1
|
Keyes KM, Platt JM. Annual Research Review: Sex, gender, and internalizing conditions among adolescents in the 21st century - trends, causes, consequences. J Child Psychol Psychiatry 2024; 65:384-407. [PMID: 37458091 DOI: 10.1111/jcpp.13864] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/07/2023] [Indexed: 07/18/2023]
Abstract
Internalizing conditions of psychopathology include depressive and anxiety disorders; they most often onset in adolescence, are relatively common, and contribute to significant population morbidity and mortality. In this research review, we present the evidence that internalizing conditions, including depression and anxiety, as well as psychological distress, suicidal thoughts and self-harm, and fatal suicide, are considerably increasing in adolescent populations across many countries. Evidence indicates that increases are currently greatest in female adolescents. We present an epidemiological framework for evaluating the causes of these increases, and synthesize research on whether several established risk factors (e.g., age of pubertal transition and stressful life events) and novel risk factors (e.g., digital technology and social media) meet conditions necessary to be plausible causes of increases in adolescent internalizing conditions. We conclude that there are a multitude of potential causes of increases in adolescent internalizing conditions, outline evidence gaps including the lack of research on nonbinary and gender nonconforming populations, and recommend necessary prevention and intervention foci from a clinical and public health perspective.
Collapse
Affiliation(s)
- Katherine M Keyes
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Jonathan M Platt
- College of Public Health, University of Iowa, Iowa City, IA, USA
| |
Collapse
|
2
|
Dickson CA, Ergun-Longmire B, Greydanus DE, Eke R, Giedeman B, Nickson NM, Hoang LN, Adabanya U, Payares DVP, Chahin S, McCrary J, White K, Moon JH, Haitova N, Deleon J, Apple RW. Health equity in pediatrics: Current concepts for the care of children in the 21st century (Dis Mon). Dis Mon 2024; 70:101631. [PMID: 37739834 DOI: 10.1016/j.disamonth.2023.101631] [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] [Indexed: 09/24/2023]
Abstract
This is an analysis of important aspects of health equity in caring for children and adolescents written by a multidisciplinary team from different medical centers. In this discussion for clinicians, we look at definitions of pediatric health equity and the enormous impact of social determinants of health in this area. Factors involved with pediatric healthcare disparities that are considered include race, ethnicity, gender, age, poverty, socioeconomic status, LGBT status, living in rural communities, housing instability, food insecurity, access to transportation, availability of healthcare professionals, the status of education, and employment as well as immigration. Additional issues involved with health equity in pediatrics that are reviewed will include the impact of the COVID-19 pandemic, behavioral health concepts, and the negative health effects of climate change. Recommendations that are presented include reflection of one's own attitudes on as well as an understanding of these topics, consideration of the role of various healthcare providers (i.e., community health workers, peer health navigators, others), the impact of behavioral health integration, and the need for well-conceived curricula as well as multi-faceted training programs in pediatric health equity at the undergraduate and postgraduate medical education levels. Furthermore, ongoing research in pediatric health equity is needed to scrutinize current concepts and stimulate the development of ideas with an ever-greater positive influence on the health of our beloved children. Clinicians caring for children can serve as champions for the optimal health of children and their families; in addition, these healthcare professionals are uniquely positioned in their daily work to understand the drivers of health inequities and to be advocates for optimal health equity in the 21st century for all children and adolescents.
Collapse
Affiliation(s)
- Cheryl A Dickson
- Department of Pediatric & Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Berrin Ergun-Longmire
- Department of Pediatric & Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Donald E Greydanus
- Department of Pediatric & Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States.
| | - Ransome Eke
- Department of Community Medicine, Mercer University School of Medicine, Columbus, GA, United States
| | - Bethany Giedeman
- Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Nikoli M Nickson
- Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Linh-Nhu Hoang
- Department of Psychology, Western Michigan University, Kalamazoo, MI, United States
| | - Uzochukwu Adabanya
- Department of Community Medicine, Mercer University School of Medicine, Columbus, GA, United States
| | - Daniela V Pinto Payares
- Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Summer Chahin
- Department of Psychology, C.S. Mott Children's Hospital/Michigan Medicine, Ann Arbor, MI, United States
| | - Jerica McCrary
- Center for Rural Health and Health Disparities, Mercer University School of Medicine, Columbus, GA, United States
| | - Katie White
- Department of Pediatric & Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Jin Hyung Moon
- Department of Community Medicine, Mercer University School of Medicine, Columbus, GA, United States
| | - Nizoramo Haitova
- Department of Educational Leadership, Research and Technology, Western Michigan University, Kalamazoo, MI, United States
| | - Jocelyn Deleon
- Department of Pediatric & Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Roger W Apple
- Department of Pediatric & Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| |
Collapse
|
3
|
Eisenberg ME, Lawrence SE, Eadeh HM, Suresh M, Rider GN, Gower AL. Emotional Distress Disparities Across Multiple Intersecting Social Positions: The Role of Bias-Based Bullying. Pediatrics 2024; 153:e2023061647. [PMID: 38273773 PMCID: PMC10827645 DOI: 10.1542/peds.2023-061647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/26/2023] [Indexed: 01/27/2024] Open
Abstract
OBJECTIVES To apply an intersectional lens to disparities in emotional distress among youth, including multiple social positions and experiences with bias-based bullying. METHODS Data are from the 2019 Minnesota Student Survey (n = 80 456). Social positions (race and ethnicity, sexual orientation, gender) and 2 forms of bias-based bullying (racist, homophobic or transphobic) were entered into decision tree models for depression, anxiety, self-injury, suicidal ideation, and suicide attempts. Groups with the highest prevalence are described. Rates of emotional distress among youth with matching social positions but no bias-based bullying are described for comparison. RESULTS LGBQ identities (90%) and transgender, gender diverse, and questioning identities (54%) were common among the highest-prevalence groups for emotional distress, often concurrently; racial and ethnic identities rarely emerged. Bias-based bullying characterized 82% of the highest-prevalence groups. In comparable groups without bias-based bullying, emotional distress rates were 20% to 60% lower (average 38.8%). CONCLUSIONS Findings highlight bias-based bullying as an important point for the intervention and mitigation of mental health disparities, particularly among lesbian, gay, bisexual, transgender, gender-diverse, queer, and questioning adolescents. Results point to the importance of addressing bias-based bullying in schools and supporting lesbian, gay, bisexual, transgender, gender-diverse, queer, and questioning students at the systemic level as a way of preventing emotional distress.
Collapse
Affiliation(s)
- Marla E. Eisenberg
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Samantha E. Lawrence
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
- University of Connecticut, School of Social Work, Hartford, CT
| | - Hana-May Eadeh
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Malavika Suresh
- University of Minnesota Medical School, Minneapolis, Minnesota
| | - G. Nic Rider
- Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota
| | - Amy L. Gower
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| |
Collapse
|
4
|
Clark KA, Pachankis JE, Dougherty LR, Katz BA, Hill KE, Klein DN, Kujawa A. Adolescents' Sexual Orientation and Behavioral and Neural Reactivity to Peer Acceptance and Rejection: The Moderating Role of Family Support. Clin Psychol Sci 2024; 12:115-132. [PMID: 38288008 PMCID: PMC10824405 DOI: 10.1177/21677026231158574] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2024]
Abstract
Sexual-minority adolescents frequently endure peer rejection, yet scant research has investigated sexual-orientation differences in behavioral and neural reactions to peer rejection and acceptance. In a community sample of adolescents approximately 15 years old (47.2% female; same-sex attracted: n = 36, exclusively other-sex attracted: n = 310), we examined associations among sexual orientation and behavioral and neural reactivity to peer feedback and the moderating role of family support. Participants completed a social-interaction task while electroencephalogram data were recorded in which they voted to accept/reject peers and, in turn, received peer acceptance/rejection feedback. Compared with heterosexual adolescents, sexual-minority adolescents engaged in more behavioral efforts to ingratiate after peer rejection and demonstrated more blunted neural reactivity to peer acceptance at low, but not medium or high, levels of family support. By using a simulated real-world social-interaction task, these results demonstrate that sexual-minority adolescents display distinct behavioral and neural reactions to peer acceptance and rejection.
Collapse
Affiliation(s)
- Kirsty A. Clark
- Department of Medicine, Health, and Society, Vanderbilt University
- Department of Psychology and Human Development, Vanderbilt University
| | - John E. Pachankis
- Department of Social and Behavioral Sciences, Yale School of Clinical Psychological Science Public Health
| | | | | | - Kaylin E. Hill
- Department of Psychology and Human Development, Vanderbilt University
| | | | - Autumn Kujawa
- Department of Psychology and Human Development, Vanderbilt University
| |
Collapse
|
5
|
Lawrence SE, McMorris BJ, Simon KA, Gower AL, Eisenberg ME. Bullying Involvement at the Intersection of Gender Identity/Modality, Sexual Identity, Race, Ethnicity, and Disability: Prevalence Disparities and the Role of School-Related Developmental Assets. LGBT Health 2023; 10:S10-S19. [PMID: 37754921 PMCID: PMC10623467 DOI: 10.1089/lgbt.2023.0076] [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: 09/28/2023] Open
Abstract
Purpose: This study examines adolescents' self-reported school-based developmental assets and four intersecting social positions as they relate to prevalence of bullying involvement. Methods: Participants were 80,456 ninth and 11th grade students who participated in the 2019 Minnesota Student Survey (30.2% youth of color; 11% lesbian/gay/bisexual/pansexual/queer/questioning; 2.9% transgender/gender diverse [TGD] or gender questioning). Exhaustive Chi-square Automatic Interaction Detection analysis was used to identify school-based developmental assets (i.e., school safety, school adult support) and intersecting social positions (i.e., sexual identity; gender identity/modality; racial/ethnic identity; physical disabilities/chronic illness; and/or mental health/behavioral/emotional problems) associated with the highest prevalence of involvement as physical and relational bullies, victims, and bully-victims. Results: Adolescents with 2+ marginalized social positions who often lacked school-based developmental assets were part of nearly all the highest prevalence bullying involvement groups. TGD and gender questioning adolescents, Native American youth, and youth living with both physical disabilities/chronic illness and mental health/emotional/behavioral problems-most of whom had additional marginalized social positions and lacked school-based assets-were particularly overrepresented in high prevalence groups. For example, 31.1% of TGD or gender questioning youth of color living with both types of disabilities/health problems who did not feel strongly that school was safe reported involvement as physical bully-victims-nearly six times the sample average rate. Conclusion: Adolescents with multiple marginalized social positions and those lacking certain school-based assets-often overlapping categories-were involved in bullying at higher-than-average rates. Findings underscore the need for schools to address intersecting experiences of stigma and structural oppression that may perpetuate bullying involvement disparities.
Collapse
Affiliation(s)
- Samantha E. Lawrence
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
| | | | - Kay A. Simon
- Department of Family Social Science, University of Minnesota, Minneapolis, Minnesota, USA
| | - Amy L. Gower
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Marla E. Eisenberg
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
| |
Collapse
|
6
|
Gower AL, Rider GN, Del Río-González AM, Erickson PJ, Thomas D, Russell ST, Watson RJ, Eisenberg ME. Application of an intersectional lens to bias-based bullying among LGBTQ+ youth of color in the United States. Stigma Health 2023; 8:363-371. [PMID: 37936868 PMCID: PMC10627550 DOI: 10.1037/sah0000415] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
Bias-based bullying influences health, academic success, and social wellbeing. However, little quantitative work takes an intersectional perspective to understand bias-based bullying among youth with marginalized social positions, which is critical to prevention. This paper describes the application of exhaustive chi-square automatic interaction detection (CHAID) to understand how prevalence of race-, gender-, and sexual orientation-based bullying varies for youth with different intersecting social positions. We used two datasets - the 2019 Minnesota Student Survey (MSS; N=80,456) and the 2017-2019 California Healthy Kids Survey (CHKS; N=512,067). Students self-reported sex assigned at birth, sexual orientation, gender identity, race/ethnicity, and presence of any race-, gender-, and sexual orientation-based bullying (MSS: past 30 days, CHKS: past 12 months). Exhaustive CHAID with a Bonferroni correction, a recommended approach for large, quantitative intersectionality research, was used for analyses. Exhaustive CHAID analyses identified a number of nodes of intersecting social positions with particularly high prevalences of bias-based bullying. Across both datasets, with varying timeframes and question wording, and all three forms of bias-based bullying, youth who identified as transgender, gender diverse, or were questioning their gender and also held other marginalized social positions were frequent targets of all forms of bias-based bullying. More work is needed to understand how systems of oppression work together to influence school-based bullying experiences. Effective prevention programs to improve the health of youth with marginalized social positions must acknowledge the complex and overlapping ways bias and stigma interact.
