Anxiety and Depression in Transgender Individuals: The Roles of Transition Status, Loss, Social Support, and Coping

ArticleinJournal of Consulting and Clinical Psychology 81(3) · February 2013with 1,296 Reads
DOI: 10.1037/a0031774 · Source: PubMed
Cite this publication
Objective: The purpose of the current study was to examine facilitative and avoidant coping as mediators between distress and transition status, social support, and loss. Method: A total of 351 transgender individuals (n = 226 transgender women and n = 125 transgender men) participated in this study. Participants completed measures on transgender identity, family history of mental health concerns, perceptions of loss, coping, depression, and anxiety. Results: The rates of depressive symptoms (51.4% for transgender women; 48.3% for transgender men) and anxiety (40.4% for transgender women; 47.5% for transgender men) within the current study far surpass the rates of those for the general population. Structural equation modeling (SEM) was used to analyze the data-2 separate models were hypothesized, based on reports of anxiety or depression. The SEM results suggest that the processes for transgender women and transgender men are primarily similar for depression and anxiety; avoidant coping served as a mediator between transition status and both distress variables. Social support was directly related to distress variables, as well as indirectly related through avoidant coping. Conclusion: Results suggest the need for practitioners to focus on interventions that reduce avoidant coping strategies, while simultaneously increasing social support, in order to improve mental health for transgender individuals. Individuals who are in the beginning stages of their transition will use different coping strategies than those who are in later stages; interventions should be adjusted on the basis of the transition status of transgender clients.

Do you want to read the rest of this article?

Request Full-text Paper PDF
  • Article
    Full-text available
    • Michal J. McDowell
    • Sari L Reisner
      Sari L Reisner
    • Jaclyn White Hughto
      Jaclyn White Hughto
    Background: Trans-masculine (TM) individuals, who are assigned female sex at birth and identify along the masculine gender spectrum, face mental health disparities relative to cisgender people. Limited research has sought to explore the multi-level risk and protective factors associated with mental health morbidity for TM populations. Methods: Between August 2015–September 2016, 150 TM adults were enrolled in a one-time biobehavioral health study. A survey assessed socio-demographics, past 12-month everyday discrimination, lifetime intimate partner violence (IPV), resilience (using the Brief Resilience Scale), and other factors. Bivariate and multivariable logistic regression analyses examined associations between participant characteristics and four mental health statuses: post-traumatic stress disorder (PTSD), depression, anxiety, and non-suicidal self-injury (NSSI). Results: In this sample (76.7% had a binary gender identity, i.e., man or transgender man; 74.7% were white, 70. 0% were under age 30 years), 42.2% had PTSD based on past 30-day symptoms; 25.7% had depression based on past 7-day symptoms; 31.1% had anxiety based on past 7-day symptoms; and 15.0% had engaged in NSSI within the past 12-months. Results from multivariable models: 1) PTSD: unemployment, lifetime IPV and past 12-month discrimination were each associated with increased odds of PTSD, while having a partner was associated with the reduced odds of PTSD. 2) Depression: lower educational attainment and past 12-month discrimination were each associated with the increased odds of depression, while greater resilience was associated with the reduced odds of depression. 3) Anxiety: low annual household income and past 12-month discrimination were each associated with the increased odds of anxiety, while resilience was associated with the reduced odds of anxiety. 4) NSSI: past 12-month discrimination was associated with the increased odds of past 12-month NSSI, while higher age and greater resilience was associated with the reduced odds of NSSI (all p-values < 0.05). Conclusions: Unemployment, low income, limited education, everyday discrimination, and violence were risk factors for poor mental health, while being in a relationship, higher age, and personal resilience were protective against mental health morbidity. Findings highlight the need for interventions to address the individual, interpersonal, and societal factors that may be driving poor mental health in this population.
  • Article
    Full-text available
    • Noelia Fernández-Rouco
      Noelia Fernández-Rouco
    • Rodrigo J. Carcedo
      Rodrigo J. Carcedo
    • Félix López
      Félix López
    • Begoña M Orgaz
      Begoña M Orgaz
    This paper explores the subjective perception of some personal and interpersonal aspects of the lives of transgender people and the relationship they have with their mental health. One hundred and twenty transgender people (60 men and 60 women) participated in semi-structured interviews. Following quantitative methodology, analysis highlighted that social loneliness is the main predictor of lower levels of mental health (anxiety and depression) for both genders and recognized romantic loneliness as the strongest factor among transgender men. In both cases, higher levels of loneliness were associated with lower levels of mental health. The results have guided us to improve institutional and social responses and have provided an opportunity to promote the mental health of transgender people.
  • Article
    • Jae A. Puckett
      Jae A. Puckett
    • Emmie Matsuno
      Emmie Matsuno
    • Christina Dyar
      Christina Dyar
    • Michael E Newcomb
      Michael E Newcomb
    Research has generally shown the benefits of social support, such as the buffering effects on life stressors, yet there has been little empirical investigation of different types of support resources for transgender individuals. We examined family support, support from friends, and connectedness to a transgender community and how these forms of support come together to influence mental health and resilience. The sample included 695 transgender participants (mean age = 25.52 years, SD = 9.68, range = 16-73; 75.7% White) who completed an online survey. Greater than half of participants reported moderate to severe levels of anxious and depressive symptoms. Family social support had the strongest correlations with symptoms of anxiety and depression (r = -.31 and -.37, respectively, p < .01) and was the only form of support associated with resilience when controlling for other forms of support. Latent profile analyses revealed 4 groups based on levels of social support from family and friends and community connectedness. Notably, Class 1 (n = 323; 47.1%) had high levels of support from family and friends and high levels of community connectedness. This class had lower levels of depression and anxiety symptoms and higher levels of resilience compared to other classes (Class 2, n = 276, 40.3%, high friend/community, low family; Class 3, n = 47, 6.9%, low support; Class 4, n = 39, 5.7%, high family, low friend/community). This study highlights the importance of examining support from a more holistic approach and provides insight into unique associations between familial social support and resilience. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
  • Article
    • Emmie Matsuno
      Emmie Matsuno
    • Tania Israel
      Tania Israel
    Transgender people experience disproportionately high mental and physical health risks. Minority stress theory identifies distal and proximal stressors that contribute to negative mental health outcomes for transgender people, and suggests that resilience factors can buffer the negative influence of these stressors. In this article, we aim to synthesize the psychological literature on resilience strategies among transgender people and position it within the minority stress framework and introduce an adapted model called the transgender resilience intervention model (TRIM). The TRIM suggests that social support, community belonging, family acceptance, participating in activism, having positive role models, and being a positive role model are group-level resilience factors. Self-worth, self-acceptance and/or pride, self-definition, hope, and transition are individual-level factors that promote resilience. Community, group, and individual interventions and their potential influence on resilience are discussed. The model calls for the development of additional interventions aimed at increasing resilience for transgender people.
  • Chapter
    • Carla A. Pfeffer
      Carla A. Pfeffer
    • Natalie N. Castañeda
    This chapter offers a broad survey of existing research on trans individuals and partnerships conducted across the disciplines and professions of counseling, family studies, medicine, psychology, social work, sociology, and women’s and gender studies, with the goal of assessing and distilling factors associated with the stability and instability of relationships in which at least one of the members is trans. This chapter also provides an assessment of key sources of support and strain for trans partnerships as identified by researchers or that deserve further research exploration. Finally, the authors identify a number of researcher assumptions and biases that may cloud the interpretation of some research findings and outcomes in trans people’s partnerships, suggesting avenues for further focus in clinical practice and research.
  • Article
    Full-text available
    • Oliver L. Haimson
      Oliver L. Haimson
    Objective: Transgender people face substantial mental health disparities, and this population's emotional well-being can be particularly volatile during gender transition. Understanding gender transition sentiment patterns can positively impact transgender people by enabling them to anticipate, and put support in place for, particularly difficult time periods. Yet, tracking sentiment over time throughout gender transition is challenging using traditional research methods. This study's objective was to use social media data to understand average gender transition sentiment patterns. Materials and methods: Computational sentiment analysis and statistics were used to analyze 41 066 posts from 240 Tumblr transition blogs (online spaces where transgender people document gender transitions) to understand sentiment patterns over time and quantify relationships between transgender identity disclosures, sentiment, and social support. Results: Findings suggest that sentiment increases over time on average throughout gender transition, particularly when people receive supportive responses to transgender identity disclosures. However, after disclosures to family members, people experienced temporary increased negative sentiment, followed by increased positive sentiment in the long term. After transgender identity disclosures on Facebook, an important means of mass disclosure, those with supportive networks experienced increased positive sentiment. Conclusions: With foreknowledge of sentiment patterns likely to occur during gender transition, transgender people and their mental healthcare professionals can prepare with proper support in place throughout the gender transition process. Social media are a novel data source for understanding transgender people's sentiment patterns, which can help reduce mental health disparities for this marginalized population during a particularly difficult time.
  • Article
    • Laurel B. Watson
      Laurel B. Watson
    • Luke Allen
      Luke Allen
    • Mirella J. Flores
      Mirella J. Flores
    • Michelle Farrell
    To date, researchers assessing the role of discrimination in trans peoples’ lives have relied upon measures that were developed and normed on LGB populations, culled specific items from large-scale survey data, or used more generalized measures of discrimination that do not specifically assess the unique forms of discrimination that trans people may encounter. Thus, the purpose of this three-part study was to develop and provide psychometric support for a measure of trans peoples’ discrimination. In Study 1, a five-factor model emerged, which included: Microaggressions and Harassment, Restricted Career and Work Opportunities, Maltreatment in Health Care Settings, Harassment by Law Enforcement, and Bullying and Harassment in Educational Settings. Internal consistency estimates for subscale and total scale scores ranged from acceptable to excellent. Results from Study 2 revealed that a bifactor model provided the best fit to the data, revealing that the scale is essentially unidimensional. In addition, convergent and concurrent validity was supported, demonstrating significant positive correlations with another measure of trans discrimination, internalized transphobia, nondisclosure, negative expectations for the future, psychological distress, and perceived stress. In Study 3, results revealed excellent test–retest reliability up to a three-week period. Collectively, results suggested that the Transgender Discrimination Scale-21 (TDS-21) is a psychometrically sound measure that may be used to advance research on the role of discrimination in trans peoples’ lives.
  • Article
    Full-text available
    • Amaya Gabriela Perez-Brumer
      Amaya Gabriela Perez-Brumer
    • Amy Nunn
    • Elaine Hsiang
    • Sarah MacCarthy
    HIV disproportionately impacts transgender communities and the majority of new infections occur in the Southern United States. Yet, limited data exists on contextual realities of HIV vulnerability and healthcare needs among transgender individuals in the Deep South. Addressing this gap in the literature, we assess the health needs, including barriers and facilitators to accessing healthcare, including and beyond HIV, from the perspective of transgender men and women in Mississippi. Between June-August 2014, in-depth, semi-structured qualitative interviews (n = 14) were conducted with adult transgender persons at an LGBT healthcare setting in Jackson, Mississippi. In-depth interviews lasted between 60-90 minutes and followed semi-structured format (themes probed: HIV vulnerability, healthcare needs, and availability of gender-affirming medical care). Audio files were transcribed verbatim and analyzed using Dedoose (v.6.1.18). Among participants (mean age = 23.3 years, standard deviation = 4.98), 43% identified as a transgender man or on a transmasculine spectrum, 43% as Black, and 21% self-reported living with HIV. HIV-related services were frequently described as the primary gateway to accessing healthcare needs. Nonetheless, participants' primary health concerns were: gender affirmation processes (hormones, silicone, binding/packing); mental health; and drug/alcohol use. Stigma and discrimination were commonly reported in healthcare settings and health-related information was primarily attained through social networks and online resources. Results highlight gender identity alongside race and pervasive marginalization as key social determinants of transgender health in Mississippi. As Mississippi is one of several states actively debating transgender access to public accommodations, findings underscore the need to treat transgender health as a holistic and multidimensional construct, including, but moving beyond, HIV prevention and care.
