Trans adolescents' perceptions and experiences of their parents' supportive and rejecting behaviors

Suicide Ideation Among Transgender and Gender Diverse Adolescents: The Role of Parental Invalidation of Adolescents' Gender Identity

Transgender and gender diverse (TGD) youth experience chronic and acute stress associated with their gender identity contributing to their increased risk of suicide and suicide ideation (SI) compared to non-TGD peers. This study examined how invalidating and accepting gender-related experiences with a parent impact SI severity among TGD adolescents cross-sectionally and longitudinally, within-person. Participants were 15 TGD adolescents with past month SI recruited across community and clinical settings. Adolescents completed a baseline assessment of validated interviews and self-report measures on parental invalidation and SI severity. Over a 14-day follow-up period, adolescents reported instances of parental gender invalidation and acceptance, relative stress of those experiences, and SI severity multiple times/day via ecological momentary assessment (EMA). Bivariate associations of parental invalidation and acceptance with SI were examined at baseline, while multilevel models examined the relationship within-person over follow-up. Cross-sectionally, greater perceived invalidation and non-affirmation by their parents was associated with more severe SI. Over the follow up, instances of perceived parental invalidation were associated with passive SI within-person. Findings partially support the minority stress theory and social safety perspective by showing that perceived gender-invalidation from parents affects SI in TGD adolescents, both cross-sectionally and longitudinally. Further research is needed to identify specific emotional and cognitive factors, such as perceived stress, that contribute to the risk of SI among TGD youth and inform the development of targeted interventions for this vulnerable population.

Stress of being outed to parents, LGBTQ family support, and depressive symptoms among sexual and gender diverse youth

Limited scholarship has explored how a lack of agency in identity disclosure (being "outed") to parents is associated with mental health experiences of sexual and gender diverse youth (SGDY). With a national sample of SGDY (N = 9272; 66.8% White non-Hispanic) aged 13-17 (Mage  = 15.63, SD = 1.24), this study first compared social position differences between SGDY who were outed to their parents compared to those not outed, and second, investigated how the stress from being outed to parents was associated with LGBTQ family support and depressive symptoms. Results revealed that SGDY who were outed to their parents reported higher levels of depressive symptoms and lower amounts of LGBTQ family support than SGDY who were not outed to their parents. In addition, greater stress from being outed to parents was indirectly associated with higher depressive symptoms through lower LGBTQ family support. These relationships significantly varied across gender identity. Findings highlight the importance of instilling greater agency in disclosure experiences among SGDY.

Risk and protective factors for suicidality among lesbian, gay, bisexual, transgender, and queer (LGBTQ+) young people, from countries with a high global acceptance index (GAI), within the context of the socio-ecological model: A scoping review

INTRODUCTION

Lesbian, gay, bisexual, transgender, and queer (LGBTQ+) young people experience higher prevalence rates of suicidality than their heterosexual and/or cisgender peers. However, there is limited research that can inform suicide prevention efforts. Our aim was to synthesize quantitative, qualitative, and mixed methods research on risk and protective factors among LGBTQ+ young people, from countries with a high Global Acceptance Index.

METHODS

A scoping review guided by Arksey and O'Malley's five-stage framework, using the Preferred Reporting Items for Systematic Reviews and Meta-analysis Extension for Scoping Reviews protocol. Five databases and grey literature were searched for relevant studies. Identified factors were clustered by thematic type, according to the socio-ecological model to identify empirical trends and knowledge gaps. The mixed methods appraisal tool was used for quality assessment of studies.

RESULTS

Sixty-six studies met our inclusion criteria. Overall, 59 unique risk factors and 37 unique protective factors were identified. Key risk factors include past suicidality, adverse childhood experiences, internalized queerphobia, minority stress, interpersonal violence, bullying, familial conflict, and anti-LGBTQ+ policies/legislation. Key protective factors include self-affirming strategies, adult/peer support, at-school safety, access to inclusive healthcare, family connectedness, positive coming out experiences, gender-affirming services and LGBTQ+ inclusive policies and legislation.

