Microaggressions Toward Lesbian, Gay, Bisexual, Transgender, Queer, and Genderqueer People: A Review of the Literature

'I've grown fearful of any rustle behind me': defining anticipating discriminatory violence as violence

Marginalised people fear and expect violence, often daily. This prompts us to ask, is anticipating violence a violence in and of itself? Asking and answering this question extends the feminist, critical race, violence and trauma studies project of broadening traditional understandings of violence to name ignored forms of violence as violence (e.g. epistemic or representational violence). Ultimately, we argue that anticipating discriminatory violence is violence in and of itself. To do so, first we contest the common assumption that violence is intentional. The idea that violence needs to be intentional is a long-held myth that functions to deny various forms of violence. Second, we challenge the idea that violence requires a clear perpetrator. Systems of oppression and discriminatory ideologies enact violence, but there often is no clear perpetrator. When we are preoccupied with claiming that violence involves an intentional actor, we neglect to attend to the ways in which oppressive ideologies and systems structure marginalised people's daily lives and experiences of (anticipating) violence. Living under the Western capitalist cisheteropatriarchal regime renders the 'everyday' a site of trauma and violence. This framework for reconceptualising what 'counts' as violence creates space to move beyond violence in its most traditional forms: the punch, the slur. Anticipating violence is the logical consequence of living under systems of oppression. When a group of marginalised people collectively anticipate violence, it is clear violence has already happened and is happening all around us: we posit that our conceptualisation of anticipating violence as violence is not intended to validate all forms of anticipated violence.

Dimensions of cisheteronormativity that influence healthcare utilization practices in LGBTQ+ populations: A systematic review

INTRODUCTION

Cisheteronormativity in healthcare settings may further exacerbate existing health disparities between LGBTQ+ and non-LGBTQ+ populations. The aim of the current review is to identify dimensions of cisheteronormativity that manifest in healthcare settings to influence healthcare utilization by LGBTQ+ individuals.

METHOD

8148 articles were screened, with 53 remaining for inclusion.

RESULTS

Thematic synthesis identified five themes linked to negative healthcare use: 1) Lack of Provider LGBTQ+ Knowledge, 2) Endorsements of Cisheteronormativity, 3) Assumptions of LGBTQ+ experiences and assumptions of non-LGBTQ+ identity, 4) Negation, and 5) Abuse of Power.

CONCLUSION

Findings emphasize the need for provider education regarding LGBTQ+ identities and the dismantling of cisheteronormative structures in healthcare.

Stereotypes of White and East Asian Women and Men with Branched Attractions

People with branched attractions may experience sexual and romantic attractions to different genders; for example, they may be sexually attracted to one gender and romantically attracted to another gender. Because branched attractions may violate folk theories about sexuality, we expected individuals with these attractions to face unique stereotypes. Across three preregistered experiments (total N = 1041), and using predominantly White, non-Latiné, and straight samples, we asked if White (Studies 1 and 2) and East Asian (Study 3) targets with branched attractions are seen as: (1) confused, dishonest, and non-monogamous (bi stereotypes), (2) uncertain about and in denial of their sexuality (instability stereotypes), and (3) desired as sexual objects (fetishized), compared to targets with aligned (same-gender, other-gender, bisexual) attractions. We also assessed warmth toward targets, and explored perceivers' need for cognition as a moderator. As expected, White and East Asian women and men with branched attractions faced heightened bi and instability stereotypes, whereas findings with warmth, fetishization, and need for cognition were mixed. Discussion considers the implications of these findings for sexually and racially minoritized individuals.

Dampening of positive affect partially accounts for the association between women's history of child maltreatment and current depressive symptoms

BACKGROUND

Child maltreatment exerts lasting effects on emotion regulation, which in turn accounts for adult's risk for psychopathology such as depression. In this vulnerable population, deficits in emotion regulation of negative affect are well established and include reliance on emotional suppression and rumination strategies. In contrast, alterations in the regulation of positive affect associated with child maltreatment history are less understood. We examined the role of positive rumination and dampening of positive affect, two emotion regulation strategies that may be impaired by the experience of child maltreatment and are associated with depression risk. We hypothesized that alterations in positive rumination and dampening would explain the association between women's childmaltreatment history and heightened risk for current depressive symptoms. To determine if positive affect regulation accounts for unique variance between child maltreatment history and depression risk we controlled for brooding rumination.

METHODS

Undergraduate women (n = 122) completed surveys on child maltreatment, depressive symptoms, and their tendency to dampen or engage in positive rumination in response to positive affect, reflecting cross-sectional data. The PROCESS macro, model 4 was run in SPSS to examine the extent to which emotion regulation strategies accounted for the association between child maltreatment history and current depressive symptoms.

RESULTS

Child maltreatment history was associated with a higher tendency to dampen positive affect but was not linked with positive rumination. Dampening partially explained the link between child maltreatment and women's current depressive symptoms. Dampening and brooding rumination each accounted for unique variance in the association between child maltreatment and depressive symptoms.

CONCLUSIONS

Results suggest that emotion suppression strategies among child maltreatment survivors may also extend to positive affect, with impairments in specific regulation strategies. Currently dysphoric women with a history of child maltreatment tend to dampen their positive moods and reactions to events as well as ruminate on their dysphoric moods, both tendencies accounted for unique variance in current depression risk. Longitudinal research is warranted to clarify the role of alterations in positive emotion regulations strategies in understanding how child maltreatment fosters risk for psychopathology such as depression.

Intrapersonal psychological empowerment: Assessing measurement invariance of the Brief Sociopolitical Control Scale for youth between LGBQ+ and non-LGBQ+ youth of color

Lesbian, Gay, Bisexual, Queer, and Questioning+ (LGBQ+) Black, Indigenous, and Persons of Color (BIPOC) youth experience significant stigmatization and injustice compared to their non-LGBQ+ BIPOC peers. Empowerment, civic engagement, and social connection are protective factors that reduce negative psychological outcomes for these youth. Despite this, validated measures to assess empowerment among LGBQ+ BIPOC youth are scarce. This study evaluated the applicability of the newly revised Brief Sociopolitical Control Scale for Youth (BSPCS-Y) through multigroup confirmatory factor analysis (MGCFA) to examine configural, metric, and scalar invariances between LGBQ+ and non-LGBQ+ BIPOC youth (N = 1789). Convergent validity was assessed with psychological sense of community and symptoms of depression and anxiety. Results indicated a good model fit for the abbreviated BSPCS-Y, with no significant group differences in metric and scalar invariances. Subscales for leadership competence and policy control were positively associated with psychological sense of community and negatively associated with depression and anxiety symptoms, with stronger effects of psychological sense of community observed in non-LGBQ+ BIPOC youth and more robust associations with reduced depression and anxiety among LGBQ+ BIPOC youth. These findings support the BSPCS-Y as a valid tool for measuring empowerment in diverse BIPOC youth populations.

Intersectional Oppression-Based Stress, Drinking to Cope Motives, and Alcohol Use and Hazardous Drinking Among Sexual and Gender Minority Adolescents Who Are Black, Indigenous, and People of Color

Purpose: This study examined the associations between intersectional oppression-based stress and recent alcohol use and hazardous drinking among sexual and gender minority (SGM; e.g., queer or transgender) adolescents who were Black, Indigenous, and People of Color (BIPOC), also known as queer and transgender BIPOC (QTBIPOC) adolescents, and the mediating role of coping motives (i.e., drinking to cope) on these associations. Methods: Data were from a subsample of QTBIPOC adolescents who used alcohol in the past year (n = 1365) from a national U.S. sample of SGM adolescents aged 13-18 years. Results: Intersectional oppression-based stressors were associated with greater odds of recent alcohol use and hazardous drinking, as well as greater coping motives. Coping motives mediated the associations between intersectional-based stressors and both recent alcohol use and hazardous drinking among the aggregate sample of QTBIPOC adolescents, as well as among some subgroups of BIPOC adolescents. Conclusions: The results of this study highlight that intersectional oppression-based stressors are prevalent among QTBIPOC adolescents and serve as a risk factor for alcohol use and hazardous drinking. Multilevel interventions are needed to target and dismantle intersectional oppressions to address alcohol inequities impacting QTBIPOC adolescents. Drinking to cope motives mediated the associations between intersectional oppression-based stress and drinking outcomes, underscoring another important mechanism to target within a context of oppression in drinking interventions.