  • Article
    Full-text available
    • Marta Evelia Aparicio Garcia
      Marta Evelia Aparicio Garcia
    Young transgender and non-binary individuals (TNBI) are exposed to situations of discrimination and have a greater risk of violence. The purpose of this study is to analyze which protective, violence and health and well-being factors have more influence on TNBI compared to cisgender people. The sample comprised 856 youth between 14 and 25 years old. A survey including questions about sociodemographic information and protective, violence and health and well-being factors was designed ad hoc for this study. The results show the non-binary group received the least support from family and friends, higher risk of suffering cyberbullying, and many feel isolated and unhappy. TNBI have suffered more verbal attacks both inside and outside their school and physical attacks at school than cisgender young. These results are important because they may contribute to the promotion of public policies and clinical interventions that favor the integration of TNBI in our society.
  • Article
    • Nova J. Bradford
      Nova J. Bradford
    • Jory M. Catalpa
    Researchers have identified important psychosocial distinctions between three emergent gender categories: cisgender, binary transgender, and non-binary transgender. The present study further examines such heterogeneous experiences and explores the methodological implications for research of the transgender community. Participants were 153 cisgender, 201 binary transgender, and 164 non-binary transgender American adults who completed questionnaires on the topics of life satisfaction, gender determinism, and perceived social support. Results demonstrate that non-binary transgender participants report lower gender determinism than both cisgender and binary transgender participants. Furthermore, correlations between significant other support and life satisfaction were higher in cisgender participants than either binary or non-binary transgender participants, whereas the correlation between friend support and life satisfaction was higher in both cisgender and binary transgender participants than in non-binary transgender participants. These results threaten the methodological coherence of studying a unitary “transgender community,” and suggest that some meaningful group differences can be attributed to one of two dimensions of gender variance: cisgender versus transgender identity, or binary versus non-binary gender identity. Future survey research should further explore the methodology of assessing non-binary identity and transgender identity using separate items.
  • Article
    • Xi Han
    • Wenting Han
    • Jiabin Qu
    • Qinghua Zhu
    Social media is increasingly popular among LGBT (lesbian, gay, bisexual and transgender) who have a higher risk of depression and dis-identification in China. However, it is unclear whether psychological dependency on social media and social media use behavior have beneficial offline effects. We conducted an online survey of 1391 valid LGBT recruited in China and also interviewed five LGBT Weibo users to better explain some results. We found LGBT with higher levels of depression and dis-identification were more likely to be psychologically dependent on social media. Higher levels of social media dependency were predictive of social media use, and both online social support seeking and offering activities contributed individually as predictor of perceived online social support. Perceived online social support was not negatively related to offline depression and dis-identification, which meant what happens online may stay online. LGBT who has a longer history of using Weibo would be less dependent on social media, perceive less online social support and have better offline psychological wellbeing. The mechanism of how social media use affects offline life of LGBT needs to be further examined. Limitations, future directions and recommendations are discussed.
  • Article
    Full-text available
    • Michael Berner
    • Peer Briken
      Peer Briken
    • Werner Ettmeier
    • Katharina Woellert
    "Die vorliegende Leitlinie wurde in einer Phase von Veränderungen der diagnostischen Kriterien und Manuale erstellt. Diese reflektieren einerseits die Diagnose Geschlechtsdysphorie im DSM-5 (APA., 2013) und den Vorschlag der Diagnose Geschlechtsinkongruenz in der ICD-11 (Drescher, Cohen-Kettenis, & Winter, 2012). Sie spiegeln ein reformiertes Verständnis einer Trans-Gesundheitsversorgung und dokumentieren, dass die ICD-10-Diagnose Transsexualis-mus (F64.0) international als überholt betrachtet wird (u. a. Drescher et al., 2012). Andererseits ist die ICD-10 weiterhin in Kraft und bis zur Übernahme der ICD-11 in Deutschland (voraus-sichtlich im Jahr 2022) auch sozialrechtlich bindend. Allerdings ist die Versorgungsrealität in-ternational und in Deutschland kaum noch am Paradigma der ICD-10-Diagnose Transsexua-lismus (F64.0) orientiert (vgl. hierzu z. B. die Empfehlungen der American Psychological Association, 2015)."
  • Preprint
    Full-text available
    • Marta Evelia Aparicio Garcia
      Marta Evelia Aparicio Garcia
    • Eva María Díaz-Ramiro
    • Susana Rubio Valdehita
      Susana Rubio Valdehita
    • Isidro García-Nieto
    Purpose: Young transgender and non-binary are exposed to situations of discrimination and have a greater risk of violence. The purpose of this study is to analyze which protective, violence and health and well-being factors have more influence on transgender and non-binary people compared to cisgender people. Method: The sample comprised 856 people between 14 and 25 years old. A survey including questions about sociodemographic information and protective, violence and health and well-being factors was designed ad hoc for this study. Results: The results show non-binary group received the least support from family and friends, higher risk of suffering cyberbullying and a higher feel isolated and unhappy. Non-binary and transgender have suffered more verbal attacks both inside and outside their school and physical attacks at school than cisgender young. Conclusions: These results are important and may contribute to promote public policies and clinical interventions to favor the integration of non-binary and transgender people in our society.
  • Article
    Full-text available
    • M. Paz Galupo
      M. Paz Galupo
    • Lex Pulice-Farrow
      Lex Pulice-Farrow
    • Alex P Bravo
      Alex P Bravo
    Microaffirmations are small, interpersonal interactions that communicate validation for an identity. The present study focuses on transgender microaffirmations received from romantic partners. Participants included 339 self-identified transgender adults in a romantic relationship (currently or within the past 5 years). Participants were recruited via social media and snowball sampling and took an online survey detailing their experiences in romantic relationships. Participant responses were analyzed via thematic analysis, resulting in seven relationship-salient themes: (1) acknowledging and using cisgender privilege, (2) centering on partner’s identity, (3) affirming gender(less) presentation, (4) helping partner process identity, (5) seeking permission, (6) using affirming language, and (7) acknowledging milestones. Findings emphasize the importance of positive aspects of romantic relationships. Implications for working with transgender clients are discussed.
  • Article
    Full-text available
    • Myria Ioannou
      Myria Ioannou
    • Angelos P. Kassianos
      Angelos P. Kassianos
    • Maria Symeou
      Maria Symeou
    Introduction: The interrelationship between social support, depressive symptoms, stress and self-esteem in young adults remains unclear. This study aims to test the mediating role of self-esteem in the relationship between social support and depressive symptoms and the moderating role of perceived stress in the relationship between the two. This is important to inform components of future intervention development targeting youth depression. Methods: Three hundred forty-four (N = 344) young adults in Cyprus aged 17–26 (78% female) completed measures of self-esteem, social support, depressive symptoms, and perceived stress. Structural equation models were used to examine the interactions between social support and depressive psychopathology, whereas mediational analyses were run to examine the mediating role of self-esteem. Latent moderated mediation models were applied to examine the potentially moderating role of perceived stress. Results: Perceived social support from family and friends were significantly related to lower depressive symptoms. Self-esteem fully mediated the relationship between perceived family support and depressive symptoms. Perceived stress moderated the model, and perceived social support was found to be more protective against depressive symptoms when moderate levels of stress were presented. Conclusion: The study demonstrates that social support is protective against depressive symptoms. Self-esteem and perceived stress are important mechanisms that interact with this effect. Implications include the efforts to increase perceived family support during college years and management of stress levels before working with depressive symptoms.
  • Article
    Full-text available
    • Anne-Marie E Alberse
    • Annelou L C de Vries
      Annelou L C de Vries
    • Wieteke S Elzinga
    • Thomas D Steensma
      Thomas D Steensma
    Transgender children and adolescents show high rates of co-occurring psychopathology, which might be related to low self-confidence. Earlier research showed that compared to the norm population, transgender clinic–referred children have lower self-perception on two domains: physical appearance and global self-worth. This study aimed to compare self-perception in a sample of transgender clinic–referred children and adolescents with their standardization samples and to examine differences between these two groups. To measure self-esteem, the Self-Perception Profile for Children was administered to 305 referred children (162 assigned males at birth (AMABs) and 143 assigned females at birth (AFABs), mean age = 9.05 (SD, 1.47), range = 5.9–13.00 years), and the Self-Perception Profile for Adolescents was administered to 369 referred adolescents (118 AMABs and 251 AFABs, mean age = 15.27 (SD, 1.80), range = 10.73–18.03 years). To measure the severity of gender dysphoria, the parents of the children completed the Gender Identity Questionnaire and the adolescents completed the Utrecht Gender Dysphoria Scale. Referred children and adolescents had a significantly lower self-concept compared to the normative population, whereby referred adolescents felt less competent compared to referred children. Compared to their peers, childhood referred AFABs perceived themselves even better on scholastic and athletic competence and social acceptance. With regard to gender differences, referred AFABs generally showed a better self-perception compared to referred AMABs. The lower self-perception of transgender clinic–referred children and adolescents compared to same age peers deserves clinical attention and interventions aimed at, for example, improving social and physical self-worth.
  • Article
    • Annalisa Anzani
      Annalisa Anzani
    • Antonio Prunas
      Antonio Prunas
    • Simona Sacchi
      Simona Sacchi
    The present study aims at investigating the role of anti-transgender bias in the psychological assessment of transgender (vs. cisgender) patients. To this purpose, a female sample of licensed psychotherapists (N = 218) was presented with clinical vignettes that described a transgender (vs. cisgender) man (vs. woman) reporting depressive symptoms or anger outbursts. Participants were asked to evaluate the fictitious patient answering questions on their diagnostic impressions (e.g., psychopathological severity). Moreover, the respondents’ individual variables (i.e., right-wing authoritarianism) were also assessed. Results revealed that, for high levels of authoritarianism, psychotherapists evaluated cisgender women as more severe than transwomen and cisgender men. Implications for clinical practice are discussed.
  • Article
    • Sari L Reisner
      Sari L Reisner
    • Noor Beckwith
    • Michal J. McDowell
    • Alex S Keuroghlian
      Alex S Keuroghlian
    Purpose: Transgender and nonbinary people have an increased burden of psychiatric problems compared with the general population. Data are needed to understand factors associated with psychiatric diagnoses, acuity in terms of suicide attempts and level-of-care escalation, and outpatient engagement among transgender and nonbinary adults. Methods: We conducted a retrospective review of records from 201 transgender and nonbinary adults who presented for primary care at a health center. Regression models were fit to examine factors associated with psychiatric diagnoses, substance use disorders (SUDs), acuity, and outpatient behavioral health engagement. Results: Male sex assignment at birth was associated with decreased odds of a psychiatric diagnosis (odds ratio [OR] 0.40, 95% confidence interval [CI]: 0.20-0.81). Increased odds of SUDs were associated with later hormone initiation (OR 1.04, 95% CI: 1.01-1.08) and suicide attempt (OR 5.79, 95% CI: 2.08-16.15). Increased odds of higher acuity were associated with alcohol use disorder (OR 31.54, 95% CI: 5.73-173.51), post-traumatic stress disorder (OR 18.14, 95% CI: 2.62-125.71), major depressive disorder (MDD) (OR 6.62, 95% CI: 1.72-25.44), and absence of psychiatrist integration into primary medical care (OR 4.52, 95% CI: 1.26-16.22). Increased odds of outpatient behavioral health engagement were associated with case management utilization (OR 10.73, 95% CI: 1.32-87.53), anxiety disorders (OR 15.84, 95% CI: 2.00-125.72), and MDD (OR 10.45, 95% CI: 2.28-47.98). Conclusion: Psychiatric disorders were highly prevalent among transgender and nonbinary adult patients. Novel findings include associations of lack of psychiatrist integration into primary care with acuity and of case management utilization with outpatient behavioral health engagement.