CONCLUSIONS

Overall, our findings affirm that multiple risk and protective factors, at all levels of the socio-ecological model, interact in complex, unique and diverse ways upon suicidality among LGBTQ+ young people. Implications for suicide prevention are discussed. Further empirical studies are required, particularly at the communities, policies, and societal levels of the socio-ecological model, and these studies should include a focus on protective factors and significant within-group differences.

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.

Nine Ways Parents Can Support Their Gender Diverse Children

Parental support is associated with improved mental health outcomes for gender diverse youth (GDY). Parents often seek guidance from pediatric providers, but few studies explore what actions make GDY feel supported. Using a qualitative analysis of open-ended survey responses, we aimed to identify ways in which GDY want to be supported by their parents or caregivers. Nine key themes were identified, including using affirming language at home and other settings as desired by GDY, seeking education, and aiding in accessing affirming items and care. Findings from this study can help pediatric medical and mental health providers help parents to support their GDY.

Transgender and nonbinary young adults' depression and suicidality is associated with sibling and parental acceptance-rejection

INTRODUCTION

Transgender and nonbinary young adults (TNB YA) report high rates of depression and more suicidality than their cisgender counterparts. Parental rejection is a known predictor of worse mental health among TNB YA; however, less is known about TNB YA experiences of sibling acceptance-rejection. The purpose of this study was to determine how TNB YA perception of sibling and parental acceptance-rejection are related to TNB YA depression and suicidality.

DESIGN

Cross-sectional.

METHODS

TNB YA (ages 18-25) who had disclosed their gender identity to an adult sibling were recruited to take part in an online study and completed measures of sibling and parent acceptance-rejection, depression, as well as lifetime and past year suicidality. Stepwise regressions were conducted to evaluate associations between acceptance-rejection and TNB YA depression and suicidality.

RESULTS

The sample consisted of 286 TNB YA (Mage  = 21.5, SD = 2.2) who were predominantly White (80.6%) and assigned female sex at birth (92.7%). Each family member's acceptance-rejection was associated with increased TNB YA depression scores when considered independently and combined. Independently, high rejection from each family member was associated with greater odds of reporting most suicidality outcomes. When all family members were considered together, only high rejection from a male parent was associated with four times greater odds of reporting lifetime suicidality. High rejection from both parents was associated with greater odds of reporting past year suicide attempt (OR: 3.26 female parent; 2.75 male parent).

CONCLUSION

Rejection from family members is associated with worse depression and suicidality, and rejection from male parents may be particularly damaging. Sibling acceptance uniquely contributes to TNB YA's depression symptoms alone and in the context of parental support.

Measuring the prevalence and impact of adverse childhood experiences in the lives of LGBTQ individuals: A much-needed expansion

BACKGROUND

Numerous studies indicate that LGBTQ people have extensive experiences with adverse childhood experiences (ACEs), more so than their heterosexual and cisgender counterparts. Research also shows that LGBTQ youth endure traumatic experiences with victimization, including bullying, harassment, and violence, based on their non-hetero-cis-normative genders and/or sexual identities. Yet, most ACE measurement strategies fail to: (1) explicitly link the risk of ACE exposure to the discrimination and stigmatization of LGBTQ people, and (2) account for the breadth of potential ACE exposure in LGBTQ populations.

OBJECTIVE

In the current article, we develop and present a more comprehensive ACE measurement strategy for understanding the cumulative and deleterious impacts of ACEs in the lives of LGBTQ individuals.

METHODS

Here, we offer three expansions to the current ACE framework: (1) the inclusion of an LGBTQ-specific ACE in addition to the standard ACE measures, (2) the addition of LGBTQ qualifiers for current ACE items (when applicable), and (3) the expansion of ACE measures to capture the unique ACE experiences of LGBTQ individuals in family life, schools, and faith communities.

