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López R, Esposito-Smythers C, Defayette AB, Harris KM, Seibel L, Whitmyre ED. Relations between discrimination, rejection sensitivity, negative affect, and decrements in problem-solving ability following social rejection: An experimental investigation. Suicide Life Threat Behav 2024; 54:233-249. [PMID: 38180127 DOI: 10.1111/sltb.13036] [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: 05/29/2023] [Revised: 11/16/2023] [Accepted: 12/18/2023] [Indexed: 01/06/2024]
Abstract
INTRODUCTION While negative affect and problem-solving deficits have been consistently linked to suicidal thoughts and behaviors, the latter are often conceptualized and studied as time- and/or context-invariant. Though requiring additional empirical support, theory suggests that discrimination may strengthen the relation between rejection sensitivity and increases in negative affect as well as declines in problem-solving abilities following rejection. The aim of the current study was to test this claim using a social rejection paradigm (i.e., Cyberball) with young adults experiencing past-month suicidal ideation. METHODS The sample consisted of 50 participants. Lifetime discrimination and rejection sensitivity were assessed prior to Cyberball. Negative affect and problem-solving abilities were assessed pre- and post-Cyberball. SPSS and the PROCESS macro were used to test relations among variables of interest. RESULTS Rejection sensitivity predicted greater problem-solving decrements, but not negative affect, following rejection among individuals who had experienced higher (vs. lower) levels of lifetime discrimination. CONCLUSION Addressing rejection sensitivity and sources of discrimination within the context of treatment may reduce the impact of social rejection on problem-solving abilities among young adults at risk for suicide.
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Affiliation(s)
| | | | | | | | | | - Emma D Whitmyre
- Children's National Hospital, Washington, District of Columbia, USA
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Usta Sağlam NG, Zengin K, Osmanlı Shirolu S, Sulu C, Kırpınar MM, Turan Ş. Disordered eating behaviors in gender-affirmative treatment seeking transgender people. Eat Disord 2024:1-16. [PMID: 38557398 DOI: 10.1080/10640266.2024.2336277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
This study aimed to explore disordered eating behaviors in gender-affirming treatment (GAT)-seeking transgender (TG) adults and cisgender people, in addition to analyzing the association between gender dysphoria intensity, body mass index, and disordered eating behaviors. Data were collected from 132 GAT-seeking TG people with gender dysphoria who had never received GAT (91 TG men, 41 TG women), and 153 cisgender (99 cisgender men, 54 cisgender women) participants from Turkey. The Utrecht Gender Dysphoria Scale was used to evaluate the intensity of gender dysphoria. Eating Disorder Examination Questionnaire and Questionnaire on Eating and Weight Patterns-5 were utilized to assess disordered eating. There was no difference between TG women and TG men in terms of ED psychopathology. The most prominent characteristic in all four groups was shape concern, which was significantly higher in TG men and TG women when compared to cisgender men and cisgender women. Binge eating was notably more frequent in TG men and TG women compared to cisgender men, with 11% of the TG men and 7.3% of the TG women meeting the criteria for possible binge eating disorder. Screening for disordered eating behaviors, particularly binge eating, may be recommended in routine care for TG people.
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Affiliation(s)
- Nazife Gamze Usta Sağlam
- Department of Psychiatry, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkiye
| | - Kerem Zengin
- Department of Psychiatry, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkiye
| | - Sadiga Osmanlı Shirolu
- Department of Psychiatry, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkiye
| | - Cem Sulu
- Division of Endocrinology, Metabolism, and Diabetes, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkiye
| | - Mehmet Murat Kırpınar
- Department of Psychiatry, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkiye
| | - Şenol Turan
- Department of Psychiatry, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkiye
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Bird K, Arcelus J, Matsagoura L, O'Shea B, Townsend E. Risk and protective factors for self-harm thoughts and behaviours in transgender and gender diverse people: A systematic review. Heliyon 2024; 10:e26074. [PMID: 38468947 PMCID: PMC10925986 DOI: 10.1016/j.heliyon.2024.e26074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 01/17/2024] [Accepted: 02/07/2024] [Indexed: 03/13/2024] Open
Abstract
Background Self-harm (any self-injury or -poisoning regardless of intent) is highly prevalent in transgender and gender diverse (TGD) populations. It is strongly associated with various adverse health and wellbeing outcomes, including suicide. Despite increased risk, TGD individuals' unique self-harm pathways are not well understood. Following PRISMA guidelines we conducted the first systematic review of risk and protective factors for self-harm in TGD people to identify targets for prevention and intervention. Methods We searched five electronic databases (PubMed, PsychInfo, Scopus, MEDLINE, and Web of Science) published from database inception to November 2023 for primary and secondary studies of risk and/or protective factors for self-harm thoughts and behaviours in TGD people. Data was extracted and study quality assessed using Newcastle-Ottawa Scales. Findings Overall, 78 studies published between 2007 and 2023 from 16 countries (N = 322,144) were eligible for inclusion. Narrative analysis identified six key risk factors for self-harm in TGD people (aged 7-98years) were identified. These are younger age, being assigned female at birth, illicit drug and alcohol use, sexual and physical assault, gender minority stressors (especially discrimination and victimisation), and depression or depressive symptomology. Three important protective factors were identified: social support, connectedness, and school safety. Other possible unique TGD protective factors against self-harm included: chosen name use, gender-identity concordant documentation, and protective state policies. Some evidence of publication bias regarding sample size, non-responders, and confounding variables was identified. Interpretation This systematic review indicates TGD people may experience a unique self-harm pathway. Importantly, the risk and protective factors we identified provide meaningful targets for intervention. TGD youth and those assigned female at birth are at increased risk. Encouraging TGD people to utilise and foster existing support networks, family/parent and peer support groups, and creating safe, supportive school environments may be critical for self-harm and suicide prevention strategies. Efforts to reduce drug and alcohol use and experiences of gender-based victimisation and discrimination are recommended to reduce self-harm in this high-risk group. Addressing depressive symptoms may reduce gender dysphoria and self-harm. The new evidence presented in this systematic review also indicates TGD people may experience unique pathways to self-harm related to the lack of social acceptance of their gender identity. However, robust longitudinal research which examines gender-specific factors is now necessary to establish this pathway.
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Affiliation(s)
- K. Bird
- School of Psychology, University of Nottingham, Nottingham, UK
| | - J. Arcelus
- Institute of Mental Health, University of Nottingham, Nottingham, UK
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - L. Matsagoura
- School of Psychology, University of Nottingham, Nottingham, UK
| | - B.A. O'Shea
- School of Psychology, University of Nottingham, Nottingham, UK
- Department of Psychology, Harvard University, Cambridge, MA, USA
- The Centre for the Experimental-Philosophical Study of Discrimination, Aarhus University, Denmark
| | - E. Townsend
- School of Psychology, University of Nottingham, Nottingham, UK
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Junewicz A, Wachtel JM, Okparaeke E, Guo F, Farahmand P, Lois R, Li A, Stein CR, Baroni A. The persistent impact of the COVID-19 pandemic on pediatric emergency department visits for suicidal thoughts and behaviors. Suicide Life Threat Behav 2024; 54:38-48. [PMID: 37933542 DOI: 10.1111/sltb.13016] [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: 06/10/2023] [Revised: 10/04/2023] [Accepted: 10/19/2023] [Indexed: 11/08/2023]
Abstract
INTRODUCTION We examined data from a large, high acuity, pediatric psychiatric emergency department (ED) to assess both the immediate and longer-term impact of the pandemic on ED visits for suicidal thoughts and behaviors (STBs) among youth. METHODS Youth ages 5-17 years presenting at a pediatric psychiatric ED in New York, NY from March 2019-November 2021 were included in this study. Visits were categorized as pre-pandemic, pandemic year 1, or pandemic year 2. We examined changes in demographic and clinical characteristics among patients presenting across the three time periods, as well as multivariable associations between these characteristics and STBs. RESULTS Over 32 months, 2728 patients presented at 4161 visits. The prevalence of a discharge diagnosis of STBs increased from 21.2% pre-pandemic to 26.3% (p < 0.001) during pandemic year 1, and further increased to 30.1% (p = 0.049) during pandemic year 2. Youth were 21% more likely to receive a discharge diagnosis of STBs in pandemic year 1 (RR 1.21, 95% CI 1.07, 1.36) and 35% more likely in pandemic year 2 (RR 1.35, 95% CI 1.19, 1.52) compared to pre-pandemic baseline. CONCLUSIONS In a large, high-acuity ED, STBs continued to increase 20 months after the initial COVID-19 lockdown. These findings highlight the persistent detrimental impact of the pandemic on youth mental health.
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Affiliation(s)
- Alexandra Junewicz
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York City, New York, USA
- NYC Health+Hospitals Bellevue, New York City, New York, USA
| | - Jonathan M Wachtel
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York City, New York, USA
| | - Eugene Okparaeke
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York City, New York, USA
- NYC Health+Hospitals Bellevue, New York City, New York, USA
| | - Fei Guo
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York City, New York, USA
| | - Pantea Farahmand
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York City, New York, USA
- NYC Health+Hospitals Bellevue, New York City, New York, USA
| | - Rebecca Lois
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York City, New York, USA
| | - Annie Li
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York City, New York, USA
- NYC Health+Hospitals Bellevue, New York City, New York, USA
| | - Cheryl R Stein
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York City, New York, USA
| | - Argelinda Baroni
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York City, New York, USA
- NYC Health+Hospitals Bellevue, New York City, New York, USA
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Cheung AS, Zwickl S, Miller K, Nolan BJ, Wong AFQ, Jones P, Eynon N. The Impact of Gender-Affirming Hormone Therapy on Physical Performance. J Clin Endocrinol Metab 2024; 109:e455-e465. [PMID: 37437247 PMCID: PMC10795902 DOI: 10.1210/clinem/dgad414] [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: 11/29/2022] [Revised: 07/03/2023] [Accepted: 07/10/2023] [Indexed: 07/14/2023]
Abstract
CONTEXT The inclusion of transgender people in elite sport has been a topic of debate. This narrative review examines the impact of gender-affirming hormone therapy (GAHT) on physical performance, muscle strength, and markers of endurance. EVIDENCE ACQUISITION MEDLINE and Embase were searched using terms to define the population (transgender), intervention (GAHT), and physical performance outcomes. EVIDENCE SYNTHESIS Existing literature comprises cross-sectional or small uncontrolled longitudinal studies of short duration. In nonathletic trans men starting testosterone therapy, within 1 year, muscle mass and strength increased and, by 3 years, physical performance (push-ups, sit-ups, run time) improved to the level of cisgender men. In nonathletic trans women, feminizing hormone therapy increased fat mass by approximately 30% and decreased muscle mass by approximately 5% after 12 months, and steadily declined beyond 3 years. While absolute lean mass remains higher in trans women, relative percentage lean mass and fat mass (and muscle strength corrected for lean mass), hemoglobin, and VO2 peak corrected for weight was no different to cisgender women. After 2 years of GAHT, no advantage was observed for physical performance measured by running time or in trans women. By 4 years, there was no advantage in sit-ups. While push-up performance declined in trans women, a statistical advantage remained relative to cisgender women. CONCLUSION Limited evidence suggests that physical performance of nonathletic trans people who have undergone GAHT for at least 2 years approaches that of cisgender controls. Further controlled longitudinal research is needed in trans athletes and nonathletes.