  • Research
    Full-text available
    • María Del Olmo Rojas
      María Del Olmo Rojas
    Transsexual and transgender population continue to suffer stigma and discrimination in our society. The aim of this study was to prove that there is a relation between psychological distress and perceived social support in this population. Moreover, the study wanted to examine if there were differences in social support and in the levels of anxiety and depression depending on the gender, expecting transgender/transsexual women to have less social support and more psychological distress. The following scales were used: Escala de Depresión para personas Transexuales (ESDETRA), Escala de Ansiedad para personas Transexuales (ESANTRA) and Zimet’s Multidimensional Scale of Perceived Social Support. A total of 242 transsexual/transgender participated on the study although the sample had to be reduced to 124 due to the different size of the gender groups. The results indicate it cannot be assumed an influence of perceived social support in anxiety and depression symptoms in transgender population. On one hand, no differences were found in anxiety and social support based on gender but on the other hand, differences were found in levels of depression based on gender, concluding that trans women have higher levels of depression than trans men. Las personas transexuales/transgénero siguen sufriendo el estigma y la discriminación de la sociedad. Es por esto que este estudio pretendía estudiar la relación existente entre los síntomas de malestar de esta población y el apoyo social percibido. Por otra parte, se quiso estudiar si existían diferencias en el apoyo y los síntomas de ansiedad y depresión según el género de las personas, teniendo como hipótesis que las mujeres transexuales viven una peor situación teniendo menor apoyo y mayor malestar. Se utilizaron las siguientes escalas: Escala de Depresión para personas Transexuales (ESDETRA), Escala de Ansiedad para personas Transexuales (ESANTRA) y Escala Multidimensional de Apoyo Social Percibido de Zimet. Se obtuvo una muestra de 242 personas aunque tuvo que reducirse a 124 para disminuir las diferencias entre los grupos según el género. No ha podido demostrarse que exista una relación entre el apoyo social percibido y los síntomas de ansiedad y depresión. En cuanto a las diferencias de género, no se han podido demostrar diferencias en cuanto a la ansiedad y el apoyo social, pero sí que ha podido constatarse que las mujeres trans tienen niveles más altos de depresión que los hombres trans.
  • Article
    • Justine Defreyne
      Justine Defreyne
    • Guy T’Sjoen
      Guy T’Sjoen
    Prescribing gender-affirming hormonal therapy in transgender men (TM) not only induces desirable physical effects but also benefits mental health. In TM, testosterone therapy is aimed at achieving cisgender male serum testosterone to induce virilization. Testosterone therapy is safe on the short term and middle term if adequate endocrinological follow-up is provided. Transgender medicine is not a strong part of the medical curriculum, although a large number of transgender persons will search for some kind of gender-affirming care. Because hormonal therapy has beneficial effects, all endocrinologists or hormone-prescribing physicians should be able to provide gender-affirming hormonal care.
  • Article
    Full-text available
    • Paula Daniella De Abreu
    • Ednaldo Cavalcante de Araújo
    • Eliane Maria Ribeiro de Vasconcelos
    • Claudia Benedita dos Santos
    Objetivo: compreender a qualidade de vida de mulheres transexuais que vivem com HIV/AIDS.Método: estudo qualitativo, descritivo, exploratório, realizado em 2017 com seis mulheres transexuais, em um hospital de referência para HIV/AIDS em Pernambuco, Brasil. Gravaram-se e se transcreveram as entrevistas com programa Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires, pela técnica da Análise de Similitude.Resultados: obtiveram-se as classes: “Vulnerabilidade ao HIV/AIDS e as implicações para o enfrentamento”; “Adesão ao tratamento do HIV/AIDS e o contexto programático”.Considerações finais: considera-se que a condição de viver com o HIV/AIDS para as mulheres transexuais vai muito além da doença, envolve o sofrimento íntimo mediante a violência social, negação dos direitos humanos e vulnerabilidade, o que limita seu desenvolvimento pessoal e social e impacta no conjunto de condições humanas para o alcance da qualidade de vida.
  • Article
    • Olivier Ferlatte
      Olivier Ferlatte
    • Travis James Salway
      Travis James Salway
    • Simon M Rice
      Simon M Rice
    • John S Ogrodniczuk
    This study examines barriers to mental health services among sexual and gender minorities (SGM) who screened positive for depression and risk of suicide. Data from an online survey of SGM (N = 2778) are analyzed. 37.5% met criteria for depression and 73.6% screened for being at risk of suicide. The most frequently cited barriers to mental health services access were inability to pay (62.3%), insufficient insurance (52.2%), a preference for ‘waiting’ for the problems to go away (51.5%), discomfort discussing emotions (45.7%), and feeling embarrassed and ashamed about mental health challenges (42.5%). Policy and practices implications of these findings are discussed.
  • Article
    Full-text available
    • Toby K. Mayer
    • Andreas Köhler
      Andreas Köhler
    • Jana Eyssel
    • Timo O. Nieder
      Timo O. Nieder
    The gender identity of trans individuals influences their treatment preferences, and this in turn seems to affect their individual treatment progress. However, there has been no research which—next to the impact of gender identity on treatment desires—has also investigated the influence of treatment progress using a measure which assumes various possible transition pathways of trans persons.Therefore, an online community survey of trans people was conducted in Germany in 2015. Data were collected via an online survey from a non-clinical sample of n = 415 trans individuals (over half assigned female at birth), aged 16–76 (Mean (M) = 38.12). Almost one fifth of participants embraced non-binary or genderqueer (NBGQ) identities. Participants progressed 60.77% (standard deviation (SD) = 35.21) through treatment at point of data collection, as measured by the individual treatment progress score (ITPS). All participants, especially participants assigned male at birth, differed significantly in desire to participate in decision-making processes based on transition progress; individuals without treatment experience had less desire to decide treatment plans. NBGQ participants assigned male at birth in early stages of transition had significantly more desire for psychotherapy during transition than participants of the same identity in later transition stages. All participants, especially binary participants, significantly differed in desire for aftercare based on transition progress; individuals without treatment experience indicated more desire for aftercare. Results indicate health professionals should expect changing treatment desires in trans individuals at various stages of transition, particularly at treatment start, and based on gender identity.
  • Article
    • Aisa Burgwal
      Aisa Burgwal
    • Natia Gvianishvili
    • Vierge Hård
    • Joz Motmans
      Joz Motmans
    Background: Genderqueer and nonbinary () people have remained largely invisible in health research. Previous research shows worse outcomes on health indicators for trans people when compared with cisgender controls, but the differences between binary trans and GQNB individuals are inconclusive. Aims: To compare overall health and well-being of GQNB people with controls of trans men and trans women, taking into account the impact of the additive effect of their socio-economic position, as well as their current need for gender affirming medical interventions. Methods: A community-driven survey was conducted in 2016 in five countries (Georgia, Poland, Serbia, Spain, and Sweden). Self-reported health and general well-being were analysed for differences between binary trans and GQNB respondents. The effects of multiple control variables (age, economic situation, educational level, belonging to an ethnic, religious, sexual or ability minority group, sex assigned at birth) as well as the current need for gender affirming medical interventions were controlled for. Results: The sample consisted of 853 respondents aged 16 and older, with 254 trans women (29.8%), 369 trans men (43.2%), and 230 GQNB people (26%). GQNB respondents showed significantly worse self-reported health and worse general well-being in comparison to binary trans respondents. Additional negative impacts of having a lower educational level, having more economic stress, and belonging to a disability minority group were found. Being in need of gender affirming medical interventions contributed significantly to worse self-reported health, whereas being younger contributed to worse general well-being. Discussion: In understanding health disparities between binary trans and GQNB people, it is necessary to take into account the additive effect of multiple socio-economic positions, and the current need for gender affirming medical interventions. The high proportion of GQNB respondents who report worse health outcomes highlights the need for policy makers and health-care providers in creating nonbinary-inclusive environments.
  • Article
    • Katarina Alanko
      Katarina Alanko
    • Heidi Lund
    Positive, gender supportive relationships have been found to promote well-being of transgender youth. The present study investigates how the quality of relationships to parents, friends and partners affects the mental well-being of transgender youth. An online-survey was used for data collection. The sample consisted of 1,613 Finnish youth between 15 and 25 years of age. Youth who identified as transgender (n =370) were compared to cisgender (= no gender conflict, n = 1,243, mostly sexual minority youth) on measures of relationship quality and positive well-being. Transgender youth reported poorer well-being and relationships to parents than the control group did. Relationship quality predicted well-being for all participants, and there were no significant interactions between gender identity and relationship quality. Social support is important for transgender youth, and has an impact on the well-being of youth regardless of gender identification.
  • Article
    • William B. Baker
    Little is understood about how sexual orientation and gender identity actually interconnect with transgender men. Eight transgender men were interviewed in depth, multiple times, and their perspectives gave insight into how sexual and gender identities are related, and how one informs the other. The present study found fluidity in gender and sexual identities among transgender men, but some trans men were more binary than others with regard to gender. These binary-leaning trans men also tended to be more binary in their sexual orientation. Fluidity in gender in pre-transition often reflected fluidity in sexual orientation. Mental health professionals may gain a better understanding of how the intersectionality of sexual and gender identities manifests in trans men. Implications for practitioners are included.
  • Article
    • K. Marie Sizemore
    • Joseph A. Carter
      Joseph A. Carter
    • Brett M. Millar
      Brett M. Millar
    • H. Jonathon Rendina
      H. Jonathon Rendina
    Transgender women are disproportionately affected by HIV and experience high rates of depression and anxiety. The importance of secure attachment in buffering against negative sexual and mental health outcomes is well established. However, few studies have examined attachment among transgender women. We recruited a community-based convenience sample of 213 transgender women in New York City (Mage =34.3; SD = 11.7). The majority were women of color (75.6%), almost half identified as heterosexual (47.4%), and 34.7% were HIV-positive. Preliminary analyses examined the sample distribution across attachment categories using the Revised Experiences in Close Relationships scale. Specifically, Brennan, Clark and Shaver’s guidelines were used for categorization (43.19% fearful, 22.5% preoccupied, 21.6% dismissive, and 12.7% secure). Regression analyses examined the association of dimensional attachment anxiety, attachment avoidance, and their interaction with depression, anxiety, self-efficacy for condom use, temptations for condomless sex, and condomless sex acts. Results indicated a positive association between attachment anxiety and depression, anxiety, temptations and probability for condomless sex; and also between attachment avoidance and condomless sex probability. A significant interaction indicated that individuals with low attachment anxiety and attachment avoidance (i.e., secure) had the greatest condom use self-efficacy and the lowest probability of engaging in condomless sex.
  • Article
    • Walter Bockting
    • Kasey Jackman
    • Brittany Edgar
    • Amanda Ling
    Transgender populations experience mental and physical health disparities compared to nontransgender populations, including nonsuicidal self-injury (NSSI). Guided by the minority stress theory and Nock’s model of NSSI, this study explored perspectives of transmasculine spectrum people (i.e., people with a gender identity that is man, male, transgender man, genderqueer, or nonbinary and who were assigned female at birth) who engage in NSSI. Qualitative interviews were conducted with transmasculine spectrum people ( N = 18) who reported a history of NSSI. Their mean age was 24.9 years old ( SD = 5.43, range = 17–38). Participants reported that NSSI was influenced by a variety of factors including stress from gender nonconformity in childhood and adolescence. Stigma related to minority status and identity as well as proximal minority stress processes of concealment and expectations of rejection were identified as contributing to NSSI. Transgender identity development tasks such as coming out and identity exploration also appeared to affect NSSI. Finding a community of peers who engage in NSSI was helpful in mitigating social isolation, but at times reinforced NSSI. We discuss clinical implications at the individual and family levels. Interventions to reduce NSSI among transmasculine-spectrum people should include facilitating connections with gender minority peers and providing individual support and family interventions to facilitate transgender identity development.
