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Mental Health of Transgender Children Who Are Supported in Their Identities
Pediatrics
Abstract
Objective:
Transgender children who have socially transitioned, that is, who identify as the gender "opposite" their natal sex and are supported to live openly as that gender, are increasingly visible in society, yet we know nothing about their mental health. Previous work with children with gender identity disorder (GID; now termed gender dysphoria) has found remarkably high rates of anxiety and depression in these children. Here we examine, for the first time, mental health in a sample of socially transitioned transgender children.
Methods:
A community-based national sample of transgender, prepubescent children (n = 73, aged 3-12 years), along with control groups of nontransgender children in the same age range (n = 73 age- and gender-matched community controls; n = 49 sibling of transgender participants), were recruited as part of the TransYouth Project. Parents completed anxiety and depression measures.
Results:
Transgender children showed no elevations in depression and slightly elevated anxiety relative to population averages. They did not differ from the control groups on depression symptoms and had only marginally higher anxiety symptoms.
Conclusions:
Socially transitioned transgender children who are supported in their gender identity have developmentally normative levels of depression and only minimal elevations in anxiety, suggesting that psychopathology is not inevitable within this group. Especially striking is the comparison with reports of children with GID; socially transitioned transgender children have notably lower rates of internalizing psychopathology than previously reported among children with GID living as their natal sex.
... Research within the area of transgender adolescents underlines the important role of the parental and family context for their well-being in everyday life [14][15][16]. A large line of research deals with the role of specific parental behaviors and attitudes towards their transgender child. ...
... Studies consistently show that parental support and acceptance, demonstrated through behaviors and attitudes that affirm their child's gender identity [17], correlate with better mental health outcomes for transgender adolescents compared to those that do not receive parental support [18]. This includes lower rates of depression, suicidal thoughts, PTSD, and eating disorders, alongside improvements in self-esteem and overall quality of life [16,19,20]. In line, transgender adolescents without parental support show higher suicidal tendencies [21,22]. ...
Background
Parents play a central role for transgender adolescents’ well-being and their coping with minority stress, like discrimination, rejection and violence. Yet, little is known about the experiences of parents facing minority stress as they support their transgender children who are either awaiting or undergoing medical transition. Therefore, we aimed to first examine minority stress experiences reported by the parents with respect to distal and proximal stressors. Second, we aimed to explore whether experiences relate to children’s stress experiences as secondary stress experiences, or if parents report minority stress directed at themselves as primary stress experiences.
Methods
In the context of the participatory TRANS*PARENT study in Berlin, Germany, from April 2022 to September 2022 five focus groups were conducted with a total of 24 parents who have a transgender and/or non-binary child at the age of 11–18 years. Qualitative structuring content analysis was applied.
Results
Parents reported distal stressors such as structural problems (in education, medical, psychiatric and psychological institutions, leisure activities and sports) and social rejection (peer rejection like bullying and violence, gaslighting, intersectionality, blame of others). Proximal stressors covered fears of future/anticipated discrimination, internalized gender stereotypes, and self-blame. Most experiences were secondary stressors, related to the child’s minority stress causing frustration and sadness for the parents, while especially fears of the future/anticipated discrimination, gaslighting and blame of others emerged as central primary stressors.
Discussion
Results show a complex interaction of minority stressors affecting both parents and their transgender children on structural and social levels. The impairment of their child’s education and worries about its safety and life prospects burdened parents the most. The additional direct and primary stress experiences might impede their efforts to navigate their child’s transition process.
Conclusion
In transgender health care, the multidimensionality of the structural and social impacts of marginalization needs to be addressed not only with respect to the transgender adolescents themselves, but also with respect to their caregivers. Further research should explore how child and parental stress interact and how family-based health care can alleviate stress on both child and parent level.
Clinical trial number
Not applicable.
... Recent bodies of evidence have examined protective factors, with transitioning, social support, and family support being identified as important buffers against the impact of minority stress (Mezza et al., 2024;Olson et al., 2016;Travers et al., 2012). Individual studies exploring this in trans youth have found that those with parents supportive of their identity and facilitative of social transition demonstrate no elevated rates of depression and anxiety compared to cisgender youth (Olson et al., 2016). ...
... Recent bodies of evidence have examined protective factors, with transitioning, social support, and family support being identified as important buffers against the impact of minority stress (Mezza et al., 2024;Olson et al., 2016;Travers et al., 2012). Individual studies exploring this in trans youth have found that those with parents supportive of their identity and facilitative of social transition demonstrate no elevated rates of depression and anxiety compared to cisgender youth (Olson et al., 2016). Family support is therefore likely to be an important mechanism for intervention to improve the mental health of trans offspring. ...
Trans people experience poorer mental health than their cisgender counterparts, likely as a result of minority stress. Caregivers can contribute to minority stress through discrimination, rejection and lack of acceptance. Interventions with family members may provide a way to address conflict and lack of acceptance of gender within the family.
A systematic review was conducted following PRISMA guidelines. Searches were conducted in PsycInfo, Embase, MEDLINE, Cinahl Plus and ProQuest Theses and Dissertations databases on 16 February 2024 to identify concepts relating to “transgender” and “family intervention.”
Seven studies were included in the review. Four evaluated interventions relating to family therapy, two to caregiver support groups, and one to an online psychoeducational programme. Outcomes related to mental health were reported on most commonly with positive results; however, overall study quality was poor, and study designs varied.
More studies on the efficacy of family-based interventions with trans people have been published in recent years. Due to heterogeneity, the conclusions that can be drawn from this review are limited. Recommendations are made for increasing the quality of future studies. The recent increase in studies assessing family interventions with trans people is an encouraging sign, and several interventions were identified that show promise in the ways they have adapted for the needs of trans people.
... have similar levels of anxiety and depression as cisgender siblings and peers [32] are more likely to have positive adult health outcomes such as self-esteem, social support, and better general health [33] are less likely to experience depression, substance abuse, and suicidal ideation and attempts [34] have improved self-esteem and coping ability [34] Transgender children who have socially transitioned (live in accordance with their gender identity) also have levels of depression and anxiety similar to their cisgender peers. [35] "For me, once I realized that my family was responding to me and interacting with me with respect and acceptance, and once I realized that this respect and acceptance was a legacy of our traditional Native past, I was empowered to present my whole self to the world and reassume the responsibilities of being a Two Spirit person." ...
... [46] Your attention to youth mental health is critical. [35] Incorporating quick mental health check-ins at each appointment can make a difference and help you detect underlying issues. ...
... Growing research highlights the significant impact of family dynamics on the psychosocial adjustment of trans young people (Pariseau et al., 2019). Parental support and affirmation are protective, reducing adverse mental health outcomes and fostering resilience (Durwood et al., 2017;Olson et al., 2016;Pullen Sansfaçon et al., 2018;Ryan et al., 2010;Simons et al., 2012). Research suggests that trans young people who experience better family communication and greater satisfaction within their family relationships tend to have lower levels of depression and anxiety, as well as higher self-esteem . ...
... In this context, literature often commends families of trans young people for challenging societal norms by accepting and supporting their children, navigating the social discomfort that arises when a child embraces their true gender identity (see Durwood et al., 2017;Olson et al., 2016;Pullen Sansfaçon et al., 2015;Ryan et al., 2010;Simons et al., 2012). However, the very social structures that create distress around non-normative gender identities remain largely unquestioned. ...
... Several recent studies investigated how the trajectory of GD (i.e., whether it began in childhood or adolescence) influenced psychological outcomes [36] such as depression, anxiety, and overall distress when individuals sought gender-affirming care. Some of these highlighted that children who exhibited consistent and persistent GD from a young age (before puberty) were generally better adjusted psychologically by the time they reached adolescence [37,38] and were seeking gender-affirming care. In contrast, those whose GD emerged later, during adolescence, often exhibited more severe psychological distress [3], including higher levels of depression, anxiety, and suicidal ideation at the time of seeking care [14,15,37]. ...
... Some of these highlighted that children who exhibited consistent and persistent GD from a young age (before puberty) were generally better adjusted psychologically by the time they reached adolescence [37,38] and were seeking gender-affirming care. In contrast, those whose GD emerged later, during adolescence, often exhibited more severe psychological distress [3], including higher levels of depression, anxiety, and suicidal ideation at the time of seeking care [14,15,37]. However, most of these studies did not directly compare adolescents with GD seeking gender reassignment by distinguishing between GD presentation in childhood or adolescence. ...
Studies have consistently shown that gender-diverse youth experience higher rates of internalizing disorders and self-harm behaviors (SH) compared to their cisgender peers. However, there is limited research on how body investment and emotion regulation influence these symptoms, especially in relation to the age of gender dysphoria (GD) presentation. Objectives: This study aimed to explore the relationship between the timing of GD presentation (early vs. late) and psychological distress in adolescents seeking gender affirmation (GA), specifically focusing on internalizing symptoms, emotion regulation, and body investment. The study also investigated how SH during the year preceding the request for gender affirmation might have impacted these factors. Methods: On a total of 80 adolescents (mean age: 14.88 years) at their first request for GA, participants were divided into two groups: early-presentation GD (EP-GD; mean age: 14.93 years) and late-presentation GD (LP-GD; mean age: 14.83 years). Among the sample, 60% exhibited SH. Internalizing symptoms, emotion regulation, and body investment were assessed using the Youth Self-Report (YSR), the Difficulties in Emotion Regulation Scale (DERS), and the Body Investment Scale (BIS). Results: Results revealed that LP-GD adolescents had significantly higher emotion dysregulation (ED), particularly in the Strategies domain of the DERS (p = 0.040), and more social problems in the YSR (p = 0.047) compared to EP-GD ones. SH were associated with higher internalizing symptoms, including anxiety, withdrawal, and somatic complaints (p < 0.03), as well as increased body dissatisfaction, particularly in the BIS Care and Protection dimensions (p = 0.044; p = 0.034). Conclusions: These findings supported the hypothesis that LP-GD adolescents and youths with a history of SH showed more pronounced emotion regulation difficulties and internalizing symptoms, further emphasizing the need for early intervention programs targeting both GD and co-occurring mental health problems.