CONCLUSIONS

The implementation of a more comprehensive ACE measurement strategy will assist scholars and policymakers in better understanding the impacts of ACEs in the lives of LGBTQ individuals. In all, ACE measurement strategies that capture the breath of exposure of ACEs in the lives of LGBTQ individuals will assist in ACE screening, public health policy, and clinical intervention efforts.

Social Isolation: An Unequally Distributed Health Hazard

Social isolation is a potent predictor of poor health, mortality, and dementia risk. A great deal of research across national contexts provides causal evidence for these linkages and identifies key explanatory mechanisms through which isolation affects health. Research on social isolation recognizes that some people are more likely than others to be isolated, but over the past several decades, researchers have focused primarily on the consequences of isolation for health rather than a systematic assessment of the social conditions that foster isolation over the life course. In this article, we review the available evidence on inequities in social isolation and develop a conceptual framework to guide future research on structural systems that fuel social isolation over the life course. Future work in this area has the potential to identify root causes of inequality in social isolation, as well as targeted policy levers to reduce isolation in vulnerable populations.

Systematic Review of Interventions to Reduce Suicide Risk in Transgender and Gender Diverse Youth

Transgender youth experience high rates of suicidal ideation and suicide attempts. This systematic review sought to examine interventions for suicide prevention in transgender children and adolescents. Literature related to suicide in the transgender population was systematically collected in accordance with PRISMA criteria. Searches identified studies with at least one suicide prevention method for participants ages 24 years or younger with gender identity and sex clearly defined. Primary outcomes include suicide-related thoughts and behaviors. A total of 1558 citations were identified with 17 articles meeting inclusion criteria. Interventions with potential effectiveness included a gender-affirming crisis hotline, medical care via interdisciplinary gender clinics, online media-based outreach, safety and connectedness in schools, and family system-based interventions. In the included studies, the overall quality of evidence was low and the risk of bias high. Further high-quality studies are needed.

Gender-Sexuality Alliance Advisors' Self-Efficacy to Address Transgender Issues: An Interpersonal Protective Factor for Transgender Student Depression

Purpose: Our purpose was to assess the association between Gender-Sexuality Alliances (GSAs) advisors' self-efficacy to address transgender issues and their students' depressive symptoms, by students' gender identity (i.e., transgender vs. cisgender). We predict that higher advisor self-efficacy will be associated with decreases in student depressive symptoms for transgender students, though not necessarily for cisgender students. Methods: Data come from surveys of student members (n = 366) and advisors (n = 58) of 38 purposively sampled GSAs in Massachusetts high schools, in 2016-2017 and 2017-2018. We used a linear mixed-effects model to assess the association between advisor self-efficacy to address transgender issues and student change in Center for Epidemiological Studies Depression-10 scores between the beginning and end of the school year by gender identity, adjusting for student covariates. Results: Students were 10-20 years old (mean = 15, standard deviation [SD] = 1.4); 28% were transgender, 28% were students of color, and 86% were lesbian, gay, bisexual, or queer/questioning or other non-heterosexual identity. The GSA advisor self-efficacy scores ranged from 13 to 25 with a mean of 20.4 (SD = 3.0). Greater advisor self-efficacy to address transgender issues was associated with a decrease in depressive symptoms for transgender students (estimate = -0.47, p = 0.01), but not for cisgender students. Conclusions: GSA advisor self-efficacy to address transgender issues could be protective for transgender student depressive symptoms. Thus, increasing advisor self-efficacy to address transgender issues may help decrease depressive symptomatology for transgender youth, and intervention work in this area is needed to bolster this claim.

Intersectional microaggressions, depressive symptoms, and the role of LGBTQ-specific parental support in a sample of Latinx sexual and gender minority youth

INTRODUCTION

Latinx and sexual and gender minority (SGM) youth experience higher incidents of racism, cissexism, and heterosexism in the forms of overt discrimination and microaggressions. These experiences could in part explain increased negative mental health outcomes, such as depressive symptoms. Evidence points to the possibility that LGBTQ-specific parental support buffers the effects of intersectional microaggressions on depressive symptoms among Latinx SGM youth.