  • Article
    Full-text available
    • Anna Nobili
      Anna Nobili
    • Cris Glazebrook
    • Jon Arcelus
      Jon Arcelus
    The study aims to systematically extract and analyse data about Quality of Life (QoL) in the transgender population. A systematic literature search and meta-analysis were conducted using the MEDLINE, EMBASE, PubMed, and PsycINFO databases, up to July 2017. Only English language quantitative studies, in adults, which reported the means for validated QoL measures were included. Random-effect meta-analysis was adopted to pool data and estimate the 95% Confidence Intervals (CI). From 94 potentially relevant articles, 29 studies were included within the review and data extraction for meta-analysis was available in 14 studies. The majority of the studies were cross-sectional, lacked controls and displayed moderate risk of bias. Findings from the systematic review suggested that transgender people display poor QoL, independent of the domain investigated. Pooling across studies showed that transgender people report poorer mental health QoL compared to the general population (-0.78, 95% CI= -1.08 to -0.48, 14 studies). However, meta-analysis in a subgroup of studies looking at QoL in participants who were exclusively post-CHT found no difference in mental health QoL between groups (-0.42, 95% CI= -1.15 to 0.31; 7 studies). There was insufficient data for a pre-treatment subgroup. Evidence suggests that transgender people have lower QoL than the general population. Some evidence suggests that QoL improves post-treatment. Better quality studies that include clearly defined transgender populations, divided by stage of gender affirming treatment and with appropriate matched control groups are needed to draw firmer conclusions.
  • Article
    • Ausma Bernotaite
    • Lukas Berredo
    • H.c Zhuo
  • Article
    • Jane Hereth
    • Dana J. Pardee
    • Sari L Reisner
      Sari L Reisner
    As awareness of issues faced by transgender individuals increases, many young people have been exposed to a dominant narrative about gender identity. Often these narratives are based on binary constructions about both sexual orientation and gender identity. The lack of diverse, representative cultural narratives has implications for identity development and sexual health. Transgender men who have sex with cisgender men in particular represent an understudied and overlooked population who likely experience unique developmental tasks related to the intersection of socially stigmatised sexual orientation and gender identities. This study explores sexual orientation and gender identity development among a sample of young adult transgender men who have sex with men. In-depth interviews using a modified life history method were conducted with 18 young men. Interview transcripts were coded using open, narrative and focused coding methods. Participants discussed milestones in the development of their sexuality and gender identity that map onto existing models, but also described ways in which these processes overlap and intersect in distinct ways. Findings highlight the need for human development models of sexual orientation and gender identity that integrate multiple identity processes. Implications for future research and practice to increase support for young adult transgender men are discussed.
  • Article
    • Walter Bockting
    • Kasey B. Jackman
    • Curtis Dolezal
    • Bruce Levin
    We investigated rates of nonsuicidal self-injury (NSSI) and correlates of past-year NSSI among transgender people to better understand factors contributing to this health disparity. A community-based sample of 332 transgender people participated in quantitative in-person interviews. The mean age of participants was 34.56 years (SD = 13.78, range = 16-87). The sample was evenly divided between transfeminine spectrum (50.3%) and transmasculine spectrum identities (49.7%) and was diverse in race/ethnicity. We evaluated associations between sociodemographic characteristics, stigma, hypothesized resilience factors, and identity variables with past-year NSSI. 53.3% of participants reported ever having self-injured in their lifetime. Past-year NSSI was reported by 22.3% of the sample and did not significantly differ based on gender identity. In logistic regression models, past-year NSSI was associated with younger age and felt stigma (perceived or anticipated rejection), but not enacted stigma (actual experiences of discrimination), and with gender dysphoria. Efforts to address the high rates of NSSI among transgender people should aim to reduce felt stigma and gender dysphoria, and promote transgender congruence. Future research using a developmental approach to assess variations in NSSI across the life course and in relation to transgender identity development may illuminate additional processes that affect NSSI in this population.
  • Article
    • Leah Hecht
      Leah Hecht
    • Chazlyn Miller
      Chazlyn Miller
    • Lisa Renee Miller-Matero
      Lisa Renee Miller-Matero
    • Kellie Martens
      Kellie Martens
    As nearly one third of transgender individuals in the USA are obese, more transgender patients may pursue bariatric surgery as a means of sustaining weight loss. Transgender individuals, like bariatric surgery patients, have high rates of mood pathology, substance use, abuse, and self-harm behaviors. However, there is no research on transgender bariatric surgery candidates. The aim of this review is to elucidate potential psychosocial risk factors, including sex hormone management, which may impact surgical clearance, presurgical psychosocial assessment, and treatment recommendations.
  • Research Proposal
    Full-text available
    • Víctor Manuel Enriquez-Estrada
      Víctor Manuel Enriquez-Estrada
    La experiencia de las personas transexuales, está compuesta por múltiples dimensiones sociales, legales, religiosas, sanitarias y económicas, marcadas en su mayor parte por la marginación y exclusión dentro de la sociedad heteronormativa predominante. Esto aunado a la incongruencia entre la apariencia física y la identidad de género, que las personas experimentan, produce en algunos casos una entidad conocida como disforia de género, condición de distres permanente, se ha asociado a un claro aumento en las conductas de riesgo y una tasa desproporcionadamente alta de depresión y ansiedad, en estos individuos comparados con la población general. Estos problemas de salud mental, además afectan directamente la calidad de vida de las personas transexuales y se ha documentado un aumento de la mortalidad, principalmente por suicidio, que en algunos estudios es del 50 % de aquellos que no han encontrado apoyo familiar y/o médico. Además la depresión por si misma se ha asociado en personas transexuales, con el consumo de sustancias, conductas sexuales de riesgo y con suicidio. Por otra parte también presentan niveles altos de insatisfacción de su imagen corporal, lo que se ha demostrado predispone a trastornos somáticos, trastornos alimenticios, conductas de riesgo, trastornos afectivos y otros factores que perpetúan y complican tanto la depresión como la ansiedad. En la Ciudad México existen limitados centros especializados en servicios públicos en el cuidado de personas transexuales, los cuales concentran prácticamente toda la población transexual del área metropolitana, en estos centros en este momento es desconocida con exactitud la prevalencia de los de depresión y ansiedad sus usuarios. Así mismo con esta propuesta se puede avanzar en el conocimiento de esta población sub-estudiada, promover la psicoeducación y las opciones reales de tratamiento. Objetivos: Objetivo general Determinar la prevalencia de depresión mayor y de ansiedad social, en una muestra de mujeres transexuales de la Ciudad de México. Objetivos específicos. Obtener datos sociodemográficos (edad, género asignado al nacimiento, género deseado, edad en que percibió la inconformidad, preferencia sexual actual y si este ha variado a lo largo del tiempo, nivel socio-económico (según niveles estandarizados en México), nivel escolar (calculado en años), trabajo actual, vínculo afectivo actual, comorbilidades e historial terapéutico de los participantes, mediante cuestionario general de salud y/o entrevista clínica. Evaluar e identificar la prevalencia de la depresión mayor de la muestra. Evaluar e identificar la prevalencia de la ansiedad social de la muestra. Materiales y Métodos: Se efectuara la invitación a participar en el presente protocolo a mujeres transexuales, en diferentes fases del tratamiento hormonal médico de confirmación de género, esto mediante la divulgación del protocolo en diversos centros comunitarios, en clínicas de la Ciudad de México y en grupos de activistas LGBTTTI. A cambio de su participación en este estudio epidemiológico, se les brindará información de su condición psiquiátrica y la posibilidad de continuar su seguimiento en el departamento de Salud Mental de la UNAM. Una forma propuesta de iniciar el reclutamiento de las personas transexuales es mediante cine clubs y talleres sobre el uso de hormonas, y prevención de enfermedades de transmisión de transmisión sexual. Este es un estudio descriptivo y transversal, que consiste en la realización de una entrevista estructurada, en donde se realizara la recolección de datos sociodemográficos, posteriormente la aplicación de la Entrevista Clínica Estructurada para los Trastornos del Eje I del DSM-IV (SCID-I), para detectar la prevalencia de depresión mayor y ansiedad social en esta muestra y la posterior aplicación de las escalas de depresión y ansiedad de Hamilton (HDRS y HARS) y la aplicación del cuestionario de Leibowitz para ansiedad social (LSAS), para evaluar niveles clínicos, de estas entidades, a los pacientes con los diagnósticos correspondientes. Se realizará la recolección de datos sociodemográficos, historia clínica y el SCID-I en una primera entrevista (de aproximadamente dos horas) y posteriormente se aplicará en una segunda entrevista las escalas de HDRS, HARS y LSAS (de una hora aproximadamente). En una tercera sesión se les informará de sus resultados y de las sugerencias y opciones terapéuticas, porque no solo se trata de hacer un muestreo de alteraciones afectivas y ansiedad, sino de que las personas de esta comunidad tengan opciones reales de tratamiento (de ser necesario ISRS, por ser medicamentos de primera elección según guías internacionales y aprobados por la FDA (67,68)). Análisis: Por ser un estudio observacional se hará estadística descriptiva, con medidas de tendencia central y dispersión de tipo no para métrica porque las escalas empleadas son del tipo cualitativas. Palabras clave: Transexualidad; Depresión Mayor; Ansiedad Social; Disforia de Género
  • Chapter
    Full-text available
    • Bianca Machado
    • Bianca Machado Borba Soll
      Bianca Machado Borba Soll
    • Andressa Mueller
      Andressa Mueller
    • Angelo Brandelli Costa
      Angelo Brandelli Costa
    Historicamente, a psiquiatria ofereceu terapias conversivas aos indivíduos que apresentavam comportamentos sexuais diferentes dos comportamentos dos heterossexuais e identidade de gênero discordante do sexo atribuído ao nascimento. Tais condutas foram revistas, levando ao reconhecimento das necessidades específicas dessas pessoas. Atualmente, a prática clínica em saúde mental com lésbicas, gays, bissexuais e transgêneros (LGBT) considera a diminuição do sofrimento e a aceitação da identidade sexual e de gênero, reconhecendo o preconceito como fator que vulnerabiliza a saúde mental dessa população. Neste artigo, serão trabalhados conceitos relativos à população LGBT de forma que o leitor possa identificar fatores de risco para a saúde mental dessas pessoas. Os principais agravos psiquiátricos relacionados a esses grupos serão abordados, destacando-se aspectos específicos. Além disso, o diagnóstico e os tratamentos das pessoas transexuais serão debatidos.
  • Article
    • Nolan Blodgett
    • Rory Coughlan
    • Neha Khullar
    This study qualitatively explores the barriers that transgender individuals experience within healthcare settings in rural Ontario. It includes an analysis of how transgender individuals overcome these barriers, as well as the methods by which healthcare interactions can be strengthened to increase their experiences of personal agency. Twelve transgender individuals and three healthcare professionals in rural Ontario participated in open‐ended, semi‐structured interviews, which were analysed using interpretive phenomenological analysis and critical discourse analysis. Together these analyses yielded insights on themes pertaining to the breaching of human rights in healthcare interactions; rural challenges experienced by transgender patients in Ontario; the effects of non‐reciprocal relationships on trans‐patients’ experiences of personal agency, autonomy, and mental health; and factors contributing to their overall resiliency and empowerment. Potential transgender healthcare models and directions for future research are also discussed.
  • Article
    Full-text available
    • Luke Allen
      Luke Allen
    • Laurel B. Watson
      Laurel B. Watson
    • Sarah B. VanMattson
      Sarah B. VanMattson
    Research on transgender and gender diverse individuals has often focused on hardships and experiences of distress or discrimination. While these studies advance the literature, much less research has focused on positive experiences. In this retrospective study, a phenomenological approach is used to identify and better understand sources of extra-familial support for transgender adolescents. Fifteen participants who self-identified as transgender were interviewed about the sources of extra-familial support they experienced during their adolescence and how these sources were discovered, developed, and accessed. Participants’ ages ranged from 18 to 24 (M = 21). Findings indicate various settings and resources wherein transgender youth have been accepted and received extra-familial support (e.g., extra-curricular activities, teachers, friends, online communities). Clinicians can benefit from understanding where and how transgender adolescents find, and experience, their sources of support.
