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Bird K, Arcelus J, Matsagoura L, O'Shea B, Townsend E. Risk and protective factors for self-harm thoughts and behaviours in transgender and gender diverse people: A systematic review. Heliyon 2024; 10:e26074. [PMID: 38468947 PMCID: PMC10925986 DOI: 10.1016/j.heliyon.2024.e26074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 01/17/2024] [Accepted: 02/07/2024] [Indexed: 03/13/2024] Open
Abstract
Background Self-harm (any self-injury or -poisoning regardless of intent) is highly prevalent in transgender and gender diverse (TGD) populations. It is strongly associated with various adverse health and wellbeing outcomes, including suicide. Despite increased risk, TGD individuals' unique self-harm pathways are not well understood. Following PRISMA guidelines we conducted the first systematic review of risk and protective factors for self-harm in TGD people to identify targets for prevention and intervention. Methods We searched five electronic databases (PubMed, PsychInfo, Scopus, MEDLINE, and Web of Science) published from database inception to November 2023 for primary and secondary studies of risk and/or protective factors for self-harm thoughts and behaviours in TGD people. Data was extracted and study quality assessed using Newcastle-Ottawa Scales. Findings Overall, 78 studies published between 2007 and 2023 from 16 countries (N = 322,144) were eligible for inclusion. Narrative analysis identified six key risk factors for self-harm in TGD people (aged 7-98years) were identified. These are younger age, being assigned female at birth, illicit drug and alcohol use, sexual and physical assault, gender minority stressors (especially discrimination and victimisation), and depression or depressive symptomology. Three important protective factors were identified: social support, connectedness, and school safety. Other possible unique TGD protective factors against self-harm included: chosen name use, gender-identity concordant documentation, and protective state policies. Some evidence of publication bias regarding sample size, non-responders, and confounding variables was identified. Interpretation This systematic review indicates TGD people may experience a unique self-harm pathway. Importantly, the risk and protective factors we identified provide meaningful targets for intervention. TGD youth and those assigned female at birth are at increased risk. Encouraging TGD people to utilise and foster existing support networks, family/parent and peer support groups, and creating safe, supportive school environments may be critical for self-harm and suicide prevention strategies. Efforts to reduce drug and alcohol use and experiences of gender-based victimisation and discrimination are recommended to reduce self-harm in this high-risk group. Addressing depressive symptoms may reduce gender dysphoria and self-harm. The new evidence presented in this systematic review also indicates TGD people may experience unique pathways to self-harm related to the lack of social acceptance of their gender identity. However, robust longitudinal research which examines gender-specific factors is now necessary to establish this pathway.
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Affiliation(s)
- K. Bird
- School of Psychology, University of Nottingham, Nottingham, UK
| | - J. Arcelus
- Institute of Mental Health, University of Nottingham, Nottingham, UK
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - L. Matsagoura
- School of Psychology, University of Nottingham, Nottingham, UK
| | - B.A. O'Shea
- School of Psychology, University of Nottingham, Nottingham, UK
- Department of Psychology, Harvard University, Cambridge, MA, USA
- The Centre for the Experimental-Philosophical Study of Discrimination, Aarhus University, Denmark
| | - E. Townsend
- School of Psychology, University of Nottingham, Nottingham, UK
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Mahfouda S, Maybery M, Moore J, Perry Y, Strauss P, Zepf F, Lin A. Gender non-conformity in childhood and adolescence and mental health through to adulthood: a longitudinal cohort study, 1995-2018. Psychol Med 2023; 53:7756-7765. [PMID: 37403583 DOI: 10.1017/s0033291723001721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Abstract
BACKGROUND Few studies have examined associations between gender non-conformity (GNC) in childhood or adolescence and mental health outcomes later in life. This study examined associations between (1) GNC and mental health over multiple time points in childhood and adolescence, and (2) GNC in childhood and/or adolescence and mental health in adulthood. METHOD Second generation participants from the Raine Study, a longitudinal cohort from Perth, Western Australia. Data were collected between 1995 and 2018, comprising seven waves: ages 5 (N = 2236), 8 (N = 2140), 10 (N = 2048), 14 (N = 1864), 17 (N = 1726), 22 (N = 1236) and 27 (N = 1190) years. History of GNC, v. absence of this history, was based on responses to item 110 from the Child Behaviour Checklist (CBCL)/Youth Self Report (YSR) ('wishes to be of opposite sex'). The CBCL/YSR were used to measure internalising and externalising symptoms. Items 18 ('deliberate self-harm [DSH] or attempts suicide') and 91 ('talks/thinks about killing self') were used as measures of suicidal ideation (SI) and DSH. For adults, Depression, Anxiety and Stress Subscales and Kessler Psychological Distress Scale assessed mental health. RESULTS Child and adolescent GNC was associated with elevated internalising and externalising behaviours and increased odds of DSH. A history of GNC was also associated with vulnerability for severe psychological distress in adulthood in some symptom scales. CONCLUSION GNC over the child and adolescent period is associated with significant emotional and behavioural difficulties, and psychological distress. A history of GNC in childhood and/or adolescence also predicts poorer mental health in adulthood on multiple symptom domains.
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Affiliation(s)
| | | | - Julia Moore
- Perth Children's Hospital, Nedlands, Australia
| | - Yael Perry
- Telethon Kids Institute, Nedlands, Australia
| | | | - Florian Zepf
- Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
- German Center for Mental Health (DZPG)
- Center for Intervention and Research on adaptive and maladaptive brain Circuits underlying mental health (C-I-R-C), Jena-Magdeburg-Halle, Germany
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Klein H, Washington TA. The "triple whammy": Serious psychological distress, suicidal ideation, and substance misuse among transgender persons. Acta Psychol (Amst) 2023; 241:104092. [PMID: 38000363 DOI: 10.1016/j.actpsy.2023.104092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/16/2023] [Accepted: 11/21/2023] [Indexed: 11/26/2023] Open
Abstract
PURPOSE This paper examines the conjoint effects of serious psychological distress, suicidal ideation, and substance abuse among transgender adults. The principal aims are to determine the prevalence of this "triple whammy," identify the factors underlying the co-occurrence of all three problems, and to determine if there is evidence of syndemic effects underlying the "triple whammy." METHODS Data from the 2015 U.S. National Transgender Survey were used to examine the "triple whammy" relationship in a sample of 27,715 transgender Americans aged 18 or older. Odds ratios and multivariate logistic regression were performed to examine the data. RESULTS 13.3 % of the study participants reported experiencing serious psychological distress, suicidal ideation, and substance abuse. The most potent predictors of the "triple whammy" were younger age, a greater number of anti-transgender experiences, and not reaching various transition milestones. Strong evidence emerged to indicate the presence of syndemic effects in operation. CONCLUSIONS Experiencing the combination of adverse mental health and substance abuse was not uncommon in this population of transgender adults. Being young, experiencing a larger variety of types of anti-transgender discrimination, harassment, and violence, and not reaching specific transition milestones all had a significant impact on the odds that people would experience the "triple whammy." This was particularly true when these measures were examined in conjunction with one another, because of strong syndemic effects.
