative strand, 113 participants completed the questionnaire. For the Health Care Communication Questionnaire scores, the raw means of the total scores at the 3 time points were as follows: baseline, 43.01 (SD 7.28); three months, 43.19 (SD 6.65); and 6 months, 42.74 (SD 6.84). In the univariate model with time as the only independent variable, the scores did not differ significantly across the 3 time points (P=.70). For the Mental Health Recovery Measure scores, the raw mean total scores at the 3 time points were as follows: baseline, 10.77 (SD 3.63); three months, 11.09 (SD 3.81); and 6 months, 11.10 (SD 3.33). In the univariate model with time as the only independent variable, the scores did not differ significantly across the 3 time points (P=.34). For the qualitative strand, 10 participants were interviewed and identified various elements of how interprofessional collaboration can be supplemented through the use of a patient portal, including improved team functioning, communication, and conflict resolution.

CONCLUSIONS

Although the quantitative data produced nonsignificant findings in interprofessional collaboration scores over time, the patients' narrative accounts described how the portal can support various interprofessional collaboration concepts, such as communication, leadership, and conflict resolution. This provides useful information for clinicians to support the interprofessional relationship when using a portal within a mental health setting.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1136/bmjopen-2018-025508.

Lessons from Grassroots Efforts to Increase Gender-Affirming Medical Care for Transgender and Gender Diverse Youth in the Community Health Care Setting

Increasingly, transgender and gender diverse (TGD) youth are seeking gender-affirming medical care. Most multidisciplinary gender-affirming pediatric clinics are located in academic facilities in urban areas. To improve access to care and advance the field, grassroots establishment-without targeted funding or explicitly trained gender health providers-of multidisciplinary gender health clinics in rural and community health care settings can increase care access and lay the foundation for dedicated funding, staff, and clinic space. In this perspective piece, we share our grassroots process of establishing a multidisciplinary gender health clinic in the community setting, highlighting critical turning points that facilitated our clinic's rapid growth. Our experience can provide important lessons learned for community health care systems seeking to establish programs that will serve TGD youth.

Gender-Affirming Care in Children

Cast into the spotlight because of recent legislative actions, gender-affirming care is a hot topic of discussion across the country when it comes to pediatric health care. And yet there is a great deal of misinformation being perpetuated about gender-affirming care that may be harmful to youth who identify as transgender and gender diverse (TGD). In addition, TGD youth continue to be an underserved and marginalized group that receive disparate health care at baseline. It is our role as pediatricians to understand the current landscape of evidence and guidance available to promote the health of TGD youth while reducing discrimination through education, nonjudgmental holistic treatment, and advocacy at local and national levels. [Pediatr Ann. 2023;52(5):e160-e163.].

Associations Among Gender-Affirming Hormonal Interventions, Social Support, and Transgender Adolescents' Mental Health

PURPOSE

We aimed to examine the concurrent associations of gender-affirming hormonal interventions (i.e., puberty blockers, testosterone, estrogen), as well as family and friend social support, on transgender and nonbinary (TNB) adolescents' reports of anxiety symptoms, depressive symptoms, nonsuicidal self-injury (NSSI), and suicidality. We hypothesized that gender-affirming hormonal interventions and greater social support would be associated with lower levels of mental health concerns.

METHODS

Participants (n = 75; aged 11-18; M_age = 16.39 years) were recruited for this cross-sectional study from a gender-affirming multidisciplinary clinic. Fifty-two percent were receiving gender-affirming hormonal interventions. Surveys assessed anxiety and depressive symptoms, NSSI and suicidality in the past year, and social support from family, friends, and significant others. Hierarchical linear regression models examined associations between gender-affirming hormonal interventions and social support (i.e., family, friend) with mental health while accounting for nonbinary gender identity.

RESULTS

Regression models explained 15%-23% of variance in TNB adolescents' mental health outcomes. Gender-affirming hormonal interventions were associated with fewer anxiety symptoms (β = -0.23; p < .05). Family support was associated with fewer depressive symptoms (β = -0.33; p = .003) and less NSSI (β = -0.27; p = .02). Friend support was associated with fewer anxiety symptoms (β = -0.32; p = .007) and less suicidality (β = -0.25; p = .03).

DISCUSSION

TNB adolescents had better mental health outcomes in the context of receiving gender-affirming hormonal interventions and having greater support from family and friends. Findings highlight the important role of quality family and friend support for TNB mental health. Providers should aim to address both medical and social factors to optimize TNB mental health outcomes.

Predictors of self-harm and suicide in LGBT youth: The role of gender, socio-economic status, bullying and school experience

BACKGROUND

Lesbian, gay and bisexual (LGB) young people's increased risk of self-harm, suicidal attempts and suicide compared with heterosexual youth is well established. The current study sought to examine whether these findings also apply to the trans (T) population and which factors act as additional risk or protective factors.

