Suicidal ideation and attempts among sexual minority youths receiving social services

Explaining Suicide Among Indian Women: Applying the Cultural Theory of Suicide to Indian Survivors of Gender-Based Violence Reporting Suicidal Ideation

Indian women account for 36.6% of suicide-related deaths worldwide and gender-based violence (GBV) is a key social determinant. The cultural theory of suicide (CTS), which synthesizes risk factors and explanations of suicide among racial/ethnic minorities, posits four tenets: idioms of distress, cultural sanctions, and social discord. Our study applied the CTS to Indian women from slums reporting GBV to explore (1) culturally relevant risk pathways towards suicidal ideation using qualitative analyses, and test (2) the association between idioms of distress and suicidal ideation. 112 women from urban slums were recruited and 99 completed surveys. A subset were administered qualitative interviews. Aim 1 explored the CTS framework among participants describing suicidal ideation in qualitative interviews [n = 18]; Aim 2 explored if idioms of distress severity was associated with suicidal ideation through an ANCOVA [N = 99]. Idioms of distress such as 'tension' indicated suicidal ideation. Communities did not sanction suicidal ideation, leading to secrecy regarding disclosure. Women in 'love marriages' (versus arranged marriages) reported minority stress. Social discord heightened suicidal thoughts. Results of the ANCOVA confirmed that women reporting suicidal ideation had higher idioms of distress severity (M = 28.56, SD = 6.37), compared to women who did not (M = 21.77, SD = 6.07), F(1, 96) = 28.58, p < .001 (ηp2 = .23). Our study empirically validates the CTS among Indian GBV survivors. Culturally responsive suicide prevention can include assessing idioms of distress, improving family support, and educating to reduce stigma and enhance help-seeking.

A systematic review and meta-analysis of health, functional, and cognitive outcomes in young people who use methamphetamine

Methamphetamine use typically starts in adolescence, and early onset is associated with worse outcomes. Yet, health, functional, and cognitive outcomes associated with methamphetamine use in young people are not well understood. The aim of this study was to comprehensively assess the evidence on health, functional, and cognitive outcomes in young people (10-25 years-old) who use methamphetamine. Sixty-six studies were included. The strongest association observed was with conduct disorder, with young people who use methamphetamine some 13 times more likely to meet conduct disorder criteria than controls. They were also more likely to have justice system involvement and to perpetrate violence against others. Educational problems were consistently associated with youth methamphetamine use. The cognitive domain most reliably implicated was inhibitory control. Key limitations in the literature were identified, including heterogenous measurement of exposure and outcomes, lack of adequate controls, and limited longitudinal evidence. Outcomes identified in the present review - suggesting complex and clinically significant behavioural issues in this population - are informative for the development of future research and targeted treatments.

Toward objective characterizations of suicide risk: A narrative review of laboratory-based cognitive and behavioral tasks

Although suicide is a leading cause of preventable death worldwide, current prevention efforts have failed to substantively mitigate suicide risk. Suicide research has traditionally relied on subjective reports that may not accurately differentiate those at high versus minimal risk. This narrative review supports the inclusion of objective task-based measures in suicide research to complement existing subjective batteries. The article: 1) outlines risk factors proposed by contemporary theories of suicide and highlights recent empirical findings supporting these theories; 2) discusses ongoing challenges associated with current risk assessment tools and their ability to accurately evaluate risk factors; and 3) analyzes objective laboratory measures that can be implemented alongside traditional measures to enhance the precision of risk assessment. To illustrate the potential of these methods to improve our understanding of suicide risk, the article reviews how acute stress responses in a laboratory setting can be modeled, given that stress is a major precipitant for suicidal behavior. More precise risk assessment strategies can emerge if objective measures are implemented in conjunction with traditional subjective measures.

The role of parents' and friends' support in preventing suicide attempts among French sexual minority adolescents

OBJECTIVES

French sexual minority adolescents are at higher risk for suicide attempts than their heterosexual peers. However, little is known about the role of parents' and friends' support among French lesbian, gay and bisexual (LGB) youth. This study aimed to research the role of their support in preventing suicide attempts among LGB adolescents in France.

MATERIALS AND METHODS

Data were drawn from a French cross-sectional study entitled "Portraits d'adolescents". Parental support was defined by satisfactory relations between participants and their parents. Friends' support was defined by satisfactory relations between participants and their friends. Chi-square and multiple logistic regression analyses were used to estimate and identify associated factors of suicide attempts in LGB as opposed to heterosexual youth.

RESULTS

Data from a sample of 14,265 French adolescents aged 13 to 20 were analyzed. Among them, 637 (4.47%) identified as LGB. Attempted suicide was independently associated with sexual orientation (30.7% vs 10.6%; OR = 2.59 [2.11-3.18]; p < 0.0001). Both parents' and friends' support appeared to be protective factors in suicide attempts among heterosexuals (adjusted ORs = 0.40 [0.35-0.46] and 0.61 [0.51-0.75], respectively), whereas in the LGB group, only parental support was significant (adjusted OR = 0.42 [0.27-0.65]), independently of other variables.

DISCUSSION

Prevention efforts might be carried out by identifying within-group differences among French adolescents with different sexual orientations. The supportive role of family members should be strengthened. Positive resources and salutary support systems may effectively prevent suicide attempts.

CONCLUSIONS

French LGB adolescents have a higher risk for suicide attempts than their heterosexual peers. Parental support was reconfirmed as a major protective factor against suicide attempts in sexual minority adolescents.

Minority stressors and suicidal ideation in sexual and gender minority youth assigned female at birth: Prospective associations and racial differences

INTRODUCTION

Suicidal ideation (SI) disproportionately affects sexual and gender minority (SGM) versus cisgender/heterosexual youth, likely due to the minority stressors (MS) they face. Research has shown cross-sectional associations between SGM MS and suicidality; however, few studies have used longitudinal data or examined racial differences in the effects of MS on SI. The current study tested whether MS prospectively predict next-year SI and whether race moderates these prospective associations.

METHOD

Three hundred and sixty-nine Black, Latinx, and White SGM youth completed baseline measures of MS, SI, and demographics, and SI 6 and 12 months later.