Collapse
Affiliation(s)
- Amy L Gower
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota. 717 Delaware St. SE, Minneapolis, MN, 55414, USA
| | - G Nic Rider
- Institute for Sexual and Gender Health, Department of Family Medicine and Community Health, University of Minnesota Medical School, 1300 S 2 St., Ste 180, Minneapolis, MN, 55454, USA
| | - Ana María Del Río-González
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University
| | - Paige J Erickson
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota. 717 Delaware St. SE, Minneapolis, MN, 55414, USA
| | - De'Shay Thomas
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota. 717 Delaware St. SE, Minneapolis, MN, 55414, USA
| | - Stephen T Russell
- Department of Human Development and Family Sciences, University of Texas, 108 E Dean Keeton St, Austin, TX, 78712, USA
| | - Ryan J Watson
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, 348 Mansfield Rd U-1058, Storrs, CT, 06269, USA
| | - Marla E Eisenberg
- Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota. 717 Delaware St. SE, Minneapolis, MN, 55414, USA
| |
Collapse
|
7
|
Feil K, Riedl D, Böttcher B, Fuchs M, Kapelari K, Gräßer S, Toth B, Lampe A. Higher Prevalence of Adverse Childhood Experiences in Transgender Than in Cisgender Individuals: Results from a Single-Center Observational Study. J Clin Med 2023; 12:4501. [PMID: 37445536 DOI: 10.3390/jcm12134501] [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] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/22/2023] [Accepted: 07/03/2023] [Indexed: 07/15/2023] Open
Abstract
Adverse childhood experiences (ACE) have been shown to have a tremendous negative impact on health outcomes later in life. This study presents data on the prevalence of ACEs, psychological distress, and trauma-related symptoms in transgender and gender-diverse (TGD) people compared to cisgender people. TGD adults (n = 35) and a matched sample of nonpsychiatric hospital patients (n = 35) were surveyed between September 2018 and March 2019. Participants completed the Maltreatment and Abuse Chronology of Exposure Scale to assess ACEs, as well as the Brief Symptom Inventory and the Essener Trauma Inventory to assess psychological distress and trauma-related symptoms. TGD patients reported a higher number of ACEs than cisgender patients (0.7 vs. 2.4; p < 0.001; d = 0.94). A total of 28.6% of TGD vs. 5.7% cisgender patients reported four or more ACEs (p < 0.001). The most common forms of ACEs were parental abuse (54.3%) and peer abuse (54.3%). No significantly increased prevalence of sexual abuse was found (p > 0.05). TGD patients also reported a higher prevalence of depression (48.4% vs. 5.7%, p < 0.001), posttraumatic stress disorder symptoms (59.4% vs. 13.8%, p < 0.001), and anxiety (58.1% vs. 28.6%, p = 0.016). Health care providers should be aware of and assess ACEs, especially in vulnerable groups such as TGD people, and create a safe place through open-minded, affirming care.
Collapse
Affiliation(s)
- Katharina Feil
- Department of Gynecological Endocrinology and Reproductive Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - David Riedl
- University Hospital of Psychiatry II, Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Medical University of Innsbruck, 6020 Innsbruck, Austria
- Ludwig Boltzmann Institute for Rehabilitation Research, 1140 Vienna, Austria
| | - Bettina Böttcher
- Department of Gynecological Endocrinology and Reproductive Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Martin Fuchs
- Department of Child and Adolescent Psychiatry, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Klaus Kapelari
- Department of Pediatrics I, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Sofie Gräßer
- University Hospital of Psychiatry II, Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Bettina Toth
- Department of Gynecological Endocrinology and Reproductive Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Astrid Lampe
- Ludwig Boltzmann Institute for Rehabilitation Research, 1140 Vienna, Austria
- VAMED Rehabilitation Center, 6780 Schruns, Austria
| |
Collapse
|
8
|
Sares-Jäske L, Czimbalmos M, Majlander S, Siukola R, Klemetti R, Luopa P, Lehtonen J. Gendered Differences in Experiences of Bullying and Mental Health Among Transgender and Cisgender Youth. J Youth Adolesc 2023:10.1007/s10964-023-01786-7. [PMID: 37199852 DOI: 10.1007/s10964-023-01786-7] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 04/28/2023] [Indexed: 05/19/2023]
Abstract
Even though previous studies have shown that transgender youth have poorer mental health and more experiences of being bullied than their cisgender counterparts, and that bullying associates with poorer mental health, knowledge on such associations in different gender identity groups is scarce. This study investigated how mental health problems and experiences of being bullied appear across different gender identity groups, and how bullying is associated with mental health among the groups in question. Data from the Finnish School Health Promotion 2021 study (n = 152,880, mean age 16.2 years (standard deviation 1.22)) was used and categorized into four gender identity groups: cisgender girls (n = 76,521), cisgender boys (n = 69,735), transfeminine youth (n = 1317), and transmasculine youth (n = 5307). Transgender youth experienced more bullying and reported poorer mental health than cisgender youth. While transfeminine youth faced the most bullying, transmasculine youth had the most mental health symptoms. In each group, bullying associated with poorer mental health. Compared to cisgender boys without bullying experiences, odds of poorer mental health were dozens-fold among transmasculine youth with weekly bullying experiences. In addition, compared to cisgender boys with bullying experiences, odds of poorer mental health were greater among all other gender identity groups with bullying experiences, and among transmasculine youth in particular (e.g., odds ratio of generalized anxiety = 8.36 (95% confidence interval, 6.59-10.6)). Bullying is associated with poorer mental health in all youth, but transgender youth, and especially transmasculine youth, may be in an even more vulnerable position for its implications. This suggests that there is a need for improving effective measures to decrease bullying in schools and to improve wellbeing of transgender youth.
Collapse
Affiliation(s)
- Laura Sares-Jäske
- Finnish Institute for Health and Welfare, P.O. Box 30, FI-00271, Helsinki, Finland.
| | - Mercedesz Czimbalmos
- Finnish Institute for Health and Welfare, P.O. Box 30, FI-00271, Helsinki, Finland
- Åbo Akademi University, Tuomiokirkontori 3, FI-20500, Turku, Finland
| | - Satu Majlander
- Finnish Institute for Health and Welfare, P.O. Box 30, FI-00271, Helsinki, Finland
| | - Reetta Siukola
- Finnish Institute for Health and Welfare, P.O. Box 30, FI-00271, Helsinki, Finland
| | - Reija Klemetti
- Finnish Institute for Health and Welfare, P.O. Box 30, FI-00271, Helsinki, Finland
| | - Pauliina Luopa
- Finnish Institute for Health and Welfare, P.O. Box 30, FI-00271, Helsinki, Finland
| | - Jukka Lehtonen
- Finnish Institute for Health and Welfare, P.O. Box 30, FI-00271, Helsinki, Finland
- University of Oulu, P.O. Box 8000, FI-90014, Oulu, Finland
| |
Collapse
|
9
|
Liu X, Yang Z, Yang M, Ighaede-Edwards IG, Wu F, Liu Q, Lai X, Lu D. The relationship between school bullying victimization and mental health among high school sexual minority students in China: A cross-sectional study. J Affect Disord 2023; 334:69-76. [PMID: 37080492 DOI: 10.1016/j.jad.2023.04.054] [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: 11/05/2022] [Revised: 04/02/2023] [Accepted: 04/14/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND School bullying has become a matter of global concern for the general public. Sexual minority youth (SMY) may experience minority stress and victimization which are known to adversely affect mental health and happiness. However, a few scholars explored and linked sexual orientation with campus bullying, depression, and anxiety symptoms under the specific cultural background of China. OBJECTIVE This study was to examine the effect of traditional and cyber bullying victimization on depression and anxiety among Chinese sexual minority adolescents. METHODS This is a cross-sectional survey with a total of 3841 subjects among senior high school students in Hunan Province, China. Related information was collected through a series of self-reported questionnaires. The association between variables was examined via a set of logistic regressions. RESULTS Homosexuality (OR: 6.398; 95 % CI: 3.321 to 12.325), bisexuality (OR: 3.146; 95 % CI: 1.499 to 6.603) and uncertainty of sexual orientation (OR: 2.341; 95 % CI: 1.516 to 3.615) were significantly associated with a combination of traditional and cyber bullying victimization. Compared to the heterosexual group, the sexual minority students, especially the bisexual students has a higher risk of depressive mood (OR: 2.349; 95 % CI: 1.664 to 3.316) and anxiety mood (OR: 3.049; 95 % CI: 2.150 to 4.324). Further multivariate binary hierarchical regression showed that the effects of sexual orientation and mental health were statistically significant only among those who are not involved in bullying victimization, OR values are from 1.929 (95 % CI: 1.061 to 3.507) to 3.209 (95 % CI: 2.090 to 4.927). CONCLUSIONS Homosexuals are most likely to be victims of a combination of traditional and cyber bullying victims. Bisexuals are most at risk for emotional problems. Sexual minorities in particular, showed differences in mental health risks between bullied and non-bullied groups. More attention needs to be paid to bullying and mental health among sexual minority students in China.
Collapse
Affiliation(s)
- Xiaoqun Liu
- Department of Maternal and Child Health, Xiangya School of Public Health, Central South University, Changsha, China
| | - Zhengmin Yang
- Department of Maternal and Child Health, Xiangya School of Public Health, Central South University, Changsha, China
| | - Mengsi Yang
- Hunan Provincial Center for Disease Control and Prevention, Changsha, China.
| | | | - Fang Wu
- Department of Medical Records, The Second Affiliated Hospital of Xiamen Medical College, Xiamen, China
| | - Qianwen Liu
- Changsha Center for Disease Control and Prevention, Changsha, China
| | - Xin Lai
- Department of Maternal and Child Health, Xiangya School of Public Health, Central South University, Changsha, China
| | - Dali Lu
- Department of Pediatric Psychology, Shenzhen Longhua Maternity and Child Healthcare Hospital, Shenzhen, China.
| |
Collapse
|
10
|
Srikummoon P, Oonarom A, Manojai N, Maneeton B, Maneeton N, Wiriyacosol P, Chiawkhun P, Kawilapat S, Homkham N, Traisathit P. Experiences of Being Bullied and the Quality of Life of Transgender Women in Chiang Mai Province, Thailand. Transgend Health 2023; 8:175-187. [PMID: 37013090 PMCID: PMC10066783 DOI: 10.1089/trgh.2021.0068] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose The objective of this study is to identify factors associated with depression and the quality of life of Thai transgender women (TGW) from Chiang Mai province, Thailand, who have experienced being bullied. Methods We conducted the study on TGW ≥18 years of age in Chiang Mai province, Thailand, from May to November 2020. Data were collected using self-reporting questionnaires at the MPlus Chiang Mai foundation. Binary logistic regression analysis was used to examine the association between potential factors associated with depression and quality of life. Results Of the 205 TGW individuals who participated in this study with a median age of 24 years, most were students (43.3%), and the most common type of bullying was verbal (30.9%). The prevalence of depression among the TGW participants was 30.1%, although most of the participants had a good overall quality of life (53.4%). The impacts of being physically bullied at primary or secondary school and experiencing cyberbullying at primary school were associated with a higher risk of depression. The impacts of being cyberbullied within the previous 6 months and physically bullied at primary or secondary school were associated with a fair quality of life. Conclusion Our results show that many TGW had experienced bullying in their childhood and within the previous 6 months. Screening for experiences of having been bullied and psychological problems might be advantageous for the wellbeing of TGW, while counseling programs or psychotherapy should be provided for those who have experienced bullying to mitigate depression and improve their quality of life.
Collapse
Affiliation(s)
- Pimwarat Srikummoon
- Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand
- Data Science Research Center, Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand
| | - Awirut Oonarom
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | - Benchalak Maneeton
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Narong Maneeton
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Punjaree Wiriyacosol
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Phisanu Chiawkhun
- Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand
| | - Suttipong Kawilapat
- Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Nontiya Homkham
- Faculty of Public Health, Thammasat University, Pathumthani, Thailand
| | - Patrinee Traisathit
- Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand
- Data Science Research Center, Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand
- Research Center in Bioresources for Agriculture, Industry and Medicine, Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand
| |
Collapse
|
11
|
Parker MN, Lavender JM, Schvey NA, Tanofsky-Kraff M. Practical Considerations for Using the Eating Disorder Examination Interview with Adolescents. Adolesc Health Med Ther 2023; 14:63-85. [PMID: 36860931 PMCID: PMC9969870 DOI: 10.2147/ahmt.s220102] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 02/14/2023] [Indexed: 02/24/2023] Open
Abstract
Approximately 35 years after its initial publication, the Eating Disorder Examination (EDE) remains one of the most widely used semi-structured interviews for assessing eating disorder diagnoses and symptomatology. Although the interview provides certain advantages over other common measurement approaches (ie, questionnaires), there are particular considerations regarding the EDE that warrant attention, including in its use with adolescents. The aims of this paper are therefore to: 1) provide a brief overview of the interview itself, as well as a description of its origin and underlying conceptual framework; 2) describe relevant factors for administering the interview with adolescents; 3) review potential limitations regarding use of the EDE with adolescents; 4) address considerations for using the EDE with pertinent subpopulations of adolescents who may experience distinct eating disorder symptoms and/or risk factors; and 5) discuss the integration of self-report questionnaires with the EDE. Advantages of using the EDE include the ability for interviewers to clarify complex concepts and mitigate inattentive responding, enhanced orientation to the interview timeframe to improve recall, increased diagnostic accuracy compared to questionnaires, and accounting for potentially salient external factors (eg, food/eating rules imposed by a parent/guardian). Limitations include more extensive training requirements, greater assessment burden, variable psychometric performance across subgroups, lack of items evaluating muscularity-oriented symptoms and avoidant/restrictive food intake disorder diagnostic criteria, and lack of explicit consideration for salient risk factors other than weight and shape concerns (eg, food insecurity).