... Among LGBTQ+ youth, in general, parental acceptance seems to provide a strong protective factor for their mental health, including lower levels of suicidality, depression, and anxiety, as well as higher levels of self-esteem (Green et al. 2021;Olson et al. 2016;Ryan et al. 2010;Simons et al. 2013). However, the literature is limited and mixed when it comes to the role of parental acceptance as a buffer for bullying experiences (Espelage et al. 2019), particularly when other minoritized identities, such as race or ethnicity are also considered. ...
... Our moderating effects found in this study provides nuance about possible protective factors when experiencing intersectional bullying. Specifically, while there has been evidence of buffering from parental acceptance for LGBTQ + youth when experiencing oppression (Green et al. 2021;Olson et al. 2016;Ryan et al. 2010;Simons et al. 2013), our results suggested most in our sample did not see these benefits, except when parental acceptance was perceived as high. Similarly, our findings, in general suggested that for participants who reported seeing a therapist in the last year, the relation between bullying and internalization, while still positive, was lower in effect than for those who had not seen a therapist. ...
Research on bullying and LGBTQ+ Black and Latinx youth is limited, yet findings suggest experiencing bullying is associated with high levels of psychological distress, which can be internalized. Similarly, research on aspects such as parental acceptance and informed therapy suggest these can operate as protective factors when experiencing oppression. Yet, these relations are often tested individually. Thus, using an intersectional approach, we explore the cumulative effect of these variables using a sample of LGBTQ+ Black and Latinx youth to highlight specific mental health disparities among these groups. Using a national online cross‐sectional survey with LGBTQ+ Black and Latinx youth (N = 2414), we assessed the relation between school bullying (predictor), internalized LGBTQ+ stigma (mediator), and psychological distress (outcome) and tested the influence of access to therapy (moderator 1) and parental acceptance (moderator 2) in a moderated mediation analysis. Additionally, a second moderated mediation analysis tested among participants who have access to therapy if LGBTQ+ informed therapy (moderator 1) and parental acceptance (moderator 2) influenced the relation between our main variables. Using a moderated mediation analysis PROCESS Model 11 for two models, results suggested in model 1 that internalized stigma mediated the relation between school bullying and psychological distress. Furthermore, both parental acceptance and access to therapy moderated the association between school bullying and internalized LGBTQ+ stigma. The second model found that for those with access to therapy, receiving LGBTQ+ ‐informed therapy and high parental acceptance disrupted the relationship between school bullying and internalized LGBTQ+ stigma. Our findings suggested that LGBTQ+ Black and Latinx youth receiving LGBTQ+ informed therapy reported less internalized LGBTQ+ stigma, particularly when parental acceptance is high. Implications and limitations are discussed.
... Distintas investigaciones han señalado que las familias oscilan entre posiciones de menos o más apoyo (i.e. Bariola et al., 2015;Olson et al., 2016;Riley et al., 2011). Algunos trabajos concluyen que las familias deberían adoptar prácticas afirmativas con muestras de apoyo y acompañamiento durante todo el proceso (Ehrensaft et al., 2019;Horton, 2023). ...
... Formar a las familias en esta materia se ha identificado como un potente recurso para promover el bienestar de las personas trans, especialmente durante la infancia (Abreu et al., 2019). En definitiva, contar con una familia que apoya se convierte en un factor protector frente a los riesgos que puede experimentar una persona trans en un entorno hostil (de Vries et al., 2016;Olson et al., 2016). ...
The purpose of this research was to explore the situation of transgender people in Spain, focusing on the analysis of their trajectories and identity experiences, as well as the role played by family, friends and associations throughout this process. To this end, qualitative research was carried out with 13 transgender people. Semi-structured interviews were used and a content analysis was carried out using the phenomenological approach. Among the main results found, it is worth highlighting that the family and peer group are essential references for trans people. In particular, having their support and recognition can be fundamental during the process of identity construction. Within friendships, it is important to point out that many of the people interviewed value their LGTB friends positively. We conclude the importance that professionals, such as social workers, can have in direct and indirect intervention with transgender people to improve their emotional well-being, as well as an advance towards social justice.
Las personas trans se enfrentan a un contexto socio-político marcado por la cisheteronormatividad y en el que su identidad de género puede ser causa de rechazo y discriminación en distintos ámbitos (Gallardo y Espinosa, 2019). El propósito de esta investigación ha sido explorar la situación de un grupo de personas trans en España, centrándose en el análisis de sus experiencias identitarias, así como el papel que han desempeñado la familia, las amistades y las asociaciones en sus trayectorias vitales. Para ello, se realizó una investigación cualitativa con 13 personas trans. Se utilizaron entrevistas semiestructuradas y se procedió con un análisis de contenido partiendo del enfoque fenomenológico. Entre los principales resultados hallados, destacar que la familia y el grupo de pares son referentes esenciales para las personas trans. En particular, tener su apoyo y reconocimiento puede ser fundamental durante el proceso de construcción de la identidad. Dentro de las amistades, es importante señalar que muchas de las personas entrevistadas valoran positivamente a sus amistades LGTB. Se concluye la importancia que profesionales, como trabajadores/as sociales, pueden tener desde una práctica afirmativa en la intervención directa e indirecta con las personas trans para mejorar su bienestar emocional, así como un avance hacia la justicia social.
... Adolescence is a broad developmental period of identity exploration, possibly leading to less social backlash for gender non-conformity compared to young adulthood. Moreover, reduced stigma and increased support for diverse gender identities in today's generation may downplay the mental health impact of gender nonconformity in some contexts (Olson et al., 2016). Consistent with this, the majority of the samplerepresenting a wide range of adolescent agesdid not have a meaningful daily link between gender expression and depressive symptoms, contrasting findings in young and middle adulthood (Beltz et al., 2021;Yan et al., 2024). ...
Gender expression is important for mental health, with masculinity and femininity having differential significance for unique adolescents. Yet, most empirical work on gender expression assumes it is trait-like or similarly shifting across teens. This intensive longitudinal study examined state-like aspects of gender expression and heterogeneity in adolescent-specific associations with depressive symptoms over 100 days. Participants were 106 adolescents, including 5 gender-expansive youth (54.7% cisgirls, 74.5% White; Mage = 13.31, SDage = 1.94). A sample-average link between daily masculinity and reduced symptoms was found for cisboys. Adolescent-specific results qualified this effect: Only ~25% evidenced an association between daily gender-congruent expression—masculinity for cisboys and femininity for cisgirls—and daily reduced symptoms. Using 9000+ daily reports, findings highlight the dynamic nature of gender expression and the need to use a person-specific approach in understanding the heterogenous psychological correlates of masculinity and femininity for today’s youth.
... La expresión sexual, decidida o creada por una persona, no conlleva a cuadros depresivos, sino el prejuicio social de la expresión de género y orientación sexual. Lo anterior puede manifestarse en problemas tales como ansiedad, depresión, ideación e intentos de suicido, principalmente en las poblaciones con identidad de género que no entran dentro de las polaridades establecidas por la sociedad (Olson et al., 2016). ...
... This addresses the potential pressure parents face to produce an "overall front of normativity" (Rahilly, 2015, p. 347). Research comparatively shows that children who have supportive parents have higher life satisfaction and self-esteem, and fewer depressive symptoms compared to children with nonsupportive parents (Olson et al, 2016). There is a requirement to explore deeper the implications normative constructs of play have on young children's gender expression. ...
The paper examines how play in the early years contexts continues to be informed and governed by parents and professionals through normative gender play constructs. It explores how psychologies of development read play in particular ways that can impact how children learn about gender especially when their movements and interests are corrected by adults in their lives. Play through a dominant developmental psychology approach is a mechanism for assessment where diversions of play outside normative gender play expectations can be questioned and lead to intervention. With play at the centre of practice in the field of early childhood education, it is critical to examine how normative pedagogical structures of play informs children’s gender expression. This research aims to examine what happens when children’s play is viewed predominantly through a traditional developmental psychology approach and how these perspectives are detrimental to young children’s sense of self. The data is derived from a qualitative research study that used semi-structured focus groups with 15 early childhood educators (ECEs) who work with young children, ages 3-5 years, at licensed early childhood centres in Nova Scotia, Canada. ECEs play an important role in shaping young children’s understandings of gender, therefore it is necessary to learn more from their lived experiences. The findings show that when play is structured predominantly through heteronormative forms of gender categorization it can stifle children’s diverse gender expression. This research concludes by arguing that diverse forms of play that support gender fluidity for young children is crucial to liberate children from traditional gender normative play paradigms.
... Storytelling is one of the oldest human tools for shifting public perspectives and eliciting empathy (Batson & Ahmad, 2009). Yet, scaling face-to-face interactions is impractical and disseminating video recordings of TGD youth could expose these young people to harassment or physical violence-which is one of the reasons why many TGD youth still feel unsafe revealing their gender identity (Olson et al., 2016). ...
... The findings of this study support the potential for using short, animated storytelling to reduce transphobia and elicit empathy. Animation also protects the identities of the TGD storytellers-an important consideration, since many of these young people still live in "stealth" [52]. ...
Background
Parents play a pivotal role in supporting transgender and gender diverse (TGD) youth. Yet only 35% of TGD youth describe their home as a gender-affirming place. Lack of parental support contributes to recent findings that TGD youth are approximately three times more likely to attempt suicide than their cisgender peers. In contrast, parents’ affirmation of their children’s gender identity significantly improves their mental health outcomes, by reducing anxiety, depression, and suicidality.
Objective
Addressing the urgent need for effective, scalable interventions, this study evaluates a novel digital approach: short, animated storytelling videos. We hypothesized that our 2.5-minute video intervention would reduce antitransgender stigma, or transphobia, and improve attitudes toward gender diverse children among US parents.
Methods
We recruited 1267 US parents, through the Prolific Academic (Prolific) online research platform, and randomized them into video intervention or control groups. We measured transphobia using the Transgender Stigma Scale, and attitudes toward transgender children using the gender thermometer , before and after watching the video. We compared outcomes between the two groups using 2 × 3 ANOVA. Both groups were invited to return 30 days later for follow-up assessment, before being offered posttrial access to the intervention video, which portrayed an authentic conversation between a mother and her transgender child.