RESULTS

Internalized stigma, microaggressions, and low support from family and from significant others demonstrated associations with next-year SI. When controlling for baseline SI, however, only low significant other support predicted next-year SI. Moderation analyses indicated that internalized stigma predicted SI for White, but not Black or Latinx, individuals and that lower friend support was associated with SI for Latinx, but not White or Black, individuals.

CONCLUSIONS

Though minority stressors appear to raise risk for SI among SGM, effects may differ by race. Internalized stigma may be particularly influential for SI among White SGM whereas lack of support from friends may be most influential for SI among Latinx SGM youth.

The roles of school in supporting LGBTQ+ youth: A systematic review and ecological framework for understanding risk for suicide-related thoughts and behaviors

The extant literature on suicide-related thoughts and behaviors (STB) has highlighted increased patterns of risk among specific minoritized populations, including lesbian, gay, bisexual, transgender, questioning, intersex, two spirit, and queer (LGBTQ+) youth. Compared to their heterosexual and cisgender peers, LGBTQ+ youth are at increased risk for having STB. Identity-specific stressors such as homonegativity and anti-queerness are among the unique factors posited to contribute to this risk and inhibit factors that protect against suicide. The school setting has been a focal point for suicide prevention and intervention and may also play a key role in linking students to care; however, schools also hold the potential to provide supports and experiences that may buffer against risk factors for STB in LGBTQ+ students. This systematic literature review presents findings from 44 studies examining school-related correlates of STB in LGBTQ+ students, informing an ecological approach to suicide prevention for school settings. Findings underscore the importance of school context for preventing STB in LGBTQ+ youth. Approaches that prioritize safety and acceptance of LGBTQ+ youth should span multiple layers of a student's ecology, including district and state level policies and school programs and interventions, such as Gender and Sexuality Alliances and universal bullying prevention programs. Beyond their role as a primary access point for behavioral health services, schools offer a unique opportunity to support suicide prevention by combating minority stressors through promoting positive social relationships and a safe community for LGBTQ+ students.

Minority Stress and Suicidal Ideation and Suicide Attempts Among LGBT Adolescents and Young Adults: A Meta-Analysis

Purpose: This meta-analytic study examined associations between minority stressors and suicidal ideation and suicide attempts among LGBT adolescents and young adults (aged 12-25 years). Methods: Identified studies were screened using the inclusion and exclusion criteria. Studies had to include an association between a minority stressor and a suicidality outcome and were categorized into 10 meta-analyses. Overall effect sizes were calculated using three-level meta-analyses. In addition, moderation by sampling strategy was examined. Results: A total of 44 studies were included. Overall, LGBT bias-based victimization, general victimization, bullying, and negative family treatment were significantly associated with suicidal ideation and/or suicide attempts. Associations of discrimination and internalized homophobia and transphobia with suicidal ideation and/or suicide attempts were not significant. No moderation effects were found for sampling strategy. Conclusion: Although overall effect sizes were small, our meta-analytic study shows a clear link between various types of minority stressors and suicidal ideation and suicide attempts among LGBT adolescents and young adults.

Adolescence and Suicide: Subjective Construction of the Suicidal Process in Young Gay and Lesbian Chileans

The association between suicide risk and sexual minority status can be understood from the perspective of the social determinants of health, an approach that requires the development of culturally sensitive knowledge. The aim of this study was to characterize young gay and lesbian people's subjective construction of their experience of having lived and survived a suicidal process. Qualitative interviews were conducted and analyzed as products based on life events. In the participants' accounts, we identified hostile contexts associated with suicide, trajectories associated with gay/lesbian identification processes, and milestones related to victimization experiences as part of the intentionality and rationality of suicide.

Suicide, Race, and Social Work: A Systematic Review of Protective Factors among African Americans

Purpose: Suicide among African Americans has increased significantly in the past 15 years, yet it remains a neglected topic in social work research. This systematic review examines social work's contribution to suicide research while focusing on the social context in which African Americans live.Method: Using a critical race theory, we examine protective factors specific to African Americans that may mitigate suicide risks. Results reveal that the social work profession has produced 20 suicide-related studies between 1980 and 2018.Results: Identify three types of protective factors against suicide among African Americans. These are: micro-level factors (private regard / strong African American identity and impulsive response to discrimination), mezzo-level factors (family support and the role of women), and macro-level factors (social support, poverty and lack of awareness, religion, access to care, and internal response to community violence).Conclusion: Finding demonstrate evidence of the relationship between protective factors and suicide among African Americans. Implications for the use of Critical Race Theory in Social Work research and practice are provided along with implications to advance suicide training in social work education programs.

A systematic review and meta-analysis of victimisation and mental health prevalence among LGBTQ+ young people with experiences of self-harm and suicide

BACKGROUND

LGBTQ+ youth have higher rates of self-harm and suicide than cisgender, heterosexual peers. Less is known about prevalence of risks within these populations.

OBJECTIVES

The first systematic review and meta-analysis to investigate the prevalence of risks among young people throughout the LGBTQ+ umbrella with experiences across the dimension of self-harm, suicidal ideation and suicide behaviour; and how they may differ between LGBTQ+ umbrella groups.

DATA SOURCES

MEDLINE, Scopus, EMBASE, PsycINFO, and Web of Science searches were run to identify quantitative research papers (database inception to 31st January, 2020).

STUDY ELIGIBILITY CRITERIA

Articles included were empirical quantitative studies, which examined risks associated with self-harm, suicidal ideation or suicidal behaviour in LGBTQ+ young people (12-25 years).

SYNTHESIS METHODS

2457 articles were identified for screening which was completed by two independent reviewers. 104 studies met inclusion criteria of which 40 had data which could be meta-analysed in a meaningful way. This analysis represents victimisation and mental health difficulties as risks among LGBTQ+ youth with self-harm and suicide experiences. Random-effects modelling was used for the main analyses with planned subgroup analyses.

RESULTS

Victimisation and mental health were key risk factors across the dimension self-harm and suicide identified through all analyses. A pooled prevalence of 0.36 was indicated for victimisation and 0.39 for mental health difficulties within LGBTQ+ young people with experiences of self-harm or suicide. Odds ratios were calculated which demonstrated particularly high levels of victimisation (3.74) and mental health difficulties (2.67) when compared to cisgender, heterosexual counterparts who also had these experiences.

