Childhood adversities are common among trans people and associated with adult depression and suicidality

Relationship between early maladaptive schemas (EMSs), adverse childhood experiences and mental health in adulthood among transgender individuals

Background: Transgender individuals experience a high level of distress over the lifespan and are at a higher risk of experiencing mental health conditions.Objective: The present study mainly aimed to investigate the complex relationship between early maladaptive schemas (EMSs), adverse childhood experiences and mental health conditions in adulthood among transgender individuals.Method: 220 participants completed an anonymous online study assessing sociodemographic and medical status, experience of childhood adversity (CTQ), EMSs (YSQ-S3), transgender specific quality of life (ETLI), current depression (PHQ-8), and generalised anxiety severity (GAD-7).Results: Transgender individuals tended to have a high prevalence for experiencing childhood adversity as well as for depressive and generalised anxiety symptoms and low quality of life in adulthood, while assigned female at birth (AFAB) transgender tend to be more vulnerable than assigned male at birth (AMAB) transgender. In general, transgender individuals showed an elevated pronounced level of EMSs, while AFAB transgender tended to focus more on the negative aspects in life, to strive more to pursue perfection and tended more to be highly critical towards others and especially themselves, as well as tended to believe that people should be harshly punished for making mistakes than AMAB transgender. According to the network analysis, schema domain and their EMSs were related to all assessed psychopathological outcomes, especially the schema domains Disconnection and Rejection and Impaired Autonomy and Performance seemed to be related to experience of childhood adversity and quality of life in adulthood.Conclusions: Transgender individuals seem to experience a high level of childhood adversity, which possibly leads to the development of an elevated level of EMSs. EMSs and their schema domains are associated with elevated depressive and generalised symptoms, as well as lower quality of life.

The mediating role of childhood maltreatment in the association between being left-behind and adolescent anxiety

BACKGROUNDS

Left-behind and separated from parents are common among Chinese adolescents and many developing countries, which may cause maltreatment and mental disorders, especially anxiety. Nevertheless, the comprehensive study in the prevalence of childhood maltreatment and its role in anxiety among left-behind adolescents is still insufficient.

METHODS

A nationally representative middle school sample of 32,620 adolescents participated the pen-paper survey regarding demographics, left-behind status and the source of abuse. The Generalized Anxiety Disorder-7 and Chinese version of the Childhood Trauma Questionnaire were used to assess anxiety symptoms and maltreatment experience. The analyses in prevalence, risk factors and mediating effects were preformed in SPSS 27.

RESULTS

30,174 valid questionnaires were collected, of which 2748 were left-behind adolescents. 46.4 % of left-behind and 35.6 % of non-left-behind adolescents reported anxiety, and left-behind increased risk of anxiety (OR = 1.180, 95%CI: 1.180-1.286, p < 0.001). In left-behind adolescents, female sex, older age, and maltreatment experience were risk factors of anxiety. Additionally, left-behind adolescents were more likely to suffer serious abuse and all abuse subtypes. The maltreatment almost completely mediated the association between left-behind and anxiety (0.857, 95%bootstrap CI = 0.743, 0.976), of which emotional abuse played the largest role (0.648, CI = 0.547, 0.751), followed by physical neglect, emotional neglect, and sexual abuse.

CONCLUSION

This study revealed the prevalence of anxiety and maltreatment in Chinese left-behind adolescents, and suggested that the maltreatment might significantly mediate the anxiety of left-behind adolescents. This may shed a light on other developing countries where the phenomenon of left-behind adolescents exists.

Similarities and differences in the functions of non-suicidal self-injury (NSSI) across gender non-conforming and cisgender young adults

BACKGROUND

Non-suicidal self-injury (NSSI) can be motivated by a broad range of functions and many individuals report multiple reasons for self-injuring. Most NSSI research has involved predominantly female samples and few studies have examined gender similarities and differences in function endorsement.