METHODS

In a sample of 1292 Latinx SGM youth (ages 13-17), we assessed: a) the association between LGBTQ-specific parental support and depressive symptoms, b) the associations between three forms of intersectional microaggressions and depressive symptoms, and c) whether parental LGBTQ-specific parental support moderated the relationship between three forms of intersectional microaggressions and depressive symptoms. Main effect and moderation analyses examined interactions between LGBTQ-specific parental support with each of the three forms of intersectional microaggressions on depressive symptoms.

RESULTS

We found that Latinx transgender youth experienced higher intersectional microaggressions compared to their cisgender counterparts and that Latinx SGM youth who reported lower LGBTQ-specific parental support experienced higher depressive symptoms. We also identified a significant interaction between intersectional microaggressions and LGBTQ-specific parental support, suggesting that parental support was more protective at low rather than high levels of intersectional microaggressions.

CONCLUSIONS

Findings suggest a need for future work examining culturally appropriate approaches to foster a supportive parent-child relationship among Latinx SGM youth and their parental figures.

University housing reinforces the negative relationship between interpersonal violence, psychological distress, and suicidality in undergraduates, particularly among gender diverse students

OBJECTIVE

To compare academic and mental health outcomes across diverse gender identities in the context of interpersonal violence and campus housing.

PARTICIPANTS

45,549 students from 124 self-selected post-secondary institutions.

METHODS

Various academic and health measures from the National College Health Assessment Spring 2017 dataset were analyzed for differences across five gender identities (cis women, cis men, transwomen, transmen, and genderqueer students), and two housing categories (university housing and non-university housing).

RESULTS

When compared to cisgender peers, gender diverse students reported greater experiences of interpersonal violence and higher levels of negative academic and mental health outcomes. Living in university housing was associated with an increase in these disparities.

CONCLUSIONS

University housing, which usually reinforces fixed gender binaries, is associated with worse outcomes for gender diverse students. These data can help higher education institutions better understand and address problems that disproportionately impact transgender and gender diverse students, who represent a growing demographic.

Sexual and Gender Diverse Young Adults’ Perception of Behaviors that are Supportive and Unsupportive of Sexual Orientation and Gender Identities

To explore specific responses that sexual and gender diverse young adults (SGD YA) perceive to be supportive and unsupportive of sexual orientation and gender identity by caregivers and other adults following identity disclosure. SGD YA ( N = 101), ages 18 to 25 years ( M = 21.2) were predominantly White (83.1%), non-Hispanic (89.1%), assigned female at birth (82.2%). The majority (97.8%) were sexually diverse (e.g., queer, pansexual, lesbian, gay, asexual, bisexual) and half (50%) were gender diverse (e.g. transgender, agender, genderqueer, nonbinary). Participants completed an online survey. This analysis is focused on participants’ responses to open-ended questions regarding responses they perceived to be supportive and unsupportive of their SGD identity/identities. Content analysis of participants’ open-ended survey responses was conducted using a combination of inductive and deductive coding. Six themes emerged for both supportive responses (communication, actions, acceptance, open-mindedness, unconditional love, and advocacy) and unsupportive responses (distancing, hostility, minimizing, controlling, blaming, and bumbling). For some themes, different sub-themes emerged based on identity. Parents/caregivers as well as other adults in the lives of SGD YA can implement specific responses to demonstrate support for sexual orientation and gender identity with the potential to improve the mental health of SGD YA.

Coping Strategies to Enhance the Mental Wellbeing of Sexual and Gender Minority Youths: A Scoping Review

Robust population-based research has established that sexual and gender minority youths (SGMYs) are at an increased risk of mental ill-health, but there is a dearth of literature that seeks to explore how to best support SGMY mental wellbeing. This scoping review aims to identify findings related to coping strategies and/or interventions for building resilience and/or enhancing the mental wellbeing of SGMYs. PRISMA extension for scoping review (PRISMA-ScR) guidelines was utilized for this review. Studies were included if they were peer-reviewed papers containing primary data; reported psycho-social coping strategies for SGMY; were conducted with SGMYs in the adolescent age range; and were published in English. MEDLINE, Embase, and PsycINFO databases were searched. Of the 3692 papers initially identified, 68 papers were included with 24 intervention-focused studies of 17 unique interventions found. The most commonly cited therapeutic modality was cognitive behavioral therapy (CBT) (n = 11 studies). Despite the need to support the mental wellbeing of SGMYs, few interventions focused on this area and unique populations have been reported upon in the peer-reviewed literature. As a result, there is considerable potential to develop supports for SGMYs.