Intersectional Microaggressions and Implications for Health Inequities and HIV Among Latino/x Sexual Minority Males in Puerto Rico

Latino/x sexual minority males (SMM) continue to be disproportionately impacted by health inequities. This study aims to understand the lived experience of Puerto Rican (PR) SMM related to how intersectional microaggressions influence health-related risk and protective factors. Young adult (ages 21-30) PR SMM from San Juan, Puerto Rico, completed a bilingual in-depth individual interview (14 in Spanish and 1 in English). A thematic analysis based on the original language of the interviews was conducted using NVivo. Six prominent themes were identified through the data analysis: (1) religious microaggressions, being gay is bad because God doesn't like it; (2) gender microaggressions, gay is not good because it's not for men; (3) sexuality microaggressions, this one is a homosexual, coming out as a sexual minority; (4) trans microaggressions, drag queens create an illusion; (5) internalized microaggressions, battling with internalized homophobia; and (6) mitigating microaggressions, establishing a supportive community. Findings suggest that multiple forms of microaggressions based on the intersectionality of sexuality and gender manifest from straight as well as gay communities. PR SMM demonstrated their resiliency by assessing interactions with others to mitigate risks and enhance supportive networks.

A Trans and Queer Discursive Approach to Gender Diversity and Misgendering in the Transgender and Gender Diverse Population: Queering a Study for ICD-11

Producing knowledge about transgender and gender-diverse (TGD) individuals is a core public health strategy challenge. Yet several systemic limitations arise, notably the exclusion or exploitation of TGD individuals by research systems reproducing systemic discrimination by embedding social norms as self-evident facts of nature. This is particularly worrying in biomedical research, and contributes to the invisibilization of participants' gender diversity. This trans research illustrates methodological challenges through queering an earlier study by focusing on misgendering as a discursive element. We based our work on discursive materials reported by TGD participants in an ICD-11 study on gender incongruence. We used network analyses to illustrate potential differences between declared gender identity and discourse practices. Our results highlight a gap between declared gender identity and discourse practices, bringing the number of non-binary participants in the sample from 15 (20.8%) to 36 (50.0%). Moreover, misgendering and the use of derogatory terms are more common toward gender-diverse individuals. Sexual orientation shows a similar trend. This study reveals the reproduction of social norms within research processes and medical knowledge, as well as how, from an individual perspective, their non-compliance seems to be a key factor in TGD individuals' experience. By providing this simple methodological example, we hope to promote better integration of gender and its various dimensions into biomedical and public health research.

Psychometric Exploration of the Swedish Translation of the Sexual Orientation Microaggressions Scale (SOMS), and a Commentary on the Validity of the Construct of Microaggressions

The aim of the present study was to assess the psychometric properties of a Swedish translation of the Sexual Orientation Microaggressions Scale (SOMS) in a convenience sample of 267 Swedish LGB+ people (Mean age = 36.41). Testing suggested some strengths in terms of factor structure and 2-week test-retest reliability (ICC > .79). Also, internal consistency (α = .80-.91) and convergent validity were supported for most subscales. However, the Assumption of Deviance subscale was associated with low response variability and internal consistency (α = .35), and the correlational pattern between the Environmental Microaggressions subscale and mental health variables diverged from the overall trend. Furthermore, measurement invariance between homo- and bisexual participants was not supported for most subscales, and although microaggressions would be theoretically irrelevant to a small comparison sample of heterosexual people (N = 76, Mean age = 40.43), metric invariance of the Environmental Microaggressions subscale was supported in comparison to LGB+ people. We argue that these limitations suggest a restricted applicability of the SOMS in a Swedish context, and this has consequences for the definition and operationalization of the construct of microaggressions as a whole. Therefore, more research on the latent properties of microaggressions in Swedish as well as in other contexts is required.

Enhancing LGBT + primary healthcare in Slovenia: A national qualitative study of experiences and expectations of LGBT + people and family doctors

BACKGROUND

Despite growing acceptance of LGBT + individuals, an underlying stigma persists even in healthcare, resulting in substandard care and worse healthcare outcomes for LGBT + individuals.

OBJECTIVES

To examine and compare the experiences and expectations regarding primary healthcare among LGBT + individuals and general practitioners (GPs) in Slovenia.

METHODS

We conducted an online national qualitative study using open-ended questions. To reach LGBT + population snowball method of recruitment was employed by sharing the questionnaire through LGBT + organisations, while GPs were invited by email of Association of family doctors in Slovenia. Anonymous data was collected from October to December 2021 and the questionnaires of 25 GPs and 90 LGBT + individuals of various ages, backgrounds, gender identities and sexual orientations were reviewed using thematic analysis.

RESULTS

Both LGBT + participants and GPs expressed a desire for equal treatment. However, while all GPs claimed to treat all patients equally, LGBT + participants reported more varied experiences. Specific knowledge, especially on LGBT + terminology and healthcare, was perceived as lacking among GPs, leading LGBT + individuals to seek advice from specialists or community counselling. Systemic barriers, including societal stigmatisation and limited formal education on LGBT + issues, were identified, highlighting the need for designated safe spaces and improved GP training. Safety emerged as a central theme, crucial for fostering trust and disclosure between patients and healthcare providers.

CONCLUSION

The study underscores the significance of a sense of safety in the patient-doctor relationship and highlights the need for improved training and attitudes to provide inclusive and affirming healthcare for LGBT + individuals.

Attitudes Toward Sexual Orientation and Gender Identity in Online Multiplayer Gaming Spaces

Online video game communities can provide a sense of belonging and support for marginalized people, while at the same time, can be rife with prejudice and discrimination. This study aimed to assess the prevalence of both positive and negative comments about sexual orientation and gender identity during online gaming, and to test the hypothesis that LGBTQ+ people witness or experience more prejudice than do heterosexual and cisgender persons. An online survey, distributed on social media sites and a psychology subject pool, included rating scales and open-ended questions on game-related conversations. Respondents (N = 185) provided negative examples made by others more frequently than positive ones and attributed serious comments to themselves versus jokes and offhand comments to others. Across all respondent gender identities, the targets of the negative comments by others were almost always LGBTQ+ persons. These results bolster critiques of online gaming environments as hostile to members of marginalized groups.

Burnout Among Service Providers for People Living with HIV: Factors Related to Coping and Resilience

Individuals who provide services for people living with HIV (PLWH) face numerous work-related challenges, including psychosocial and structural factors affecting the quality of care that they provide. Little is known about the factors that relate to burnout among service providers for PLWH. The current study seeks to examine the factors associated with burnout and the role of resilience and coping in the context of burnout. Via convenience sampling, data was collected from 28 professionals (e.g., peer counselors, HIV testers, case managers/case workers, group facilitators, or social workers) serving PLWH in the USA. Participants completed quantitative measures on sociodemographics, organizational factors, discrimination, trauma, depression, and burnout. A sub-sample of 19 participants provided in-depth qualitative data via semi-structured interviews on burnout, coping, and resilience as a buffer against the effects of burnout. Thematic content analysis revealed themes on the factors related to burnout (e.g., discrimination, limited financial and housing resources, and COVID-19), rejuvenating factors, coping with burnout, and intervention strategies. Additionally, Pearson's product moment correlations revealed significant associations between mental health variables such as depressive and posttraumatic stress disorder symptomology with (a) discrimination and microaggressions and (b) burnout. The current study highlights challenges to providing HIV care, including structural barriers and discrimination that are doubly impactful to the professionals in this sample who share identities with the PLWH whom they serve. These findings may inform the development of an intervention targeting burnout among individuals providing services to PLWH and motivate change to remove structural barriers and improve quality of care for PLWH.

Predictors of depressive and anxiety symptoms among lesbian, gay and bisexual young adult individuals experiencing the COVID-19 pandemic: A four-year follow-up study

BACKGROUND/PURPOSE

Depressive and anxiety symptoms were common among lesbian, gay, and bisexual (LGB) individuals during the COVID-19 pandemic. This 4-year follow-up study was conducted to investigate the predictors of depressive and anxiety symptoms in Taiwan's young adult LGB population.

METHODS

Baseline data, including depressive and anxiety symptoms, demographic characteristics, sexual stigma, self-identity confusion, and family support were collected from 1000 LGB individuals. The participants' depressive and anxiety symptoms were reassessed 4 years after the baseline measurements. The predictive effects of the baseline factors on depressive and anxiety symptoms at follow-up were examined through linear regression analysis.

RESULTS

Greater lack of identity, unconsolidated identity, sexual orientation microaggression, and lower perceived family function at baseline were significantly associated with more severe depressive and anxiety symptoms at follow-up. After adjustment for baseline depressive symptoms, being men, greater lack of identity, lower perceived family function, and more severe anxiety symptoms at baseline were significantly associated with more severe depressive symptoms at follow-up. After adjustment for baseline anxiety symptoms, greater unconsolidated identity and more severe depressive symptoms at baseline were significantly associated with more severe anxiety symptoms at follow-up.

CONCLUSIONS

Intervention aimed at reducing depressive and anxiety symptoms in LGB individuals should be developed considering the predictors identified in this study.