Results
Single exposure to a short, animated story video significantly reduced transphobia and improved attitudes toward transgender children among US parents, immediately post intervention. We observed a significant group-by-time interaction in mean Transgender Stigma Scale scores ( F 2,1 =3.7, P =.02) and significant between-group changes when comparing the video and control groups from baseline to post intervention ( F 1 =27.4, P <.001). Effect sizes (Cohen d ) indicated small to moderate immediate changes in response to the 2.5-minute video, though the effect was no longer observed at the 30-day follow-up. Gender thermometer scores revealed significant immediate improvements in the attitudes of participants in the video intervention arm, and this improvement was sustained at the 30-day time point.
Conclusions
Short, animated storytelling is a novel digital approach with the potential to boost support and affirmation of transgender children, by offering authentic insights into the lived experiences of TGD youth. Repeated exposures to such interventions may be necessary to sustain improvements over time. Future studies could test a series of short, animated storytelling videos featuring the lived experiences of several TGD youth. Evaluating the effect of such a series could contribute to the fields of digital health communication and transgender health. Digital approaches, such as short, animated storytelling videos, that support empathy and acceptance of TGD youth could foster a more inclusive society in which every child can thrive.
... During adolescence, they begin to suffer from anxiety and depression, have anger and behavioural problems, engage in self-harm, and suicidal thoughts may emerge (Olson et al., 2015). These usually subside once gender identity is confirmed (Olson et al., 2016) and often require engaging in psychological, hormonal and surgical treatment to match the desired identity (Vitale, 2010). Research indicates that social transition, specialised care and genderaffirming medical therapy improve well-being and correlate with better psychological functioning for transgender youth (Connolly et al., 2016;Pullen Sansfaçon et al., 2018;van der Miesen et al., 2020). ...
This paper aims to reconstruct parents’ actions to protect their transgender/non-binary children from stigma. An analysis of the literature on the subject indicates that family acceptance and support are crucial to the well-being of transgender/non-binary youth, and affirmation of gender identity protects their mental and physical health. The theoretical framework of the research was symbolic interactionism, and empirical data were collected through the narrative interview technique (F. Schütze). The research sample, selected according to the snowball procedure, consisted of cisgender, heterosexual mothers of transgender/non-binary children residing throughout Poland. The 10 autobiographical narrative interviews were subjected to a coding procedure specific to the grounded theory method (K. Charmaz). The empirical data were discussed in reference to the ways in which gender minorities experience stigmatisation. An in-depth analysis of the narrative interviews identified parenting activities focused on their intrapersonal, interpersonal and social dimensions. On this basis, four interrelated stages of the process of protecting transgender/non-binary children from stigma were analytically identified: identity recognition, normalisation, advocacy and allyship.
... According to the 2015 U.S. Transgender Survey Report conducted with over 27,000 U.S. TNB people, TNB individuals with supportive families were significantly less likely to experience serious psychological distress compared to those with unsupportive families (31% vs. 50%) and had a significantly lower rate of attempted suicide (37% vs. 54%). Although it has been established that relationships with parents are important for TNB mental health (Olson et al., 2016;Simons et al., 2013), how these lead to well-being or health disparity among TNB people are largely unexplored, both globally and within Korea (Brown et al., 2020). As parental attachment plays a pivotal role across cultures in how one perceives oneself and others (Mesman et al., 2016), it is critical for counseling psychologists to understand how parental attachment impacts TNB people's resilience against minority stress. ...
Internalization of stigmatizing messages from society is a primary risk factor for transgender and nonbinary (TNB) people. To locate points of intervention for TNB people with a high level of internalized transnegativity, the present study examined predictors of internalized transnegativity in Korean TNB adults ( N = 268) using a multiple mediator model. We hypothesized that parental attachment would predict internalized transnegativity through the mediating effect of self-shame, rejection sensitivity, and self-concept clarity. The analysis provided partial support for the mediator hypothesis. The results were consistent with a model in which self-shame fully mediates the relation between parental attachment and internalized transnegativity, with no evidence of a mediating role for self-concept clarity or rejection sensitivity. This study shows that TNB individuals reporting insecure attachment with parents are more likely to experience internalized transnegativity, and the relation is largely accounted for by the indirect effect via general self-shame.
... La salud mental es un tema crítico para todos/as las/los adolescentes, pero los/las adolescentes trans* pueden enfrentar desafíos adicionales debido a la discriminación, el estigma, la falta de comprensión y apoyo. Por ejemplo, estudios han mostrado que jóvenes TGNC tienen hasta cuatro veces más probabilidades de experimentar depresión y ansiedad que sus pares cisgénero (Olson et al., 2016). A su vez, el estrés y la angustia psicológica también aumentan el riesgo de pensamientos y comportamientos suicidas. ...
... La salud mental es un tema crítico para todos/as las/los adolescentes, pero los/las adolescentes trans* pueden enfrentar desafíos adicionales debido a la discriminación, el estigma, la falta de comprensión y apoyo. Por ejemplo, estudios han mostrado que jóvenes TGNC tienen hasta cuatro veces más probabilidades de experimentar depresión y ansiedad que sus pares cisgénero (Olson et al., 2016). A su vez, el estrés y la angustia psicológica también aumentan el riesgo de pensamientos y comportamientos suicidas. ...
El capítulo describe, desde la perspectiva transdisciplinaria de los estudios de género, la situación actual de niños, niñas y adolescentes mexicanos que se identifican como trans*. considerando los efectos que han tenido tanto los procesos activistas como las políticas públicas implementadas cinco años después del surgimiento del movimiento de familias organizadas.
... Though the field has a history of neglecting transgender and nonbinary populations or even actively harming transgender and nonbinary individuals by policing the boundaries of "normal" and "abnormal" gender identity and pathologizing nonconformity (Ansara and Hegarty, 2012;Tosh, 2016;Riggs et al., 2019), research on these topics is becoming more common (and more ethical). For example, clinical, counseling, and developmental psychologists have produced powerful research on trangender and nonbinary wellbeing (e.g., Simons et al., 2013;Olson et al., 2015Olson et al., , 2016Connolly et al., 2016;Testa et al., 2017;McLemore, 2018;Tordoff et al., 2022). At the same time, in social psychology, Hyde et al. (2019) reviewed scholarship and activism that present challenges to the gender binary in a paper strengthened by interdisciplinary collaboration, Morgenroth and Ryan (2018) suggested ways for gender researchers to better reflect the complexities of gender, and Axt et al. (2021) developed a measure to study implicit attitudes toward transgender people. ...
... Simultaneously, this study found qualitative decreases in suicidality, anxiety and dysphoria, and increases in self-esteem and confidence. Such evidence aligns with benefits of other gender affirming practices, such as name changes and social transition (Olson et al., 2016;Russell et al., 2018). Evidently, transmasculine people experience a range of positive benefits from binding practices. ...
... La salud mental es un tema crítico para todos/as las/los adolescentes, pero los/las adolescentes trans* pueden enfrentar desafíos adicionales debido a la discriminación, el estigma, la falta de comprensión y apoyo. Por ejemplo, estudios han mostrado que jóvenes TGNC tienen hasta cuatro veces más probabilidades de experimentar depresión y ansiedad que sus pares cisgénero (Olson et al., 2016). A su vez, el estrés y la angustia psicológica también aumentan el riesgo de pensamientos y comportamientos suicidas. ...
Niñeces trans*: Voces, experiencias y reflexiones en torno a la vida y acompañamiento de les niñes trans* es una obra colaborativa y multidisciplinaria que se erige como un recurso imprescindible para comprender, desde perspectivas diversas, las realidades, desafíos y derechos de las niñeces trans*. Compilado por Ximena Faúndez Abarca, Débora Fernández Cárcamo, Lucha Leftraru Venegas Navarrete y Ketty Cazorla Becerra, el libro reúne una variedad de ensayos académicos, testimonios familiares y representaciones artísticas realizadas por les niñes, conformando un retrato amplio y profundo de esta temática.
La obra se organiza en capítulos que abordan desde testimonios personales hasta análisis legales, educativos y psicológicos. Entre sus aportes más destacados están:
Testimonios personales y familiares: Historias de vida que reflejan las vivencias de niñeces trans* y sus familias, narradas con una sinceridad que invita a reflexionar sobre el amor incondicional y los retos sociales.
Marco teórico y crítico: Textos académicos que exploran la relación entre derechos humanos, educación y afirmación de género, destacando las brechas legales y la importancia de políticas inclusivas.
Abordaje psicológico y legal: Análisis sobre cómo los sistemas educativos y de salud deben adaptarse para garantizar la protección y bienestar de las infancias trans*, enfatizando enfoques afirmativos y despatologizantes.
Arte y expresión gráfica: Ilustraciones creadas por niñes trans* que plasman su identidad y emociones, ofreciendo una ventana única hacia sus mundos internos.
El libro no solo se enfoca en las experiencias locales de Chile, sino que incluye perspectivas internacionales que enriquecen el debate sobre los derechos y la visibilización de las niñeces trans*. Destaca por su compromiso con el uso del lenguaje inclusivo, que subraya la diversidad y dignidad de todas las identidades de género.
En síntesis, Niñeces trans es una obra necesaria para educadores, activistas, familias, profesionales de la salud y cualquier persona interesada en construir una sociedad más inclusiva y respetuosa de los derechos humanos. A través de sus páginas, se propone trascender los prejuicios y las resistencias, invitando a un entendimiento más profundo y empático de las niñeces trans*.
There are over one million transgender and gender diverse adults in the United States, some of whom may decide to undergo medical or surgical interventions. Hormone therapy and gender-affirming surgeries help align an individual’s physical characteristics with their gender identity. Head and neck surgeries are especially important as facial features influence one’s perceived gender in among our society. When facial features are noncongruent with gender identity, individuals can experience discrimination and social marginalization, impacting their education, employment, and housing opportunities, among a myriad of other potential social biases. Facial gender-affirming surgeries are considered medically necessary procedures which reduce gender dysphoria and improve social functioning and quality of life. Medical and mental health providers should be knowledgeable about established clinical practice guidelines in transgender health and be aware of available surgical options in order to help patients successfully attain high quality surgical care.
