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The relationship between family acceptance-rejection and transgender youth psychosocial functioning.
... A primary focus of transgender youth mental health research has been environmental experiences of acceptance, support, stigma, and rejection and their impact on emotional functioning. This line of research has revealed significant associations, generally with medium effect sizes, between transgender stigma-and rejectionrelated experiences and mental health/wellbeing (Pariseau et al., 2019;Toomey et al., 2010;Veale et al., 2017). The result of this work has included recommendations for families, communities, and society, such as consistent use of a young person's correct name and pronouns and access to appropriate bathrooms (Russell et al., 2018;Weinhardt et al., 2017). ...
... The theoretical framework for this study builds on the gender minority stress model (Testa et al., 2017), including well-established findings that perceived stigma and rejection predict poorer mental health in transgender youth (Pariseau et al., 2019;Toomey et al., 2010;Veale et al., 2017). We add to this model ASD diagnosis and ASD symptoms as well as EF problems and EF-related gender barriers as additional hypothesized predictors of poor mental health in transgender adolescents (see Figure 1). ...
... This scale has demonstrated strong internal reliability (Cronbach's α = 0.84) and has been psychometrically validated in transgender youth, with findings that higher scores (i.e., greater perceived LGBT-related stigma) are strongly related to specific experiences of day-to-day transgender-related stigma and bias (Weinhardt et al., 2017). The LGBT-SS is used in this study to assess perceived LGBT-related stigma and rejection experiences, which are established predictors of mental health in gender-diverse youth (Pariseau et al., 2019;Toomey et al., 2010;Veale et al., 2017). Within this sample, internal reliability for the LGBT-SS was acceptable: Cronbach's α = 0.74. ...
Objective: Autism spectrum disorder (ASD) is significantly over-represented among transgender adolescents. Independently, ASD and gender diversity are associated with increased mental health risks. Yet, mental health in autistic-transgender adolescents is poorly understood. This study investigates mental health in the largest matched sample to date of autistic-transgender, non-autistic (allistic) transgender, and autistic-cisgender adolescents diagnosed using gold-standard ASD diagnostic procedures. In accordance with advancing understanding of sex/gender-related autism phenotypes, slightly subthreshold autistic diagnostic presentations (common in autistic girls/women) are modeled.
Method: This study includes 93 adolescents aged 13–21, evenly divided between autistic-transgender, autistic-cisgender, and allistic-transgender groups; 13 transgender adolescents were at the margin of ASD diagnosis and included within a larger “broad-ASD” grouping. Psychological and neuropsychological evaluation included assessment of mental health, IQ, LGBT stigma, ASD-related social symptoms, executive functioning (EF), and EF-related barriers to achieving gender-related needs.
Results: Autistic-transgender adolescents experienced significantly greater internalizing symptoms compared to allistic-transgender and autistic-cisgender groups. In addition to stigma-related associations with mental health, ASD-related cognitive/neurodevelopmental factors (i.e., poorer EF and greater social symptoms) were associated with worse mental health: specifically, social symptoms and EF gender barriers with greater internalizing and EF problems and EF gender barriers with greater suicidality. Comparing across all ASD and gender-related groups, female gender identity was associated with greater suicidality.
Conclusions: Parsing the heterogeneity of mental health risks among transgender youth is critical for developing targeted assessments and interventions. This study identifies ASD diagnosis, ASD phenotypic characteristics, and EF-related gender barriers as potential risks for poorer mental health in transgender adolescents.
... Disproportionate risk for poor mental health functioning among TGE adolescents is increasingly understood to result, in part, from minority stress experiences, including rejection because of gender identity and/ or expression (Delozier, et al. 2020;Hendricks & Testa 2012;Toomey et al. 2014;Travers et al. 2012). Research shows that support from parents or caregivers (hereafter: parents) buffers against negative mental health outcomes in TGE youth (Pariseau, et al. 2019;Simons et al. 2013;Travers et al. 2012). For instance, higher parental support predicts greater life satisfaction and lower depressive symptoms in TGE youth (Simons, et al. 2013), whereas family rejection or nonaffirmation of gender identity predicts greater depression, anxiety, and suicidality (Pariseau, et al. 2019). ...