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Affiliation(s)
- Ada S Cheung
- Trans Health Research Group, Department of Medicine (Austin Health), The University of Melbourne, Melbourne 3084, Australia
- Department of Endocrinology, Austin Health, Heidelberg 3084, Australia
| | - Sav Zwickl
- Trans Health Research Group, Department of Medicine (Austin Health), The University of Melbourne, Melbourne 3084, Australia
| | | | - Brendan J Nolan
- Trans Health Research Group, Department of Medicine (Austin Health), The University of Melbourne, Melbourne 3084, Australia
- Department of Endocrinology, Austin Health, Heidelberg 3084, Australia
| | - Alex Fang Qi Wong
- Trans Health Research Group, Department of Medicine (Austin Health), The University of Melbourne, Melbourne 3084, Australia
| | - Patrice Jones
- Institute for Health and Sport (IHeS), Victoria University, Footscray 3011, Australia
| | - Nir Eynon
- Institute for Health and Sport (IHeS), Victoria University, Footscray 3011, Australia
- Australian Regenerative Medicine Institute, Monash University, Clayton 3800, Australia
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Uddin T, Pitman A, Benson G, Kamal Z, Hawton K, Rowe S. Attitudes toward and experiences of clinical and non-clinical services among individuals who self-harm or attempt suicide: a systematic review. Psychol Med 2024; 54:13-31. [PMID: 37772412 DOI: 10.1017/s0033291723002805] [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] [Indexed: 09/30/2023]
Abstract
The prevalence of self-harm has increased substantially in recent decades. Despite the development of guidelines for better management and prevention of self-harm, service users report that quality of care remains variable. A previous systematic review of research published to June 2006 documented largely negative experiences of clinical services among patients who self-harm. This systematic review summarized the literature published since then to July 2022 to examine contemporary attitudes toward and experience of clinical and non-clinical services among individuals who self-harm and their relatives. We systematically searched for literature using seven databases. Quality of studies was assessed using the Mixed-Methods Appraisal Tool and findings were summarized using a narrative synthesis. We identified 29 studies that met our inclusion criteria, all of which were from high- or middle-income countries and were generally of high methodological quality. Our narrative synthesis identified negative attitudes toward clinical management and organizational barriers across services. Generally, more positive attitudes were found toward non-clinical services providing therapeutic contact, such as voluntary sector organizations and social services, than clinical services, such as emergency departments and inpatient units. Views suggested that negative experiences of service provision may perpetuate a cycle of self-harm. Our review suggests that in recent years there has been little improvement in attitudes toward and experiences of services for patients who self-harm. These findings should be used to reform clinical guidelines and staff training across clinical services to promote patient-centered and compassionate care and deliver more effective, acceptable and accessible services.
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Affiliation(s)
- Tasnim Uddin
- Epidemiology and Applied Clinical Research Department, UCL Division of Psychiatry, London, UK
| | - Alexandra Pitman
- Epidemiology and Applied Clinical Research Department, UCL Division of Psychiatry, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Gemma Benson
- Epidemiology and Applied Clinical Research Department, UCL Division of Psychiatry, London, UK
| | - Zeast Kamal
- Epidemiology and Applied Clinical Research Department, UCL Division of Psychiatry, London, UK
| | - Keith Hawton
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Sarah Rowe
- Epidemiology and Applied Clinical Research Department, UCL Division of Psychiatry, London, UK
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7
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Wright LC, Lopez Chemas N, Cooper C. Lived experience codesign of self-harm interventions: a scoping review. BMJ Open 2023; 13:e079090. [PMID: 38151276 PMCID: PMC10753750 DOI: 10.1136/bmjopen-2023-079090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 12/04/2023] [Indexed: 12/29/2023] Open
Abstract
OBJECTIVES This study aims to map existing literature describing how people with lived experience of self-harm have engaged in codesigning self-harm interventions, understand barriers and facilitators to this engagement, and how the meaningfulness of codesign has been evaluated. DESIGN Scoping review by Joanna Briggs Institute methodology. A protocol was published online (http://dx.doi.org/10.17605/OSF.IO/P52UD). DATA SOURCES PubMed, Embase, PsycINFO, Web of Science, Cochrane Library, PROSPERO, ClinicalTrials.gov and relevant websites were searched on 24 December 2022 (repeated 4 November 2023). ELIGIBILITY CRITERIA We included studies where individuals with lived experience of self-harm (first-hand or caregiver) have codesigned self-harm interventions. DATA EXTRACTION AND SYNTHESIS Results were screened at title and abstract level, then full-text level by two researchers independently. Prespecified data were extracted, charted and sorted into themes. RESULTS We included 22 codesigned interventions across mobile health, educational settings, prisons and emergency departments. Involvement varied from designing content to multistage involvement in planning, delivery and dissemination. Included papers described the contribution of 159 female, 39 male and 21 transgender or gender diverse codesigners. Few studies included contributors from a minoritised ethnic or LGBTQIA+ group. Six studies evaluated how meaningfully people with lived experience were engaged in codesign: by documenting the impact of contributions on intervention design or through postdesign reflections. Barriers included difficulties recruiting inclusively, making time for meaningful engagement in stretched services and safeguarding concerns for codesigners. Explicit processes for ensuring safety and well-being, flexible schedules, and adequate funding facilitated codesign. CONCLUSIONS To realise the potential of codesign to improve self-harm interventions, people with lived experience must be representative of those who use services. This requires processes that reassure potential contributors and referrers that codesigners will be safeguarded, remunerated, and their contributions used and valued.
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Affiliation(s)
- Lucy C Wright
- Barts and the London School of Medicine, Queen Mary University of London, London, UK
| | - Natalia Lopez Chemas
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Claudia Cooper
- Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
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Coyne SM, Christensen Duerden C, Sheppard JA, Ashby S, Van Alfen M, Harris H, Schilaty B, Hunt Q, Shawcroft J, Gale M, Graver H. "I'll Walk with You": LGBTQ+ Individuals and Religious Belonging. J Homosex 2023:1-23. [PMID: 37782078 DOI: 10.1080/00918369.2023.2246617] [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] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
Research on LGBTQ+ individuals, belonging, and religiosity has been mixed. Some studies have illustrated the ways religion can harm LGBTQ+ individuals while others suggest religion has positive impacts. In the current study, we sought to understand this complexity by examining the experiences of LGBTQ+ individuals who have been or currently are affiliated with The Church of Jesus Christ of Latter-day Saints (i.e. Mormon, LDS). A thematic analysis of 100 interviews with LGBTQ+ individuals currently or previously affiliated with the Church revealed various ways they feel belonging or the lack thereof in Latter-day Saint congregations and communities. These include sharing physical space, being invited to and included at events, receiving gifts or acts of service, seeing others' safety signals, hearing accepting and character-affirming language, and having others listen to them and give them voice. With the intent of fostering belonging, we discuss implications of this research for church communities and propose the belonging in practice: LGBTQ+ and religion model.
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Affiliation(s)
- Sarah M Coyne
- School of Family Life, JFSB 2086C, Brigham Young University, Provo, Utah, USA
| | | | - J Andan Sheppard
- School of Family Life, JFSB 2086C, Brigham Young University, Provo, Utah, USA
| | - Sarah Ashby
- School of Family Life, JFSB 2086C, Brigham Young University, Provo, Utah, USA
| | - Megan Van Alfen
- School of Family Life, JFSB 2086C, Brigham Young University, Provo, Utah, USA
| | - Holly Harris
- School of Family Life, JFSB 2086C, Brigham Young University, Provo, Utah, USA
| | - Ben Schilaty
- School of Family Life, JFSB 2086C, Brigham Young University, Provo, Utah, USA
| | - Quintin Hunt
- School of Family Life, JFSB 2086C, Brigham Young University, Provo, Utah, USA
| | - Jane Shawcroft
- School of Family Life, JFSB 2086C, Brigham Young University, Provo, Utah, USA
| | - Megan Gale
- School of Family Life, JFSB 2086C, Brigham Young University, Provo, Utah, USA
| | - Haley Graver
- School of Family Life, JFSB 2086C, Brigham Young University, Provo, Utah, USA
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9
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Xu L, Chang R, Wang H, Xu C, Yu X, Chen H, Wang R, Liu S, Liu Y, Wang Y, Cai Y. Validation of the Patient Health Questionnaire-9 for Suicide Screening in Transgender Women. Transgend Health 2023; 8:450-456. [PMID: 37810941 PMCID: PMC10551761 DOI: 10.1089/trgh.2021.0075] [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 High prevalence of depression in transgender women highlights the importance of validating the measure to assess depression. Moreover, depression is significantly associated with suicide across research studies. The aims of the current study were to validate a Chinese-language version of the Patient Health Questionnaire-9 (PHQ-9) and to assess operating characteristics of the PHQ-9 for suicide screening in transgender women. Methods With the approval of an Institutional Review Board (IRB), a total of 198 transgender women living in Shenyang, China, were recruited, and asked to complete the PHQ-9, including measures of their suicidal ideation, planning and attempt. Results A one-factor model of the PHQ-9 was supported in the current sample, showing good reliability and validity. The best cutoff point for the PHQ-9 in suicidal ideation was 17, with a sensitivity/specificity of 77.78%; the best cutoff point for PHQ-9 in suicidal planning was 17, with a sensitivity of 81.82% and a specificity of 73.26%; and the best cutoff point for PHQ-9 in suicidal attempt was 20, with a sensitivity of 75% and a specificity of 90.21%. Conclusion Findings supported the validity of the PHQ-9. With potential clinical or research application, the PHQ-9 can be an efficient instrument for suicide screening in transgender women.
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Affiliation(s)
- Lulu Xu
- Department of Student Affairs, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ruijie Chang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huwen Wang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chen Xu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoyue Yu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hui Chen
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rongxi Wang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shangbin Liu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yujie Liu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ying Wang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yong Cai
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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10
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Thoma BC, Hone E, Roig A, Goodfriend E, Jardas EJ, Brummitt B, Riston S, Sakolsky D, Zelazny J, Marsland AL, Chen K, Douaihy AB, Brent DA, Melhem NM. Risk for Suicidal Behavior After Psychiatric Hospitalization Among Sexual and Gender Minority Patients. JAMA Netw Open 2023; 6:e2333060. [PMID: 37682570 PMCID: PMC10492186 DOI: 10.1001/jamanetworkopen.2023.33060] [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] [Received: 04/24/2023] [Accepted: 07/22/2023] [Indexed: 09/09/2023] Open
Abstract
Importance The months following inpatient psychiatric hospitalization are a period of high risk for suicidal behavior. Sexual and gender minority (SGM) individuals have elevated risk for suicidal behavior, but no prior research has examined whether SGM inpatients have disproportionate risk for suicidal behavior following discharge from psychiatric hospitalization. Objectives To evaluate whether SGM patients have elevated risk for suicidal behavior following discharge from psychiatric hospitalization compared with heterosexual and cisgender patients and to examine whether differences in risk across groups were accounted for by demographic characteristics and clinical factors known to be associated with suicidal behavior. Design, Setting, and Participants This prospective cohort study was conducted from August 2017 to July 2021 among inpatients aged 18 to 30 years who were voluntarily enrolled during psychiatric hospitalization. The study was conducted at an inpatient psychiatric hospital, with prospective data collected via follow-up visits and electronic health records. Main Outcomes and Measures Onset and/or recurrence of suicidal behavior following discharge from psychiatric hospitalization, assessed at follow-up visits and through electronic health records. Results A total of 160 patients were included, with 56 sexual minority (SM) and 15 gender minority (GM) patients. The median (IQR) age of the patients was 23.5 (20.4-27.6) years, 77 (48%) reported male sex assigned at birth, and 114 (71%) identified their race as White. During the follow-up period, 33 suicidal behavior events occurred (among 21% of patients). SM (hazard ratio [HR], 2.02; 95% CI, CI, 1.02-4.00; log-rank P = .04) and GM (HR, 4.27; 95% CI, 1.75-10.40; log-rank P < .001) patients had significantly higher risk for suicidal behavior compared with their heterosexual and cisgender counterparts, respectively, in bivariable analyses. Risk between SM and heterosexual patients was not different after controlling for demographic characteristics and clinical factors associated with suicidal behavior. GM patients exhibited elevated risk during the 100 days following discharge even after controlling for demographic and clinical characteristics (HR, 3.80; 95% CI, 1.18-11.19; P = .03). Conclusions and Relevance Within this cohort study of psychiatric patients, SGM patients had higher risk for suicidal behavior than non-SGM patients following discharge. While SM patients' risk was accounted for by clinical characteristics, GM patients' risk for suicidal behavior was not accounted for by their acute psychiatric state on admission. Future studies with larger subsamples of GM individuals are needed, and inpatient clinicians must attend to the unique needs of SGM individuals to ensure they receive affirming services.
