ArticleLiterature Review

Stigma and Minority Stress as Social Determinants of Health Among Lesbian, Gay, Bisexual, and Transgender Youth

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Abstract

In this article, we review theory and evidence on stigma and minority stress as social/structural determinants of health among lesbian, gay, bisexual, and transgender (LGBT) youth. We discuss different forms of stigma at individual (eg, identity concealment), interpersonal (eg, victimization), and structural (eg, laws and social norms) levels, as well as the mechanisms linking stigma to adverse health outcomes among LGBT youth. Finally, we discuss clinical (eg, cognitive behavioral therapy) and public health (eg, antibullying policies) interventions that effectively target stigma-inducing mechanisms to improve the health of LGBT youth.

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... According to this model, LGBTQ individuals face stigma and discrimination that generate stress (Brooks, 1982;Meyer, 2003). LGBTQ people who experience sexual orientation (Brooks, 1982;Meyer, 2003) and gender identity-related discrimination (Hendricks & Testa, 2012), including mistreatment in health care settings (Institute of Medicine, 2011), may use substances as a stress coping mechanism (Hatzenbuehler & Pachankis, 2016;Lehavot & Simoni, 2011;Slater et al., sample (27.6%) reported substance use to cope with discrimination in health care settings (Reisner, Pardo, et al., 2015). ...
... Although research has not explored the specific relationship between stigma and discrimination and opioid use-related service utilization, studies suggest that discrimination is a key barrier to LGBTQ health care access more broadly (Bradford et al., 2013;Hatzenbuehler & Pachankis, 2016;Institute of Medicine, 2011;Qureshi et al., 2018;Reisner, Greytak, et al., 2015). For example, U.S. transgender adults who were denied medical care reported significantly higher odds of avoiding subsequent care (Reisner, Pardo, et al., 2015). ...
... LGBTQ individuals (Hatzenbuehler & Pachankis, 2016;Lehavot & Simoni, 2011;Slater et al., 2017). The pandemic has also caused a troubling increase in opioid overdose rates among the general population as a result of disruptions in both OUD treatment and harm reduction (e.g., syringe exchange) services (Slavova et al., 2020). ...
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Introduction Lesbian, gay, bisexual, transgender, and queer (LGBTQ) populations experience opioid-related disparities compared to heterosexual and cisgender populations. LGBTQ-specific services are needed within opioid use disorder (OUD) treatment settings to minimize treatment barriers; research on the availability and accessibility of such services is limited. The purpose of the current study was to mimic the experience of an LGBTQ-identified individual searching for LGBTQ-specific OUD treatment services, using the SAMHSA National Directory of Drug and Alcohol Abuse Treatment Facilities - 2018 (Treatment Directory). Methods We contacted treatment facilities listed in the Treatment Directory as providing both medications for OUD (MOUD) and “special programs/groups” for LGBTQ clients within states with the top 20 highest national opioid overdose rates. We used descriptive statistics to characterize the outcome of calls; the overall number of facilities offering LGBTQ-specific services, MOUD, and both LGBTQ-specific services and MOUD; and the availability of both LGBTQ-specific services and MOUD in each state by 100,000 state population and in relation to opioid overdose mortality rates (programs-per-death rate). Results Of the N = 570 treatment facilities contacted, n = 446 (78.25 %) were reached and answered our questions. Of n = 446 reached (all of which advertised both MOUD and LGBTQ-specific services), n = 366 (82.06 %) reported offering MOUD, n = 125 (28.03 %) reported offering special programs or groups for LGBTQ clients, and n = 107 (23.99 %) reported offering both MOUD and LGBTQ-specific services. Apart from Washington, DC, New Mexico, South Carolina, and West Virginia, which did not have any facilities that reported offering both MOUD and LGBTQ-specific services, Illinois had the lowest, and Michigan had the highest programs-per-death rate. Most of the northeastern states on our list (all but New Hampshire) clustered in the top two quarters of programs-per-death rates, while most of southeastern states (all but North Carolina) clustered in the bottom two quarters of programs-per-death rates. Conclusions The lack of LGBTQ-specific OUD treatment services may lead to missed opportunities for supporting LGBTQ people most in need of treatment; such treatment is especially crucial to prevent overdose mortality and improve the health of LGBTQ populations across the United States, particularly in the southeast.
... El estigma social se entiende como la discriminación de una población minoritaria debido a las características que la describe (Hatzenbuehler y Pachankis, 2016). Pérez-Brumer y colaboradores (2015) señalan que la población trans se enfrenta constantemente a situaciones de estrés relacionadas con el estigma social, lo que incrementa el riesgo de padecer algún problema psicológico en el transcurso de su vida (Timmins et al., 2017). ...
... Por último, también existe estigma a nivel estructural, dicho de otro modo, la estigmatización está presente en la sociedad como en las tradiciones culturales y en las instituciones como la sanidad y la educación. Como se verá más adelante, esta estigmatización institucional y política influye directamente en la accesibilidad a los recursos de atención primaria, limitando su uso por parte de esta población (Hatzenbuehler y Pachankis, 2016). ...
... La soledad al ser percibida también podría interferir en el enriquecimiento de las relaciones interpersonales mediante conductas de huida o conflictos originados por la percepción subjetiva de falta de apoyo. No obstante, en ocasiones este sentimiento de soledad podría ser real (Hatzenbuehler y Pachankis, 2016). ...
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El suicidio supone la primera causa de muerte no natural en España, y la segunda causa general en la población joven. La pertenencia a un grupo social minoritario aumenta la vulnerabilidad ante el suicidio. Este es el caso del colectivo LGBTIQ+, y concretamente, de las personas trans. El objetivo de este estudio fue revisar la literatura científica referente al suicidio en las personas trans, incluyendo factores de riesgo específicos y de protección para mejorar los programas de prevención e intervención. La literatura localizada para el estudio es escasa, en especial en el ámbito de la prevención y la intervención. Se concluye que este colectivo es más vulnerable ante el suicidio por factores como el estigma social, las diversas situaciones vividas a lo largo del ciclo vital, y los problemas psicológicos asociados. Se ha encontrado que la ideación suicida es frecuente en población trans. Su aparición precoz correlaciona positivamente con la aparición de conductas suicidas, por lo que se propone mejorar los programas de prevención. Entre las intervenciones con mayor eficacia se encuentran las técnicas dirigidas a la autoafirmación de género y la construcción de una red de apoyo social.
... People who belong to any kind of minority group suffer from unique stress related to their marginalization, including discrimination, expectation of discrimination, and internalized stigma. 1 Applied to sexual minority people, this includes stressors of everyday discrimination (e.g., microaggressions), expectation of rejection, self-devaluation because of internalized homophobia, the concealment of their identity (i.e., outness), and other forms of stigmatization. [2][3][4] The various stressors potentially influencing the mental health of people with minority sexual identities are summarized in the minority stress model. ...
... 44 15 The current findings in this study connect well to the minority stress theory, which expects mental health disparities for people with minority sexual orientations compared with heterosexuals in light of excess stress related to a variety of stigma-related experiences. 1,19 F I G U R E 4 Forest plot of bisexual people versus lesbian women and gay men. Note: Weights are from random effects analysis (Not trimand-fill corrected) Minority stress may include discrimination, micro aggressions, verbal and physical violence, and internalized sexual stigma, 19 which can promote the development of mental disorders. ...
... 29 Several limitations must be taken into account when interpreting the presented findings. [1] The results must be interpreted in relation to the number of available studies. While there were 21 studies that compared the risk for depression, there were only 10 studies reporting comparisons for alcohol use disorder, 9 studies for anxiety disorders, and only 8 studies for suicidality. ...
Article
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Aims: To conduct a meta-analysis of population-based studies to quantify the association between sexual minority status (lesbian women, gay men and bisexual people) and the risk of common mental disorders (depressive disorders, alcohol use disorders (AUD), anxiety disorders, and suicidality). Method: PubMed, PsycInfo, Web of Science, the Cochrane Library Database, the Applied Social Sciences Index and Abstracts, and ProQuest were searched for relevant studies published between 2000 and May 2020. The PRISMA guidelines were followed for selection processes. Twenty-six studies met the inclusion criteria which included a total of 519.414 heterosexuals, 10.178 lesbian/gay people and 14.410 bisexual people. Results: Lesbian/gay people (ORs between 1.97, 95% [CI = 1.76, 2.19] and 2.89, 95% [CI = 2.41,3.38]) and bisexual people (ORs between 2.70; 95% [CI = 2.21,3.18], and 4.81; 95% [CI = 3.63, 5.99]) had a higher risk for mental disorders than heterosexuals for all investigated diagnostic categories. The risk for depression (OR=2.70; 95% [CI = 2.21, 3.18]) and suicidality (OR= 4.81; 95% [CI = 3.63, 5.99] was higher in bisexual compared to lesbian/gay people. Exploratory meta-regressions revealed no evidence for a decrease in mental health differences between people with minority sexual orientations and heterosexuals in more recent years of data assessment, except for AUD. Conclusions: These findings clearly suggest disparities in mental health between people with minority sexual orientations and heterosexual people. There is a lack of data regarding a wider spectrum of sexual orientations and mental disorders and studies in non-Western countries.
... Researchers working across the social and health sciences have explained sexual minority health disparities using social stress paradigms (Frost, 2017;Hatzenbuehler & Pachankis, 2016;Meyer, 2003;Meyer et al., 2008). These models recognize that sexual minority populations are exposed to excess social stress due to the stigmatized status assigned to their identities by society. ...
... Studies that have utilized the minority stress framework have produced a strong body of evidence that exposure to minority stressors is associated with mental health problems, including DSM-diagnosable mood and anxiety disorders, symptoms of depression, substance use, and suicide ideation, as well as lower levels of psychological and social well-being (for reviews, see Hatzenbuehler & Pachankis, 2016;Meyer & Frost, 2013;Pitoňák, 2017). Exposure to minority stress has also been shown to be associated with increased physical health problems (Frost et al., 2015). ...
... Our results show that despite improvements in the social environment of sexual minority people in the USA, they continue to experience the negative association between minority stress and health and well-being. It further showcases the importance of attention to variability across the life course (Hammack et al., 2018) in the applicability of the minority stress model, which has become perhaps the most influential framework guiding public health research and interventions aimed at understanding and addressing health inequalities faced by sexual minority populations (Chaudoir et al., 2017;Hatzenbuehler & Pachankis, 2016; National Academies of Sciences, Engineering, & Medicine, 2020). The attention devoted to positive social and policy change in the popular media should not distract from the continuing negative association between minority stress and the health and well-being of sexual minorities (Meyer, 2016), which although sometimes slightly attenuated, persists even for young cohorts of sexual minority emerging adults who came of age in more accepting social climates. ...
Article
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This study examined the extent to which social stress stemming from a stigmatized social status (i.e., minority stress) was associated with three domains of health in younger as compared with older age cohorts of sexual minority individuals. Data were analyzed from the Generations Study, a longitudinal study using a probability sample ( N = 1518) of age cohorts of sexual minority individuals in the USA. Exposure to a variety of minority stressors was associated with poorer health for all age cohorts. We hypothesized that because of improved social and legal environments in recent years, the associations between minority stress and health would be diminished in the younger cohort. As expected, we found that the associations between some minority stressors and health outcomes were diminished in the younger cohort compared to older cohorts. Positive associations between community connectedness and mental health and social well-being were observed for all participants but were attenuated in the younger cohort. Findings demonstrate the continuing negative association between minority stress and health among sexual minorities, which, despite some attenuation, persists even for young cohorts of sexual minority individuals in a more equal and accepting social climate.
... Minority stress theory also posits that stigma is a fundamental stressor in the health of sexual minority individuals. Stigma and minority stress theories suggest that stigma occurs at multiple levels (structural/cultural, interpersonal, and individual), affecting the health of sexual minority individuals (Hatzenbuehler & Pachankis, 2016). Structural stigma refers to societal-level conditions, cultural norms, and policies that may directly affect sexual minority individuals (Hatzenbuehler & Link, 2014). ...
... Interpersonal stigma refers to interactional processes, including prejudice and discrimination, that occur during social interactions (Hatzenbuehler & Pachankis, 2016). Social discrimination has been shown to contribute to Chinese sexual minority adults' engagement in unhealthy behaviors such as daily tobacco use, frequent binge drinking, and other substance use (Xu et al., 2019. ...
... Individual levels of stigma refer to individuals' cognitive, affective, and behavioral responses to stigma such as rejection sensitivity, internalized homophobia, and concealment of sexual orientation (Hatzenbuehler & Pachankis, 2016). Sexual minority individuals often anticipate rejection because of past experiences with prejudice and discrimination either personally or toward their group (Frable et al., 1990;Mendoza-Denton et al., 2002). ...
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In traditional Confucianist culture in China, marriage and offspring are highly valued, placing sexual minority adults under tremendous pressure to marry an opposite sex partner. This study explored how Confucianism and stigma were associated with the intention to pursue a heterosexual marriage among Chinese sexual minority individuals as well as the moderating mechanisms of gender and age. Cross-sectional data were collected from 747 participants via online social networks from March to June 2020. Items assessed Confucianism values (communalism, filial piety, traditional gender roles); stigma (rejection sensitivity, social discrimination); and heterosexual marital intention (HMI). A total of 1.7% (n = 12) participants had ever been married, 11.6% (n = 87) planned to marry a different-sex partner, 60.4% (n = 451) had no intention to pursue a heterosexual marriage, and 26.4% (n = 197) had no specific marital plan. Bisexual participants scored significantly higher than homosexual individuals in HMI. Sexual minority adults with high levels of Confucianism and stigma were more likely to intend to marry. Importantly, both individual stigma (rejection sensitivity) and interpersonal stigma (social discrimination) partially mediated the relationship between Confucianism and HMI. Confucianism had a stronger impact on HMI for men than women, and age moderated the influence of Confucianism (including communalism and filial piety) on HMI, with a stronger impact for younger than older generations. This study contributes to a better understanding of how Confucianism and stigma may be connected to the intention to pursue a heterosexual marriage, suggesting culture-modified theories of stigma and sexual minority stress are needed to explain the experiences of sexual minority people in contemporary China.