... Research shows that support from parents or caregivers (hereafter: parents) buffers against negative mental health outcomes in TGE youth (Pariseau, et al. 2019;Simons et al. 2013;Travers et al. 2012). For instance, higher parental support predicts greater life satisfaction and lower depressive symptoms in TGE youth (Simons, et al. 2013), whereas family rejection or nonaffirmation of gender identity predicts greater depression, anxiety, and suicidality (Pariseau, et al. 2019). ...
... Limitations of current research on parental support and rejection in TGE youth include its primary reliance on general indicators of support (e.g., Simons et al. 2013;Travers et al. 2012) rather than support specific to gender identity and expression. Also, existing research that has examined genderspecific parental support and rejection uses complex coding systems of medical chart documentation that may not be easily used in clinical settings (e.g., Pariseau et al. 2019). These are critical limitations because gender-specific parental support and rejection may be particularly salient to TGE youth. ...
Purpose
The purpose of this study was to determine the existence and strength of association between chest dysphoria and mental health in transmasculine and nonbinary adolescents.
Methods
This is a cross-sectional cohort study of transmasculine and nonbinary adolescents designated female at birth between 12 and 18 years old. None had undergone prior top surgery. Patients complete the Chest Dysphoria Measure and Youth Inventory-4 (YI-4) upon presentation to our institution. Outcomes were retrospectively reviewed. The primary outcome of interest was the association between chest dysphoria and anxiety and depression symptom severity, as measured by the YI-4.
Results
One hundred fifty-six patients met inclusion criteria. Mean age was 15.3 years (standard deviation [SD] = 1.7). Most patients identified as transmasculine (n = 132); 18 identified as nonbinary and 6 as questioning. Mean (SD) YI-4 symptom severity scores were 10.67 (6.64) for anxiety and 11.99 (7.83) for depression. Mean (SD) Chest Dysphoria Measure composite score was 30.15 (9.95); range 2–49. Chest dysphoria was positively correlated with anxiety (r = .146; p = .002) and depression (r = .207; p < .001). In multivariate linear regression models, chest dysphoria showed a significant, positive association with anxiety and depression, after accounting for gender dysphoria, degree of appearance congruence, and social transition status.
Conclusions
Chest dysphoria is associated with higher anxiety and depression in transmasculine and nonbinary adolescents designated female at birth. This association is independent of level of gender dysphoria, degree of appearance congruence, and social transition status. Treatment options aimed at alleviating chest dysphoria should be made accessible to adolescents and tailored to individual needs.
... Disproportionate risk for poor mental health functioning among TGE adolescents is increasingly understood to result, in part, from minority stress experiences, including rejection because of gender identity and/ or expression (Delozier, et al. 2020;Hendricks & Testa 2012;Toomey et al. 2014;Travers et al. 2012). Research shows that support from parents or caregivers (hereafter: parents) buffers against negative mental health outcomes in TGE youth (Pariseau, et al. 2019;Simons et al. 2013;Travers et al. 2012). For instance, higher parental support predicts greater life satisfaction and lower depressive symptoms in TGE youth (Simons, et al. 2013), whereas family rejection or nonaffirmation of gender identity predicts greater depression, anxiety, and suicidality (Pariseau, et al. 2019). ...
... Research shows that support from parents or caregivers (hereafter: parents) buffers against negative mental health outcomes in TGE youth (Pariseau, et al. 2019;Simons et al. 2013;Travers et al. 2012). For instance, higher parental support predicts greater life satisfaction and lower depressive symptoms in TGE youth (Simons, et al. 2013), whereas family rejection or nonaffirmation of gender identity predicts greater depression, anxiety, and suicidality (Pariseau, et al. 2019). ...