METHODS

We characterise the prevalence and versatility of NSSI functions within a gender-diverse online sample of cisgender women (cis-women; n = 280), cisgender men (cis-men; n = 176), and transgender, non-binary, and other gender non-conforming young adults (TGNC; n = 80) age 18-30 (M = 23.73, SD = 3.55). The Ottawa Self-Injury Inventory (OSI-F) assessed 24 intrapersonal and social functions across nine domains: affect regulation, self-punishment, anti-dissociation, anti-suicide, sensation seeking, sexuality, interpersonal influence, and body image.

RESULTS

TGNC participants and cis-women were significantly more likely to report intrapersonally motivated NSSI and greater function versatility than cis-men. Low mood, emotional distress, suicidality, and trauma symptomology appeared to contribute to gender differences in function endorsement. Gender similarities also emerged; across groups, intrapersonal functions were substantially more common than social functions, and the most endorsed domains were affect regulation and self-punishment. No domains were gender specific.

LIMITATIONS

The OSI-F was developed from majority female samples and may not adequately capture the experiences of other gender groups.

CONCLUSIONS

Interventions which reduce distress and strengthen emotion regulation are likely to benefit individuals who self-injure regardless of gender. However, most individuals report multiple NSSI functions and person-centred interventions which address this complexity are needed. Future research should develop gender-informed treatment models which consider the unique experiences of TGNC individuals and cis-men who self-injure.

Psychosexual Health and Well-Being of Trans and Gender-Diverse Individuals in Portugal

This study aimed to explore and describe the perceptions of trans and gender-diverse individuals (TGD) in Portugal regarding the implications on their psychological, social, and psychosexual health. A qualitative investigation was conducted using an electronic interview answered by 32 participants. The data were examined through a thematic analysis, and the following themes were identified: experiences with healthcare services, social interaction, discrimination experiences, mental health, social support systems, self-esteem, social identity, sex and sexual health, quality of life, and sociopolitical enhancement strategy proposals. The analysis of these themes provides information on the perceptions and experiences of the participants and suggests factors that impact the well-being and quality of life of the individuals in the current sample.

Associations between early child adversity and lifetime suicide attempts among gender diverse individuals: A moderated mediation

BACKGROUND

This study examines the effect of adverse childhood experiences (ACEs) on lifetime suicide attempts (LSA) across five gender subgroups (i.e., transgender men, transgender women, transgender non-binary, cisgender men and cisgender women).

OBJECTIVE

To examine (1) the prevalence of LSA across gender identity subgroups; (2) whether the association between ACEs and LSA is moderated by gender identity subgroup; (3) depressive symptoms, alcohol use disorder, social support, and social well-being as mechanisms linking ACEs with LSA; and (4) the moderating role of gender identity on the four putative mediators.

PARTICIPANTS AND SETTINGS

We used nationally representative data from a population-based survey of N = 1368 transgender and cisgender individuals collected between 2016 and 2019.

METHODS

Structural equation modeling was used to explore the indirect effect of depressive symptoms on the relation between ACEs and LSA, and the moderating impact of gender identity.

RESULTS

LSA was significantly more prevalent among transgender respondents (cisgender man = 5 %; cisgender woman = 9 %; transgender man = 42 %; transgender woman = 33 %; transgender non-binary = 37 %; p < 0.001). Individuals with more ACEs had a greater risk of engaging in LSA regardless of gender identity; however, moderation results showed that the impact of each additional ACE on LSA was stronger for individuals with transgender identities: the likelihood of engaging in LSA was statistically similar for transgender men with no ACEs and cisgender men with all 8 ACEs. Indirect effects of ACEs on LSA via depressive symptoms were also observed, and the mediating effect was moderated by gender identity.

CONCLUSIONS

By examining the mechanisms linking childhood adversity to LSA, this study demonstrates that not all ACEs impact gender minority subgroups equally.