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Affiliation(s)
- Hugh Klein
- Kensington Research Institute, Silver Spring, Maryland, United States of America; School of Social Work, California State University-Long Beach, Long Beach, CA, United States of America.
| | - Thomas Alex Washington
- School of Social Work, California State University-Long Beach, Long Beach, CA, United States of America
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Marconi E, Monti L, Marfoli A, Kotzalidis GD, Janiri D, Cianfriglia C, Moriconi F, Costa S, Veredice C, Sani G, Chieffo DPR. A systematic review on gender dysphoria in adolescents and young adults: focus on suicidal and self-harming ideation and behaviours. Child Adolesc Psychiatry Ment Health 2023; 17:110. [PMID: 37735422 PMCID: PMC10515052 DOI: 10.1186/s13034-023-00654-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 08/30/2023] [Indexed: 09/23/2023] Open
Abstract
INTRODUCTION Gender dysphoria (GD) is characterized by the incongruence between one's experienced and expressed gender and assigned-sex-at-birth; it is associated with clinically significant distress. In recent years, the number of young patients diagnosed with GD has increased considerably. Recent studies reported that GD adolescents present behavioural and emotional problems and internalizing problems. Furthermore, this population shows a prevalence of psychiatric symptoms, like depression and anxiety. Several studies showed high rates of suicidal and non-suicidal self-injurious thoughts and behaviour in GD adolescents. To increase understanding of overall mental health status and potential risks of young people with GD, this systematic review focused on risk of suicide and self-harm gestures. METHODS We followed the PRISMA 2020 statement, collecting empirical studies from four electronic databases, i.e., PubMed, Scopus, PsycINFO, and Web of Science. RESULTS Twenty-one studies on GD and gender nonconforming identity, suicidality, and self-harm in adolescents and young adults met inclusion criteria. Results showed that GD adolescents have more suicidal ideation, life-threatening behaviour, self-injurious thoughts or self-harm than their cisgender peers. Assessment methods were heterogeneous. CONCLUSION A standardised assessment is needed. Understanding the mental health status of transgender young people could help develop and provide effective clinical pathways and interventions.
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Affiliation(s)
- Elisa Marconi
- Clinical Psychology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 1, 00168, Rome, Italy.
| | - Laura Monti
- Clinical Psychology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 1, 00168, Rome, Italy
| | - Angelica Marfoli
- Catholic University of the Sacred Heart-Rome, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Georgios D Kotzalidis
- NESMOS Department (Neurosciences, Mental Health, and Sensory Organs), University of Rome "La Sapienza", Via Di Grottarossa1035-1039, 00198, Rome, Italy
- Department of Psychiatry, Department of Neuroscience, Head, Neck and Thorax, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 1, 00168, Rome, Italy
- Institute of Psychiatry, Department of Neuroscience, Catholic University of the Sacred Heart-Rome, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Delfina Janiri
- Department of Psychiatry, Department of Neuroscience, Head, Neck and Thorax, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 1, 00168, Rome, Italy
- Institute of Psychiatry, Department of Neuroscience, Catholic University of the Sacred Heart-Rome, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Cecilia Cianfriglia
- Catholic University of the Sacred Heart-Rome, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Federica Moriconi
- Clinical Psychology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 1, 00168, Rome, Italy
| | - Stefano Costa
- UOSD Operative Unit Psychiatry and Psychotherapy for Adolescents, Azienda USL Di Bologna, Ospedale MaggioreLargo Bartolo Nigrisoli, 2, 40133, Bologna, Italy
| | - Chiara Veredice
- Pediatric Neuropsychiatry Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168, Rome, Italy
| | - Gabriele Sani
- Department of Psychiatry, Department of Neuroscience, Head, Neck and Thorax, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 1, 00168, Rome, Italy
- Institute of Psychiatry, Department of Neuroscience, Catholic University of the Sacred Heart-Rome, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Daniela Pia Rosaria Chieffo
- Clinical Psychology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 1, 00168, Rome, Italy
- Departement of Life Sciences and Public Health Department, Catholic University of Sacred Heart, 00168, Rome, Italy
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Pampati S, Dana Flanders W, Zhang Q, Ahmedani BK, Bhasin S, Getahun D, Lash TL, McCracken C, Sandberg DE, Silverberg MJ, Tangpricha V, Vupputuri S, Goodman M. Prevalence of self-inflicted injuries among transgender and gender diverse adolescents and young adults compared to their peers: an examination of interaction with mental health morbidity. Ann Epidemiol 2023; 81:40-46.e2. [PMID: 36907519 PMCID: PMC10424574 DOI: 10.1016/j.annepidem.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 03/06/2023] [Accepted: 03/06/2023] [Indexed: 03/13/2023]
Abstract
PURPOSE Compare occurrence of self-inflicted injuries among transgender and gender diverse (TGD) youth to that of their cisgender peers while accounting for mental health diagnoses. METHODS Review of electronic health records from three integrated health care systems identified 1087 transfeminine and 1431 transmasculine adolescents and young adults. Poisson regression was used to calculate prevalence ratios comparing the proportion of TGD participants with at least one self-inflicted injury (a surrogate for suicide attempt) before index date (first evidence of TGD status) to the corresponding proportions in presumed cisgender male and female referents matched on age, race/ethnicity, and health plan. Interactions between gender identities and mental health diagnoses were assessed on multiplicative and additive scales. RESULTS TGD adolescents and young adults were more likely to have a self-inflicted injury, various mental health diagnoses, and multiple mental health diagnoses than their cisgender peers. The prevalence of self-inflicted injuries among TGD adolescents and young adults was high even in the absence of mental health diagnoses. Results were consistent with positive additive interaction and negative multiplicative interaction. CONCLUSIONS Universal suicide prevention efforts for all youth, including those with no mental health diagnoses, and more intensive suicide prevention efforts for TGD adolescents and young adults and those with at least one mental health diagnosis are warranted.
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Affiliation(s)
- Sanjana Pampati
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA.
| | - W Dana Flanders
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Qi Zhang
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Brian K Ahmedani
- Center for Health Policy & Health Services Research, Henry Ford Health System, Detroit, MI
| | - Shalender Bhasin
- Brigham and Women's Hospital, Boston, MA; Harvard School of Medicine, Boston, MA
| | - Darios Getahun
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena; Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA
| | - Timothy L Lash
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | | | - David E Sandberg
- Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan Medical School, Ann Arbor
| | | | - Vin Tangpricha
- Division of Endocrinology, Metabolism and Lipids, Department of Medicine, Emory University, School of Medicine, Atlanta, GA; The Atlanta VA Medical Center, Atlanta, GA
| | - Suma Vupputuri
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlanta States, Rockville, MD
| | - Michael Goodman
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
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Clary K, Goffnett J, King M, Hubbard T, Kitchen R. "It's the Environment, Not Me": Experiences shared by transgender and gender diverse adults living in Texas. J Community Psychol 2023; 51:906-923. [PMID: 36206522 DOI: 10.1002/jcop.22948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 09/19/2022] [Accepted: 09/21/2022] [Indexed: 06/16/2023]
Abstract
Transgender and gender diverse people (TGD) experience elevated rates of behavioral health problems, including depression, anxiety, substance misuse, and suicidality. Minority stressors (e.g., discrimination and victimization) contribute to these poor health outcomes. A salient form of discrimination is the use of gender nonaffirming language, such as using incorrect pronouns or names, yet less is known about other environmental stimuli that may be reined as affirming or nonaffirming. A recent study uncovered the impact symbols (e.g., flags, stickers) may have on invoking positive or negative feelings among TGD youth in the Midwest. Our study further investigates this phenomenon with TGD adults in Texas. During Summer 2021, 3 researchers conducted audio-recorded semistructured focus groups and interviews with 11 participants who identified as transgender, gender nonconforming, or nonbinary. Interview topics included gender-affirming and nonaffirming language, positive and negative experiences, nonsupportive and supportive symbolism, and coping mechanisms. In this manuscript, we present findings regarding symbolism. Within our two primary themes, supportive and nonsupportive symbolism, subthemes emerged. Supportive symbolism includes flags and signage, written and oral language and communication, and representation of diversity. Nonsupportive symbolism includes extreme patriotism and religious symbols and highly gendered settings. Further, Texas-specific culture and a meter of safety were identified as being related to interacting with and observing an array of symbols. Symbolism can have a profound impact on someone's identity development, expression, emotions, coping mechanisms, and access to and engagement with social environments, exemplifying the importance of understanding geographic and cultural-specific mechanisms within environments TGD people occupy.