  • Article
    • Nancy J W Lewis
    • Peter Batra
    • Brayden A Misiolek
    • Caitlin Tupper
    Purpose: Transgender/gender nonconforming (TGNC) adults' worries and coping actions related to discrimination by healthcare professionals were evaluated. Methods: A community-led participatory approach was used to develop, implement, and analyze the survey. Respondents were recruited using a snowball recruitment method. The questionnaire measured population demographics, health status, worry about discrimination, perceptions of health professional competency in gender-affirming care, and actions taken to cope with discrimination. Analysis used mainly descriptive methods and chi-square analysis, where appropriate. Results: There were 316 usable responses from a total of 325 responses. The typical respondent was young, white, lived within the Midwest and in urban/suburban areas. About half had college degrees and 41.7% had annual household incomes of less than $25,000. High degrees of depression risk and anxiety were reported along with low self-reported health status. Most used pharmacist services with 41.6% reporting worry about discrimination associated with such services. About half (52.5%) reported pharmacists as having very little or no competency in providing gender-affirming care. Common coping actions included delayed seeking of healthcare and non-disclosure of authentic gender identity. Thirteen percent of respondents avoided healthcare because of perceived purposeful embarrassment experienced at a pharmacy. Conclusion: Worry about discrimination from pharmacists was common among TGNC adults and was associated with high levels of anxiety. The majority perceived pharmacists to lack competency in transgender care.
  • Article
    • Cathy J Reback
    • Kirsty Clark
      Kirsty Clark
    • Jesse B Fletcher
      Jesse B Fletcher
    • Ian W Holloway
      Ian W Holloway
    This study examined the empirical structure (i.e., size, density, duration) of transgender women’s social networks and estimated how network alters’ perceived HIV risk/protective behaviors influenced transgender women’s own HIV risk/protective behaviors. From July 2015 to September 2016, 271 transgender women completed surveys on sociodemographic characteristics, HIV risk/protective behaviors, and social networks. Hierarchical generalized linear models examined the associations of social network alter member data ‘nested’ within participant data. Analyses revealed that social network factors were associated with HIV risk/protective behaviors, and that the gender identity of the alters (cisgender vs. transgender), and social network sites and technology use patterns (“SNS/tech”) moderated these associations. Among network alters with whom the participant communicated via SNS/tech, participants’ HIV risk behavior was positively associated with alters’ HIV risk behavior (cisgender alters aOR 4.10; transgender alters aOR 5.87). Among cisgender alters (but not transgender alters) with whom the participant communicated via SNS/tech, participants’ HIV protective behavior was positively associated with alters’ HIV protective behavior (aOR 8.94).
  • Article
    • Julia Spielmann
    • Chadly Stern
    We examined whether and why the amount of time a transgender person has spent transitioning influences perceived sexual orientation. We found that transgender individuals who had spent more time transitioning were more likely to be categorized as straight (vs. gay), and that greater gender typicality in part accounted for shifts in perceived sexual orientation. These perceptions were not contingent on whether people made judgments about how they personally felt or what the average person would say. Overall, these findings support the idea that gender and sexuality intersect in people’s minds, and that shifts in one can lead to changes in perceptions of the other. We discuss how these findings contribute to understanding perceptions and experiences of transgender individuals.
  • Article
    • G. Nic Rider
      G. Nic Rider
    • Jennifer A. Vencill
      Jennifer A. Vencill
    • Dianne R. Berg
    • Katherine G. Spencer
    Background: The limited research on nonbinary individuals suggests that this community 10 experiences significant health disparities. Compared to binary transgender individuals, research suggests that nonbinary individuals are at elevated risk for discrimination and negative mental health outcomes, including depression, anxiety, traumatic stress, and suicidality. Even mental health providers who work with binary transgender individuals often lack knowledge of and training to work competently with nonbinary individuals. Methods: The authors of this conceptual article present the Gender Affirmative Lifespan Approach (GALA), a psychotherapy framework based in health disparities theory and research, which asserts that therapeutic interventions combating internalized oppression have the potential to improve mental health symptomatology resulting in improved overall health and well-being for gender diverse clients. GALA’s therapeutic interventions are designed to promote positive gender identity 20 development through five core components: (1) building resiliency; (2) developing gender literacy; (3) moving beyond the binary; 4) promoting positive sexuality; and (5) facilitating empowering connections to medical interventions (if desired). Results: The core components of the GALA model are individualized to each client’s unique needs, while taking into consideration age and acknowledging developmental shifts in, or fluidity of, 25 gender across the lifespan. This model represents an inclusive, trans-affirmative approach to competent clinical care with nonbinary individuals. Discussion: Application of the GALA model with nonbinary clients is discussed, including one clinical case vignette.
  • Article
    • Leigh A. Bukowski
    • Melvin C. Hampton
    • César G. Escobar-Viera
      César G. Escobar-Viera
    • Ronald D. Stall
    Depression among Black transgender women (BTW) in the USA is an often understudied mental health concern with far-reaching consequences for overall physical and mental health at both the individual and community levels. Intimate partner violence (IPV) among BTW is also a frequently understudied and important social determinant of health in need of further exploration. This study sought to address the gap in research on the relationship between IPV and depression among BTW using a time- and location-based community sample of BTW from six US cities. In addition, it sought to explore the potential protective or suppressive effect of perceived social support on this relationship. Generalized structural equation models were used to assess conditional direct and indirect effects of IPV on depression via the suppression effect of perceived social support. Evidence was found of a statistically significant conditional direct effect of IPV on depression as well as a statistically significant suppression effect for perceived social support. Specifically, there was a 20% lower likelihood of increased depressive symptomatology for every 1-unit increase in perceived social support reported by participants. These findings indicated that perceived social support may be an important intervention point for helping to improve the mental health and well-being of BTW.
  • Article
    • Lindsay Edwards
      Lindsay Edwards
    • Anibal Torres Bernal
      Anibal Torres Bernal
    • Scotty M. Hanley
    • Shannon Martin
    This study explored how individual- and community-based resilience factors operated together in order to reduce risk of suicide for a sample of transgender therapy clients. We collected cross-sectional survey data from 106 transgender therapy clients at a local community center, including demographic information, experiences of relational support, participants' emotional stability, and risk for suicide. Results from our mediation analysis indicated that high levels of perceived relational support are related to reduced risk for suicide and that this happens by way of a person's emotional stability. Clinical implications for family therapists are discussed based on the significant indirect effect found in this study. © 2019 Family Process Institute.
  • Article
    • Jia-Lin Gao
    • Li-Hui Wang
    • Xue-Qin Yin
    • Jin-Liang Wang
      Jin-Liang Wang
    Mental health issues among Chinese adolescents in boarding schools have attracted the attention of researchers in recent years. Our study was to examine the relationship between negative life events and depression experienced by Chinese adolescents at boarding schools, and to study whether peer support and active coping would moderate the relationship between negative life events and depression. Questionnaires were administered in 2015 to a sample of 521 boarding school students (51.1% females) in two counties in Jiangxi Province, central China. The mean age of the sample was 13.47 years (SD = 1.04). The Adolescent Negative Life Event Scale, Peer Support Scale, Simple Active Coping Style Scale, and Children Depression Scale were used for data collection. Latent moderation structural equation (LMS) method was used to test the moderating effect of peer support and active coping on depression. Negative life events were related with more depression among boarding school students. Peer support had a negative effect on depression and active coping moderated the association between negative life events and depression. Peer support and active coping are important to relieve the adverse consequences of negative life events among boarding school students. School mental health practice that focuses on these factors may be helpful for boarding school students.
  • Article
    • Walter Bockting
    • Renato Barucco
    • Allen LeBlanc
    • Anke Ehrhardt
    Transgender and gender non-conforming (TGNC) people have gained visibility in public discourse leading to greater awareness, understanding, and social change. However, progress made in policies to combat stigma and improve public accommodation and healthcare for this minority population has been targeted for reversal, particularly since the 2016 presidential election. This study investigated the impact of changes in sociopolitical climate on perceptions of vulnerability and resilience among participants of a longitudinal study of transgender identity development. We randomly selected 19 TGNC participants in New York, San Francisco, and Atlanta and conducted in-depth interviews about their perceptions of societal progress and setbacks, community engagement, and desired future change. The participants ranged in age from 18 to 68; half (47.4%) identified their gender identity along the feminine spectrum (male assigned at birth) and the other half (52.6%) along the masculine spectrum (female assigned at birth). Content analysis revealed that greater media visibility was perceived as both positive (improved awareness of needs) and negative (increased vulnerability to stigma). Setbacks included concerns about personal safety, the safety of others (particularly those with multiple stigmatized identities), healthcare access, and policies regarding public accommodation and non-discrimination protections. Coping strategies included social support, activism and resistance, and an enduring sense of optimism about the future. TGNC Americans, in spite of a long history of adversity, are resilient. The participants demonstrated unwavering motivation to create a better future for themselves, other minorities, and society. Research is needed to quantify the impact of policy changes on health and well-being and identify moderators of resilience amenable to intervention.
  • Chapter
    • Ladan Ahmadi
    • Angelica Nocerino
    • Daniel Puneky
    Transgender persons are disproportionately affected by HIV compared to the general population. In this chapter, we hope to shed light on the true burden of HIV on this marginalized population. We will review the factors that contribute to the high prevalence of HIV among transgender persons, in particular, high-risk sexual behaviors and substance abuse. Additionally, we will discuss the unique socioeconomic and psychosocial barriers that predispose this population to poor outcomes related to HIV prevention and treatment. We will also explain the contribution of transphobia in healthcare systems to the poor outcomes across the continuum of HIV care. This chapter will highlight challenges for transgender persons living with HIV, and attempt to offer solutions to overcome some of the obstacles. The choice of antiretroviral therapy with concomitant use of gender-affirming therapies will be discussed in detail.
  • Article
    Full-text available
    • Annalisa Anzani
      Annalisa Anzani
    • Ezra R. Morris
      Ezra R. Morris
    • M. Paz Galupo
      M. Paz Galupo
    Although mental health disparities for transgender individuals are well documented, a number of obstacles exist for receiving affirming therapy. In order to provide an understanding of transgender peoples’ help-seeking experiences, the present study aimed to investigate their positive experiences of identity microaffirmations within a therapeutic relationship. Sixty-four transgender participants answered an open-ended question online regarding their experience of gender identity-based affirmations in therapy. Using thematic analysis, responses were evaluated and four main themes were identified: 1) absence of microaggressions, 2) acknowledging cisnormativity, 3) disrupting cisnormativity, and 4) seeing authentic gender. Implications for therapeutic work with transgender clients are discussed.
  • Article
    • L. Nuttbrock
    • A. Rosenblum
    • R. Blumenstein
    This paper formulates a social psychological perspective for the mental health functioning of transgender persons. Affective symptomatology in this population is viewed as significantly affected by the extent to which transgender identity is successfully incorporated in social roles and relationships. The extent to which transgender identity is disclosed to others so as to be recognized by them, performed in the presence of others, responded to by others, and supported by others, is summarized in terms of a broad construct - transgender identity affirmation. Affirmation of identity, following social psychological identity theory, is posited as crucial for emotional well-being. Some support for this perspective was observed in a preliminary study of 43 trans women sex workers in New York City. Additional research along these lines is needed to better understand the complex association between transgender identification and mental health functioning.