... Limitations of current research on parental support and rejection in TGE youth include its primary reliance on general indicators of support (e.g., Simons et al. 2013;Travers et al. 2012) rather than support specific to gender identity and expression. Also, existing research that has examined genderspecific parental support and rejection uses complex coding systems of medical chart documentation that may not be easily used in clinical settings (e.g., Pariseau et al. 2019). These are critical limitations because gender-specific parental support and rejection may be particularly salient to TGE youth. ...
Objective:
Parental acceptance and support are associated with positive psychosocial outcomes among transgender and gender expansive (TGE) adolescents. Understanding the degree of parental acceptance and support of gender identity and expression is an important component of gender affirmative pediatric assessment and can inform intervention. Although there are reliable measures assessing general family support, there are no existing parent self-report measures assessing acceptance and support of their gender expansive children. The present study examines the factor structure of the Parental Attitudes of Gender Expansiveness Scale for Parents (PAGES-P).
Methods:
Participants included 739 parents who completed the PAGES-P as standard-of-care during their child's gender health clinic visit within a children's hospital in the Midwestern United States. Principal Component Analysis (PCA) was used to identify subscales reflected in the PAGES-P.
Results:
PCA yielded four subscales reflecting the following domains: (1) support and affirmation, (2) guilt and loss, (3) gender concealment, and (4) pride.
Conclusions:
This study provides preliminary evidence of the factor structure of the PAGES-P. The resulting subscales lend insight into the thoughts and behaviors of parents of TGE youth and can inform clinical practice to facilitate parental support and promote overall well-being in TGE youth.
... Studies with exclusively transgender-rather than LGBT -adolescents and young adults also show that family support is directly associated with lower levels of internalizing psychopathology (Gower et al. 2018;Grossman et al. 2019;Lefevor et al. 2019;Pariseau et al. 2019;Simons et al. 2013;Wilson et al. 2016), as is school support (Gower et al. 2018) and generalized social support (Grossman et al. 2011;Veale et al. 2017). Tests of the association between other forms of support and internalizing symptoms in transgender adolescents and young adults are lacking, as are tests of the potential role of social support in buffering against the association between victimization experiences and internalizing symptoms. ...
... LGBT identity in adolescents and young adults Pariseau et al. 2019;Ryan et al. 2010;Shilo & Savaya 2011;Toomey et al. 2011), very little empirical work tests the potential protective role of gender-related social support in young transgender youth. ...
... The direct associations between higher levels of support and lower levels of internalizing symptoms found here are Fig. 2 The association between victimization experiences and internalizing symptoms at varying levels of peer support Fig. 3 The association between victimization experiences and internalizing symptoms at varying levels of school support Journal of Youth and Adolescence generally consistent with prior work in older samples of LGBT adolescents and young adults Pariseau et al. 2019;Ryan et al. 2010;Shilo & Savaya 2011;Toomey et al. 2011). The present study's finding that higher levels of parent-reported family support for the youth's gender identity is associated with lower levels of internalizing symptoms runs counter to a recent finding in a clinical sample of gender diverse children, which found that higher levels of gender-related parent support were associated with more depression symptoms (Kolbuck et al. 2019), a contrast perhaps attributable to differences between clinical and community samples. ...
Although increasing numbers of children have socially transitioned to live in line with their gender identities, little is known about factors associated with their wellbeing. This study examines the associations between parent-reported family, peer, and school support for a youth’s gender identity, as well as an objective measure of state-level support, with parent-reported internalizing symptoms in 265 transgender youth (67.2% transgender girls, 32.8% transgender boys), ages 3–15 years (M = 9.41, SD = 2.62). Parents who reported higher levels of family, peer, and school support for their child’s gender identity also reported fewer internalizing symptoms; the objective measure of state-level support was not related to internalizing symptoms. Additionally, peer and school support buffered against the association between gender-related victimization and internalizing symptoms, as reported by parents. This work demonstrates that even among transgender youth with families who supported their transitions, parents see better well-being in their children when they also see more support for the child’s gender identity from family, peers, and schools.