... The theoretical framework posits that lived discrimination/victimization, internalized stigma, and expectations of rejection are social processes through which the environment contributes to stress and health. The empirical evidence to support significant associations between minority stressors and poor mental health outcomes is long-standing (Cronin et al., 2021;Hatzenbuehler & Pachankis, 2016). However, more research is needed to examine intervention mechanisms targeting these social processes to reduce youth suicide outcomes. ...
... Empirical data on the experiences and consequences of stigma among sexual minority youth portray stigma as the driver of a range of health disparities (e.g., Hatzenbuehler & Pachankis, 2016), including adverse psychological consequences. For instance, Pachankis et al.'s (2018) 8-year longitudinal study of young gay and bisexual men found that felt stigma, such as not wanting to be associated with the "stereotypical image of effeminate gays," was predictive of social anxiety symptoms (p. ...
... Stigma and discrimination are multilevel constructs that are enacted at structural (i.e., state policies and institutional practices), interpersonal (abuse, rejection, and discrimination), and individual (self-stigma and disclosure) levels (Hatzenbuehler & Pachankis, 2016). Although sexual minority youth are victimized at disproportionate rates, which contributes to a range of adverse psychological outcomes, including increased suicidality, research suggests that interventions targeting individual, interpersonal, and structural stigma can mitigate these outcomes. ...
Article
Sexual minority youth are at elevated risk for suicide, and previous research supports an association between hate crimes targeting sexual minority youth and suicide attempts. Hate crime laws (HCLs) may reduce bias-motivated victimization or reflect community support for marginalized groups, although not all states with such laws explicitly name sexual minorities as a protected class. We used a quasi-experimental design to examine whether the inclusion of sexual orientation as an explicitly protected group within states' HCLs was associated with decreased suicide attempts among high school aged adolescents using data from the Youth Risk Behavior Survey. Results showed that sexual minority youth attempted suicide at rates 2.9 to 4.3 times higher than heterosexual youth. The enactment of enumerated HCLs was associated with a small but significant 1.2-percentage point (95% confidence interval, CI [À1.8%, À0.6%], p , .001) reduction in suicide attempts among high school aged adolescents, and these reductions were not specific to sexual minority youth. Among sexual minority youth, enumerated HCLs were associated with larger reductions in suicide attempts among questioning and bisexual youth than gay and lesbian peers. By contrast, general HCLs that did not explicitly name sexual minorities as a protected group did not differ from the absence of any HCL in their association with suicide attempts (À.5%, 95% CI [À1.6%, 0.7%], p = .43). We conclude that HCLs may help to decrease rates of adolescent suicide attempt, but this potential appears to be contingent on naming sexual minorities as a protected group.
... Minority stress theory offers a framework for understanding the experiences of SGD youth in excluding environments. This framework posits that individuals may experience unique stressors over time such as stereotypes, stigma, and discrimination because of their social, potentially minoritized, position (Meyers, 2003;Pachankis, 2016). These experiences cause stress that can impact health for SGD individuals and in fact have been linked to greater physical and mental health concerns including specific disease instances such as cancer and heart disease (see Lick et al., 2013). ...
... These experiences cause stress that can impact health for SGD individuals and in fact have been linked to greater physical and mental health concerns including specific disease instances such as cancer and heart disease (see Lick et al., 2013). For example, minority stress theory stipulates that health disparities that exist specifically for SGD individuals may be a result of these social experiences of stigma and discrimination (Pachankis, 2016). Furthermore, for SGD youth, experiences of minority stress have been linked to higher rates of depression and suicidal ideation (Baams et al., 2015). ...
... The exclusion of accurate and helpful information for SGD youth in SBSE has broader implications than simply sexual health. The Minority Stress Theory posits that those who are exposed to stigma, including institutional policies of exclusion and misinformation, experience stress reactions that can impact physical and mental health (Pachankis, 2016). SBSE that is excluding, inaccurate, or othering for SGD youth can be one source of stress impacting both their physical and mental health. ...
Article
The purpose of this study is to describe how school-based sexuality education (SBSE) in the context of health education frames and teaches sexuality, sexual orientation, and gender identity. Understanding how schools address sexuality and gender provides insight into how school systems might ostracize sexual and gender diverse (SGD) youth. This study used content analysis to survey 13 health education textbooks in the United States. The content of textbooks provides a sampling of cultural, economic, and political activities and the ways they may be portrayed in the school setting. All textbooks had to be (1) health education textbooks, (2) intended for middle and high school, (3) published in the last 15 years, and (4) required or recommended by a state or local Department of Education, or produced by a publisher recommended by a department of education. Results of this study indicate that 11 of the 13 reviewed textbooks had abstinence based or abstinence only until marriage sexuality education that presented narrow, binary definitions of gender and sexual orientation, and that ignored or provided misinformation about gender identity and sexual orientation. Results of this study suggest that school personnel should consider alternatives to widely available health textbooks to teach more inclusive, affirming, and effective sexuality education.
... Desta forma, os três estressores que merecem destaque são: (i) estigma imposto (enacted stigma): conceitualmente compreendido como um conjunto de experiências de perseguição, rejeição, agressão, violência ou discriminação motivadas pela orientação sexual; (ii) homonegatividade internalizada (internalized homonegativity): definida como o processo individual de absorver atitudes sociais negativas e assimilá-las como parte da identidade pessoal; e (iii) ocultação da identidade sexual (concealment of sexual identity): refere-se às tentativas que o indivíduo realiza para esconder a sua sexualidade pelo receio de punição e rejeição. Todas elas são associadas à expectativa antecipatória de rejeição (Hatzenbuehler & Pachankis, 2016). ...
... Alguns modelos de compreensão da teoria do estresse de minorias com base em pressupostos comportamentais também já foram propostos e deram origem a tecnologias de intervenção (Skinta et al, 2020). No entanto, o suporte empírico mais validado refere-se a fatores cognitivos, emocionais e interpessoais (Hatzenbuehler, 2009;Pachankis, 2014;Hatzenbuehler & Pachankis, 2016) que fazem a mediação entre o estresse social adicional e problemas de saúde mental em minorias sexuais: homens ou mulheres cisgênero com orientações sexuais não-heterossexuais, operacionalizadas tanto em termos de comportamento e atração sexual, quanto em termos de auto--identificação sexual -gays, lésbicas, bissexuais (Hatzenbuehler, 2009;Plöderl & Tremblay, 2015). ...
... Tal "expectativa" pode ser compreendida em termos analítico-comportamentais como uma aprendizagem resultante de múltiplas experiências em que a apresentação de certas classes de comportamentos (que por padrões culturais possam expor sua condição como minoria sexual e/ou de gênero) na interação com outros indivíduos (especialmente indivíduos heterossexuais cisgênero), foi associada a experiências aversivas (estressores distais, conforme Hatzenbuehler & Pachankis, 2016), estabe-lecendo as interações sociais como estímulos aversivos condicionados e potenciais fontes de punição. ...
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Resumo: A teoria do estresse de minorias se propõe a explicar os prejuízos de saúde de grupos minoritários de sexo e de gênero que são expostas a estruturas sociais estigmatizan-tes a partir de três processos: estigma imposto, homonegatividade internalizada e ocultação da identidade sexual. A literatura brasileira mostra que essas minorias têm mais problemas de saúde mental quando comparadas com pessoas cisgêneras heterossexuais, corroborando estudos internacionais. Este artigo tem como objetivo analisar o impacto do estresse social na saúde mental de minorias de sexo e de gênero a partir de uma compreensão comportamental da teoria do estresse de minorias, com vistas a subsidiar o desenvolvimento de políticas públicas e tecnologias de intervenção para esta população. Há poucos estudos com o referencial da análise do comportamento que exploram essa definição. O estudo de modelos experimentais como o de supressão condicionada, estado motivacional defensivo e estrese crônico moderado descrevem processos comportamentais relevantes para a compreensão do efeito dos estressores ambientais sobre os desfechos negativos na saúde mental dessa população. Os modelos teóricos que descrevem os processos de punição/fuga-esquiva, ambiente invalidante, esquiva experiencial, desenvolvimento de self instável ou inseguro, por sua vez, permitem uma interpretação analítico-comportamental de alguns processos comportamentais que constituem a subjetividade e o sofrimento psicológico do indivíduo LGBT+, bem como seus mecanismos de enfrentamento aos estressores ambientais e seus efeitos imediatos e atrasados. Tais modelos e conceitos permitem levantar variáveis relevantes e fomentar políticas públicas para o desenvolvimento de protocolos de intervenção no âmbito da análise do comportamento aplicada.
... Minority stress theory (Meyer & Frost, 2013) proposes that holding a minority or stigmatised identity can become internalised to increase the risk for psychological distress, known as internalised stigma (Hendricks & Testa, 2012). Internalised stigma may constitute shame for oneself or aspects of identity (Hatzenbuehler & Pachankis, 2016). A wide range of research reports increased rates of psychological distress for those with minority identities (Dhejne et al., 2016), and self-criticism and shame may be some consequences of stigma (Hatzenbuehler & Pachankis, 2016;Vincent & Lorimer, 2018), both of which are known trans-diagnostic factors in mental health difficulties. ...
... Internalised stigma may constitute shame for oneself or aspects of identity (Hatzenbuehler & Pachankis, 2016). A wide range of research reports increased rates of psychological distress for those with minority identities (Dhejne et al., 2016), and self-criticism and shame may be some consequences of stigma (Hatzenbuehler & Pachankis, 2016;Vincent & Lorimer, 2018), both of which are known trans-diagnostic factors in mental health difficulties. It is therefore important to better understand how to address the psychological mechanisms contributing to internalised stigma in groups at elevated risk to promote psychological well-being. ...
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Objectives Transgender and gender non-conforming people may face elevated rates of shame and self-criticism in light of minority stress. Compassion-focused therapy has a growing evidence base in addressing trans-diagnostic processes in mental health difficulties, including shame and self-criticism. The objective of the present study was to explore the experience of an initial pilot compassion-focused therapy group delivered online in a Gender Service during the COVID-19 pandemic. Methods Six transgender people completed a semi-structured interview after attending an 8-week compassion-focused therapy group in a national Gender Service. Inductive thematic analysis was used to identify themes in the data. Results Four themes were identified from the data: Transition Needs Compassion; Acceptability of the Compassion-Focused Approach; Being in a group with other transgender people; and Online delivery works despite its challenges. Participants reported that the compassion-focused framework was an appropriate and helpful way of understanding their experiences of stigma and that both the content and process of the group had benefitted them. Being with other transgender people raised some anxieties, such as comparisons or fear of offending, but also enabled seeing the self in more positive and accepting ways. While online delivery had some challenges, participants largely felt it was an effective mode of delivery, aided by the experiential nature of the group. Conclusions Compassion-focused therapy seems to be a feasible and acceptable approach for transgender and gender non-conforming people. Group processes may be helpful in increasing self-acceptance. Further quantitative exploration of therapy process and outcomes is warranted.
... It considers that the acquisition of gender roles, as well as aggressive and discriminatory behaviors toward this group, constitute a process of vicarious learning or that which is gained through observation. Likewise, it can be pointed out that negative attitudes toward gender equality and stereotypes can translate into a greater predisposition toward harassment, discrimination, and violence against lesbian, gay, bisexual, transgender, queer, intersex, asexual, and plus (LGBTQIA+) individuals [5][6][7], which has a negative impact on their self-esteem [8]. ...
... Regarding bullying, several studies [1,2,5] showed that gender identity is a risk that influences bullying and/or violence at school. This bullying is characterized by teasing, insults, and physical aggression. ...
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Affective-sexual and gender diversity is an increasingly distinctive and extended reality and should be acknowledged and respected. From a psychosocial and educational point of view, it is appropriate to review young people’s attitudes and knowledge regarding this, relating them to aspects such as empathy, violence, or bullying, to implement quality education in the early stages of primary education. The main objective of this study was to analyze the relationship between empathy levels, attitudes toward transsexuality, and bullying among Spanish university students. The sample consisted of 247 students. Instruments were administered to evaluate negative attitudes toward transsexual people, gender ideology, transphobia, bullying, and empathy. Inverse relationships were found between transphobia and empathy. Regression analysis demonstrated the predictive ability of empathy on attitudes toward transsexual people. The results of this study are expected to increase awareness in society and encourage appropriate, satisfactory, or tolerable coexistence, in which all individuals can be free to live and express themselves. While the results indicated that the quality of life of transgender people has comparatively improved, there is still a long way to go.
... A growing proportion of the literature has also found that self-identified sexual minority youth (such as lesbian, gay, and bisexual individuals) are also more likely than heterosexually-identifying adolescents to report high levels of anxiety, stress, and depression and experience risky sexual outcomes (sex while intoxicated, early intercourse debut, and STIs) [19][20][21]. It has been suggested that discrimination and stigma related to one's minority status may impact mental health status and put them at risk of vulnerability to risky sexual behaviors [22,23]. In addition, a recent body of evidence suggests that adolescents who experience poorer mental health and practice risky sexual behaviors are at higher risk of experiencing more adverse events, including partner violence victimization, defined as physical, psychological, and sexual assaults by an intimate partner [24][25][26][27]. ...
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Risky sexual behaviors, such as not using a condom for preventing sexually transmittable diseases and unwanted pregnancies, are associated with emotional and psychological problems in adolescence, including higher levels of depression, anxiety, stress, and low self-esteem. Adolescents with a history of violence victimization are also at increased risk of engaging in sexual risk behaviors. In this study, we examined the associations between mental health disturbances and partner violence victimization and the non-use of condoms among young people in Spain. We also examined self-esteem as a mediator of mental health problems and unprotected sexual relationships. A cross-sectional study was conducted on a sample of 831 adolescents randomly selected from 25 high schools in Spain. From the initial sample, 285 students (144 men and 141 women) from high schools in Alicante (Spain) who reported having experienced sexual activity with at least one partner were approached. The results showed that one in three adolescents between 14 and 19 years old did not use condoms during sexual intercourse. The factors associated with the non-use of condoms in the estimated models of Poisson robust variance were having a history of physical, psychological, or sexual violence; having been expelled from school because of behavioral problems; and having higher levels of depression, anxiety, and stress and lower levels of self-esteem. Self-esteem was independently associated with the non-use of condoms. Having lower levels of self-esteem increased the risk of not using a condom during participants’ last sexual intercourse. These findings suggest the importance of developing public health strategies for mental health promotion to increase condom use among adolescents.