Collapse
Affiliation(s)
- Megan N Parker
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Jason M Lavender
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA,Military Cardiovascular Outcomes Research (MiCOR) Program, Bethesda, MD, USA,The Metis Foundation, San Antonio, TX, USA,Correspondence: Jason M Lavender, Military Cardiovascular Outcomes Research Program, 4301 Jones Bridge Road, Building 17, Suite 2A, Bethesda, MD, 20814, USA, Email
| | - Natasha A Schvey
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Marian Tanofsky-Kraff
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA,Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA,Military Cardiovascular Outcomes Research (MiCOR) Program, Bethesda, MD, USA
| |
Collapse
|
12
|
London-Nadeau K, Chadi N, Taylor AB, Chan A, Pullen Sansfaçon A, Chiniara L, Lefebvre C, Saewyc EM. Social Support and Mental Health Among Transgender and Nonbinary Youth in Quebec. LGBT Health 2023; 10:306-314. [PMID: 36787477 DOI: 10.1089/lgbt.2022.0156] [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] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
Purpose: Transgender and nonbinary (TNB) youth face elevated levels of discrimination, stigma, mental health disorders, and suicidality when compared with their cisgender counterparts. Family and school support may mitigate some of the effects of the stressors facing TNB youth. This study aimed to better understand the impact of each of these sources of support on TNB youths' mental health and wellbeing. Methods: We used data collected between 2018 and 2019 as part of the Canadian Trans Youth Health Survey, a bilingual online survey to measure social support, physical health, and mental health in a sample of 220 TNB youth aged 14-25 living in Québec, Canada. We examined the relationships among different sources of support, and mental health and wellbeing outcomes using logistic regression. Analyses were conducted on the full sample and according to linguistic groups (French and English). Results: Participants reported high levels of mental health symptoms, self-harm, and suicidality, and mental health symptoms were higher in the English-speaking group (p = 0.005). In models controlling for age, family connectedness was associated with good/excellent self-reported mental health (odds ratio [OR] = 2.62, p = 0.001) and lower odds of having considered suicide (OR = 0.49, p = 0.003) or attempted suicide (OR = 0.43, p = 0.002), whereas school connectedness was associated with higher odds of good/very good/excellent general (OR = 2.42, p = 0.013) and good/excellent mental (OR = 2.45, p = 0.045) health. Conclusion: Family and school support present consistent associations with TNB youths' health and may constitute key areas for intervention for those supporting them.
Collapse
Affiliation(s)
- Kira London-Nadeau
- Department of Psychology, Université de Montréal, Montréal, Québec, Canada.,CHU Sainte-Justine Research Center, Montréal, Québec, Canada
| | - Nicholas Chadi
- CHU Sainte-Justine Research Center, Montréal, Québec, Canada.,Division of General Pediatrics, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, Québec, Canada.,Division of Adolescent Medicine, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
| | - Ashley B Taylor
- Stigma and Resilience Among Vulnerable Youth Centre, School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ace Chan
- Stigma and Resilience Among Vulnerable Youth Centre, School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Annie Pullen Sansfaçon
- Canada Research Chair on Transgender Children and their Families, School of Social Work, Université de Montréal, Montréal, Québec, Canada.,School of Social Work, Stellenbosch University, Stellenbosch, South Africa
| | - Lyne Chiniara
- Division of Endocrinology, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
| | - Claire Lefebvre
- Division of General Pediatrics, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
| | - Elizabeth M Saewyc
- Stigma and Resilience Among Vulnerable Youth Centre, School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
13
|
Voss RV, Kuhns LM, Phillips G, Wang X, Wolf SF, Garofalo R, Reisner S, Beach LB. Physical Inactivity and the Role of Bullying Among Gender Minority Youth Participating in the 2017 and 2019 Youth Risk Behavior Survey. J Adolesc Health 2023; 72:197-206. [PMID: 36369113 DOI: 10.1016/j.jadohealth.2022.08.020] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 07/15/2022] [Accepted: 08/17/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE Evidence from small-scale studies suggests that transgender youth are less physically active than nontransgender youth, putting them at risk for worse health outcomes. This study examined the relationship between gender modality and participation in physical activity, physical education (PE), and sports teams in a multistate sample of high school youth and assessed whether bullying impacted this relationship. METHODS Multiple regression was used to analyze data from the state and local Youth Risk Behavior Survey from 2017 to 2019 to examine the relationship between the gender modality and participation in physical activity, PE, and sports teams. The sample was stratified by sex and adjusted for demographics and in-school and online bullying victimization. RESULTS Transgender participants who reported a male or female sex, respectively, reported lower odds of physical activity (adjusted odds ratio [aOR] 0.46, p < .001; aOR 0.46, p < .001, respectively) but similar odds of PE participation. Female transgender students were less likely to participate in sports (aOR 0.55, p = .007); however, this relationship was not seen in adjusted models. Adjusting for demographics, male transgender students were significantly more likely to participate in sports (aOR 2.1, p = .002). Adjusting for bullying experiences did not significantly change these results. DISCUSSION Transgender youth are less likely to participate in physical activity but participate similarly or more than cisgender peers in PE and sports. Factors other than bullying may limit physical activity among transgender youth, and the Youth Risk Behavior Survey may not capture experiences of trans-specific victimization. Increased inclusion and safety may help increase physical activity and amplify its benefits for transgender students.
Collapse
Affiliation(s)
- Raina V Voss
- Division of Adolescent Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Lisa M Kuhns
- Division of Adolescent Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Gregory Phillips
- Department of Medical Social Sciences, Northwestern University, Chicago, Illinois
| | - Xinzi Wang
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Sigrid F Wolf
- Department of Orthopedic Surgery and Sports Medicine, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Robert Garofalo
- Division of Adolescent Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Sari Reisner
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Lauren B Beach
- Department of Medical Social Sciences, Northwestern University, Chicago, Illinois.
| |
Collapse
|
14
|
Alam P, Marston C. 'Bending' against straightening devices: queer lived experiences of sexuality and sexual health in Bangladesh. BMC Public Health 2023; 23:173. [PMID: 36698108 PMCID: PMC9878820 DOI: 10.1186/s12889-023-15085-0] [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] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 01/18/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Despite global data around increased health risks among sexual and gender diverse populations, lived experiences of young lesbian, gay, bisexual, transgender, queer or questioning, and others (LGBTQ+) people are often ignored in mainstream health research. This is particularly evident in countries such as Bangladesh where the rights of sexual minorities are not recognised. This article looks at queer lived experiences of sexuality and sexual health within such a context. We use the phenomenological framework of heteronormative 'straightening devices' - mechanisms working to direct people towards heterosexuality, gender conformity, and procreative marriage - to identify 'invisible' structures upholding normative sexual behaviours and see how young people in Bangladesh navigate these in their everyday lives. METHODS This article is based on qualitative data collected in Dhaka, Bangladesh over nine months in 2019 as part of the first author's doctoral research. Using thematic analysis, we draw on experiences of normative sexual expectations from biographical in-depth interviews with 14 purposively sampled LGBTQ + individuals aged 18 to 24. RESULTS Respondents identified heteronormative expectations around gender norms of traditional behaviour and presentation for men and women as well as parental expectations of compulsory heterosexuality through marriage. These straightening devices existed at multiple levels, including individual, interpersonal, community, and societal. The four main themes around straightening devices include marriage norms for women; harassment of feminine-presenting bodies in public spaces; heteronormative healthcare; and consequences of not embodying heteronormativity. CONCLUSION Our study highlighted young people's everyday experiences of having to 'bend' to - and against - heteronormative straightening devices at home, in public spaces, and within institutions such as healthcare in Bangladesh. The exploration of queer experiences provides new insights into context-specific ways in which sexual and gender diverse people understand themselves. Further research using the framework of straightening devices can help public health professionals to identify more 'barriers' confronted by sexual and gender diverse young people.
Collapse
Affiliation(s)
- Prima Alam
- Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.
| | - Cicely Marston
- grid.8991.90000 0004 0425 469XDepartment of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
15
|
Lin HC, Chang CC, Chang YP, Chen YL, Yen CF. Associations among Perceived Sexual Stigma from Family and Peers, Internalized Homonegativity, Loneliness, Depression, and Anxiety among Gay and Bisexual Men in Taiwan. Int J Environ Res Public Health 2022; 19:ijerph19106225. [PMID: 35627760 PMCID: PMC9141414 DOI: 10.3390/ijerph19106225] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 05/13/2022] [Accepted: 05/19/2022] [Indexed: 11/16/2022]
Abstract
This study aimed to examine the moderating factors of the association between perceived sexual stigma from family and peers and internalized homonegativity, as well as to compare the effects of perceived sexual stigma from family and peers and internalized homonegativity on loneliness, depression, and anxiety in gay and bisexual men. In total, 400 gay and bisexual men participated in this study. The experiences of perceived sexual stigma from family and peers on the Homosexuality subscale of the HIV and Homosexuality Related Stigma Scale, internalized homonegativity on the Measure of Internalized Sexual Stigma for Lesbians and Gay Men, loneliness on the UCLA Loneliness Scale (Version 3), depression on the Center for Epidemiological Studies-Depression Scale, and anxiety on the State subscale of the State-Trait Anxiety Inventory were collected. The results indicated that perceived sexual stigma from family and peers was significantly associated with internalized homonegativity in both gay and bisexual men, and that sexual orientation moderated the association. Moreover, the association between internalized homonegativity and loneliness was significantly greater than that between perceived sexual stigma from family and peers and loneliness, although no significant differences were observed in their associations with depression and anxiety. Intervention programs that promote changes in the attitudes toward gay and bisexual men among the general population are needed to help prevent the development of internalized homonegativity and further loneliness, depression and anxiety.
Collapse
Affiliation(s)
- Huang-Chi Lin
- Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan;
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan
| | - Chih-Cheng Chang
- Department of Psychiatry, Chi Mei Medical Center, Tainan 70246, Taiwan;
- Department of Health Psychology, College of Health Sciences, Chang Jung Christian University, Tainan 71101, Taiwan
| | - Yu-Ping Chang
- School of Nursing, The State University of New York, University at Buffalo, New York, NY 14214-3079, USA;
| | - Yi-Lung Chen
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung 41354, Taiwan
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung 41354, Taiwan
- Correspondence: (Y.-L.C.); (C.-F.Y.); Tel.: +886-4-23323456 (ext. 20106) (Y.-L.C.); +886-7-3121101 (ext. 6822) (C.-F.Y.)
| | - Cheng-Fang Yen
- Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan;
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan
- College of Professional Studies, National Pingtung University of Science and Technology, Pingtung 91201, Taiwan
- Correspondence: (Y.-L.C.); (C.-F.Y.); Tel.: +886-4-23323456 (ext. 20106) (Y.-L.C.); +886-7-3121101 (ext. 6822) (C.-F.Y.)
| |
Collapse
|
16
|
Lin HC, Chang YP, Chen YL, Yen CF. Relationships of Homophobic Bullying Victimization during Childhood with Borderline Personality Disorder Symptoms in Early Adulthood among Gay and Bisexual Men: Mediating Effect of Depressive Symptoms and Moderating Effect of Family Support. Int J Environ Res Public Health 2022; 19:4789. [PMID: 35457655 DOI: 10.3390/ijerph19084789] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/07/2022] [Accepted: 03/14/2022] [Indexed: 02/04/2023]
Abstract
This study investigated (1) the associations of homophobic bullying victimization in childhood with borderline personality disorder (BPD) symptoms in early adulthood among gay and bisexual men; (2) the mediating effect of depressive symptoms on the association between homophobic bullying victimization and BPD symptoms, and (3) the moderating effects of perceived family support on the association between homophobic bullying victimization and BPD symptoms. A total of 500 gay or bisexual men aged between 20 and 25 years were recruited into this study. The experiences of physical, verbal and social relationship bullying victimization during childhood were evaluated using the Mandarin Chinese version of the School Bullying Experience Questionnaire. The experiences of cyberbullying victimization during childhood were evaluated using the Cyberbullying Experiences Questionnaire. BPD symptoms were assessed using the Borderline Symptom List. Depressive symptoms were examined using the Center for Epidemiologic Studies Depression Scale. Perceived family support was evaluated using the Family Adaptation, Partnership, Growth, Affection, and Resolve index. The results of mediation analyses demonstrated that all the types of homophobic bullying victimization in childhood were directly associated with BDP symptoms in young adulthood as well as indirectly associated with BPD symptoms through the mediation of depressive symptoms. The results of moderation analyses demonstrated that the association between homophobic bullying victimization and BPD symptoms decreased when the individuals had more family support. Intervention programs to reduce homophobic bullying victimization and enhance family support for gay and bisexual men and their families are necessary. Interventions to improve depressive and BPD symptoms among gay and bisexual men are also necessary, especially for those who experienced homophobic bullying victimization during childhood.