LGBTQ+ youth are at disproportionate risk for suicidal ideation and behavior (SIB). Family relationships within this population act as both a risk and protector factor for SIB, yet family-based treatments are rarely utilized at LGBTQ+ community centers. Prior research has explored the perceptions of LGBTQ+ youth, caregivers, and treatment providers on the use of family based treatment. Notably, no research has explored perceptions of another key stakeholder group: administrators. The present study used semi-structured interviews with administrators (N = 10) supporting LGBTQ+ community centers regarding implementation of family-based services for LGBTQ+ youth with SIB. Semi-structured interviews explored (1) the needs of LGBTQ+ youth, (2) where a program that includes family-based interventions should be housed, and (3) how a program could be sustained. Interviews were transcribed and analyzed using thematic analysis. Results include nine needs, nine barriers, and 12 facilitators of family-based services for LGBTQ+ youth with SIB. Administrators generally found family-based services to be important, beneficial, and needed. They described missing, necessary factors (needs), existing barriers to implementation, and existing facilitative factors. Administrators generally described a need for additional education on affirmative practice, professionals to examine their own biases, and an improvement in standardization of care. They identified implementation barriers related to youth rejection from caregivers, lack of affirming healthcare, and logistical concerns. Lastly, they described inner-agency collaboration, family interventions, youth driven care, and resources for clinicians as facilitative implementation factors.
Our study explored perspectives of transgender and non-binary (TNB) patients regarding gender-inclusive care at our medical center. Thirty participants (13-21 years old) completed semi-structured interviews and demographic surveys. Surveys were analyzed using descriptive statistics, and interviews were analyzed using thematic analysis. Key themes contributing to positive experiences were: (1) personnel with experience caring for TNB youth, (2) Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexual (LGBTQIA) identified health care team members, (3) visible improvements made over time, (4) provider and staff advocacy, and (5) parent advocacy. Areas for improvement were: (1) training on use of pronouns, gender-affirming terminology, and exam techniques, (2) accurate display of name and pronouns in the electronic medical record and patient labels throughout clinical settings, and (3) more LGBTQIA-inclusive décor and resources. While improvements were recognized, participants identified persistent gaps. Multilevel advocacy and standards set by accrediting bodies can be the next steps in ensuring quality care for TNB patients.
Across four studies ( N = 1,427), we examined the impact of identity-safety cues (Black Lives Matter or Pride posters) on marginalized (Black, LGBTQ+) and advantaged (White, cisgender-heterosexual) parents’ evaluations of elementary classrooms. Black (Study 1) and LGBTQ+ parents (Studies 2 and 3a) perceived identity-relevant safety cues as more appropriate and as prompting more positive education-related outcomes (child belonging, classroom interest) than advantaged parents, who preferred control classrooms. Effects among cisgender-heterosexual parents were consistent between third- and eighth-grade classrooms (Study 3b); despite expressing less classroom interest in and finding Pride classrooms inappropriate across grades, cisgender-heterosexual parents’ expectations of child belonging, child grade, and teacher support did not differ between classrooms. Brief qualitative analyses assessed parents’ beliefs on appropriate inclusive imagery and who should educate on diversity-related information. We highlight identity-based disparities in perceptions of educational inclusivity efforts in the context of current movements toward heightened parental control in education.
The present study aims to study gender dysphoria, sexual health communication, and healthcare challenges within the transgender community, owing to the dearth of studies on this topic, especially in the North Indian context. The objective is to examine the intersectional dynamics of psychological well-being, social support, and healthcare utilization in the context of the three variables. Using a mixed method design, 115 participants were recruited from Delhi and Uttar Pradesh. The tools used were the Gender Dysphoria Scale, a general health questionnaire, the Health Protective Sexual Communication Scale, in-depth interviews, and focus group discussion. The analysis showed a high level of gender dysphoria, above-average overall health, and below-average communication level concerning sexual health and sexually transmitted diseases (STDs). A significant positive correlation was found between the general health questionnaire and the Health Protective Sexual Communication Scale, suggesting that better communication led to better health practices. The level of education seemed to impact protective health communication. The qualitative analysis further uncovered manifestations of gender dysphoria in overall health. Social, emotional, financial, and systemic support played a pivotal role in the participants’ well-being and healthcare-seeking behaviors. Therefore, advocacy for inclusive healthcare policies, government funding or support, enhancement of infrastructure, and inclusive environment in schools is suggested in order to dismantle taboos hindering sexual health discussions.
Transgender and gender diverse (TGD) students often face discrimination, harassment, and inadequate support in educational settings, leading to increased stress and negative health outcomes. This study investigated differences in perceived social support from various sources and types between TGD students and their cisgender peers, and how this support is associated with school belonging. A total of 744 middle school students from a Midwestern US school participated in the survey, including 60 students who identified as TGD. Compared to cisgender students, TGD students reported lower levels of social support from all sources (teachers, peers, and parents) and types (emotional, appraisal, instrumental, and informational). Teacher support was positively associated with school belonging for TGD students, while parent support was negatively associated. Among TGD students, appraisal and informational support were positively associated with school belonging, while emotional and instrumental support showed no significant associations. For cisgender students, all types of social support were positively associated with school belonging. These findings highlight the unique challenges faced by TGD students in terms of social support and school belonging, and implications are discussed.
There has been a significant increase in adolescent children identifying as transgender and undertaking a social transition. Research into how parents experience their child’s social transition away from their sex assigned at birth, especially during adolescence, is limited. As gender identity in adolescence is more likely to persist in adulthood and how this process is supported and experienced by parents will influence outcomes for young people themselves, this is an important area to address. We recruited participants online through parenting websites, social media, and parental gender support groups. We conducted semi-structured interviews with nine parents via Zoom/telephone call. Interviews were analyzed using Reflexive Thematic Analysis (RTA). We identified four themes comprising of three to four additional subthemes; making sense of it all; being driven to action; providing protection; and embracing a new world. Parents in this study largely adopted an affirmative stance to their child’s social transition. The themes reflect the challenges parents faced at a micro, meso, and macro level. Parents in most cases also experienced personal growth and changes in their self-identity through their child’s social transition. Affirmative responses appeared to promote their child’s well-being. Considerations for future research and practice are made.
Keywords: transition; parenting; adolescence; gender
Background
In the United Kingdom, trans young people find themselves at the centre of political storms and debate regarding their access to health care and treatment. This research was carried out against a backdrop of increasing evidence of repeated failings in health care for trans people. Compounding this, trans young people face lengthy waiting lists when seeking specialist gender services and problems with the referral process. In order to cope and thrive, online resources and spaces have become increasingly important for trans young people. Finding good-quality resources and information can be difficult for young people and families.
Objectives
Our aim was to improve the care and support of gender-diverse youth, and their families, through identifying improvements to National Health Service care and services. Within this overall aim, our objectives were to gain a better understanding of the experiences of trans youth, family members and health professionals; and to develop and evaluate sections of the Healthtalk website on young people and parent/carer experiences.
Methods
The primary method of data collection was qualitative in-depth interviews conducted between 2019 and 2021. In total, 91 interviews were conducted with 50 young people (42 aged 13–24 years and 10 aged 25–35 years), 19 family members (parents/carers) and 20 health professionals working with trans patients. We evaluated the resources with young people and families who have experience of being on the waiting list for specialist gender services.
Results
From interviews with health professionals, we identified four key domains that prevent trans and gender-diverse young people receiving good-quality care. These were structural, educational, cultural and social, and technical barriers. Parents/carers’ healthcare experiences were marked by multiple challenges. These occurred at all stages of the pathway and range from getting a referral to specialist gender services, lack of support during waiting times through to sometimes unclear and lengthy assessment processes, which many experience as gatekeeping of gender-affirming care.
The majority of the young people in our sample felt the current healthcare system does not cater for the diversity of trans identities and needs. A linear, one-dimensional, conception of gender identity informs services. This is restrictive and does not reflect the plurality and fluidity of experiences. Young people we spoke with generally perceived National Health Service services as built around a culture of pathologisation, gatekeeping and trans hostility, resulting in a general level of mistrust.
The research supported the development of two sections of the Healthtalk website concerning young people and parent/carer experiences.
Conclusions
We make five recommendations: (1) better and empowered decision-making for trans young people; (2) recognising and catering for gender diversity in health care; (3) a ‘systems change’ intervention approach that goes beyond training for individual health practitioners; (4) a restructured service based upon informed consent; and (5) a positive role for the National Health Service in public debate, challenging misinformation. These findings have wider applicability to other settings/services such as education and social work.
Limitations
This research was not a service evaluation and did not evaluate current practice in Gender Identity Development Service or Gender Identity Clinics. The research was conducted in a rapidly changing field where specialist gender services for children and adolescents are undergoing significant changes based on the Cass review recommendations, which might render some service-specific information out of date.
Future work
An evaluation in partnership with trans organisations to assess the reorganisation of specialist services. Research on homeless trans youth, sibling and grandparent experiences, and trans youth in care/care leavers.
Study registration
This study is registered on ISRCTN Registry ISRCTN26256441.
Funding
This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 17/51/07) and is published in full in Health and Social Care Delivery Research ; Vol. 13, No. 4. See the NIHR Funding and Awards website for further award information.
This chapter outlines the literature addressing various aspects related to marginalized groups in our global society. This chapter includes a summary of 19 well-researched academic articles published in journals across different subjects and brings together the varied perspectives of authors from different countries and continents. The literature grounded in evidence-based studies included in this chapter provides a holistic understanding of the various issues related to marginalized sections, their challenges and social work interventions.
There is an increasing number of high‐conflict custody cases involving transgender and gender expansive (TGE) youth within family courts. The current sociopolitical climate, giving rise to an unprecedented amount of anti‐transgender legislation, adds further complexity to decision‐making and creates a contentious and unpredictable climate for TGE youth and affirming parents in family court. Although researchers in health, child development, and well‐being have generated a robust body of evidence supporting the importance of affirming family and community for TGE youth, there remains a disconnect between evidence‐based best practices and actual practice in the family courts. Courts are frequently diverted by the question of whether the child is TGE, or who is “to blame” for the child's TGE identity, rather than seeking to determine which parent is better able to meet the needs of the whole child—including, but not limited to, needs related to the child's gender identity and expression. Contested custody litigation provides an opportunity for family courts to prevent harm and promote the well‐being of TGE youth and families by facilitating access to care, education, and support, which can promote more effective approaches to decision‐making for complex cases involving TGE youth, and better establish post‐separation success for families. This paper proposes a mental map that leverages the body of interdisciplinary research on gender identity development and expression coupled with the use of a child‐centered approach, and provides strategies for applying the mental map, with the goal of improving family court practices for cases involving TGE youth.