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Affiliation(s)
- Brian C. Thoma
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Emily Hone
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Alyssa Roig
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | - EJ Jardas
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Bradley Brummitt
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Sarah Riston
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Dara Sakolsky
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Jamie Zelazny
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Anna L. Marsland
- Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kehui Chen
- Department of Statistics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Antoine B. Douaihy
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - David A. Brent
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Nadine M. Melhem
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Nolan BJ, Zwickl S, Locke P, Zajac JD, Cheung AS. Early Access to Testosterone Therapy in Transgender and Gender-Diverse Adults Seeking Masculinization: A Randomized Clinical Trial. JAMA Netw Open 2023; 6:e2331919. [PMID: 37676662 PMCID: PMC10485726 DOI: 10.1001/jamanetworkopen.2023.31919] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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] [Received: 05/06/2023] [Accepted: 07/27/2023] [Indexed: 09/08/2023] Open
Abstract
Importance Testosterone treatment is a necessary component of care for some transgender and gender-diverse individuals. Observational studies have reported associations between commencement of gender-affirming hormone therapy and improvements in gender dysphoria and depression, but there is a lack of data from randomized clinical trials. Objective To assess the effect of testosterone therapy compared with no treatment on gender dysphoria, depression, and suicidality in transgender and gender-diverse adults seeking masculinization. Design, Setting, and Participants A 3-month open-label randomized clinical trial was conducted at endocrinology outpatient clinics and primary care clinics specializing in transgender and gender-diverse health in Melbourne, Australia, from November 1, 2021, to July 22, 2022. Participants included transgender and gender-diverse adults aged 18 to 70 years seeking initiation of testosterone therapy. Interventions Immediate initiation of testosterone commencement (intervention group) or no treatment (standard care waiting list of 3 months before commencement). This design ensured no individuals would be waiting longer than the time to standard care. Main Outcomes and Measures The primary outcome was gender dysphoria, as measured by the Gender Preoccupation and Stability Questionnaire. Secondary outcomes included the Patient Health Questionnaire-9 (PHQ-9) to assess depression and the Suicidal Ideation Attributes Scale (SIDAS) to assess suicidality. Questionnaires were undertaken at 0 and 3 months. The evaluable cohort was analyzed. Results Sixty-four transgender and gender-diverse adults (median [IQR] age, 22.5 [20-27] years) were randomized. Compared with standard care, the intervention group had a decrease in gender dysphoria (mean difference, -7.2 points; 95% CI, -8.3 to -6.1 points; P < .001), a clinically significant decrease in depression (ie, change in score of 5 points on PHQ-9; mean difference, -5.6 points; 95% CI, -6.8 to -4.4 points; P < .001), and a significant decrease in suicidality (mean difference in SIDAS score, -6.5 points; 95% CI, -8.2 to -4.8 points; P < .001). Resolution of suicidality assessed by PHQ-9 item 9 occurred in 11 individuals (52%) with immediate testosterone commencement compared with 1 (5%) receiving standard care (P = .002). Seven individuals reported injection site pain/discomfort and 1 individual reported a transient headache 24 hours following intramuscular administration of testosterone undecanoate. No individual developed polycythemia. Conclusions and Relevance In this open-label randomized clinical trial of testosterone therapy in transgender and gender-diverse adults, immediate testosterone compared with no treatment significantly reduced gender dysphoria, depression, and suicidality in transgender and gender-diverse individuals desiring testosterone therapy. Trial Registration ANZCTR Identifier: ACTRN1262100016864.
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Affiliation(s)
- Brendan J. Nolan
- Department of Endocrinology, Austin Health, Heidelberg, Victoria, Australia
- Trans Health Research Group, Department of Medicine (Austin Health), University of Melbourne, Heidelberg, Victoria, Australia
- Equinox Gender Diverse Clinic, Thorne Harbour Health, Abbotsford, Victoria, Australia
| | - Sav Zwickl
- Trans Health Research Group, Department of Medicine (Austin Health), University of Melbourne, Heidelberg, Victoria, Australia
| | - Peter Locke
- Equinox Gender Diverse Clinic, Thorne Harbour Health, Abbotsford, Victoria, Australia
| | - Jeffrey D. Zajac
- Department of Endocrinology, Austin Health, Heidelberg, Victoria, Australia
- Trans Health Research Group, Department of Medicine (Austin Health), University of Melbourne, Heidelberg, Victoria, Australia
| | - Ada S. Cheung
- Department of Endocrinology, Austin Health, Heidelberg, Victoria, Australia
- Trans Health Research Group, Department of Medicine (Austin Health), University of Melbourne, Heidelberg, Victoria, Australia
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12
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Cooper S, Péloquin T, Lachowsky NJ, Salway T, Oliffe JL, Klassen B, Brennan DJ, Houle J, Ferlatte O. Conformity to Masculinity Norms and Mental Health Outcomes Among Gay, Bisexual, Trans, Two-Spirit, and Queer Men and Non-Binary Individuals. Am J Mens Health 2023; 17:15579883231206618. [PMID: 37886907 PMCID: PMC10612460 DOI: 10.1177/15579883231206618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 07/21/2023] [Accepted: 09/14/2023] [Indexed: 10/28/2023] Open
Abstract
Homophobia and biphobia negatively impact the mental health of gay, bisexual, trans, Two-Spirit, and queer men and non-binary individuals (GBT2Q) and sexual and gender minority men, but little is known about the impact of gender-related oppression. The current study examines the impact of pressure to conform to masculine norms in Canada-based GBT2Q individuals. Specifically, the associations between (a) gender expression and pressure to be masculine and (b) pressure to be masculine and depression, anxiety, and self-rated mental health were investigated. Drawing from an online national cross-sectional survey of 8,977 GBT2Q individuals and sexual and gender minority men living in Canada aged 15 years or older, 56.4% (n = 5,067) of respondents reported experiencing pressure to conform to masculine norms. Respondents were more likely to report masculine pressure if they were younger than 30 years, described their gender expression as fluid, identified their sexuality as queer, were an ethnoracial minority, and were trans. Pressure to be masculine was associated with increased odds of depression, anxiety, and reporting poor or fair mental health. The current study provides evidence of the detrimental impact of pressure to conform to masculine norms on the mental health of gay, bisexual, trans, Two-Spirit, and queer men and non-binary peoples.
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Affiliation(s)
- Sarah Cooper
- École de Santé Publique de l’Université de Montréal, Montréal, Quebec, Canada
- Centre de Recherche en Santé Publique, Montréal, Quebec, Canada
| | - Tristan Péloquin
- École de Santé Publique de l’Université de Montréal, Montréal, Quebec, Canada
| | - Nathan J. Lachowsky
- Community-Based Research Centre, Vancouver, British Columbia, Canada
- School of Public Health & Social Policy, University of Victoria, Victoria, British Columbia, Canada
| | - Travis Salway
- Community-Based Research Centre, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- BC Centre for Disease Control, Vancouver, British Columbia, Canada
- Centre for Gender & Sexual Health Equity, Vancouver, British Columbia, Canada
| | - John L. Oliffe
- School of Nursing, The University of British Columbia, Vancouver, British Columbia, Canada
- Department of Nursing, The University of Melbourne, Parkville, Victoria, Australia
| | - Benjamin Klassen
- Community-Based Research Centre, Vancouver, British Columbia, Canada
| | - David J. Brennan
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Janie Houle
- Department of Psychology, Université du Québec à Montréal, Montréal, Quebec, Canada
| | - Olivier Ferlatte
- École de Santé Publique de l’Université de Montréal, Montréal, Quebec, Canada
- Centre de Recherche en Santé Publique, Montréal, Quebec, Canada
- Community-Based Research Centre, Vancouver, British Columbia, Canada
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13
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Hong D, Tang C, Barnhart WR, Cui S, He J. Testing the associations between internalized cisgenderism, self-objectification, body shame, and mental health correlates in the framework of the pantheoretical model of dehumanization: A study in Chinese transgender adults. Body Image 2023; 46:62-72. [PMID: 37244012 DOI: 10.1016/j.bodyim.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 05/05/2023] [Accepted: 05/08/2023] [Indexed: 05/29/2023]
Abstract
As an integrated framework informed by the Minority Stress Model and Objectification Theory, the Pantheoretical Model of Dehumanization was proposed to better understand mental health outcomes in transgender individuals. With a sample of 200 Chinese transgender adults, the present study tested the associations and potential mechanisms between internalized cisgenderism, self-objectification, body shame, and mental health correlates in the framework of the Pantheoretical Model of Dehumanization. Correlation and regression analyses were used. Results showed that internalized cisgenderism was positively related to body shame, psychological distress, disordered eating, non-suicidal self-injury (NSSI), suicidal ideation, and suicide attempts. Body shame showed significant indirect effects in the association between internalized cisgenderism and suicide attempts, and in the associations between internalized cisgenderism and psychological distress, disordered eating, and NSSI. In addition, body shame had significant indirect effects in the associations between body surveillance and disordered eating, NSSI, and suicide attempts, and in the association between body surveillance and psychological distress. As the first study testing the associations of core variables in the Pantheoretical Model of Dehumanization in a Chinese transgender sample, the findings largely supported the model in describing meaningful variance in Chinese transgender adults' psychological distress, disordered eating, and self-injurious thoughts and behaviors.
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Affiliation(s)
- Dinan Hong
- School of Humanities and Social Science, The Chinese University of Hong Kong, Shenzhen, Guangdong, China
| | - Chanyuan Tang
- School of Humanities and Social Science, The Chinese University of Hong Kong, Shenzhen, Guangdong, China
| | - Wesley R Barnhart
- Department of Psychology, Bowling Green State University, Bowling Green, OH, USA
| | - Shuqi Cui
- School of Humanities and Social Science, The Chinese University of Hong Kong, Shenzhen, Guangdong, China
| | - Jinbo He
- School of Humanities and Social Science, The Chinese University of Hong Kong, Shenzhen, Guangdong, China.
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14
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von der Warth R, Metzner G, Körner M, Farin-Glattacker E. Exploring communication preferences of trans and gender diverse individuals-A qualitative study. PLoS One 2023; 18:e0284959. [PMID: 37611052 PMCID: PMC10446207 DOI: 10.1371/journal.pone.0284959] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 04/12/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Trans and gender-diverse individuals experience adverse health outcomes that might be due, in addition to other factors, to stigma and discrimination in the health care sector. At the same time, the concept of person-centred care acknowledges the role of patient-physician communication in health care outcomes. This study aims to explore patient-physician communication preferences in trans and gender-diverse individuals. METHOD A qualitative interview study was conducted, including N = 10 participants between February and March 2022. Participants were interviewed using a semi-structured interview guideline, based on previous knowledge in person-centred care and sample specific communication. Participants were asked about their experiences and wishes in patient-physician centeredness. Analyses were conducting using a qualitative content analysis strategy. RESULTS Mean age was 29.3 years; n = 6 participants identified themselves within the binary gender concept, while n = 4 identified themselves with a non-binary gender. Communication preferences for patient-physician communication were categorised into four themes: general communication aspects (e.g. active listening); the role of gender during appointments (e.g. appropriate/inappropriate addressing); gender-neutral language (e.g. experiences use of gender neutral language by physicians); own communication style (e.g. early outing and justification). Furthermore, possible contextual factors of patient-physician communication where found (e.g. trusting relationship). CONCLUSION Adding knowledge to communication preferences of trans and gender-diverse individuals, this study was able to identify preferences that are specific to the sample as well as preferences that differ from the cis-gendered population. However, it remains unclear how the patient-physician communication preferences affects health care utilization and outcomes. TRIAL REGISTRATION German Clinical Trial Register (DRKS00026249).
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Affiliation(s)
- Rieka von der Warth
- Section of Health Care Research and Rehabilitation Research, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg; Germany
| | - Gloria Metzner
- Section of Health Care Research and Rehabilitation Research, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg; Germany
| | - Mirjam Körner
- Institute of Medical Psychology and Medical Sociology, University of Freiburg, Freiburg, Germany
| | - Erik Farin-Glattacker
- Section of Health Care Research and Rehabilitation Research, Medical Center–University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg; Germany
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15
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Jones BA, Cahill L, McDermott DT. Assessing Attitudes Toward Trans and Gender Diverse People: Adapting the 'Transgender Attitudes and Beliefs' Scale. J Homosex 2023:1-12. [PMID: 37561420 DOI: 10.1080/00918369.2023.2245524] [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] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
This study aimed to update the gender-based terminology of a measure used to assess attitudes toward trans and gender diverse people (the Transgender Attitudes and Beliefs Scale; TABS) in order to reflect appropriate and inclusive language standards and conventions while maintaining the psychometric integrity of the tool. The updated TABS was administered to 247 heterosexual, cisgender adults in the UK. Participants also completed the original TABS as well as measure of self-esteem and social desirability to test construct validity. We demonstrate that after updating the language of the TABS to reflect best-practice, the psychometric properties of the TABS were unaffected.
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Affiliation(s)
- Bethany A Jones
- NTU Psychology, School of Social Sciences, Nottingham Trent University, Nottingham, UK
| | - Liam Cahill
- NTU Psychology, School of Social Sciences, Nottingham Trent University, Nottingham, UK
| | - Daragh T McDermott
- NTU Psychology, School of Social Sciences, Nottingham Trent University, Nottingham, UK
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16
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Campbell T, Rodgers YVDM. Conversion therapy, suicidality, and running away: An analysis of transgender youth in the U.S. J Health Econ 2023; 89:102750. [PMID: 36963209 DOI: 10.1016/j.jhealeco.2023.102750] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 03/09/2023] [Accepted: 03/10/2023] [Indexed: 06/18/2023]
Abstract
This study analyzes the relationship between conversion therapy and mental health and wellbeing of transgender youth in the U.S. We create a retrospective panel of transgender youth using the 2015 U.S. Transgender Survey to test how exposure to conversion therapy affects the likelihood of attempting suicide and running away from home. The empirical approach employs a difference-in-differences design. Results indicate that exposure to conversion therapy substantially increases the likelihood a transgender adolescent will attempt suicide and run away. The average treatment effect on treated (ATT) of conversion therapy on having attempted suicide is an increase of 17 percentage points, which amounts to a 55% increase in the risk of attempting suicide, and the ATT on the risk of running away is an increase of 7.8 percentage points, more than doubling the risk of running away. These effects are largest when exposure to conversion therapy occurs at a young age (11-14).