CONCLUSIONS

Victimisation and mental health difficulties are highly prevalent among LGBTQ+ youth with experiences of self-harm and suicide. Due to inconsistency of reporting, further risk synthesis is limited. Given the global inclusion of studies, these results can be considered across countries and inform policy and suicide prevention initiatives.

PROSPERO REGISTRATION NUMBER

CRD42019130037.

Evaluation of sexual minority identity as a moderator of the association between intimate partner violence and suicidal ideation and attempts among a national sample of youth

Sexual minority (SM) youth are at high risk for intimate partner violence (IPV) and suicidal ideation/attempts compared to their heterosexual peers. We examined whether SM identity enhanced the relationship between experiences of IPV and suicidal ideation/attempts. Weighted logistic regression models were run using the 2017 Youth Risk Behavior Survey. All main effects were significant; each SM identity and both physical and sexual IPV were significantly associated with suicidal ideation and suicide attempts. The interaction between bisexual identity and physical IPV was significant for suicidal ideation; as physical IPV experiences increased, the difference between bisexual identity and heterosexual youth was non-significant. Findings suggest exploring trauma and suicidal ideation by aggregate groups and increasing support for SM youth in schools and communities.

Mental health outcomes associated with of the use of amphetamines: A systematic review and meta-analysis

BACKGROUND

The use of amphetamines is a global public health concern. We summarise global data on use of amphetamines and mental health outcomes.

METHODS

A systematic review and meta-analysis (CRD 42017081893). We searched Medline, EMBASE, PsycInfo for methamphetamine or amphetamine combined with psychosis, violence, suicidality, depression or anxiety. Included studies were human empirical cross-sectional surveys, case-control studies, cohort studies and randomised controlled trials that assessed the association between methamphetamine and one of the mental health outcomes. Random effects meta-analysis was used to pool results for any use of amphetamines and amphetamine use disorders.

FINDINGS

149 studies were eligible and 59 were included in meta-analyses. There was significant heterogeneity in effects. Evidence came mostly from cross-sectional studies. Any use of amphetamines was associated with higher odds of psychosis (odds ratio [OR] = 2.0, 95%CI 1.3-3.3), violence (OR = 2.2, 95%CI 1.2-4.1; adjusted OR [AOR] = 1.4, 95%CI 0.8-2.4), suicidality OR = 4.4, 95%CI 2.4-8.2; AOR = 1.7, 95%CI 1.0-2.9) and depression (OR = 1.6, 95%CI 1.1-2.2; AOR = 1.3, 95%CI 1.2-1.4). Having an amphetamine use disorder was associated with higher odds of psychosis (OR = 3.0, 95%CI 1.9-4.8; AOR = 2.4, 95%CI 1.6-3.5), violence (OR = 6.2, 95%CI 3.1-12.3), and suicidality (OR = 2.3, 95%CI 1.8-2.9; AOR = 1.5, 95%CI 1.3-1.8).

INTERPRETATION

Methamphetamine use is an important risk factor for poor mental health. High quality population-level studies are needed to more accurately quantify this risk. Clinical responses to methamphetamine use need to address mental health harms.

Do Anti-Bullying Laws Reduce In-School Victimization, Fear-based Absenteeism, and Suicidality for Lesbian, Gay, Bisexual, and Questioning Youth?

Lesbian, gay, and bisexual youth are at heightened risk for bullying and other forms of in-school victimization. Anti-bullying laws are a potential policy mechanism for addressing this issue, yet there has been little investigation of the impact of such policies for this population using generalizable samples or quasi-experimental designs. The current study explores whether the presence of state anti-bullying laws predicts lower likelihood of bullying victimization, fear-based absenteeism, in-school threats or injury with a weapon, and suicidality for lesbian, gay, bisexual, and questioning high school students in the United States. Based on Youth Risk Behavior Survey data across 22 states from 2005-2015, coupled with data about the presence of general and enumerated anti-bullying laws that include sexual orientation as a protected class, this study analyzes this topic using a quasi-experimental design (linear difference-in-difference models). The results indicate that lesbian, gay, bisexual, and questioning youth (particularly boys aged 15 or younger) experienced less bullying victimization in states with general or enumerated anti-bullying laws. There was modest evidence of a reduction in fear-based absenteeism among boys in states with such laws. However, there was little evidence of a relationship between such policies and in-school threats or injuries or suicidality. Further, lesbian, bisexual, and questioning girls' likelihood of victimization, absenteeism, or suicidality was generally not related to the presence of anti-bullying laws. The results suggest that general and enumerated anti-bullying laws may help reduce bullying victimization for gay, bisexual, and questioning boys.

What sexual minority youths want in a program to assist with disclosure to their family

Disclosing one's sexual orientation to family members can be a difficult process for sexual minority youth (SMY). There are many decisions to make and factors to consider, such as whom to tell first and how family members may react. SMY are in need of resources to help them through this process, including programs that help them to make decisions about safe disclosure. Through interviews and open-ended surveys with 48 participants, the authors found that overall, SMY want a program that helps them connect with others. There were no strong preferences for facilitators' gender, and participants differed in opinions on facilitators' sexual orientation. However, most agreed that they would like a program that provides education and the opportunity to hear from and share stories with others.

Non-Monosex Research Publication in U.S.-Based Social Work Journals Between 2008-2016

An estimated 4% of men and 9% of women identify as non-monosex, a term for sexual identities outside of the heterosexual/homosexual binary, such as bisexual, pansexual, polysexual, and asexual. In addition to experiences of oppression shared with all sexual minorities, non-monosex-identifying persons face additional issues of monosex bias in their personal lives, in mass media, and in research. Despite social work's commitment to issues of social justice and inclusion, prior reviews of the literature have indicated a gap in research on non-monosex-identifying persons, which can lead to inappropriate clinical practices and continued stigmatization. The authors of this article examined the state of social work literature on non-monosex-identifying persons through a systematic review and content analysis of primary-study data-based publications from 2008 to 2016 in 24 social work journals based in the United States. Only four articles were found that met the inclusion criteria, and while 31% of the 357 total study participants identified as non-monosex, a content analysis showed subtle forms of monosex bias in the reporting of study results, such as collapsing of gay/lesbian participants with non-monosex participants and the use of marginalizing language. Implications and suggestions for future social work researchers are discussed.