... Empirical research finds that trans pop u la tions in the United States are often at greater risk of mor bid con di tions than the gen eral pub lic, and these disparities are Mortality Differences Among Transgender and Non-Transgender People the o rized to be fun da men tally caused by antitrans stigma (Hatzenbuehler et al. 2013;Transgender Law Center n.d.;White Hughto et al. 2015). Indeed, the nation's dom i nant gen der ideology nor mal izes and reifies the man/woman binary, stig ma tiz ing those whose gen der does not align with the iden tity or expres sion typ i cally asso ci ated with their sex assigned at birth (Hatzenbuehler and Pachankis 2016;West and Zimmerman 1987;White Hughto et al. 2015). Antitrans stigma pro motes wide spread dis crim i na tion and stereotyping of trans peo ple, which reduces trans peo ple's access to crit i cal resources needed to pro mote health and wellbeing (e.g., health care, hous ing, employ ment), increases risk of inter per sonal vio lence, and causes excess stress and hyper vig i lance within trans indi vid u als (Hendricks and Testa 2012;White Hughto et al. 2015). ...
Article
Few studies have analyzed mortality rates among transgender (trans) populations in the United States and compared them to the rates of non-trans populations. Using private insurance data from 2011 to 2019, we estimated age-specific all-cause mortality rates among a subset of trans people enrolled in private insurance and compared them to a 10% randomly selected non-trans cohort. Overall, we found that trans people were nearly twice as likely to die over the period as their non-trans counterparts. When stratifying by gender, we found key disparities within trans populations, with people on the trans feminine to nonbinary spectrum being at the greatest risk of mortality compared to non-trans males and females. While we found that people on the trans masculine to nonbinary spectrum were at a similar risk of overall mortality compared to non-trans females, their overall mortality rate was statistically smaller than that of non-trans males. These findings provide evidence that some trans and non-trans populations experience substantially different mortality conditions across the life course and necessitate further study.
... Public policy evaluation should employ an intersectional lens to improve health outcomes and assess equitable adoption and execution (Hankivsky et al., 2014;Turan et al., 2019). As policy can affect individuals with various social identities differently (Hatzenbuehler, 2014;Hatzenbuehler, 2016;Hatzenbuehler et al., 2014;Hatzenbuehler and Pachankis, 2016;Pachankis et al., 2017;Philbin et al., 2019), the unique impact of social and structural stressors due to one's intersecting racial, ethnic, and sexual minoritized identities could lead to differences in policy effects (Bauer, 2014;Bowleg, 2012). The multiple overlapping stigmas that non-Hispanic Black sexual minoritized adults face (e.g., racism, sexual orientation-related discrimination) may limit their access to medical cannabis due to stigma and medical mistrust (Bonn-Miller et al., 2014;Brenick et al., 2017;Eaton et al., 2015;Haug et al., 2017;Quinn et al., 2019). ...
Article
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Differences in cannabis use patterns among racial, ethnic and sexual minoritized identity subgroups have been attributed to marginalized identity stressors. However, associations at the intersection of these minoritized identities remain underexplored in a changing medical cannabis law (MCL) context. We estimated medical cannabis and daily cannabis use, and cannabis use disorder (CUD) by intersecting racial, ethnic and sexual minoritized identity subgroups. We included 189,800 adults in the 2015-2019 National Survey on Drug Use and Health identifying as non-Hispanic white, non-Hispanic Black, or Hispanic and self-reported heterosexual, gay/lesbian, or bisexual sexual identity. We estimated the adjusted odds of past-year: (a) any medical cannabis, (b) daily cannabis use (i.e., 300+ days/year), and (c) DSM-5-proxy CUD by sexual identity, stratified by race and ethnicity. Cannabis measures were higher among sexual minoritized groups than heterosexual adults across racial and ethnic subgroups. Bisexual adults had higher odds of any medical cannabis use than their heterosexual counterparts: non-Hispanic white (6.4% vs. 1.8%; aOR=2.6, 95% CI=[2.5-3.5]), non-Hispanic Black (4.1% vs. 1.7%; aOR=2.7, 95% CI=[1.6-4.5]), and Hispanic adults (5.3% vs. 1.8 %; aOR=2.6, 95% CI=[1.9-3.3]). We found heterogeneous associations with state MCL status across subgroups stratified by race and ethnicity. Bisexual adults in MCL states had higher odds of any medical cannabis use among non-Hispanic white (aOR=2.0, 95% CI=[1.4-2.9]) and Hispanic (aOR=3.6, 95% CI=[1.2-10.2]) adults compared to their non-MCL counterparts, but this was marginal among non-Hispanic Black bisexual adults (aOR=1.6, 95% CI=[1.0-2.6]). Studies should assess intended and unintended cannabis policy effects among racial, ethnic, and sexual identity subgroups.
... While the stress associated with CAR is pervasive and cuts across demographic groups, differences in purpose seeking care and partner composition may have different consequences and, thus, implications for tailoring policies, care, and supportive measures to meet the needs of different patient populations. For example, sexual minority stress Hatzenbuehler & Pachankis, 2016;Meyer & Frost, 2013) may play a role in how SMW couples experience the process of trying to conceive. Yet, few studies have explicitly investigated SMW couple-level experiences (Umberson et al., 2015;Van Parys et al., 2016). ...
Article
Full-text available
Introduction Clinically assisted reproduction has created opportunities for pregnancy and parenthood for many who experience fertility challenges. For decades, sexual minority women (SMW; defined in this article as non-heterosexual cisgender females) in same-sex couples have used assisted reproduction to help them form families of their own. Yet, little research has described SMW’s couple-level, shared experiences in the context of clinically intensive approaches to family expansion. Methods This paper examines couples’ shared experiences with assisted reproduction through qualitative analysis of 30 in-depth interviews conducted between June and August 2019. We recruited 20 sexual minority women who comprised 10 same-sex couples to participate in in-depth interviews and a brief survey. We applied thematic analysis to interviews (20 individual interviews, 10 dyadic interviews) to better understand couples’ shared experiences with assisted reproduction. Using four sorting groups based on relative experience with assisted reproduction (i.e., first timers; staying-the-course; pivoters; finally pregnant), we identified three themes that highlight dimensions of couple-level, shared experiences. Results Three broad themes were identified across the sample: (1) normative assumptions, (2) physical asymmetries in efforts to conceive, and (3) emotional dimensions of clinically assisted reproduction within couples. Conclusions Expanded understanding of SMW couples’ shared experiences suggests the need for policy modifications and tailored interventions to assist SMW couples navigating assisted reproduction. Policy Implications Multilevel approaches, for example, regulatory policies and health systems operational updates, may provide meaningful shifts in care for SMW couples.
... Introduction and Pachankis 2016). Consequently, minority stress is the leading framework for understanding health inequity among SGM people relative to the general population (Institute of Medicine of the National Academies 2011). ...
Conference Paper
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Because of their stigmatized social status, sexual and gender minority (SGM; e.g., gay, transgender) people experience minority stress (i.e., identity-based stress arising from adverse social conditions). Given that minority stress is the leading framework for understanding health inequity among SGM people, researchers and clinicians need accurate methods to detect minority stress. Since social media fulfills important developmental, affiliative, and coping functions for SGM people, social media may be an ecologically valid channel for detecting minority stress. In this paper, we propose a bidirectional long short-term memory (BI-LSTM) network for classifying minority stress disclosed on Reddit. Our experiments on a dataset of 12,645 Reddit posts resulted in an average accuracy of 65%.
... This model helps to understand how discrimination, violence, and victimization due to a pervasive homophobic and biphobic culture are the primary sources of stress, and most probable driving mechanisms, of mental health problems among sexual minorities (Atkin et al., 2018). Sexual minority populations experience higher levels of stigma than their heterosexual counterparts, which is deeply ingrained in society (and therefore labeled 'structural') and is directly linked to discrimination and bullying of sexual minority youth (Hatzenbuehler & Pachankis, 2016). Minority stress theory postulates that sexual minority young people may become hypervigilant to cues of aggressive behavior from others and may maintain a constant readiness to avoid overt aggression (Meyer, 2003). ...
Article
Sexual minority youth are at greater risk for bullying victimization than their heterosexual peers but data on perpetration and cybervictimization is limited. Using representative data from seven European countries and one region (N = 14,545), this study compared traditional bullying victimization and perpetration, and cyberbullying victimization among 15-year-old adolescents who reported ever being in love with same- or both- gender peers (sexual minority) versus opposite-gender peers (non-minority). Adolescents who have never been in love and non-respondents were also included. Analyses were stratified by gender and adjusted for country/region and family affluence. Compared to those attracted to opposite-gender peers, traditional bullying perpetration was more likely to be reported by both-gender attracted girls, while bullying victimization was more likely to be reported by both-gender attracted girls and both- and same-gender attracted boys. All sexual minority youth were more likely to report cybervictimization compared to their non-minority peers. Adolescents who have never been in love reported lower levels of bullying involvement than all other youth. Sexual minority stigma may contribute to higher risk of bullying involvement among adolescents. Interventions need to specifically address bullying involvement and associated health risks of sexual minority youth. Available evidence shows that explicit school policies and interventions tailored to local settings are particularly effective.
... A possible explanation for this pattern could be related to complexities of a bisexual identity. Many people are dismissive of bisexual identity or do not consider it a valid identity (Dodge et al. 2016); this stigmatization likely contributes to additional mental health burdens for bisexual men and women (Bostwick, 2012;Chan, Operario, & Mak, 2020;Hatzenbuehler, 2014;Hatzenbuehler & Pachankis, 2016). Notably, antibisexual stigma can be perpetrated by both heterosexual and lesbian or gay individuals or communities (Arnett, Frantell, Miles, & Fry, 2019), which can leave bisexual individuals with reduced access to social support and community resources, both of which can mitigate the effects of stigma on adverse mental health outcomes (Frost & Meyer, 2012). ...
Article
Objectification theory and the tripartite influence model provide useful frameworks for understanding the body image experiences of men and women. However, there is little systematic investigation of how sexual orientation moderates the links between these constructs and body image satisfaction. It has been hypothesized, for example, that the associations of surveillance (i.e., monitoring of one’s appearance due to objectification by others) would be strongest for groups targeted by the male gaze (e.g., gay men, lesbian women, and bisexual men and women). Here we proposed an integrated sociocultural model and examined these pathways in multigroup structural equation models in a national sample of heterosexual, bisexual, and lesbian women (ns = 5395; 598; 213, respectively), and heterosexual, bisexual, and gay men (4869; 194; and 194, respectively) aged 18–65 years. Sexual orientation moderated some of these pathways. The most consistent pattern was that appearance pressures were internalized to a greater extent among bisexual participants. The pathways to poorer body image were generally similar among heterosexual and gay/lesbian men and women. These findings highlight the importance of examining sexual orientation-specific influences on body image across diverse groups, as well as the commonalities in the experiences of men and women across sexual orientations.
... For sexual and gender minority (SGM) adolescents, sex education tends to be an experience that leaves them feeling invisible [19,20]. This invisibility can reinforce feelings of isolation and marginalization, leading to higher rates of depression, suicidal ideation, increased number of sexual partners, and higher rates of pregnancy [21][22][23][24]. ...
Article
Full-text available
Introduction The United States (U.S.) has higher rates of sexually transmitted infections (STIs) and adolescent pregnancy than most other industrialized countries. Furthermore, health disparities persist among racial and ethnic minority adolescents (e.g., African American and Latinx) and in counties located along the U.S.–Mexico border region—they demonstrate the highest rates of STIs and unintended pregnancy among adolescents. Methods Qualitative data were collected as part of formative research for the development of a mobile app that provides gender-inclusive sexual education to adolescents living in the U.S.—Mexico border region. From August 2019 to March 2020, the study team conducted 11 in-depth interviews with healthcare providers and three focus groups with cisgender, heterosexual, and SGM adolescents ages 15–18 (n = 20). Results Providers and adolescents reported similar barriers to accessing SRH in this region such as transportation, lack of insurance and cost of services or accessing services without their parent’s knowledge. However, providers shared that some adolescents in this region face extreme poverty, family separation (i.e., parent has been deported), have a mixed family legal status or are binational and have to travel every day from Mexico to the U.S. for school. These challenges further limit their ability to access SRH. Conclusions Adolescents in the U.S.-Mexico border region face unique economic and social challenges that further limit their access to SRH care, making them uniquely vulnerable to STIs and unintended pregnancy. The prototype of the app was developed based on the needs expressed by providers and adolescents, including providing comprehensive Sex Ed and mapping of free comprehensive and confidencial SRH services available in the region and is being pilot tested. Our findings provide further evidence for the need for interventions and service delivery, programs tailored for residents in the border region.
... It has long been recognised that stigma and minority stress occur among sexual and gender minorities on an individual, interpersonal, and structural level (Hatzenbuehler and Pachankis, 2016). In this sense, minority stress theory posits sexual and gender minorities experience unique minority stressors per their social, often a minority, position, contributing to mental and behavioural health disparities (Mallory et al., 2021;Meyer, 2003). ...