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Affiliation(s)
- Kelly Clary
- School of Social Work, Texas State University, San Marcos, Texas, USA
| | - Jacob Goffnett
- School of Social Work, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Marley King
- School of Social Work, Texas State University, San Marcos, Texas, USA
| | - Taylor Hubbard
- School of Social Work, University of Arkansas at Fayetteville, Fayetteville, Arkansas, USA
| | - Rylee Kitchen
- School of Social Work, Texas State University, San Marcos, Texas, USA
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Jackson D. Suicide-Related Outcomes Following Gender-Affirming Treatment: A Review. Cureus 2023; 15:e36425. [PMID: 36950718 PMCID: PMC10027312 DOI: 10.7759/cureus.36425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2023] [Indexed: 03/24/2023] Open
Abstract
Gender-affirming treatment remains a topic of controversy; of particular concern is whether gender-affirming treatment reduces suicidality. A narrative review was undertaken evaluating suicide-related outcomes following gender-affirming surgery, hormones, and/or puberty blockers. Of the 23 studies that met the inclusion criteria, the majority indicated a reduction in suicidality following gender-affirming treatment; however, the literature to date suffers from a lack of methodological rigor that increases the risk of type I error. There is a need for continued research in suicidality outcomes following gender-affirming treatment that adequately controls for the presence of psychiatric comorbidity and treatment, substance use, and other suicide risk-enhancing and reducing factors. There is also a need for future systematic reviews given the inherent limitations of a narrative review. There may be implications on the informed consent process of gender-affirming treatment given the current lack of methodological robustness of the literature reviewed.
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Affiliation(s)
- Daniel Jackson
- Psychiatry and Behavioral Sciences, Norton College of Medicine, Upstate Medical University, Syracuse, USA
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Murphy M, Rogers BG, Streed C, Hughto JM, Radix A, Galipeau D, Napoleon S, Scott T, Noh M, Sutten Coats C, Hubbard L, Chan PA, Nunn A, Berk J. Implementing Gender-Affirming Care in Correctional Settings: A Review of Key Barriers and Action Steps for Change. J Correct Health Care 2023; 29:3-11. [PMID: 36378847 PMCID: PMC10081719 DOI: 10.1089/jchc.21.09.0094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Transgender and gender-diverse (TGD) people are disproportionately impacted by incarceration, interpersonal violence, HIV and other sexually transmitted infections, substance use disorders, and suicidality. Little is known about successful approaches to improve health outcomes for TGD individuals impacted by incarceration. We review the barriers to providing gender-affirming clinical care in correctional systems in the United States, identify key knowledge gaps regarding the provision of gender-affirming care to incarcerated TGD populations, and highlight necessary steps to improve the health and safety of this highly vulnerable population. We also describe the components of a gender-affirming care model implemented in a state correctional facility, including support from correctional administrators, identifying a gender-affirming care provider, standardizing clinical care protocols, and adapting clinical services to TGD population needs. Similar models should be employed elsewhere to improve health outcomes for TGD populations during incarceration and on release.
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Affiliation(s)
- Matthew Murphy
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Rhode Island Department of Corrections, Cranston, Rhode Island, USA
- Rhode Island Public Health Institute, Providence, Rhode Island, USA
| | - Brooke G. Rogers
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Carl Streed
- Section of General Internal Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
- Center for Transgender Medicine and Surgery, Boston Medical Center, Boston, Massachusetts, USA
| | - Jaclyn M.W. Hughto
- Department of Social and Behavioral Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Asa Radix
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Drew Galipeau
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Siena Napoleon
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Ty Scott
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Madeline Noh
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Cassie Sutten Coats
- Rhode Island Public Health Institute, Providence, Rhode Island, USA
- Department of Social and Behavioral Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Leigh Hubbard
- Rhode Island Public Health Institute, Providence, Rhode Island, USA
| | - Philip A. Chan
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Rhode Island Public Health Institute, Providence, Rhode Island, USA
- Department of Social and Behavioral Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Amy Nunn
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Rhode Island Public Health Institute, Providence, Rhode Island, USA
- Department of Social and Behavioral Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Justin Berk
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Rhode Island Department of Corrections, Cranston, Rhode Island, USA
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Kirakosian N, Stanton AM, McKetchnie SM, King D, Dolotina B, O'Cleirigh C, Grasso C, Potter J, Mayer KH, Batchelder AW. Suicidal Ideation Disparities Among Transgender and Gender Diverse Compared to Cisgender Community Health Patients. J Gen Intern Med 2023; 38:1357-1365. [PMID: 36650322 PMCID: PMC9844943 DOI: 10.1007/s11606-022-07996-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 12/23/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Transgender and gender diverse (TGD) individuals experience more severe psychological distress and may be at higher risk for suicide compared to cisgender individuals. The existing literature largely consists of small-sample studies that do not assess subgroup differences. OBJECTIVE To examine rates of self-reported suicidal ideation among four TGD groups compared to cisgender individuals. DESIGN Data were extracted from the electronic health records of patients receiving primary care at a community health center specializing in sexual and gender minority health. A logistic regression was used to examine the relationship between sociodemographic variables and the presence of current suicidal ideation. PARTICIPANTS 29,988 patients receiving care at a community health center in Northeastern US between 2015 and 2018. MAIN MEASURES Demographic questionnaire, 9-item Patient Health Questionnaire KEY RESULTS: Younger age, sexual and gender minority identity, and public/grants-based insurance were associated with significantly higher odds of suicidal ideation. Relative to cisgender men, transgender men (OR=2.08; 95% CI=1.29-3.36; p=.003), transgender women (OR=3.08; 95% CI=2.05-4.63; p<.001), nonbinary (NB) individuals assigned male at birth (AMAB; OR=3.55; 95% CI=1.86-6.77; p<001), and NB individuals assigned female at birth (AFAB; OR=2.49; 95% CI=1.52-4.07; p<001) all endorsed significantly higher odds of current suicidal ideation, controlling for age, race, ethnicity, sexual orientation, and insurance status. Larger proportions of transgender women (23.6%) and NB AMAB individuals (26.7%) reported suicidal ideation not only compared to cisgender men (6.1%) and women (6.6%), but also compared to transgender men (17.4%; χ2[5, n=25,959]=906.454, p<0.001). CONCLUSIONS TGD patients were at significantly increased risk of suicidal ideation, even after accounting for age, race, ethnicity, sexual orientation, and insurance status. Findings suggest distinct risk profiles by assigned sex at birth. Consistent assessment of and intervention for suicidal ideation should be prioritized in settings that serve TGD patients.
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Affiliation(s)
- Norik Kirakosian
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Amelia M Stanton
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Samantha M McKetchnie
- School of Social Work, Boston College, Newton, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Dana King
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Brett Dolotina
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Conall O'Cleirigh
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Chris Grasso
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Jennifer Potter
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Abigail W Batchelder
- The Fenway Institute, Fenway Health, Boston, MA, USA.