Higher Prevalence of Adverse Childhood Experiences in Transgender Than in Cisgender Individuals: Results from a Single-Center Observational Study

Adverse childhood experiences (ACE) have been shown to have a tremendous negative impact on health outcomes later in life. This study presents data on the prevalence of ACEs, psychological distress, and trauma-related symptoms in transgender and gender-diverse (TGD) people compared to cisgender people. TGD adults (n = 35) and a matched sample of nonpsychiatric hospital patients (n = 35) were surveyed between September 2018 and March 2019. Participants completed the Maltreatment and Abuse Chronology of Exposure Scale to assess ACEs, as well as the Brief Symptom Inventory and the Essener Trauma Inventory to assess psychological distress and trauma-related symptoms. TGD patients reported a higher number of ACEs than cisgender patients (0.7 vs. 2.4; p < 0.001; d = 0.94). A total of 28.6% of TGD vs. 5.7% cisgender patients reported four or more ACEs (p < 0.001). The most common forms of ACEs were parental abuse (54.3%) and peer abuse (54.3%). No significantly increased prevalence of sexual abuse was found (p > 0.05). TGD patients also reported a higher prevalence of depression (48.4% vs. 5.7%, p < 0.001), posttraumatic stress disorder symptoms (59.4% vs. 13.8%, p < 0.001), and anxiety (58.1% vs. 28.6%, p = 0.016). Health care providers should be aware of and assess ACEs, especially in vulnerable groups such as TGD people, and create a safe place through open-minded, affirming care.

Suicide-Related Outcomes Following Gender-Affirming Treatment: A Review

Gender-affirming treatment remains a topic of controversy; of particular concern is whether gender-affirming treatment reduces suicidality. A narrative review was undertaken evaluating suicide-related outcomes following gender-affirming surgery, hormones, and/or puberty blockers. Of the 23 studies that met the inclusion criteria, the majority indicated a reduction in suicidality following gender-affirming treatment; however, the literature to date suffers from a lack of methodological rigor that increases the risk of type I error. There is a need for continued research in suicidality outcomes following gender-affirming treatment that adequately controls for the presence of psychiatric comorbidity and treatment, substance use, and other suicide risk-enhancing and reducing factors. There is also a need for future systematic reviews given the inherent limitations of a narrative review. There may be implications on the informed consent process of gender-affirming treatment given the current lack of methodological robustness of the literature reviewed.

Emotions and sensory processing in adolescents: The effect of childhood traumatic experiences

Reportedly, maltreated children are more likely to have a mental illness, interpersonal violence, and other social behavior problems than those without trauma experience. However, there are few studies regarding childhood trauma and sensory processing relationship and the relationship is not clear until today. To verify the association between childhood trauma emotions and sensory processing in adolescents is the aim of this study. To gather traumatized adolescents, we conducted survey questionnaires from six alternative schools and one general high school in South Korea. A total of 260 students has answered the questions: trauma/parenting/school adaptation factors, childhood trauma, the difficulty of emotion regulation, positive and negative emotional measure, shortened self-control measure, and adolescent/adult sensory profile. We analyzed linear regression between childhood trauma and other emotions/sensory processing in total subjects and conducted group comparisons between general school and alternative school. With childhood trauma, negative emotion, emotion dysregulation, sensory profile including subscales showed positive correlations. A significant negative correlation was observed between the self-control scale and childhood trauma score. In group comparison results, trauma factors, primary caregiver, custody transfer, and school life adaptation factors were significantly higher in alternative school students (p < 0.002) while the parental relationship did not show a difference. Childhood trauma score, vision, and tactile were significantly higher in alternative school students. To summarize, our results present a direct effect of childhood trauma on sensory function in adolescents and was confirmed the importance of family environments in adolescents.

Early Life Adversity and Neuropsychiatric Disease: Differential Outcomes and Translational Relevance of Rodent Models

It is now well-established that early life adversity (ELA) predisposes individuals to develop several neuropsychiatric conditions, including anxiety disorders, and major depressive disorder. However, ELA is a very broad term, encompassing multiple types of negative childhood experiences, including physical, sexual and emotional abuse, physical and emotional neglect, as well as trauma associated with chronic illness, family separation, natural disasters, accidents, and witnessing a violent crime. Emerging literature suggests that in humans, different types of adverse experiences are more or less likely to produce susceptibilities to certain conditions that involve affective dysfunction. To investigate the driving mechanisms underlying the connection between experience and subsequent disease, neuroscientists have developed several rodent models of ELA, including pain exposure, maternal deprivation, and limited resources. These studies have also shown that different types of ELA paradigms produce different but somewhat overlapping behavioral phenotypes. In this review, we first investigate the types of ELA that may be driving different neuropsychiatric outcomes and brain changes in humans. We next evaluate whether rodent models of ELA can provide translationally relevant information regarding links between specific types of experience and changes in neural circuits underlying dysfunction.