The Protective Role of Gay-Straight Alliances for Lesbian, Gay, Bisexual, and Questioning Students: A Prospective Analysis

Prior studies show a strong association between gay-straight alliances (GSAs) and the well-being and safety of sexual minority students at school. However, nearly all existing literature has relied on cross-sectional data. Using data from the first two panels of a multi-site longitudinal study on risk and protective factors for suicide among lesbian, gay, bisexual, and questioning (LGBQ) youth in three U.S. cities, we examined the influence of presence of and participation in a GSA on perceptions of safety at school, homophobic bullying experiences, and psychosocial adjustment (depression and self-esteem) in 327 LGBQ students across two school years. LGBQ students who had GSAs in their schools or were members of GSAs in the prior year showed no differences in psychological adjustment, but they reported perceptions of more school safety and less homophobic bullying in the following school year. Further, changes in GSA presence (gaining a GSA) and changes in participation (from non-participation to participation) were independently associated with stronger perceived safety in the subsequent school year. This study provides the first prospective evidence of the lasting positive role of GSAs for high school students, and documents that changes in GSA presence and participation are associated with safety at school. Education policy and practice implications are discussed.

Implementing school nursing strategies to reduce LGBTQ adolescent suicide: a randomized cluster trial study protocol

BACKGROUND

Reducing youth suicide in the United States (U.S.) is a national public health priority, and lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ) youth are at elevated risk. The Centers for Disease Control and Prevention (CDC) endorses six evidence-based (EB) strategies that center on meeting the needs of LGBTQ youth in schools; however, fewer than 6 % of U.S. schools implement all of them. The proposed intervention model, "RLAS" (Implementing School Nursing Strategies to Reduce LGBTQ Adolescent Suicide), builds on the Exploration, Preparation, Implementation, and Sustainment (EPIS) conceptual framework and the Dynamic Adaptation Process (DAP) to implement EB strategies in U.S. high schools. The DAP accounts for the multilevel context of school settings and uses Implementation Resource Teams (IRTs) to facilitate appropriate expertise, advise on acceptable adaptations, and provide data feedback to make schools implementation ready and prepared to sustain changes.

METHODS/DESIGN

Mixed methods will be used to examine individual, school, and community factors influencing both implementation process and youth outcomes. A cluster randomized controlled trial will assess whether LGBTQ students and their peers in RLAS intervention schools (n = 20) report reductions in suicidality, depression, substance use, bullying, and truancy related to safety concerns compared to those in usual care schools (n = 20). Implementation progress and fidelity for each EB strategy in RLAS intervention schools will be examined using a modified version of the Stages of Implementation Completion checklist. During the implementation and sustainment phases, annual focus groups will be conducted with the 20 IRTs to document their experiences identifying and advancing adaptation supports to facilitate use of EB strategies and their perceptions of the DAP.

DISCUSSION

The DAP represents a data-informed, collaborative, multiple stakeholder approach to progress from exploration to sustainment and obtain fidelity during the implementation of EB strategies in school settings. This study is designed to address the real-world implications of enabling the use of EB strategies by school nurses with the goal of decreasing suicide and youth risk behaviors among LGBTQ youth. Through its participatory processes to refine and sustain EB strategies in high schools, the RLAS represents a novel contribution to implementation science.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT02875535.

Sexual minority youth of color: A content analysis and critical review of the literature

This study analyzed the content of 125 unique reports published since 1990 that have examined the health and well-being-as well as the interpersonal and contextual experiences-of sexual minority youth of color (SMYoC). One-half of reports sampled only young men, 73% were noncomparative samples of sexual minority youth, and 68% of samples included multiple racial-ethnic groups (i.e., 32% of samples were mono-racial/ethnic). Most reports focused on health-related outcomes (i.e., sexual and mental health, substance use), while substantially fewer attended to normative developmental processes (i.e., identity development) or contextual and interpersonal relationships (i.e., family, school, community, or violence). Few reports intentionally examined how intersecting oppressions and privileges related to sexual orientation and race-ethnicity contributed to outcomes of interest. Findings suggest that research with SMYoC has been framed by a lingering deficit perspective, rather than emphasizing normative developmental processes or cultural strengths. The findings highlight areas for future research focused on minority stress, coping, and resilience of SMYoC.

Perceived Discrimination Is an Independent Risk Factor for Suicidal Ideation among Sexual and Gender Minorities in Nepal

Sexual and gender minorities experience an elevated burden of suicidality compared with the general population. Still, little is known about that burden and the factors generating it in the context of low- and middle-income countries. The present study assessed the prevalence of suicidal ideation, planned suicide, and attempted suicide among men who have sex with men (MSM) and transgender people (TG) in Nepal, and examined the association of perceived discrimination on the basis of sexual orientation with suicidal ideation and with attempted suicide. Data were obtained from a surveillance survey among MSM and TG in Nepal in 2012. A sample of 400 MSM and TG, recruited using respondent-driven sampling, completed a structured face-to-face interview. Throughout their lifetime, 26.8% of the participants had experienced suicidal ideation, 12.0% had made a suicide plan, and 9.0% had attempted suicide. In particular, more TG than MSM had experienced suicidal ideation (39.8% vs. 21.3%), had made a suicide plan (19.5% vs. 8.9%), and had attempted suicide (15.3% vs. 6.4%). Overall, the odds of having experienced suicidal ideation was significantly higher among the 38.3% of participants who had perceived discrimination based on their sexual orientation (AOR: 3.17; 95% CI: 1.83-5.48). Moreover, the odds of suicidal ideation was significantly higher as the extent of perceived discrimination increased (AOR: 1.35; 95% CI: 1.15-1.60). However, the odds of attempted suicide was not significantly associated with perceived discrimination (AOR: 1.40; 95% CI: 0.62-3.15). The findings highlight perceived discrimination as an independent risk factor for suicidal ideation. Future suicide prevention programs should target sexual and gender minorities and include elements focusing on discrimination.