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Knudson GA, Feldman J, Neira P, Fraser L. Closing the gap in education: Raising medical professionals' knowledge and attitudes in transgender health. Best Pract Res Clin Obstet Gynaecol 2023; 89:102339. [PMID: 37295317 DOI: 10.1016/j.bpobgyn.2023.102339] [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: 11/10/2022] [Revised: 01/19/2023] [Accepted: 04/08/2023] [Indexed: 06/12/2023]
Abstract
Transgender and gender diverse (TGD) health is a rapidly evolving, underserviced, and underresearched healthcare field. This chapter will provide a brief review of the research in TGD health and medical education and offer further areas of research and curriculum design.
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18
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Cheung AS, Nolan BJ, Zwickl S. Transgender health and the impact of aging and menopause. Climacteric 2023; 26:256-262. [PMID: 37011669 DOI: 10.1080/13697137.2023.2176217] [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: 04/05/2023]
Abstract
Gender affirming hormone therapy (GAHT) is used by many transgender people to reduce gender incongruence and improve psychological functioning. As GAHT shares many similarities with menopausal hormone therapy, clinicians supporting people through menopause are ideally placed to manage GAHT. This narrative review provides an overview of transgender health and discusses long-term effects of GAHT to consider when managing transgender individuals across the lifespan. Menopause is less relevant for transgender individuals who take GAHT (often given lifelong) to achieve sex steroid concentrations generally in the range of the affirmed gender. For people using feminizing hormone therapy, there is an elevated risk of venous thromboembolism, myocardial infarction, stroke and osteoporosis relative to cisgender individuals. For trans people using masculinizing hormone therapy, there is an increased risk of polycythemia, probable higher risk of myocardial infarction and pelvic pain which is poorly understood. Proactive mitigation of cardiovascular risk factors is important for all transgender people and optimization of bone health is important for those using feminizing hormones. With a lack of research to guide GAHT in older age, a shared decision-making approach is recommended for the provision of GAHT to achieve individual goals whilst minimizing potential adverse effects.
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Affiliation(s)
- A S Cheung
- Trans Health Research Group, Department of Medicine (Austin Health), The University of Melbourne, Melbourne, Australia
- Department of Endocrinology, Austin Health, Heidelberg, Australia
| | - B J Nolan
- Trans Health Research Group, Department of Medicine (Austin Health), The University of Melbourne, Melbourne, Australia
- Department of Endocrinology, Austin Health, Heidelberg, Australia
| | - S Zwickl
- Trans Health Research Group, Department of Medicine (Austin Health), The University of Melbourne, Melbourne, Australia
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Logel SN, Maru J, Whitehead J, Brady C, Walch A, Lasarev M, Rehm JL, Millington K. Higher Rates of Certain Autoimmune Diseases in Transgender and Gender Diverse Youth. Transgend Health 2023. [DOI: 10.1089/trgh.2022.0079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
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20
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Lavender R, Shaw S, Maninger JK, Butler G, Carruthers P, Carmichael P, Masic U. Impact of Hormone Treatment on Psychosocial Functioning in Gender-Diverse Young People. LGBT Health 2023. [PMID: 36989498 DOI: 10.1089/lgbt.2022.0201] [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: 03/31/2023] Open
Abstract
Purpose: Few studies have assessed the effects of hormonal treatments such as gonadotropin-releasing hormone agonists (GnRHa) and gender-affirming hormones (GAH) on mental health outcomes in clinically referred gender-diverse young people from a younger age. Where this research has been conducted, findings have been mixed. This study investigated a cohort of young people before treatment, 1 year into GnRHa, and 1 year into GAH treatment to understand psychological and behavioral impacts over time. Methods: Thirty-eight young people (28 assigned female and 10 assigned male) referred to endocrinology, younger than 15 years at/beyond Tanner stage two, who received GnRHa followed by GAH treatment, were assessed in a retrospective analysis study. Young people completed the Youth Self Report (YSR), the Body Image Scale, and the Utrecht Gender Dysphoria Scale, while caregivers completed the Child Behavior Checklist (CBCL) and the Social Responsiveness Scale-2 at all time points. Results: Dissatisfaction with primary sexual characteristics (p = 0.02), gender dysphoria (p = 0.01), and social motivation (p = 0.04) improved significantly over time. Self-harm and suicidality also showed a general decrease. Caregivers reported a significant reduction in internalizing (p = 0.03) behaviors on the CBCL after GnRHa. Other subcategories of the YSR and CBCL were within normal ranges with no significant difference (p > 0.05). Conclusion: These findings demonstrate some improvements in psychological and behavioral outcomes in young people concurrently receiving psychosocial support and hormone treatment. Future research with larger and more diverse samples is warranted to further understand generalizability.
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Affiliation(s)
- Rosemary Lavender
- Gender Identity Development Service, Tavistock and Portman NHS Foundation Trust, London, United Kingdom
| | - Selina Shaw
- Gender Identity Development Service, Tavistock and Portman NHS Foundation Trust, London, United Kingdom
| | | | - Gary Butler
- Gender Identity Development Service, Tavistock and Portman NHS Foundation Trust, London, United Kingdom
- Department of Paediatric and Adolescent Endocrinology, University College London Hospital, London, United Kingdom
- Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Paul Carruthers
- Leeds Children's Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Polly Carmichael
- Gender Identity Development Service, Tavistock and Portman NHS Foundation Trust, London, United Kingdom
| | - Una Masic
- Gender Identity Development Service, Tavistock and Portman NHS Foundation Trust, London, United Kingdom
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Newell V, Phillips L, Jones C, Townsend E, Richards C, Cassidy S. A systematic review and meta-analysis of suicidality in autistic and possibly autistic people without co-occurring intellectual disability. Mol Autism 2023; 14:12. [PMID: 36922899 PMCID: PMC10018918 DOI: 10.1186/s13229-023-00544-7] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 02/27/2023] [Indexed: 03/17/2023] Open
Abstract
BACKGROUND Suicidality is highly prevalent in autistic people without co-occurring intellectual disabilities, and high autistic traits are found in adults who have attempted suicide. However, prevalence rates for both autistic and possibly autistic people have not been synthesised meta-analytically. AIMS To (1) calculate pooled prevalence estimates of suicidality in autistic people and possibly autistic people without co-occurring intellectual disability; (2) evaluate the influence of participant and study level characteristics on heterogeneity; and (3) determine the quality of evidence. METHODS Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed. PsycINFO, Embase, MEDLINE and Web of Science were systematically searched from 1992 to January 25, 2022. Empirical quantitative studies reporting prevalence of suicidal ideation, suicide plans, or suicide attempts and behaviours were considered for inclusion. Random effects models were used to estimate pooled prevalence of each suicidality outcome with 95% confidence intervals. Heterogeneity was explored using sensitivity and moderator analyses. RESULTS Data from 48,186 autistic and possibly autistic participants in 36 primary studies were meta-analysed. Pooled prevalence of suicidal ideation was 34.2% (95% CI 27.9-40.5), suicide plans 21.9% (13.4-30.4), and suicidal attempts and behaviours 24.3% (18.9-29.6). High levels of heterogeneity (I2 > 75) were observed in all three analyses. Estimates did not differ between autistic or possibly autistic samples. Geographical location (p = 0.005), transgender or gender non-conforming samples (p < 0.001) and type of report (p < 0.001) significantly moderated suicidal ideation, whereas age group (p = 0.001) and measure of suicidality (p = 0.001) significantly moderated suicide plans. There was a significant association between the proportion of male participants and prevalence of suicide plans, with a decrease in the proportion of males for every unit change of suicide plan prevalence (p = 0.013). No variables were found to moderate estimates of suicide attempts and behaviours. CONCLUSIONS The results confirm suicidality is highly prevalent in both autistic and possibly autistic people without co-occurring intellectual disability and highlights potential moderators. Possibly autistic individuals require more attention in clinical and research considerations going forward to further understand and prevent suicide in both groups.
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Affiliation(s)
- Victoria Newell
- School of Psychology, University of Nottingham, University Park, Nottingham, NG7 2RD, UK.
| | - Lucy Phillips
- School of Sport, Exercise and Health Sciences, Loughborough University, Epinal Way, Loughborough, LE11 3TU, UK
| | - Chris Jones
- School of Psychology, University of Birmingham, 52 Pritchatts Road, Birmingham, B15 2TT, UK
| | - Ellen Townsend
- School of Psychology, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - Caroline Richards
- School of Psychology, University of Birmingham, 52 Pritchatts Road, Birmingham, B15 2TT, UK
| | - Sarah Cassidy
- School of Psychology, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
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Jadva V, Guasp A, Bradlow JH, Bower-Brown S, Foley S. Predictors of self-harm and suicide in LGBT youth: The role of gender, socio-economic status, bullying and school experience. J Public Health (Oxf) 2023; 45:102-108. [PMID: 34850220 PMCID: PMC10017085 DOI: 10.1093/pubmed/fdab383] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 08/12/2021] [Accepted: 09/20/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Lesbian, gay and bisexual (LGB) young people's increased risk of self-harm, suicidal attempts and suicide compared with heterosexual youth is well established. The current study sought to examine whether these findings also apply to the trans (T) population and which factors act as additional risk or protective factors. METHODS In a national cross-sectional survey, 3713 LGBT adolescents, aged 11-19 years, reported on their own history of self-harm, suicidal ideation and suicide attempts, as well as their experiences of school and homophobic, biphobic and transphobic bullying. Logistic regressions tested the association between risk and protective factors on self-harm, suicidal ideation and suicide attempts. RESULTS A high proportion of the sample reported self-harm (65.3%), suicidal ideation (73.8%) and suicide attempts (25.7%). Demographic risk factors included identifying as female, non-binary or trans and being from a low-income background. Bullying and online bullying were associated with an increased risk for each outcome, and positive school experience was associated with a reduced risk for each outcome. CONCLUSIONS Consistent with minority stress theory, the study found high rates of mental health problems within LGBT youth. Interventions focused on improving young people's experiences in schools appear useful targets to help improve mental health outcomes.
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Affiliation(s)
- V Jadva
- Address correspondence to V. Jadva, E-mail:
| | - A Guasp
- Stonewall, 192 St John St EC1V 4JY, UK
| | | | - S Bower-Brown
- Centre for Family Research, University of Cambridge, Free School Lane, Cambridge CB2 3RQ, UK
| | - S Foley
- Moray House School of Education and Sport, University of Edinburgh, Edinburgh, UK
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23
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Watts J, Scarton C, Chumbler NR, With E, Knapp-Grosz T, Ousby S. Disparities in Suicidal Behaviors and Mental Health Issues Among Gender Minority College Students. Journal of College Student Psychotherapy 2023. [DOI: 10.1080/87568225.2023.2188572] [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: 03/11/2023]
Affiliation(s)
- Justin Watts
- Rehabilitation Health Services, University of North Texas, Denton, Texas, USA
| | - Carly Scarton
- Counselor Education, California State University Sacramento, Sacramento, California, USA
| | - Neale R Chumbler
- Department of Diagnostic and Health Sciences, The University of Tennessee Health Science Center VolShop Memphis, Memphis, Tennessee, USA
| | - Elizabeth With
- Student Affairs, University of North Texas, Denton, Texas, USA
| | | | - Sara Ousby
- Student Affairs, University of North Texas, Denton, Texas, USA
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Hill AO, Cook T, McNair R, Amos N, Carman M, Hartland E, Lyons A, Bourne A. Demographic and psychosocial factors associated with recent suicidal ideation and suicide attempts among trans and gender diverse people in Australia. Suicide Life Threat Behav 2023; 53:320-333. [PMID: 36786221 DOI: 10.1111/sltb.12946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 11/15/2022] [Accepted: 01/03/2023] [Indexed: 02/15/2023]
Abstract
INTRODUCTION Correlates of suicidal ideation and suicide attempts among a large cross-section of trans and gender diverse populations in Australia were examined. METHODS A national survey was conducted that included 1466 trans and gender diverse participants aged 18+ years. Multivariable regressions identified factors associated with recent suicidal ideation and suicide attempts. RESULTS Overall, 62.4% reported suicidal ideation and 9.5% suicide attempt in the past 12 months. The likelihood of suicidal ideation was higher for younger participants or those who felt treated unfairly or socially excluded due to their gender identity in the past 12 months. It was lower for those with a postgraduate degree, who felt accepted by family or work, or who felt their gender identity was respected when accessing a mainstream medical clinic in the past 12 months. The likelihood of suicide attempts was greater for those aged younger or who had recently experienced sexual harassment based on their sexual orientation or gender identity, and lower for those who were non-binary. CONCLUSION Urgent attention for suicide prevention is necessary for trans and gender diverse communities. These findings point to a range of risk and protective factors, which may help inform the targeting and design of suicide prevention strategies.