Background
Little research has been conducted solely exploring gender diversity in people with intellectual disabilities. This review explores the literature, discusses the prevalence, and identifies clinical best practices for people at the intersection of gender diversity and intellectual disability.
Method
A scoping review was conducted utilising PRISMA methodology of the following databases: PubMed, CINAHL Complete (EBSCO), Cochrane Library (Wiley), Dissertations & Theses Global (ProQuest), PsycInfo (EBSCO), Scopus and Web of Science.
Results
Five hundred seventy five titles and abstracts were screened, 61 full‐text articles were reviewed and 17 met inclusion criteria. Four major themes were identified: prevalence, trauma and co‐occurring mental health disorders, barriers to care and best practices.
Conclusion
This review highlights the lack of research and provides valuable insight into the experiences of people with gender diversity and intellectual disability. Further research is needed to understand the prevalence and explore the intersection and experience of gender‐diverse people with intellectual disabilities.
Lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth who experience family rejection are at increased risk for depression and suicide. Attachment‐Based Family Therapy (ABFT) demonstrates promising results for reducing this risk with LGBTQ youth. This community‐participatory, mixed‐method study piloted the use of ABFT with LGBTQ youth. Fourteen families completed treatment with adolescent youth, pre‐ and post‐individual and family interviews, and a measure of youth mental health. Post‐therapy, 80% of youth showed a significant reduction in psychological distress. The qualitative thematic analysis constructed four themes describing how families present to therapy with emotional distress, caregiver support needed during ABFT, how caregivers acquired new listening and communication skills, and LGBTQ youth experiences of finding freedom to explore and talk about sexual and gender identities. Implications from the study suggest the need to challenge heteronormative emotional structures of families for increasing emotional support of fathers with their LGBTQ children.
The aim of this article is to provide a theoretical application of transformative learning theory and politicized collective identity framework to examine the process cisgender parents and caregivers of transgender and gender diverse (TGD) children undergo to become advocates for TGD justice. With an intensifying anti‐TGD political climate and anti‐TGD rhetoric, this novel approach to understanding identity development through the lens of these two theories provides a timely and relevant framework for future research to explore motivators for participation in civic engagement for TGD justice among parents and caregivers.
Background
Suicide attempts and deaths among children are increasing in the United States, yet suicide in this preadolescent population remains understudied. A clearer understanding of which youth experience early onset of suicidal behavior is crucial for predicting risk and identifying youth best suited to early intervention. This paper examines how intersectional marginalized identities may predict the onset of suicidal behaviors among preadolescent youth.
Methods
The Adolescent Brain and Cognitive Development (ABCD) Study is a prospective cohort study with annual assessments of youth ages 9 and 10 and their caregivers. Lifetime suicide attempts and preparatory suicidal behaviors were assessed annually. Survival models examined overall trends and demographic differences in the onset of suicidal behaviors.
Results
The final sample included 11,223 participants (mean age = 9.9 years old, SD = 7.5 months). 5,280 (47%) reported a minoritized racial/ethnic identity, and 1,410 (12.6%) were categorized as sexual or gender minorities. 208 suicide attempts and 143 instances of preparatory suicidal behaviors were reported across the study period. An interaction effect was found such that youth who hold multiple minoritized identities (i.e., sexual and gender minority youth from minoritized racial/ethnic backgrounds) were at elevated risk for onset of both suicide attempts (HR = 2.97, 95% CI = 1.59–5.56, p = .001) and preparatory suicidal behaviors (b = 3.09, 95% CI = 1.38–6.93, p = .006).
Conclusions
Intersectional marginalized identities were associated with earlier onset of suicide attempts and preparatory suicidal behaviors. Findings suggest that early interventions for minoritized youth may be important to reduce the rapidly increasing suicide rate among preadolescent youth.
In many parts of the world, increasing numbers of transgender and gender diverse (TGD) youth are seeking medical services to enable the development of physical characteristics aligned with their gender identities. Such medical services include use of agents to pause endogenous puberty as early as Tanner stage 2 with subsequent use of gender-affirming sex hormones and are based on longitudinal studies, demonstrating that those individuals who were first identified as gender dysphoric in early or middle childhood and continue to meet the mental health criteria for gender incongruence at early puberty are likely to persist in their gender identities as adults. This chapter addresses terms and definitions applicable to TGD youth, studies that shed light on the biologic underpinnings of gender identity, outcomes and potential complications of current treatment models, gaps in knowledge, and priorities for research.
Purpose
Healthcare providers often lack training and education in caring for gender diverse youth. We aimed to explore changes in provider confidence and behaviors following the implementation of an online learning course focused on gender affirming care for youth.
Methods
An asynchronous, online training consisting of 2 modules was made available in October 2021. Participants were asked to complete 3 surveys for each module they completed: a pre-survey, a post-survey, and a 3-month follow-up survey. Surveys included demographic data and an assessment of provider confidence and self-reported behaviors related to the provision of gender affirming care for adolescents that were in line with the objectives outlined in each module. Paired sample t-tests were used to compare participant confidence at all timepoints.
Results
Participants (n = 487) completed at least one survey from one module. There was notable diversity in provider types, including mental health providers (n = 86, 17.7%), community health workers (n = 71, 14.6%), and medical students or health professionals (n = 61, 12.5%). Participants were significantly more confident in all aspects of care provision when comparing pre-surveys and post-surveys (p < 0.001 for all survey items focused on change in provider confidence ). At 3-month follow-up after module completion, improvements in confidence were sustained in providing information and resources to adolescents and their families, and having conversations with them about gender identity along with the importance of using affirming language. However, these modules did not result in self-reported behavior change regarding provision of gender affirming hormones or puberty blockers.
Conclusions
Online learning modules may be an effective means of educating a large number of healthcare providers about caring for gender diverse youth in a variety of settings and across disciplines.
Background: Transgender youth are more likely than cisgender youth to encounter risk, such as a lack of social support from families and offline friends, leading many to turn to online friendships for social support. Feeling supported is crucial for psychological adjustment, measured in positive outcomes such as pride, self-esteem, and belongingness and in negative outcomes such as internalized transphobia, depression, and loneliness. Aims: Using the risk and resilience framework, this study explores the relationship between social support across social contexts (families, offline friends, and online friends) and psychological adjustment using hierarchical regression modeling in a sample of 335 binary and nonbinary transgender young adults. Results: Family and offline friend support had stronger associations with adjustment than online friend support, and online friend support moderated the relationship between family support and pride and the relationship between offline friend support and pride. A qualitative analysis of participants' experiences of being transgender online explored additional insights into how transgender young adults use the internet for support. The qualitative analyses contextualized the qualitative findings, showcasing the varied experiences of trans individuals online and the importance of offline support as a cornerstone for psychological adjustment. Conclusions: Social support from offline social contexts are more foundational and paramount to promoting positive psychological adjustment than online social support. Online engagement in trans young adults is individualized and offers a variety of supportive and unsupportive experiences.
Background
Stigma toward transgender children and adolescents negatively impacts their health and educational outcomes. Contact with members of stigmatized groups can dismantle stereotypes and reduce stigma by facilitating exposure to the unique cognitive and emotional perspectives of individuals within the group. Recent evidence suggests that video-based contact interventions can be as effective as face-to-face encounters, but challenges lie in protecting the identities of transgender youth, since many of them live in stealth.
Objective
This study aims to evaluate the impact of an animated online course, rooted in authentic, personal narratives, on course participants’ stigma toward transgender youth.
Methods
The online course was offered free of charge on Coursera and contained 19 teaching videos (3-7 minutes each), intermittent practice quizzes, and discussion prompts. Using real voice recordings of transgender children and their caregivers, the videos were designed to elicit empathy and transmit knowledge. All videos conveying the narratives of transgender youth were animated to protect their identities. A total of 447 course participants, distributed around the globe, completed pre- and postcourse surveys. While the course primarily targeted parents and caregivers of transgender youth, it was open to anyone with a Coursera account. The survey was based on the Transgender Attitudes and Beliefs Scale but modified to reflect the context of parents and caregivers. Using a 5-point Likert scale, it contained 5 questions that captured participants’ levels of transgender stigma. Results of the pre- and postcourse surveys were then compared.
Results
The results were obtained in January 2023. Baseline levels of stigma were relatively low (18/25 across all questions, with 25 representing the lowest possible levels of stigma) and decreased further after completion of the course (to 19/25 across all questions, P<.001). A multivariate ordinal probit regression showed that, depending on the question, participants were 7%-34% more likely to endorse statements that indicated the lowest levels of stigma after completing the course. The course was equally effective across all demographics represented in our participant population.
Conclusions
Our findings document a significant reduction in stigma toward transgender youth in participants who chose to enroll in the first animated, open online gender health course, rooted in the authentic narratives of transgender youth. Stigma levels decreased significantly after taking the course, even among participants whose baseline levels of stigma were low. Future interventions should include participants with more variable baseline levels of stigma, ideally in the setting of a randomized controlled trial. Despite its limitations, this evaluation adds to the existing evidence that digital, contact-based antistigma interventions, animated to protect the identity of the narrators, can effectively reduce stigma toward transgender youth.
Across Europe, Canada, and the United States, 22-43 % of transgender (trans) people report a history of suicide attempts. We aimed to identify intervenable factors (related to social inclusion, transphobia, or sex/gender transition) associated with reduced risk of past-year suicide ideation or attempt, and to quantify the potential population health impact.
The Trans PULSE respondent-driven sampling (RDS) survey collected data from trans people age 16+ in Ontario, Canada, including 380 who reported on suicide outcomes. Descriptive statistics and multivariable logistic regression models were weighted using RDS II methods. Counterfactual risk ratios and population attributable risks were estimated using model-standardized risks.
Among trans Ontarians, 35.1 % (95 % CI: 27.6, 42.5) seriously considered, and 11.2 % (95 % CI: 6.0, 16.4) attempted, suicide in the past year. Social support, reduced transphobia, and having any personal identification documents changed to an appropriate sex designation were associated with large relative and absolute reductions in suicide risk, as was completing a medical transition through hormones and/or surgeries (when needed). Parental support for gender identity was associated with reduced ideation. Lower self-reported transphobia (10(th) versus 90(th) percentile) was associated with a 66 % reduction in ideation (RR = 0.34, 95 % CI: 0.17, 0.67), and an additional 76 % reduction in attempts among those with ideation (RR = 0.24; 95 % CI: 0.07, 0.82). This corresponds to potential prevention of 160 ideations per 1000 trans persons, and 200 attempts per 1,000 with ideation, based on a hypothetical reduction of transphobia from current levels to the 10(th) percentile.