Article
Background Microaggressions, stigma and minority stress still occur among sexual and gender minorities on an individual, interpersonal, and structural level. Cultural immersion may therefore be an effective strategy in order to find potential healthcare approaches and foster more comprehensive, critical, intersectional, and inclusive care practices. Objective The aim of this study was to develop insight into the experiences of LGBTQ+ community members to obtain in-depth perceptions of microaggressions and an understanding of their healthcare needs to provide a culturally safe and sensitive care. Design A qualitative descriptive study was conducted between September to November 2021. Settings This study was conducted at [Hidden for blinding purposes] with LGBTQ+ community members. Participants Twenty-one LGBTQ+ individual participated in this study, aged between 18 and 56 years old. Methods Participants were recruited using a purposive sampling. Responses from semi-structured interviews were studied using a thematic analysis. Methods and findings are reported in line with Standards for Reporting Qualitative Research recommendations. Results Three themes emerged from the qualitative analysis: (i) experiences to understand the impact of a heteronormative society, (ii) perceptions of engaging with health education and promotion, and (iii) healthcare access, use and experiences within the LGTBQ+ community. Conclusions This study yields findings about the difficulties that LGBTQ+ community members face in the healthcare system in order to ensure equal care for vulnerable communities and integrate a culturally safe care approach into nursing practice. Certain microaffirmation strategies against social determinants of health such as school-based nursing strategies can help to raise awareness and knowledge among heterosexual peers and reduce cultural invisibility, microaggressions, stigma and minority stress. In order to provide culturally safe care, educators might also explore the inclusion of gender and sexual minority care content in both in-faculty education and ongoing continuing education for nurse practitioners.
... Bisexual women have also presented more substance-related problems and psychological distress compared to heterosexual women (Bränström and Pachankis, 2018). A number of publications have shown an association between stigma in forms of discrimination, violence, less satisfying economic and social features and a higher risk for mental health and substance use problems among lesbian, gay and bisexual populations (Lehavot and Simoni, 2011;Hatzenbuehler and Pachankis, 2016;Gustafsson et al., 2017;Bränström and Pachankis, 2018;Bränström et al., 2020). ...
Article
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Background Addictive behavior of gambling, gaming and internet activity is partly a new research domain and has not been well investigated with regard to sexual minority populations. Although health disparities between sexual minorities and the general population are well documented, there is a lack of inclusion of sexual minorities in both research and clinic. Among lesbian, gay and bisexual populations certain features could be present that play a role for the development of addictive behaviors, such as social isolation and increased risk of other psychiatric problems. The aim of this study was to investigate problem gambling, problem gaming and problematic internet behavior in a European context and if it is affected by sexual orientation status. Methods An online web-survey was distributed among web-panels in England, Poland, Switzerland, Italy, Spain, Denmark, and Sweden in 2017–2018. Result 10 983 complete answers were collected. 7.1% of the participants had a sexual minority status ( n = 774). Regression models found that there was no difference in gambling, gaming and internet behavior among heterosexual and sexual minority men. Sexual minority women were associated with problematic gambling and gaming behavior, when also controlling for age and nationality. When also controlling for psychological distress, women defining as having another sexual minority status than lesbian and bisexual remained significant for having a problematic gaming behavior (AOR = 2.3). Conclusion An awareness of female sexual minority perspectives is relevant in facilities treating behavioral addiction as well as in future research in behavioral addiction. More research is needed in problematic gambling and gaming behavior in different sexual minority populations with regard to psychiatric comorbidity and living conditions. An inclusion of sexual minority groups defining as other than gay and bisexual is needed in future research. No significant differences were found between heterosexual and sexual minority men in adjusted analysis in this study.
... Because of their stigmatized social status, sexual and gender minority (SGM; e.g., gay, transgender) people experience minority stress (Meyer 2003). Minority stress is associated with poorer health outcomes (e.g., Hatzenbuehler and Pachankis 2016). Consequently, minority stress is the leading framework for understanding health inequity among SGM people relative to the general population (Institute of Medicine of the National Academies 2011). ...
Article
Full-text available
Because of their stigmatized social status, sexual and gender minority (SGM; e.g., gay, transgender) people experience minority stress (i.e., identity-based stress arising from adverse social conditions). Given that minority stress is the leading framework for understanding health inequity among SGM people, researchers and clinicians need accurate methods to detect minority stress. Since social media fulfills important developmental, affiliative, and coping functions for SGM people, social media may be an ecologically valid channel for detecting minority stress. In this paper, we propose a bidirectional long short-term memory (BI-LSTM) network for classifying minority stress disclosed on Reddit. Our experiments on a dataset of 12,645 Reddit posts resulted in an average accuracy of 65%.
... In another study among 719 sexual minority adults recruited online, those who reported LGB-related victimization (e.g., verbal abuse or harassment) were at risk for suicide (Mereish, Peters, & Yen, 2019). Similarly, other factors such as structural stigma and residing in neighborhoods with higher rates of lesbian, gay, bisexual, and transsexual (LGBT) assault-based hate crimes has also been associated with increased incidence of suicide attempts among LGB individuals (Hatzenbuehler & Pachankis, 2016). Therefore, greater exposure to discrimination and stigma that LGB individuals often experience appears to contribute to higher prevalence of mental health problems and suicide attempts. ...
Article
Background: Suicide continues to be one of the leading causes of death in the United States and lesbian, gay, and bisexual (LGB) individuals are disproportionately at risk of suicide in comparison to heterosexuals. Methods: We examined data from adults participating for five waves (2015-2019) of the National Survey on Drug Use and Health. We first determined whether there is differential risk of suicidal thoughts, suicide plans, and suicide attempts (self-injurious thoughts and behaviors [SITBs]) in the past year according to current sexual orientation. We then estimated linear trends in prevalence of each SITB outcome stratified by each sexual orientation category. Results: We estimate that compared to heterosexual men and women, gay and bisexual men and lesbian and bisexual women are at greater odds of past-year suicidal thoughts, suicide plans, and suicide attempts, respective to their sexes. Between 2015 and 2019, suicidal thoughts increased among bisexual men (by 34.3%, p = 0.037), lesbian women (by 18.4%, p = 0.033), and bisexual women (by 15.7%, p < 0.001). Prevalence of suicide plans increased among heterosexual men (by 15.3%, p = 0.017), gay men (by 28.5%, p = 0.037), and bisexual women (by 23.2%, p < 0.001). Suicide attempts increased among bisexual women by 26.6% (p < 0.001). Conclusions: Sexual minority identity is a risk factor for SITBs. Bisexual women in particular are not only at greater risk for SITBs, but estimated prevalence has increased in recent years. More attention needs to be paid to LGB populations regarding future suicide prevention efforts.
... Minority stress theory suggests that expectations and experiences of interpersonal discrimination and stigma related to one's sexual minority identity lead to an increased probability of developing mental disorders (Meyer, 2003). Research has provided overwhelming support for the relationship between minority stress and depression, anxiety, and suicidality in sexual minority populations (e.g., Feinstein et al., 2012;Hatzenbuehler & Pachankis, 2016). Furthermore, experiences of acceptance and support from family and others decreases minority stress in sexual minorities, which in turn decreases their levels of psychopathology and suicidality (Feinstein et al., 2014;Plöderl et al., 2014). ...
Article
Sexual minority college students experience higher rates of depression, anxiety, and suicidality compared with their heterosexual peers. Significant social progress has been made in the last few decades, such that attitudes and policies toward sexual minorities in the United States have improved dramatically. It is unclear, however, whether this progress has decreased disparities in mental health outcomes between cisgender sexual minorities and heterosexuals. Therefore, the current study sought to determine whether disparities in depression, anxiety, and suicidality between cisgender sexual minority and heterosexual college students has decreased in the last 2 decades. Data were derived from the National College Health Assessment (NCHA), a national population-based survey of health outcomes among U.S. college students conducted every semester since 2000. Logistic regression was used to examine main and interaction effects of sexual orientation and time on lifetime and 12-month depression and anxiety diagnosis and treatment, suicidal ideation, and suicide attempt. As hypothesized, significant main effects of time and sexual orientation were observed such that sexual minorities had higher rates of all outcomes compared with heterosexuals, and rates of these outcomes increased over time for all participants. However, despite observed improvements in climate and policies toward sexual minority college students, disparities in rates of depression and anxiety diagnosis/treatment and suicidality among college students have expanded in recent years. These results indicate that further research is needed to determine the extent to which changes in minority stress and structural stigma lead to changes in rates of depression, anxiety, and suicidality in sexual minorities.
... Further, though the impact of these social and economic stressors on adverse physical and mental health outcomes has been well-established in the literature (Adler & Stewart, 2010;Braveman, Egerter, & Williams, 2011;Marmot & Bell, 2012), most healthcare systems do not screen for these stressors and patients' broader lived experience is rarely addressed in addictions and/or other behavioral interventions in clinical settings. Interventions that address the lived experiences of persons with addictions are in their nascence and should be further developed and tested (Tsui et al., 2021), particularly for transgender individuals (Austin & Goodman, 2017;Blosnich et al., 2013;Blosnich, Lehavot, et al., 2017;Brown & Jones, 2016;Glick et al., 2018;Hatzenbuehler et al., 2013;Hatzenbuehler & Pachankis, 2016;Lehavot & Simoni, 2011). ...
Article
Full-text available
Transgender persons have high rates of alcohol and other drug use disorders (AUD and DUD, respectively) and commonly experience social and economic stressors that may compound risk for adverse substance-related outcomes. National VA electronic health record data were extracted for all outpatients in each facility with documented alcohol screening 10/1/09-7/31/17. We describe the prevalence of eight individual-level social and economic stressors (barriers to accessing care, economic hardship, housing instability, homelessness, social and family problems, legal problems, military sexual trauma, and other victimization) among transgender patients with and without AUD and DUD (alone and in combination), overall and compared to cisgender patients in a national sample of VA outpatients. Among 8,872,793 patients, 8619 (0.1%) were transgender; the prevalence of AUD, DUD, and both was 8.6%, 7.2%, and 3.1% among transgender patients and 6.1%, 3.9%, and 1.7% among cisgender patients, respectively. Among all patients, prevalence of stressors was higher among those with AUD, DUD, or both, relative to those with neither. Within each of these groups, prevalence was 2-3 times higher among transgender compared to cisgender patients. For instance, prevalence of housing instability for transgender vs. cisgender patients with AUD, DUD, and both was: 40.8% vs 24.1%, 45.8% vs. 36.6%, and 57.4% vs. 47.0%, respectively. (all p-values <0.001). Social and economic stressors were prevalent among patients with AUD, DUD, or both, and the experience of these disorders and social and economic stressors was more common among transgender than cisgender patients in all groups. Further research regarding experiences of transgender persons and influences of stressors on risk of AUD and DUD, substance-related outcomes, and treatment uptake are needed. Routine screening for social and economic stressors among patients with substance use disorders (SUDs) could improve equitable substance-related care and outcomes. Treatment of SUDs among all persons should consider social and economic risk factors.
... The South's legacy of racism and discrimination across social systems (e.g., housing, education), lack of supportive policies for marginalized individuals, and high rates of mass incarceration may also fuel mistrust in healthcare systems and reduce engagement in HIV prevention and care (Caldwell et al., 2017;Forsyth & Valdiserri, 2015;Jeffries & Henny, 2019). Furthermore, experiences of stigma and discrimination, as well as minority stress, serve as additional barriers for marginalized communities (English et al., 2018;Hatzenbuehler & Pachankis, 2016;Scott, 2021). ...
Article
Full-text available
Scaling up use of Pre-Exposure Prophylaxis (PrEP) among young men who have sex with men and transgender women (YMSM/TGW) is a critical part of the Ending the HIV Epidemic plan. This qualitative study contextualized the social determinants of health (SDOH) that can impede HIV prevention in rural North and South Carolina with 14 key informant interviews with stakeholders and 3 focus groups with YMSM/TGW (N = 23). A deductive-inductive approach with multiple coders was employed to identify themes related to SDOH in rural areas, including economic challenges (e.g., housing and food insecurity), neighborhood characteristics (e.g., lack of transportation), healthcare-related issues (e.g., provider shortages) and educational barriers (e.g., lack of comprehensive and inclusive sexual education). The socio-environmental context of the rural South and prioritization of local, community-based partnerships are necessary to reduce the burden of HIV.
... This intensive data collection allowed us to gain insights into the types of rumination experienced by TGD people, and the role this may play in health outcomes. Given that rumination is an important process through which stigma and other social determinants of health come to impact TGD people (Hatzenbuehler et al., 2013;Hatzenbuehler & Pachankis, 2016), learning more about these experiences may shed light on avenues for promoting resilience in the face of these adversities. ...
Article
Full-text available
Transgender and gender diverse (TGD) people face a myriad of daily stressors because of the hegemonic gender norms embedded within U.S. society. Due to these minority stressors, TGD people report elevated anxiety, depression, stress, and suicidality, among other health issues. One mechanism through which stigma may lead to these negative mental health outcomes is through increased rumination. In this intensive daily diary study with 181 TGD individuals (ages 16-40), we gathered qualitative data on their ruminative thoughts over the course of 56 days. There were a total of 2,431 responses across participants, with individuals providing a range of 1-53 responses (M = 15 responses). Using an experiential framework and an inductive approach to thematic analysis, we generated the following themes: (a) interpersonal relationships as a site of struggle, (b) fear and worry in response to contextual factors, (c) the weight of basic needs and safety, (d) gender as experienced through self and others, (e) intersections of health and rumination, and (f) the occasional reprieve. Using a deductive approach, we also placed these data within the context of Bronfenbrenner's Person-Process-Context-Time model to provide a conceptual model for future research in this area. These ruminative experiences revealed significant adversities and challenges weighing on participants' minds that spanned many areas of life. These findings also highlight the nuanced nature of rumination for TGD individuals and areas that may be overlooked in current assessments of this construct. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
... The mental health challenges facing SGM can be better understood through the Minority Stress Model as conceptualized by Meyer [10]. This model posits that health disparities in minority groups stem from persistent stigma and discrimination directed towards them, creating a host of additional, unique, chronic, and social stressors that are not experienced by the general population [11]. Minority stress operates and bears consequences on multiple levels including the intrapersonal, interpersonal, and structural levels. ...