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
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Braciszewski JM, Lanier A, Yeh HH, Sala-Hamrick K, Simon GE, Rossom RC, Lynch FL, Waring SC, Lu CY, Owen-Smith AA, Beck A, Daida YG, Maye M, Frank C, Hendriks M, Fabian N, Ahmedani BK. Health Diagnoses and Service Utilization in the Year Before Youth and Young Adult Suicide. Psychiatr Serv 2022:appips20220145. [PMID: 36349497 PMCID: PMC10166760 DOI: 10.1176/appi.ps.20220145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Suicide rates among young people are rising. Health care visits provide opportunities for identification and intervention, yet studies have been limited by small or circumscribed samples. This study sought to expand the knowledge base by examining health care encounters and diagnoses among young people who later died by suicide. METHODS This case-control study examined diagnoses of mental and general medical disorders and health care utilization in the 30 and 365 days before suicide death in nine large U.S. health care systems. Data (years 2000-2015) from 445 suicide decedents ages 10-24 years were matched with data from 4,450 control group patients. RESULTS Suicide decedents were more likely to have at least one mental disorder diagnosis (51% vs. 16%; adjusted OR [AOR]=5.74, 95% CI=4.60-7.18) and had higher rates of nearly all mental health conditions. Substance use disorders were common (12%) and more likely (AOR=8.50, 95% CI=5.53-13.06) among suicide decedents. More than one in three (42%) suicide decedents had a health care visit in the month before death, and nearly all (88%) had a visit in the previous year. CONCLUSIONS Despite the greater likelihood of suicide associated with mental disorder diagnoses, such disorders were present among only 51% of suicide decedents. High rates of health care utilization among suicide decedents indicate a need for improving identification of mental health conditions and suicide risk across the health care system. Increased substance use screening may help identify youths at high risk because substance use disorders were significantly more prevalent and likely among suicide decedents.
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Affiliation(s)
- Jordan M Braciszewski
- Center for Health Policy and Health Services Research (Braciszewski, Yeh, Maye, Ahmedani) and Department of Psychiatry (Braciszewski, Frank, Hendriks, Fabian, Ahmedani), Henry Ford Health, Detroit; School of Medicine, Wayne State University, Detroit (Lanier); Michigan Public Health Institute, Okemos (Sala-Hamrick); Health Research Institute, Kaiser Permanente Washington, Seattle (Simon); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring); Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu); Center for Research and Evaluation, Kaiser Permanente Georgia, and School of Public Health, Georgia State University, Atlanta (Owen-Smith); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Ana Lanier
- Center for Health Policy and Health Services Research (Braciszewski, Yeh, Maye, Ahmedani) and Department of Psychiatry (Braciszewski, Frank, Hendriks, Fabian, Ahmedani), Henry Ford Health, Detroit; School of Medicine, Wayne State University, Detroit (Lanier); Michigan Public Health Institute, Okemos (Sala-Hamrick); Health Research Institute, Kaiser Permanente Washington, Seattle (Simon); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring); Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu); Center for Research and Evaluation, Kaiser Permanente Georgia, and School of Public Health, Georgia State University, Atlanta (Owen-Smith); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Hsueh-Han Yeh
- Center for Health Policy and Health Services Research (Braciszewski, Yeh, Maye, Ahmedani) and Department of Psychiatry (Braciszewski, Frank, Hendriks, Fabian, Ahmedani), Henry Ford Health, Detroit; School of Medicine, Wayne State University, Detroit (Lanier); Michigan Public Health Institute, Okemos (Sala-Hamrick); Health Research Institute, Kaiser Permanente Washington, Seattle (Simon); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring); Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu); Center for Research and Evaluation, Kaiser Permanente Georgia, and School of Public Health, Georgia State University, Atlanta (Owen-Smith); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Kelsey Sala-Hamrick
- Center for Health Policy and Health Services Research (Braciszewski, Yeh, Maye, Ahmedani) and Department of Psychiatry (Braciszewski, Frank, Hendriks, Fabian, Ahmedani), Henry Ford Health, Detroit; School of Medicine, Wayne State University, Detroit (Lanier); Michigan Public Health Institute, Okemos (Sala-Hamrick); Health Research Institute, Kaiser Permanente Washington, Seattle (Simon); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring); Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu); Center for Research and Evaluation, Kaiser Permanente Georgia, and School of Public Health, Georgia State University, Atlanta (Owen-Smith); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Gregory E Simon
- Center for Health Policy and Health Services Research (Braciszewski, Yeh, Maye, Ahmedani) and Department of Psychiatry (Braciszewski, Frank, Hendriks, Fabian, Ahmedani), Henry Ford Health, Detroit; School of Medicine, Wayne State University, Detroit (Lanier); Michigan Public Health Institute, Okemos (Sala-Hamrick); Health Research Institute, Kaiser Permanente Washington, Seattle (Simon); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring); Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu); Center for Research and Evaluation, Kaiser Permanente Georgia, and School of Public Health, Georgia State University, Atlanta (Owen-Smith); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Rebecca C Rossom
- Center for Health Policy and Health Services Research (Braciszewski, Yeh, Maye, Ahmedani) and Department of Psychiatry (Braciszewski, Frank, Hendriks, Fabian, Ahmedani), Henry Ford Health, Detroit; School of Medicine, Wayne State University, Detroit (Lanier); Michigan Public Health Institute, Okemos (Sala-Hamrick); Health Research Institute, Kaiser Permanente Washington, Seattle (Simon); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring); Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu); Center for Research and Evaluation, Kaiser Permanente Georgia, and School of Public Health, Georgia State University, Atlanta (Owen-Smith); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Frances L Lynch
- Center for Health Policy and Health Services Research (Braciszewski, Yeh, Maye, Ahmedani) and Department of Psychiatry (Braciszewski, Frank, Hendriks, Fabian, Ahmedani), Henry Ford Health, Detroit; School of Medicine, Wayne State University, Detroit (Lanier); Michigan Public Health Institute, Okemos (Sala-Hamrick); Health Research Institute, Kaiser Permanente Washington, Seattle (Simon); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring); Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu); Center for Research and Evaluation, Kaiser Permanente Georgia, and School of Public Health, Georgia State University, Atlanta (Owen-Smith); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Stephen C Waring
- Center for Health Policy and Health Services Research (Braciszewski, Yeh, Maye, Ahmedani) and Department of Psychiatry (Braciszewski, Frank, Hendriks, Fabian, Ahmedani), Henry Ford Health, Detroit; School of Medicine, Wayne State University, Detroit (Lanier); Michigan Public Health Institute, Okemos (Sala-Hamrick); Health Research Institute, Kaiser Permanente Washington, Seattle (Simon); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring); Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu); Center for Research and Evaluation, Kaiser Permanente Georgia, and School of Public Health, Georgia State University, Atlanta (Owen-Smith); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Christine Y Lu
- Center for Health Policy and Health Services Research (Braciszewski, Yeh, Maye, Ahmedani) and Department of Psychiatry (Braciszewski, Frank, Hendriks, Fabian, Ahmedani), Henry Ford Health, Detroit; School of Medicine, Wayne State University, Detroit (Lanier); Michigan Public Health Institute, Okemos (Sala-Hamrick); Health Research Institute, Kaiser Permanente Washington, Seattle (Simon); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring); Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu); Center for Research and Evaluation, Kaiser Permanente Georgia, and School of Public Health, Georgia State University, Atlanta (Owen-Smith); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Ashli A Owen-Smith
- Center for Health Policy and Health Services Research (Braciszewski, Yeh, Maye, Ahmedani) and Department of Psychiatry (Braciszewski, Frank, Hendriks, Fabian, Ahmedani), Henry Ford Health, Detroit; School of Medicine, Wayne State University, Detroit (Lanier); Michigan Public Health Institute, Okemos (Sala-Hamrick); Health Research Institute, Kaiser Permanente Washington, Seattle (Simon); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring); Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu); Center for Research and Evaluation, Kaiser Permanente Georgia, and School of Public Health, Georgia State University, Atlanta (Owen-Smith); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Arne Beck
- Center for Health Policy and Health Services Research (Braciszewski, Yeh, Maye, Ahmedani) and Department of Psychiatry (Braciszewski, Frank, Hendriks, Fabian, Ahmedani), Henry Ford Health, Detroit; School of Medicine, Wayne State University, Detroit (Lanier); Michigan Public Health Institute, Okemos (Sala-Hamrick); Health Research Institute, Kaiser Permanente Washington, Seattle (Simon); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring); Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu); Center for Research and Evaluation, Kaiser Permanente Georgia, and School of Public Health, Georgia State University, Atlanta (Owen-Smith); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Yihe G Daida