... The 25 included studies represented 20 unique samples. Ten of the studies (40%) focused on trans youth, [30][31][32][33][34][35][36][37][38][39] while the remainder enrolled exclusively adult samples. 21,28,[40][41][42][43][44][45][46][47][48][49][50][51][52] Regarding gender identity, 11 studies (44%) included only trans women and girls 21,28,33,39,42,44,46,47,[49][50][51] and 1 (4%) included only trans men. ...
... Among diverse samples, six of the seven studies that measured an outcome related to depression found a negative association with social gender affirma-tion. 21,28,35,38,39,46 The study that did not find an association operationalized gender affirmation as parental acceptance of transgender identity, which was not associated with depressive symptoms among trans female youth from San Francisco. However, in three other studies of trans youth, acceptance from a primary caregiver and chosen name use across settings (i.e., home, school, and work) were associated with decreased likelihood of depressive symptoms. ...
... However, in three other studies of trans youth, acceptance from a primary caregiver and chosen name use across settings (i.e., home, school, and work) were associated with decreased likelihood of depressive symptoms. 35,36,38 Social gender affirmation was consistently negatively associated with depression for adult trans women. 21,28,46 No studies examined depression and social or legal gender affirmation among other trans adults. ...
Purpose: Transgender (trans) populations experience health inequities. Gender affirmation refers to psychological, social, legal, and medical validation of one's gender and is a key social determinant of trans health. The majority of research has focused on medical affirmation; however, less is known about the role of social and legal affirmation in shaping trans health. This review aimed to (1) examine how social and legal gender affirmation have been defined and operationalized and (2) evaluate the association between these forms of gender affirmation and health outcomes among trans populations in the United States. Methods: We conducted a systematic search of LGBT Life, PsycInfo, and PubMed using search strings targeting transgender populations and gender affirmation. This review includes 24 of those articles as well as 1 article retrieved through hand searching. We used a modified version of the National Institute of Health Quality Assessment Tool to evaluate study quality. Results: All studies relied on cross-sectional data. Studies measured and operationalized social and legal gender affirmation inconsistently, and some measures conflated social gender affirmation with other constructs. Health outcomes related to mental health, HIV, smoking, and health care utilization, and studies reported mixed results regarding both social and legal gender affirmation. The majority of studies had serious methodological limitations. Conclusion: Despite conceptual and methodological limitations, social and legal gender affirmation were related to several health outcomes. Study findings can be used to develop valid and reliable measures of these constructs to support future multilevel interventions that improve the health of trans communities.
... Nevertheless, research suggests that LGBTQ+ adults, in general, retrospectively report more ACEs than heterosexual adults (Anderson & Blosnich, 2013;Austin et al., 2016). LGBTQ+ individuals may be exposed to higher rates of ACEs, especially those specific to child maltreatment (e.g., harsh discipline, verbal abuse), due to parental rejection of their child's sexual orientation and/or gender identity and expression (Friedman et al., 2011;Pariseau et al., 2019;Parker et al., 2018). ...
... Existing work also demonstrates that childhood abuse predicts internalized homonegativity among LGBTQ+ adults (Gold & Marx, 2007;Gold et al., 2011). Internalized homonegativity is a proximal form of minority stress shaped by distal forms, such as childhood maltreatment related to one's LGBTQ+ identity (Meyer, 2003;Pariseau et al., 2019;Parker et al., 2018). However, research demonstrates that LGBTQ+ youth with parents who affirm their sexual or gender identities are less likely to struggle with identity issues (Bregman et al., 2013;D'Amico & Julien, 2012;Katz-Wise et al., 2017). ...