METHODS

In a national cross-sectional survey, 3713 LGBT adolescents, aged 11-19 years, reported on their own history of self-harm, suicidal ideation and suicide attempts, as well as their experiences of school and homophobic, biphobic and transphobic bullying. Logistic regressions tested the association between risk and protective factors on self-harm, suicidal ideation and suicide attempts.

RESULTS

A high proportion of the sample reported self-harm (65.3%), suicidal ideation (73.8%) and suicide attempts (25.7%). Demographic risk factors included identifying as female, non-binary or trans and being from a low-income background. Bullying and online bullying were associated with an increased risk for each outcome, and positive school experience was associated with a reduced risk for each outcome.

CONCLUSIONS

Consistent with minority stress theory, the study found high rates of mental health problems within LGBT youth. Interventions focused on improving young people's experiences in schools appear useful targets to help improve mental health outcomes.

The associations between social environment and adolescents’ psychosomatic health: An ecological perspective

Objectives

It has been known that social environments are associated with adolescents’ health. However, the complex relationship between diverse types of social environments and adolescents’ psychosomatic heath remained unclear. Thus, using an ecological perspective, the current study aimed to examine the associations between social environment and adolescents’ psychosomatic health.

Methods

We used the data from the Health Behavior in School-aged Children (HBSC) project conducted in the Czech Republic in 2018. A total of 13377 observations were included.

Results

The region, as a macrosystem, could not explain the variance in adolescents’ psychological and somatic health. The quality of neighborhood environment (exosystem) was significantly related to adolescents’ psychological and somatic health. At the microsystem level, teacher support had stronger, family support had weaker, and peer support had no association with psychological and somatic health. At the mesosystem level, the interactions between family, teacher, and friend support were negligible for adolescents’ psychological and somatic health.

Conclusions

The results underscore the importance of teachers’ support and neighborhood environment for adolescents’ psychosomatic health. Therefore, the findings suggest the need to improve teacher-adolescent relationships and the neighborhood community quality.

"We don't have a template to follow": Sexual identity development and its facilitative factors among sexual minority men in the context of China

Extant research on sexual identity development among sexual minority individuals has been predominantly conducted in Western contexts and focused on factors that hinder identity development processes. Using thematic analysis, this qualitative study sought to explore the experiences of sexual identity development among Chinese sexual minority men as well as the facilitative factors in China that positively influence this developmental process. The sample comprised 24 participants who self-identified as Chinese sexual minority men. The analysis yielded five overarching themes: awareness of one's attraction and corresponding reactions, identity exploration, moving toward identity acceptance and commitment, acceptance and support from others, and environmental support. The first three themes described the processes of sexual identity development among Chinese sexual minority men, whereas the latter two themes centered on the related facilitative factors in the context of China. The results highlight the importance of understanding the identity development process within Chinese minority men's unique sociocultural contexts. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Association between co-residence and loneliness during COVID-19 among sexual minority people in Hong Kong

BACKGROUND

Research has identified that loneliness during COVID-19 is associated with co-residence status, and individuals living alone were more likely to report loneliness. However, it may not apply to sexual minority people as those living with their family may experience different sexual orientation-related stressors.

AIMS

This study aims to (1) understand the pattern of living arrangement and loneliness among sexual minority people during COVID-19, (2) examine parental acceptance, family conflict and loneliness among sexual minority people with different living arrangements and (3) investigate the association between parental acceptance and loneliness among sexual minority people with different living arrangements during COVID-19.

METHOD

An online survey with 1,457 Hong Kong sexual minority people was conducted.

RESULTS

Sexual minority people living with their partner(s) were less likely to report loneliness. Concurrently, those living with their parent(s) showed a similar level of loneliness as those who lived alone. Living with parent(s) during COVID-19 does not necessarily alleviate feelings of loneliness among them, which we argue may be due to parental unacceptance of their sexual orientation. Nearly half of the respondents stated that their parent(s) were unaccepting of their sexual orientation and 41.8% of them indicated an increase in family conflict during COVID-19. For those living with their parent(s), parental unacceptance is related to more family conflict during COVID-19, which in turn is associated with higher levels of loneliness.

CONCLUSIONS

Not living with unaccepting parents may reduce family conflict and feelings of loneliness, but this has not been the case for many respondents from a city with high population density and cost of living. Social and mental health service providers need to come up with timely and appropriate interventions to address the unique needs faced by sexual minority people during and after the COVID-19 pandemic.