- Center for Health Policy and Health Services Research (Braciszewski, Yeh, Maye, Ahmedani) and Department of Psychiatry (Braciszewski, Frank, Hendriks, Fabian, Ahmedani), Henry Ford Health, Detroit; School of Medicine, Wayne State University, Detroit (Lanier); Michigan Public Health Institute, Okemos (Sala-Hamrick); Health Research Institute, Kaiser Permanente Washington, Seattle (Simon); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring); Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu); Center for Research and Evaluation, Kaiser Permanente Georgia, and School of Public Health, Georgia State University, Atlanta (Owen-Smith); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Melissa Maye
- Center for Health Policy and Health Services Research (Braciszewski, Yeh, Maye, Ahmedani) and Department of Psychiatry (Braciszewski, Frank, Hendriks, Fabian, Ahmedani), Henry Ford Health, Detroit; School of Medicine, Wayne State University, Detroit (Lanier); Michigan Public Health Institute, Okemos (Sala-Hamrick); Health Research Institute, Kaiser Permanente Washington, Seattle (Simon); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring); Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu); Center for Research and Evaluation, Kaiser Permanente Georgia, and School of Public Health, Georgia State University, Atlanta (Owen-Smith); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Cathrine Frank
- Center for Health Policy and Health Services Research (Braciszewski, Yeh, Maye, Ahmedani) and Department of Psychiatry (Braciszewski, Frank, Hendriks, Fabian, Ahmedani), Henry Ford Health, Detroit; School of Medicine, Wayne State University, Detroit (Lanier); Michigan Public Health Institute, Okemos (Sala-Hamrick); Health Research Institute, Kaiser Permanente Washington, Seattle (Simon); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring); Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu); Center for Research and Evaluation, Kaiser Permanente Georgia, and School of Public Health, Georgia State University, Atlanta (Owen-Smith); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Melissa Hendriks
- Center for Health Policy and Health Services Research (Braciszewski, Yeh, Maye, Ahmedani) and Department of Psychiatry (Braciszewski, Frank, Hendriks, Fabian, Ahmedani), Henry Ford Health, Detroit; School of Medicine, Wayne State University, Detroit (Lanier); Michigan Public Health Institute, Okemos (Sala-Hamrick); Health Research Institute, Kaiser Permanente Washington, Seattle (Simon); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring); Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu); Center for Research and Evaluation, Kaiser Permanente Georgia, and School of Public Health, Georgia State University, Atlanta (Owen-Smith); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Nina Fabian
- Center for Health Policy and Health Services Research (Braciszewski, Yeh, Maye, Ahmedani) and Department of Psychiatry (Braciszewski, Frank, Hendriks, Fabian, Ahmedani), Henry Ford Health, Detroit; School of Medicine, Wayne State University, Detroit (Lanier); Michigan Public Health Institute, Okemos (Sala-Hamrick); Health Research Institute, Kaiser Permanente Washington, Seattle (Simon); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring); Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu); Center for Research and Evaluation, Kaiser Permanente Georgia, and School of Public Health, Georgia State University, Atlanta (Owen-Smith); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida)
| | - Brian K Ahmedani
- Center for Health Policy and Health Services Research (Braciszewski, Yeh, Maye, Ahmedani) and Department of Psychiatry (Braciszewski, Frank, Hendriks, Fabian, Ahmedani), Henry Ford Health, Detroit; School of Medicine, Wayne State University, Detroit (Lanier); Michigan Public Health Institute, Okemos (Sala-Hamrick); Health Research Institute, Kaiser Permanente Washington, Seattle (Simon); HealthPartners Institute, Bloomington, Minnesota (Rossom); Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon (Lynch); Essentia Institute of Rural Health, Essentia Health, Duluth, Minnesota (Waring); Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston (Lu); Center for Research and Evaluation, Kaiser Permanente Georgia, and School of Public Health, Georgia State University, Atlanta (Owen-Smith); Institute for Health Research, Kaiser Permanente Colorado, Aurora (Beck); Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu (Daida)
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11
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Flanders WD, Waller LA, Zhang Q, Getahun D, Silverberg M, Goodman M. Negative Control Exposures: Causal Effect Identifiability and Use in Probabilistic-bias and Bayesian Analyses With Unmeasured Confounders. Epidemiology 2022; 33:832-839. [PMID: 35895515 PMCID: PMC9562027 DOI: 10.1097/ede.0000000000001528] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Probabilistic bias and Bayesian analyses are important tools for bias correction, particularly when required parameters are nonidentifiable. Negative controls are another tool; they can be used to detect and correct for confounding. Our goals are to present conditions that assure identifiability of certain causal effects and to describe and illustrate a probabilistic bias analysis and related Bayesian analysis that use a negative control exposure. METHODS Using potential-outcome models, we characterized assumptions needed for identification of causal effects using a dichotomous, negative control exposure when residual confounding exists. We defined bias parameters, characterized their relationships with the negative control and with specified causal effects, and described the corresponding probabilistic-bias and Bayesian analyses. We present analytic examples using data on hormone therapy and suicide attempts among transgender people. To address possible confounding by healthcare utilization, we used prior tetanus-diphtheria-pertussis (TdaP) vaccination as a negative control exposure. RESULTS Hormone therapy was weakly associated with risk (risk ratio [RR] = 0.9). The negative control exposure was associated with risk (RR = 1.7), suggesting confounding. Based on an assumed prior distribution for the bias parameter, the 95% simulation interval for the distribution of confounding-adjusted RR was (0.17, 1.6), with median 0.5; the 95% credibility interval was similar. CONCLUSIONS We used dichotomous negative control exposure to identify causal effects when a confounder was unmeasured under strong assumptions. It may be possible to relax assumptions and the negative control exposure could prove helpful for probabilistic bias analyses and Bayesian analyses.
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Affiliation(s)
- W Dana Flanders
- From the Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Lance A Waller
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Qi Zhang
- From the Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Darios Getahun
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Michael Silverberg
- Division of Research, Kaiser Permanente, Northern California, Oakland, CA
| | - Michael Goodman
- From the Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
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12
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Bommersbach TJ, Rosenheck RA, Petrakis IL, Rhee TG. Why are women more likely to attempt suicide than men? Analysis of lifetime suicide attempts among US adults in a nationally representative sample. J Affect Disord 2022; 311:157-164. [PMID: 35598742 DOI: 10.1016/j.jad.2022.05.096] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 05/09/2022] [Accepted: 05/15/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE While it is well-known that women are more likely to attempt suicide than men, little is known about risk and protective factors underlying this difference. METHODS Using data from the National Epidemiologic Survey on Alcohol and Related Conditions Wave III (NESARC-III), we compared women and men with and without self-reported lifetime suicide attempts to identify sociodemographic, clinical, and behavioral characteristics that were associated with suicide attempts for each gender. We then examined the interaction of gender and risk factors to identify specific factors that have a significantly different association with the risk of suicide attempts by gender. Multivariate analyses identified factors that were independently associated with a significant interaction of gender and risk of suicide attempt and the extent to which these interactions accounted for the greater risk of suicide attempts among women. RESULTS In unadjusted analysis, women had 1.78 greater odds of self-reported lifetime suicide attempts than men (95% confidence interval (CI), 1.61-1.96). While men and women shared similar risk and protective factors for suicide attempts, several factors were associated with significantly different risks for women than men. In multivariate analysis, these factors only partially accounted for the gender difference in lifetime risk of suicide attempt (adjusted odds ratio, 1.53; 95% CI, 1.12-2.08). CONCLUSIONS Several risk factors for suicide attempts appear to have significantly different magnitude of association among women and men; however, these differences only partially account for gender difference in risk for suicide attempts, suggesting that other factors, not measured in this study, are at play.