Can acoustic measurements predict gender perception in the voice?

PURPOSE

To determine if there is an association between vocal gender presentation and the gender and context of the listener.

METHOD

Quantitative and transversal study. 47 speakers of Brazilian Portuguese of different genders were recorded. Recordings included sustained vowel emission, connected speech, and the expressive recital of a poem. Subsequently, four scripts were used in Praat to extract 16 acoustic measurements related to prosody. Voices underwent Auditory-Perceptual Assessment (APA) of the gender presentation by 236 people [65 speech and language pathologist (SLP) with experience in the area of the voice (SLP), 101 cisgender people (CG), and 70 transgender and non-binary people (TNB)]. Gender presentation was evaluated by visual analogue scale. Agreement analyses were executed among quantitative variables and multiple linear regression models were generated to predict APA, taking the judge context/gender and speaker gender into consideration.

RESULTS

Acoustic analysis revealed that cis and transgender women had higher median fundamental frequency (fo) values than other genders. Cisgender women exhibited greater breathiness, while cisgender men showed more vocal quality deviations. In terms of APA, significant differences were observed among judge groups: SLP judged vowel samples differently from other groups, and TNB judged speech samples differently (both p<0.001). The predictive measures for the APA varied based on the sample type, speaker gender, and judge group. For vowel samples, only SLP judges had predictive measures (fo and ABI Jitter) for cisgender speakers. In number counting samples, predictive measures for cisgender speakers included fomed and HNR for CG judges, and fomed for both SLP and TNB judges. For transgender and non-binary speakers, predictive measures were fomed for CG and SLP judges, and fomed, CPPs, and ABI for TNB judges. In the poem recital task, predictive measures for cisgender speakers were fomed and HNR for both SLP and CG judges, with additional measures of cvint and sr for CG judges, and fomed, HNR, cvint, and fopeakwidth for TNB judges. For transgender and non-binary speakers, the predictive measures included a wider range of acoustic features such as fomed, fosd, sr, fomin, emph, HNR, Shimmer, and fo peakwidth for SLP judges, and fomed, fosd, sr, fomax, emph, HNR, and Shimmer for CG judges, while TNB judges considered fomed, sr, emph, fosd, Shimmer, HNR, Jitter, and fomax.

CONCLUSIONS

There is an association between the perception of gender presentation in the voice and the gender or context of the listener and the speaker. Transgender and non-binary judges diverged to a higher degree from cisgender and SLP judges. Compared to the evaluation of cisgender speakers, all judge groups used a greater number of acoustic measurements when analyzing the speech of transgender and non-binary individuals in the poem recital samples.

Predictors of new-onset suicide risk and persistent suicide risk among young adult lesbian, gay and bisexual individuals experiencing the COVID-19 pandemic: a follow-up study

AIMS

The aim of this 4-year follow-up study was to examine the predictive effects of demographics, three types of sexual stigma, three types of self-identity confusion, anxiety, depression, family support and problematic Internet use before the coronavirus disease 2019 (COVID-19) pandemic on new-onset suicide risk and persistent suicide risk in young adult lesbian, gay and bisexual individuals who experienced the COVID-19 pandemic in Taiwan.

METHODS

Baseline data were collected from 1,000 lesbian, gay and bisexual individuals in 2018 and 2019. Outcome data on suicide risk were collected again in 2023. The suicide module of the Mini International Neuropsychiatric Interview was used to assess suicide risk in terms of thoughts of death, desire to self-harm, thoughts of suicide, plans for suicide and suicide attempts in the preceding month at the initial and follow-up assessments. Baseline three types of sexual stigma, self-identity disturbance, depression, anxiety and problematic Internet use were used to examine their prediction of new-onset suicide risk and persistent suicide risk at follow-up.

RESULTS

In total, 673 individuals participated in the follow-up survey. Notably, 16.5% of the participants who had no suicide risk at baseline had new-onset suicide risk at follow-up; 46.4% of the participants who had suicide risk at baseline also had suicide risk at follow-up. Participants who were transgender (p = .003), who perceived greater levels of microaggression (p < .001), and who had greater levels of problematic Internet use at baseline (p = .024) were more likely to have new-onset suicide risk at follow-up. Participants who had greater levels of self-identity confusion were more likely to have persistent suicide risk at follow-up (p = .023).

CONCLUSION

Intervention strategies for reducing suicide risk in lesbian, gay and bisexual individuals should be developed with consideration of the predictors identified in this study.

Revisiting Student Stories: Understanding Microaggressions and Interpersonal Conflict Within Speech-Language and Hearing Sciences Training Programs

PURPOSE

The current study revisits our previous research, delving deeper into microaggressions (MAs) and interpersonal conflict (IC) in speech, language, and hearing sciences (SLHS) training programs. Participants came from both marginalized and nonmarginalized backgrounds.

METHOD

A 39-item electronic survey based on our previous research was distributed online to 236 participants of current and former SLHS students through social media and e-mail listservs.

RESULTS

Students that identified as belonging to marginalized and nonmarginalized groups reported high levels of MAs and IC, respectively. Linear regression revealed that the more marginalized identities a participant reported, the more aggression they experienced. Analyses also suggest that specific cultural and linguistic identities more likely predicted experiencing specific types of MAs than others. MAs and IC were largely underreported.

CONCLUSIONS

This study highlights the quantifiable prevalence of MAs and IC in SLHS training programs. It underscores the urgent need for targeted interventions to address systemic inequities. Overall, these findings emphasize the importance of fostering an inclusive and equitable environment in SLHS, promoting cultural competence, and social justice in the professions.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.27105613.

Attitudes and knowledge of mental health practitioners towards LGBTQ+ patients: A mixed-method systematic review

LGBTQ+ patients exhibit higher rates of mental disorder relative to the general population. This is particularly concerning since deficiencies in mental health practitioners' skills and knowledge, along with negative attitudes and behaviors, are associated with a decreased likelihood of LGBTQ+ patients seeking mental healthcare services and an increased likelihood of reporting unmet mental healthcare needs. To address these concerns, a mixed-method systematic review was conducted to evaluate mental health practitioners' attitudes towards and knowledge of LGBTQ+ patients and the impact of these factors on service utilization. Thirty-two relevant empirical qualitative and quantitative studies were retrieved from five databases following PRISMA guidelines, for a total of N = 13,110 mental health practitioners included. The results indicated that mental health practitioners generally hold affirming attitudes towards LGBTQ+ patients. However, significant gaps in practitioners' knowledge and skills emerged, describing feelings of inadequate skill, lack of competence, low clinical preparedness in addressing specific LGBTQ+ needs, insufficient training opportunities, and desire for further education on LGBTQ+ issues. These findings underscore the need to enhance inclusivity and cultural competence at both organizational and educational levels. Such improvements are essential to better care for LGBTQ+ patients and reduce disparities in access to mental health services.

Setting the Game Agenda: Reviewing the Emerging Literature on Video Gaming and Psychological Well-Being of Sexual and Gender Diverse Youth

Video gaming is a popular youth pastime that has prompted scholarship into its relationship with psychological well-being. However, sexual and gender diverse youth (SGDY) who play video games are largely overlooked in this research. SGDY experience significant mental health challenges, but utilize coping strategies mediated by digital technologies, necessitating an examination of their video game playing and its effects on well-being. This literature review synthesizes the emerging evidence base by identifying key constructs related to SGDY well-being and video gaming. Five themes were derived from the literature: (a) SGDY identity development and self-expression in video games; (b) SGDY video gaming and coping skills; (c) Social support in SGDY video gaming communities; (d) SGDY digital microaggressions in video gaming; and (e) SGDY civic engagement through video gaming. The findings establish multiple risks and opportunities for harnessing video games to support SGDY's well-being. Recommendations for practice, research, and industry collaborations are presented.

State of the Science on Racial Microaggressions

Despite racism being widespread and research evidence of racial disparities growing, those who lack the lived experience of racial oppression often find it difficult to acknowledge this specific phenomena due to in-group bias and social learning, among other reasons. The devaluing of this research topic within psychology and greater scientific skepticism around the construct continues to undermine research on racism and microaggressions. The science of microaggressions has advanced significantly in conceptual and theoretical clarity over the last 15 years. Many initial assumptions about the nature of microaggressions have since been found to be incorrect. This state of the science review addresses these concerns by reviewing the concept, validated measures, physical and mental health impacts, critiques and misinformation, recommended strategies and interventions, and clinical implications. We propose future research directions to help advance the scientific study of racial microaggressions.