Prevalence and Correlates of Lifetime Suicide Attempts Among Transgender Persons in Argentina

This study examined the lifetime prevalence and correlates of attempted suicide among transgender persons in Argentina. Data were derived from a nation-wide, cross-sectional survey conducted in 2013. We assessed individual, social, and structural correlates of reporting a history of attempting suicide using logistic regression. Among 482 participants, the median age was 30, 91% identified as transwomen, and 32% resided in the Buenos Aires metropolitan area. A lifetime suicide attempt was reported by 159 (33%), among whom the median age at first attempt was 17. In a multivariate model, internalized stigma was positively associated with a history of suicidal behavior, while participants with stable housing had reduced odds of prior suicide attempt(s). These findings suggest that reducing stigma and mitigating structural vulnerabilities (through, for example, the enactment and enforcement of laws that prohibit discrimination based on gender identity to ensure equitable access to housing) could be effective targets for intervention to reduce suicide attempts among transgender individuals in Argentina.

Relationship between quality of life and unprotected anal intercourse among Chinese men who have sex with men: a cross-sectional study

Background

The prevalence of unprotected anal intercourse (UAI) is high among Chinese men who have sex with men (MSM). As important aspects of quality of life (QOL), psychological health and social relationships have been found to be associated with UAI among MSM, which was of great concern for intervening on UAI.

Methods

We conducted a cross-sectional study in Zhengzhou, Henan province, and in Huludao, Liaoning province, China, to measure quality of life (QOL) using the brief version of the World Health Organization Quality of Life (WHOQOL-BREF). Cronbach's α coefficient was used to test the internal consistency of the questionnaire items, and construction validity was assessed by exploratory factor analysis. T-test, chi-square test and multivariate logistic analysis were carried out to test the relationship between quality of life and unprotected anal intercourse.

Results

The questionnaires of 320 of the 373 men who have sex with men that were surveyed met our validity criteria (response rate: 85.8 %). A total of 161 subjects (50.3 %) reported having unprotected anal sex in the last 6 months. The results of univariate analysis indicated that having unprotected anal sex was significantly associated with psychological health (PSYCH), social relationships (SOCIL), age, and marital status (P-value <0.05). The 3 items (“Negative feelings”, “Hopeness on your life”, and “Be able to concentrate”) in the PSYCH subscale were associated with UAI significantly (P-value <0.05). Multivariate analysis showed that psychological health (adjusted odd ratio (AOR) 0.979, 95 % confidence interval (CI) 0.961-0.998) was independent factor affecting the likelihood of having UAI in the population of Chinese MSM, and participants who aged 45 or more had higher odds of UAI (AOR 3.986, 95 % CI 1.199-13.255).

Conclusions

WHOQOL-BREF was acceptable for evaluating the quality of life of MSM. Psychological health, as one important aspect of quality of life, was negatively associated with unprotected anal intercourse. The finding underscored the needs to incorporate the strategies on improving psychological health into the UAI intervention to reduce the HIV transmission among MSM.

Influences of peers, teachers, and climate on students' willingness to intervene when witnessing anti-transgender harassment

Transgender young people are at increased risk for bullying, harassment, and negative mental health and academic outcomes compared to the general population as well as compared to other members of lesbian, gay, bisexual, transgender, queer, questioning, and similarly identified (LGBTQQ) communities. To inform interventions to support transgender students, the present study investigates students' willingness to intervene when witnessing anti-transgender harassment, using data collected from a participatory action research project investigating school climate. Multi-step linear regression was used to test the impacts of hearing transphobic language and witnessing teachers and others students intervene, while controlling for demographics and school. Hostile climate negatively predicted intervention intentions while witnessing peer intervention positively predicted likelihood to intervene. Witnessing teacher intervention did not significantly predict the outcome. These findings suggest that youth-led interventions in peer networks might be effective in diminishing transphobic bullying and supporting the healthy development of transgender young people.

An update to "among the missing: lesbian and gay content in social work journals"

The needs of lesbians and gay men appear to be minimally represented in social work literature. This study applied content analysis to four major social work journals published between 1998 and 2012, and it served to update the work of Van Voorhis and Wagner that examined content in the same four journals between 1988 and 1997. Of the 2,335 articles published in Child Welfare, Families in Society, Social Service Review, and Social Work during the 15-year period, 55 met the criteria for inclusion. Results reflect a significant decrease in the quantity of articles when compared with the previous report, with the largest decrease noticed in articles that addressed HIV/AIDS. The need to expand the type and amount of content related to this population continues.

Structural stigma and cigarette smoking in a prospective cohort study of sexual minority and heterosexual youth

BACKGROUND

Sexual minority youth are more likely to smoke cigarettes than heterosexuals, but research into the determinants of these disparities is lacking.

PURPOSE

This study aimed to examine whether exposure to structural stigma predicts cigarette smoking in sexual minority youth.

METHODS

Prospective data from adolescents participating in the Growing Up Today Study (2000-2005) were utilized.

RESULTS

Among sexual minority youth, living in low structural stigma states (e.g., states with non-discrimination policies inclusive of sexual orientation) was associated with a lower risk of cigarette smoking after adjustment for individual-level risk factors (relative risk [RR] = 0.97; 95 % confidence interval [CI], 0.96, 0.99; p = 0.02). This association was marginally significant after additional controls for potential state-level confounders (RR = 0.97; 95 % CI, 0.93, 1.00; p = 0.06). In contrast, among heterosexual youth, structural stigma was not associated with past-year smoking rates, documenting specificity of these effects to sexual minority youth.

CONCLUSIONS

Structural stigma represents a potential risk factor for cigarette smoking among sexual minority adolescents.

Lesbian, gay, bisexual, and transgender hate crimes and suicidality among a population-based sample of sexual-minority adolescents in Boston

OBJECTIVES

We examined whether past-year suicidality among sexual-minority adolescents was more common in neighborhoods with a higher prevalence of hate crimes targeting lesbian, gay, bisexual, and transgender (LGBT) individuals.

METHODS

Participants' data came from a racially/ethnically diverse population-based sample of 9th- through 12th-grade public school students in Boston, Massachusetts (n = 1292). Of these, 108 (8.36%) reported a minority sexual orientation. We obtained data on LGBT hate crimes involving assaults or assaults with battery between 2005 and 2008 from the Boston Police Department and linked the data to the adolescent's residential address.