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Affiliation(s)
- Adam O Hill
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia.,Graduate School of Public Health, St Luke's International University, Tokyo, Japan
| | - Teddy Cook
- ACON Health, Surry Hills, New South Wales, Australia
| | - Ruth McNair
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | - Natalie Amos
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia
| | - Marina Carman
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia
| | | | - Anthony Lyons
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia
| | - Adam Bourne
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia.,Kirby Institute, UNSW, Sydney, New South Wales, Australia
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Genzor S, Prasko J, Mizera J, Kufa J, Zurkova M, Jakubec P, Vykopal M, Vanek J. Sex transition from female to male as a risk factor for sleep-disordered breathing. Sleep Med 2023; 102:180-185. [PMID: 36701832 DOI: 10.1016/j.sleep.2023.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 08/19/2022] [Revised: 01/02/2023] [Accepted: 01/10/2023] [Indexed: 01/16/2023]
Abstract
AIM The female-to-male (FtM) sex transition requires lifelong supplementation with male sex hormones, resulting in high prevalence of weight gain, fat redistribution and other metabolic changes. Although sleep-disordered breathing (SDB) data for this group of patients are very limited, increased prevalence is expected. We report a mini-series of six case reports of FtM transsexuals treated in our centre. PATIENTS AND METHODS All reported cases are consecutive patients referred to a department of respiratory diseases and tuberculosis of a university hospital from 2017 to 2022. The standard pulmonary examination was performed, followed by limited polysomnography. RESULTS In all FtM subjects, SDB was present and continuous positive airway pressure (CPAP) therapy was indicated. The sex transition process was completed in three individuals while the other three only took testosterone supplementation at the assessment time. The subjects' age ranged from 21 to 38 years, the apnoea-hypopnea index ranged from 17.3 to 104.1, and the BMI was 33.48-43.41. The CPAP therapy was effective in five patients, with one requiring bi-level positive airway pressure therapy. One subject committed suicide before the first check-up, four patients had a good level of compliance at one-year follow-up, and one had insufficient CPAP adherence. CONCLUSION SDB decreases the quality of life and life expectancy of FtM individuals. Their prognosis is undoubtedly better with effective treatment. Hence, obese FtM subjects should be considered at risk and screened for SDB.
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Affiliation(s)
- Samuel Genzor
- Department of Respiratory Diseases and Tuberculosis, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic; Center for Digital Health, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech republic
| | - Jan Prasko
- Department of Psychiatry, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic; Institute for Postgraduate Education in Health Care, Prague, Czech Republic; Department of Psychology Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University in Nitra, Slovak Republic.
| | - Jan Mizera
- Department of Respiratory Diseases and Tuberculosis, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic
| | - Jiri Kufa
- Department of Respiratory Diseases and Tuberculosis, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic
| | - Monika Zurkova
- Department of Respiratory Diseases and Tuberculosis, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic
| | - Petr Jakubec
- Department of Respiratory Diseases and Tuberculosis, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic
| | - Martin Vykopal
- Department of Respiratory Diseases and Tuberculosis, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic
| | - Jakub Vanek
- Department of Psychiatry, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
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Xu L, Chang R, Chen Y, Xia D, Xu C, Yu X, Chen H, Wang R, Liu Y, Liu S, Ge X, Ma T, Zhou Y, Wang Y, Ma S, Cai Y. The prevalence of childhood sexual experiences and intimate partner violence among transgender women in China: Risk factors for lifetime suicidal ideation. Front Public Health 2023; 10:1037622. [PMID: 36755737 PMCID: PMC9900504 DOI: 10.3389/fpubh.2022.1037622] [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: 09/06/2022] [Accepted: 12/13/2022] [Indexed: 01/13/2023] Open
Abstract
Objective Several studies highlighted childhood sexual experiences (CSEs) and intimate partner violence (IPV) as risk factors that affected lifetime suicidal ideation. TW had higher rates of CSEs and IPV than cisgender people. The aim of this study was to comprehensively assess the prevalence of CSEs and IPV among TW and their association with lifetime suicidal ideation. Methods A cross-sectional survey was conducted among 247 TW in Shenyang and Kunming, China, from April to September 2018. CSEs, IPV, and lifetime suicidal ideation were assessed. Logistic regression models were used to examine the association between self-reported CSEs under 18 years of age, IPV in adulthood, and lifetime suicidal ideation. Results In the study, 14.2% (35/247) of the sample participants reported CSEs under 18 years of age; 44.9% (111/247) reported experiencing IPV in adulthood, including 18.6% (44/247) of physical IPV, 27.1% (67/247) of trans-specific identity IPV, 31.6% (78/247) of verbal IPV, and 19.4% (48/247) of sexual IPV; and 26.3% (65/247) had thought about attempting suicide at least one time. CSEs and any form of IPV were significantly associated with suicidal ideation in this sample population. A final stepwise multivariate logistic regression model found that both physical and verbal IPVs were significantly associated with suicidal ideation when controlling for other factors (ORm1 = 2.58, 95% confidence interval (CI) = 1.163-5.724; ORm2 = 2.72, 95% CI = 1.334-5.547). Conclusions The findings highlight the effects of CSEs and IPV among TW and suggest the need for research on suicide in the future. Suicide prevention efforts for this invisible and vulnerable population should focus on those with physical and verbal IPV.
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Affiliation(s)
- Lulu Xu
- School of Public Health, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ruijie Chang
- School of Public Health, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yingjie Chen
- School of Public Health, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Danni Xia
- School of Public Health, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Chen Xu
- School of Public Health, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaoyue Yu
- School of Public Health, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Hui Chen
- School of Public Health, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Rongxi Wang
- School of Public Health, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yujie Liu
- School of Public Health, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Shangbin Liu
- School of Public Health, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xin Ge
- School of Public Health, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Tiecheng Ma
- Shenyang Consultation Centre of AIDS Aid and Health Service, Shenyang, China
| | - Yiwen Zhou
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ying Wang
- School of Public Health, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Sunxiang Ma
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China,*Correspondence: Sunxiang Ma ✉
| | - Yong Cai
- Hongqiao International Institute of Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China,Center for Community Health Care, Hospital Development Institute Shanghai Jiao Tong University, Shanghai, China,Yong Cai ✉
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Drescher CF, Kassing F, Mahajan A, Stepleman LM. The Impact of Transgender Minority Stress and Emotion Regulation on Suicidality and Self-Harm. Psychology & Sexuality 2023. [DOI: 10.1080/19419899.2023.2164867] [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: 01/04/2023]
Affiliation(s)
- Christopher F. Drescher
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University
| | | | - Aaron Mahajan
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University
| | - Lara M. Stepleman
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta University
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28
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Clark KA, Salway T, McConocha EM, Pachankis JE. How do sexual and gender minority people acquire the capability for suicide? Voices from survivors of near-fatal suicide attempts. SSM Qual Res Health 2022; 2:100044. [PMID: 35845718 PMCID: PMC9282160 DOI: 10.1016/j.ssmqr.2022.100044] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Despite well-documented disparities by sexual and gender minority (SGM) status in suicide attempt and mortality rates, few studies have investigated the lived experiences that contribute to SGM people's disproportionate risk of suicide. Having a history of at least one near-fatal (or medically serious) suicide attempt serves as a proxy for suicide mortality, but no known study has involved SGM people who have made such an attempt. Ideation-to-action theories of suicide posit that individuals acquire the capability for suicide through repeated exposure to painful and provocative events - namely, traumatic, threatening, and risky experiences - that can diminish the pain and fear of death. Yet whether identity-specific features of acquired capability for suicide contribute to SGM people's disproportionate risk of suicide remains unknown. Drawing upon interviews with 22 SGM people who experienced a recent near-fatal suicide attempt, the current study sought to identify specific determinants of how SGM individuals acquire the capability to kill themselves, a potentially powerful, and modifiable, pathway to suicide. Results identified three SGM-specific contributors to the acquired capability for suicide: (1) identity invalidation during developmentally sensitive periods of childhood and adolescence that left participants feeling erased, invisible, and, in some cases, non-existent; (2) normalization of suicide within SGM social networks that increased acceptability and reduced the fear of suicide; and (3) structural stigma and SGM community trauma as habituating sources of pain that engendered feelings of exhaustion and positioned suicide as a reprieve from pervasive anti-SGM norms. This study demonstrates that dominant suicidology theories might need to be refined to account for the stigma-related determinants of SGM suicide. Further, this study reinforces the importance of qualitative methods for understanding the lived experience of suicide and calls for SGM-specific suicide prevention efforts to respond to stigma to support those SGM people who contemplate suicide.
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Affiliation(s)
- Kirsty A. Clark
- Department of Medicine, Health, and Society, Vanderbilt University, United States
- Corresponding. Department of Medicine, Health, and Society, Vanderbilt University, Nashville, TN, 37235, United States. (K.A. Clark)
| | - Travis Salway
- Faculty of Health Sciences, Simon Fraser University, Canada
| | | | - John E. Pachankis
- Department of Social and Behavioral Sciences, Yale School of Public Health, United States
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Belloir JA, Kidd JD, Dworkin JD, Bockting WO. Examining the role of problematic drug use in the relationship between discrimination and sleep disturbance in transgender and nonbinary individuals. Addict Behav 2022; 135:107459. [PMID: 35986953 DOI: 10.1016/j.addbeh.2022.107459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 07/19/2022] [Accepted: 08/02/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Transgender and nonbinary (TGNB) individuals are a health disparity population at high risk for sleep disturbance (e.g., insomnia). Recent evidence suggests minority stress (e.g., discrimination) is associated with sleep disturbance in TGNB adults. However, investigators have yet to identify factors that might explain this relationship. In this study, we investigated the role of problematic drug use (PDU) in the relationship between discrimination and sleep disturbance in TGNB individuals. METHODS The study sample included 194 TGNB participants from Wave 5 (2021) of Project AFFIRM, a multi-site longitudinal study of transgender health. Discrimination, PDU, and sleep disturbance were measured using the Everyday Discrimination Scale, Drug Use Disorders Identification Test (DUDIT), and PROMIS Sleep Disturbance measures, respectively. Individuals were classified as having PDU using established DUDIT criteria that were applied based on sex assigned at birth. Regression analyses were used to estimate the associations of study variables, and subsequently, mediation analysis was used to determine whether PDU partially mediated the association between discrimination and sleep disturbance. RESULTS Nearly half of participants reported PDU, of which 83.2% reported cannabis use. Higher levels of discrimination were associated with worse self-reported sleep disturbance scores. Additionally, participants with greater discrimination were more likely to have PDU. Surprisingly, participants with PDU had lower sleep disturbance scores. CONCLUSIONS Our cross-sectional findings suggest that PDU partially suppressed the association between discrimination and sleep disturbance in TGNB people. Efforts to address PDU in TGNB adults may consider assessing sleep disturbance as a motivating factor for drug use and the potential role of discrimination in perpetuating PDU.
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Affiliation(s)
- Joseph A Belloir
- Columbia University School of Nursing, 560 West 168(th) Street, New York, NY 10032, USA.
| | - Jeremy D Kidd
- Columbia University and the New York State Psychiatric Institute, USA.
| | - Jordan D Dworkin
- Columbia University and the New York State Psychiatric Institute, USA.
| | - Walter O Bockting
- Columbia University and the New York State Psychiatric Institute, USA.