Born This Way? National Collective Narcissism, Implicit Homophobia, and Homosexual Essentialism in Populist Poland

Prejudice toward the LGBT community has become prevalent in Poland under the ultraconservative populist government. The results of three studies conducted between 2018 and 2019 (N1 = 879, N2 = 324, and N3 = 374) indicate that Polish collective narcissism-the belief that the exaggerated greatness of the nation is not recognized by others-is associated with implicit homophobia assessed as the intuitive disapproval of gay men and automatic evaluative preference of heterosexuality over homosexuality. Those associations were to a large extent explained by the relationships between collective narcissism and (1) the belief that groups defined by sexual orientations are essentially distinct; (2) the belief that homosexuality is a personal choice, not genetically determined or culturally universal. The experimental results of Study 3 indicated that inducing the belief that non-normative sexuality is genetically determined and culturally universal reduced automatic preference for heterosexuality over homosexuality (but not intuitive disapproval of gay men) across levels of collective narcissism (contrary to predictions). The obtained results complete the picture of the association of narcissistic beliefs about the nation and homophobia emerging from previous studies. National narcissism is linked not only to explicit but also to latent, implicit homophobia likely to be triggered by increased presence of national narcissism in public discourse. Moreover, national narcissism is linked to implicit homophobia, especially via the agentic belief that sexual orientation is a matter of choice. Changing this belief reduces implicit homophobia also among national narcissists.

"There is No One Way to Be Transgender and to Live Sex": Transgender and Non-Binary Individuals' Experiences with Pornography

Transgender or non-binary (TGNB) people are often present as protagonists of pornographic material. This study is the first to consider TGNB people as critical consumers of sexually explicit material. The sample included 212 self-identified TGNB individuals: 47.2% trans man/transmasculine, 15.6% trans woman/transfeminine and 37.3% non-binary. The online questionnaire consisted of a sociodemographic data collection, multiple-choice questions about preferences and habits concerning pornography, and open-ended questions about the sensations experienced when watching pornography, opinions on the representation of TGNB people in pornography, and their experience in watching pornographic videos with cisgender or TGNB protagonists. The answers were analyzed using the qualitative method of thematic analysis. We identified four themes that appeared across the responses: 1) heteronormativity and cisnormativity in pornography: the need for deconstructing the current cis-het-patriarchial normative and binary system, which dominates pornography except for the ethical porn industry, 2) cisgender pornography compared to TGNB pornography, 3) pleasurable sensations (e.g., identification and empowerment) associated with TGNB pornography, and 4) negative sensations (e.g., objectification and dysphoria) associated with TGNB pornography. Results are discussed in light of the objectification framework and the minority stress model.

The association between microaggressions and mental health among UK trans people: a cross-sectional study

PURPOSE

Epidemiological studies investigating the mental health impacts of microaggressions in the trans population have tended to have methodological limitations, including a lack of validated measures, raising concerns about the validity of their findings. To address this evidence gap, we investigated the associations between microaggressions and poor mental health (depression; anxiety; non-suicidal self-harm [NSSH]; suicidal thoughts; suicide attempt) amongst trans people.

METHODS

We conducted a cross-sectional survey of 787 trans adults in the UK, measuring mental health and exposure to microaggressions using the Gender Identity Microaggressions Scale (GIMS). Using univariable and multivariable linear and logistic regression models we tested for an association of microaggressions with depressive symptoms (PHQ-9), anxiety symptoms (GAD-7), lifetime NSSH, lifetime suicidal thoughts, and lifetime suicide attempt.

RESULTS

Of the 787 participants, 574 (73%) provided complete data. Microaggressions were a common experience, affecting 97.6% of participants over their lifetime. In adjusted analyses, using sociodemographic and clinical variables, increased microaggression scores were associated with increased depressive symptoms (adjusted coefficient: 1.86 (95%CI = 1.35 to 2.36)), anxiety symptoms (adjusted coefficient: 1.57 (95%CI = 1.09 -2.05)) and with increased odds of NSSH (Odds Ratio [OR]adj 1.83 (95%CI = 1.45 -2.30)), suicidal thoughts (ORadj 2.18, (95%CI = 1.52 -3.13)), and suicide attempt (ORadj, 1.59, (95%CI = 1.32 -1.92)). In exploratory analyses different GIMS subscales were associated with these various outcomes.

CONCLUSIONS

There was evidence of associations between microaggressions and adverse mental health outcomes, as well as to support specific microaggressions being associated with specific outcomes, emphasizing the importance of public health interventions that target microaggressions directed at trans adults. Longitudinal studies are needed to investigate the temporality of the associations between microaggressions and mental health outcomes.

"Suck it up, go play": Mental health stigma in college coaches and their use of mental illness microaggressions

Objective: This study explored the extent to which college athletic coaches endorse mental illness microaggressions toward their student-athletes and the importance of mental toughness in sports, and how these impact support for help-seeking among student-athletes. Methods: Fifty-eight coaches at Northeastern U.S. colleges in the National Collegiate Athletic Association completed an online survey, including measures of mental illness microaggressions, mental toughness, and questions about vignettes portraying scenarios with a physically injured athlete and an athlete with anxiety. Results: Multivariate analyses revealed that endorsement of mental illness microaggressions was negatively related to willingness to refer an athlete with anxiety to counseling services and positively related to willingness to allow a physically injured athlete to return to play. However, mental toughness was not predictive of microaggressions or vignette responses. Conclusions: Endorsement of mental illness microaggressions appears to be related to how coaches respond to athletes experiencing a mental health issue or physical injury.

Queer Faculty in the Academy: Is It Getting Better?

This paper weaves the author's personal experience as an out lesbian researcher of LGBTQ health with contemporary research on LGBTQ faculty members' experiences. It also draws from the literature on other marginalized faculty members' experiences (women, faculty of color) to identify common themes that prevent the full inclusion of diverse faculty in higher education. Structural oppression is often invisible and university's focus on values of meritocracy, individual effort, competition, and elitism create unspoken barriers to faculty success. The paper discusses three general themes: the paradox of visibility (including being out on faculty, doing LGBTQ research, and being an advocate/activist), curricular issues, and internalizing of oppression. The final section outlines strategies for overcoming some of the barriers, including LGBTQ-specific organizing and community building and creating coalitions across marginalized faculty groups.

My Partner Is My Family: Engaging and Advocating for Lesbian, Gay, Bisexual, Transgender, Queer+ Patients in Goals of Care Conversations

In goals of care conversations and through the care trajectory, to avoid insensitive or discriminatory care, it is vital clinicians recognize lesbian, gay, bisexual, transgender, queer+ patients' values and wishes. In clinical settings, implicit bias operating within unconscious awareness may challenge the commitment to equitable care, negatively affecting patient outcomes. In this composite case, during a conversation with a social worker/nurse team, a cisgender woman repeatedly expressed her wishes for her female partner to be her decision maker instead of her biological family. The conversation stalled during the patient's attempts to identify her partner as her most valued and trusted person. Interviewer follow-up responses based on motivational interviewing techniques, which do not include strategies for lesbian, gay, bisexual, transgender, queer+ interactions, inaccurately reflected the patient's needs. Two ethical issues emerged, (1) autonomy and (2) beneficence. Clinicians should approach all patients using nongendered language, and allow patients to self-identify and decide which people are in their support system. Lack of inclusivity training has significant potential to affect the patient experience and decrease clinician/patient trust. Clinicians should not assume the decision maker is a cisgender, heterosexual partner or a biological family member. When patients speak about their partners, it is imperative clinicians use the patient's language and not avoid or redirect responses.

Improving the integration of care for trans adults: ICTA a mixed-methods study

Background

This research concerns improving the National Health Service health services trans adults need. These include the national specialist Gender Identity Clinics that support people making a medical transition. Not all trans people need to make a medical transition, and transition can take many different paths. Waits to be seen by Gender Identity Clinics are, however, several years long, and there may be significant problems of co-ordination between different aspects of transition-related care, and between transition-related care and general health care.

Objectives

The main objectives were to understand: Which factors make services more or less accessible and acceptable to the variety of trans adults? How initiatives for providing more person-centred and integrated care can be successfully implemented and further improved?

Design, data sources and participants

An online and paper screening survey was used to gather data on demographics and service use of trans people across the United Kingdom, with 2056 responses. Researchers used survey data to construct five purposive subsamples for individual qualitative interviews, identifying groups of people more likely to experience social exclusion or stigma. There were 65 online interviews. In addition, 23 trans Black people and people of colour attended focus groups. Six case studies were completed: four on initiatives to improve care and two on experiences of particular trans populations. Fifty-five service provider staff and 45 service users were interviewed.