Measurement equivalence of family acceptance/rejection among sexual and gender minority youth by disclosure status

Family acceptance is a crucial component of healthy development during adolescence, especially for sexual and gender minority youth (SGMY) who often fear rejection from family members. Studies focused on SGMY family environments often utilize broad measures that fail to capture SGMY-specific aspects of family acceptance and rejection. Less research has considered how the measurement of family acceptance and rejection might differ depending on whether SGMY have disclosed their sexual and/or gender identities to their parents. We used data from a national nonprobability sample of 9,127 SGMY in the United States who had either disclosed (n = 6,683) or not disclosed (n = 2,444) their sexual and/or gender identities to parents to test the factor structure of an eight-item measure of family acceptance and rejection and differences by disclosure status. A two-factor, negatively correlated model reflecting constructs of family acceptance and family rejection was equivalent across disclosure groups. Youth who had disclosed their identity reported greater acceptance and less rejection and showed a stronger negative association between the two constructs than nondisclosed youth. Family acceptance, but not rejection, had higher variability among disclosed youth than nondisclosed youth. Results suggest that the family environments of SGMY are simultaneously characterized by accepting and rejecting behaviors. Though families of disclosed youth appear to be more accepting and less rejecting, the experiences of these youth are complex. Findings suggest that research on SGMY family environment must consider both supportive and undermining behaviors and that the measures assessed here operate similarly for youth based on disclosure. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Psychosocial challenges and coping strategies among people with minority gender and sexual identities in Zambia: health promotion and human rights implications

Background

Sexual and gender minorities face high levels of stigma, discrimination, and violence. In many countries, they are often criminalized and are at risk of mental health challenges. In Zambia, little is known about the psychosocial challenges and coping strategies of sexual and gender minorities. This study sought to explore psychosocial challenges and coping strategies among sexual and gender minority populations in Lusaka, Zambia to inform mental health and human rights promotion for this population.

Methods

The study used a qualitative phenomenological study design. Data were collected through in-depth interviews with 16 sexual and gender minority participants (lesbian, gay, bisexual, and transgender) and four key informants. The sexual minorities included four lesbian, five gay, and three bisexual participants while the gender minorities included two transgender men and two transgender women. Interviews with gender and sexual minorities were mostly focused on the lived experiences of participants, while those of key informants focused on their work with sexual and gender minorities. Snowball strategy was used to recruit participants, while purposive sampling was used to select key informants. All interviews were recorded and transcribed verbatim. Thematic analysis was carried out with the aid of Nvivo 12 software.

Results

Psychosocial challenges included victimization in the form of threats and physical assault. Stigma and discrimination were experienced in different settings such as healthcare, the workplace, and school. Participants reported having experienced feelings of depression. Rejection from family members was experienced by those who revealed their sexual or gender minority status. Reported coping strategies included social support, self-concealment, listening to music, and substance use.

Conclusion

This study suggests that sexual and gender minorities in Zambia experience various psychosocial challenges related to their sexuality and gender identity. To assist them cope better with the obstacles they experience, improved psychosocial counseling and mental health services are needed.

"You're not gay; You're a child of god": Microaggressions experienced by LGBTQ+ teens and their parents in the Church of Jesus Christ of Latter-day saints

Like other teens in conservative religious environments, LGBTQ+ teens raised in the Church of Jesus Christ of Latter-day Saints (CJCLDS) likely experience unique microaggressions. Furthermore, like other conservatively religious parents of LGBTQ+ teens, active Latter-day Saint (LDS) parents who openly support their LGBTQ+ teens likely both witness microaggressions toward their teens and may personally experience microaggressions. The present study sought to understand parents' and teens' experiences of microaggressions in conservative religious contexts by focusing specifically on the microaggressions experienced by (a) LGBTQ+ teens raised in the CJCLDS and (b) their active LDS parents. Thematic analysis of separate interviews with 19 dyads of LGBTQ+ teens and their active LDS parents (38 total interviews) revealed various ways in which they experienced verbal, nonverbal, and environmental microaggressions. We highlight parents' and teens' shared experiences of microaggressions that may be uniquely related to their religious contexts, such as assumptions that LGBTQ+ teens or their parents are not faithful and exclusionary Church policies. Additionally, we identified microaggressions that specifically targeted parents of LGBTQ+ teens, such as comments suggesting parents should limit their support for their teens. Finally, we found that parents had vicarious experiences with microaggressions through witnessing or learning about microaggressions that targeted their teens. Findings highlight the ways that the religious contexts in which microaggressions occur can influence the way that microaggressions are communicated to and experienced by LGBTQ+ teens - and their parents.

Support over Social Media among Socially Isolated Sexual and Gender Minority Youth in Rural U.S. during the COVID-19 Pandemic: Opportunities for Intervention Research

Sexual and gender minority (SGM) rural adolescents are at risk for higher levels of social isolation, a well-known risk factor for depression and other negative health outcomes. We qualitatively examined how rural SGM youth seek emotional and informational support, which are protective factors for social isolation on social media (SM) regarding their SGM identity, and determined which SM platforms and tools are most effective in providing support. We conducted semistructured online interviews with rural SGM teens who screened positive for social isolation in spring 2020 and used a thematic analysis approach to analyze the data. Sixteen youths participated in interviews. Themes included seeking emotional support through SM groups and communities, seeking emotional support in designated online SGM spaces, using SM feeds for informational support, and disclosing SGM identity differentially across platforms. SM-based interventions could be leveraged to provide emotional and informational support for rural SGM youth across specific SM platforms and consider whether they are providing emotional or information support. Interventions focused on informational support may best be used on content-based platforms. Those designed to combat social isolation and connect marginalized SGM youths to similar others might benefit from community and forum-based platforms.