  • Article
    • R. Raj
    Traditionally, the research, assessment and treatment of 'gender dysphoria' (GD) and 'gender variance' (GV) has tended to pathologize transvestites/ crossdressers, transsexuals and transgendered people, including 'transqueers'. This article will cite examples of clinical 'transphobia' to underscore the need to revolutionize our way of doing therapy with transpeople. To optimize the recent trend towards a more respectful, collaborative relationship between GD/GV clients and the mental health community, we must ensure that our clinical orientation is truly responsive to the changing real-life needs of a highly-diversified trans population, including the rights to self-determination and comprehensive health care. To help meet this goal, this paper will develop a generic transpositive therapeutic model, building from existing trans-affirmative approaches. A series of nine major guidelines to build the theoretical framework for a transpositive model of psychotherapy is proposed, with specific recommendations around: 1) clinical orientation/treatment philosophy, 2) assessment considerations, 3) treatment considerations (including psychotherapy, diversified subpopulations and marginalized subpopulations), 4) the therapeutic relationship, 5) comprehensive case management, 6) accountability/quality assurance, 7) advocacy/alliance building, 8) knowledge base/professional development, and 9) research.
  • Article
    Full-text available
    • Ilan H Meyer
      Ilan H Meyer
    In this article the author reviews research evidence on the prevalence of mental disorders in lesbians, gay men, and bisexuals (LGBs) and shows, using meta-analyses, that LGBs have a higher prevalence of mental disorders than heterosexuals. The author offers a conceptual framework for understanding this excess in prevalence of disorder in terms of minority stress— explaining that stigma, prejudice, and discrimination create a hostile and stressful social environment that causes mental health problems. The model describes stress processes, including the experience of prejudice events, expectations of rejection, hiding and concealing, internalized homophobia, and ameliorative coping processes. This conceptual framework is the basis for the review of research evidence, suggestions for future research directions, and exploration of public policy implications.
  • Article
    • Mark Leary
      Mark Leary
    • Ellen S. Tambor
    • Sonja K. Terdal
    • Deborah L. Downs
    Five studies tested hypotheses derived from the sociometer model of self-esteem according to which the self-esteem system monitors others' reactions and alerts the individual to the possibility of social exclusion. Study 1 showed that the effects of events on participants' state self-esteem paralleled their assumptions about whether such events would lead others to accept or reject them. In Study 2, participants' ratings of how included they felt in a real social situation correlated highly with their self-esteem feelings. In Studies 3 and 4, social exclusion caused decreases in self-esteem when respondents were excluded from a group for personal reasons, but not when exclusion was random, but this effect was not mediated by self-presentation. Study 5 showed that trait self-esteem correlated highly with the degree to which respondents generally felt included versus excluded by other people. Overall, results provided converging evidence for the sociometer model.
  • Article
    • Susan Folkman
    Investigated the functional relations among cognitive appraisal and coping processes and their short-term outcomes within stressful encounters. The authors used an intraindividual analysis of the interrelations among primary appraisal (what was at stake in the encounter), secondary appraisal (coping options), 8 forms of problem- and emotion-focused coping, and encounter outcomes in a sample of 85 married couples (females aged 35–45 yrs and males aged 26–54 yrs). Findings show that coping was strongly related to cognitive appraisal; the forms of coping that were used varied depending on what was at stake and the options for coping. Coping was also differentially related to satisfactory and unsatisfactory encounter outcomes. Findings clarify the functional relations among appraisal and coping variables and the outcomes of stressful encounters. (47 ref)
  • Article
    • David Valentiner
      David Valentiner
    • RH MOOS
    An integrative model of mediating and moderating mechanisms in the coping process was examined in a 2-year prospective framework with 175 college students using both single-group and multigroup LISREL analyses. Consistent with the hypothesized model, initial parental support was associated with subsequent changes in psychological adjustment both directly and indirectly through adaptive coping strategies. Moreover, as predicted, appraisals of event controllability moderated both the degree to which parental support influenced coping and the effectiveness of coping responses. With controllable events, family support predicted adaptive coping, and coping predicted changes in adjustment. With uncontrollable events, family support related directly to changes in adjustment.
  • Article
    • Steven S. Schwartzberg
    • Ronnie Janoff-Bulman
      Ronnie Janoff-Bulman
    Researchers have recently begun to challenge long-standing views of grief and have called for new approaches to help understand the phenomenon. In this vein, the present study examined the impact of bereavement on people's basic assumptions about themselves and their world. Three categories of assumptions were explored: Benevolence of the World, Meaningfulness of the World, and Self-Worth. Twenty-one undergraduates who had recently lost a parent and 21 matched controls were compared on a series of objective measures; in addition, the bereaved sample also participated in lengthy semistructured clinical interviews. Assumptions about meaning emerged as an important variable, both in distinguishing between the bereaved and control samples and also in accounting for differences in the grief responses of the bereaved. Compared with matched controls, the bereaved subjects were significantly less likely to believe in a meaningful world. Further, within the bereaved sample, the greater the subjects' ability to fin...
  • Article
    • Vicki L. Gluhoski
    • Camille Wortman
      Camille Wortman
    The impact of diverse traumas on world views was assessed with a community sample (N = 3,617) interviewed in 1986 and 1989. Four types of world views were examined including fatalism, justice, vulnerability, and self-view. Types of trauma included the death of a spouse, parent, or child, job loss, life-threatening illness, and physical assault. Overall, fatalism and justice were not greatly affected by trauma. Perceptions of vulnerability and self-view were significantly altered for all subjects who had experienced any type of trauma.
  • Article
    • Janice A Blalock
      Janice A Blalock
    • Thomas E. Joiner Jr
    This study investigated (1) the moderating effects of gender and cognitive avoidance coping on the negative life events–depressive/anxious symptoms relationship, and (2) the validity of the cognitive avoidance coping construct. One hundred seventy-nine men and women completed the Coping Responses Inventory (CRI), Negative Life Events Questionnaire, and Beck Depression and Anxiety Inventories at Time 1 and, 3 weeks later, at Time 2. A confirmatory factor analysis of the four CRI Avoidant Coping subscales revealed that a two-factor model, comprising Cognitive and Behavioral Avoidance Coping, was superior to the one-factor model composed of Avoidant Coping. Multiple regression analyses revealed that high negative life event scores were predictive of significant increases in symptoms among females who endorsed greater use of cognitive avoidance coping, but not among males. Behavioral avoidance coping was unrelated to changes in depressive and anxious symptoms.
  • Article
    • Stephanie L Budge
      Stephanie L Budge
    • Sabra Katz-Wise
      Sabra Katz-Wise
    • Esther N. Tebbe
    • Adriana Rodriguez
    Eighteen transgender-identified individuals participated in semi-structured interviews regarding emotional and coping processes throughout their gender transition. The authors used grounded theory to conceptualize and analyze the data. There were three distinct phases through which the participants described emotional and coping experiences: (a) pretransition, (b) during the transition, and (c) posttransition. Five separate themes emerged, including descriptions of coping mechanisms, emotional hardship, lack of support, positive social support, and affirmative emotional experiences. The authors developed a model to describe the role of coping mechanisms and support experienced throughout the transition process. As participants continued through their transitions, emotional hardships lessened and they used facilitative coping mechanisms that in turn led to affirmative emotional experiences. The results of this study are indicative of the importance of guiding transgender individuals through facilitative coping experiences and providing social support throughout the transition process. Implications for counselors and for future research are discussed.
  • Article
    • Patrick Coughlin
    • Jay Wade
      Jay Wade
    This research assessed factors that may affect men’s heterosexual romantic relationships in which their partner earns a greater income. Forty-seven men from the United States completed measures that assessed masculinity ideology, the importance of the partner’s greater income, and romantic relationship quality. We examined whether the perceived importance of the income disparity mediated the relationship between men’s masculinity ideology and the quality of their romantic relationships. Using multiple regression analyses to test for mediation, results showed the relationship between masculinity ideology and romantic relationship quality was due in part to the importance one placed on the difference in income. Specifically, men who were more traditional in their masculinity ideology and have higher earning female partners were more likely to have poor quality romantic relationships in part because such men view the disparity in income as having importance. Conversely, results showed men who were more nontraditional in their masculinity were more likely to perceive the disparity in income as having little or no importance and have high romantic relationship quality.
  • Article
    • Arnold H. Grossman
      Arnold H. Grossman
    • Anthony R. DAugelli
    • John A. Frank
      John A. Frank
    Fifty-five transgender youth described their gender development and some of the stressful life experiences related to their gender identity and gender expression. More than two-thirds of youth reported past verbal abuse by their parents or peers related to their gender identity and nonconformity, and approximately one-fifth to one-third reported past physical abuse. The more gender non-conforming the youth were, the more abuse they reported. Four aspects of psychological resilience were examined: a sense of personal mastery, self-esteem, perceived social support, and emotion-oriented coping. A regression model of the selected aspects of resilience accounted for 40%–55% of the variance in relation to depression, trauma symptoms, mental health symptoms, and internalizing and externalizing problems. Emotion-oriented coping was a significant predictor of negative mental health as determined by each of the mental health variables.
  • Article
    • Knud Knudsen
      Knud Knudsen
    • Kari Wærness
      Kari Wærness
    This article examines how a general social process—the struggle toward gender equality—is reflected in the public opinion on mothers' employment in three different modern welfare states: Great Britain, Sweden and Norway. Viewing such attitudes as reponses to structural changes in women's relation to the labour market, the possible between- and within-country variations in these attitudes are hypothesized. The data are drawn from the International Social Survey Programme (ISSP) and the results from a large cross-national survey are used. It is found that women are more positive than men, and that the younger, the better-educated and the less religious members of society are the most positive to mother's employment in all three countries. As for the between-country variations, it is found that the Swedes are the most positive and the Norwegians the most negative. It is suggested that Great Britain's longer history of industrialization and of urban married women's employment explains why the British people are more positive towards mothers' employment than Norwegians, despite the Norwegian welfare policies with their much stronger emphasis on supporting gender equality and mothers' employment.
  • Article
    • Patricia Gagné
    • Richard Tewksbury
    Research on transgendered individuals has tended to come from medical, psychiatric, or deviance perspectives, with little attention to the social context in which these individuals exist or their efforts to resist normative expectations of sex and gender. Based upon in-depth interviews with 65 masculine-to-feminine transgendered individuals, this research examines gender as a social institution. Focusing on the pressures experienced by individuals to maintain binary enactments of gender, we demonstrate how the institution of gender is taken for granted as a presumably natural aspect of social life. Social pressures to conform, experienced as desires for relationship maintenance and self-preservation, as well as the overwhelming need to actualize an identity that does not fit within the binary system of sex and gender, illuminate the gender resistance and conformity exhibited among the individuals in our sample. Our analysis is rooted in an expanded Foucauldian perspective incorporating the theoretical insights of contemporary feminists who consider social actors as active agents in the development and enactment of everyday resistance. Transgenderism is a discursive act that both challenges and reifies the binary gender system. As such, it provides important lessons about the power dynamics of gender and how such systems may and may not be resisted.
  • Article
    Full-text available
    • Crystal L Park
      Crystal L Park
    The meaning making model of adjusting to highly stressful events is widely accepted among stress and trauma researchers. This model posits that distress arises from discrepancies between appraised and global meaning and that individuals attempt to make meaning by reappraising their situation to reduce the discrepancy and thereby ease their distress. Little research has directly tested these assumptions. The present study tested six specific hypotheses derived from the meaning making model in a sample of 108 college students dealing with a significant loss (primarily bereavement) in the past six months. Results provided uneven support for the meaning making model across the specific hypotheses. These findings suggest that the methodology presently used by many researchers in this area should be reconsidered and that future studies of meaning making might profitably implement improved approaches to conceptualization and assessment.
  • Article
    • J. H. Harvey
    • E. D. Miller
    This article argues for the development of an interdisciplinary psychology of loss that is focused on people's pervading commonsense experience and recognition of loss in their own and others' lives. This field may be defined as broader than related fields such as traumatology, thanatology, and stress and coping. The psychology of loss focuses on the perception of major loss deriving from events such as death and divorce, but also on the perception of major loss in connection with such diverse phenomenna as loss of employment, los of bodily functioning, and being the target of violence or prejudice, including genocide. An important research topic for this field concerns people's stories of how major losses are interrelated in their lives. It is argued that perceived loss is a critical phenomenal state that must be dealt with in adaptation to most significant stressors.