Results

The following undermine person-centred co-ordinated care and can lead to experiences of harm: lack of respectful treatment of trans people by general practitioner practices; inadequate funding of services; lack of support during waiting; the extended and challenging nature of Gender Identity Clinic diagnostic assessments, sometimes experienced as adversarial; breakdowns in collaboration between Gender Identity Clinics and general practitioner practices over hormone therapy; lack of National Health Service psychological support for trans people. Case studies indicated ways to improve care, although each has significant unresolved issues: training in trans health care for general practitioners; third-sector peer-support workers for trans people who come to National Health Services; gender services taking a collaborative approach to assessing what people need, clarifying treatment options, benefits and risks; regional general practitioner-led hormone therapy clinics, bringing trans health care into the mainstream; psychology services that support trans people rather than assess them.

Limitations

Some contexts of care and experiences of particular groups of trans people were not addressed sufficiently within the scope of the project. While efforts were made to recruit people subject to multiple forms of stigma, there remained gaps in representation.

Conclusions and future work

The findings have significant implications for commissioners and providers of existing National Health Services gender services, including recently established pilot services in primary care. In particular they point to the need for assessments for access to transition care to be more collaborative and culturally aware, implying the value of exploring informed consent models for accessing transition-related care. Further research is needed to investigate how far the findings apply with particular subpopulations.

Study registration

This study is registered as Research Registry, no. 5235.

Funding

This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 17/51/08) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 28. See the NIHR Funding and Awards website for further award information.

Measuring Propensity to Perpetrate Microaggressions Toward LGBTQ Individuals: Sexual Orientation Microaggression Scale (SOMS-P) and Gender Identity Microaggression Scale (GIMS-P) Perpetration Version

This study is an initial psychometric evaluation of the Sexual Orientation Microaggression Perpetration Scale (SOMS-P) and Gender Identity Microaggression Perpetration Scale (GIMS-P). Using data from 2,059 undergraduate students (Mage = 21.37, SD = 4.98; Range 18-68; 78.6% assigned female at birth, 13.3% self-identified as sexual minority person), item factor analysis for binary indicators and model comparisons indicated that a correlated four- and five-factor solution for the SOMS-P and GIMS-P, respectively, outperformed a one-factor and higher-order solutions. SOMS-P and GIMS-P scores were positively associated with self-reports of bullying, violence perpetration, and hostile attitudes toward individuals who self-identify as sexual or gender minorities. They were negatively associated with attitudes supportive of sexual or gender minority persons. Reliability of .80 and higher was observed only for theta values between + 0.40 to + 2.60 SD. The psychometric evaluation showed that, while there remain to be opportunities to examine their validity across diverse contexts, SOMS-P and GIMS-P are sound measures of the propensity for SOGI microaggression.

Microaggressions Toward Sexual and Gender Minority Emerging Adults: An Updated Systematic Review of Psychological Correlates and Outcomes and the Role of Intersectionality

Purpose: Quantitative data on the psychological effects of microaggressions toward sexual and gender minority individuals have grown substantially. Sexual orientation-based and transgender and gender-diverse (trans+) identity-based microaggressions have been thematically identified in prior research. In addition, combined lesbian, gay, bisexual, transgender and gender-diverse, queer/questioning, and other non-heterosexual (LGBTQ) microaggressions can be examined intersectionally with other marginalized identities. This systematic review synthesizes research on the relationships among these microaggressions and psychological correlates and outcomes. Methods: Forty-five quantitative studies examining sexual orientation-, trans+ identity-, or intersectional identity-based microaggressions and various psychological outcomes were identified from systematic searches of PsycINFO, PsycARTICLES, MEDLINE, and PubMed databases. Data regarding microaggressions were extracted, synthesized, and grouped by mental health outcome or correlate. Results: Sexual orientation-based microaggressions were risk factors for depression, anxiety, and internalized stigma and were positively associated with psychological distress, traumatic stress symptoms, alcohol use and abuse, cannabis use and problems, suicidal ideation, and suicide attempt. Trans+ identity-based microaggressions were positively associated with depression, suicide attempt, and cannabis use. LGBTQ intersectional identity-based microaggressions concerning race/ethnicity were associated with depression, anxiety, and suicidal ideation. Research on other intersectional identity-based microaggressions is scarce. Conclusion: These findings emphasize the psychological harm inflicted by various microaggressions on LGBTQ late adolescents and early adults. Future work should focus on microaggressions toward individuals with trans+ and intersectional identities and protective factors for these experiences. This review also highlights the distinct need for community-based research on implementing microintervention strategies in family, school, and work environments to mitigate the harmful effects of these microaggressions.

'My safety depends on everyone else feeling safe and good': emotion work among transgender and gender diverse Texans

Emotion work is a regulatory method used to change the degree or quality of one's own or another's emotions. Among sexual minority people, emotion work is a regulatory method utilised to maximise identity expression while maintaining harmony in interpersonal connections. However, little is known about the utilisation of emotion work among transgender and gender diverse (TGD) people. We sought to address this gap by qualitatively exploring emotion work among members of this population. We conducted semi-structured focus groups and interviews with 11 TGD adults. Eligibility criteria included (1) English speaking, (2) at least 18 years old, (3) currently living in Texas, and (4) identifying as TGD. Interviews explored identity-related experiences of discrimination and affirmation in different social environments, and emotional, physiological and behavioural responses. Interview transcripts were analysed by four researchers using thematic analysis. Four superordinate themes were developed: 1) feeling rules, 2) intrapersonal processes, 3) identity management strategies, and 4) psychophysiological strain. We found transgender and gender diverse participants feel responsible for emotion work to maintain comfort in social interactions often at the expense of authentic identity expression and psychosocial wellbeing. Findings are interpreted using the existing literature on identity management and emotion regulation. Implications for clinical practice are also provided.

Examining the Role of Mononormative Beliefs, Stigma, and Internalized Consensual Non-Monogamy Negativity for Dehumanization

Interest in consensually non-monogamous (CNM) relationships has been increasing in the general population in recent years. However, given the cultural dominance of monogamy and the normative expectations often imposed through socialization (i.e., mononormativity), people in CNM relationships may experience negativity, which can become internalized and harm their individual and relationship health. The present study investigated if mononormativity beliefs and CNM relationship stigma were associated with more dehumanization and if internalized CNM negativity was an underlying mechanism for these associations. Results showed that participants who endorsed more mononormative beliefs and CNM relationship stigma also reported more internalized CNM negativity. In turn, participants who experienced more internalized CNM negativity attributed more negative (vs. positive) emotions to themselves and treated their partners as more immature, unrefined, exploitable, and emotionless. These results show that mononormativity and internalized negativity can shape the attitudes, perceptions, and behaviors of CNM individuals toward themselves and their partners.

Microaggression toward LGBTIQ people and implications for mental health: A systematic review

BACKGROUND

Research suggests that microaggressions detrimentally impact the mental health of members of marginalized social groups.

AIMS

The aim of this systematic review was to assess the exposure to microaggressions and related implications on mental health of Lesbian, Gay, Bisexual, Transgender, Intersex, and Queer (LGBTIQ) people.

METHOD

Medline, Scopus, PsycINFO, CINAHL, and EMBASE were searched until January 2023. Studies reporting data on the exposure to microaggressions toward LGBTIQ people were identified. Meta-analyses of rates of exposure to microaggression and of the association between microaggressions and mental health outcomes were based on odds ratio (OR) and standardized mean difference (SMD) with 95% confidence intervals (95% CI), estimated through inverse variance models with random effects.

RESULTS

The review process led to the selection of 17 studies, involving a total of 9036 LGBTIQ people, of which 6827 identifying as cisgenders, and 492 as heterosexuals, were included in the quantitative synthesis. Overall, LGBTIQ people showed an increased risk of microaggression (SMD: 0.89; 95% CI [0.28, 1.50]), with Transgender people having the highest risk (OR: 10.0; 95% CI [3.08, 32.4]). Microaggression resulted associated with risk of depression (SMD: 0.21; 95% CI [0.05, 0.37]), anxiety (SMD: 0.29; 95% CI [0.17, 0.40]), suicide attempts (OR: 1.13; 95% CI [1.08, 1.18]), alcohol abuse (OR: 1.32; 95% CI [1.13, 1.54]), but not to suicidal ideation (OR: 1.56; 95% CI [0.64, 3.81]) and cannabis abuse (OR: 1.44; 95% CI [0.82, 2.55]). The quality of the evidence was limited by the small number of studies.

CONCLUSIONS

LGBTIQ people are at higher risk of microaggressions compared with their cisgender/heterosexual peers, which may lead to mental health consequences. This evidence may contribute to public awareness of LGBTIQ mental health needs and suggest supportive strategies as well as preventive interventions (e.g., supportive programs and destigmatizing efforts) as parts of tailored health-care planning aimed to reduce psychiatric morbidity in this population.