Despite alarming rates of sexual assault on college campuses, little research has examined risk factors for sexual victimization among LGBTQ+ college students. This exploratory study aims to examine adolescent sexual assault, internalized homonegativity, and problematic alcohol use as mediators linking several types of adverse childhood experiences (ACEs; i.e., childhood sexual abuse, parental abuse, and household disorder) to collegiate sexual assault. Utilizing data from 241 LGBTQ+ college students, path analysis findings demonstrated that these proposed mediators increased risk for sexual assault and that various types of ACEs exerted differential impacts on sexual re-victimization, internalized homonegativity, and problematic alcohol use. Practice-based implications are offered, including the need for affirming programming that includes problem drinking prevention components and considers the role of ACEs and internalized homonegativity in increasing risk for sexual assault during college as well as the need for LGBTQ+ resource centers on campus.
... For transgender youth, family social support is associated with positive outcomes such as greater life satisfaction (Guss et al., 2016). Given that transgender SMY may have to navigate aspects of sexuality-and gender-related social support (Pariseau et al., 2019), understanding if asexual youth's experiences differ based on gender identity is imperative to understanding their mental health and related outcomes. ...
... This could explain why transgender asexual youth are less likely to receive sexuality-related family support. Previous research indicates that lower caregiver acceptance predicts higher depressive symptoms and internalizing problems among transgender youth (Pariseau et al., 2019). Thus, relative to each other, transgender asexual and transgender non-asexual youth in the current study may have received similar levels of acceptance or support related to their transgender identity. ...
Despite increasing efforts to better understand sexual and gender minority youth (SGMY), asexual youth remain understudied. This study examines differences in health, family support, and school safety among asexual youth (n = 938) from a national study of SGMY (N = 17,112) ages 13–17. Compared to non-asexual youth, asexual youth were more likely to identify as transgender and report a disability, and less likely to identify as Black or Hispanic/Latino. Transgender (versus cisgender) asexual youth fared worse on most study outcomes. Cisgender asexual (versus cisgender non-asexual) youth fared worse on all study outcomes. Transgender asexual (versus transgender non-asexual) youth reported lower sexuality-related family support. These findings underscore the role of gender identity in understanding the experiences of asexual youth.
... Inclusion of identity confusion and body dysphoria from Testa (2019). Inclusion of family support for gender identity in model is based on literature that highlights the importance of family affirmation (Pariseau et al., 2019). mental health functioning among TNB youth. ...
... Clinical care may include outreach to spaces where TNB youth feel connected but are not fully affirmed. Engaging caregivers in treatment provides an opportunity to directly address how caregivers and family members may contribute to TNB youth's experiences with gender minority stressors, and sharing research showing that parental and sibling affirmation and support predict better mental health and psychosocial adjustment for young people (e.g., Pariseau et al., 2019;Simons et al., 2013). It is notable that the ways in which caregivers show support may differ across development. ...
Mental health disparities between transgender and non-binary (TNB) youth and their cisgender peers are widely documented; however, evidence-based interventions designed to address these disparities do not yet exist. In this article, we outline the mental health needs of TNB youth by identifying relevant treatment targets grounded in developmental and gender minority stress theories and highlight potential gaps in existing evidence-based interventions and initial attempts at adapting evidence-based interventions for TNB youth. We propose different pathways to distinct mental health outcomes in TNB youth based on the intersection of risk and protective factors. Considering the potential for diverse mechanisms driving mental health outcomes in TNB youth, adaptations of evidence-based treatments are necessary to account for gender minority stress processes. We share a case formulation approach that focuses on (1) normalizing the adverse impact of minority stress, (2) facilitating emotional awareness and regulation, (3) restructuring minority stress cognitions, (4) empowering assertive communication, (5) reducing maladaptive avoidance, (6) validating strengths, and (7) building supportive relationships.
... Persistent victimization on the basis of identity may also result in identity concealment efforts, which while potentially protective in the short-term (e.g., concealing one's identity reduces risk for victimization), may be harmful in the long term (e.g., internalized transphobia). Nonaffirmation of gender identity by family members is also associated with poor mental health outcomes; rejected adolescents experience more depression, anxiety, and suicidality (Pariseau et al., 2019). ...