Collapse
|
17
|
Abstract
Surveillance data indicate youth have many sexual and gender identities that should be included in clinical forms and surveys to document and improve health equity.
Collapse
Affiliation(s)
- Amy L. Gower
- Division of General Pediatrics and Adolescent Health,
Department of Pediatrics
| | - G. Nic Rider
- Institute for Sexual and Gender Health, Department of
Family Medicine and Community Health
| | - Camille Brown
- Division of General Pediatrics and Adolescent Health,
Department of Pediatrics
- School of Nursing, University of Minnesota, Minneapolis,
Minnesota
| | - Marla E. Eisenberg
- Division of General Pediatrics and Adolescent Health,
Department of Pediatrics
| |
Collapse
|
18
|
Society for Adolescent Health and Medicine. Recommendations for Promoting the Health and Well-being of Sexual and Gender-diverse Adolescents Through Supportive Families and Affirming Support Networks. J Adolesc Health 2022; 70:692-6. [PMID: 35181244 DOI: 10.1016/j.jadohealth.2022.01.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 01/11/2022] [Indexed: 11/15/2022]
Abstract
Adolescent and young adult (AYA) health care providers (HCPs) frequently serve sexual and gender-diverse (SGD) youth. Sexual orientation refers to a person's sexual identity in relation to the gender(s) to which they are attracted. Gender-diverse, sometimes addressed as gender-expansive, persons are a subset of the population whose gender identity, expressions, or behaviors differ from those typically associated with the sex they were assigned at birth in the society in which they live. These constructs may develop separately, and terminology should acknowledge and include the broad range of SGD identities that exist. Although many SGD AYAs navigate the adolescent transition successfully and become healthy, happy, successful adults, the pervasive discrimination, stigma, bias, and disparities they face throughout society place many at risk for poor health and developmental outcomes. The resilience and risk profiles of these youth are further compounded by the intersectionality of the person's unique identities, including, but not limited to, race/ethnicity, religion, and language. Support for SGD AYAs is critical at all levels. The Society for Adolescent Health and Medicine (SAHM) encourages HCPs who care for AYAs and researchers to incorporate the impact of these developmental processes (and understand the consequences of concurrent potential discrimination) when working with SGD adolescents. SAHM also encourages HCPs to advocate for improved policy related to sexual and gender diversity within families, schools, the foster care system, and the juvenile justice system. Consistent with other professional organizations, SAHM rejects the mistaken notion that SGD identities are mental disorders and opposes the use of any type of reparative therapy for SGD adolescents.
Collapse
|
19
|
Esteban Mora J, Morales Rodríguez FM, Martínez Ramón JP. Attitudes toward Transsexuality, Empathy, and Bullying in Young Population. Int J Environ Res Public Health 2022; 19:ijerph19073849. [PMID: 35409533 PMCID: PMC8997397 DOI: 10.3390/ijerph19073849] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 03/15/2022] [Accepted: 03/20/2022] [Indexed: 12/10/2022]
Abstract
Affective-sexual and gender diversity is an increasingly distinctive and extended reality and should be acknowledged and respected. From a psychosocial and educational point of view, it is appropriate to review young people’s attitudes and knowledge regarding this, relating them to aspects such as empathy, violence, or bullying, to implement quality education in the early stages of primary education. The main objective of this study was to analyze the relationship between empathy levels, attitudes toward transsexuality, and bullying among Spanish university students. The sample consisted of 247 students. Instruments were administered to evaluate negative attitudes toward transsexual people, gender ideology, transphobia, bullying, and empathy. Inverse relationships were found between transphobia and empathy. Regression analysis demonstrated the predictive ability of empathy on attitudes toward transsexual people. The results of this study are expected to increase awareness in society and encourage appropriate, satisfactory, or tolerable coexistence, in which all individuals can be free to live and express themselves. While the results indicated that the quality of life of transgender people has comparatively improved, there is still a long way to go.
Collapse
Affiliation(s)
- Jesús Esteban Mora
- Department of Educational and Developmental Psychology, Faculty of Psychology, Campus Universitario de Cartuja, University of Granada, 18071 Granada, Spain;
| | - Francisco Manuel Morales Rodríguez
- Department of Educational and Developmental Psychology, Faculty of Psychology, Campus Universitario de Cartuja, University of Granada, 18071 Granada, Spain;
- Correspondence: ; Tel.: +34-68-097-6924
| | - Juan Pedro Martínez Ramón
- Departament of Evolutionary and Educational Psychology, Faculty of Psychology, Mare Nostrum Campus, University of Murcia, 30100 Murcia, Spain;
| |
Collapse
|
20
|
Katz-Wise SL, Godwin EG, Parsa N, Brown CA, Sansfaçon AP, Goldman R, MacNish M, Rosal MC, Austin SB. Using Family and Ecological Systems Approaches to Conceptualize Family- and Community-Based Experiences of Transgender and/or Nonbinary Youth From the Trans Teen and Family Narratives Project. Psychol Sex Orientat Gend Divers 2022; 9:21-36. [PMID: 35755166 PMCID: PMC9231420 DOI: 10.1037/sgd0000442] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The current study used family and ecological systems approaches to understand transgender and/or nonbinary (TNB) youths' experiences of their gender identity within family and community contexts. A sample of 33 TNB youth, ages 13-17 years (M = 15.18, SD = 1.24), were recruited from community-based venues in the New England region of the United States to participate in the Trans Teen and Family Narratives Project, a longitudinal community-based mixed methods study. TNB youth in the sample identified as trans girls (n = 12), trans boys (n = 17), and nonbinary (n = 3 assigned female at birth; n = 1 assigned male at birth). Race/ethnicity of the sample was 73% White and 15% mixed race/ethnicity. All participants completed a one-time, in-person semi-structured qualitative interview at baseline about their family and community-based experiences related to their TNB identity. Interviews were audio-recorded and professionally transcribed. Interview transcripts were coded and analyzed using immersion/crystallization and thematic analysis approaches. Eight themes were developed, which correspond to different levels of the ecological systems model: individual-level (identity processes, emotions/coping), family-level (general family experiences, family support), community-level (general community experiences; community support; lesbian, gay, bisexual, transgender, queer (LGBTQ) community), and societal/institutional-level (external forces). Findings emphasize the importance of using family and ecological systems approaches to understanding the family- and community-based experiences of TNB youth and have implications for improving clinical practice with TNB youth and families.
Collapse
Affiliation(s)
- Sabra L. Katz-Wise
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Department of Pediatrics, Harvard Medical School, Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Eli G. Godwin
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA and Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Neeki Parsa
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA
| | - Courtney A. Brown
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA
| | - Annie Pullen Sansfaçon
- Canada Research Chair on transgender children and their families, School of Social Work, University of Montreal, Montreal, Canada
| | - Roberta Goldman
- Department of Family Medicine, Warren Alpert Medical School of Brown University, Providence, RI
| | - Melissa MacNish
- SAYFTEE: Supporting Alternative Youth and Families through Education and Empowerment, Boston, MA
| | - Milagros C. Rosal
- Division of Preventive and Behavioral Medicine, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - S. Bryn Austin
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Department of Pediatrics, Harvard Medical School, Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA
| |
Collapse
|
21
|
Madireddy S, Madireddy S. Supportive model for the improvement of mental health and prevention of suicide among LGBTQ+ youth. International Journal of Adolescence and Youth 2022. [DOI: 10.1080/02673843.2022.2025872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
|
22
|
Chen JS, Huang YT, Lin CY, Yen CF, Griffiths MD, Pakpour AH. Relationships of Sexual Orientation Microaggression with Anxiety and Depression among Lesbian, Gay, and Bisexual Taiwanese Youth: Self-Identity Disturbance Mediates but Gender Does Not Moderate the Relationships. Int J Environ Res Public Health 2021; 18:12981. [PMID: 34948591 DOI: 10.3390/ijerph182412981] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/07/2021] [Accepted: 12/08/2021] [Indexed: 12/03/2022]
Abstract
The aims of this cross-sectional survey study were to examine the association between sexual orientation microaggression and anxiety and depression among young adult lesbian, gay, and bisexual (LGB) individuals in Taiwan, as well as to examine the mediating effect of self-identity disturbance and the moderating effect of gender. In total, 1000 self-identified LGB individuals participated in the study. The experience of sexual orientation microaggression was assessed using the Sexual Orientation Microaggression Inventory, self-identity disturbance was assessed using the Self-Concept and Identity Measure, anxiety was assessed using the State subscale on the Chinese version of the State-Trait Anxiety Inventory, and depression was assessed using the Center for Epidemiological Studies-Depression Scale. Structural equation modeling (SEM) was used to examine relationships between the variables. The SEM results demonstrated that sexual orientation microaggression was directly associated with increased anxiety and depression, as well as being indirectly associated with increased anxiety and depression via the mediation of self-identity disturbance among young adult LGB individuals. Gender did not moderate the relationships between any of the variables. Both sexual orientation microaggression and self-identity disturbance warrant program interventions for enhancing mental health among LGB individuals.
Collapse
|
23
|
Sava LM, Earnshaw VA, Menino DD, Perrotti J, Reisner SL. LGBTQ Student Health: A Mixed-Methods Study of Unmet Needs in Massachusetts Schools. J Sch Health 2021; 91:894-905. [PMID: 34553384 DOI: 10.1111/josh.13082] [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] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/09/2021] [Accepted: 07/10/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Lesbian, gay, bisexual, transgender, and queer and questioning (LGBTQ) youth experience poor physical and mental health outcomes relative to their non-LGBTQ peers. School health professionals (SHPs), such as school nurses, play a key role in addressing LGBTQ student health needs. However, few studies examine school health needs of LGBTQ students from both the youth and SHP perspective. METHODS From August 2017 to July 2018, 28 LGBTQ youth and 19 SHPs (N = 47) in Massachusetts participated in online focus groups and a brief survey on school health needs and experiences. Qualitative themes were coded using Rapid Qualitative Inquiry principles and NVIVO. RESULTS Both LGBTQ students and SHPs identified an urgent need for inclusive sexual education and mental health services. LGBTQ students raised access to safer bathrooms, information, and guidance on gender transitioning, and access to safe spaces as school-based needs. Missing from SHPs' perspectives, students also discussed sexual violence/harassment of transgender students and racism impacting youth of color. CONCLUSIONS LGBTQ students, especially transgender students and LGBTQ youth of color, have unmet health needs that need to be addressed. Recognizing these needs is the first step towards inclusive health services and support for all students in schools. Next, interventions to increase the capacity of SHPs to address LGBTQ student health are necessary.
Collapse
Affiliation(s)
- Lauren M Sava
- The Fenway Institute at Fenway Health, Boston, MA, 02215
| | | | - David D Menino
- Boston Children's Hospital, 21 Autumn Street, Boston, MA, 02215
| | - Jeff Perrotti
- The Massachusetts Commission on LGBTQ Youth, 250 Washington Street 4th Floor, Boston, MA, 02108
| | - Sari L Reisner
- Director of Transgender Research, Brigham and Women's Hospital, Assistant Professor of Medicine, Harvard Medical School, Assistant Professor of Epidemiology, Harvard T.H. Chan School of Public Health, Director of Transgender Health Research and Affiliated Research Scientist, The Fenway Institute at Fenway Health, 221 Longwood Ave, Boston, MA, 02215
| |
Collapse
|
24
|
Scheer JR, Edwards KM, Helminen EC, Watson RJ. Victimization Typologies Among a Large National Sample of Sexual and Gender Minority Adolescents. LGBT Health 2021; 8:507-518. [PMID: 34619055 DOI: 10.1089/lgbt.2021.0024] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Purpose: The overall objective of this study was to examine the hypothesis that victimization exposure among sexual and gender minority (SGM) youth would result in different latent classes and that victimization exposure class membership would relate to demographic, SGM-specific risk and protective factors, and health variables. Methods: Between April 2017 and December 2017, SGM youth (N = 17,112) aged 13-17 years completed self-report online surveys as part of the LGBTQ National Teen Survey. Data were analyzed between August 2020 and November 2020. Results: Three classes emerged: (1) no victimization exposure, (2) sexual harassment and bullying, and (3) poly-victimization (sexual victimization, sexual harassment, SGM-based bullying, and non-SGM bullying). The results demonstrated that victimization experiences co-occur disproportionately in vulnerable subpopulations of SGM youth, including those who identify as transgender or other gender minority, who are experiencing stigma-related stress and family rejection, and who had disclosed their sexual orientation to family members/parents. SGM youth who reported a diversity of strengths seemed to be protected against victimization. Finally, SGM youth in the sexual harassment and bullying class and the poly-victimization class were more likely to report depressive symptoms, self-perceived stress, and substance use than were SGM youth in the no victimization class, regardless of sex assigned at birth. Conclusion: These findings underscore the urgency with which affirmative prevention and intervention initiatives are needed for SGM youth to reduce risk factors for and correlates of victimization experiences. The data also underscore the importance of addressing SGM-specific risk and protective factors as part of comprehensive violence-related initiatives.