LGBTQ+ Microaggressions in Health Care: Piloting an Observation Framework in a Standardized Patient Assessment

Microaggressions are subtle derogatory behaviors that unintentionally communicate hostility toward marginalized social groups. This article describes the preliminarily validation of a framework for observing LGBTQ+ microaggressions in health care, which can lead to distrust and disengagement from the healthcare system. Coders used the framework to observe microaggressions in video-recorded clinical-skills assessments with medical students who elicited health histories from standardized patients. Microaggression classifications were reviewed to determine construct reliability and the presence/absence among eight framework categories. Among 177 encounters with sexual and gender minority standardized patients, heteronormative/cisnormative language and assumptions occurred in the largest proportion of encounters (85.3%). Only identity-based referrals decreased significantly after a clinical skills intervention (20.0% to 4.9%, p = .01). These outcomes show that LGBTQ+ healthcare microaggressions are pervasive and will likely require nuanced training to address them. This groundwork can also be used to develop scales for patients and observers to identify microaggressions and assess perceived impact.

A 4-year prospective investigation of predictive effects of prepandemic sexual stigma, affective symptoms, and family support on fear of COVID-19 among lesbian, gay, and bisexual individuals

Aim

This prospective study examined whether prepandemic sexual stigma, affective symptoms, and family support can predict fear of coronavirus disease 2019 (COVID-19) among lesbian, gay, and bisexual (LGB) individuals.

Methods

Data of 1,000 LGB individual on prepandemic sociodemographic characteristics, sexual stigma (familial sexual stigma [FSS] measured by the Homosexuality-Related Stigma Scale, internalized sexual stigma [ISS] measured by the Measure of Internalized Sexual Stigma for Lesbians and Gay Men, and sexual orientation microaggression [SOM] measured by the Sexual Orientation Microaggression Inventory), affective symptoms (i.e., depression measured by the Center for Epidemiologic Studies-Depression Scale and anxiety measured by the State-Trait Anxiety Inventory-State version), and family support measured by the Adaptability, Partnership, Growth, Affection, and Resolve Index were collected. Four years later, the fear of COVID-19 was assessed using the Fear of COVID-19 Scale and the associations of prepandemic sexual stigma, affective symptoms, and perceived family support on fear of COVID-19 4 years later were analyzed using multiple linear regression analysis.

Results

In total, 670 (67.3%) participants agreed and completed the follow-up assessment. Greater prepandemic FSS, ISS, SOM, affective symptoms, and perceived family support were significantly associated with a greater fear of COVID-19 at follow-up.

Conclusion

The identified predictors should be considered when designing interventions aimed at preventing and reducing the fear of COVID-19 in LGB individuals.

Epistemic Peerhood as a Model To Improve Gender-Affirming Care in Medical Education

Issue: Inadequate training around gender-affirming care is a critical gap in health care and medical education that causes disparities and leads to injury for transgender, nonbinary, and other gender-diverse patients. In contrast to this widespread provider knowledge gap, gender-diverse patients bring critical knowledge from their own experiences to health care. Embracing varied epistemologies, or sources of knowledge, within medical education has the potential to enhance gender-affirming care by intentionally placing value on the lived experiences and emphasizing the credibility of gender-diverse patients. Evidence: In this article, the authors endorse a model of epistemic peerhood in which the embodied knowledge of gender-diverse patients and the authoritative knowledge of providers are each valued for their contribution to care. The authors reflect on experiences developing gender-affirming healthcare curricula and how medical education has not yet adequately addressed gender-diverse care without embracing community knowledge. Implications: The authors identify three vital areas to integrate epistemic peerhood in medical training to address gaps in gender-affirming care: (1) collaborative student training methods that reflect embodied knowledge in the absence of, or in addition to, clinical expertise on gender-affirming care; (2) sustainable partnerships between academic programs and gender-diverse communities that foster continuous engagement from collaborators with lived experience; and (3) broad community input about best practices for representing gender diversity in patient simulation. Embracing epistemic peerhood in each of these areas would result in broader gender-diverse community representation and leadership in medical education, which would ultimately strengthen gender-affirming healthcare training.

An Exploration of Sex Trading for Compensation and LGBTQ+ Inclusive Screening Practices: Perspectives of Young People who have Experienced Sex Trading and/or Homelessness

Young people's perspectives on social and healthcare providers' assessments of sex trading for financial compensation are lacking. This is particularly important for LGBTQ+ youth who experience substantial barriers in navigating health and social services. Further, increased internet access (because of COVID-19 and other factors) has changed the landscape of the sex trades in ways that are not fully understood. Our study aimed to understand (1) how young people trade sex, and (2) provider strategies that increase youths' comfort in disclosing sex trading and related risks. This community-based participatory research study surveyed currently or formerly homeless youth (ages 16-29). We co-created a cross sectional survey that explored youths' perceptions of: (1) sex trading type, compensation, and meaning; and (2) practices to increase youths' comfort in disclosing sex trading. Participants (N = 103; Mage = 22.9 [SD = 3.5]; 34% white, 55% ciswomen/21% trans; 51% queer) reported that "sex trading" signified multiple meanings, ranging from sex work/occupation to exploitation/trafficking, and included diverse in-person and virtual forms for varied compensation types. Youth reported being more comfortable disclosing when the provider indicated they would advocate for them if they are victims of discrimination. Compared to cisgender youth, trans youth reported feeling significantly more comfortable disclosing sexual activity when a service provider used gender/sexuality inclusive practices (e.g., pronoun pins). Findings suggest important implications for gender-inclusive practice strategies to ultimately reduce potential harms of sex trading and multi-item measures to assess the complexity of sex trading.

Exploring Individual and Contextual Factors Associated With Sexual Risk and Substance Use Among Underserved GBQMSM and Transgender and Nonbinary Persons in South Central Appalachia

Gay, bisexual, queer, and other men who have sex with men (GBQMSM) and transgender and nonbinary persons are at elevated risk for HIV, sexually transmitted infections (STIs), and hepatitis C (HCV); in Appalachia, these communities experience more disease burden. However, little is known about the factors influencing risk. Sixteen semistructured in-depth interviews were conducted examining factors influencing prevention and care. Data were analyzed using constant comparison methodology. Fifteen themes emerged within four domains: social environment (e.g., microaggressions across gender, sexual orientation, and racial identities), substance use (e.g., high prevalence, use as coping mechanism), sexual health (e.g., misinformation and denial of risk for HIV and STIs), and access to health care (e.g., cost and transportation barriers, lack of local respectful care). Findings highlighted salient barriers and assets influencing prevention and care and suggest that multilevel interventions are needed to improve access to and use of HIV, STI, and HCV prevention and care services.

"If You Don't Lose Weight, the Government Will Take You Away": An Analysis of Memorable Messages and Eating Disorders in the LGBTQ+ Community

Family communication plays a key role in children's body image, disordered eating, and full-blown eating disorders;. However, much existing communication research on eating disorders has focused on general populations. As the LGBTQ+ community is disproportionately affected by eating disorders , more work is needed to better understand how family communication may be perceived as influencing eating disorders in the LGBTQ+ community. Thus, the current study aimed to further this understanding by examining familial memorable messages reported by LGBTQ+ individuals which they perceived to have influenced their eating disorders. In a Qualtrics survey, participants (n = 73) provided memorable messages received from family members and explained their significance. Results of a thematic analysis indicate five themes among the memorable messages: Problematic Body Size/Weight, Pathologized Eating, Emphasizing Appearance Ideals, Emotion Origins, and Other Focus. Findings support the theory of memorable messages and reveal the ways in which diet culture and LGBTQ+ identity stigma intersect within parent-child communication toward a perceived influence on LGBTQ+ eating disorders. Implications for future communication research on LGBTQ+ eating disorders, as well as practical applications, are discussed.

Lesbian, Gay, Bisexual, Queer, Questioning and Transgender, Nonbinary, Genderqueer, and Gender Questioning Adult Alcohol Use Outcomes Associated with State Alcohol-Related Laws During the Coronavirus Pandemic in the United States

Purpose: We assessed how COVID-19-related alcohol sales policies influenced alcohol use behaviors during the pandemic for U.S. adults of diverse sexual (lesbian, gay, bisexual, queer, questioning [LGBQ]) and gender identities (transgender, nonbinary, genderqueer, and gender questioning [T/NB/GQ]). Methods: Time-specific, state-level, restaurant, bar, and off-premise alcohol policy data were collected from the National Institute on Alcohol Abuse and Alcoholism-sponsored Alcohol Policy Information System and merged with the 2020 Behavioral Risk Factor Surveillance System survey data. Treatments included bar, restaurant, and delivery alcohol sales policies. Outcomes included past 30-day drinking frequency, quantity, and heavy episodic drinking (HED). We fitted negative binomial regression models for all outcomes, clustered standard errors by state and used sample weights. We also controlled for seasonality, state Alcohol Policy Scale scores, pre-/postpandemic time period, and included demographic control variables in our cross-sectional analyses. Results: The sample included 10,505 adults identifying as LGBQ and 809 as T/NB/GQ from 32 states. Restaurant and bar closures were associated with less alcohol use for LGBQ respondents. Outdoor-only policies at bars were also associated with significantly less quantity of use and HED for T/NB/GQ adults in the sample. Off-premise home delivery was associated with greater quantity of use for LGBQ respondents and less frequency for T/NB/GQ respondents. Conclusion: The COVID-19-related alcohol sales policy changes offer an opportunity to better understand alcohol policy and availability's influence on drinking behaviors among sexual and gender-diverse populations in the United States.