... Parents may weigh more heavily the risks of gender-affirming medical treatment (e.g., hormone blockers, gender-affirming hormone therapy, surgery) without a clear understanding of minority stress processes, which pose physical and psychological risks to their child. Helping parents affirm their child's gender exploration will bolster resilience (Pariseau et al., 2019). In addition to supporting parents in providing an affirming environment within the home, referrals to support groups to increase connection with other TGE adolescents, as well as referrals to mentorship programs can assist with strengthening pride in identity. ...
Objective:
To present a topical review of minority stressors contributing to psychosocial and physical health disparities in transgender and gender expansive (TGE) adolescents.
Methods:
We conducted a topical review of original research studies focused on distal stressors (e.g., discrimination; victimization; rejection; nonaffirmation), proximal stressors (e.g., expected rejection; identity concealment; internalized transphobia), and resilience factors (e.g., community connectedness; pride; parental support) and mental and physical health outcomes.
Results:
Extant literature suggests that TGE adolescents experience a host of gender minority stressors and are at heightened risk for negative health outcomes; however, limited research has directly applied the gender minority stress framework to the experiences of TGE adolescents. Most research to date has focused on distal minority stressors and single path models to negative health outcomes, which do not account for the complex interplay between chronic minority stress, individual resilience factors, and health outcomes. Research examining proximal stressors and resilience factors is particularly scarce.
Conclusions:
The gender minority stress model is a helpful framework for understanding how minority stressors contribute to health disparities and poor health outcomes among TGE adolescents. Future research should include multiple path models that examine relations between gender minority stressors, resilience factors, and health outcomes in large, nationally representative samples of TGE adolescents. Clinically, adaptations of evidence-based interventions to account for gender minority stressors may increase effectiveness of interventions for TGE adolescents and reduce health disparities in this population of vulnerable youth.
... In addition, relationships without rejection, according to the IPTS [28], can reduce suicidal ideation and suicide attempts. In the literature [53][54][55], rejection by family, friends, and colleagues is associated with negative outcomes, including suicidal ideation and suicide attempts. Our study investigated support for the transgender identity of young people by friends and parents. ...
The rates of suicidal ideation and suicide attempts among transgender youths are high. However, in Brazil, there are no studies about these outcomes in this population. The present study aims to investigate the prevalence of suicidal ideation and suicide attempts in Brazilian transgender youths (binary and non-binary), in association with predictor variables, following the Minority Stress Theory. The predictor variables analyzed were depressive symptoms, discrimination, gender distress, deprivation, social support, and gender identity support from parents and friends. Participants were recruited through an online survey. The final sample consisted of 213 participants, aged 13 to 25 years old. Two equal regression analyses were performed, one for each outcome. Out of the total, 103 (48.6%) identified as transgender boys, 44 (20.8%) as transgender girls, and 65 (30.7%) as non-binary. The mean age was 18.53 years (SD 2.50). The study found that 57.6% of the sample had depressive symptoms, 72.3% experienced suicidal ideation, and 42.7% had attempted suicide. In the final model, the variables that were associated with suicidal ideation were deprivation, gender distress, and depressive symptoms. As for suicide attempts, the variables deprivation and depressive symptoms were correlated. Further studies on this population should be conducted to analyze protective factors for these outcomes.
... Social support and acceptance remain integral to mental health of TGDY, with a fundamental emphasis on parental acceptance. Multiple studies have shown lack of parental support as a predictor for increased depression, anxiety, suicidal ideation, and homelessness among TGDY (Pariseau et al., 2019;Russell et al., 2018). Moreover, gender-affirming hormones have been shown as an important factor in decreasing rates of depression for both transmasculine and transfeminine youth (Achille et al., 2020;Allen et al., 2019), though many TGDY do not have access to affirming health care (Bauer et al., 2009;Merkel, 2017). ...