Moving Beyond the LGBTQIA+ Acronym: Toward Patient-Centered Care

PURPOSE

The LGBTQIA+ communities experience distinct health disparities and inequities in health outcomes. Healthcare providers must be conscious of these factors to facilitate optimal, person-centered care. This narrative briefly covers health disparities in the LGBTQIA+ community and posits strategies to promote inclusive care.

METHODS

Current literature and clinical best practices from several authoritative sources on LGBTQIA+-specific issues and gender-affirming care were reviewed. Sources included several LGBTQIA+-specific healthcare organizations, national healthcare provider organizations, and federal agency policy statements. Inclusive terminology and healthcare practices are included.

RESULTS

Healthcare providers must educate themselves on caring for gender- and sexual orientation-diverse populations to optimize the health status of these communities. It is essential that providers examine their own potential biases and maintain an openness to learning about LGBTQIA+ communities.

CONCLUSIONS

Healthcare providers have a responsibility to not only understand issues specific to LGBTQIA+ individuals but also advocate for these groups. As nurses, we must continue to support public health policies that seek to end disparities and ensure health equity for all.

CLINICAL RELEVANCE TO THE PRACTICE OF REHABILITATION NURSING

Rehabilitation nurses are caring for more diverse populations than ever before and must understand how to provide compassionate, individualized care. Although this article focuses on the LGBTQIA+ community, the principles discussed are applicable across all populations.

Attachment-based family therapy for sexual and gender minority young adults and their nonaccepting parents

This pilot open trial examined the efficacy of attachment-based family therapy (ABFT) for Israeli sexual and gender minority (SGM) young adults and their persistently nonaccepting parents. Thirty families received up to 26 weeks of treatment, with parental rejection, parental acceptance, and young adults' attachment avoidance and attachment anxiety assessed at baseline, 8, 16, 24, and 36 weeks (three months post-treatment). Analyses using multilevel growth models revealed that both young adults and their mothers independently reported increases in mothers' acceptance of their young adult's same-sex orientation or noncisgender identity. In addition, young adults reported decreases in both parents' levels of rejection. Also, mothers, but not fathers, reported decreases in their own level of rejection. Finally, young adults reported a decrease in attachment avoidance in their relationships with both mothers and fathers, but not a decrease in attachment anxiety. Importantly, these treatment gains were maintained three months after the end of treatment. Together, these results suggest that ABFT-SGM, a manualized, affirmative, experiential, family-based treatment, may be effective in reducing long-standing parental rejection, promoting parental acceptance, and improving the quality of LGBTQ+ young adults' relationships with their parents. These findings are encouraging in light of the urgent need for efficacious interventions to reduce family generated minority stress and promote safer, more supportive environments for sexual and gender minority people.

A narrative exploration of the importance of intersectionality in a Black trans woman's mental health experiences