Article
Full-text available
Purpose of review: To review the role of digital health technologies in behavioral health treatment and promotion for sexual and gender minorities (SGM). Recent findings: Digital technologies have advantages and limitations at multiple levels in addressing SGM's behavioral health needs. For patients, digital technologies improve convenience and may reduce stigma; however, privacy concerns in the home may limit their utilization. Providers also benefit from the convenience of these technologies; however, not all providers are comfortable delivering virtual care to SGM. For society, digital technologies reduce transportation-related costs and increase access to healthcare in an increasingly hostile political climate for SGM; however, these advantages are limited by technological access and anti-SGM policies. Digital technologies can improve the behavioral health of SGM at the patient, provider, and systemic levels. Further efforts are necessary to standardize provider training, improve SUD-specific care delivery, and increase quality and accessibility of these technologies.
... In other LMIC, sexual health education programs for adolescents are still a challenge (DeMaria et al., 2009;Mashora et al., 2019;Melesse et al., 2020), which means this educational void tends to be filled by the internet (Burki, 2016). Furthermore, when an adolescent's sexual orientation or gender identity does not conform to prevailing cisgender and heteronormative standards, they tend to be more vulnerable socially and programmatically, which is further aggravated by stigma and discrimination (Hatzenbuehler & Pachankis, 2016;Peng et al., 2019). ...
Article
Full-text available
Using baseline data from the PrEP1519 cohort, in this article we aimed to analyze: (i) the effectiveness of demand creation strategies (DCS) to enroll adolescent men who have sex with men (AMSM) and adolescent transgender women (ATGW) into an HIV combination prevention study in Brazil; (ii) the predictors of DCS for adolescents’ enrollment; and (iii) the factors associated with DCS by comparing online and face-to-face strategies for enrollment. The DCS included peer recruitment (i.e., online and face-to-face) and referrals from health services and non-governmental organizations (NGOs). AMSM and ATGW who agreed to participate in the study could opt to enroll in either PrEP (PrEP arm) or to use other prevention methods (non-PrEP arm). Bivariate and multivariate analyses were conducted and logistic regression odds ratios were estimated. The DCS reached 4529 AMSM and ATGW, the majority of which were derived online (73.8%). Of this total, 935 (20.6%) enrolled to participate (76.6% in PrEP arm and 23.4% in non-PrEP arm). The effectiveness of enrolling adolescents into both arms was greater via direct referrals (235/382 and 84/382, respectively) and face-to-face peer recruitment (139/670 and 35/670, respectively) than online (328/3342). We found that a combination under DCS was required for successful enrollment in PrEP, with online strategies majorly tending to enroll adolescents of a higher socioeconomic status. Our findings reinforce the need for DCS that actively reaches out to all adolescents at the greatest risk for HIV infection, irrespective of their socioeconomic status.
Article
Introduction Heavy alcohol use negatively impacts health outcomes among people with HIV and is especially prevalent among men who have sex with men (MSM). Alcohol problems among MSM with HIV may occur, in part, due to increased stress caused by experiences of identity-based discrimination, such as heterosexism, HIV stigma, and racism. The current study examined (a) whether MSM with HIV who experience greater identity-based discrimination reported higher levels of alcohol problems over time in the absence of alcohol intervention, and (b) whether motivational interviewing (MI) to reduce alcohol use would attenuate the effects of discrimination on alcohol problems. Methods: Data came from a clinical trial in which MSM with HIV were randomized into brief MI for alcohol harm reduction [n = 89] or an HIV treatment as usual assessment only control [TAU; n = 91]. Alcohol use and problems were assessed at baseline, 3, 6, and 12 months. Results: Generalized Estimating Equations found a significant interaction between MI and baseline identity-based discrimination, such that in those not receiving MI, discrimination prospectively predicted alcohol problems over time (B =.065, SE =.018, p <.001, 95% Wald CI [.030 -.100]). In those receiving MI, discrimination did not have an effect (B = -.002, SE =.131, p =.987, 95% Wald CI [-.258 -.254]). Conclusions: Even without explicitly targeting experiences of identity-based discrimination, a person-centered intervention, like MI, appears to mitigate the negative impact of identity-based discrimination on alcohol-related problems.
Article
Many youth with mental health needs cannot access treatment, with multiply-marginalized youth, such as sexual minority youth of Color (SMYoC), experiencing both structural and identity-related barriers to care. The COVID-19 pandemic threatens to exacerbate multi-level treatment access barriers facing SMYoC youth nationwide. However, little large-scale research has examined access to mental health care among SMYoC across the United States, either during or prior to the pandemic. Such work is critical to understanding and ameliorating barriers in this domain. Using data from adolescents who self-identified as SMYoC and who endorsed a desire for mental health support during the COVID-19 pandemic (N = 470, ages 13-16, from 43 U.S. states), we examined associations between state-level, structural factors (income inequality; mental health-care provider shortage; anti-Black racism; homophobia; and the interaction between anti-Black racism and homophobia) and SMYoC mental health treatment access. Multinomial logistic regressions revealed state-level mental health-care provider shortage as the only significant predictor of SMYoC reporting they never (versus always) accessed mental health support during the COVID-19 pandemic. SMYoC living in areas with both lower homophobia and lower anti-Black racism were more likely to report always (versus sometimes) accessing mental health treatment. Results highlight the critical importance of considering diverse structural factors and applying an intersectional lens when exploring barriers to mental health treatment among multiply-marginalized youth. In locations where provider shortages are less severe, cultural stigma - including anti-Black racism and homophobia - may still pose challenges for SMYoC in need of mental health care.
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Background: Gender diversity in young adolescents is understudied outside of referral clinics. We investigated gender diversity in an urban, ethnically diverse sample of adolescents from the general population and examined predictors and associated mental health outcomes. Methods: The study was embedded in Generation R, a population-based cohort of children born between 2002 and 2006 in Rotterdam, the Netherlands (n = 5727). At ages 9-11 and 13-15 years, adolescents and/or their parents responded to two questions addressing children's contentedness with their assigned gender, whether they (a) 'wished to be the opposite sex' and (b) 'would rather be treated as someone from the opposite sex'. We defined 'gender-variant experience' when either the parent or child responded with 'somewhat or sometimes true' or 'very or often true'. Mental health was assessed at 13-15 years, using the Achenbach System of Empirically Based Assessment. Results: Less than 1% of the parents reported that their child had gender-variant experience, with poor stability between 9-11 and 13-15 years. In contrast, 4% of children reported gender-variant experience at 13-15 years. Adolescents who were assigned female at birth reported more gender-variant experience than those assigned male. Parents with low/medium educational levels reported more gender-variant experience in their children than those with higher education. There were positive associations between gender-variant experience and symptoms of anxiety, depression, somatic complaints, rule-breaking, and aggressive behavior as well as attention, social, and thought problems. Similar associations were observed for autistic traits, independent of other mental difficulties. These associations did not differ by assigned sex at birth. Conclusions: Within this population-based study, adolescents assigned females were more likely to have gender-variant experience than males. Our data suggest that parents may not be aware of gender diversity feelings in their adolescents. Associations between gender diversity and mental health symptoms were present in adolescents.
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A growing number of adolescents have diverse sexual identities, including lesbian, gay, bisexual, queer, and questioning (i.e., LGBQ). As a marginalized and minoritized group, LGBQ youth face unique challenges in peer relationships that impact their mental health and well-being. Minority stress theory (Meyer, 2003) provides a framework for understanding how marginalization and discrimination experiences, rather than sexual identity per se, contribute to health disparities among LGBQ youth. In the current chapter, we consider minority stressors that LGBQ adolescents experience in the peer context, including identity concealment, coming out, peer rejection, harassment and victimization, and friendship instability. We describe research linking these experiences of peer adversity with LGBQ adolescents’ health and well-being, including substance use, depression, and suicidality. Additionally, we highlight school connectedness and supportive friendships as potential protective factors. Finally, we summarize conclusions and implications of the research and offer suggestions for how future work might expand the scholarship on LGBQ adolescents’ peer relationships by increasing attention to diverse emerging sexual identities, intersectionality, the developmental course of sexual identity in sociopolitical context, and friendship features and processes that promote enhanced well-being among LGBQ youth.
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Statistics concerning the high prevalence of discrimination, suicidal ideation, and feelings of hopelessness among LGBTQIA+ youth are a major concern in schools. This chapter provides counselor educators with foundational information and recommendations for training school counseling graduate students to provide affirmative LGBTQIA+ youth services. By highlighting two main components of intentional educational processes and inclusive educational content, this chapter provides strategies and ideas for each CACREP core area in relation to the American School Counselor Association (ASCA) Ethical Standards. Recommendations are provided and are intentionally designed to be inclusive and equity-oriented to decenter heteronormative and gender-normative views in counselor training while emphasizing the primacy of social justice and advocacy.
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Háttér és célkitűzések Hazánkban eddig kevés kutatást végeztek szexuális kisebbségekhez tartozó fiatalok egészségével és jóllétével kapcsolatban. Ebben a vizsgálatban egy összetett indikátorkészlet alkalmazásával összehasonlítottunk azonos vagy mindkét nemű partnerekhez vonzódó fiatalokat nem kisebbségi (ellenkező nemhez vonzódó vagy vonzódást át nem élt) kortársaikkal. A változók kedvező és kedvezőtlen kimeneteket is magukba foglaltak, és kiterjedtek a pszichés jóllétre és a mentális egészségre, az egészségvédő és kockáztató magatartásokra, valamint az egészség pszichoszociális determinánsaira. Módszer Az Iskoláskorú Gyermekek Egészségmagatartása (HBSC) kutatás 2018. évi adatfelvételében részt vevő 2651 középiskolás fiatalt vizsgáltuk (életkoruk 16,79 ± 1,19 év). A kimeneti változókat kétértékűvé alakítottuk, és gyakoriságukat összehasonlítottuk a romantikus vonzódás négy csoportjában (ellenkező neműekhez vonzódók, azonos neműekhez vonzódók, mindkét neműekhez vonzódók és nem vonzódók). Ezután a változókat bináris logisztikus regressziós modellekbe építettük. A referenciacsoportot az ellenkező nemhez vonzódó fiatalok képezték. Az esélyhányadosokat korrigáltuk a nem és a családi jómódúság hatására. Eredmények A mindkét nemhez vonzódó fiatalok a fizikai aktivitás és alkoholfogyasztás kivételével minden változón kedvezőtlenebb értékeket mutattak, mint az ellenkező nemhez vonzódó társaik. A kizárólag azonos nemhez vonzódó fiatalok kockázata szintén magasabb volt a kannabiszfogyasztásra és az öngyilkossági gondolat és szándék megjelenésére. A vonzalmat még át nem élt fiatalok értékei sok változó tekintetében kedvezőbbek voltak, mint az ellenkező nemhez vonzódó társaiké. A nem és a családi jómódúság befolyása nem volt jelentős. Következtetések Az eredmények elhelyezhetők a kisebbségi stressz, a strukturális stigma és a romantikus stressz elméleti modelljeiben, igazolják a szexuális kisebbségi (főképp a mindkét nemhez vonzódó vagy biszexuális) fiatalok egészségi egyenlőtlenségeit, és alátámasztják az iskolai intervenciók és a dolgozói továbbképzés fontosságát. Background and aims In Hungary, there are only a few studies on the health and well-being of sexual minority young people. In this analysis, a complex indicator set was used to compare same- and both-gender attracted youth with their non-minority (opposite-gender attracted or not attracted) peers. The indicators included positive and negative outcomes of psychological well-being and mental health, health-protective and health-compromising behaviours, and psychosocial determinants of health. Method Data from 2651 secondary school students, participating in the 2018 data collection of the Hungarian Health Behaviour in School-aged Children (HBSC) study (age: 16.79 ± 1.19 years), were analysed. Indicators were dichotomised and compared across groups of romantic attraction: opposite-gender attracted; same-gender attracted; both-gender attracted; and not attracted. Binary logistic regression models were created, with opposite-gender attracted youth being the reference group. Odds ratios were adjusted for gender and family affl uence. Results Compared to their opposite-gender attracted peers, both-gender attracted youth had poorer outcomes on all variables, with the exception of physical activity and alcohol consumption. Youth exclusively attracted to same-gender partners also had higher risk for cannabis use and suicidality. Youth not attracted fared better on many variables than their opposite-gender attracted peers. Gender and family affl uence had small impact on the effects. Conclusions The results can be interpreted within the theories of minority stress, structural stigma and romantic stress. They confi rm health inequalities in sexual minority (especially in both-gender attracted or bisexual) youth, and underscore the need for school-based interventions and training for youth service providers.
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Purpose Chlamydia trachomatis/Neisseria gonorrhea (CT/NG) retesting three months after diagnosis is a guideline-recommended strategy to detect re-infections. Adolescents and young adults are priority populations in the U.S. Sexually Transmitted Infections National Strategic Plan, but there is a lack of research examining CT/NG retesting among these populations. This study describes retesting following CT/NG diagnosis among adolescent and young adult patients at Title X and non-Title X clinics and measures the association of patient-level factors with CT/NG retesting. Methods We evaluated electronic medical records from 2014 to 2020 from an academic urban-suburban primary care network. The primary outcome was retesting, defined as a diagnostic test for CT or NG ordered 8–16 weeks after index diagnosis. Mixed effects logistic regression modeling stratified by Title X funding was conducted to evaluate the association of patient-level factors with CT/NT retesting. Results Overall, 23.5% (n = 731) of patients were retested within 8–16 weeks following index CT/NG diagnosis. A significantly greater proportion of Title X patients were retested compared to non-Title X patients. Males were significantly less likely to be retested compared to females, and the proportion of patients retested decreased significantly over the study period. Discussion Guideline-recommended retesting following CT/NG diagnosis was low in this young primary care cohort, especially among male and non-Title X clinic patients. Decreases in CT/NG retesting over the study period may be contributing to worsening of the STI epidemic. Our results provide insights into CT/NG retesting that can inform efforts to end the STI epidemic.