Collapse
Affiliation(s)
- Jillian R Scheer
- Department of Psychology, Syracuse University, Syracuse, New York, USA
| | - Katie M Edwards
- Nebraska Center for Research on Children, Youth, Families and Schools, University of Nebraska-Lincoln, Lincoln, Nebraska, USA
| | - Emily C Helminen
- Department of Psychology, Syracuse University, Syracuse, New York, USA
| | - Ryan J Watson
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, Connecticut, USA.,Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, Connecticut, USA
| |
Collapse
|
25
|
Hirschtritt ME, Folk JB, Marshall BDL, Li Y, Tolou-Shams M. Cannabis Use Among Court-Involved Minority Sexual Orientation and Gender Identity Adolescents. J Am Acad Psychiatry Law 2021; 49:350-360. [PMID: 34001670 PMCID: PMC8429183 DOI: 10.29158/jaapl.200104-20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
We examined the effects of family functioning and beliefs regarding peers' cannabis use among minority (n = 112) and non-minority (n = 275) sexual orientation and gender identity (SOGI), first-time court-involved adolescents. We examined longitudinally the effects of baseline general family functioning and peer cannabis use beliefs on self-reported cannabis use and cannabis-related consequences after 12 months. At baseline, 39.2 percent of adolescents reported using cannabis. Minority SOGI adolescents reported worse family functioning (p = .017) and higher peer cannabis use beliefs (p = .047). Higher peer cannabis use beliefs at baseline predicted recent cannabis use at the 12-month assessment for both minority and non-minority SOGI adolescents. Better family functioning predicted a lower likelihood of recent cannabis use at 12 months for non-minority SOGI adolescents, but not for minority SOGI adolescents. Baseline peer cannabis use beliefs and family functioning predicted cannabis-related consequences for both cohorts at 12 months when accounting for intermediate (i.e., four-month and eight-month) data. Among all first-time court-involved adolescents, those who believed greater cannabis use among their peers reported more subsequent cannabis use themselves. Conversely, higher general family functioning may be less of a protective factor for minority SOGI adolescents. These results suggest the utility of feedback interventions to modify peer norm beliefs among first-time court-involved adolescents.
Collapse
Affiliation(s)
- Matthew E Hirschtritt
- Dr. Hirschtritt is Clinical Professor, Dr. Folk is Assistant Professor, and Dr. Tolou-Shams is Professor, Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA. Dr. Marshall is Associate Professor and Dr. Li is Biostatistician, Department of Epidemiology, Brown University School of Public Health, Providence, RI. Dr. Tolou-Shams is Director, Division of Infant, Child, and Adolescent Psychiatry, Zuckerberg San Francisco General Hospital, San Francisco, CA.
| | - Johanna B Folk
- Dr. Hirschtritt is Clinical Professor, Dr. Folk is Assistant Professor, and Dr. Tolou-Shams is Professor, Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA. Dr. Marshall is Associate Professor and Dr. Li is Biostatistician, Department of Epidemiology, Brown University School of Public Health, Providence, RI. Dr. Tolou-Shams is Director, Division of Infant, Child, and Adolescent Psychiatry, Zuckerberg San Francisco General Hospital, San Francisco, CA
| | - Brandon D L Marshall
- Dr. Hirschtritt is Clinical Professor, Dr. Folk is Assistant Professor, and Dr. Tolou-Shams is Professor, Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA. Dr. Marshall is Associate Professor and Dr. Li is Biostatistician, Department of Epidemiology, Brown University School of Public Health, Providence, RI. Dr. Tolou-Shams is Director, Division of Infant, Child, and Adolescent Psychiatry, Zuckerberg San Francisco General Hospital, San Francisco, CA
| | - Yu Li
- Dr. Hirschtritt is Clinical Professor, Dr. Folk is Assistant Professor, and Dr. Tolou-Shams is Professor, Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA. Dr. Marshall is Associate Professor and Dr. Li is Biostatistician, Department of Epidemiology, Brown University School of Public Health, Providence, RI. Dr. Tolou-Shams is Director, Division of Infant, Child, and Adolescent Psychiatry, Zuckerberg San Francisco General Hospital, San Francisco, CA
| | - Marina Tolou-Shams
- Dr. Hirschtritt is Clinical Professor, Dr. Folk is Assistant Professor, and Dr. Tolou-Shams is Professor, Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA. Dr. Marshall is Associate Professor and Dr. Li is Biostatistician, Department of Epidemiology, Brown University School of Public Health, Providence, RI. Dr. Tolou-Shams is Director, Division of Infant, Child, and Adolescent Psychiatry, Zuckerberg San Francisco General Hospital, San Francisco, CA
| |
Collapse
|
26
|
Hanshaw BD. Reimagining Inclusivity in Health Care for Sexual Minorities to End the HIV Epidemic: A Student Perspective. Am J Public Health 2021; 111:1263-1264. [PMID: 34110918 DOI: 10.2105/ajph.2021.306346] [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] [Indexed: 11/04/2022]
Affiliation(s)
- Brady D Hanshaw
- Brady D. Hanshaw is with the Institute for Global Health and Infectious Diseases, University of North Carolina, Chapel Hill
| |
Collapse
|
27
|
Juárez-Chávez E, Cooney EE, Hidalgo A, Sánchez J, Poteat T. Violence Experiences in Childhood and Adolescence Among Gay Men and Transgender Women Living in Perú: A Qualitative Exploration. J Interpers Violence 2021; 36:4235-4255. [PMID: 30049246 DOI: 10.1177/0886260518787811] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The overall goal of this study was to qualitatively explore the different types of violence experienced by gay men (GM) and transgender women (TW) living in Peru during childhood and adolescence, as well as their potential consequences and sources of protection. Participants were selected using purposive sampling. Recruitment took place in a community-based organization in Lima, Peru. In all, 32 GM and 23 TW participated in a total of four Focus Group Discussions (FGD) and 25 in-depth interviews (IDI). Qualitative data collection was conducted between July and October 2016. Four FGD took place with GM (n = 21) and one with TW (n = 9). In addition, 11 IDI with GM and 14 with TW were conducted. Data were analyzed using descriptive inductive analysis. Three main types of violence were experienced in childhood and adolescence: (a) violence occurring in the home or otherwise perpetrated by family members, (b) school-based violence, and (c) sexual violence. Both GM and TW experience violence within and outside school and home. School systems should make teachers and parents aware of the impact of homophobic and transphobic bullying and violence. Certain modifications in schools, such as having all-gender bathrooms and promoting activities that are not grounded in gender roles, could be very effective at reducing homophobic and transphobic violence. Schools should also address sexual violence more actively, among both male and female students. Parents' attitudes toward homosexuality and gender diversity need to be addressed by future interventions.
Collapse
Affiliation(s)
| | - Erin E Cooney
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Alberto Hidalgo
- Centro de Promoción y Defensa de los Derechos Sexuales y Reproductivos-PROMSEX, Lima, Perú
| | - Jorge Sánchez
- Asociación Civil Impacta Salud y Educación (IMPACTA), Lima, Peru
| | - Tonia Poteat
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
28
|
Turpin RE, Salerno JP, Rosario AD, Boekeloo B. Victimization, Substance Use, Depression, and Sexual Risk in Adolescent Males Who Have Sex with Males: A Syndemic Latent Profile Analysis. Arch Sex Behav 2021; 50:961-971. [PMID: 32274744 PMCID: PMC10712424 DOI: 10.1007/s10508-020-01685-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 03/01/2020] [Accepted: 03/13/2020] [Indexed: 05/10/2023]
Abstract
Adolescent males who have sex with males (AMSM) are at increased risk of HIV/STI acquisition compared to other adolescents, making sexual risk behaviors in this population a priority public health focus. AMSM experience more victimization (including sexual/partner violence), depression, and substance abuse than their heterosexual counterparts; these may form a syndemic associated with risky sexual behavior. We pooled data from the 2015 and 2017 Youth Risk Behavior Survey, restricted to male students who reported a previous male sexual partner (n = 448). Latent profile analysis was used to identify syndemic profiles, with log-binomial and cumulative complementary log-log models used to test associations with substance use at last intercourse, condomless sex at last intercourse, and the number of sexual partners. Nearly all measures of victimization, depression, and substance use had bivariate associations with greater substance use during sex and more sexual partners. We identified three profiles of AMSM: The profile (n = 55) with the greatest risk factors (evident of a syndemic) had substantially higher prevalence of substance use during sex (aPR = 4.74, 95% CI 3.02, 7.43) and more sexual partners (aPR = 2.45, 95% CI 1.39, 4.31) than the profile with the lowest risk factors (n = 326) after adjusting for confounders. This profile was not associated with condomless sex. We identified a syndemic characterized by victimization, depression, and substance use associated with risky sexual behaviors in a nationally representative sample of AMSM. Comprehensive sexual risk reduction interventions incorporating mental health and substance use are critically important in this population.
Collapse
Affiliation(s)
- Rodman E Turpin
- Department of Epidemiology and Biostatistics, School of Public Health, University of Maryland, College Park, 4200 Valley Dr., #2242, College Park, MD, 20742, USA.
| | - John P Salerno
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, College Park, MD, USA
| | - Andre D Rosario
- Department of Psychiatry and Behavioral Sciences, Howard University Hospital, Washington, DC, USA
| | - Bradley Boekeloo
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, College Park, MD, USA
| |
Collapse
|
29
|
Abstract
Lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) adolescents are more likely to report suicidality and worse mental health than their heterosexual peers. We conducted a systematic review to examine the relationship between positive school climate and suicidality and mental health among LGBTQ adolescents. We searched the literature using PubMed, PsycINFO, and CINAHL. Six studies met inclusion criteria, and all had low to moderate risks of bias. Results indicate that LGBTQ students in schools with more positive school climates were at lower risk of suicidality and reported fewer depressive symptoms compared to students in less positive school climates. Being at the forefront of health in schools, school nurses have the opportunity to advocate for changes in school environments that promote positive mental health for all youth, including LGBTQ adolescents.
Collapse
Affiliation(s)
- April J. Ancheta
- Program for the Study of LGBT Health, Columbia University School of Nursing, New York, NY, USA
| | | | - Tonda L. Hughes
- Program for the Study of LGBT Health, Columbia University School of Nursing, New York, NY, USA
| |
Collapse
|
30
|
Elkin B, Beck-Esmay K, Chu K, Donlon T, So M. An LGBTQIA+ Symposium to Improve Care for Sexual and Gender Minority Youth. PRiMER 2021; 5:11. [PMID: 33860166 PMCID: PMC8041217 DOI: 10.22454/primer.2021.802969] [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] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND AND OBJECTIVES Multilevel factors drive health disparities experienced by sexual and gender minority (SGM) populations. We developed a 3-hour symposium focusing on care for SGM youth to address this. The symposium was a free, extracurricular event open to the public, with an emphasis on health professional students and providers from all disciplines and involved interprofessional didactic and interactive components. METHODS Participants completed optional retrospective pre/postsurveys immediately and 10-months postsymposium. Surveys contained Likert-scale questions addressing five indicators of symposium effectiveness related to knowledge, confidence, and comfort in providing care for SGM populations. We used 1-tailed paired t tests to evaluate the effectiveness of the symposium, and analysis of variance tests to compare differences by professional role. RESULTS Of 208 individuals who attended the symposium, 67 completed the initial survey, and 23 completed the 10-months postsymposium survey. Participants reported significantly higher ( P<.001) scores across all five measures of effectiveness from pre- to immediately postsymposium, and remained at significantly higher ( P<.05) scores across all measures from presymposium to 10 months postsymposium, except for comfort recommending care for SGM pediatric patients or clients. CONCLUSION Results suggest that the symposium improved participants' perceived effectiveness in serving SGM pediatric patients, although selection bias is a concern. Dissemination of educational approaches that incorporate interprofessional didactic and active learning components may help improve workforce capacity to improve SGM health.