Objectives
This study explores the openness of transgender and gender diverse youth and young adults (TGDY) to mindfulness meditation programs in order to create culturally informed interventions to benefit this population.Method
Two focus groups were conducted with a total of ten TGDY ages 14–24 years old at a transgender youth health center in a large metropolitan city in the USA. A 10-min guided mindfulness meditation was included for participants to experience and voice reactions to. The State-Trait Anxiety Inventory (STAI) was utilized to measure the quantitative impact of the meditation on participants’ anxiety and thematic analysis for the qualitative data.ResultsReflexive Thematic Analysis on qualitative focus group data revealed the following four themes: Active in Self-care, Silent Meditation Is “Not for Me,” Guided Mindfulness Calms and Connects, and Program Ideas for Future. STAI results indicated a statistically significant reduction in anxiety following participation in the group meditation.Conclusions
Participants were open to mindfulness as an additional method of self-care, and they emphasized future programs should include sensory stimulation, a pressure-free environment accepting of active minds and bodies, and a transgender instructor if possible. Meditation and mindfulness have the potential to be a very powerful healing modality for TGDY in clinical and therapeutic care.PreregistrationThis study is not preregistered.
... For children whose gender is different to their sex presumed at birth (hereafter referred to as "trans"), the important, and sometimes precarious role of their parents is being increasingly recognized. It has been demonstrated that family, and in particular, parental support can play a significant protective role for trans children, increasing their resilience and contributing to positive mental health outcomes (Olson et al., 2016;Pariseau et al., 2019;Weinhardt et al., 2019). There is also preliminary evidence to suggest that higher rates of parenting stress predict higher rates of internalizing and externalizing mental health difficulties amongst prepubertal trans children (Kolbuck et al., 2019). ...
Research has shown that parents of trans children face numerous challenges as they navigate their parenting role, however, little is known about the impact of these challenges on parents’ psychological wellbeing. Utilizing an interpretative phenomenological approach and interpretive phenomenological analysis (IPA), the current study aimed to address this gap in the literature by exploring how parents perceive their experience of having a trans child has impacted their psychological wellbeing. Semi-structured in-depth interviews were conducted with Australian parents of trans children aged 17 and under (N = 12). Five major themes were identified in the data: 1) Dyadic factors; 2) Threats to mental health; 3) Personal growth; 4) Support and acceptance; and 5) Coping. Overall, results indicated that experiences of psychological wellbeing were multidimensional, characterized by numerous mental health threats and concurrent positive experiences of personal growth. Findings also highlighted the importance of support and acceptance from others, and various coping strategies employed by parents to protect against mental health threats and enhance their wellbeing. These findings provide an in-depth understanding of factors that both threaten and enhance wellbeing amongst parents of trans children, offering nuanced insight for clinicians and a foundation for future research.
... Parents may have a range of responses to SGD identity disclosure that have been categorized as neutral, positive, negative, and mixed (Chrisler, 2017). Previous research on parental responses to gender identity disclosure has identified responses ranging from explicit rejection to unconditional acceptance (e.g., Koken et al., 2009), with the potential for responding in ways that demonstrate both acceptance and rejection (Catalpa & McGuire, 2018;Pariseau et al., 2019). Parental acceptance and/or rejection of sexual orientation and/or gender identity can either improve or exacerbate health outcomes among SGD YA (Zimmerman et al., 2015). ...
To explore specific responses that sexual and gender diverse young adults (SGD YA) perceive to be supportive and unsupportive of sexual orientation and gender identity by caregivers and other adults following identity disclosure. SGD YA ( N = 101), ages 18 to 25 years ( M = 21.2) were predominantly White (83.1%), non-Hispanic (89.1%), assigned female at birth (82.2%). The majority (97.8%) were sexually diverse (e.g., queer, pansexual, lesbian, gay, asexual, bisexual) and half (50%) were gender diverse (e.g. transgender, agender, genderqueer, nonbinary). Participants completed an online survey. This analysis is focused on participants’ responses to open-ended questions regarding responses they perceived to be supportive and unsupportive of their SGD identity/identities. Content analysis of participants’ open-ended survey responses was conducted using a combination of inductive and deductive coding. Six themes emerged for both supportive responses (communication, actions, acceptance, open-mindedness, unconditional love, and advocacy) and unsupportive responses (distancing, hostility, minimizing, controlling, blaming, and bumbling). For some themes, different sub-themes emerged based on identity. Parents/caregivers as well as other adults in the lives of SGD YA can implement specific responses to demonstrate support for sexual orientation and gender identity with the potential to improve the mental health of SGD YA.