Characteristics and Mediating Effect of Gut Microbiota With Experience of Childhood Maltreatment in Major Depressive Disorder

Gut microbiota and childhood maltreatment are closely related to depressive symptoms. This study aimed to analyze the characteristics of gut microbiota in major depressive disorder (MDD) patients with childhood maltreatment experience and explore the correlation between gut microbiota, childhood maltreatment, and depressive symptoms. A total of 37 healthy controls (HCs) and 53 patients with MDD were enrolled, including 18 MDD patients without childhood maltreatment experience and 35 MDD patients with childhood maltreatment experience. The Hamilton’s Depression Scale (HAMD-24) and Childhood Trauma Questionnaire-Short Form (CTQ-SF) were used to evaluate their depressive symptoms and childhood maltreatment experience, respectively. The composition of gut microbiota was evaluated using 16S rRNA sequencing. Spearman’s correlation analysis was used to evaluate the correlation between different gut microbiota, depressive symptoms and childhood maltreatment. The mediation analysis was used to evaluate the mediating effect of gut microbiota. In the α-diversity analysis, we found that the Simpson index and Pielou’s Evenness index differed significantly between MDD patients without childhood maltreatment experience and HCs. In the β-diversity analysis, principal coordinate analysis (PCoA) showed significant differences between MDD patients without childhood maltreatment experience, MDD patients with childhood maltreatment experience and HCs. Twenty-seven different bacteria were identified through Linear discriminant analysis effect size (LEfSe) analysis at different levels of classification. The analysis of the correlation showed that Blautia, Bifidobacterium, Bacteroides, Roseburia, and Phascolarctobacterium were significantly correlated with HAMD and CTQ-SF scores. The mediation analysis showed that childhood maltreatment had a significant direct effect on the patients’ depressive symptoms, and Blautia, Bifidobacterium, Roseburia had a significant mediating effect. The findings of this study suggested that MDD patients with childhood maltreatment experience had different gut microbiota, which might have a mediating effect on the influence of childhood maltreatment on depressive symptoms.

The association of different parenting styles among depressed parents and their offspring's depression and anxiety: a cross-sectional study

BACKGROUND

Parenting styles play a critical role in children's development, especially for those in families with a depressed parent. To date, no study has explored whether youth perceptions of parenting style are heterogeneous in families with a depressed parent or whether heterogeneous parenting styles are associated with children's internalizing symptoms.

METHODS

Participants were children aged 8-16 years who had a parent with major depressive disorder; they were enrolled through their parents, who were outpatients at two hospitals in Ningxia. Parenting styles were measured using the Parental Bonding Instrument. Youth depression and anxiety were measured using the Depression Self-Rating Scale for Children and the Screen for Child Anxiety-Related Emotional Disorders, respectively. We applied latent profile analysis to identify the subtypes of parenting styles with similar patterns. Differences between subtypes in relation to demographic variables and parenting style scores were calculated using one-way ANOVAs, Wilcoxon rank sum tests, and chi-squared tests. Bivariate logistic analyses were conducted to examine the associations between parental bonding subtypes and children's depression and anxiety.

RESULTS

Four parenting styles were identified through latent profile analysis: care-autonomy, overprotection-indifference, indifference, and undifferentiated parenting. Youth with care-autonomy parents had a lower risk of depression (OR: 0.16; 95% CI: 0.06-0.41) and anxiety (OR: 0.22; 95% CI: 0.10-0.48), while indifference parenting increased children's risk of depression (OR: 5.29; 95% CI: 1.30-21.54) more than undifferentiated parenting.

CONCLUSIONS

Children with a depressed parent had heterogeneous perceptions of parenting styles. Mothers' and fathers' parenting styles were largely congruent. Care-autonomy parenting (high care and high autonomy) may decrease children's risk of depression, whereas indifference parenting (low care and autonomy) may increase their risk of depression.