Background: The current United States presidential administration's statements and policies have, in a shockingly short time, catastrophically affected people of color and LGBTQIA + communities. And although these numerous discriminatory policies and policy revisions have negatively affected both US people of color and LGBTQIA + people, trans women of color have been disproportionately affected. Even more specifically, when focusing on vulnerability to violence-including murder-it is Black trans women who are most directly affected by the intersections of transphobia and racism in the US. This article explores a Black trans woman's experiences with mental health professionals across two decades and different regions of the US. Aims: This article argues for the necessity of understanding trans people's mental health experiences as necessarily intersectional, in order to more fully appreciate and address the degrees to which factors such as race, socioeconomic class, and geographic context matter in trans people's efforts to access ethical and effective mental healthcare. Methods: Using a theoretical framework informed by Kimberlé Crenshaw's single-axis concept, the authors fully center Aryah's intersectional experiences and counter a single-axis in exploring trans mental health issues, our article relies on a narrative-based approach. As narrative inquiry is a broad field, we selected Butler-Kisber's narrative analytic approach, "Starting with the Story" as our method. The narratives are pulled from approximately 10 intensive qualitative interviews over the course of several months. Discussion: These narratives disrupt the common threads in the literature that ignore the degrees to which race and class matter alongside being a trans woman. In addition, as we noted that nearly all of the mental health literature relied on large-scale survey-based data, this article offers a qualitative narrative exploration of Aryah's experiences and works to humanize trans mental health challenges and needs, while emphasizing the multilayered oppressions and obstacles that affected Aryah.

Protective Factors for LGBTI+ Youth Wellbeing: A Scoping Review Underpinned by Recognition Theory

Considerable research has been undertaken regarding the mental health inequalities experienced by lesbian, gay, bisexual, transgender and intersex (LGBTI+) youth as a consequence of societal and individual prejudice, stigma and discrimination. Far less research has focussed on protective factors that promote wellbeing for this population. A scoping review was conducted using a six-stage methodological framework, and is reported in accordance with the PRISMA-ScR statement. This explored the extent, range and nature of the peer-reviewed, published, academic literature on what is known about the protective factors that promote LGBTI+ youth wellbeing. Six databases were systematically searched applying Population–Concept–Context key inclusion criteria, complemented by contact with authors to identify additional sources, reference checks and hand searches. Ninety-six individual research records were identified and analysed, drawing from Honneth’s Recognition Theory. Interpersonal relations with parents (n = 40), peers (n = 32) and providers (n = 22) were associated with indicators of enhanced wellbeing, as were LGBTI+ community relations (n = 32). Importantly, online (n = 10), faith (n = 10) and cultural (n = 5) communities were potentially protective. Content and thematic analysis highlighted the importance of Gay–Straight Alliances (GSAs) (n = 23) offering powerful protective opportunities through intersecting interpersonal, community and legal forms of recognition. GSAs enhance allyship by peers and providers (n = 21), facilitate access to LGBTI+ community networks (n = 11) and co-exist alongside inclusive policies (n = 12), curricular (n = 5) and extracurricular activities (n = 1). This scoping review underscores the need to move beyond the predominant focus on risk factors for LGBTI+ youth, which subsequently inform protectionist approaches. It concludes with an appeal to develop mechanisms to apply recognitive justice to policy, practice and, importantly, future research directions. This emphasises the salience of enhanced understandings of inclusion, which is rights-based, universally available and of potential benefit to all.

Experiences and Perceptions of Trans and Gender Non-Binary People Regarding Their Psychosocial Support Needs: A Systematic Review of the Qualitative Research Evidence

People who identify as trans and gender non-binary experience many challenges in their lives and more interest is being paid to their overall health and wellbeing. However, little is known about their experiences and perceptions regarding their distinct psychosocial needs. The aim of this systematic review is to critically evaluate and synthesize the existing research evidence relating to the unique psychological and social experiences of trans people and identify aspects that may help or hinder access to appropriate psychosocial interventions and supports. The PRISMA procedure was utilized. A search of relevant databases from January 2010 to January 2021 was undertaken. Studies were identified that involved trans people, and addressed issues related to their psychosocial needs. The search yielded 954 papers in total. Following the application of rigorous inclusion and exclusion criteria a total of 18 papers were considered suitable for the systematic review. Quality was assessed using the MMAT instrument. Following analysis, four themes were identified: (i) stigma, discrimination and marginalization (ii) trans affirmative experiences (iii) formal and informal supports, and (iv) healthcare access. The policy, education and practice development implications are highlighted and discussed. Future research opportunities have been identified that will add significantly to the body of evidence that may further the development of appropriate health interventions and supports to this population.