Collapse
Affiliation(s)
- Baila Elkin
- University of Minnesota Medical School, Minneapolis, MN
| | | | - Kristin Chu
- University of Minnesota Medical School, Minneapolis, MN
| | - Tobias Donlon
- University of Minnesota Medical School, Department of Pediatrics, Minneapolis, MN
| | - Marvin So
- University of Minnesota Medical School, Minneapolis, MN
| |
Collapse
|
31
|
Tankersley AP, Grafsky EL, Dike J, Jones RT. Risk and Resilience Factors for Mental Health among Transgender and Gender Nonconforming (TGNC) Youth: A Systematic Review. Clin Child Fam Psychol Rev 2021; 24:183-206. [PMID: 33594611 DOI: 10.1007/s10567-021-00344-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2021] [Indexed: 11/24/2022]
Abstract
In recent years, there has been a proliferation of research regarding transgender and gender nonconforming (TGNC) people. The stigma and legal discriminations that this population faces have obvious and documented repercussions for mental health. In 2015, the American Psychological Association (APA) published Guidelines for Psychological Practice with TGNC People. The APA noted that due to the nuances of working with TGNC youth and the dearth of related literature, the guidelines focus primarily on TGNC adults. To date, there has not been a systematic review of risk and resilience factors for mental health among TGNC children, adolescents, and young adults under the age of 25. Forty-four peer-reviewed articles met inclusion criteria for this systematic review, and were evaluated for their methodological rigor and their findings. Common risk factors for negative mental health variables included physical and verbal abuse, exposure to discrimination, social isolation, poor peer relations, low self-esteem, weight dissatisfaction, and age. Across studies, older children and adolescents tended to report higher rates of psychological distress. Resilience-promoting factors for mental health were also documented, including parent connectedness, social support, school safety and belonging, and the ability to use one's chosen name. By synthesizing the existing literature using a resilience-focused and minority stress framework, the present review provides clinicians and researchers with a coherent evidence-base to better equip them to promote psychological adaptation and wellbeing among TGNC youth.
Collapse
|
32
|
van der Star A, Pachankis JE, Bränström R. Country-Level Structural Stigma, School-Based and Adulthood Victimization, and Life Satisfaction Among Sexual Minority Adults: A Life Course Approach. J Youth Adolesc 2021; 50:189-201. [PMID: 33196894 PMCID: PMC7815544 DOI: 10.1007/s10964-020-01340-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 10/21/2020] [Indexed: 02/05/2023]
Abstract
Country-level structural stigma, defined as prejudiced population attitudes and discriminatory legislation and policies, has been suggested to compromise the wellbeing of sexual minority adults. This study explores whether and how structural stigma might be associated with sexual minorities' school-based and adulthood experiences of victimization and adulthood life satisfaction. Using a sample of 55,263 sexual minority individuals (22% female; 53% 18-29 years old; 85% lesbian/gay, 15% bisexual) living across 28 European countries and a country-level index of structural stigma, results show that sexual minorities, especially men, reported school bullying in both higher- and lower-stigma countries. Higher rates of school bullying were found among sexual minorities living in higher-stigma countries when open about their identity at school. Past exposure to school bullying was associated with lower adulthood life satisfaction, an association partially explained by an increased risk of adulthood victimization. These findings suggest that sexual minorities living in higher-stigma countries might benefit from not being open about their sexual identity at school, despite previously established mental health costs of identity concealment, because of the reduced risk of school bullying and adverse adulthood experiences. These results provide one of the first indications that structural stigma is associated with sexual minority adults' wellbeing through both contemporaneous and historical experiences of victimization.
Collapse
Affiliation(s)
- Arjan van der Star
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
- Department of Social and Behavioral Sciences, Yale University School of Public Health, New Haven, CT, USA.
| | - John E Pachankis
- Department of Social and Behavioral Sciences, Yale University School of Public Health, New Haven, CT, USA
| | - Richard Bränström
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Social and Behavioral Sciences, Yale University School of Public Health, New Haven, CT, USA
| |
Collapse
|
33
|
Clark KA, Cochran SD, Maiolatesi AJ, Pachankis JE. Prevalence of Bullying Among Youth Classified as LGBTQ Who Died by Suicide as Reported in the National Violent Death Reporting System, 2003-2017. JAMA Pediatr 2020; 174:1211-1213. [PMID: 32453408 PMCID: PMC7251501 DOI: 10.1001/jamapediatrics.2020.0940] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
This cohort study uses data from the National Violent Death Reporting System from 2003-2017 to assess the prevalence of bullying among youth classified as LGBTQ who died by suicide.
Collapse
Affiliation(s)
- Kirsty A. Clark
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut
| | - Susan D. Cochran
- Department of Epidemiology, UCLA (University of California at Los Angeles) Jonathan and Karin Fielding School of Public Health, Los Angeles
| | - Anthony J. Maiolatesi
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut,Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, Connecticut
| | - John E. Pachankis
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut
| |
Collapse
|
34
|
Batista RL, Verduguez EDR, Inacio M, Cunha FS, Marques MD, Gomes NLRA, Faria JAD, Sircili MHP, Mendonça BB, Costa EMF, Domenice S. Impact of schooling in the HIV/AIDS prevalence among Brazilian transgender women. Arch Endocrinol Metab 2020; 64:369-373. [PMID: 32813764 PMCID: PMC10522086 DOI: 10.20945/2359-3997000000260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 10/18/2019] [Accepted: 01/19/2020] [Indexed: 11/23/2022]
Abstract
Objective Discrimination and bullying are common conditions among LGBT people. During schooling, these practices compromising education. The aim of this study is to evaluate educational attainment among Brazilian transgender women (TW) and how their education level affects the risk of HIV infection. Study design a cross-sectional population-based study. Subjects and methods 95 adult TW were selected. Information concerning verbal and physical aggression, school dropout, school years (SY), and educational level were assessed. HIV status was screened using a fourth-generation immunoassay followed by western blot testing. Results The mean of SY was 9.1 ± 3.8 ys. The mean age at school dropout was 16.3 ± 3.4 ys old. Verbal aggression was reported by 83%, physical by 48%, and 18% of the TW dropped out school immediately after being physically assaulted. Participants who suffered physical aggression attended school for almost 4 years less than those participants who did not suffer this abuse (OR = -3.96, p < 0.0001). A similar result was found for verbal aggression (OR = -4.35; p < 0.0001). HIV/AIDS prevalence was 18% (n = 17). The mean of SY among HIV/AIDS positive and negative individuals were 6.8 ± 43 versus 9.7 ± 3, respectively (p = 0.004). Lower education was associated with higher frequency of HIV/AIDS among TW and this relationship was sustained after adjustment for injectable drug use and sex work (OR = 0.79, p = 0.04). Conclusion Among Brazilian TW, lower education level was a risk factor associated with HIV. The reasons for low schooling among TW are multifactorial, but verbal and physical harassment strongly contribute for it.
Collapse
Affiliation(s)
- Rafael Loch Batista
- Hospital de ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular (LIM/42), Hospital de Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Elisa dal Rosario Verduguez
- Hospital de ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular (LIM/42), Hospital de Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Marlene Inacio
- Hospital de ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular (LIM/42), Hospital de Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Flávia Siqueira Cunha
- Hospital de ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular (LIM/42), Hospital de Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Mateus Diniz Marques
- Departamento de Clínica MédicaUniversidade Federal de Santa MariaSanta MariaRSBrasilDepartamento de Clínica Médica, Universidade Federal de Santa Maria (UFSM), Santa Maria, RS, Brasil
| | - Natália Lisboa Rosa Almeida Gomes
- Hospital de ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular (LIM/42), Hospital de Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - José Antônio D Faria
- Hospital de ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular (LIM/42), Hospital de Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Maria Helena Palma Sircili
- Hospital de ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular (LIM/42), Hospital de Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Berenice B. Mendonça
- Hospital de ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular (LIM/42), Hospital de Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Elaine M. Frade Costa
- Hospital de ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular (LIM/42), Hospital de Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Sorahia Domenice
- Hospital de ClínicasFaculdade de MedicinaUniversidade de São PauloSão PauloSPBrasil Unidade de Endocrinologia do Desenvolvimento, Laboratório de Hormônios e Genética Molecular (LIM/42), Hospital de Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| |
Collapse
|
35
|
Reisner SL, Sava LM, Menino DD, Perrotti J, Barnes TN, Humphrey DL, Nikitin RV, Earnshaw VA. Addressing LGBTQ Student Bullying in Massachusetts Schools: Perspectives of LGBTQ Students and School Health Professionals. Prev Sci 2020; 21:408-421. [PMID: 31933159 DOI: 10.1007/s11121-019-01084-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Lesbian, gay, bisexual, transgender, queer/questioning (LGBTQ) youth face disparities in bullying victimization are associated with higher rates of physical injury, psychological distress, and even suicide. Innovative strategies to address bullying victimization are needed to prevent adverse physical and mental health outcomes, including those engaging school health professionals (SHPs; school nurses, psychologists). This mixed-methods study sought to identify factors that facilitate or impede SHPs' reporting and responding to LGBTQ bullying in Massachusetts from the perspectives of LGBTQ students and SHPs. Between August 2017 and July 2018, asynchronous online focus group discussions and a brief survey were conducted separately for 28 LGBTQ students and 19 SHPs in Massachusetts (9-12 participants per group; n = 47 enrolled). Focus groups probed on bullying experiences. Rapid qualitative inquiry was used for thematic coding of facilitators and barriers to address LGBTQ student bullying described by youth and SHPs. Facilitators and barriers largely coalesced around the social ecological model. Youth and SHPs identified factors at multiple levels of the social ecological model: (1) individual (knowledge, skills, attitudes); (2) interpersonal (trust and follow-through, confidentiality and fear of being "outed," close relationships, champion SHPs); and (3) structural (school buy-in, time, reporting and protocols, staff roles, resources, and school culture of inclusivity). LGBTQ students expressed a need for an intersectional lens for SHPs when addressing LGBTQ student bullying. Interventions that help SHPs overcome multilevel barriers and leverage facilitators are needed. Consideration of intersectionality will better equip SHPs to support LGBTQ students and address disparities in LGBTQ student bullying that confer health risks.
Collapse
Affiliation(s)
- Sari L Reisner
- Department of Pediatrics, Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA. .,Division of General Pediatrics, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA. .,Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA. .,The Fenway Institute, Fenway Health, 1340 Boylston St, Boston, MA, 02215, USA.
| | - Lauren M Sava
- Division of General Pediatrics, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA
| | - David D Menino
- Division of General Pediatrics, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA
| | - Jeff Perrotti
- Safe Schools Program for LGBTQ Students, Massachusetts Department of Elementary and Secondary Education, 75 Pleasant St, Malden, MA, 02148, USA
| | - Tia N Barnes
- Human Development and Family Sciences, University of Delaware, Newark, DE, 19716, USA.,Center for Research in Education and Social Policy, University of Delaware, Newark, DE, 19716, USA
| | - D Layne Humphrey
- Human Development and Family Sciences, University of Delaware, Newark, DE, 19716, USA.,Center for Research in Education and Social Policy, University of Delaware, Newark, DE, 19716, USA
| | - Ruslan V Nikitin
- Harvard Catalyst, Clinical and Translational Science Center, Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
| | - Valerie A Earnshaw
- Human Development and Family Sciences, University of Delaware, Newark, DE, 19716, USA.,Center for Research in Education and Social Policy, University of Delaware, Newark, DE, 19716, USA
| |
Collapse
|
36
|
Gato J, Leal D, Moleiro C, Fernandes T, Nunes D, Marinho I, Pizmony-Levy O, Freeman C. "The Worst Part Was Coming Back Home and Feeling Like Crying": Experiences of Lesbian, Gay, Bisexual and Trans Students in Portuguese Schools. Front Psychol 2020; 10:2936. [PMID: 32010018 PMCID: PMC6974618 DOI: 10.3389/fpsyg.2019.02936] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 10/14/2019] [Accepted: 12/11/2019] [Indexed: 11/13/2022] Open
Abstract
Portugal is one of the most egalitarian countries in Europe in terms of lesbian, gay, bisexual, transgender, and intersex (LGBTI) individuals' legal rights. However, regarding education Portugal still lacks specific policies, plans and interventions to protect LGBTI students. To assess the perceptions of self-identified LGBTI youth regarding their school context, a total of 663 participants (aged from 15 to 20 years old) filled in an on-line questionnaire about their school climate. One hundred and forty-six of them answered an open-ended question about their personal experiences. A thematic analysis of these answers was conducted, and four main categories were identified: (i) victimization, (ii) coming out experiences, (iii) support networks, and (iv) demands. Most participants reported experiences of discrimination, and several sources of prejudice were identified. Furthermore, participants also recognized a lack of LGBTI information in school curriculum and made several demands. Besides inclusive laws, we suggest that the safety and the well-being of LGBTI youths in Portuguese schools depend upon others measures, such as teacher and school staff training, curricula inclusive of LGBTI diversity, and local strategies, such as Gay-Straight Alliances.
