Moderating Effect of Community and Individual Resilience on Structural Stigma and Suicidal Ideation among Sexual and Gender Minority Adults in the United States

Socioecological Predictors of Resilience in Sexual and Gender Minority Individuals

Many factors affect an individual's resilience. Low resilience has been attributed to increased stress, anxiety, depression, and suicidality within the LGBTQIA + population, which is heightened compared to different populations. This study identifies predictors of resilience in the LGBTQIA + population and aims to identify predicting factors at all levels of the socioecological model. This was a cross-sectional study of data from a web-based survey that was conducted from January to February 2022. A national sample of 1033 LGBTQIA + adults was utilized for hierarchical regression analysis. Hierarchical regression analyses were performed for total resilience, which had an average score of 143.66 (SD = 33.88) and accounted for 53.4% of resiliency variance. Factors that were found to decrease an individuals resiliency score were depression, stress, suicidality, and isolation discrimination distress. Factors found to increase an individuals resiliency scores are college graduate 4 years+, married, outness, personal comfortability with being SGM, gender expression discrimination distress, and vicarious discrimination distress. Understanding the factors that influence resilience is vital to improving the resilience of the LGBTQIA + communities. Interventions that focus on decreasing depression, stress, and suicidality may be particularly impactful for all types of resilience.

Developing Trans Wellness, Trans Brilliance: A Virtual Peer-Support Wellness Intervention by and for Trans/Gender Diverse Michiganders

The U.S. trans/gender diverse (TGD) community experiences considerable mental health disparities and barriers to health care. To address these challenges, Trans Wellness, Trans Brilliance (TWTB) was developed to advance the resilience, self-compassion, and community connectedness of TGD people in Michigan. Designed by TGD people for TGD people, this community-based research project was a joint partnership between a local trans community care organization and a large Midwestern research institution, supported by state foundation funding. The construction of TWTB was sequential and iterative. The project concept originally emerged from previous research, which identified a need for a program to enhance resilience, capacity, and emotional well-being in the broader Michigan TGD community. This led to the innovative idea of designing an intervention that was both virtually accessible and capable of being implemented by any community advocate, regardless of professional training. Interviews were conducted with community stakeholders statewide to identify the needs, desired skills, and objectives for such a skill-based program. Findings from these interviews were used to design the online intervention. Community members further shaped the intervention through a focus group, which assessed the desirability and anticipated effectiveness of the curriculum. The final product was TWTB: an 8-week, peer-support, virtual wellness intervention.

Social-Ecological Determinants of Suicidal Ideation Among Sexual and Gender Minority Adults: A Cross-Sectional Study in the United States

Background/Objectives: Sexual and gender minority (SGM) adults are at an increased risk for suicide and suicidal ideation compared with cisgender/heterosexual adults. Due to the complexity of suicidal ideation, individual, social, and systemic factors must be considered. The purpose of this study was to identify determinants of suicidal ideation among SGM adults using constructs from the Social-Ecological Model (SEM). Methods: This was a cross-sectional study of data collected from 1034 SGM adults between 27 January and 7 February 2022, and variables reflected the four constructs of the SEM, including individual, family, community, and societal levels. Hierarchical multiple linear regression was used to enter the variables in blocks. Results: The final model explained 55% of the variance in suicidal ideation, and determinants of suicidal ideation were identified at all four levels. At the individual level, factors were depression (p < 0.001, β = 0.231), anxiety (p < 0.001, β = 0.279), vigilance distress (p = 0.036, β = 0.157), not being out/open (p = 0.046, β = 1.136), having some college education (p = 0.002, β = -1.875), and personal strength (p = 0.012, β = -0.131). Family of origin discrimination distress was significant at the family level (p = 0.016, β = 0.174). Social resources (p < 0.001, β = -0.113), victimization distress (p < 0.001, β = 0.795), and harassment/discrimination distress (p = 0.035, β = 0.179) were significant at the community level. At the social level, SGM protective state law score (p = 0.43, β = -0.35) and having a proposed or enacted transgender sports ban (p = 0.027, β = 1.480) were significant. Conclusions: Understanding the factors across the various levels of the SEM that influence suicidal ideation allows for the development of multi-level, social-ecological suicide prevention programs. Such programs can address the unique needs of SGM individuals and help mitigate suicidal ideation.

Considerations for the care of transgender patients in orthopaedics and sports medicine: a narrative review

Orthopaedic and sports medicine clinicians can improve outcomes for transgender patients by understanding the physiological effects of gender-affirming hormone therapy (GAHT). This narrative review investigated the role of GAHT on bone mineral density, fracture risk, thromboembolic risk, cardiovascular health and ligament/tendon injury in this population. A search from the PubMed database using relevant terms was performed. Studies were included if they were levels 1-3 evidence. Due to the paucity of studies on ligament and tendon injury risk in transgender patients, levels 1-3 evidence on the effects of sex hormones in cisgender patients as well as basic science studies were included for these two topics. This review found that transgender patients on GAHT have an elevated fracture risk, but GAHT has beneficial effects on bone mineral density in transgender women. Transgender women on GAHT also have an increased risk of venous thromboembolism, stroke and myocardial infarction compared with cisgender women. Despite these elevated risks, studies have found it is safe to continue GAHT perioperatively for both transgender women and men undergoing low-risk operations. Orthopaedic and sports medicine clinicians should understand these unique health considerations for equitable patient care.