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Affiliation(s)
- Tanner J Bommersbach
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States of America
| | - Robert A Rosenheck
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States of America; VA New England Mental Illness, Research Education, and Clinical Center, VA Connecticut Healthcare System, West Haven, CT, United States of America
| | - Ismene L Petrakis
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States of America; VA New England Mental Illness, Research Education, and Clinical Center, VA Connecticut Healthcare System, West Haven, CT, United States of America
| | - Taeho Greg Rhee
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States of America; VA New England Mental Illness, Research Education, and Clinical Center, VA Connecticut Healthcare System, West Haven, CT, United States of America; Department of Public Health Sciences, University of Connecticut School of Medicine, Farmington, CT, United States of America.
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13
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Collin LJ, MacLehose RF, Ahern TP, Gradus JL, Getahun D, Silverberg MJ, Goodman M, Lash TL. Sampling Validation Data to Achieve a Planned Precision of the Bias-Adjusted Estimate of Effect. Am J Epidemiol 2022; 191:1290-1299. [PMID: 35136909 PMCID: PMC9989334 DOI: 10.1093/aje/kwac025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 01/10/2022] [Accepted: 02/02/2022] [Indexed: 01/26/2023] Open
Abstract
Data collected from a validation substudy permit calculation of a bias-adjusted estimate of effect that is expected to equal the estimate that would have been observed had the gold standard measurement been available for the entire study population. In this paper, we develop and apply a framework for adaptive validation to determine when sufficient validation data have been collected to yield a bias-adjusted effect estimate with a prespecified level of precision. Prespecified levels of precision are decided a priori by the investigator, based on the precision of the conventional estimate and allowing for wider confidence intervals that would still be substantively meaningful. We further present an applied example of the use of this method to address exposure misclassification in a study of transmasculine/transfeminine youth and self-harm. Our method provides a novel approach to effective and efficient estimation of classification parameters as validation data accrue, with emphasis on the precision of the bias-adjusted estimate. This method can be applied within the context of any parent epidemiologic study design in which validation data will be collected and modified to meet alternative criteria given specific study or validation study objectives.
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Affiliation(s)
- Lindsay J Collin
- Correspondence to Dr. Lindsay J. Collin, Department of Population Health Science, Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT 84112 (e-mail: )
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14
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Pinna F, Paribello P, Somaini G, Corona A, Ventriglio A, Corrias C, Frau I, Murgia R, El Kacemi S, Galeazzi GM, Mirandola M, Amaddeo F, Crapanzano A, Converti M, Piras P, Suprani F, Manchia M, Fiorillo A, Carpiniello B. Mental health in transgender individuals: a systematic review. Int Rev Psychiatry 2022; 34:292-359. [PMID: 36151828 DOI: 10.1080/09540261.2022.2093629] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Several lines of evidence indicate the prevalence of mental health disorders in Transgender (TG) individuals is higher than that of cisgender individuals or the general population. In this systematic review, we aim to propose a summary of some of the most significant research investigating mental health disorders' prevalence among this population. We performed a double-blind systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting (PRISMA) on PUBMED/MEDLINE and SCOPUS, specifically using peer-reviewed articles examining the mental health status of transgender (TG) individuals. This review did not exclude any research based on publication date. The last search was performed in February 2022. The employed search strategy led to the selection of 165 peer-reviewed articles. The majority of these papers presented a cross-sectional design with self-reported diagnoses and symptoms, signaling a significant prevalence of mental health disorders amongst TG Individuals. Of the reviewed articles, 72 examined the prevalence of mood and anxiety disorders; 8 examined eating disorders; 43 examined the prevalence of suicidal or self-harm ideation or behaviors; 5 papers examined the prevalence of trauma and stress-related disorders; 10 examined the frequency of personality disorders; 44 examined substance use disorders; and 9 papers examined the prevalence of autism spectrum disorder. Finally, 22 studies reported on the prevalence of TG individuals diagnosed with co-morbid mental health disorders or unspecified mental disorders. Our findings coincide with existing research, which indicates TG individuals do experience a higher prevalence of mental health disorders than that of the general population or cisgender individuals. However, further research is needed to address the existing gaps in knowledge.
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Affiliation(s)
- Federica Pinna
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Pasquale Paribello
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Giulia Somaini
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Alice Corona
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Antonio Ventriglio
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Carolina Corrias
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Ilaria Frau
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Roberto Murgia
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Sabrina El Kacemi
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Gian Maria Galeazzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Dipartimento ad attività integrata di Salute Mentale e Dipendenze Patologiche, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Massimo Mirandola
- Department of Diagnostics and Public Health, Infectious Diseases Section, University of Verona, Verona, Italy.,School of Sport and Health Sciences, University of Brighton, Brighton, UK
| | - Francesco Amaddeo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Andrea Crapanzano
- Department of Counseling, San Francisco State University, San Francisco, California, USA
| | - Manlio Converti
- Dipartimento di salute mentale, ASL Napoli 2 Nord, Naples, Italy
| | - Paola Piras
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Federico Suprani
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
| | - Mirko Manchia
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy.,Department of Pharmacology, Dalhousie University, Halifax, NS, Canada
| | - Andrea Fiorillo
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Bernardo Carpiniello
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.,Unit of Clinical Psychiatry, University Hospital of Cagliari, Cagliari, Italy
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15
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Sousa ARD, Machuca-Contreras FA, Morais AVCD, Araújo RDDD, Silva GWDS, Camargo CLD, Oliveira JFD, Carvalho ESDS. Rupturas biográficas por la pandemia del COVID-19 en adolescentes y jóvenes hombres trans y transmasculinos: demandas para la enfermería. Rev Lat Am Enfermagem 2022. [DOI: 10.1590/1518-8345.6243.3752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Resumen Objetivo: comprender las rupturas biográficas provocadas por la pandemia del COVID-19 en adolescentes y jóvenes hombres trans y personas transmasculinas en el contexto de Brasil. Método: estudio cualitativo - encuesta en línea - multicéntrico. Participaron 97 hombres trans y 22 personas transmasculinas autoidentificadas, que respondieron un formulario semiestructurado en dos etapas. Los datos se sometieron al Análisis de Contenido Temático Reflexivo. La interpretación se realizó sobre una base sociológica a partir del concepto de ruptura biográfica. Resultados: surgieron cinco categorías: interrupción de la terapia hormonal, cirugías y seguimiento especializado; malestares precipitados por la interrupción de las características masculinas, autoimagen, autopercepción e identidad; vulnerabilidad por la pérdida de familiares y seres queridos, empleo y debilitamiento de las redes de apoyo; aparición de problemas psicoemocionales, como la pérdida del sentido de la vida; demandas de atención de enfermería y valoración de la vida de adolescentes y jóvenes transexuales en el pospandemia. Conclusión: las rupturas biográficas provocadas por la pandemia amenazaron las identidades de los hombres trans y personas transmasculinas adolescentes y jóvenes, produjeron degradación y discontinuidad de las biografías, llevándolas a perder el sentido de la vida. Los profesionales de enfermería pueden ser estratégicos e imprescindibles en la superación de estas amenazas al promover una intervención anticipada.