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Sex trafficking is serious form of gender-based violence that results in profound adverse health outcomes, yet one that is poorly understood. New York City is a major hub for sex trafficking, with a significant but unquantified number of victims originating from East Asian countries and trafficked via illicit massage businesses. Peer-reviewed studies among Asian survivors of international criminal sex trafficking do not exist. The aim of this study is to qualitatively examine the factors at various levels of influence that impact the recovery and reintegration process of Asian criminal sex trafficking survivors in the United States from the perspective of survivors and front-line service providers. The study was guided by community-based participatory research and trauma-informed approaches, leveraging a collaboration with a well-established service provider organization. Ten in-depth interviews were conducted between 2018 and 2019 with three Korean survivors and seven key informants who were anti-trafficking service providers working with East Asian clients. Data were analyzed using a grounded theory approach. Survivors and service providers vocalized factors at multiple levels that either facilitate or impede recovery and well-being. Levels of influence included structural (e.g., poverty/debt bondage, immigration status, limited English proficiency), cultural (e.g., fatalism, collectivism), institutional (e.g., lack of culturally appropriate, trauma-informed care), interpersonal (e.g., exploitation, social support), and individual (e.g., resilience). Stigma was a crosscutting factor that spanned all levels of influence. This study highlights the voices of survivors and front-line service providers to understand the lives of an under-researched population of Asian sex trafficking survivors. Ultimately, the root, structural causes of survivor marginalization need to be addressed, which stem from the intersection of class-, gender-, and race-related inequities. While survivors continue to experience exploitation and marginalization post-trafficking, they also carry an enormous amount of resilience that must be leveraged in their path to recovery from trauma.
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Introduction: Prior research suggests sexual and gender minority (SGM) youth are profoundly impacted by levels of parental support. This study assessed mediating effects of generalized family acceptance and conflict on lifetime suicidal behaviors among a large diverse sample comprising both SGM and non-SGM youth in early adolescence, when intervention to optimize family dynamics may be critical. Materials: Using data from the first-year follow-up of the Adolescent Brain Cognitive Development Study based in the United States, mediation was tested using a binary logistic regression model fitted with a generalized structural equation. Models included SGM status as the independent variable, family acceptance or family conflict sum score as the mediator, and the presence of lifetime suicidal behaviors as the dependent variable. Models adjusted for age, birth-assigned sex (as reported by the parent/guardian), and race/ethnicity. Results: Of 11,235 youths, lifetime suicidal behaviors were reported by 1.5% (n = 164). Youths with SGM identities reported 40% less parental acceptance and 47% greater family conflict, compared to non-SGM peers. Both parental acceptance and family conflict partially mediated associations between SGM identification and odds of lifetime suicidal behavior (ps = .001). Conclusions: Identification of modifiable risk factors for suicidality in this vulnerable population, including parental acceptance and family conflict, is critical to improving health outcomes. Clinicians should work with SGM youth and their families starting in childhood to optimize family dynamics and bolster acceptance to potentially reduce adverse health outcomes. HIGHLIGHTSYouths with SGM identity reported 40% less parental acceptance than non-SGM peers.Parental acceptance was associated with lower odds of lifetime suicidal behaviors.Family factors partially mediated associations between SGM status and suicidal behaviors.
Article
The presence of a Gender and Sexuality Alliance (GSA) reduces risk for sexual and gender minority (SGM) youth across a variety of domains, but little is known about the adult advisor‐level variables contributing to these observed benefits. This study explored relationships between advisors' tenure, receipt of professional development, self‐efficacy, and social emotional competencies (SECs). Participants (N = 167) completed an online survey measuring their own social‐emotional competencies and their perceived self‐efficacy as a GSA advisor. As hypothesized, results demonstrated relationships between advisor tenure and self‐efficacy and between advisor receipt of professional development and self‐efficacy. Further, advisor SEC significantly predicted self‐efficacy, and both receipt of professional development and SEC positively predicted perceived self‐efficacy, as well. Findings point to opportunities for providing training to GSA advisors, with a focus on SEC to increase their efficacy in working with SGM youth. Implications for school psychologists are discussed. 1. Gender and Sexuality Alliance (GSA) advisors who received role‐specific professional development reported greater self‐efficacy in supporting sexual and gender minority (SGM) youth. 2. GSA advisors' own social and emotional competencies were related to greater reported self‐efficacy. 3. Professional development focused on GSA advisors' social and emotional skills may increase their perceived capability to support SGM students. Gender and Sexuality Alliance (GSA) advisors who received role‐specific professional development reported greater self‐efficacy in supporting sexual and gender minority (SGM) youth. GSA advisors' own social and emotional competencies were related to greater reported self‐efficacy. Professional development focused on GSA advisors' social and emotional skills may increase their perceived capability to support SGM students.
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Introduction Little research has been conducted on the sexual health needs and risk behaviors of queer womxn and trans men, making it difficult to identify specific health needs and disparities. This is especially the case in the Global South, where their needs are poorly understood. This study presents findings on demographics, sources of information, sexual (risk) behaviors, and substance use in Kenyan queer womxn and trans men. Methods An online survey among 335 Kenyan queer womxn and trans men was used to collect data on sexual health, risk behavior, health information sources, and substance use. The participants needed to have had at least one self-identified female sexual partner. Results The sample presented young, highly-educated queer womxn and trans men. A high incidence of childhood sexual trauma found was found. Risk behaviors included sexual activities with partners of multiple genders, violence, and low use of barrier methods. One in three participants had been treated for an STD in the previous year. The incidences of smoking and drinking were high, and a quarter of participants indicated having taken drugs at least once a month or more. The internet was either the first or second most important source of sexual health information for 44.1% of the participants, followed by schools (30.9%). Discussion and conclusion Our findings indicate that queer womxn and trans men are at risk of negative sexual health outcomes due to a lack of appropriate information, risk behavior, substance use, and low uptake of sexual health services. Kenya’s Penal Code still criminalizes consensual same-sex activities and may play a role in perpetuating barriers that prohibit them from making healthier choices. Developing tailored programming and policies require local, national, and global stakeholders to engage with the inclusion of queer womxn and trans men’s sexual health needs within strategic planning and healthcare delivery.
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Racism is a chronic stressor fueled by stigma that can result in significant distress and dysfunction as well as negatively affect emotions, behavior, quality of life, and brain health. The effects of stigma and discrimination emerge early in life, with long-term consequences. The present review sought to use neuroscience research to describe how stigma, racism, and discrimination can impact the brain and mental health. Societal stigmas may be ‘encoded’ by associative fear learning and pattern completion networks, and experiences of racial discrimination may similarly affect threat-responsive regions and circuits. Race-related differences in brain function and structure supporting threat circuitry are largely attenuated when negative life experiences and discrimination are taken into account. Downstream, chronic activation of the hypothalamic-pituitary-adrenal (HPA) axis and the sympathetic-adrenal medullary (SAM) axis in the context of discrimination and stigma can contribute to physical health disparities in minoritized and marginalized groups. Finally, we discuss models that provide a framework for interventions and societal-level strategies across ecological systems to build resilience and foster posttraumatic growth.
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Ferreira, E. (2022). (In)visibilidades LGBTI+. In S. Neves e M. Ferreira (Org.), Investigação e prática: Abordagens interdisciplinares sobre a saúde e o bem-estar das pessoas LGBTI+. (pp. 43-64). Associação Plano I. A legislação de direitos de pessoas LGBTI+ em Portugal teve avanços significativos nos últimos anos. No entanto, a legislação por si só não é suficiente para promover mudanças ao nível da discriminação social. São necessárias políticas de igualdade. E ao nível das políticas de igualdade, só a partir de 2011 os planos de igualdade em Portugal começaram a incluir de forma consistente medidas de combate à discriminação com base na orientação sexual e identidade de género. Embora muitas áreas da vida das pessoas LGBTI+ tenham tido alterações profundas com a adoção de legislação mais inclusiva, a invisibilidade no espaço público em diversos contextos de vida continua a ser uma realidade dominante. A forte pressão da sociedade para confinar e esconder os comportamentos afetivos entre pessoas do mesmo sexo dentro de espaços privados é uma das formas de discriminação social mais comum. A sexualidade não é uma característica da vida privada, é um processo de relações de poder que medeia todas as nossas interações quotidianas, e discursos hegemónicos, como a heteronormatividade, estão literalmente inscritos no espaço. Também ao nível da produção académica em Portugal podemos falar de invisibilidade dos estudos LGBTI+, sendo quase inexistentes as ofertas curriculares nas ciências sociais especificamente focadas nas sexualidades LGBTI+. Refletir sobre futuros possíveis, no contexto social e político mundial atual, também é equacionar os riscos de retrocessos dos direitos LGBTI+. Para uma mudança positiva, consolidação dos aspetos legais e o aprofundar das mudanças sociais, é fundamental a ação conjunta das políticas de igualdade, do ativismo e da academia.
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Pereira, H. (2022). Relacionamentos em pessoas LGBTQIA+. In S. Neves & M. Correia, Investigação e prática: Abordagens interdisciplinares sobre a saúde e o bem-estar das pessoas LGBTI+ (pp. 14-42). Associação Plano I.
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Loneliness is a significant risk factor for depression in adults. Sexual and gender minority (SGM) individuals are at risk for loneliness and depression due to stigma and discrimination. However, little is known about the influences of loneliness on the mental health of SGM populations. Guided by the Minority Stress and Integrative Mediation Frameworks, the authors aimed to examine loneliness's direct and indirect effects on the relationships between minority stressors and depression among Thai SGM adults. Data were drawn from a larger cross‐sectional survey. Standardized measures of minority stressors (discrimination, victimization, identity concealment, and internalized sexual stigma), loneliness, and depression were selected and translated by expert panels. A convenience sample was recruited, and data were collected using online and in‐person methods. Participants (N = 411, M = 29.5 years) were primarily male (90.5%), gay (79.3%), and cisgender (76.6%). More than 40% of participants reported clinically significant levels of loneliness (M = 38.59, standard deviation [SD] = 11.11) and depression (M = 9.46, SD = 8.43). Discrimination, identity concealment, and internalized sexual stigma were directly associated with loneliness (all p < 0.05). Minority stressors were significantly related to depression through indirect associations via loneliness accounting for 33%–54% of the total effect. Indirect effects (95% confidence interval) were 0.25 [0.12, 0.40] for discrimination, −0.41 [−0.67, −0.18] for identity concealment, and 0.42 [0.06, 0.79] for internalized sexual stigma. Loneliness was prevalent and played a mediating role in the associations between minority stressors and depression. Study findings have implications for the development of intervention research.
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This qualitative, community-based participatory research (CBPR) study examines the occurrence of LGBTQ+ stigma in healthcare guided by the Health Stigma and Discrimination Framework. We conducted focus groups with healthcare professionals, analyzed using a thematic analysis approach. Stigma drivers included knowledge deficits and transphobia. Facilitators were the binary organization of medical education and training, cisnormative system procedures, a lack of enforceable policy to reduce stigma, and workplace culture and norms. Stigma practices, such as prejudicial attitudes, gossip, and misgendering, primarily focused on transgender individuals. This study reinforces the need to reduce LGBTQ+ stigma in healthcare settings, with implications for multi-level interventions.
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Introduction: Numerous studies have reported a high prevalence of suicidality among transgender individuals. Yet few studies have reported results from population-based samples, leaving open questions about the generalizability of existing findings. Factors proposed to explain transgender individuals' elevated risk of suicidality derive from several theoretical models (i.e., clinical model, interpersonal model, minority stress model, and societal integration model). These models identify both general risk factors (e.g., mental health risks and interpersonal risks) assumed to be elevated among transgender individuals because of transgender individuals' exposure to stigma-related disadvantage and the stigma-specific risks themselves (e.g., minority stressors such as discrimination). This is one of the first population-based studies to examine differences in suicidality between transgender and cisgender individuals and theoretically derived factors potentially explaining such differences. Methods: A sample of 533 transgender and 104,757 cisgender individuals (age 16-84) was analyzed. Results: Compared to cisgender individuals, transgender individuals were at a substantially higher risk of reporting both lifetime and past 12-month suicidality. Several factors partially mediated the increased risk of suicidality among transgender compared to cisgender individuals, including depressive symptoms, lack of social support, and exposure to discrimination. Conclusions: This study suggests that transgender people experience multiple psychosocial health threats and calls for interventions to reduce these threats.
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In this article the author reviews research evidence on the prevalence of mental disorders in lesbians, gay men, and bisexuals (LGBs) and shows, using meta-analyses, that LGBs have a higher prevalence of mental disorders than heterosexuals. The author offers a conceptual framework for understanding this excess in prevalence of disorder in terms of minority stress— explaining that stigma, prejudice, and discrimination create a hostile and stressful social environment that causes mental health problems. The model describes stress processes, including the experience of prejudice events, expectations of rejection, hiding and concealing, internalized homophobia, and ameliorative coping processes. This conceptual framework is the basis for the review of research evidence, suggestions for future research directions, and exploration of public policy implications.
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Rationale Transgender people in the United States experience widespread prejudice, discrimination, violence, and other forms of stigma. Objective This critical review aims to integrate the literature on stigma towards transgender people in the US. Results This review demonstrates that transgender stigma limits opportunities and access to resources in a number of critical domains (e.g., employment, healthcare), persistently affecting the physical and mental health of transgender people. The applied social ecological model employed here elucidates that transgender stigma operates at multiple levels (i.e., individual, interpersonal, structural) to impact health. Stigma prevention and coping interventions hold promise for reducing stigma and its adverse health-related effects in transgender populations. Conclusion Additional research is needed to document the causal relationship between stigma and adverse health as well as the mediators and moderators of stigma in US transgender populations. Multi-level interventions to prevent stigma towards transgender people are warranted. DOI: http://dx.doi.org/10.1016/j.socscimed.2015.11.010
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Gay-related rejection sensitivity has been linked to numerous adverse health outcomes, but its relationship to condomless sex remains unexamined. The present study investigated the role of gay-related rejection sensitivity as a predictor of condomless sex. Gay and bisexual men completed questionnaires measuring rejection sensitivity and condom use self-efficacy as well as a timeline followback interview regarding past 90-day sexual behaviors. Gay-related rejection sensitivity was positively associated with the number of condomless anal sex acts with casual partners, and condom use self-efficacy mediated this association. These findings have important implications for effective HIV prevention efforts among this at-risk population.