RESULTS

Sexual-minority youths residing in neighborhoods with higher rates of LGBT assault hate crimes were significantly more likely to report suicidal ideation (P = .013) and suicide attempts (P = .006), than were those residing in neighborhoods with lower LGBT assault hate crime rates. We observed no relationships between overall neighborhood-level violent and property crimes and suicidality among sexual-minority adolescents (P > .05), providing evidence for specificity of the results to LGBT assault hate crimes.

CONCLUSIONS

Neighborhood context (i.e., LGBT hate crimes) may contribute to sexual-orientation disparities in adolescent suicidality, highlighting potential targets for community-level suicide-prevention programs.

Protective school climates and reduced risk for suicide ideation in sexual minority youths

OBJECTIVES

We examined whether sexual minority students living in states and cities with more protective school climates were at lower risk of suicidal thoughts, plans, and attempts.

METHODS

Data on sexual orientation and past-year suicidal thoughts, plans, and attempts were from the pooled 2005 and 2007 Youth Risk Behavior Surveillance Surveys from 8 states and cities. We derived data on school climates that protected sexual minority students (e.g., percentage of schools with safe spaces and Gay-Straight Alliances) from the 2010 School Health Profile Survey, compiled by the Centers for Disease Control and Prevention.

RESULTS

Lesbian, gay, and bisexual students living in states and cities with more protective school climates reported fewer past-year suicidal thoughts than those living in states and cities with less protective climates (lesbians and gays: odds ratio [OR] = 0.68; 95% confidence interval [CI] = 0.47, 0.99; bisexuals: OR = 0.81; 95% CI = 0.66, 0.99). Results were robust to adjustment for potential state-level confounders. Sexual orientation disparities in suicidal thoughts were nearly eliminated in states and cities with the most protective school climates.

CONCLUSIONS

School climates that protect sexual minority students may reduce their risk of suicidal thoughts.

[Factors Associated with Suicide in Adolescents and Young People Self-Identified as Lesbian, Gay, and Bisexual: Current State of the Literature]

INTRODUCTION

A framework within sexual and reproductive health is presented to understand the mental health issues of the population of lesbian, gay and bisexual (LGB) adolescents and young people. Different ways of understanding the nature of internalized homophobia were developed. On the other hand, in suicidology studies it is understood that the risk of suicide consists of the steps of ideation, planning and attempted suicide, and that there is an increased risk of suicide in the LGB population. Numerous factors have been associated with suicide risk in this population, one of the main internalized homophobia and other mental health problems.

OBJECTIVES

By means of a literature review, to establish the possible relationship between internalized homophobia and ideation and attempted suicide in the LGB population, as well as to identify the mental health problems associated to suicide risk in sexually diverse communities.

METHOD

Articles in English and Spanish, mainly within the last five years, were reviewed. They included articles in peer reviewed journals, and databases, such as Google Scholar, Redalyc, Byreme, Ovid, Science Direct, Taylor and Francis, MEDLINE, Scopus, PsycINFO, and Ebsco.

RESULTS

It was found in the available literature that internalized homophobia is associated with suicide ideation and attempts in adults. A state of science of the major mental health problems associated with suicide risk in young LGB people reported contradictory findings. While some studies showed an association between depression, anxiety and distress and suicidal ideation and attempts, in others, the data do not allow such a conclusion. The theoretical framework presents the most important conceptualizations of suicide risk and emphasizes the social type. It identifies issues of suicide prevention, protective factors that contribute towards this, as well as elements of psychotherapy for LGB consultants.

CONCLUSIONS

It concludes and discusses the importance of studying the sexually diverse as regards determining factors of mental health in Latin America, given the limited amount of literature found in the Spanish language, and myths of major disease that persist in many segments of the population. This review considers it necessary to overcome such contradictions, in order to inform the general population and avoid further stigmatization.

Population-level evaluation of school-based interventions to prevent problem substance use among gay, lesbian and bisexual adolescents in Canada

OBJECTIVE

This study examined whether students' odds of recent substance use were lower in the presence of gay-straight alliances or explicit anti-homophobia policy that had been established at their school recently, or at least 3 years prior.

METHODS

We analyzed a population-based sample of students in grades 8 through 12 from the British Columbia Adolescent Health Survey of 2008 (weighted N=21,708). We used multi-nomial logistic regressions to test the hypothesized effects of gay-straight alliances and policies on substance use outcomes for lesbian, gay and bisexual students, and heterosexual students separately.

RESULTS

Results indicated that gay-straight alliances and anti-homophobic bullying policies were linked to significantly lower odds of some but not all types of recent risky alcohol use, and past-year harms from alcohol or drug use, but almost exclusively in schools where the policies or gay-straight alliances had been established for at least 3 years; and among lesbian, gay and bisexual adolescents, only for girls.

CONCLUSIONS

Our findings suggest that these school-based strategies (gay-straight alliances and anti-homophobia policies) to reduce homophobia and foster school inclusion may be beneficial in reducing problem alcohol use among all students, not just sexual minority students.

Office-based care for lesbian, gay, bisexual, transgender, and questioning youth

The American Academy of Pediatrics issued its last statement on homosexuality and adolescents in 2004. Although most lesbian, gay, bisexual, transgender, and questioning (LGBTQ) youth are quite resilient and emerge from adolescence as healthy adults, the effects of homophobia and heterosexism can contribute to health disparities in mental health with higher rates of depression and suicidal ideation, higher rates of substance abuse, and more sexually transmitted and HIV infections. Pediatricians should have offices that are teen-friendly and welcoming to sexual minority youth. Obtaining a comprehensive, confidential, developmentally appropriate adolescent psychosocial history allows for the discovery of strengths and assets as well as risks. Referrals for mental health or substance abuse may be warranted. Sexually active LGBTQ youth should have sexually transmitted infection/HIV testing according to recommendations of the Sexually Transmitted Diseases Treatment Guidelines of the Centers for Disease Control and Prevention based on sexual behaviors. With appropriate assistance and care, sexual minority youth should live healthy, productive lives while transitioning through adolescence and young adulthood.

Inclusive anti-bullying policies and reduced risk of suicide attempts in lesbian and gay youth

PURPOSE

To evaluate whether anti-bullying policies that are inclusive of sexual orientation are associated with a reduced prevalence of suicide attempts among lesbian, gay, and bisexual youths.