  • Article
    • Nicole A. Roberts
    • Christine Zalecki
      Christine Zalecki
    Anxiety and depression frequently co-occur and are viewed by many theorists as aspects of a unitary disorder. In contrast, the diagnostic nomenclature views anxiety and depression as discrete disorders, and current protocols for anxiety and depression treat the disorders separately. To test the hypothesis (based on the unitary view) that anxiety and depression are tightly related and change together over the course of treatment, we monitored week-by-week changes in symptoms of anxiety and depression in 58 outpatients treated naturalistically in private practice with cognitive-behavior therapy. Results were more supportive of a unitary than a discrete view, and showed that anxiety and depression were highly predictive of one another over the course of treatment. These findings lend support to a view of anxiety and depression as more unitary than discrete, and suggest the need to consider changes in the diagnostic nomenclature and in treatment strategies for anxious depressed patients.
    • Bernadette Wren
      Bernadette Wren
    In this article I describe the accounts of a group of parents with transgendered adolescents. I look specifically at how the parents try to build an intelligible story of the young people's gender identity and how their story shapes their coping strategies. For the qualitative study on which this article is based, I interviewed adolescents with a well-established cross-gender identification and their parents from families referred to a specialist NHS service. The first-person reports were analysed using grounded theory methodology. There were a number of suggestive findings. First, communication about gender identity issues within the family and outside was handled with enormous care; second, it was clear that these parents are aware that their response to the gender problems is a deeply moral issue; third, there was an iterative relationship between the activities of making-meaning and accepting (or not) the child's claims, and a similar interaction between the activity of meaning-making and the tasks of practical coping; fourth, a belief in biological causation of transgenderism was associated with a more benign view of the adolescent; and fifth, there were interesting differences between the accounts of mothers and fathers. The findings of the study hopefully illuminate clinical encounters, stimulate further research into how families cope with this unusual predicament and encourage reflexive thinking in practitioners in related fields.
  • Article
    • Lenore Sawyer Radloff
    The CES-D scale is a short self-report scale designed to measure depressive symptomatology in the general population. The items of the scale are symptoms associated with depression which have been used in previously validated longer scales. The new scale was tested in household interview surveys and in psychiatric settings. It was found to have very high internal consistency and adequate test- retest repeatability. Validity was established by pat terns of correlations with other self-report measures, by correlations with clinical ratings of depression, and by relationships with other variables which support its construct validity. Reliability, validity, and factor structure were similar across a wide variety of demographic characteristics in the general population samples tested. The scale should be a useful tool for epidemiologic studies of de pression.
  • Article
    • Rupert Brown
      Rupert Brown
    This article presents a critical review of Social Identity Theory. Its major contributions to the study of intergroup relations are discussed, focusing on its powerful explanations of such phenomena as ingroup bias, responses of subordinate groups to their unequal status position, and intragroup homogeneity and stereotyping. In addition, its stimulative role for theoretical elaborations of the Contact Hypothesis as a strategy for improving intergroup attitudes is noted. Then five issues which have proved problematic for Social Identity Theory are identified: the relationship between group identification and ingroup bias; the self-esteem hypothesis; positive – negative asymmetry in intergroup discrimination; the effects of intergroup similarity; and the choice of identity strategies by low-status groups. In a third section a future research agenda for the theory is sketched out, with five lines of enquiry noted as being particularly promising: expanding the concept of social identity; predicting comparison choice in intergroup settings; incorporating affect into the theory; managing social identities in multicultural settings; and integrating implicit and explicit processes. The article concludes with some remarks on the potential applications of social identity principles. Copyright © 2000 John Wiley & Sons, Ltd.
  • Article
    Full-text available
    • Gregory Zimet
      Gregory Zimet
    • Nancy W. Dahlem
    • Sara G. Zimet
    • Gordon K. Farley
    The development of a self-report measure of subjectively assessed social support, the Multidimensional Scale of Perceived Social Support (MSPSS), is described. Subjects included 136 female and 139 male university undergraduates. Three subscales, each addressing a different source of support, were identified and found to have strong factorial validity: (a) Family, (b) Friends, and (c) Significant Other. In addition, the research demonstrated that the MSPSS has good internal and test-retest reliability as well as moderate construct validity. As predicted, high levels of perceived social support were associated with low levels of depression and anxiety symptomatology as measured by the Hopkins Symptom Checklist. Gender differences with respect to the MSPSS are also presented. The value of the MSPSS as a research instrument is discussed, along with implications for future research.
  • Article
    • Jennifer Katz
      Jennifer Katz
    • Michael Petracca
    • Jill A Rabinowitz
      Jill A Rabinowitz
    Emotional role reversal occurs when children provide for the emotional needs of their parents. This reversal of the hierarchical family structure can have negative, enduring costs for daughters who primarily provide, rather than receive, nurturance. More specifically, emotional role reversal was expected to foster attachment anxiety and excessive reassurance-seeking, both of which may promote negative long term effects on daughters’ emotional well-being. Female undergraduates ( N = 163) from intact families provided self report data on these constructs. Role reversal with mothers predicted daughters’ depressive symptoms. This effect was fully mediated by anxious attachment tendencies. Clinical implications of role reversal are discussed. (PsycINFO Database Record (c) 2010 APA )(journal abstract)
  • Article
    • Aaron H. Devor
    Coming to recognize oneself as transsexual involves a number of stages of exploration and analysis on both an interpersonal and intrapersonal level over the course of many years. A model encompassing fourteen possible stages is proposed: (1) Abiding Anxiety, (2) Identity Confusion About Originally Assigned Gender and Sex, (3) Identity Comparisons About Originally Assigned Gender and Sex, (4) Discovery of Transsexualism, (5) Identity Confusion About Transsexualism, (6) Identity Comparisons About Transsexualism, (7) Tolerance of Transsexual Identity, (8) Delay Before Acceptance of Transsexual Identity, (9) Acceptance of Transsexualism Identity, (10) Delay Before Transition, (11) Transition, (12) Acceptance of Post-Transition Gender and Sex Identities, (13) Integration, and (14) Pride.
  • Article
    • David Valentiner
      David Valentiner
    • Charles J. Holahan
    • Rudolf H. Moos
    An integrative model of mediating and moderating mechanisms in the coping process was examined in a 2-yr prospective framework with 175 college students using both single-group and multigroup LISREL analyses. Consistent with the hypothesized model, initial parental support was associated with subsequent changes in psychological adjustment both directly and indirectly through adaptive coping strategies. Moreover, as predicted, appraisals of event controllability moderated both the degree to which parental support influenced coping and the effectiveness of coping responses. With controllable events, family support predicted adaptive coping, and coping predicted changes in adjustment. With uncontrollable events, family support related directly to changes in adjustment. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
  • Article
    • Peter M. Lewinsohn
    • Gregory N. Clarke
    • Paul Rohde
      Paul Rohde
    • John R. Seeley
    describe [the authors'] program of research on adolescent depression, especially the evaluation of a cognitive-behavioral treatment approach / [Ss were 14–18 yr olds] [summarize] some of the findings pertaining to adolescent depression that have emerged from our research with the OADP [Oregon Adolescent Depression Project] / review the rationale and theoretical background for our treatment approach / describe the CWD-A [Coping with Depression] course for adolescents and the companion course for the parents of the depressed adolescents, and summarize results from 2 randomized clinical trials with 24-mo followup / address additional issues, such as variables that mediate treatment seeking and the characteristics of those depressed adolescents who did not respond well to the CWD-A course / [describe] initial results from a project evaluating the efficacy of a school-based intervention aimed at preventing depressive episodes in at-risk adolescents (PsycINFO Database Record (c) 2012 APA, all rights reserved)
  • Article
    • Andrea L. Dwyer
    • Anne L. Cummings
    Examined the relationship of self-efficacy, social support, and coping strategies with stress levels of university students. 75 education students (aged 22–48 yrs) completed 4 questionnaires assessing these variables. Significant correlations were found for stress with total number of coping strategies and the use of avoidance-focused coping strategies. As well, there was a significant correlation between social support from friends and emotion-focuscd coping strategies. Gender differences were found, with women reporting more social support from friends than men. Implications of these results for counselling university students are discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
  • Article
    Full-text available
    • Susan Folkman
    • Richard S. Lazarus
    • Christine Dunkel Schetter
      Christine Dunkel Schetter
    • Rand Gruen
      Rand Gruen
    Investigated the functional relations among cognitive appraisal and coping processes and their short-term outcomes within stressful encounters. The authors used an intraindividual analysis of the interrelations among primary appraisal (what was at stake in the encounter), secondary appraisal (coping options), 8 forms of problem- and emotion-focused coping, and encounter outcomes in a sample of 85 married couples (females aged 35–45 yrs and males aged 26–54 yrs). Findings show that coping was strongly related to cognitive appraisal; the forms of coping that were used varied depending on what was at stake and the options for coping. Coping was also differentially related to satisfactory and unsatisfactory encounter outcomes. Findings clarify the functional relations among appraisal and coping variables and the outcomes of stressful encounters. (47 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
  • Article
    Full-text available
    • Stephanie L Budge
      Stephanie L Budge
    • Esther N. Tebbe
    • Kimberly A.S. Howard
      Kimberly A.S. Howard
    This study explored the work experiences of individuals who have started transitioning from their biological sex to a different gender expression through 18 interviews of transgender-identified individuals. Thirteen of the participants identified as male-to-female transsexuals, 2 participants identified as female-to-male transsexuals, 2 participants identified as female-bodied gender queer individuals, and 1 participant identified as a biological male cross-dresser. Using a grounded theory (K. Charmaz, 2006) approach, 2 separate work experience models emerged: (a) the process of gender transitioning at work and (b) the career decision-making process. The 3 phases of the first model included a pretransition phase, during the transition phase, and posttransition phase. Within these 3 phases, the following 5 major themes emerged: preparation for the work transition, coming out at work, presentation and appearance at work, others' reactions at work, and affective/coping experiences related to work. The second model resulted in 6 major themes related to career decision making: occupational barriers, occupational prospects, occupational aspirations, taking action, occupational gratification, and contextual influences. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
  • Article
    Full-text available
    • Stephen R. Wester
      Stephen R. Wester
    • Heidi Fowell Christianson
    • David L Vogel
      David L Vogel
    • Meifen Wei
      Meifen Wei
    Recent theoretical work in the psychology of men suggests that the negative consequences associated with traditional male gender roles might be lessened for men who experience a sense of social support. However, little research exists exploring how men adaptively utilize social support. Using a sample of 396 male participants, this study explores whether social support mediates or moderates the relationship between gender role conflict and psychological distress. Results demonstrate that social support acts as a mediator only between Restricted Emotionality and psychological distress as well as Restricted Affectionate Behavior Between Men and psychological distress. Furthermore, social support moderated only Restricted Affectionate Behavior Between Men and psychological distress. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
  • Article
    Full-text available
    • Robert E. Kraut
      Robert E. Kraut
    • Olson
    • Mahzarin Banaji
      Mahzarin Banaji
    • Couper
    As the Internet has changed communication, commerce, and the distribution of information, so too it is changing psychological research. Psychologists can observe new or rare phenomena online and can do research on traditional psychological topics more efficiently, enabling them to expand the scale and scope of their research. Yet these opportunities entail risk both to res earch quality and to human subjects. Internet research is inherently no more risky than traditional observational, survey or experimental methods. Yet the rapidly changing nature of technology, norms, and online behavior means that the risks and safeguards against them will differ from those characterizing traditional research and will themselves change over time. This paper describes some benefits and challenges of conducting psychological research via the Internet and offers recommendations to both researchers and Institutional Review Boards for dealing with the challenges. Send comments and editorial correspondence to:
  • Article
    • Stacey Wareham
    • Ken Fowler
    • Andrea Pike
      Andrea Pike
    This study examined the effects of 4 subtypes of social support (tangible, affective, positive social interaction, and emotional/informational) and gender on the severity and duration of depressive symptoms within the general adult Canadian population. Data were collected from the Canadian Community Health Survey (CCHS; Statistics Canada, 2002). Upon meeting predetermined criteria, 6,316 participants were included in the study. The findings suggest that, overall, positive social interaction was significantly associated with decreases in depression severity; while emotional/informational support was significantly associated with increases in depression severity. Positive social interaction and emotional/informational support appeared to significantly decrease the duration of depression. Interesting gender differences also emerged among the 4 subtypes of social support. Implications of the findings are discussed.