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16
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Sousa ARD, Machuca-Contreras FA, Morais AVCD, Araújo RDDD, Silva GWDS, Camargo CLD, Oliveira JFD, Carvalho ESDS. Biographical ruptures by the COVID-19 pandemic on adolescent and young trans men and transmasculine people: demands for nursing. Rev Lat Am Enfermagem 2022; 30:e3753. [DOI: 10.1590/1518-8345.6243.3753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 07/25/2022] [Indexed: 11/09/2022] Open
Abstract
Abstract Objective: to understand the biographical ruptures caused by the COVID-19 pandemic on adolescent and young trans men and transmasculine people in the Brazilian context. Method: qualitative study - multicenter, online survey. A total of 97 self-identified trans men and 22 transmasculine people participated and completed a semi-structured form in two stages. The data was subjected to Reflective Thematic Content Analysis. The interpretation was made on a sociological basis, based on the concept of biographical rupture. Results: five categories were derived: interruption of hormonization, surgeries and specialized follow-up; discomforts caused by the rupture of masculine characteristics, self-image, self-perception, and identity; vulnerability from the losses of family members and significant people, employment, and weakening of support networks; emergence of psycho-emotional problems, such as loss of meaning in life; demands for nursing care and valuing the life of transmasculine adolescents and young men in post-pandemic times. Conclusion: the biographical ruptures caused by the pandemic threatened the identities of trans and transmasculine people of adolescents and youth, degraded and interrupted biographies, leading them to the loss of meaning in life. Nursing professionals can be strategic and essential in overcoming threats by intervening early.
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17
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Sousa ARD, Machuca-Contreras FA, Morais AVCD, Araújo RDDD, Silva GWDS, Camargo CLD, Oliveira JFD, Carvalho ESDS. Rupturas biográficas pela pandemia da COVID-19 sobre adolescentes e jovens homens trans e transmasculinos: demandas para a enfermagem. Rev Lat Am Enfermagem 2022. [DOI: 10.1590/1518-8345.6243.3754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Resumo Objetivo: compreender as rupturas biográficas causadas pela pandemia da COVID-19 sobre adolescentes e jovens homens trans e pessoas transmasculinas no contexto do Brasil. Método: estudo qualitativo - survey on-line, multicêntrico. Participaram 97 homens trans e 22 pessoas transmasculinas, autoidentificados, que responderam formulário semiestruturado em duas etapas. Os dados foram submetidos à Análise de Conteúdo Temática Reflexiva. Realizou-se a interpretação com base sociológica, a partir do conceito de ruptura biográfica. Resultados: derivadas cinco categorias: interrupção da hormonização, cirurgias e acompanhamento especializado; desconfortos precipitados pela ruptura das características masculinas, autoimagem, autopercepção e identidade; vulnerabilidade a partir das perdas de familiares e pessoas significativas, emprego e fragilização das redes de apoio; emergência de problemas psicoemocionais, como perda do sentido da vida; demandas para o cuidado de enfermagem e valorização da vida de adolescentes e jovens transmasculinos no pós-pandemia. Conclusão: as rupturas biográficas provocadas pela pandemia ameaçaram as identidades de homens trans e pessoas transmasculinas de adolescentes e jovens, produziram degradação e descontinuidade das biografias, conduzindo-os à perda de sentido da vida. Profissionais de enfermagem podem ser estratégicos e essenciais na superação das ameaças, intervindo antecipadamente.
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18
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de Graaf NM, Steensma TD, Carmichael P, VanderLaan DP, Aitken M, Cohen-Kettenis PT, de Vries ALC, Kreukels BPC, Wasserman L, Wood H, Zucker KJ. Suicidality in clinic-referred transgender adolescents. Eur Child Adolesc Psychiatry 2022; 31:67-83. [PMID: 33165650 DOI: 10.1007/s00787-020-01663-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 10/11/2020] [Indexed: 12/20/2022]
Abstract
Gender and sexually diverse adolescents have been reported to be at an elevated risk for suicidal thoughts and behaviors. For transgender adolescents, there has been variation in source of ascertainment and how suicidality was measured, including the time-frame (e.g., past 6 months, lifetime). In studies of clinic-referred samples of transgender adolescents, none utilized any type of comparison or control group. The present study examined suicidality in transgender adolescents (M age, 15.99 years) seen at specialty clinics in Toronto, Canada, Amsterdam, the Netherlands, and London, UK (total N = 2771). Suicidality was measured using two items from the Child Behavior Checklist (CBCL) and the Youth Self-Report (YSR). The CBCL/YSR referred and non-referred standardization samples from both the U.S. and the Netherlands were used for comparative purposes. Multiple linear regression analyses showed that there was significant between-clinic variation in suicidality on both the CBCL and the YSR; in addition, suicidality was consistently higher among birth-assigned females and strongly associated with degree of general behavioral and emotional problems. Compared to the U.S. and Dutch CBCL/YSR standardization samples, the relative risk of suicidality was somewhat higher than referred adolescents but substantially higher than non-referred adolescents. The results were discussed in relation to both gender identity specific and more general risk factors for suicidality.
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Affiliation(s)
- Nastasja M de Graaf
- Gender Identity Development Service, The Tavistock and Portman NHS Trust, London, England
- Department of Medical Psychology, Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, the Netherlands
| | - Thomas D Steensma
- Department of Medical Psychology, Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, the Netherlands
| | - Polly Carmichael
- Gender Identity Development Service, The Tavistock and Portman NHS Trust, London, England
| | - Doug P VanderLaan
- Department of Psychology, University of Toronto Mississauga, Mississauga, ON, Canada
- Child and Youth Psychiatry, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Madison Aitken
- Child and Youth Psychiatry, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Peggy T Cohen-Kettenis
- Department of Medical Psychology, Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, the Netherlands
| | - Annelou L C de Vries
- Department of Medical Psychology, Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, the Netherlands
| | - Baudewijntje P C Kreukels
- Department of Medical Psychology, Center of Expertise on Gender Dysphoria, VU University Medical Center, Amsterdam, the Netherlands
| | - Lori Wasserman
- Reproductive Life Stages Program, Women's College Hospital, Toronto, ON, Canada
| | - Hayley Wood
- Psychological Services, Toronto Board of Education, Toronto, ON, Canada
| | - Kenneth J Zucker
- Department of Psychiatry, University of Toronto, 250 College St., Toronto, ON, M5T 1R8, Canada.
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19
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Tabler J, Schmitz RM, Nagata JM, Geist C. Self-perceived gender expression, discrimination, and mental health disparities in adulthood. SSM - Mental Health 2021. [DOI: 10.1016/j.ssmmh.2021.100020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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20
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Reis A, Sperandei S, de Carvalho PGC, Pinheiro TF, de Moura FD, Gomez JL, Porchat P, Bastos FI, McFarland W, Wilson EC, Veras MA. A cross-sectional study of mental health and suicidality among trans women in São Paulo, Brazil. BMC Psychiatry 2021; 21:557. [PMID: 34758758 PMCID: PMC8579408 DOI: 10.1186/s12888-021-03557-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 10/20/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Trans women have been shown to experience disproportionately poor outcomes in physical and mental health. Although it is common to talk about the violence against trans people, little is still known about mental health outcomes and experiences of suicidality among trans women, particularly in developing countries. This study aims to investigate risk factors and associations with mental health, suicide ideation and suicide attempts among trans women in the largest metropolitan area in Brazil. METHODS Trans women living in São Paulo were recruited between May 2017 and July 2019 using the long-chain peer referral method Respondent-Driven Sampling. Multivariate regression models were used to investigate the associations with K10 score classification (logistic) and suicidal ideation/suicide attempt (ordinal logistic). RESULTS A total of 763 trans women were included in the study. Over one quarter (26.5%) of trans women had been diagnosed with anxiety in the past, and close to one in five (19.1%) trans women had received a diagnosis of depression. More than two in five (41.9%) trans women had moderate to severe psychological distress. More than half of all participating trans women reported having previously either experienced suicidal ideation or attempted to take their own lives (25.0 and 31.2% respectively). In multivariate regression, moderate to severe psychological distress was associated with homelessness, income, current sex work, use of stimulant drugs, history of physical abuse, depression diagnosis and access to mental health treatment. Suicidal ideation and suicide attempts were associated with race/skin color, living arrangements, marital status, current sex work, history of sexual violence, depression and PTSD diagnoses, access to mental health treatment and psychological distress. CONCLUSIONS This study showed that there is a significant association between mental health conditions, lack of treatment for these conditions and suicidality among trans gender women. Findings point to the need for a structural transformation in Brazil that enables a reduction in the social inequality and violence that impact the mental health of trans women. A number of recommendations to achieve this are provided.