METHODS

A total of 31,852 11th-grade public school students (1,413 lesbian, gay, and bisexual individuals; 4.4%) in Oregon completed the Oregon Healthy Teens survey in 2006-2008. The independent variable was the proportion of school districts in the 34 counties participating in the Oregon Healthy Teens survey that adopted anti-bullying policies inclusive of sexual orientation. The outcome measure was any self-reported suicide attempt in the past 12 months. We stratified results by sexual orientation.

RESULTS

Lesbian and gay youths living in counties with fewer school districts with inclusive anti-bullying policies were 2.25 times (95% confidence interval [CI], 1.13-4.49) more likely to have attempted suicide in the past year compared with those living in counties where more districts had these policies. Inclusive anti-bullying policies were significantly associated with a reduced risk for suicide attempts among lesbian and gay youths, even after controlling for sociodemographic characteristics (sex, race/ethnicity) and exposure to peer victimization (odds ratio, .18; 95% CI, .03-.92). In contrast, anti-bullying policies that did not include sexual orientation were not associated with lower suicide attempts among lesbian and gay youths (odds ratio, .38; 95% CI, .02-7.33).

CONCLUSIONS

Inclusive anti-bullying policies may exert protective effects for the mental health of lesbian and gay youths, including reducing their risk for suicide attempts.

Office-based care for lesbian, gay, bisexual, transgender, and questioning youth

The American Academy of Pediatrics issued its last statement on homosexuality and adolescents in 2004. This technical report reflects the rapidly expanding medical and psychosocial literature about sexual minority youth. Pediatricians should be aware that some youth in their care may have concerns or questions about their sexual orientation or that of siblings, friends, parents, relatives, or others and should provide factual, current, nonjudgmental information in a confidential manner. Although most lesbian, gay, bisexual, transgender, and questioning(LGBTQ) youth are quite resilient and emerge from adolescence as healthy adults, the effects of homophobia and heterosexism can contribute to increased mental health issues for sexual minority youth. LGBTQ and MSM/WSW (men having sex with men and women having sex with women) adolescents, in comparison with heterosexual adolescents,have higher rates of depression and suicidal ideation, high errates of substance abuse, and more risky sexual behaviors. Obtaining a comprehensive, confidential, developmentally appropriate adolescent psychosocial history allows for the discovery of strengths and assets as well as risks. Pediatricians should have offices that are teen-friendly and welcoming to sexual minority youth. This includes having supportive, engaging office staff members who ensure that there are no barriers to care. For transgender youth, pediatricians should provide the opportunity to acknowledge and affirm their feelings of gender dysphoria and desires to transition to the opposite gender. Referral of transgender youth to a qualified mental health professional is critical to assist with the dysphoria, to educate them,and to assess their readiness for transition. With appropriate assistance and care, sexual minority youth should live healthy, productive lives while transitioning through adolescence and young adulthood.

Social networks and risk for depressive symptoms in a national sample of sexual minority youth

The aim of the study was to examine the social networks of sexual minority youths and to determine the associations between social networks and depressive symptoms. Data were obtained from the National Longitudinal Study of Adolescent Health (Add Health), a nationally representative cohort study of American adolescents (N = 14,212). Wave 1 (1994-1995) collected extensive information about the social networks of participants through peer nomination inventories, as well as measures of sexual minority status and depressive symptoms. Using social network data, we examined three characteristics of adolescents' social relationships: (1) social isolation; (2) degree of connectedness; and (3) social status. Sexual minority youths, particularly females, were more isolated, less connected, and had lower social status in peer networks than opposite-sex attracted youths. Among sexual minority male (but not female) youths, greater isolation as well as lower connectedness and status within a network were associated with greater depressive symptoms. Moreover, greater isolation in social networks partially explained the association between sexual minority status and depressive symptoms among males. Finally, a significant 3-way interaction indicated that the association between social isolation and depression was stronger for sexual minority male youths than non-minority youths and sexual minority females. These results suggest that the social networks in which sexual minority male youths are embedded may confer risk for depressive symptoms, underscoring the importance of considering peer networks in both research and interventions targeting sexual minority male adolescents.

Suicidal ideation and self-harm in lesbian, gay, bisexual, and transgender youth

BACKGROUND

Suicide is the third-leading cause of death among adolescents and nonsuicidal self-harm occurs in 13%-45% of individuals within this age group, making these phenomena major public health concerns. Lesbian, gay, bisexual, and transgender (LGBT) youth particularly are at risk for engaging in these behaviors. Nevertheless, relatively little is known about the specific risk factors associated with suicidal ideation and self-harm behaviors in the population.

PURPOSE

This study provides a longitudinal evaluation of the relative contributions of general and LGBT-specific risk factors as well as protective factors to the occurrence of suicidal ideation and self-harm in an ethnically diverse sample of LGBT youth.

METHODS

A community sample of 246 LGBT youth (aged 16-20 years) was followed prospectively over five time points at regular 6-month intervals. Participants completed a baseline structured interview assessing suicide attempt history and questionnaires measuring gender nonconformity, impulsivity, and sensation-seeking. At follow-up assessments, participants completed a structured interview assessing self-harm and questionnaires for suicidal ideation, hopelessness, social support, and LGBT victimization. Data were collected from 2007 to 2011, and HLM analyses were conducted in 2011.

RESULTS

A history of attempted suicide (p=0.05); impulsivity (p=0.01); and prospective LGBT victimization (p=0.03) and low social support (p=0.02) were associated with increased risk for suicidal ideation. Suicide attempt history (p<0.01); sensation-seeking (p=0.04); female gender (p<0.01); childhood gender nonconformity (p<0.01); and prospective hopelessness (p<0.01) and victimization (p<0.01) were associated with greater self-harm.

CONCLUSIONS

General and LGBT-specific risk factors both uniquely contribute to likelihood of suicidal ideation and self-harm in LGBT youth, which may, in part, account for the higher risk of these phenomena observed in this population.