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30
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Kamali A, Sackey H, Gran I, Sigurjónsson H, Farnebo F, Lundgren K, Granath F, Sommar P. Implant Attributes or Patient Characteristics? Factors Affecting Outcome after Breast Augmentation in Transgender Women. Plast Reconstr Surg Glob Open 2022; 10:e4645. [PMID: 37731908 PMCID: PMC10508468 DOI: 10.1097/gox.0000000000004645] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 09/02/2022] [Indexed: 09/22/2023]
Abstract
Implant-based breast augmentation is a valuable tool for treatment of gender dysphoria in transgender women. The aim was to assess whether implant attributes, plane selection, and patient characteristics had an impact on the surgical outcome, and to compare these parameters between transgender and cisgender breast augmentations. Methods A cohort of transgender women who underwent breast augmentation at our department during 2009-2018 were retrospectively studied. The cohort was also compared with a cohort of 12,884 mainly cisgender women registered in the Swedish breast implant registry (BRIMP) during 2014-2019. Results A total of 143 transgender individuals were included, with a median follow-up of 5.7 years. Complications occurred in 20 patients (14.0%), four patients (2.8%) underwent acute reoperation, and 20 patients (14.0%) had secondary corrections. No differences were seen in complication rates when comparing prepectoral with subpectoral placement (15.1% versus 12.9%; P = 0.81); size, less than 400 mL versus greater than or equal to 400 mL (14.7% versus 13.3%; P = 0.81), or the shape of the implants, round versus anatomic (10.7% versus 22.2%; P = 0.10). In comparison with the cohort from BRIMP, the transgender cohort had more round implants (72.0% versus 60.7%; P < 0.01), larger implants (44.1% had volumes of 400-599 mL, compared with 25.4%; P < 0.0001), and more prepectoral placement (51.0% versus 7.3%; P < 0.0001). The risk of reoperation less than 30 days was 1.2% in BRIMP and 2.8% in the transgender cohort (P = 0.08). Conclusions In transgender women, implants are often larger, round, and placed prepectoral' compared with cisgender women. Despite these differences, complication rates were equivalent. Implant attributes, surgical techniques, and patient characteristics were not independently associated with the rate of complications.
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Affiliation(s)
- Alexander Kamali
- From the Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Akademiskt Centrum Plastikkirurgi, Department of Plastic Surgery, Stockholm, Sweden
| | - Helena Sackey
- From the Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Breast, Endocrine Tumors and Sarcoma, Karolinska University Hospital, Stockholm, Sweden
| | - Isak Gran
- From the Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Reconstructive Plastic and Craniofacial Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Hannes Sigurjónsson
- From the Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Filip Farnebo
- From the Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Reconstructive Plastic and Craniofacial Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Kalle Lundgren
- From the Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Fredrik Granath
- Department of Medicine Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
| | - Pehr Sommar
- From the Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Reconstructive Plastic and Craniofacial Surgery, Karolinska University Hospital, Stockholm, Sweden
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Zinchuk M, Kustov G, Beghi M, Voinova N, Pashnin E, Beghi E, Avedisova A, Guekht A. Factors Associated with Non-Binary Gender Identity in Psychiatric Inpatients with Suicidal Ideation Assigned Female at Birth: A Case-Control Study. Arch Sex Behav 2022; 51:3601-3612. [PMID: 36109451 DOI: 10.1007/s10508-022-02424-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 09/03/2022] [Accepted: 09/03/2022] [Indexed: 06/15/2023]
Abstract
The study aimed to investigate factors associated with non-binary gender identity in Russian female psychiatric inpatients with suicidal ideation. This case-control study included 38 female inpatients with non-binary gender identity and a control group-76 cisgender women matched for age (age range 19-35 years, M age, 21.5 years); both groups were psychiatric inpatients with suicidal thoughts. All patients underwent the Self-Injurious Thoughts and Behaviors Interview and completed the brief Reasons for Living Inventory. We also used the WHO Quality of Life Questionnaire (WHOQOL-100) and the Life Style Index (LSI). Non-binary gender identity in inpatients with suicidal ideation was associated with lower educational level, higher unemployment rate, being more socially reticent in preschool, and lifetime sexual experience with both male and female partners. In addition, they were younger at the time of the first suicidal ideation, suicide plan development, and attempt. Non-binary inpatients had lower scores in freedom, physical safety, and security facets of WHOQOL-100 and a higher level of intellectualization on LSI. People with non-binary gender identity face educational, employment, and communication issues. They also have distinct suicidal thoughts and behavioral profiles. These issues and differences mean unique approaches to suicide prevention for a population of inpatients with non-binary gender identity are needed.
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Affiliation(s)
- Mikhail Zinchuk
- Moscow Research and Clinical Center for Neuropsychiatry of the Healthcare Department of Moscow, 43, Donskaya ul., Moscow, 115419, Russian Federation.
| | - Georgii Kustov
- Moscow Research and Clinical Center for Neuropsychiatry of the Healthcare Department of Moscow, 43, Donskaya ul., Moscow, 115419, Russian Federation
| | | | - Nadezhda Voinova
- Moscow Research and Clinical Center for Neuropsychiatry of the Healthcare Department of Moscow, 43, Donskaya ul., Moscow, 115419, Russian Federation
| | - Evgenii Pashnin
- Moscow Research and Clinical Center for Neuropsychiatry of the Healthcare Department of Moscow, 43, Donskaya ul., Moscow, 115419, Russian Federation
| | - Ettore Beghi
- Laboratory of Neurological Disorders, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Alla Avedisova
- Moscow Research and Clinical Center for Neuropsychiatry of the Healthcare Department of Moscow, 43, Donskaya ul., Moscow, 115419, Russian Federation
- Federal Medical Research Centre for Psychiatry and Narcology, Moscow, Russian Federation
| | - Alla Guekht
- Moscow Research and Clinical Center for Neuropsychiatry of the Healthcare Department of Moscow, 43, Donskaya ul., Moscow, 115419, Russian Federation
- Department of Neurology, Neurosurgery and Medical Genetics, Pirogov Russian National Research Medical University, Moscow, Russian Federation
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Blosnich JR. Interpersonal and self-directed violence among sexual and gender minority populations: Moving research from prevalence to prevention. CURR EPIDEMIOL REP 2022; 9:142-160. [PMID: 36845319 PMCID: PMC9957556 DOI: 10.1007/s40471-022-00299-4] [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] [Subscribe] [Scholar Register] [Accepted: 06/27/2022] [Indexed: 11/03/2022]
Abstract
Purpose of review This scoping review of reviews aimed to detail the breadth of violence research about sexual and gender minorities (SGM) in terms of the three generations of health disparities research (i.e., documenting, understanding, and reducing disparities). Recent findings Seventy-three reviews met inclusion criteria. Nearly 70% of the reviews for interpersonal violence and for self-directed violence were classified as first-generation studies. Critical third-generation studies were considerably scant (7% for interpersonal violence and 6% for self-directed violence). Summary Third-generation research to reduce or prevent violence against SGM populations must account for larger scale social environmental dynamics. Sexual orientation and gender identity (SOGI) data collection has increased in population-based health surveys, but administrative datasets (e.g., health care, social services, coroner and medical examiner offices, law enforcement) must begin including SOGI to meet the needs of scaled public health interventions to curb violence among SGM communities.
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Affiliation(s)
- John R. Blosnich
- University of Southern California, Suzanne Dworak-Peck School of Social Work, 669 W 34 St., Los Angeles, CA 90089, USA
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania 15240, USA
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Mitchell RH, Ani C, Cyr C, Irvine J, Joffe AR, Skinner R, Wong S, Stang AS, Laffin M, Korczak DJ. Near-Fatal Self-Harm Among Canadian Adolescents. Can J Psychiatry 2022; 67:598-607. [PMID: 34846182 PMCID: PMC9301146 DOI: 10.1177/07067437211058602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the clinical features of Canadian adolescents admitted to the intensive care unit (ICU) for medically serious self-harm. METHODS 2700 Canadian paediatricians were surveyed monthly over two years (January 2017 to December 2018) through the Canadian Paediatric Surveillance Program to ascertain data from eligible cases. RESULTS Ninety-three cases (73 female; age 15.2 ± 1.5) met the case definition. Four provinces reported the majority of cases: Quebec (n = 27), Ontario (n = 26), Alberta (n = 21), and British Columbia (n = 8). There were 10 deaths, 9 by hanging. Overdose and hanging were the most frequently reported methods of self-harm (74.2% and 19.4%, respectively). Overdose was more common in females (80.8% females vs. 50% males; χ2 = 7.8 (1), p = .005), whereas hanging was more common in males (35% males vs. 15.1% females, χ2 = 3.9 (1), p = .04). More females than males had a past psychiatric diagnosis (79% vs. 58%; χ2 = 4.1 (1), p = .06), a previous suicide attempt (55.9% vs. 29.4%, χ2 = 3.8 (1), p = .05), and prior use of mental health service (69.7% vs. 27.8%, χ2 = 10.4 (1), p = .001). Family conflict was the most commonly identified precipitating factor (43%) of self-harm. CONCLUSIONS Among Canadian adolescents admitted to the ICU with medically serious self-harm, females demonstrate a higher rate of suicide attempts and prior mental health care engagement, whereas males are more likely to die by suicide. These findings are consistent with data from other adolescent samples, as well as data from working-age and older adults. Therefore, a sex-specific approach to suicide prevention is warranted as part of a national suicide prevention strategy; family conflict may be a specific target for suicide prevention interventions among adolescents.
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Affiliation(s)
- Rachel Hb Mitchell
- Department of Psychiatry, 71545Sunnybrook Health Science Centre, University of Toronto, Toronto, ON, Canada
| | - Cornelius Ani
- Division of Psychiatry, 156647Imperial College London Hammersmith Hospital Campus, London, United Kingdom
| | - Claude Cyr
- Département de Pédiatrie, Université de Sherbrooke, 33495CHUS - Hôp Fleurimont, Sherbrooke, QC, Canada
| | - James Irvine
- Department of Family Medicine, Community Health and Epidemiology, 12371University of Saskatchewan, La Ronge, SK, Canada
| | - Ari R Joffe
- Division of Critical Care Medicine, Department of Pediatrics, 103116Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada
| | - Robin Skinner
- 41687Public Health Agency of Canada, Ottawa, ON, Canada
| | - Sam Wong
- Division of Critical Care Medicine, Department of Pediatrics, 103116Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada.,37214Stanton Territorial Hospital, Yellowknife, NT, Canada
| | - Antonia S Stang
- Department of Pediatrics, 9978Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada
| | - Melanie Laffin
- Canadian Paediatric Surveillance Program, Ottawa, ON, Canada
| | - Daphne J Korczak
- Department of Psychiatry, Hospital for Sick Children, Toronto, ON, Canada
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Gosling H, Pratt D, Lea J. Understanding self-harm urges and behavior amongst non-binary young adults: A grounded theory study. Journal of Gay & Lesbian Mental Health 2022. [DOI: 10.1080/19359705.2022.2073310] [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: 10/18/2022]
Affiliation(s)
- Hannah Gosling
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Daniel Pratt
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - James Lea
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
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35
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Waldman G, Benson R. Epilepsy Care in Transgender Patients. Curr Neurol Neurosci Rep 2022; 22:451-458. [PMID: 35666366 DOI: 10.1007/s11910-022-01208-4] [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] [Accepted: 05/01/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW The goal of this review is to outline the main considerations when treating transgender patients with epilepsy. Points to be addressed include the gender affirming hormone therapy regimens and how they interact with anti-seizure medications and seizure control, as well as common co-morbidities in the transgender epilepsy population. RECENT FINDINGS Gender affirming hormone therapy (GAHT) may affect seizure control directly, due to proconvulsant or anticonvulsant properties. GAHT may interact with anti-seizure medications; most notably, estrogen will decrease serum concentration of lamotrigine. Enzyme-inducing anti-seizure medications may decrease hormone levels, potentially interfering with goals of GAHT. Transgender epilepsy patients are at risk for co-morbidities such as decreased bone mineral density and depression. There are minimal direct studies on treatment or outcomes in the transgender epilepsy population. Providers must be knowledgeable about the bi-directional interactions between gender affirming hormone therapy and anti-seizure medications, as well as direct hormonal influences on seizure control. Future research should directly evaluate outcomes in transgender epilepsy patients with regard to seizure control, success of hormone therapy, and management of co-morbidities, to further educate providers and patients how to best manage their healthcare.
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Affiliation(s)
- Genna Waldman
- Department of Neurology, Columbia University, 710 W. 168th Street, 7th floor, New York, NY, 10032, USA.,New York Presbyterian Hospital, 630 West 168th Street , New York, NY, 10032, USA
| | - Rachael Benson
- Department of Neurology, Columbia University, 710 W. 168th Street, 7th floor, New York, NY, 10032, USA.