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Previous studies have found that sexual orientation concealment affords escape from stigma and discrimination but also creates a psychological toll. While disclosure alleviates the mental burden of concealment, it invites the stress of navigating a new public identity. Population-based samples that include both "in" and "out" sexual minorities provide an ideal opportunity to resolve limitations and inconsistencies of previous nonprobability investigations into the mental health correlates of concealment and disclosure. Sexual minority participants in the California Quality of Life Survey (n = 2,083) indicated whether and when they first disclosed their sexual orientation to others. Prevalence of 1-year major depressive disorder and generalized anxiety disorder was derived from the Composite International Diagnostic Interview-Short Form. Closeted men (n = 84) were less likely to be depressed than out men, n = 1,047; odds ratio (OR) = 0.41; 95% CI [0.17, 0.996]. Men who were recently out (n = 201) experienced higher odds of major depressive disorder, OR = 6.21; 95% CI [1.53, 24.47], and generalized anxiety disorder, OR = 5.51; 95% CI [1.51, 20.13], as compared to closeted men. Men who were distantly out (n = 846) also experienced higher odds of major depressive disorder than men who were closeted, OR = 2.91; 95% CI [1.10, 7.69]. Recently out women (n = 243) experienced lower odds of depression than closeted women, n = 63; OR = 0.21; 95% CI [0.05, 0.96]. Whether being in or out of the closet is associated with depression and anxiety largely depends on gender. Clinical and policy implications are discussed in terms of the unique stressors facing men and women both in and out of the closet. (PsycINFO Database Record (c) 2015 APA, all rights reserved).
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Policy points: Since 2012, Massachusetts law has provided legal protections against discrimination on the basis of gender identity in employment, housing, credit, public education, and hate crimes. The law does not protect against discrimination based on gender identity in public accommodations settings such as transportation, retail stores, restaurants, health care facilities, and bathrooms. A 2013 survey of Massachusetts transgender and other gender minority adults found that in the past 12 months, 65% had experienced public accommodations discrimination since the law was passed. This discrimination was associated with a greater risk of adverse emotional and physical symptoms in the past 30 days. Nondiscrimination laws inclusive of gender identity should protect against discrimination in public accommodations settings to support transgender people's health and their ability to access health care. Context: Gender minority people who are transgender or gender nonconforming experience widespread discrimination and health inequities. Since 2012, Massachusetts law has provided protections against discrimination on the basis of gender identity in employment, housing, credit, public education, and hate crimes. The law does not, however, protect against discrimination in public accommodations (eg, hospitals, health centers, transportation, nursing homes, supermarkets, retail establishments). For this article, we examined the frequency and health correlates of public accommodations discrimination among gender minority adults in Massachusetts, with attention to discrimination in health care settings. Methods: In 2013, we recruited a community-based sample (n = 452) both online and in person. The respondents completed a 1-time, electronic survey assessing demographics, health, health care utilization, and discrimination in public accommodations venues in the past 12 months. Using adjusted multivariable logistic regression models, we examined whether experiencing public accommodations discrimination in health care was independently associated with adverse self-reported health, adjusting for discrimination in other public accommodations settings. Findings: Overall, 65% of respondents reported public accommodations discrimination in the past 12 months. The 5 most prevalent discrimination settings were transportation (36%), retail (28%), restaurants (26%), public gatherings (25%), and health care (24%). Public accommodations discrimination in the past 12 months in health care settings was independently associated with a 31% to 81% increased risk of adverse emotional and physical symptoms and a 2-fold to 3-fold increased risk of postponement of needed care when sick or injured and of preventive or routine health care, adjusting for discrimination in other public accommodations settings (which also conferred an additional 20% to 77% risk per discrimination setting endorsed). Conclusions: Discrimination in public accommodations is common and is associated with adverse health outcomes among transgender and gender-nonconforming adults in Massachusetts. Discrimination in health care settings creates a unique health risk for gender minority people. The passage and enforcement of transgender rights laws that include protections against discrimination in public accommodations-inclusive of health care-are a public health policy approach critically needed to address transgender health inequities.
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Phenomenon: Lesbian, gay, bisexual, and transgender (LGBT) individuals face significant barriers in accessing appropriate and comprehensive medical care. Medical students' level of preparedness and comfort caring for LGBT patients is unknown. An online questionnaire (2009-2010) was distributed to students (n = 9,522) at 176 allopathic and osteopathic medical schools in Canada and the United States, followed by focus groups (2010) with students (n = 35) at five medical schools. The objective of this study was to characterize LGBT-related medical curricula, to determine medical students' assessments of their institutions' LGBT-related curricular content, and to evaluate their comfort and preparedness in caring for LGBT patients. Of 9,522 survey respondents, 4,262 from 170 schools were included in the final analysis. Most medical students (2,866/4,262; 67.3%) evaluated their LGBT-related curriculum as "fair" or worse. Students most often felt prepared addressing human immunodeficiency virus (HIV; 3,254/4,147; 78.5%) and non-HIV sexually transmitted infections (2,851/4,136; 68.9%). They felt least prepared discussing sex reassignment surgery (1,061/4,070; 26.1%) and gender transitioning (1,141/4,068; 28.0%). Medical education helped 62.6% (2,669/4,262) of students feel "more prepared" and 46.3% (1,972/4,262) of students feel "more comfortable" to care for LGBT patients. Four focus group sessions with 29 students were transcribed and analyzed. Qualitative analysis suggested students have significant concerns in addressing certain aspects of LGBT health, specifically with transgender patients. Insights: Medical students thought LGBT-specific curricula could be improved, consistent with the findings from a survey of deans of medical education. They felt comfortable, but not fully prepared, to care for LGBT patients. Increasing curricular coverage of LGBT-related topics is indicated with emphasis on exposing students to LGBT patients in clinical settings.
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We tested the preliminary efficacy of a transdiagnostic cognitive-behavioral treatment adapted to improve depression, anxiety, and co-occurring health risks (i.e., alcohol use, sexual compulsivity, condomless sex) among young adult gay and bisexual men. Treatment adaptations focused on reducing minority stress processes that underlie sexual orientation-related mental health disparities. Young gay and bisexual men (n = 63; M age = 25.94) were randomized to immediate treatment or a 3-month waitlist. At baseline, 3-month, and 6-month assessments, participants completed self-reports of mental health and minority stress and an interview of past-90-day risk behavior. Compared to waitlist, treatment significantly reduced depressive symptoms (b = -2.43, 95% CI: -4.90, 0.35, p < .001), alcohol use problems (b = -3.79, 95% CI: -5.94, -1.64, p < .001), sexual compulsivity (b = -5.09, 95% CI: -8.78, -1.40, p < .001), and past-90-day condomless sex with casual partners (b = -1.09, 95% CI: -1.80, -0.37, p < .001), and improved condom use self-efficacy (b = 10.08, 95% CI: 3.86, 16.30, p < .001). The treatment yielded moderate and marginally significant greater improvements than waitlist in anxiety symptoms (b = -2.14, 95% CI: -4.61, 0.34, p = .09) and past-90-day heavy drinking (b = -0.32, 95% CI: -0.71, 0.07, p = .09). Effects were generally maintained at follow-up. Minority stress processes showed small improvements in the expected direction. This study demonstrated preliminary support for the first intervention adapted to address gay and bisexual men's co-occurring health problems at their source in minority stress. If found to be efficacious compared to standard evidence-based treatments, the treatment will possess substantial potential for helping clinicians translate LGB-affirmative treatment guidelines into evidence-based practice. (PsycINFO Database Record (c) 2015 APA, all rights reserved).
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In 1978, when the Task Panel report to the U.S. President’s Commission on Mental Health emphasized the importance of improving health care and easing the pain of those suffering from emotional distress syndromes including loneliness, few anticipated that this issue would still need to be addressed 40 years later. In 2011, a meta-analysis on the efficacy of treatments to reduce loneliness identified a need for well-controlled randomized clinical trials focusing on the rehabilitation of maladaptive social cognition. We review assessments of loneliness and build on this meta-analysis to discuss the efficacy of various treatments for loneliness. With the advances made over the past 5 years in the identification of the psychobiological and pharmaceutical mechanisms associated with loneliness and maladaptive social cognition, there is increasing evidence for the potential efficacy of integrated interventions that combine (social) cognitive behavioral therapy with short-term adjunctive pharmacological treatments.
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Gay and bisexual men disproportionately experience depression, anxiety, and related health risks at least partially because of their exposure to sexual minority stress. This article describes the adaptation of an evidence-based intervention capable of targeting the psychosocial pathways through which minority stress operates. Interviews with key stakeholders, including gay and bisexual men with depression and anxiety and expert providers, suggested intervention principles and techniques for improving minority stress coping. These principles and techniques are consistent with general cognitive behavioral therapy approaches, the empirical tenets of minority stress theory, and professional guidelines for LGB-affirmative mental health practice. If found to be efficacious, the psychosocial intervention described here would be one of the first to improve the mental health of gay and bisexual men by targeting minority stress.
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Objectives: We examined whether sexual minority students living in states and cities with more protective school climates were at lower risk of suicidal thoughts, plans, and attempts. Methods: Data on sexual orientation and past-year suicidal thoughts, plans, and attempts were from the pooled 2005 and 2007 Youth Risk Behavior Surveillance Surveys from 8 states and cities. We derived data on school climates that protected sexual minority students (e.g., percentage of schools with safe spaces and Gay-Straight Alliances) from the 2010 School Health Profile Survey, compiled by the Centers for Disease Control and Prevention. Results: Lesbian, gay, and bisexual students living in states and cities with more protective school climates reported fewer past-year suicidal thoughts than those living in states and cities with less protective climates (lesbians and gays: odds ratio [OR] = 0.68; 95% confidence interval [CI] = 0.47, 0.99; bisexuals: OR = 0.81; 95% CI = 0.66, 0.99). Results were robust to adjustment for potential state-level confounders. Sexual orientation disparities in suicidal thoughts were nearly eliminated in states and cities with the most protective school climates. Conclusions: School climates that protect sexual minority students may reduce their risk of suicidal thoughts.
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Sexual minority youth are more likely to smoke cigarettes than heterosexuals, but research into the determinants of these disparities is lacking. This study aimed to examine whether exposure to structural stigma predicts cigarette smoking in sexual minority youth. Prospective data from adolescents participating in the Growing Up Today Study (2000-2005) were utilized. Among sexual minority youth, living in low structural stigma states (e.g., states with non-discrimination policies inclusive of sexual orientation) was associated with a lower risk of cigarette smoking after adjustment for individual-level risk factors (relative risk [RR] = 0.97; 95 % confidence interval [CI], 0.96, 0.99; p = 0.02). This association was marginally significant after additional controls for potential state-level confounders (RR = 0.97; 95 % CI, 0.93, 1.00; p = 0.06). In contrast, among heterosexual youth, structural stigma was not associated with past-year smoking rates, documenting specificity of these effects to sexual minority youth. Structural stigma represents a potential risk factor for cigarette smoking among sexual minority adolescents.
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Sexual minority youth (SMY) are at high risk for negative mental health outcomes such as depression, anxiety, substance abuse, and suicidality. However, there has been a disconnect between clinical social work practice and research with SMY, resulting in a lack of rigorous research that demonstrates the use of effective interventions. While cognitive behavioral therapy (CBT) has long been established as a best practice option for the general adolescent population suffering from mental health problems, knowledge about the use of CBT with SMY lags far behind. Thus, the purpose of this article is to present a clearly defined adaptation of CBT for SMY that integrates gay affirmative practices for youth (e.g., coming out, stigma and discrimination, the role of social support and community). Specifically, the authors: (a) discuss the impact of minority stress on SMY; (b) highlight the specific components of CBT that represent a good fit for SMY and also address the criticisms of using such an approach; (c) consider the importance of using gay affirmative practices with SMY; and (d) offer recommendations for incorporating gay affirmative practices into traditional CBT models to better meet the needs of SMY.
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Lesbian, gay, and bisexual youth are at increased risk for a variety of poor health outcomes, relative to their heterosexual counterparts, and recent research implicates family responses to a child's sexual orientation as an important predictor of these health difficulties. Lead with Love is a 35-min documentary-style preventive intervention created to improve parents' behaviors toward their lesbian, gay, and bisexual (LGB) children, by providing parents with support, information, and concrete behavioral guidance. The film was made available free online, and was promoted widely with a multi-media marketing campaign. In this paper we describe the theoretical and empirical rationale for the intervention, and report findings from pilot data collected in the first year after the film's release. Specifically, we gathered data to examine the feasibility of reaching parents of LGB youth with this intervention, to determine whether it was acceptable, and to provide preliminary indicators of its potential efficacy. In the first 12 months after launch, 10,949 individuals viewed the film online. The film successfully reached parents of LGB youth (n = 1,865), including the hardest to reach parents: 21 % had only learned about their child's sexual orientation in the past month, 36 % reported having an LGB child was "very" or "extremely" hard for them, and 86 % had never obtained any other formal support for having an LGB child. Parents who completed a follow-up assessment immediately after the film reported significant pre- to post-film increases in self-efficacy for parenting an LGB child.
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This study aimed to examine the psychological long-term effects of social peer rejection (SPR) experienced during adolescence as retrospectively perceived by young adults. A convenient sample of 387 undergraduate university students were administered self-report questionnaires consisting of the following measures: demographic variables, traumatic life events, SPR, PTSD, depression, potency and the belief in the existence of social support. Results indicated that about one-third of the participants reported having experienced SPR during adolescence. They perceived it as their most traumatic event. SPR and the belief in the existence of social support determined the PTSD severity, whereas the SPR, potency, and PTSD determined the level of depression.