High School Gay-Straight Alliances (GSAs) and Young Adult Well-Being: An Examination of GSA Presence, Participation, and Perceived Effectiveness

Gay-Straight Alliances (GSAs) are student-led, school-based clubs that aim to provide a safe environment in the school context for lesbian, gay, bisexual, and transgender (LGBT) students, as well as their straight allies. The present study examines the potential for GSAs to support positive youth development and to reduce associations among LGBT-specific school victimization and negative young adult well-being. The sample includes 245 LGBT young adults, ages 21-25, who retrospectively reported on the presence of a GSA in their high school, their participation in their school's GSA, and their perceptions of whether or not their GSA was effective in improving school safety. Findings revealed that the presence of a GSA, participation in a GSA, and perceived GSA effectiveness in promoting school safety were differentially associated with young adult well-being and in some cases, buffered the negative association between LGBT-specific school victimization and well-being. Implications for future research and schools are discussed.

The social environment and suicide attempts in lesbian, gay, and bisexual youth

OBJECTIVE

To determine whether the social environment surrounding lesbian, gay, and bisexual youth may contribute to their higher rates of suicide attempts, controlling for individual-level risk factors.

METHODS

A total of 31 852 11th grade students (1413 [4.4%] lesbian, gay, and bisexual individuals) in Oregon completed the Oregon Healthy Teens survey in 2006-2008. We created a composite index of the social environment in 34 counties, including (1) the proportion of same-sex couples, (2) the proportion of registered Democrats, (3) the presence of gay-straight alliances in schools, and (4) school policies (nondiscrimination and antibullying) that specifically protected lesbian, gay, and bisexual students.

RESULTS

Lesbian, gay, and bisexual youth were significantly more likely to attempt suicide in the previous 12 months, compared with heterosexuals (21.5% vs 4.2%). Among lesbian, gay, and bisexual youth, the risk of attempting suicide was 20% greater in unsupportive environments compared to supportive environments. A more supportive social environment was significantly associated with fewer suicide attempts, controlling for sociodemographic variables and multiple risk factors for suicide attempts, including depressive symptoms, binge drinking, peer victimization, and physical abuse by an adult (odds ratio: 0.97 [95% confidence interval: 0.96-0.99]).

CONCLUSIONS

This study documents an association between an objective measure of the social environment and suicide attempts among lesbian, gay, and bisexual youth. The social environment appears to confer risk for suicide attempts over and above individual-level risk factors. These results have important implications for the development of policies and interventions to reduce sexual orientation-related disparities in suicide attempts.

The social environment and suicide attempts in lesbian, gay, and bisexual youth

OBJECTIVE

To determine whether the social environment surrounding lesbian, gay, and bisexual youth may contribute to their higher rates of suicide attempts, controlling for individual-level risk factors.

METHODS

A total of 31 852 11th grade students (1413 [4.4%] lesbian, gay, and bisexual individuals) in Oregon completed the Oregon Healthy Teens survey in 2006-2008. We created a composite index of the social environment in 34 counties, including (1) the proportion of same-sex couples, (2) the proportion of registered Democrats, (3) the presence of gay-straight alliances in schools, and (4) school policies (nondiscrimination and antibullying) that specifically protected lesbian, gay, and bisexual students.

RESULTS

Lesbian, gay, and bisexual youth were significantly more likely to attempt suicide in the previous 12 months, compared with heterosexuals (21.5% vs 4.2%). Among lesbian, gay, and bisexual youth, the risk of attempting suicide was 20% greater in unsupportive environments compared to supportive environments. A more supportive social environment was significantly associated with fewer suicide attempts, controlling for sociodemographic variables and multiple risk factors for suicide attempts, including depressive symptoms, binge drinking, peer victimization, and physical abuse by an adult (odds ratio: 0.97 [95% confidence interval: 0.96-0.99]).

CONCLUSIONS

This study documents an association between an objective measure of the social environment and suicide attempts among lesbian, gay, and bisexual youth. The social environment appears to confer risk for suicide attempts over and above individual-level risk factors. These results have important implications for the development of policies and interventions to reduce sexual orientation-related disparities in suicide attempts.

Health outcomes associated with methamphetamine use among young people: a systematic review

OBJECTIVES

Methamphetamine (MA) use among young people is of significant social, economic and public health concern to affected communities and policy makers. While responses have focused upon various perceived severe harms of MA use, effective public health interventions require a strong scientific evidence base.

METHODS

We conducted a systematic review to identify scientific studies investigating health outcomes associated with MA use among young people aged 10-24 years. The International Classification of Diseases (ICD-10) was used to categorize outcomes and determine the level of evidence for each series of harms.

RESULTS

We identified 47 eligible studies for review. Consistent associations were observed between MA use and several mental health outcomes, including depression, suicidal ideation and psychosis. Suicide and overdose appear to be significant sources of morbidity and mortality among young MA users. Evidence for a strong association between MA use and increased risk of human immunodeficiency virus (HIV) and other sexually transmitted infections is equivocal. Finally, we identified only weak evidence of an association between MA use and dental diseases among young people.

CONCLUSIONS

Available evidence indicates a consistent relationship between MA use and mental health outcomes (e.g. depression, psychosis) and an increased risk of mortality due to suicide and overdose. We found insufficient evidence of an association between MA use and other previously cited harms, including infectious diseases and dental outcomes. As such, future research of higher methodological quality is required to further investigate possible associations. Current interventions should focus attention upon MA-related health outcomes for which sound scientific evidence is available.

How does sexual minority stigma "get under the skin"? A psychological mediation framework

Sexual minorities are at increased risk for multiple mental health burdens compared with heterosexuals. The field has identified 2 distinct determinants of this risk, including group-specific minority stressors and general psychological processes that are common across sexual orientations. The goal of the present article is to develop a theoretical framework that integrates the important insights from these literatures. The framework postulates that (a) sexual minorities confront increased stress exposure resulting from stigma; (b) this stigma-related stress creates elevations in general emotion dysregulation, social/interpersonal problems, and cognitive processes conferring risk for psychopathology; and (c) these processes in turn mediate the relationship between stigma-related stress and psychopathology. It is argued that this framework can, theoretically, illuminate how stigma adversely affects mental health and, practically, inform clinical interventions. Evidence for the predictive validity of this framework is reviewed, with particular attention paid to illustrative examples from research on depression, anxiety, and alcohol-use disorders.