Large effect sizes were observed for this controlled analysis of intervenable factors, suggesting that interventions to increase social inclusion and access to medical transition, and to reduce transphobia, have the potential to contribute to substantial reductions in the extremely high prevalences of suicide ideation and attempts within trans populations. Such interventions at the population level may require policy change.
The present study represents findings from interviews with five mothers, each of whom had a transgender child. All of the transgender children were natal/biological males between the ages of 8 and 11 years old and had socially transitioned to living as girls. Ehrensaft's (2012) notion of the “true gender self” was integrated with an ecological perspective to examine multiple interacting contexts, including family, neighborhood, and school, in which the participants lived. An overarching theme of “transformation” (or lack thereof) was used to organize the findings in relation to the transgender children, their families, and their communities. Changes in relation to the children's demeanor and well-being before and after their social transitions (e.g., from shy and depressed to happy and well-adjusted), the parents’ and other family members’ feelings and reactions to the children's gender identities and expressions over time (e.g., health care professionals and school staff learning along with and from the families), and the responses of others in the community (e.g., lack of knowledgeable health care professionals and school personnel) are discussed. Findings have implications for practice and future research.
Family support is protective against health risks in sexual minority individuals. However, few studies have focused specifically on transgender youth, who often experience rejection, marginalization, and victimization that place them at risk for poor mental health. This study investigated the relationships among parental support, quality of life, and depression in transgender adolescents.
A total of 66 transgender youth presenting for care at Children's Hospital Los Angeles completed a survey assessing parental support (defined as help, advice, and confidante support), quality of life, and depression. Regression analyses assessed the associations between parental support and mental health outcomes.
Parental support was significantly associated with higher life satisfaction, lower perceived burden of being transgender, and fewer depressive symptoms.
Parental support is associated with higher quality of life and is protective against depression in transgender adolescents. Interventions that promote parental support may significantly affect the mental health of transgender youth.
The recent film Boys Don't Cry illustrates in a highly dramatised form the problems that the phenomenon of gender identity disorder can create in an extreme situation. The film is based on the true story of a young person, Brandon, with a female body who perceived himself as a male. In the film we do not know when the issue of his male gender identity first appeared, but we see him living in a male role as a teenager trying to conceal, to his peers, the reality of his female body. (I refer to Brandon as ‘he’ because this is how Brandon presents himself in the film. The dilemma about using ‘he’ or ‘she’ typically confronts professionals in the management of teenagers like Brandon.) The struggles of these concealments are well portrayed, as in the scene when he steals tampons from a shop. He joins in male activities and displays of physical strength as a confirmation of his male role. He is well accepted as a boy within a troubled and troublesome group of young people. He falls passionately in love with a girl, Lana, who accepts him as he is without much questioning, and a close intimate relationship develops, which the peer group seems to accept. The reality of his body is eventually revealed. His girlfriend can accept the new situation, but had she really not known or had she turned a blind eye? Unfortunately, two young men become more and more disturbed by this realisation. It stirs a primitive violence in them, which leads first to Brandon's rape and then to his murder.
The authors investigated the emergence of gender differences in clinical depression and the overall development of depression from preadolescence to young adulthood among members of a complete birth cohort using a prospective longitudinal approach with structured diagnostic interviews administered 5 times over the course of 10 years. Small gender differences in depression (females greater than males) first began to emerge between the ages of 13 and 15. However, the greatest increase in this gender difference occurred between ages 15 and 18. Depression rates and accompanying gender differences for a university student subsample were no different than for a nonuniversity subsample. There was no gender difference for depression recurrence or for depression symptom severity. The peak increase in both overall rates of depression and new cases of depression occurred between the ages of 15 and 18. Results suggest that middle-to-late adolescence (ages 15–18) may be a critical time for studying vulnerability to depression because of the higher depression rates and the greater risk for depression onset and dramatic increase in gender differences in depression during this period.
Objectives:
We assessed the association between minority stress, mental health, and potential ameliorating factors in a large, community-based, geographically diverse sample of the US transgender population.
Methods:
In 2003, we recruited through the Internet a sample of 1093 male-to-female and female-to-male transgender persons, stratified by gender. Participants completed an online survey that included standardized measures of mental health. Guided by the minority stress model, we evaluated associations between stigma and mental health and tested whether indicators of resilience (family support, peer support, identity pride) moderated these associations.
Results:
Respondents had a high prevalence of clinical depression (44.1%), anxiety (33.2%), and somatization (27.5%). Social stigma was positively associated with psychological distress. Peer support (from other transgender people) moderated this relationship. We found few differences by gender identity.
Conclusions:
Our findings support the minority stress model. Prevention needs to confront social structures, norms, and attitudes that produce minority stress for gender-variant people; enhance peer support; and improve access to mental health and social services that affirm transgender identity and promote resilience.
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.
We examined the frequency and predictors of suicide attempts among gender minority individuals (N = 153) who were recruited at a transgender conference. Eighteen percent of the participants reported a past suicide attempt, with trans men reporting the highest rate of suicide attempts (41%), followed by trans women (20%). Factors associated with having a past suicide attempt included female sex assigned at birth, psychiatric hospitalisations, and having experienced transgender-related violence. Implications of these data are considered in the context of intervention development for this at-risk group.
In recent years, a new phenomenon has been observed in U.S. culture, that of pre-pubescent children transitioning socially
from one gender role to another, with the support of their families. As this phenomenon becomes more widespread, families,
schools and other institutions will turn to mental health care professionals for guidance in navigating new territory. Such
children have often been assessed for gender identity disorder; the traditional treatment plan for those so diagnosed included
attempts to steer their gender behavior in more “gender-appropriate” directions. Allowing such children to self-actualize,
viewing their behavior as indicative of innate identity, is a relatively new approach. This paper will focus on the social
worker’s or therapist’s role in helping pre-pubescent children and their families, should the families decide identity actualization
is the path they would prefer.
This article provides a summary of the therapeutic model and approach used in the Gender Identity Service at the Centre for Addiction and Mental Health in Toronto. The authors describe their assessment protocol, describe their current multifactorial case formulation model, including a strong emphasis on developmental factors, and provide clinical examples of how the model is used in the treatment.
Suicide is the third-leading cause of death among adolescents and nonsuicidal self-harm occurs in 13%-45% of individuals within this age group, making these phenomena major public health concerns. Lesbian, gay, bisexual, and transgender (LGBT) youth particularly are at risk for engaging in these behaviors. Nevertheless, relatively little is known about the specific risk factors associated with suicidal ideation and self-harm behaviors in the population.
This study provides a longitudinal evaluation of the relative contributions of general and LGBT-specific risk factors as well as protective factors to the occurrence of suicidal ideation and self-harm in an ethnically diverse sample of LGBT youth.
A community sample of 246 LGBT youth (aged 16-20 years) was followed prospectively over five time points at regular 6-month intervals. Participants completed a baseline structured interview assessing suicide attempt history and questionnaires measuring gender nonconformity, impulsivity, and sensation-seeking. At follow-up assessments, participants completed a structured interview assessing self-harm and questionnaires for suicidal ideation, hopelessness, social support, and LGBT victimization. Data were collected from 2007 to 2011, and HLM analyses were conducted in 2011.
A history of attempted suicide (p=0.05); impulsivity (p=0.01); and prospective LGBT victimization (p=0.03) and low social support (p=0.02) were associated with increased risk for suicidal ideation. Suicide attempt history (p<0.01); sensation-seeking (p=0.04); female gender (p<0.01); childhood gender nonconformity (p<0.01); and prospective hopelessness (p<0.01) and victimization (p<0.01) were associated with greater self-harm.
General and LGBT-specific risk factors both uniquely contribute to likelihood of suicidal ideation and self-harm in LGBT youth, which may, in part, account for the higher risk of these phenomena observed in this population.
Internalizing psychopathology, anxiety in particular, is assumed to contribute to the development of gender Identity disorder (GID). Until now, anxiety has only been reported in studies using parent-report questionnaires; physiological correlates of anxiety have not been studied. In this study we assessed anxiety and stress in children with GID by measuring their cortisol, heart rate (HR) and skin conductance levels (SCL) and asking them to repeat their moods and experience of control.
By using an established psychological challenge, involving provocation and frustration, we investigated whether children with GID as compared to healthy controls react in a more anxious way under these experimental circumstances. We assessed anxiety levels in 25 children with GID and 25 matched controls by measuring cortisol, HR and skin conductance and examined whether a pattern of increased physiological activity corresponded with the feeling of being less in control and having more intense negative emotions.
The results showed that children with GID had more negative emotions and a tonically elevated SCL. There were no differences between the groups in cortisol and HR.
This is the first study that shows that children with GID have a more anxious nature as compared to their normal counterparts.
Despite strong indications of elevated risk of suicidal behavior in lesbian, gay, bisexual, and transgender people, limited attention has been given to research, interventions or suicide prevention programs targeting these populations. This article is a culmination of a three-year effort by an expert panel to address the need for better understanding of suicidal behavior and suicide risk in sexual minority populations, and stimulate the development of needed prevention strategies, interventions and policy changes. This article summarizes existing research findings, and makes recommendations for addressing knowledge gaps and applying current knowledge to relevant areas of suicide prevention practice.
This is a report on parents who have children who exhibit gender variant behaviors and who contacted an affirmative program in the United States for assistance. All parents completed the Child Behavior Checklist, the Gender Identity Questionnaire, and the Genderism and Transphobia Scale, as well as telephone interviews. The parents reported comparatively low levels of genderism and transphobia. When compared to children at other gender identity clinics in Canada and The Netherlands, parents rated their children's gender variance as no less extreme, but their children were overall less pathological. Indeed, none of the measures in this study could predict parents' ratings of their child's pathology. These findings support the contention that this affirmative program served children who were no less gender variant than in other programs, but they were overall less distressed.