  • Article
    • Li-tze Hu
    • Peter M. Bentler
    This article examines the adequacy of the “rules of thumb” conventional cutoff criteria and several new alternatives for various fit indexes used to evaluate model fit in practice. Using a 2‐index presentation strategy, which includes using the maximum likelihood (ML)‐based standardized root mean squared residual (SRMR) and supplementing it with either Tucker‐Lewis Index (TLI), Bollen's (1989) Fit Index (BL89), Relative Noncentrality Index (RNI), Comparative Fit Index (CFI), Gamma Hat, McDonald's Centrality Index (Mc), or root mean squared error of approximation (RMSEA), various combinations of cutoff values from selected ranges of cutoff criteria for the ML‐based SRMR and a given supplemental fit index were used to calculate rejection rates for various types of true‐population and misspecified models; that is, models with misspecified factor covariance(s) and models with misspecified factor loading(s). The results suggest that, for the ML method, a cutoff value close to .95 for TLI, BL89, CFI, RNI, and Gamma Hat; a cutoff value close to .90 for Mc; a cutoff value close to .08 for SRMR; and a cutoff value close to .06 for RMSEA are needed before we can conclude that there is a relatively good fit between the hypothesized model and the observed data. Furthermore, the 2‐index presentation strategy is required to reject reasonable proportions of various types of true‐population and misspecified models. Finally, using the proposed cutoff criteria, the ML‐based TLI, Mc, and RMSEA tend to overreject true‐population models at small sample size and thus are less preferable when sample size is small.
  • Chapter
    • Richard Stanley Lazarus
    • Susan Folkman
  • Article
    • Margaret Rosario
      Margaret Rosario
    • Marybeth Shinn
    • Hanne Mørch
    • Carol B. Huckabee
    Two theories have been advanced to explain gender differences in coping. Socialization theory states that women are socialized into using less effective coping strategies than men. Role constraint theory affirms that no gender differences in coping exist when men and women occupy the same roles. Three studies, where the roles occupied by women and men were the same, were conducted to test the theories. Two of them also compared role constraint and socialization theories for social support. The results for coping did not support the socialization theory and partially supported the role constraint theory. With one exception, men and women did not differ in the ways they coped with similar role stressors. The results for social support indicated that women reported using more support than men in similar role situations. These findings suggest that higher levels of psychological disturbance among women cannot be attributed to their coping styles independent of their social roles.
  • Article
    • Jennifer A. Boisvert M.A
    • Kristi D. Wright M.A
    • Jennifer A. Boisvert
    • Gordon J G Asmundson
      Gordon J G Asmundson
    Despite widespread use of the Center for Epidemiologic Studies Depression Scale [CES-D], there are no investigations that examine its factor structure in a military sample. Separate confirmatory factor analyses were performed on responses to the CES-D obtained from 102 female and 102 male Canadian military peacekeepers in order to compare the fit of a four-factor intercorrelated (lower-order) model to a four-factor hierarchical (higher-order) model. The intercorrelated and hierarchical models fit the data well for both women and men, with hierarchical models fitting the data slightly better for women than men. These findings suggest that, for military women and men, the CES-D can be used to measure a set of distinct but interrelated depressive symptoms as well as a global construct of depression. Implications and future directions are discussed. Depression and Anxiety 17:19–25, 2003. © 2003 Wiley-Liss, Inc.
  • Article
    • Tohru Nemoto
      Tohru Nemoto
    • Birte Boedeker
    • Mariko Iwamoto
    We determined racial/ethnic differences in social support and exposure to violence and transphobia, and explored correlates of depression among male-to-female transgender women with a history of sex work (THSW). A total of 573 THSW who worked or resided in San Francisco or Oakland, California, were recruited through street outreach and referrals and completed individual interviews using a structured questionnaire. More than half of Latina and White participants were depressed on the basis of Center For Epidemiologic Studies Depression Scale scores. About three quarters of White participants reported ever having suicidal ideation, of whom 64% reported suicide attempts. Half of the participants reported being physically assaulted, and 38% reported being raped or sexually assaulted before age 18 years. White and African American participants reported transphobia experiences more frequently than did others. Social support, transphobia, suicidal ideation, and levels of income and education were significantly and independently correlated with depression. For THSW, psychological vulnerability must be addressed in counseling, support groups, and health promotion programs specifically tailored to race/ethnicity.
  • Article
    • Peter M. Lewinsohn
    • Amanda Mathew
      Amanda Mathew
    • Jeremy W Pettit
    • R.E. Roberts
    Major depressive disorder (MDD) and anxiety disorders (ANX) are debilitating and prevalent conditions that often co-occur in adolescence and young adulthood. The leading theoretical models of their co-morbidity include the direct causation model and the shared etiology model. The present study compared these etiological models of MDD-ANX co-morbidity in a large, prospective, non-clinical sample of adolescents tracked through age 30. Logistic regression was used to examine cross-sectional associations between ANX and MDD at Time 1 (T1). In prospective analyses, Cox proportional hazards models were used to examine T1 predictors of subsequent disorder onset, including risk factors specific to each disorder or common to both disorders. Prospective predictive effect of a lifetime history of one disorder (e.g. MDD) on the subsequent onset of the second disorder (e.g. ANX) was then examined. This step was repeated while controlling for common risk factors. The findings supported relatively distinct profiles of risk between MDD and ANX depending on order of development. Whereas the shared etiology model best explained co-morbid cases in which MDD preceded ANX, direct causation was supported for co-morbid cases in which ANX preceded MDD. Consistent with previous research, significant cross-sectional and prospective associations were found between MDD and ANX. The results of the present study suggest that different etiological models may characterize the co-morbidity between MDD and ANX based upon the temporal order of onset. Implications for classification and prevention efforts are discussed.
  • Article
    Full-text available
    • Brian Mustanski
    • Robert Garofalo
      Robert Garofalo
    • Erin Emerson
      Erin Emerson
    We examined associations of race/ethnicity, gender, and sexual orientation with mental disorders among lesbian, gay, bisexual, and transgender (LGBT) youths. We assessed mental disorders by administering a structured diagnostic interview to a community sample of 246 LGBT youths aged 16 to 20 years. Participants also completed the Brief Symptom Inventory 18 (BSI 18). One third of participants met criteria for any mental disorder, 17% for conduct disorder, 15% for major depression, and 9% for posttraumatic stress disorder. Anorexia and bulimia were rare. Lifetime suicide attempts were frequent (31%) but less so in the prior 12 months (7%). Few racial/ethnic and gender differences were statistically significant. Bisexually identified youths had lower prevalences of every diagnosis. The BSI 18 had high negative predictive power (90%) and low positive predictive power (25%) for major depression. LGBT youths had higher prevalences of mental disorder diagnoses than youths in national samples, but were similar to representative samples of urban, racial/ethnic minority youths. Suicide behaviors were similar to those among representative youth samples in the same geographic area. Questionnaires measuring psychological distress may overestimate depression prevalence among this population.
  • Article
    Full-text available
    • Sarit Golub
      Sarit Golub
    • Ja'Nina Joy Garrett-Walker
      Ja'Nina Joy Garrett-Walker
    • Buffie Longmire-Avital
      Buffie Longmire-Avital
    • Jeffrey T Parsons
      Jeffrey T Parsons
    Transgender women completed questionnaires of religiosity, social support, stigma, stress-related growth, and sexual risk behavior. In a multivariate model, both social support and religious stress-related growth were significant negative predictors of unprotected anal sex, but religious behaviors and beliefs emerged as a significant positive predictor. The interaction between religious behaviors and beliefs and social support was also significant, and post-hoc analyses indicated that high-risk sex was least likely among individuals with high-levels of social support but low levels of religious behaviors and beliefs. These data have important implications for understanding factors that might protect against HIV risk for transgender women.
  • Article
    Full-text available
    • Rogério M Pinto
      Rogério M Pinto
    • Rita M Melendez
    • Anya Y Spector
    The literature on male-to-female transgender (MTF) individuals lists myriad problems such individuals face in their day-to-day lives, including high rates of HIV/AIDS, addiction to drugs, violence, and lack of health care. These problems are exacerbated for ethnic and racial minority MTFs. Support available from their social networks can help MTFs alleviate these problems. This article explores how minority MTFs, specifically in an urban environment, develop supportive social networks defined by their gender and sexual identities. Using principles of community-based participatory research (CBPR), 20 African American and Latina MTFs were recruited at a community-based health care clinic. Their ages ranged from 18 to 53. Data were coded and analyzed following standard procedure for content analysis. The qualitative interviews revealed that participants formed their gender and sexual identities over time, developed gender-focused social networks based in the clinic from which they receive services, and engaged in social capital building and political action. Implications for using CBPR in research with MTFs are discussed.
  • Article
    Full-text available
    • Francisco J. Sánchez
      Francisco J. Sánchez
    • Eric Vilain
      Eric Vilain
    The fear of experiencing discrimination often provokes symptoms of psychological distress. One coping resource is positive identification with one's social group-known as collective self-esteem. This preliminary study investigated whether collective self-esteem was related to fears regarding a transsexual identity and psychological distress among 53 self-identified male-to-female transsexuals (mean age = 50.79). Participants were recruited from transgender events held in Arizona and California. The majority (81%) reported living full-time as women (mean length of time living as a woman = 6.33 years). Negative feelings about the transsexual community and fears regarding the impact of a transsexual identity were positively related to psychological distress. A regression model revealed that the fear of how a transsexual identity would affect one's life was the best predictor of the severity of psychological distress. These results are consistent with findings from other historically marginalized groups whereby the stress of being stigmatized by society adversely affects mental health.
  • Article
    • Walter Bockting
    • Larry Nuttbrock
    • Sel J. Hwahng
      Sel J. Hwahng
    • Jeffrey Becker
    The psychiatric impact of interpersonal abuse associated with an atypical presentation of gender was examined across the life course of 571 male-to-female (MTF) transgender persons from the New York City Metropolitan Area. Gender-related abuse (psychological and physical), suicidality, and Diagnostic and Statistical Manual of Mental Disorders (4th ed., text revision) major depression were retrospectively measured across five stages of the life course using the Life Chart Interview. Among younger respondents (current age of 19-39), the impact of both types of abuse on major depression was extremely strong during adolescence and then markedly declined during later stages of life. Among older respondents (current age of 40-59), the impact of both types of abuse on major depression was strong during adolescence and then marginally declined during later stages of life. The effects of both types of abuse on suicidality were weaker but more consistently observed across the life course among both the younger and older respondents. Gender-related abuse is a major mental health problem among MTF transgender persons, particularly during adolescence. As these individuals mature, however, the consequences of this abuse appear less severe, which may represent the development of moderately effective mechanisms for coping with this abuse.
  • Article
    • Holly E Schleicher
    • Kari Jo Harris
      Kari Jo Harris
    • Delwyn Catley
    • Niaman Nazir
      Niaman Nazir
    Expectancies about nicotine's ability to alleviate negative mood states may play a role in the relationship between smoking and depression. The authors examined the role of negative affect regulation expectancies as a potential mediator of depression (history of depression and depressive symptoms) and smoking among college students. As part of a larger study, 315 undergraduate smokers completed a 296-item survey from January to May of 2001 and 2002. Cross-sectional analyses revealed that negative affect regulation expectancies fully mediated the positive relationship between depressive symptoms and level of smoking. Although depressive symptoms are associated with higher levels of tobacco smoking, the expectation that smoking will reduce negative emotions is 1 factor that accounts for this relationship.