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Affiliation(s)
- Arianne Reis
- grid.1029.a0000 0000 9939 5719School of Health Sciences, Western Sydney University, Penrith, Australia ,grid.1029.a0000 0000 9939 5719Translational Health Research Institute, Western Sydney University, Penrith, Australia
| | - Sandro Sperandei
- grid.1029.a0000 0000 9939 5719Translational Health Research Institute, Western Sydney University, Penrith, Australia
| | | | - Thiago Félix Pinheiro
- grid.419014.90000 0004 0576 9812Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, Brazil
| | - Ferdinando Diniz de Moura
- grid.419014.90000 0004 0576 9812Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, Brazil
| | - José Luis Gomez
- grid.419014.90000 0004 0576 9812Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, Brazil
| | - Patrícia Porchat
- grid.410543.70000 0001 2188 478XSchool of Sciences, São Paulo State University, Bauru, Brazil
| | - Francisco Inácio Bastos
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Willi McFarland
- grid.410359.a0000 0004 0461 9142San Francisco Department of Public Health, Center for Public Health Research, San Francisco, CA USA ,grid.266102.10000 0001 2297 6811Department of Epidemiology and Statistics, University of California, San Francisco, CA USA
| | - Erin C. Wilson
- grid.410359.a0000 0004 0461 9142San Francisco Department of Public Health, Trans Research unit for Equity (TRUE), San Francisco, CA USA
| | - Maria Amélia Veras
- Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, Brazil.
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21
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Rafael RDMR, Jalil EM, Luz PM, de Castro CRV, Wilson EC, Monteiro L, Ramos M, Moreira RI, Veloso VG, Grinsztejn BGJ, Velasque LDS. Prevalence and factors associated with suicidal behavior among trans women in Rio de Janeiro, Brazil. PLoS One 2021; 16:e0259074. [PMID: 34679106 PMCID: PMC8535442 DOI: 10.1371/journal.pone.0259074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 10/11/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Trans women face disproportionate burden of adverse health outcomes, including mental health issues. Very little is known about suicidal behavior among trans women in low- and middle-income settings, such as Brazil. We aimed to estimate the prevalence of lifetime suicidal behavior and to identify its associated factors among Brazilian trans women. METHODS This was a cross-sectional study conducted among 345 trans women living in Rio de Janeiro, Brazil. We examined the prevalence of suicidal behavior (ideation and suicide attempt) and its associated factors using stepwise backward Poisson regression analysis with robust variance. RESULTS Suicidal ideation was present among 47.25% of participants, and the prevalence of lifetime suicide attempt was 27.25%. Trans women with prior physical violence perpetrated by a family member had significantly higher prevalence of suicidal ideation (adjusted prevalence ratios [aPR]1.37), whereas those who reported sex work had lower prevalence ratio of suicidal ideation (aPR 0.76). Suicide attempt was significantly associated with living alone (aPR 1.48), physical violence by a casual partner (aPR 1.92), and sexual violence by a family member (aPR 1.69). Depression was significantly associated with both outcomes (aPR 1.90 for suicidal ideation and aPR 2.21 for suicide attempt). CONCLUSION Suicidal behavior prevalence rates among Brazilian trans women were alarming and directly linked to violence and poor mental health. Effective mental health and public health policies addressing violence against trans women are urgently needed to prevent suicidal behavior among this highly vulnerable population.
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Affiliation(s)
| | - Emilia Moreira Jalil
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Paula Mendes Luz
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | | | - Erin C. Wilson
- San Francisco Department of Public Health, Center for Public Health Research, San Francisco, California, United States of America
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, United States of America
| | - Laylla Monteiro
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Michelle Ramos
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Ronaldo Ismério Moreira
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Valdiléa Gonçalves Veloso
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | | | - Luciane de Souza Velasque
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
- Department of Quantitative Methods, Federal University of Rio de Janeiro State, Rio de Janeiro, Brazil
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Abstract
One of the most impactful ways to create a dynamic team is to foster diversity and inclusivity within the workplace. Workplaces have become more heterogenous as advances in human, women, and civil rights group have spurred greater labor force participation by members of historically underrepresented groups. Studies have shown that leveraging diversity has important implications for the promotion of positive organization change through facilitation of individual and organization performance. Diverse clientele may be more comfortable and feel more welcome working with people in a diverse workplace.
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23
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Kameg B. Antitransgender legislation and the need to advocate for transgender youth. J Child Adolesc Psychiatr Nurs 2021; 34:81-82. [PMID: 33963629 DOI: 10.1111/jcap.12322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 04/18/2021] [Accepted: 04/22/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Brayden Kameg
- Department of Health and Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, USA
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24
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Mirabella M, Giovanardi G, Fortunato A, Senofonte G, Lombardo F, Lingiardi V, Speranza AM. The Body I Live in. Perceptions and Meanings of Body Dissatisfaction in Young Transgender Adults: A Qualitative Study. J Clin Med 2020; 9:jcm9113733. [PMID: 33233761 PMCID: PMC7699932 DOI: 10.3390/jcm9113733] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 11/16/2020] [Accepted: 11/18/2020] [Indexed: 02/06/2023] Open
Abstract
Body dissatisfaction in individuals with Gender Incongruence (GI) represents a primary source of suffering. Several studies have highlighted how this suffering has psychological, physical, and biological implications. This work aims to explore experiences related to body dissatisfaction and investigate the issues associated with living in a body perceived as incongruent for individuals with GI. Thirty-six individuals, aged between 18 and 30 years old and at stage T0 of hormone treatment, participated in the study. Body dissatisfaction and experiences related to it were investigated using the Clinical Diagnostic Interview. The Consensual Qualitative Research methodology was applied to the transcripts of the interviews. Several themes emerged: experiences with GI development, experiences with puberty and bodily changes, perception of one’s body, psychological problems and complex behavioral patterns related to body dissatisfaction. Results pointed out the complexity implied in the relationship with one’s body for individuals with GI, highlighting specific aspects of body dissatisfaction among these individuals (e.g., eating disorders, sexual difficulties, social withdrawal). This study underlines the need for a deeper understanding of some aspects of GI to better define guidelines for a correct assessment of it. In this way it will be easier to avoid negative outcomes for the psychological and general health of transgender people.
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Affiliation(s)
- Marta Mirabella
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Via degli Apuli 1, 00185 Roma, Italy; (G.G.); (A.F.); (V.L.); (A.M.S.)
- Correspondence: ; Tel.: +39-340-986-7587
| | - Guido Giovanardi
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Via degli Apuli 1, 00185 Roma, Italy; (G.G.); (A.F.); (V.L.); (A.M.S.)
| | - Alexandro Fortunato
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Via degli Apuli 1, 00185 Roma, Italy; (G.G.); (A.F.); (V.L.); (A.M.S.)
| | - Giulia Senofonte
- Laboratory of Seminology, Sperm Bank “Loredana Gandini,” Department of Experimental Medicine, Sapienza University of Rome, 00185 Roma, Italy; (G.S.); (F.L.)
| | - Francesco Lombardo
- Laboratory of Seminology, Sperm Bank “Loredana Gandini,” Department of Experimental Medicine, Sapienza University of Rome, 00185 Roma, Italy; (G.S.); (F.L.)
| | - Vittorio Lingiardi
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Via degli Apuli 1, 00185 Roma, Italy; (G.G.); (A.F.); (V.L.); (A.M.S.)
| | - Anna Maria Speranza
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, Via degli Apuli 1, 00185 Roma, Italy; (G.G.); (A.F.); (V.L.); (A.M.S.)
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