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36
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Hughes LD, King WM, Gamarel KE, Geronimus AT, Panagiotou OA, Hughto JM. Differences in All-Cause Mortality Among Transgender and Non-Transgender People Enrolled in Private Insurance. Demography 2022; 59:1023-1043. [PMID: 35548863 PMCID: PMC9195044 DOI: 10.1215/00703370-9942002] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [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: 11/19/2022]
Abstract
Few studies have analyzed mortality rates among transgender (trans) populations in the United States and compared them to the rates of non-trans populations. Using private insurance data from 2011 to 2019, we estimated age-specific all-cause mortality rates among a subset of trans people enrolled in private insurance and compared them to a 10% randomly selected non-trans cohort. Overall, we found that trans people were nearly twice as likely to die over the period as their non-trans counterparts. When stratifying by gender, we found key disparities within trans populations, with people on the trans feminine to nonbinary spectrum being at the greatest risk of mortality compared to non-trans males and females. While we found that people on the trans masculine to nonbinary spectrum were at a similar risk of overall mortality compared to non-trans females, their overall mortality rate was statistically smaller than that of non-trans males. These findings provide evidence that some trans and non-trans populations experience substantially different mortality conditions across the life course and necessitate further study.
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Affiliation(s)
- Landon D. Hughes
- School of Public Health and Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Wesley M. King
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | | | - Arline T. Geronimus
- School of Public Health and Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
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37
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Campbell T, Rodgers YVDM. Health insurance coverage and health outcomes among transgender adults in the United States. Health Econ 2022; 31:973-992. [PMID: 35246917 DOI: 10.1002/hec.4483] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 12/22/2021] [Accepted: 01/18/2022] [Indexed: 06/14/2023]
Abstract
This study provides evidence of health and insurance coverage disparities between the cisgender and transgender US populations using repeated cross sections from the 2014-2020 Behavioral Risk Factors Surveillance Systems. The analysis tests whether increasing the incidence of insurance coverage among transgender people could alleviate the health disparity. The empirical approach uses a fuzzy regression discontinuity design that leverages breaks in government health assistance eligibility by age. Results indicate that, for transgender recipients only, insurance coverage meaningfully improves mental health; for cisgender recipients only, insurance coverage reduces difficulties with concentration and memory; and for both the transgender and cisgender populations, insurance coverage contributes to important improvements in physical health, overall health, and healthcare access.
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Affiliation(s)
- Travis Campbell
- Department of Economics, Southern Oregon University, Ashland, Oregon
| | - Yana van der Meulen Rodgers
- Labor Studies and Employment Relations Department, School of Management and Labor Relations, Rutgers University, Piscataway, New Jersey, USA
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38
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Pisani AR, Gould MS, Gallo C, Ertefaie A, Kelberman C, Harrington D, Weller D, Green S. Individuals who text crisis text line: Key characteristics and opportunities for suicide prevention. Suicide Life Threat Behav 2022; 52:567-582. [PMID: 35615898 PMCID: PMC9324113 DOI: 10.1111/sltb.12872] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 04/23/2022] [Accepted: 04/27/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Text-based crisis services are increasingly prominent, with inclusion in the national 988 crisis number launching in 2022. Yet little is known about who uses them. This study seeks to understand the population served by Crisis Text Line (CTL), the largest crisis text service in the United States. METHODS Secondary data analysis was conducted on de-identified Crisis Counselor reports, texter post-conversation survey responses, and anonymized text conversation data from 85,877 texters who contacted CTL during a 12-month period. We examined Crisis Counselor's ratings of suicide ideation severity, texters' reports of race, gender, sexual orientation, recent mental health symptoms, and additional sources of help, and logs of frequency of contact. RESULTS 76% of texters were under 25. 79% were female. 48% identified as other than heterosexual/straight. 64% had only one conversation. 79% were above the clinical cutoff for depression and 80% for anxiety, while 23% had thoughts of suicide. 23% received help from a doctor or therapist, and 28% received help only from CTL. CONCLUSIONS CTL reaches a highly distressed, young, mostly female population, including typically underserved minorities and a substantial percentage of individuals who do not receive help elsewhere. These findings support the decision to include texting in the forthcoming national 988 implementation.
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Affiliation(s)
- Anthony R. Pisani
- Department of Psychiatry, Center for the Study and Prevention of SuicideUniversity of RochesterRochesterNew YorkUSA
| | - Madelyn S. Gould
- Department of PsychiatryColumbia UniversityNew YorkNew YorkUSA,Department of EpidemiologyColumbia UniversityNew YorkNew YorkUSA
| | - Carlos Gallo
- Department of Psychiatry and Behavioral ScienceNorthwestern UniversityChicagoIllinoisUSA
| | - Ashkan Ertefaie
- Department of Biostatics and Computational BiologyUniversity of RochesterRochesterNew YorkUSA
| | - Caroline Kelberman
- Department of Psychiatry, Center for the Study and Prevention of SuicideUniversity of RochesterRochesterNew YorkUSA
| | - Donald Harrington
- Department of Biostatics and Computational BiologyUniversity of RochesterRochesterNew YorkUSA
| | - Daniel Weller
- Department of Biostatics and Computational BiologyUniversity of RochesterRochesterNew YorkUSA
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Reynish T, Hoang H, Bridgman H, Nic Giolla Easpaig B. Barriers and enablers to mental health help seeking of sexual, gender, and erotic minorities: A systematic literature review. Journal of Gay & Lesbian Mental Health 2022. [DOI: 10.1080/19359705.2022.2036666] [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: 10/18/2022]
Affiliation(s)
- Tamara Reynish
- Centre for Rural Health, College of Health and Medicine, School of Health Sciences, University of Tasmania, Launceston, Tasmania, Australia
| | - Ha Hoang
- Centre for Rural Health, College of Health and Medicine, School of Health Sciences, University of Tasmania, Launceston, Tasmania, Australia
| | - Heather Bridgman
- Centre for Rural Health, College of Health and Medicine, School of Health Sciences, University of Tasmania, Launceston, Tasmania, Australia
| | - Bróna Nic Giolla Easpaig
- Centre for Healthcare Resilience & Implement Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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40
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Gosling H, Pratt D, Montgomery H, Lea J. The relationship between minority stress factors and suicidal ideation and behaviours amongst transgender and gender non-conforming adults: A systematic review. J Affect Disord 2022; 303:31-51. [PMID: 34958812 DOI: 10.1016/j.jad.2021.12.091] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 11/10/2021] [Accepted: 12/19/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND The impact of Minority Stress (MS) upon suicidal ideation and behaviours amongst Transgender and Gender Non-Conforming (TGNC) adults is not sufficiently understood, hence our intervention efforts on an individual and societal level are limited. This review aims to evaluate recent literature that reports on the association between MS and suicidal ideation and behaviours amongst TGNC adults. METHODS PsycINFO, Web of Science, MEDLINE, CINAHL and EMBASE were systematically searched for relevant articles. Peer reviewed and grey literature were considered. Included papers reported quantitative analyses on associations between MS factors and suicidal ideation and behaviours amongst TGNC adults. The quality of papers was assessed. RESULTS 28 papers were identified as eligible. Findings suggested positive associations between external and internal minority stressors and suicidal ideation and behaviour. Dysfunctional individual coping was associated with a greater likelihood of suicide attempts. Community resilience was negatively associated with suicidal outcomes, but did not consistently buffer the effects of minority stress. LIMITATIONS Overall quality of included papers was 'poor'. Almost all papers were cross-sectional by design, therefore causality cannot be inferred. Many papers measured variables using non-standardised measures undermining the reliability and validity of reported results. CONCLUSIONS Findings offer support to the application of MS theory to the understanding of suicidal ideation and behaviour amongst TGNC. Future research should use standardised measures and longitudinal designs to better support the investigation of directionality and causality. More research is needed to understand the complex interactions between minority stress factors and the role of resilience in this population.
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Affiliation(s)
- H Gosling
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, UK
| | - D Pratt
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, UK
| | - H Montgomery
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, UK
| | - J Lea
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, UK.
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41
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Caceres BA, Jackman KB, Belloir J, Dworkin J, Dolezal C, Duncan DT, Bockting WO. Examining the associations of gender minority stressors with sleep health in gender minority individuals. Sleep Health 2022; 8:153-160. [PMID: 34922858 PMCID: PMC8995317 DOI: 10.1016/j.sleh.2021.10.006] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 09/07/2021] [Accepted: 10/07/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Investigate the associations of gender minority stressors (including stigma consciousness [SC] and gender-related discrimination [GRD]) with sleep health in gender minority individuals. DESIGN Cohort. PARTICIPANTS 279 gender minority individuals. MEASUREMENTS SC and GRD were measured using the Stigma Consciousness and Everyday Discrimination scales, respectively. Sleep disturbance was assessed using the PROMIS Sleep Disturbance measure. Subjective short sleep duration (<7 hours) was assessed. We used k-means longitudinal clustering to identify minority stress clusters (including SC and GRD scores). Linear and logistic regression models were used to examine the associations of these clusters with sleep disturbance and sleep duration, respectively, adjusted for demographic characteristics. RESULTS Mean age was 36.9 ± 13.6 years; most were non-White (54.5%), 52.5% were transmasculine, and 22.6% were heterosexual. Mean sleep disturbance score was 17.2 ± 6.1 (range 6-30) and 52% reported short sleep duration. We identified 3 minority stress clusters. Compared to participants with low SC/low GRD, those with high SC/low GRD (B 3.33, 95% confidence interval [CI] = 1.64, 5.01) and high SC/high GRD (B 4.51, 95% CI = 2.63, 6.39) had worse sleep disturbance scores. Participants in the high SC/high GRD cluster were more likely to report short sleep duration relative to the low SC/low GRD cluster (adjusted odds ratios 2.17; 95% CI = 1.11-4.26). CONCLUSIONS Participants with both high SC and high GRD had worse sleep health. Future longitudinal studies should examine factors that drive the link between gender minority stress and sleep health in gender minority individuals to inform sleep health interventions tailored for this population.
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Affiliation(s)
- Billy A. Caceres
- Columbia University School of Nursing, 560 West 168 Street, New York, NY 10032
| | - Kasey B. Jackman
- Columbia University School of Nursing, Nurse Researcher, New York-Presbyterian Hospital
| | | | - Jordan Dworkin
- Columbia University and the New York State Psychiatric Institute
| | - Curtis Dolezal
- Division of Gender, Sexuality, and Health, Columbia University and the New York State Psychiatric Institute
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42
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Skuban T, Orzechowski M, Steger F. Restriction of Access to Healthcare and Discrimination of Individuals of Sexual and Gender Minority: An Analysis of Judgments of the European Court of Human Rights from an Ethical Perspective. Int J Environ Res Public Health 2022; 19:2650. [PMID: 35270340 DOI: 10.3390/ijerph19052650] [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: 01/03/2022] [Revised: 02/18/2022] [Accepted: 02/23/2022] [Indexed: 01/27/2023]
Abstract
Individuals of sexual and gender minority (SGM) form a vulnerable group with specific healthcare needs that might be prone to experience discrimination and restrictions regarding their access to healthcare. As the judgments of the European Court of Human Rights (ECtHR) offer a normative perspective on these issues, we analyzed them systematically (1) to identify whether and in what manner ECtHR's judgments concern restriction of access to healthcare for SGM individuals and (2) to identify and categorize the ways of discrimination to which SGM individuals are exposed. We conducted a systematic search of the database of the ECtHR's judgments with the use of specified search terms. Descriptive statistics were performed on the identified judgments. Subsequently, we analyzed the judgments with the use of a qualitative method of thematic analysis. We identified n = 73 cases relevant for our study. In n = 7 (9.59%) of judgments, we found limitations of access to healthcare for SGM individuals, e.g., in cases of restrictions for transsexual individuals to receive hormone or surgical therapy. We regard this as a specific form of discrimination. Furthermore, we identified five other categories of discrimination: restriction of parental rights, failure to respect one's gender identity/sexual orientation, discrimination by jurisdiction, prohibition of promotion, and verbal/physical attacks. The ECtHR proves to have a balanced view on the sensitive topic of sexual self-determination condemning any form of discrimination or restriction of access to healthcare. However, there is a need for further research on discriminatory acts by other individuals, e.g., healthcare providers, rather than by public authorities.