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One important reason why clinicians abstain from medical intervention in trans- sexual adolescents is that they assume that transsexualism and psychopathology are necessarily associated. However, several studies among transsexual adolescents considered eligible for sex reassignment, employing self-report questionnaires and the Rorschach according to Exner’s Comprehensive System, did not find the high levels of psychopathology encountered in psychiatric populations. Thus far, no data have been gathered from sources other than the patients themselves. It has been argued that the method used may create a bias, as the sources of information were persons who have a stake in the outcome. In this study we therefore assessed the number and type of psychological problems among trans- sexual adolescents using Child Behavior Checklist and DISC data gathered from parents or other caretakers, at the time of application. In about one quarter of the patients DSM criteria were fulfilled (one specific phobia, one tic disorder, one oppositional disorder and one anxiety disorder), and in about one third of the patients, parents reported high levels of behavioural or emotional problems on the Child Behavior Checklist (CBCL). A post hoc qualitative inspection of the clinical CBCL group’s situation revealed that in all patients important unfavourable family circumstances could be observed, such as having major conflicts with parents. This might have led to an over-reporting of problems by parents or may be indicative of a real elevation of emotional or behavioural disturbance, perhaps as a reaction of family problems that already existed or were a consequence of the child’s gender dysphoria. However, in line with previous data, transsexual adolescents as a group did not score in the clinical range at the time of application.
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To evaluate whether anti-bullying policies that are inclusive of sexual orientation are associated with a reduced prevalence of suicide attempts among lesbian, gay, and bisexual youths. A total of 31,852 11th-grade public school students (1,413 lesbian, gay, and bisexual individuals; 4.4%) in Oregon completed the Oregon Healthy Teens survey in 2006-2008. The independent variable was the proportion of school districts in the 34 counties participating in the Oregon Healthy Teens survey that adopted anti-bullying policies inclusive of sexual orientation. The outcome measure was any self-reported suicide attempt in the past 12 months. We stratified results by sexual orientation. Lesbian and gay youths living in counties with fewer school districts with inclusive anti-bullying policies were 2.25 times (95% confidence interval [CI], 1.13-4.49) more likely to have attempted suicide in the past year compared with those living in counties where more districts had these policies. Inclusive anti-bullying policies were significantly associated with a reduced risk for suicide attempts among lesbian and gay youths, even after controlling for sociodemographic characteristics (sex, race/ethnicity) and exposure to peer victimization (odds ratio, .18; 95% CI, .03-.92). In contrast, anti-bullying policies that did not include sexual orientation were not associated with lower suicide attempts among lesbian and gay youths (odds ratio, .38; 95% CI, .02-7.33). Inclusive anti-bullying policies may exert protective effects for the mental health of lesbian and gay youths, including reducing their risk for suicide attempts.
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The current study explored the potential impact of a training program on graduate counseling students' competency to serve lesbian, gay, and bisexual (LGB) clients. In this pilot study, the Sexual Orientation Counselor Competency Scale (SOCCS; Bidell, 2005) was administered to students enrolled in a counselor education program. Results indicated that the training program had a positive impact upon the competency areas of knowledge and skills as measured by the SOCCS. The benefits of incorporating an LGB counselor competency component in training modules to serve the LGB community are discussed. Ways for counselor educators and supervisors to enhance their own LGB competencies and help their student's ability to meet the needs of LGB clients are also presented.
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"That's so gay," a popular expression on campuses, is a sexual orientation microaggression that can contribute to a hostile environment for lesbian, gay, and bisexual (LGB) students. Using data from a campus climate survey conducted at a large urban university, we investigated use of the phrase among heterosexual male undergraduates who are emerging adults (18-25 years). Multiple regression analysis suggested that saying the phrase is positively associated with hearing peers say it and with holding negative perceptions of feminine men, whereas having LGB acquaintances was negatively associated with use of this expression. We offer practice and policy recommendations for curbing its use, thereby enhancing campus climate.
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Lesbian, gay, bisexual, and transgender (LGBT) individuals experience health and health care disparities and have specific health care needs. Medical education organizations have called for LGBT-sensitive training, but how and to what extent schools educate students to deliver comprehensive LGBT patient care is unknown. To characterize LGBT-related medical curricula and associated curricular development practices and to determine deans' assessments of their institutions' LGBT-related curricular content. Deans of medical education (or equivalent) at 176 allopathic or osteopathic medical schools in Canada and the United States were surveyed to complete a 13-question, Web-based questionnaire between May 2009 and March 2010. Reported hours of LGBT-related curricular content. Of 176 schools, 150 (85.2%) responded, and 132 (75.0%) fully completed the questionnaire. The median reported time dedicated to teaching LGBT-related content in the entire curriculum was 5 hours (interquartile range [IQR], 3-8 hours). Of the 132 respondents, 9 (6.8%; 95% CI, 2.5%-11.1%) reported 0 hours taught during preclinical years and 44 (33.3%; 95% CI, 25.3%-41.4%) reported 0 hours during clinical years. Median US allopathic clinical hours were significantly different from US osteopathic clinical hours (2 hours [IQR, 0-4 hours] vs 0 hours [IQR, 0-2 hours]; P = .008). Although 128 of the schools (97.0%; 95% CI, 94.0%-99.9%) taught students to ask patients if they "have sex with men, women, or both" when obtaining a sexual history, the reported teaching frequency of 16 LGBT-specific topic areas in the required curriculum was lower: at least 8 topics at 83 schools (62.9%; 95% CI, 54.6%-71.1%) and all topics at 11 schools (8.3%; 95% CI, 3.6%-13.0%). The institutions' LGBT content was rated as "fair" at 58 schools (43.9%; 95% CI, 35.5%-52.4%). Suggested successful strategies to increase content included curricular material focusing on LGBT-related health and health disparities at 77 schools (58.3%, 95% CI, 49.9%-66.7%) and faculty willing and able to teach LGBT-related curricular content at 67 schools (50.8%, 95% CI, 42.2%-59.3%). The median reported time dedicated to LGBT-related topics in 2009-2010 was small across US and Canadian medical schools, but the quantity, content covered, and perceived quality of instruction varied substantially.
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Sexual orientation health disparities are rooted in sexual minorities’ exposure to stress and challenges to effective coping. This article reviews the “toolkit” of psychosocial interventions available to reduce sexual minority stress effects. A systematic search uncovered 44 interventions that both seek to reduce sexual minority stress at its source in unjust and discriminatory social structures as well as bolster sexual minorities’ stigma-coping abilities. These interventions were implemented in a variety of contexts (e.g., education, health care delivery) and utilized heterogeneous modalities to create change (e.g., policy implementation, role-playing activities). They were designed to affect change across structural, interpersonal, and individual levels. The interventions reviewed here, while in early stages of efficacy testing, possess potential for meeting the needs and resources of mental and medical health care providers, policy makers, and other stakeholders who aim to lessen the burden of sexual minority stress and the health disparities it generates.
Book
At a time when lesbian, gay, bisexual, and transgender individuals--often referred to under the umbrella acronym LGBT--are becoming more visible in society and more socially acknowledged, clinicians and researchers are faced with incomplete information about their health status. While LGBT populations often are combined as a single entity for research and advocacy purposes, each is a distinct population group with its own specific health needs. Furthermore, the experiences of LGBT individuals are not uniform and are shaped by factors of race, ethnicity, socioeconomic status, geographical location, and age, any of which can have an effect on health-related concerns and needs. The Health of Lesbian, Gay, Bisexual, and Transgender People assesses the state of science on the health status of LGBT populations, identifies research gaps and opportunities, and outlines a research agenda for the National Institute of Health. The report examines the health status of these populations in three life stages: childhood and adolescence, early/middle adulthood, and later adulthood. At each life stage, the committee studied mental health, physical health, risks and protective factors, health services, and contextual influences. To advance understanding of the health needs of all LGBT individuals, the report finds that researchers need more data about the demographics of these populations, improved methods for collecting and analyzing data, and an increased participation of sexual and gender minorities in research. The Health of Lesbian, Gay, Bisexual, and Transgender People is a valuable resource for policymakers, federal agencies including the National Institute of Health (NIH), LGBT advocacy groups, clinicians, and service providers. © 2011 by the National Academy of Sciences. All rights reserved.
Chapter
A key function of romantic relationships is to make people feel accepted and loved, thus promoting well-being. Yet, many relationships do not serve this function. Adults give relationship difficulties as the most common reason for seeking therapy (Veroff, Kulka, & Douvan, 1981). People in conflicted marriages are often depressed (Coyne, Downey, & Boergers, 1994), and intimate violence is a leading cause of injuries to both adult and adolescent women (Browne, 1993; Centers for Disease Control, 1990). Because troubled romantic relationships are both pervasive and costly, there is considerable interest in understanding how relationships are undermined. Initially, research on the causes of troubled intimate relationships focused on married couples. It is now clear that the destructive interactional patterns that undermine marriages are evident in adult dating relationships and may be present in adolescent relationships. Intimate violence is a case in point. Minor dating violence precedes serious marital violence in 25% to 50% of cases (Gayford, 1975; O'Leary & Arias, 1988; Roscoe & Benaske, 1985). The level of violence in adult dating relationships is similar to that found in marital relationships (Sugarman & Hotaling, 1989). Reported rates of dating violence in high school students range from 9% to 45% (Bergman, 1992; Downey, Lebolt, & O'Shea-Lauber, 1995; Henton, Cate, Koval, Lloyd, & Christopher, 1983; Molidor, 1993; O'Keefe, Brockopp, & Chew, 1986; Roscoe & Callahan, 1985; Roscoe, & Kelsey, 1986).
Article
Objective: As empirical evidence for the effectiveness of LGB-affirmative psychotherapy emerges, the question of whether some clients may derive greater benefit than others becomes important. The current study investigated whether internalized homonegativity (IH), both explicit and implicit, moderated the efficacy of a cognitive- behavioral intervention designed to improve the mental and sexual health of young gay and bisexual men through facilitating minority stress coping. Method: At baseline, young gay and bisexual men (n = 54) experiencing symptoms of depression and anxiety completed measures of explicit and implicit IH. Participants also completed self-reports of mental health and an interviewer-based assessment of past-90-day risk behavior before and after treatment in a 10-session individual LGB-affirmative intervention. Results: Moderation analyses showed that participants higher in implicit IH experienced greater reductions in depression (b = -2.99, p = .031, 95% confidence interval [CI] [-5.69, -0.29]), anxiety (b = -3.56, p = .014, 95% CI [-6.35, -0.76]), and past-90-day condomless anal sex with casual partners (b = -1.29, p = .028, 95% CI [-2.44, -0.14]). Participants higher in explicit IH experienced greater reductions in past-90-day heavy drinking (b = -0.42, p = .003, 95% CI [-0.69, -0.15]). Conclusions: These findings indicate that greater gains from LGB-affirmative psychotherapy were observed in gay and bisexual men who were higher in IH, particularly when measured implicitly. As the first study that examines factors moderating the efficacy of LGB-affirmative psychotherapy, the present research has important implications for intervention development and highlights the value of incorporating implicit measures into clinical work. (PsycINFO Database Record
Article
This study assessed individual (ie, internalized transphobia) and structural forms of stigma as risk factors for suicide attempts among transgender adults. Internalized transphobia was assessed through a 26-item scale including four dimensions: pride, passing, alienation, and shame. State-level structural stigma was operationalized as a composite index, including density of same-sex couples; proportion of Gay-Straight Alliances per public high school; 5 policies related to sexual orientation discrimination; and aggregated public opinion toward homosexuality. Multivariable logistic generalized estimating equation models assessed associations of interest among an online sample of transgender adults (N = 1,229) representing 48 states and the District of Columbia. Lower levels of structural stigma were associated with fewer lifetime suicide attempts (AOR 0.96, 95% CI 0.92-0.997), and a higher score on the internalized transphobia scale was associated with greater lifetime suicide attempts (AOR 1.18, 95% CI 1.04-1.33). Addressing stigma at multiple levels is necessary to reduce the vulnerability of suicide attempts among transgender adults.
Article
Social science research on stigma has grown dramatically over the past two decades, particularly in social psychology, where researchers have elucidated the ways in which people construct cognitive categories and link those categories to stereotyped beliefs. In the midst of this growth, the stigma concept has been criticized as being too vaguely defined and individually focused. In response to these criticisms, we define stigma as the co-occurrence of its components-labeling, stereotyping, separation, status loss, and discrimination-and further indicate that for stigmatization to occur, power must be exercised. The stigma concept we construct has implications for understanding several core issues in stigma research, ranging from the definition of the concept to the reasons stigma sometimes represents a very persistent predicament in the lives of persons affected by it. Finally, because there are so many stigmatized circumstances and because stigmatizing processes can affect multiple domains of people's lives, stigmatization probably has a dramatic bearing on the distribution of life chances in such areas as earnings, housing, criminal involvement, health, and life itself. It follows that social scientists who are interested in understanding the distribution of such life chances should also be interested in stigma.
Article
The goal of this study was to evaluate a novel measure of environmental risk factors for bullying among sexual minority youths. Data on lesbian, gay, bisexual, and transgender (LGBT) assault hate crimes were obtained from police records, geocoded, and then linked to individual-level data on bullying and sexual orientation from the 2008 Boston Youth Survey Geospatial Dataset (N = 1,292; 108 sexual minorities). Results indicated that sexual minority youths who reported relational and electronic bullying were more likely to reside in neighborhoods with higher LGBT assault hate crime rates. There was no association between LGBT assault hate crimes and bullying among heterosexual youths, providing evidence for specificity to sexual minority youth. Moreover, no relationships were observed between sexual minority bullying and neighborhood-level violent and property crimes, indicating that the results were specific to LGBT assault hate crimes.
Article
The purpose of this study was to examine the relationship between heterosexist events, internalized homophobia, and substance use and abuse among 824 lesbian, gay, and bisexual (LGB) individuals. Participants completed the Schedule for Heterosexist Events (SHE), Internalized Homophobia Scale (IHP), Alcohol Use Disorders Identification Test (AUDIT), and the Drug Abuse Screening Test (DAST). A MANCOVA with age as a covariate and sexual orientation as a cofactor indicated there were significant differences in how lesbians, gay males, and bisexuals experienced heterosexism and internalized homophobia. In particular, gay males and lesbians reported ex