Because of the stigma associated with transgenderism, many transwomen (biological males who identify as female or transgender) experience rejection or abuse at the hands of their parents and primary caregivers as children and adolescents. The Parental Acceptance-Rejection (PAR) theory indicates that a child's experience of rejection may have a significant impact on their adult lives. The purpose of this study was to conduct a qualitative analysis of adult transwomen of color's experiences with caregivers, guided by PAR theory. Twenty transwomen of color completed semi-structured interviews exploring the reaction of their parents and primary caregivers to their gender. While many participants reported that at least one parent or close family member responded with warmth and acceptance, the majority confronted hostility and aggression; reports of neglect and undifferentiated rejection were also common. Many transwomen were forced out of their homes as adolescents or chose to leave, increasing their risk of homelessness, poverty, and associated negative sequelae. Future research is needed to explore how families come to terms with having a transgender child and how best to promote acceptance of such children.
Peer victimization experiences represent developmentally salient stressors among adolescents and are associated with the development of internalizing symptoms. However, the mechanisms linking peer victimization to adolescent psychopathology remain inadequately understood. This study examined emotion dysregulation as a mechanism linking peer stress to changes in internalizing symptoms among adolescents in a longitudinal design. Peer victimization was assessed with the Revised Peer Experiences Questionnaire (M. J. Prinstein, J. Boergers, & E. M. Vernberg, 2001) in a large (N = 1,065), racially diverse (86.6% non-White) sample of adolescents 11-14 years of age. Emotion dysregulation and symptoms of depression and anxiety were also assessed. Structural equation modeling was used to create a latent construct of emotion dysregulation from measures of discrete emotion processes and of peer victimization and internalizing symptoms. Peer victimization was associated with increased emotion dysregulation over a 4-month period. Increases in emotion dysregulation mediated the relationship between relational and reputational, but not overt, victimization and changes in internalizing symptoms over a 7-month period. Evidence for a reciprocal relationship between internalizing symptoms and relational victimization was found, but emotion dysregulation did not mediate this relationship. The implications for preventive interventions are discussed.
The current research provides a framework for understanding how concealable stigmatized identities impact people's psychological well-being and health. The authors hypothesize that increased anticipated stigma, greater centrality of the stigmatized identity to the self, increased salience of the identity, and possession of a stigma that is more strongly culturally devalued all predict heightened psychological distress. In Study 1, the hypotheses were supported with a sample of 300 participants who possessed 13 different concealable stigmatized identities. Analyses comparing people with an associative stigma to those with a personal stigma showed that people with an associative stigma report less distress and that this difference is fully mediated by decreased anticipated stigma, centrality, and salience. Study 2 sought to replicate the findings of Study 1 with a sample of 235 participants possessing concealable stigmatized identities and to extend the model to predicting health outcomes. Structural equation modeling showed that anticipated stigma and cultural stigma were directly related to self-reported health outcomes. Discussion centers on understanding the implications of intraindividual processes (anticipated stigma, identity centrality, and identity salience) and an external process (cultural devaluation of stigmatized identities) for mental and physical health among people living with a concealable stigmatized identity.
The authors evaluated emotional distress among 9th-12th grade students, and examined whether the association between being lesbian, gay, bisexual, and/or transgendered (i.e., "LGBT") and emotional distress was mediated by perceptions of having been treated badly or discriminated against because others thought they were gay or lesbian. Data come from a school-based survey in Boston, Massachusetts (n = 1,032); 10% were LGBT, 58% were female, and ages ranged from 13 to 19 years. About 45% were Black, 31% were Hispanic, and 14% were White. LGBT youth scored significantly higher on the scale of depressive symptomatology. They were also more likely than heterosexual, non-transgendered youth to report suicidal ideation (30% vs. 6%, p < 0.0001) and self-harm (21% vs. 6%, p < 0.0001). Mediation analyses showed that perceived discrimination accounted for increased depressive symptomatology among LGBT males and females, and accounted for an elevated risk of self-harm and suicidal ideation among LGBT males. Perceived discrimination is a likely contributor to emotional distress among LGBT youth.
This article provides a selected overview of the literature on gender identity disorder and psychosexual problems in children and adolescents, with a focus on diagnosis, clinical course, etiology, and treatment.
Cross-sectional quantitative designs are often used to investigate whether peer victimization is positively related to psychosocial maladjustment. This paper presents a meta-analytic review of cross-sectional studies, published between 1978 and 1997, of the association of peer victimization with psychosocial maladjustment. Mean effect sizes were calculated for the association between peer victimization and each form of maladjustment (depression, loneliness, generalized and social anxiety, and global and social self-worth) assessed. The results suggested that victimization is most strongly related to depression, and least strongly related to anxiety. There was no evidence that victimization is more strongly related to social than to psychological forms of maladjustment. Effect sizes were stronger when the same informants were used to assess both victimization and maladjustment than when different informants were used. There were some design limitations to the studies reviewed, but all together their results provide a strong background for more complex research into the course and treatment of victims' distress.
The heritability and prevalence of the gender identity disorder (GID) was examined, as well as its comorbidity with separation anxiety and depression, in a nonretrospective study of child and adolescent twins. The parents of 314 twins (ages 4-17 years; 96 monozygotic pairs [MZ] and 61 dizygotic [DZ] pairs) completed the Coolidge Personality and Neuropsychological Inventory (CPNI) containing a six-item DSM-IV-based GID scale. Prevalence of clinically significant GID symptomatology in the twin sample was estimated to be 2.3%. Univariate model fitting analyses were conducted using an ordinal transformation of the GID scale. The model that best described the data included a significant additive genetic component accounting for 62% of the variance and a nonshared environmental component accounting for the remaining 38% of the variance. Results suggested no heterogeneity in the parameter estimates resulting from age. The correlation between GID and depression was modest, but significant (r = .20; P < .05), whereas the correlation between GID and separation anxiety was nonsignificant (P > .05). Overall, the results support the hypothesis that there is a strong heritable component to GID. The findings may also imply that gender identity may be much less a matter of choice and much more a matter of biology.
This study examined demographic characteristics, social competence, and behavior problems in clinic-referred children with gender identity problems in Toronto, Canada (N = 358), and Utrecht, The Netherlands (N = 130). The Toronto sample was, on average, about a year younger than the Utrecht sample at referral, had a higher percentage of boys, had a higher mean IQ, and was less likely to be living with both parents. On the Child Behavior Checklist (CBCL), both groups showed, on average, clinical range scores in both social competence and behavior problems. A CBCL-derived measure of poor peer relations showed that boys in both clinics had worse ratings than did the girls. A multiple regression analysis showed that poor peer relations were the strongest predictor of behavior problems in both samples. This study-the first cross-national, cross-clinic comparative analysis of children with gender identity disorder-found far more similarities than differences in both social competence and behavior problems. The most salient demographic difference was age at referral. Cross-national differences in factors that might influence referral patterns are discussed.
Self-evaluation is crucial to mental and social well-being. It influences aspirations, personal goals and interaction with others. This paper stresses the importance of self-esteem as a protective factor and a non-specific risk factor in physical and mental health. Evidence is presented illustrating that self-esteem can lead to better health and social behavior, and that poor self-esteem is associated with a broad range of mental disorders and social problems, both internalizing problems (e.g. depression, suicidal tendencies, eating disorders and anxiety) and externalizing problems (e.g. violence and substance abuse). We discuss the dynamics of self-esteem in these relations. It is argued that an understanding of the development of self-esteem, its outcomes, and its active protection and promotion are critical to the improvement of both mental and physical health. The consequences for theory development, program development and health education research are addressed. Focusing on self-esteem is considered a core element of mental health promotion and a fruitful basis for a broad-spectrum approach.
This study examined influences of gender identity on change in preadolescents' adjustment over time. In each of two successive years, three measures of gender identity (felt gender typicality, contentment with gender assignment, and felt pressure for gender conformity) and four measures of adjustment (self-esteem, internalizing symptoms, externalizing symptoms, and acceptance by peers) were collected. Low gender typicality, low gender contentedness, and high felt pressure all foreshadowed deterioration on one or more indexes of adjustment. The combination of low gender typicality with high felt pressure was especially conducive to internalizing problems, underscoring the importance of the cognitive organization of the gender identity variables. The advantages of a multidimensional perspective on gender identity are discussed.
High prevalences of depression have been reported in male-to-female (MTF) transgender communities. We explored factors associated with depressive symptomatology among MTF spectrum trans people in Ontario, using data from the Trans PULSE Project Phase II respondent-driven sampling survey (n = 433 participants, including 191 MTFs with data needed for this analysis). We estimated the prevalence of depression at 61.2%. Factors associated with higher odds of depressive symptomatology included living outside of Toronto, having some college or university (vs. completed), being unemployed, and experiencing higher levels of transphobia. Increasing social support was associated with reduced odds of depressive symptomatology. Multivariable analyses suggested complex relationships between these factors, passing, and childhood abuse, which require additional study.
The aim of the present study was to evaluate the presence of psychiatric diseases/symptoms in transsexual patients and to compare psychiatric distress related to the hormonal intervention in a one year follow-up assessment. We investigated 118 patients before starting the hormonal therapy and after about 12 months. We used the SCID-I to determine major mental disorders and functional impairment. We used the Zung Self-Rating Anxiety Scale (SAS) and the Zung Self-Rating Depression Scale (SDS) for evaluating self-reported anxiety and depression. We used the Symptom Checklist 90-R (SCL-90-R) for assessing self-reported global psychological symptoms. Seventeen patients (14%) had a DSM-IV-TR axis I psychiatric comorbidity. At enrollment the mean SAS score was above the normal range. The mean SDS and SCL-90-R scores were on the normal range except for SCL-90-R anxiety subscale. When treated, patients reported lower SAS, SDS and SCL-90-R scores, with statistically significant differences. Psychiatric distress and functional impairment were present in a significantly higher percentage of patients before starting the hormonal treatment than after 12 months (50% vs. 17% for anxiety; 42% vs. 23% for depression; 24% vs. 11% for psychological symptoms; 23% vs. 10% for functional impairment). The results revealed that the majority of transsexual patients have no psychiatric comorbidity, suggesting that transsexualism is not necessarily associated with severe comorbid psychiatric findings. The condition, however, seemed to be associated with subthreshold anxiety/depression, psychological symptoms and functional impairment. Moreover, treated patients reported less psychiatric distress. Therefore, hormonal treatment seemed to have a positive effect on transsexual patients’ mental health.