Conformity to Masculinity Norms and Mental Health Outcomes Among Gay, Bisexual, Trans, Two-Spirit, and Queer Men and Non-Binary Individuals

Homophobia and biphobia negatively impact the mental health of gay, bisexual, trans, Two-Spirit, and queer men and non-binary individuals (GBT2Q) and sexual and gender minority men, but little is known about the impact of gender-related oppression. The current study examines the impact of pressure to conform to masculine norms in Canada-based GBT2Q individuals. Specifically, the associations between (a) gender expression and pressure to be masculine and (b) pressure to be masculine and depression, anxiety, and self-rated mental health were investigated. Drawing from an online national cross-sectional survey of 8,977 GBT2Q individuals and sexual and gender minority men living in Canada aged 15 years or older, 56.4% (n = 5,067) of respondents reported experiencing pressure to conform to masculine norms. Respondents were more likely to report masculine pressure if they were younger than 30 years, described their gender expression as fluid, identified their sexuality as queer, were an ethnoracial minority, and were trans. Pressure to be masculine was associated with increased odds of depression, anxiety, and reporting poor or fair mental health. The current study provides evidence of the detrimental impact of pressure to conform to masculine norms on the mental health of gay, bisexual, trans, Two-Spirit, and queer men and non-binary peoples.

"The Damage Happens … You Just Try Not to Dwell on It": Experiences of Discrimination by Gender and Sexual Minority Veterinary Professionals and Students in the US and the UK

Data collected in a 2016 survey of veterinary students and professionals from the United States and the United Kingdom who identified as lesbian, gay, bisexual, transgender, queer, questioning, or asexual (LGBTQ+) indicated that 34.5% (152/440) had experienced difficulties related to their sexual orientation or gender identity at school or work. This study's objective was to examine narrative responses collected in the 2016 survey and utilize content analysis to explore the research questions: What are the concerns of the LGBTQ+ veterinary population, and how do they attempt to resolve difficulties at work and school? To address these questions, we developed two taxonomies that cataloged (a) the difficulties reported by veterinary professionals and students in the 2016 survey sample and (b) the outcomes of their attempts to resolve these difficulties. The themes related to difficulties that occurred most frequently were exposure to homophobic or transphobic language (n = 69; 45.4%), outness/staying in the closet (45, 29.6%), and negative emotional outcomes (32, 21.2%). The most common themes that described the outcomes of their attempts to resolve those difficulties were unresolved (n = 41, 27.0%), changed jobs or graduated (22, 14.5%), and found self-acceptance of acceptance from others (21, 13.8%). Our findings can inform the efforts of schools and colleges of veterinary medicine, professional organizations, and workplaces in targeting improvements to support LGBTQ+ students and professionals and the development of measures tailored to this population.

Post-traumatic stress disorder among LGBTQ people: a systematic review and meta-analysis

AIMS

Lesbian, gay, bisexual, transgender and queer people (LGBTQ) are at increased risk of traumatization. This systematic review aimed to summarize data regarding the risk of post-traumatic stress disorder (PTSD) for LGBTQ people and their subgroups.

METHODS

Medline, Scopus, PsycINFO and EMBASE were searched until September 2022. Studies reporting a comparative estimation of PTSD among LGBTQ population and the general population (i.e., heterosexual/cisgender), without restrictions on participants' age and setting for the enrolment, were identified. Meta-analyses were based on odds ratio (OR and 95% confidence intervals [CI]), estimated through inverse variance models with random effects.

RESULTS

The review process led to the selection of 27 studies, involving a total of 31,903 LGBTQ people and 273,842 controls, which were included in the quantitative synthesis. Overall, LGBTQ people showed an increased risk of PTSD (OR: 2.20 [95% CI: 1.85; 2.60]), although there was evidence of marked heterogeneity in the estimate (I2 = 91%). Among LGBTQ subgroups, transgender people showed the highest risk of PTSD (OR: 2.52 [95% CI: 2.22; 2.87]) followed by bisexual people (OR: 2.44 [95% CI: 1.05; 5.66]), although these comparisons are limited by the lack of data for other sexual and gender minorities, such as intersex people. Interestingly, the risk of PTSD for bisexual people was confirmed also considering lesbian and gay as control group (OR: 1.44 [95% CI: 1.07; 1.93]). The quality of the evidence was low.

CONCLUSIONS

LGBTQ people are at higher risk of PTSD compared with their cisgender/heterosexual peers. This evidence may contribute to the public awareness on LGBTQ mental health needs and suggest supportive strategies as well as preventive interventions (e.g., supportive programs, counselling, and destigmatizing efforts) as parts of a tailored health-care planning aimed to reduce psychiatric morbidity in this at-risk population.

Consortium for violence prevention research, leadership training, and implementation for excellence (CONVERGE): a protocol to train science leaders in gender-based-violence and violence-against-children research for impact

Background

Gender-based violence (GBV) and violence against children (VAC) are two prevalent and highly interconnected global health challenges, yet data and research capacities to study these forms of violence and to generate evidence-based policies and programs remain limited. To address critical shortages in research capacity in Vietnam and to establish a model for other Low- and Middle-Income Countries (LMICs), we are establishing CONVERGE-the Consortium for Violence Prevention Research, Implementation, and Leadership Training for Excellence.

Methods

Based on a needs assessment with partners in Vietnam, CONVERGE will provide a comprehensive research training program supporting 15 long-term, postdoctoral trainees with multi-disciplinary research training in GBV and VAC. We also will offer in-country trainings and short-courses to 40 short-term mid-career academic trainees and 60 short-term practitioner/stakeholder trainees over 5  years to build productive GBV and VAC academic, scientific, and practitioner networks. The CONVERGE training program has four components: (1) 14 h of virtual/in-person annual mentorship training to prepare research mentors and to create a pipeline of future mentors in Vietnam; (2) a one-month intensive research training for long-term postdoctoral fellows at Emory University; (3) a structured 17-month, in-country mentored research project for long-term trainees that results in a peer-reviewed manuscript and a subsequent grant submission; and, (4) week-long in-country intensive translational trainings on implementation science, advanced topics in leadership, and advanced topics in science dissemination. Opportunities for on-going virtual training and professional networking will be provided for CONVERGE trainees and mentors in Vietnam with other trainees and mentors of D43s focused on injury/violence prevention, D43s housed at Emory, and D43s with other institutions in Southeast Asia. To assess the reach, implementation, fidelity, and effectiveness of these four components, we will implement a rigorous, mixed-methods, multi-level evaluation strategy using process and outcome measures. Findings from the evaluation will be used to refine program components for future trainee and mentor cohorts and to assess long-term program impact.

Discussion

Led by Emory University in the US and Hanoi Medical University in Vietnam, CONVERGE represents leading institutions and experts from around the world, with a goal of providing mentorship opportunities for early-career scientists with an interest in violence prevention.

Lateral Violence and Microaggressions in the LGBTQ+ Community: A Scoping Review

Violence and microaggressions against the LGBTQ+ community from those outside of the community is commonly known and understood within academic literature. However, there is limited comprehensive knowledge about violence and microaggressions that occur within LGBTQ+ communities. This scoping review helps to fill this gap in knowledge, analyzing and synthesizing 18 research articles published in English language scholarly journals all of which have been published between 2010 and 2020. Online databases ProQuest, SAGE Journals, Google Scholar, Taylor and Francis Journals, Scopus, Informit, Project MUSE, PubMed, and EBSCOhost were utilized to search for existing literature on ingroup LGBTQ+ microaggression. The found literature focused on power dynamics within the LGBTQ+ community and how that power has enabled subgroups within the community to enact microaggression on one another. We found that ingroup microaggressions experienced by members of the LGBTQ+ community are a result of dominant norms that give certain groups power over another.

When complications arise during birth: LBTQ people's experiences of care

OBJECTIVE

To explore the care experiences of lesbian, bisexual, transgender, and queer (LBTQ) people during births where complications have arisen.