Collapse
Affiliation(s)
- Jorge Gato
- Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
- Center for Psychology, University of Porto, Porto, Portugal
| | - Daniela Leal
- Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
- Center for Psychology, University of Porto, Porto, Portugal
| | - Carla Moleiro
- ISCTE-University Institute of Lisbon, Lisbon, Portugal
| | - Telmo Fernandes
- Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
| | - Diogo Nunes
- ISCTE-University Institute of Lisbon, Lisbon, Portugal
| | - Inês Marinho
- Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
| | | | - Cody Freeman
- Faculty of Learning Sciences and Education, Thammasat University, Bangkok, Thailand
| |
Collapse
|
37
|
Earnshaw VA, Menino DD, Sava LM, Perrotti J, Barnes TN, Humphrey DL, Reisner SL. LGBTQ bullying: a qualitative investigation of student and school health professional perspectives. J LGBT Youth 2020; 17:280-297. [PMID: 33224407 PMCID: PMC7678806 DOI: 10.1080/19361653.2019.1653808] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 06/19/2019] [Accepted: 07/24/2019] [Indexed: 05/19/2023]
Abstract
Researchers and practitioners have recently called for greater involvement of school health professionals (SHPs; e.g., school psychologists, nurses, guidance counselors) in interventions to identify and address bullying of lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) students. To inform future interventions, this study explored the perspectives of LGBTQ students and SHPs on LGBTQ bullying and SHPs' responses to LGBTQ bullying. Five online, asynchronous focus groups were held in 2018 with 28 LGBTQ students and 19 SHPs recruited from Massachusetts, US. Methods were guided by Rapid Qualitative Inquiry. Results revealed a disconnect in perceptions of LGBTQ bullying among LGBTQ students versus SHPs, with LGBTQ students reporting a range of often significant verbal, social, and physical bullying experiences and SHPs reporting minimal awareness of LGBTQ bullying at their schools. Transgender students reported bullying related to their gender identity, including verbal, physical, and sexual harassment, deadnaming (referred to by their birth name), and misgendering (called an incorrect pronoun). LGBTQ students of color reported bullying based on their race/ethnicity and pronounced social isolation. LGBTQ students reported mixed experiences with reporting bullying to SHPs. Intervention efforts are needed to enhance communication between LGBTQ students and SHPs, and to strengthen SHPs' skills to respond to LGBTQ bullying.
Collapse
Affiliation(s)
- V A Earnshaw
- Department of Human Development and Family Sciences, University of Delaware, Newark, DE, USA
| | - D D Menino
- Division of General Pediatrics, Boston Children's Hospital, Boston, MA, USA
| | - L M Sava
- Division of General Pediatrics, Boston Children's Hospital, Boston, MA, USA
| | - J Perrotti
- Safe Schools Program for LGBTQ Students, Massachusetts Department of Elementary and Secondary Education, Boston, MA, USA
| | - T N Barnes
- Department of Human Development and Family Sciences, University of Delaware, Newark, DE, USA
- Center for Research in Education and Social Policy, University of Delaware, Newark, DE, USA
| | - D L Humphrey
- Center for Research in Education and Social Policy, University of Delaware, Newark, DE, USA
| | - S L Reisner
- Division of General Pediatrics, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| |
Collapse
|
38
|
Tollit MA, Pace CC, Telfer M, Hoq M, Bryson J, Fulkoski N, Cooper C, Pang KC. What are the health outcomes of trans and gender diverse young people in Australia? Study protocol for the Trans20 longitudinal cohort study. BMJ Open 2019; 9:e032151. [PMID: 31690608 PMCID: PMC6858096 DOI: 10.1136/bmjopen-2019-032151] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION Being transgender is frequently accompanied by gender dysphoria, which often coexists with mental health concerns. Increased referrals of transgender and gender diverse (TGD) youth to gender clinics have been observed in many countries. Nevertheless, there are limited empirical data on the presentation and outcomes of these patients, and there is an urgent need for more evidence to ensure optimal medical and psychosocial interventions. Here, we describe Trans20, a longitudinal study of TGD patients attending a multidisciplinary paediatric gender service in Melbourne, Australia. Trans20 aims to understand the demographic and clinical characteristics of these patients, to document the natural history of gender diversity presenting in childhood and to investigate long-term outcomes for those receiving interventions. METHODS AND ANALYSIS Trans20 is a prospective cohort study based on children and adolescents first seen at the Royal Children's Hospital Gender Service (RCHGS) between February 2017 and February 2020. Current estimates indicate the final sample size will be approximately 600. Patients and their parents complete online questionnaires prior to the first appointment with RCHGS and regularly thereafter as part of routine clinical care. On discharge from RCHGS, patients are invited to continue undertaking questionnaires biennially. In this way, a naturally forming cohort study has been created. The primary outcomes include gender dysphoria, physical and mental health, schooling, family functioning and quality of life. Subgroup analyses based on factors such as gender identity, birth-assigned sex and treatment received will be performed using bivariate and multivariate modelling as appropriate, and relevant statistical methods will be applied for the repeated measures over time. ETHICS AND DISSEMINATION The Royal Children's Hospital Human Research Ethics Committee approved this study (#36323). Findings from Trans20 will have translational impact by informing future treatment guidelines and gender affirming healthcare practices and will be disseminated through conferences and peer reviewed journals.
Collapse
Affiliation(s)
- Michelle Anne Tollit
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Adolescent Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
- Melbourne Graduate School of Education, The University of Melbourne, Parkville, Victoria, Australia
| | - Carmen C Pace
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Adolescent Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Michelle Telfer
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Adolescent Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Monsurul Hoq
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Janet Bryson
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Nicholas Fulkoski
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Charlie Cooper
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Ken C Pang
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Adolescent Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
- The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
| |
Collapse
|
39
|
Peng K, Zhu X, Gillespie A, Wang Y, Gao Y, Xin Y, Qi J, Ou J, Zhong S, Zhao L, Liu J, Wang C, Chen R. Self-reported Rates of Abuse, Neglect, and Bullying Experienced by Transgender and Gender-Nonbinary Adolescents in China. JAMA Netw Open 2019; 2:e1911058. [PMID: 31490542 PMCID: PMC6735403 DOI: 10.1001/jamanetworkopen.2019.11058] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
IMPORTANCE This is the first comprehensive national study reporting the rates of abuse, neglect, and bullying from family and classmates or teachers among Chinese transgender and gender-nonbinary adolescents and identifying risk factors associated with poor mental health in this population. OBJECTIVE To assess the rates of abuse, neglect, and bullying and their association with poor mental health among Chinese transgender and gender nonbinary adolescents. DESIGN, SETTING, AND PARTICIPANTS This national survey study used an online self-selecting survey conducted between January 1, 2017, and September 29, 2017, in China. Eligibility criteria included reporting being aged 12 to 18 years and being transgender or gender nonbinary. Data analysis was performed from March 25 to 28, 2019. MAIN OUTCOMES AND MEASURES The main outcome was self-reported poor mental health, including depressive symptoms, anxiety symptoms, and suicidal ideation. Depressive symptoms were measured using the Center for Epidemiological Studies Depression 9-item scale. Anxiety symptoms were measured using the 7-item General Anxiety Disorder scale. Suicidal ideation was measured using standardized questions adapted from previous Chinese studies. Abuse, neglect, and bullying were measured using specifically designed questions. RESULTS Of 564 responses collected, 385 respondents (mean [SD] age, 16.7 [1.2] years) met inclusion criteria, including 109 (28.3%) transgender adolescent boys, 167 (43.4%) transgender adolescent girls, and 109 (28.3%) gender-nonbinary adolescents. Among 319 respondents who reported that their parents were aware of their gender identity, 296 (92.8%) reported having experienced parental abuse or neglect. Among the full cohort, 295 respondents (76.6%) reported having experienced abuse or bullying owing to being transgender or gender nonbinary in school from classmates or teachers. There were 173 respondents (44.9%) with Center for Epidemiological Studies Depression 9-item scale scores indicating they were at risk of major depressive disorder, and 148 respondents (38.4%) had 7-item General Anxiety Disorder scale scores indicating they were at risk of an anxiety disorder. In univariate analysis, reporting experiences of bullying from a classmate or teacher was significantly associated with suicidal ideation (odds ratio, 1.68 [95% CI, 1.04-2.70]; P = .03), but the association was no longer statistically significant after controlling for level of educational attainment, aversion to assigned sex, and depressed mood at the onset of puberty (odds ratio, 1.63 [95% CI, 0.97-2.73]; P = .06). CONCLUSIONS AND RELEVANCE In this survey study, transgender and gender-nonbinary adolescents in China reported high rates of abuse, neglect, and bullying at home and in school and high rates of symptoms associated with poor mental health. This study highlights the importance of reducing home- and school-based abuse, neglect, and bullying of transgender and gender-nonbinary adolescents in China to improve mental health outcomes; however, broader change in the social environment may be required to address the prejudice and stigma aimed at gender minorities.
Collapse
Affiliation(s)
- Ke Peng
- National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders and Advanced Innovation Center for Human Brain Protection, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Xuequan Zhu
- National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders and Advanced Innovation Center for Human Brain Protection, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Amy Gillespie
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Yuanyuan Wang
- Division of Psychology, Faculty of Health and Life Sciences, De Montfort University, Leicester, United Kingdom
| | - Yue Gao
- National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders and Advanced Innovation Center for Human Brain Protection, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Ying Xin
- Beijing LGBT Center, Beijing, China
| | - Ji Qi
- Beijing LGBT Center, Beijing, China
| | - JianJun Ou
- Department of Psychiatry and Mental Health Institute, Second Xiangya Hospital, Central South University, Chinese National Clinical Research Centre on Mental Disorders, Changsha, China
| | - Shaoling Zhong
- Department of Psychiatry and Mental Health Institute, Second Xiangya Hospital, Central South University, Chinese National Clinical Research Centre on Mental Disorders, Changsha, China
| | - Lixian Zhao
- First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Jianbo Liu
- Department of Child Psychiatry, Shenzhen Kangning Hospital, Shenzhen Mental Health Center, Shenzhen, China
| | - Chaoyue Wang
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Runsen Chen
- National Clinical Research Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders and Advanced Innovation Center for Human Brain Protection, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| |
Collapse
|
40
|
Earnshaw VA, Mateo CM, Reisner SL. LGBT Policy Discourse and Prevention of Homophobic Bullying. Pediatrics 2019; 143:peds.2019-0903. [PMID: 31085736 PMCID: PMC6564059 DOI: 10.1542/peds.2019-0903] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/19/2019] [Indexed: 11/24/2022] Open
Affiliation(s)
- Valerie A. Earnshaw
- Department of Human Development and Family Sciences, University of Delaware, Newark, Delaware
| | - Camila M. Mateo
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts;,Division of General Pediatrics, Boston Children’s Hospital, Boston, Massachusetts
| | - Sari L. Reisner
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts;,Division of General Pediatrics, Boston Children’s Hospital, Boston, Massachusetts;,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts; and,The Fenway Institute, Fenway Health, Boston, Massachusetts
| |
Collapse
|
41
|
Hu HF, Chang YP, Lin C, Yen CF. Quality of life of gay and bisexual men during emerging adulthood in Taiwan: Roles of traditional and cyber harassment victimization. PLoS One 2019; 14:e0213015. [PMID: 30818330 PMCID: PMC6394984 DOI: 10.1371/journal.pone.0213015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 06/22/2018] [Accepted: 02/13/2019] [Indexed: 11/18/2022] Open
Abstract
This study examined factors related to the quality of life (QOL) of gay and bisexual men during emerging adulthood in Taiwan. The factors included traditional harassment (e.g., verbal ridicule, relational exclusion, physical aggression, and theft of belongings), cyber harassment, sex- and gender-related factors (e.g., sexual orientation, age at initial identification of sexual orientation, self-reported level of gender nonconformity, and perceived social acceptance toward homosexuality and bisexuality), and demographic characteristics. In total, 305 Taiwanese gay and bisexual men, aged 20-25 years, were recruited. Their QOL, traditional harassment, and cyber harassment data were collected using the World Health Organization Questionnaire on Quality of Life: Short Form, School Bullying Experience Questionnaire, and Cyberbullying Experiences Questionnaire, respectively. In total, 60.3%, 34.4%, 28.2%, and 29.5% of the participants reported experiencing traditional harassment, cyber harassment, traditional harassment across multiple contexts, and harassment in multiple forms, respectively. Both traditional and cyber harassment were significantly associated with lower QOL. Individuals who experienced traditional harassment across multiple contexts and harassment in multiple forms had lower QOL in nearly all domains than did individuals who had experienced traditional harassment in a single context and harassment of a single form. However, the QOL did not significantly differ between individuals who had experienced traditional harassment in a single context and nonvictims nor between individuals who had experienced harassment of a single form and nonvictims. Lower education level, older age at initial identification of sexual orientation, higher perception of gender nonconformity, and lower perceived social acceptance toward homosexuality and bisexuality were significantly associated with lower QOL. Clinical and public health professionals should consider these factors when developing programs to enhance the QOL of gay and bisexual men.