A distinction is made between two different but closely related syndromes—“cross gender identification” and “gender behavior disturbance”—in male children. Based on assessment data and systematic clinical observations of a group of 47 such children in a longitudinal research study, a set of factors are identified as relevant to the diagnostic task. Specific diagnostic procedures were developed for the clinical evaluation and psychological testing of male children referred for potential gender dysphoric problems, and these procedures are presented in detail with accompanying rationale.
This paper aims to provide professionals working with adolescents with gender-dysphoric feelings practical clinical guidelines for diagnosis and treatment. The different phases of the assessment procedure and treatment process are described. Differential diagnostic considerations and possible psychotherapeutic treatment options are given. Physical interventions, including GnRH analogues to inhibit puberty and cross-sex hormones, are described with consideration of eligibility and readiness issues. We end with discussion of post-treatment evaluation.
Mixed-race individuals often encounter situations in which their identities are a source of tension, particularly when expressions of multiracial and biracial identity are not supported or allowed. Two studies examined the consequences of this identity denial. In Study 1, mixed-race participants reported that their biracial or multiracial identity caused tension in a variety of contexts. Study 2 focused on one often-mentioned situation: completing a demographic questionnaire in which only one racial background can be specified. Relative to mixed-race participants who were permitted to choose multiple races, those compelled to choose only one showed lower subsequent motivation and self-esteem. These studies demonstrate the negative consequences of constraining mixed-race individuals’ expression of their chosen racial identity. Policy implications for the collection of racial and ethnic demographic data are discussed.
The objective of the present study is to describe the item response theory (IRT) analysis of the National Institutes of Health (NIH) Patient Reported Outcomes Measurement Information System (PROMIS(®)) pediatric parent proxy-report item banks and the measurement properties of the new PROMIS(®) Parent Proxy Report Scales for ages 8-17 years.
Parent proxy-report items were written to parallel the pediatric self-report items. Test forms containing the items were completed by 1,548 parent-child pairs. CCFA and IRT analyses of scale dimensionality and item local dependence, and IRT analyses of differential item functioning were conducted.
Parent proxy-report item banks were developed and IRT parameters are provided. The recommended unidimensional short forms for the PROMIS(®) Parent Proxy Report Scales are item sets that are subsets of the pediatric self-report short forms, setting aside items for which parent responses exhibit local dependence. Parent proxy-report demonstrated moderate to low agreement with pediatric self-report.
The study provides initial calibrations of the PROMIS(®) parent proxy-report item banks and the creation of the PROMIS(®) Parent Proxy-Report Scales. It is anticipated that these new scales will have application for pediatric populations in which pediatric self-report is not feasible.
In this study, we tried to clarify the prevalence of suicidal ideation and self-mutilation including suicide attempts among patients with gender identity disorder (GID) and the relationship of those behaviors to demographic characteristics. A total of 500 consecutive Japanese GID patients without any other psychiatric comorbidity were evaluated at the outpatient GID Clinic of Okayama University Hospital. The lifetime rate of suicidal ideation was 72.0% of the total sample. There were no significant differences in the prevalence of suicidal ideation among groups divided by sex, age, age at onset or education. The lifetime prevalence of self-mutilation including suicide attempts was 31.8% of the total sample. Low level of education was significantly related to self-mutilation among both male-to-female and female-to-male GID patients. Younger age at onset was a significant factor affecting self-mutilation only among MTF GID patients. A lack of strategies to cope with severe distress among persons with lower education might induce a high frequency of self-mutilation including suicidal attempt. GID patients with a low level education might be at high risk of self-mutilation and should be watched with special attention to self-mutilation.
Adolescent school victimization due to lesbian, gay, bisexual, or transgender (LGBT) status is commonplace, and is associated with compromised health and adjustment. Few studies have examined the long-term implications of LGBT school victimization for young adult adjustment. We examine the association between reports of LGBT school victimization and young adult psychosocial health and risk behavior.
The young adult survey from the Family Acceptance Project included 245 LGBT young adults between the ages of 21 and 25 years, with an equal proportion of Latino and non-Latino White respondents. A 10-item retrospective scale assessed school victimization due to actual or perceived LGBT identity between the ages of 13 and 19 years. Multiple regression was used to test the association between LGBT school victimization and young adult depression, suicidal ideation, life satisfaction, self-esteem, and social integration, while controlling for background characteristics. Logistic regression was used to examine young adult suicide attempts, clinical levels of depression, heavy drinking and substance use problems, sexually transmitted disease (STD) diagnoses, and self-reported HIV risk.
Lesbian, gay, bisexual, and transgender-related school victimization is strongly linked to young adult mental health and risk for STDs and HIV; there is no strong association with substance use or abuse. Elevated levels of depression and suicidal ideation among males can be explained by their high rates of LGBT school victimization.
Reducing LGBT-related school victimization will likely result in significant long-term health gains and will reduce health disparities for LGBT people. Reducing the dramatic disparities for LGBT youth should be educational and public health priorities.
the role of family acceptance as a protective factor for lesbian, gay, bisexual, and transgender (LGBT) adolescents and young adults has not been established.
a quantitative measure with items derived from prior qualitative work retrospectively assessed family accepting behaviors in response to LGBT adolescents' sexual orientation and gender expression and their relationship to mental health, substance abuse, and sexual risk in young adults (N= 245).
family acceptance predicts greater self-esteem, social support, and general health status; it also protects against depression, substance abuse, and suicidal ideation and behaviors.
family acceptance of LGBT adolescents is associated with positive young adult mental and physical health. Interventions that promote parental and caregiver acceptance of LGBT adolescents are needed to reduce health disparities.
Hour-to-hour emotional states reported by children, ages 9-15, were examined in order to evaluate the hypothesis that the onset of adolescence is associated with increased emotional variability. These youths carried electronic pagers for 1 week and filled out reports on their emotional states in response to signals received at random times. To evaluate possible age-related response sets, a subset of children was asked to use the same scales to rate the emotions shown in drawings of 6 faces. The expected relation between daily emotional variability and age was not found among the boys and was small among the girls. There was, however, a linear relation between age and average mood states, with the older participants reporting more dysphoric average states, especially more mildly negative states. An absence of age difference in the ratings of the faces indicated that this relation could not be attributed to age differences in response set. Thus, these findings provide little support for the hypothesis that the onset of adolescence is associated with increased emotionality but indicate significant alterations in everyday experience associated with this age period.
Twenty-five extremely feminine boys with DSM-III diagnosis of gender identity disorder of childhood were evaluated for the presence of behavioral disturbances, social competence and separation anxiety. Using the Child Behavior Checklist created by Achenbach and Edelbrock in 1983, 84% of feminine boys were reported to display behavioral disturbances usually seen in clinic-referred children. Sixty-four percent of the sample had difficulties with peers that were comparable to those of psychiatric-referred boys. Sixty percent of the sample met the criteria for diagnosis of DSM-III separation anxiety disorder. Only one child in sample fell within the normal range on all three of these parameters. Results suggest extreme boyhood femininity is not an isolated finding, but part of a more pervasive psychological disturbance. Additional clinical findings support this contentione.
This exploratory study involved the qualitative analysis of the responses of eight children with atypical gender identity organization to open-ended questions about their experiences of secondary school. The aim was to develop an understanding of these young people's interaction with their peers. It became apparent that all but one of the participants had been bullied. In this context, participants reported difficulties in developing friendships, although each participant received support from at least one of their peers. Given the hostile school environment participants did not necessarily talk to these individuals about their experiences in relation to their gender identity. The clinical implications for working with young people on a developing gender identity, and the impact on their mental health, are considered.
To determine the independent predictors of attempted suicide among transgender persons we interviewed 392 male-to-female (MTF) and 123 female-to-male (FTM) individuals. Participants were recruited through targeted sampling, respondent-driven sampling, and agency referrals in San Francisco. The prevalence of attempted suicide was 32% (95% CI = 28% to 36%). In multivariate logistic regression analysis younger age (<25 years), depression, a history of substance abuse treatment, a history of forced sex, gender-based discrimination, and gender-based victimization were independently associated with attempted suicide. Suicide prevention interventions for transgender persons are urgently needed, particularly for young people. Medical, mental health, and social service providers should address depression, substance abuse, and forced sex in an attempt to reduce suicidal behaviors among transgender persons. In addition, increasing societal acceptance of the transgender community and decreasing gender-based prejudice may help prevent suicide in this highly stigmatized population.
Gender identity disorder entered the psychiatric nomenclature in the DSM-III in 1980. This article reviews three domains of empirical research on gender identity disorder in children and adolescents: diagnosis and assessment, associated psychopathology, and developmental trajectories.
Sexual minority status is a key risk factor for suicide among lesbian, gay, and bisexual youth; however, it has not been studied among transgender youth. Fifty-five transgender youth reported on their life-threatening behaviors. Nearly half of the sample reported having seriously thought about taking their lives and one quarter reported suicide attempts. Factors significantly related to having made a suicide attempt included suicidal ideation related to transgender identity; experiences of past parental verbal and physical abuse; and lower body esteem, especially weight satisfaction and thoughts of how others evaluate the youths' bodies. Sexual minority status is a key risk factor for life-threatening behaviors among transgender youth.
To test whether the experience of being bullied has an environmentally mediated effect on internalizing symptoms in young children.
A genetically informative, longitudinal 1994-1995 birth cohort.
A nationally representative sample from the United Kingdom.
We examined 1116 twin pairs who are participants in the Environmental Risk Longitudinal Twin Study. Main Exposure The experience of being bullied between the ages of 7 and 9 years.
Mothers' and teachers' reports of children's internalizing problems at 7 and 10 years of age.
Monozygotic twins who had been bullied had more internalizing symptoms (mean, 0.23; SD, 1.00) compared with their co-twin who had not been bullied (mean, -0.13; SD, 0.86), indicating that being bullied has an environmentally mediated effect on children's internalizing problems (beta, 0.36 [95% confidence interval (CI), 0.18-0.54]). This effect remained significant after controlling for preexisting internalizing problems (beta, 0.26 [95% CI, 0.09-0.44]).
Being bullied at a young age is an environmentally mediated contributing factor to children's internalizing problems. Intervention programs aimed at reducing bullying behavior in schools and in the community have the potential to influence children's early symptoms of mental health problems.
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