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43
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Malpas J, Pellicane MJ, Glaeser E. Family-Based Interventions with Transgender and Gender Expansive Youth: Systematic Review and Best Practice Recommendations. Transgend Health 2022; 7:7-29. [PMID: 36644030 PMCID: PMC9829155 DOI: 10.1089/trgh.2020.0165] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 01/18/2023] Open
Abstract
Research on transgender and gender expansive (TGE) youth has highlighted the disproportionate and challenging mental health and developmental outcomes faced by these young people. Research also largely suggests that family acceptance of TGE youth's gender identity and expression is crucial to preventing poor psychosocial outcomes in this community. Recently, family-based treatment has become common practice with TGE youth whose families are available for care, but it is unclear whether research provides outcome data for family interventions with TGE youth. This study follows Preferred Systematic Reviews and Meta-Analyses (PRISMA) guidelines to systematically review articles that provide outcome data or clinical recommendations for family-based interventions with TGE youth and their families. No quantitative outcome data for family therapy with TGE youth were found, but numerous articles spanning decades (n=32) provided clinical practice recommendations for family-based interventions with this population. Very few articles provided outcome data for family therapy with sexual minority youth (n=2). Over time, clinical strategies have moved from pathologizing to affirming of TGE youths' gender journey. Common clinical strategies of affirming interventions include (1) providing psychoeducation, (2) allowing space for families to express reactions to their child's gender, (3) emphasizing the protective power of family acceptance, (4) utilizing multiple modalities of support, (5) giving families opportunities for allyship and advocacy, (6) connecting families to TGE community resources, and (7) centering intersectional approaches and concerns. Future research should examine the efficacy of family-based interventions that incorporate these clinical strategies and collect quantitative data to systematically determine their effect on psychosocial outcomes.
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Affiliation(s)
- Jean Malpas
- The Gender & Family Project, Ackerman Institute for the Family, New York, New York, USA.,Private Practice, New York, New York, USA.,Address correspondence to: Jean Malpas, LMFT, LMHC, 1133 Broadway, Suite 1511, New York, NY 10010, USA,
| | - Michael J. Pellicane
- The Gender & Family Project, Ackerman Institute for the Family, New York, New York, USA.,Department of Psychological Sciences, Kent State University, Kent, Ohio, USA
| | - Elizabeth Glaeser
- The Gender & Family Project, Ackerman Institute for the Family, New York, New York, USA.,Department of Counseling Psychology, Teachers College Columbia University, New York, New York, USA
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44
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Dempsey B, Looney K, Mcnamara R, Michalek S, Hennessy E. An experimental investigation of adolescent and young adult responses to stigmatizing and supportive social media posts in response to a depressed peer. Computers in Human Behavior 2022. [DOI: 10.1016/j.chb.2022.107229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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45
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Carranza AB, Wallis CRD, Jonnson MR, Klonsky ED, Walsh Z. Nonsuicidal Self-Injury and Intimate Partner Violence: Directionality of Violence and Motives for Self-Injury. J Interpers Violence 2022; 37:1688-1707. [PMID: 32437310 DOI: 10.1177/0886260520922372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Nonsuicidal self-injury (NSSI) is associated with intimate partner violence (IPV) perpetration and victimization. However, extant research has not distinguished between unidirectional and bidirectional IPV and has not examined relationships between IPV and functions of self-injury. This study of 1,018 university students revealed a significantly higher prevalence of NSSI among those who reported bidirectional IPV compared with nonviolent individuals. However, rates of NSSI in the unidirectional IPV groups are more similar to rates of NSSI in the bidirectional group than in nonviolent individuals. Individuals who engaged in bidirectional IPV were more likely to endorse interpersonal functions of self-injury than those who engaged in unidirectional IPV or no IPV. In contrast, intrapersonal functions of NSSI were not associated with IPV. Findings suggest that the association between IPV and NSSI may be best understood in the context of relationship conflict, rather than as a distinct correlate of either IPV victimization or IPV perpetration.
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Affiliation(s)
| | | | | | | | - Zach Walsh
- University of British Columbia, Kelowna, Canada
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46
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Pellicane MJ, Ciesla JA. Associations between minority stress, depression, and suicidal ideation and attempts in transgender and gender diverse (TGD) individuals: Systematic review and meta-analysis. Clin Psychol Rev 2022; 91:102113. [PMID: 34973649 DOI: 10.1016/j.cpr.2021.102113] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 12/13/2021] [Accepted: 12/16/2021] [Indexed: 02/07/2023]
Abstract
Minority stress theory posits that transgender and gender diverse (TGD) individuals exhibit greater rates of depression and suicidality due to internal (proximal) and external (distal) stressors related to their TGD identity. Yet, the magnitude of the relationship between minority stress processes and mental health outcomes has not been quantitatively summarized. The current research meta-analyzed the relationship between minority stress constructs and depression, suicidal ideation, and suicide attempt. Results from 85 cross-sectional quantitative studies indicate that distal stress, expectations of rejection, internalized transphobia, and concealment are significantly associated with increased depression, suicidal ideation, and suicide attempt. Greater effect sizes were observed for expectations of rejection and internalized transphobia when compared to distal stress and concealment. Future research on the relationship between minority stress, depression, and suicide would benefit from longitudinal designs and more diverse and representative samples of TGD individuals.
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47
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Kauten RL, Carter SP, Stivers M, Novak LA, Baer MM, Lacroix JM, Grant NE, Sickmann B, Goldston DB, Soumoff A, Ghahramanlou-holloway M. Post-Admission Cognitive Therapy for a Transgender Service Member With a Recent Suicidal Crisis: A Case Study of Gender-Affirming Care. Cognitive and Behavioral Practice 2022. [DOI: 10.1016/j.cbpra.2021.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Abstract
Transgender (trans) communities in the USA and globally have long organized for health and social equity but have only recently gained increased visibility within public health. In this review, we synthesize evidence demonstrating that trans adults in the USA are affected by disparities in physical and mental health and in access to health care, relative to cisgender (nontrans) persons. We draw on theory and data to situate these disparities in their social contexts, explicating the roles of gender affirmation, multilevel and intersectional stigmas, and public policies in reproducing or ameliorating trans health disparities. Until recently, trans health disparities were largely made invisible by exclusionary data collection practices. We highlight the importance of, and methodological considerations for, collecting inclusive sex and gender data. Moving forward, we recommend routine collection of gender identity data, an emphasis on intervention research to achieve trans health equity, public policy advocacy, and investment in supporting gender-diverse public health leadership. Expected final online publication date for the Annual Review of Public Health, Volume 43 is April 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- Ayden I Scheim
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA; .,Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Kellan E Baker
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Whitman-Walker Institute, Whitman-Walker Health, Washington, DC, USA
| | - Arjee J Restar
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington 98195, USA
| | - Randall L Sell
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
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49
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Kiyar M, Kubre MA, Collet S, Bhaduri S, T’Sjoen G, Guillamon A, Mueller SC. Minority Stress and the Effects on Emotion Processing in Transgender Men and Cisgender People: A Study Combining fMRI and 1H-MRS. Int J Neuropsychopharmacol 2021; 25:350-360. [PMID: 34878531 PMCID: PMC9154245 DOI: 10.1093/ijnp/pyab090] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 11/12/2021] [Accepted: 12/06/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Minority stress via discrimination, stigmatization, and exposure to violence can lead to development of mood and anxiety disorders and underlying neurobiochemical changes. To date, the neural and neurochemical correlates of emotion processing in transgender people (and their interaction) are unknown. METHODS This study combined functional magnetic resonance imaging and magnetic resonance spectroscopy to uncover the effects of anxiety and perceived stress on the neural and neurochemical substrates, specifically choline, on emotion processing in transgender men. Thirty transgender men (TM), 30 cisgender men, and 35 cisgender women passively viewed angry, neutral, happy, and surprised faces in the functional magnetic resonance imaging scanner, underwent a magnetic resonance spectroscopy scan, and filled out mood- and anxiety-related questionnaires. RESULTS As predicted, choline levels modulated the relationship between anxiety and stress symptoms and the neural response to angry and surprised (but not happy faces) in the amygdala. This was the case only for TM but not cisgender comparisons. More generally, neural responses in the left amygdala, left middle frontal gyrus, and medial frontal gyrus to emotional faces in TM resembled that of cisgender women. CONCLUSIONS These results provide first evidence, to our knowledge, of a critical interaction between levels of analysis and that choline may influence neural processing of emotion in individuals prone to minority stress.
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Affiliation(s)
- Meltem Kiyar
- Correspondence: Meltem Kiyar, MSc, Department of Experimental Clinical and Health Psychology, Ghent University, Henri Dunantlaan 2, 9000, Ghent, Belgium ()
| | - Mary-Ann Kubre
- Department of Experimental Clinical and Health Psychology, Ghent University, Belgium
| | - Sarah Collet
- Department of Endocrinology, Ghent University Hospital, Belgium
| | - Sourav Bhaduri
- Department of Experimental Clinical and Health Psychology, Ghent University, Belgium,Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, United Kingdom
| | - Guy T’Sjoen
- Department of Endocrinology, Ghent University Hospital, Belgium
| | - Antonio Guillamon
- Department of Psychobiology, National Distance Education University, Madrid, Spain
| | - Sven C Mueller
- Department of Experimental Clinical and Health Psychology, Ghent University, Belgium
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50
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Warne N, Heron J, Mars B, Kwong ASF, Solmi F, Pearson R, Moran P, Bould H. Disordered eating and self-harm as risk factors for poorer mental health during the COVID-19 pandemic: a UK-based birth cohort study. J Eat Disord 2021; 9:155. [PMID: 34861897 PMCID: PMC8640708 DOI: 10.1186/s40337-021-00510-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 11/16/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Young adults and especially those with pre-existing mental health conditions, such as disordered eating and self-harm, appear to be at greater risk of developing metal health problems during the COVID-19 pandemic. However, it is unclear whether this increased risk is affected by any changes in lockdown restrictions, and whether any lifestyle changes could moderate this increased risk. METHODS In a longitudinal UK-based birth cohort (The Avon Longitudinal Study of Parents and Children, ALSPAC) we assessed the relationship between pre-pandemic measures of disordered eating and self-harm and mental health during the COVID-19 pandemic in 2657 young adults. Regression models examined the relationship between self-reported disordered eating, self-harm, and both disordered eating and self-harm at age 25 years and depressive symptoms, anxiety symptoms and mental wellbeing during a period of eased restrictions in the COVID-19 pandemic (May-July 2020) when participants were aged 27-29 years. Analyses were adjusted for sex, questionnaire completion date, pre-pandemic socioeconomic disadvantage and pre-pandemic mental health and wellbeing. We also examined whether lifestyle changes (sleep, exercise, alcohol, visiting green space, eating, talking with family/friends, hobbies, relaxation) in the initial UK lockdown (April-May 2020) moderated these associations. RESULTS Pre-existing disordered eating, self-harm and comorbid disordered eating and self-harm were all associated with the reporting of a higher frequency of depressive symptoms and anxiety symptoms, and poorer mental wellbeing during the pandemic compared to individuals without disordered eating and self-harm. Associations remained when adjusting for pre-pandemic mental health measures. There was little evidence that interactions between disordered eating and self-harm exposures and lifestyle change moderators affected pandemic mental health and wellbeing. CONCLUSIONS Young adults with pre-pandemic disordered eating, self-harm and comorbid disordered eating and self-harm were at increased risk for developing symptoms of depression, anxiety and poor mental wellbeing during the COVID-19 pandemic, even when accounting for pre-pandemic mental health. Lifestyle changes during the pandemic do not appear to alter this risk. A greater focus on rapid and responsive service provision is essential to reduce the impact of the pandemic on the mental health of these already vulnerable individuals. The aim of this project was to explore the mental health of young adults with disordered eating behaviours (such as fasting, vomiting/taking laxatives, binge-eating and excessive exercise) and self-harm during the COVID-19 pandemic. We analysed data from an established study that has followed children from birth (in 1991 and 1992) up to present day, including during the pandemic when participants were 28 years old. We looked at the relationship between disordered eating and/or self-harm behaviours from before the pandemic and mental health problems (symptoms of depression and anxiety) and mental wellbeing during the pandemic. We also explored whether there were any lifestyle changes (such as changes in sleep, exercise, visiting green space) that might be linked to better mental health and wellbeing in young adults with disordered eating and self-harm. We found that young adults with prior disordered eating and/or self-harm had more symptoms of depression and anxiety, and worse mental wellbeing than individuals without prior disordered eating or self-harm. However, lifestyle changes did not appear to affect mental health and wellbeing in these young adults. Our findings suggest that people with a history of disordered eating and/or self-harm were at high risk for developing mental health problems during the pandemic, and they will need help from mental health services.
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Affiliation(s)
- Naomi Warne
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK.
| | - Jon Heron
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
| | - Becky Mars
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
| | - Alex S F Kwong
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, Bristol, UK
- Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | | | - Rebecca Pearson
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
- MRC Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, Bristol, UK
| | - Paul Moran
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
| | - Helen Bould
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
- MRC Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, Bristol, UK
- Gloucestershire Health and Care NHS Foundation Trust, Gloucester, UK
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