Collapse
Affiliation(s)
- Huei-Fan Hu
- Department of Psychiatry, Tainan Municipal Hospital (Managed by Show Chwan Medical Care Corporation), Tainan, Taiwan
| | - Yu-Ping Chang
- School of Nursing, The State University of New York, University at Buffalo, New York, United States of America
| | - Chienho Lin
- Department of Psychiatry, Chimei Medical Center, Tainan, Taiwan
- * E-mail: (CFY); (CL)
| | - Cheng-Fang Yen
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Graduate Institute of Medicine, and Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- * E-mail: (CFY); (CL)
| |
Collapse
|
42
|
Walls NE, Atteberry-Ash B, Kattari SK, Peitzmeier S, Kattari L, Langenderfer-Magruder L. Gender Identity, Sexual Orientation, Mental Health, and Bullying as Predictors of Partner Violence in a Representative Sample of Youth. J Adolesc Health 2019; 64:86-92. [PMID: 30392863 DOI: 10.1016/j.jadohealth.2018.08.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [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: 05/15/2018] [Revised: 07/24/2018] [Accepted: 08/06/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE Partner violence (PV) is prevalent among US adolescents, though little is known about its prevalence and correlates across gender identities and sexual orientations. Existing research has frequently placed lesbian, gay, bisexual (LGB), questioning, and transgender adolescents in the same category, obscuring potential differences in risk of PV. METHODS This study (N = 9,352) uses the 2015 Healthy Kids Colorado Study, a statewide representative survey, to explore how sexual orientation and gender identity are associated with PV victimization among high-school youth, and whether there is a relationship between mental health and bullying victimization and PV. RESULTS Out of all youth who dated in the past year, 9.4% reported experiencing past-year PV. Compared to their cisgender heterosexual peers, cisgender LGB youth (AOR = 1.48 [1.17, 1.86]) and cisgender questioning youth (AOR = 1.68 [1.13, 2.48]) had elevated risk of experiencing PV. Transgender youth, particularly those who are both transgender and LGB (AOR = 3.25 [2.02, 5.22]) or transgender and questioning their sexual orientation (AOR = 8.57 [4.28, 17.16]), had the highest risk of PV. Depressive symptoms (AOR = 1.99 [1.67, 2.37]), suicidality (AOR = 1.83 [1.62, 2.06]), bullying victimization (AOR = 1.58 [1.31, 1.91]), and online bullying victimization (AOR = 1.98 [1.62, 2.06]) were associated with PV. CONCLUSIONS LGB, questioning and transgender high school students are at elevated risk of PV, with the highest risk among those who are both LGB and transgender. Adolescents who report PV are also more likely to be struggling with bullying, depression, and suicidality. PV prevention and response interventions should use intersectional approaches responsive to the unique needs of LGBT youth.
Collapse
Affiliation(s)
- N Eugene Walls
- Graduate School of Social Work, University of Denver, Denver, Colorado.
| | | | - Shanna K Kattari
- School of Social Work, University of Michigan, Ann Arbor, Michigan
| | | | - Leo Kattari
- School of Social Work, University of Michigan, Ann Arbor, Michigan
| | | |
Collapse
|
43
|
Lu WH, Chang YP, Lin CH, Yen CF. Negative Facebook experiences among Taiwanese gay and bisexual men in emerging adulthood: associations with traditional harassment victimization and quality of life. Neuropsychiatr Dis Treat 2019; 15:1163-1170. [PMID: 31190824 PMCID: PMC6511608 DOI: 10.2147/ndt.s190878] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 03/26/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose: To examine the prevalence of negative Facebook (FB) experiences among gay and bisexual men in emerging adulthood in Taiwan and their association with traditional harassment victimization and quality of life (QOL). Materials and methods: In total, 302 gay or bisexual men aged 20-25 years old with experience of FB use in the preceding year were recruited. We measured the types, severities, and prevalence of negative FB experiences by self-report questionnaires. Traditional harassment victimization experiences were assessed using the adapted form of Chinese-version School Bullying Experience Questionnaire (C-SBEQ). QOL was evaluated by The World Health Organization (WHO) Questionnaire on Quality of Life: Short Form (WHOQOL-BREF). Regression analysis was used to assess respective associations. Results: Among the study participants, 26.5% reported having negative FB experiences in the preceding year. Negative FB experiences were significantly associated with victimization of verbal ridicule and relational exclusion, but not physical aggression or theft of belongings. Negative FB experiences were also significantly associated with unsatisfactory QOL in all domains except social relationships, even the effects of traditional bullying victimization were controlled. Conclusion: Negative FB experiences are closely associated with both real life victimization and QOL in gay and bisexual men. Subjective experiences on social networking sites require consideration in conception of measures to reduce bullying victimization as well as improve QOL in this population.
Collapse
Affiliation(s)
- Wei-Hsin Lu
- Department of Psychiatry, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan
| | - Yu-Ping Chang
- School of Nursing, The State University of New York, University at Buffalo, New York, USA
| | - Chien-Ho Lin
- Department of Psychiatry, Chimei Medical Center, Tainan, Taiwan
| | - Cheng-Fang Yen
- Graduate Institute of Medicine, Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| |
Collapse
|
44
|
Burk J, Park M, Saewyc EM. A Media-Based School Intervention to Reduce Sexual Orientation Prejudice and Its Relationship to Discrimination, Bullying, and the Mental Health of Lesbian, Gay, and Bisexual Adolescents in Western Canada: A Population-Based Evaluation. Int J Environ Res Public Health 2018; 15:ijerph15112447. [PMID: 30400236 PMCID: PMC6265963 DOI: 10.3390/ijerph15112447] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 10/30/2018] [Accepted: 10/30/2018] [Indexed: 01/21/2023]
Abstract
School interventions to address sexual orientation discrimination can be important tools for fostering inclusive school climate, and improving student wellbeing. In this study, we empirically evaluated a film-based intervention, Out in Schools, designed to reduce sexual orientation prejudice and foster inclusive school attitudes. Our evaluation mapped data about Out in Schools presentations onto student data from the random cluster-stratified, province-wide 2013 British Columbia Adolescent Health Survey (BCAHS) as well as potential confounding variables of Gay-Straight Alliance clubs (GSAs) and inclusive school policies. Outcome measures included past year sexual orientation discrimination, bullying, suicidal ideation, and school connectedness among lesbian, gay, and bisexual (LGB) and heterosexual (HET) students in grades 8 through 12 (ages 13 to 18; unweighted N = 21,075, weighted/scaled N = 184,821). Analyses used complex samples logistic regression, adjusted for sample design, conducted separately by gender and orientation. We found Out in Schools presentations were associated with reduced odds of LGB students experiencing discrimination, and both LGB and HET girl students being bullied or considering suicide, and increased levels of school connectedness, even after controlling for GSAs and policies. Out in Schools appears to have an additive contribution to reducing orientation prejudice and improving LGB and heterosexual student wellbeing within schools.
Collapse
Affiliation(s)
- Jillian Burk
- Stigma and Resilience Among Vulnerable Youth Centre, School of Nursing, University of British Columbia, Vancouver, BC V6T 2B5, Canada.
| | - Minjeong Park
- Stigma and Resilience Among Vulnerable Youth Centre, School of Nursing, University of British Columbia, Vancouver, BC V6T 2B5, Canada.
| | - Elizabeth M Saewyc
- Stigma and Resilience Among Vulnerable Youth Centre, School of Nursing, University of British Columbia, Vancouver, BC V6T 2B5, Canada.
| |
Collapse
|
45
|
Abstract
OBJECTIVE Due to the limited effectiveness of extant prevention and intervention strategies, the current study is an initial evaluation of a cognitive behavioral group intervention, originally designed to treat symptoms of depression and anxiety, for youth who experienced peer victimization. METHODS Twelve third- through fifth-grade youth participated in the intervention, and their data were compared with 12 youth who were a part of a naturalistic control group. Additionally, school-wide data are reported to provide overall school trends. RESULTS Whereas the intervention group participants exhibited decreases in relational victimization, depressive symptoms, and passive coping, the control group participants exhibited nonsignificant increases in relational victimization, depressive symptoms, and passive coping. School-wide data also indicated overall increases in relational victimization and depressive symptoms, but no changes in passive coping. CONCLUSION Findings suggest that cognitive behavioral group interventions may provide a promising avenue for addressing the mental health needs of victimized elementary school-age youth.
Collapse
Affiliation(s)
- Paula J Fite
- Clinical Child Psychology Program, University of Kansas, Lawrence, Kansas
| | - John L Cooley
- Clinical Child Psychology Program, University of Kansas, Lawrence, Kansas
| | - Jonathan Poquiz
- Clinical Child Psychology Program, University of Kansas, Lawrence, Kansas
| | - Anne Williford
- School of Social Work, Colorado State University, Fort Collins, Colorado
| |
Collapse
|
46
|
|
47
|
Abstract
OBJECTIVES To describe the extant literature on social determinants of health as they relate to the cancer disparities and to highlight the research findings relating to lesbian, gay, bisexual, and transgender (LGBT) populations. DATA SOURCES Published scientific literature and clinical literature, and published reports from the World Health Organization and US Department of Health and Human Services. CONCLUSION The larger literature on health inequities is moving beyond individual-level predictors of risk to evaluate the influence of social determinants of health on the persistent health inequalities in a population. As it has for other groups, additional research into social determinants of health for LGBT persons of color may play an important role in identifying and reducing cancer inequities for this group. IMPLICATIONS FOR NURSING PRACTICE Increased awareness of the factors that contribute to health inequities for the LGBT population may provide insight into improving patient-provider relationships with LGBT patients. A large body of experiential and clinical knowledge positions nurses to conduct meaningful research to expand the current understanding of the social determinants of LGBT cancer health inequities.
Collapse
|
48
|
Earnshaw VA, Reisner SL, Juvonen J, Hatzenbuehler ML, Perrotti J, Schuster MA. LGBTQ Bullying: Translating Research to Action in Pediatrics. Pediatrics 2017; 140:peds.2017-0432. [PMID: 28947607 PMCID: PMC5613818 DOI: 10.1542/peds.2017-0432] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/17/2017] [Indexed: 11/24/2022] Open
Abstract
Lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth experience significant bullying that undermines their mental and physical health. National health organizations have called for the development of innovative strategies to address LGBTQ bullying. Pediatricians and other clinicians, medical and public health students, interdisciplinary researchers, government officials, school leaders, community members, parents, and youth from around the country came together at a national symposium entitled "LGBTQ Bullying: Translating Research to Action to Improve the Health of All Youth" in May 2016 to generate strategies to prevent LGBTQ bullying and meet the needs of LGBTQ youth experiencing bullying. This article describes key scientific findings on bullying, LGBTQ stigma, and LGBTQ bullying interventions that were shared at the symposium and provides recommendations for pediatricians to address LGBTQ bullying via clinical care, research, interventions, and policy. Symposium participants recommended that pediatricians engage in efforts to foster inclusive and affirming health care environments wherein LGBTQ youth feel comfortable discussing their identities and experiences, identify youth experiencing LGBTQ bullying, and prevent the negative health consequences of bullying among youth. Moreover, pediatricians can attend to how multiple identities (eg, sexual orientation, gender identity, race and/or ethnicity, disability, and others) shape youth experiences of bullying and expand intervention efforts to address LGBTQ bullying in health care settings. Pediatricians can further advocate for evidence-based, antibullying policies prohibiting bullying on the basis of sexual orientation and gender identity. Collaboration between pediatricians and diverse stakeholders can contribute to the development and implementation of lasting change in all forms of bullying, including LGBTQ bullying.
Collapse
Affiliation(s)
- Valerie A. Earnshaw
- Division of General Pediatrics, Boston Children’s Hospital, Boston, Massachusetts;,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts;,Department of Human Development and Family Sciences, University of Delaware, Newark, Delaware
| | - Sari L. Reisner
- Division of General Pediatrics, Boston Children’s Hospital, Boston, Massachusetts;,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts;,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts;,The Fenway Institute, Fenway Health, Boston, Massachusetts
| | - Jaana Juvonen
- Department of Psychology, University of California, Los Angeles, Los Angeles, California
| | - Mark L. Hatzenbuehler
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York; and
| | - Jeff Perrotti
- Safe Schools Program for LGBTQ Students, Massachusetts Department of Elementary and Secondary Education, Malden, Massachusetts
| | - Mark A. Schuster
- Division of General Pediatrics, Boston Children’s Hospital, Boston, Massachusetts;,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|