Protective and Risk Factors for Suicidal Ideation and Behavior Among Sexual Minority Women in the United States: A Cross-Sectional Study

Purpose: The purpose of this study was to understand the factors associated with suicidal ideation and behavior and serious suicidal ideation and behavior among sexual minority women (SMW), including resilience, discrimination, mental health, and sociodemographic characteristics. Methods: Web-based surveys were conducted with SMW from across the United States during January-February, 2022 using psychometric valid tools. Bivariate, hierarchical regression, and logistic regression analyses were used to analyze the data. Results: Of 497 participants, 70% were identified as bisexual and 30% as lesbian. The mean scores for anxiety, depression, and stress were significantly higher among bisexual women compared to their lesbian counterparts (p < 0.05). The proportion of serious suicidal ideation and behavior was higher among bisexual women compared to lesbian women (53.9% vs. 41.2%, p = 0.012). Conversely, the mean scores of resilience were lower among bisexual women compared to lesbian women (139.7 ± 33.4 vs. 147.5 ± 33.6, p = 0.024). Lesbian women had nearly 57.4% lower odds of having serious suicidal ideation and behavior as compared to bisexual women (adjusted odds ratio = 0.426; p = 0.023). Experiencing anxiety, depression, victimization distress, and family discrimination distress were positively associated with serious suicidal ideation and behavior, whereas personal resilience and family cohesion were negatively associated with serious suicidal ideation and behavior. Conclusions: Tackling structural inequities such as racism and homophobia remains vital to improving the mental health of SMW. Interventions to strengthen social and familial supports may be particularly impactful, especially at the family level.

Moderated Mediation Analysis of Structural Stigma and Suicidal Ideation and Behaviors Among Sexual and Gender Minority Adults

Purpose: This study aimed to conduct a moderated mediation analysis to understand further the complex pathways through which structural stigma in the form of transgender sports bans was associated with suicidal ideation and behaviors among sexual and gender minority (SGM) adults. Methods: A cross-sectional survey of 1033 adults who identified as SGM from across the 50 U.S. states and Washington, DC was conducted between January 28 and February 7, 2022. Distal discrimination distress was the mediation variable; individual resilience and social resources were the moderation variables. Familiarity with transgender sports bans represented structural stigma. The conditional process analysis was applied to build a moderated mediation model. Both conditional direct and indirect effects were computed by estimated coefficients. All models were based on linear regression. Results: Our final model explained nearly half (46%) of the variation in suicidal ideation and behaviors between those SGM adults familiar and those not familiar with transgender sports bans. Social resources significantly moderated the conditional indirect effect of distal discrimination distress (adjusted estimate = -0.23; 95% confidence interval = -0.37 to -0.08). Conclusion: Both discrimination distress and social resources influenced the association between structural stigma as measured by familiarity with transgender sports bans and suicidal ideation and behaviors among SGM adults. Findings support the need for future research examining the pathway between structural stigma and suicidal ideation and behaviors among SGM adults and how minority stress, social safety, and other constructs shape this pathway.

Impact of COVID-19 on Sexual and Gender Minority Communities: Focus Group Discussions

BACKGROUND

People who identify as sexual and gender minorities (SGM) experienced disproportionate economic and mental health issues related to COVID-19 when compared to the general population. The purpose of this study was to better understand how COVID-19 has impacted the SGM community and ways to address vaccine hesitancy.

METHODS

Three focus groups were conducted with 21 members of the SGM community between 5 November and 10 December 2020. A thematic analysis using the reflexive approach was applied to the transcripts of the focus groups.

RESULTS

Four themes emerged: (1) Impact of COVID-19 on the Community, (2) Perceptions of Contact Tracing and Testing, (3) Perceptions of a Potential COVID-19 Vaccine, and (4) Decreasing Vaccine Hesitancy. The most relevant subthemes were that social isolation led to anxiety, stress, and fear in the SGM community during COVID-19; resilience and adaptation were positive outcomes of the pandemic; histories of medical racism contributed to hesitancy to get tested; and specific messaging from trusted messengers may be needed to encourage SGM communities to get vaccinated. These findings support other COVID-19 research on the SGM community during the start of the pandemic.

CONCLUSIONS

This study provides insight into the impact of the early stages of COVID-19 on the SGM community, highlighting the unique hurdles faced by SGM individuals with regard to contact tracing and vaccine hesitancy.