DESIGN

Data were collected through semi-structured interviews with self-identified LBTQ people who had experienced obstetrical and/or neonatal complications.

SETTING

Interviews were conducted in Sweden.

PARTICIPANTS

A total of 22 self-identified LBTQ people participated. 12 had experienced birth complications as the birth parent and ten as the non-birth parent.

FINDINGS

Most participants had felt invalidated as an LBTQ family. Separation of the family due to complications elevated the number of hetero/cisnormative assumptions, as new encounters with healthcare professionals increased. Dealing with normative assumptions was particularly difficult in stressful and vulnerable situations. A majority of the birth parents experienced disrespectful treatment from healthcare professionals that violated their bodily integrity. Most participants experienced lack of vital information and emotional support, and expressed that the LBTQ identity made it harder to ask for help.

CONCLUSIONS

Disrespectful treatment and deficiencies in care contributed to negative experiences when complications arose during birth. Trusting care relationships are important to protect the birth experience in case of complications. Validation of the LBTQ identity and access to emotional support for both birth and non-birth parents are crucial for preventing negative birth experiences.

IMPLICATIONS FOR PRACTICE

To reduce minority stress and create conditions for a trusting relationship, healthcare professionals should specifically validate the LBTQ identity, strive for continuity of carer and zero separation of the LBTQ family. Healthcare professionals should make extensive efforts to transfer LBTQ related information between wards.

Minority stress theory: Application, critique, and continued relevance

The minority stress model has been influential in guiding research on sexual and gender minority health and well-being in psychology and related social and health sciences. Minority stress has theoretical roots in psychology, sociology, public health, and social welfare. Meyer provided the first integrative articulation of minority stress in 2003 as an explanatory theory aimed at understanding the social, psychological, and structural factors accounting for mental health inequalities facing sexual minority populations. This article reviews developments in minority stress theory over the past two decades, focusing on critiques, applications, and reflections on its continued relevance in the context of rapidly changing social and policy contexts.

A Google Trends Analysis of Interest in Nonbinary Identities

Emerging research on stigma suggests that society's mistreatment of nonbinary individuals can, in part, be attributed to public uncertainty and a lack of knowledge about nonbinary identities. In response to this, this study drew upon the theoretical framework of uncertainty management to explore research questions related to nonbinary identity and information behaviors by investigating uncertainty management as evidenced by longitudinal Google Trends data related to nonbinary gender identities. If individuals were found to be engaging in information seeking, the result of this behavior may be that they become less likely to hold stigmatizing attitudes toward nonbinary people, and ultimately be less likely to engage in discrimination toward them. Results indicated that indeed there has been an increase in search volume interest related to nonbinary identities in the past decade. The study concludes by presenting the need for further research to clarify the nature of the relationship between stigma and information seeking, as well as presenting a quandary for researchers regarding the desire for more detailed demographic data, as balanced with concerns for privacy.

A Scoping Review on the Role of Sexual Orientation and Gender Identity Microaggressions in Substance Use

Objectives

Disparities in substance use patterns and outcomes are evident among sexual and gender minority groups. Sexual orientation and gender identity (SOGI) microaggression, or the subtle forms of aggression experienced by lesbian, gay, bisexual, transgender, gender non-conforming/non-binary, and gender diverse individuals, has recently been explored as a mechanism that leads to negative adjustment outcomes, including substance use. In this study we examined extant literature on the association between SOGI microaggression and substance use, and the intermediary factors that mediate or moderate this relationship.

Method

Scoping review method was used to systematically map the literature base using database aggregators (e.g., Scopus, EBSCO) following the PRISMA Extension for Scoping Reviews (PRISMA-ScR) guidelines.

Results

We found that SOGI microaggression is positively associated with substance use and negative consequences, and this relationship is mediated or moderated by motivational, relational, and identity processes.

Conclusion

These findings suggest the need to consider microaggression experience when working with clients of diverse sexual and gender identities. Likewise, additional studies are needed on other intermediary factors and effects of microaggression on substances other than alcohol. Most importantly, this study underscores the need for understanding the link between microaggression and substance use in greater efforts to promote sexual well-being and building competence in fostering the trifecta of sexual health, sexual rights, and sexual pleasure.

Experiences in the delivery of preconception and pregnancy care for LGBTIQA+ people: A systematic review and thematic synthesis of patient and healthcare provider perspectives

BACKGROUND

The widespread availability of reproductive technology and family planning services has led to an increase in the number of available pathways to parenthood for LGBTIQA+ people. However, emerging research indicates that significant healthcare inequities have been documented among LGBTIQA+ people and attributed to the pervasiveness of structural and systemic discrimination that extends to preconception and pregnancy care.

AIM

The aim of this systematic review was to synthesise qualitative research that has explored the experiences of LGBTIQA+ people in navigating preconception and pregnancy care services to inform healthcare quality improvement.

METHOD

Six databases were searched for relevant research published between 2012 and 2023. The findings of all included studies underwent a secondary thematic synthesis, and methodological quality was assessed using the Joanna Briggs Institute Checklist for Qualitative Research.

FINDINGS

A total of 37 studies were eligible for inclusion. Four major themes were constructed through thematic synthesis: (1) unavailability of information, services, and support; (2) clinical competencies of healthcare staff; (3) hetero- and cis-sexist care experiences; and (4) discrimination and traumatisation.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

The findings of this review indicate that LGBTIQA+ people experience significant challenges during the journey towards parenthood, marked predominantly by the pervasiveness of inequity, and defined by discriminatory healthcare processes. This review has led to several recommendations for future healthcare quality improvement through an investment in policies, procedures, and interactions that are sensitive to the needs of LGBTIQA+ people. Importantly, future research must be co-designed and led by LGBTIQA+ community input.

Transgender Dehumanization and Mental Health: Microaggressions, Sexual Objectification, and Shame

Using structural equation modeling in a national, nonprobabilistic sample of 292 transgender women and men, this project extends the pantheoretical dehumanization framework by testing direct and indirect relations between dehumanization (i.e., a higher-order construct from experiences of transgender microaggressions and sexual objectification), internalization processes (i.e., internalized transnegativity, self-objectification), shame, and general mental health. The model explained 55% of the variance in general mental health. Direct relations between dehumanization and all internalization processes were positive and significant. Internalized transnegativity and shame were significant, negative, direct predictors of mental health, but neither dehumanization nor self-objectification was a significant direct predictor of transgender mental health. Both self-objectification and internalized transnegativity directly predicted more feelings of shame. However, only shame yielded a significant indirect pathway from dehumanization to mental health. The indirect relations from self-objectification and internalized transnegativity to mental health through shame were significant. Research, advocacy, and clinical implications are discussed.

The barriers and needs of transgender men in pregnancy and childbirth: A qualitative interview study

OBJECTIVE

Transgender and gender diverse individuals are individuals whose gender identity differs from their sex assigned at birth. The discordance between gender identity and sex assignment may cause significant psychological distress: gender dysphoria. Transgender individuals may choose to undergo gender-affirming hormone treatment or surgery, but some decide to (temporarily) refrain from surgery and gender affirming hormone treatment and hence retain the possibility to become pregnant. Pregnancy may enhance feelings of gender dysphoria and isolation. To improve perinatal care for transgender individuals and their health care providers, we conducted interviews to explore the needs and barriers of transgender men in family planning, pregnancy, childbirth, puerperium and perinatal care.

DESIGN

In this qualitative study five in-depth semi-structured interviews were conducted with Dutch transgender men who had given birth while identifying on the transmasculine spectrum. The interviews were conducted online through a video remote-conferencing software program (n=4) or live (n=1). Interviews were transcribed verbatim. An inductive approach was used to find patterns and collect data from the participants' narratives and constant comparative method was adapted in analysing the interviews.

MEASUREMENTS AND FINDINGS

The experiences of transgender men regarding the preconception period, pregnancy and puerperium and with perinatal care varied widely. Though all participants expressed overall positive experiences, their narratives emphasized they had to overcome substantial hurdles pursuing pregnancy. For instance the necessity to prioritise becoming pregnant over gender transitioning, lack of support by healthcare providers and increased gender dysphoria and isolation during pregnancy KEY CONCLUSIONS: Since pregnancy in transgender men enhances feelings of gender dysphoria, transgender men comprise a vulnerable group in perinatal care. Health care providers are perceived as feeling unaccustomed for the care of transgender patients, as they are perceived to often lack the right tools and knowledge to provide adequate care. Our findings help strengthen the foundation of insight in the needs and hurdles of transgender men pursuing pregnancy and therefore may guide health care providers to provide equitable perinatal care, and emphasize the necessity of patient-centred gender-inclusive perinatal care. A guideline including the option for consultation of an expertise center is advised to facilitate patient-centered gender-inclusive perinatal care.