... p < .001), (Fotti et al., 2006;Herba et al., 2008;Pariseau et al., 2019;Reyes et al., 2015). Three studies found a relationship between parental rejection and suicide attempts and two studies state there is a relationship between parental rejection and NSSI. ...
Background: In recent years, the rates of young people presenting with self-harming have increased dramatically, with self-harm being a predictor of suicide. Despite evidence suggesting that self-harm is common in young people and that hospital admissions are increasing, research exploring the reasons behind young people’s motivations is not easily accessed. Systematic reviews have explored this from a range of perspectives, but none have drawn all this literature together.
Methods: A systematic review of systematic reviews was conducted in accordance with PRISMA guidelines. Seven databases were searched using a peer reviewed search strategy, with a focus on the factors of child and adolescent self-harming. All English language articles, published between 2008 and 2021, were considered, and screened against inclusion criteria. References of included articles were also searched for eligible articles.
Results: Twenty-two systematic reviews were included after screening against eligibility criteria. Narrative synthesis identified eight themes for motivation or reasons for self-harming: identity and subcultures, peer influences, educational stressors, mental ill health, cognitive and neuropsychological factors, trauma and attachment, internet influences and social media.
Conclusion: Reasons for self-harming in adolescents are complex and multifactorial. Many studies focus on single causes or associations with self-harm rather than open-mindedly exploring a range of factors or the interactions between them. This leaves gaps in the research where hypothetical reasons for self-harm have not been systematically explored. The themes identified here could help in the clinical assessment process and guide future research in this area, including the development of potential differentiated prevention and treatment approaches.
... 10 When parents and caregivers are unsupportive of a TGD child's gender identity, TGD young people are at increased risk for adverse mental health outcomes. [11][12][13] Conversely, TGD children who are affirmed in their gender identity by their parents and caregivers (eg, through the use of pronouns and/or name consistent with a child's gender identity; allowing a child to express their gender through hairstyle or clothing), show no increased risk to mental health, with similar outcomes to the general population of United States children. 14 Parents and caregivers who are initially unsupportive of their TGD child's gender identity may need additional support and resources to reach acceptance. ...
OBJECTIVES
Parents and caregivers’ responses to their child’s gender identity or expression play a pivotal role in their mental health. Despite increasing visibility of transgender and gender diverse (TGD) children, few scientific resources exist to advise their parents and caregivers.
METHODS
We used an online Delphi study to generate expert consensus. Expert adult participants (N = 93; 55% cisgender women, 12% cisgender men, 33% gender minority; 83% White race or ethnicity) rated statements describing parenting strategies compiled from a systematic search of community-generated online literature. Participants represented 3 distinct “panels” of expertise: parents and caregivers of a TGD child, TGD persons, and/or professionals working with TGD populations. Statements rated as essential or important by 80% to 100% of each panel were endorsed as a guideline. Three rounds of surveys were used with iterative feedback to develop consensus.
RESULTS
Of 813 total statements, only 125 were endorsed by all 3 panels. Key domains of consensus included: supportive strategies for parents (eg, open communication, listening), behaviors to avoid (eg, pressuring a child into a gender transition), strategies for navigating healthcare and school systems, and common responses for parents (eg, confusion). Areas of disagreement, in which professional and TGD panels concurred but the parent panel did not, included whether to allow gender identity experimentation during childhood, the value of providing access to gender diverse media, and how to avoid misgendering a child.
CONCLUSIONS
These consensus-based guidelines offer a unique and needed resource for parents and caregivers and clinicians and can be used to promote the mental health and well-being of TGD children.
... p < .001), (Fotti et al., 2006;Herba et al., 2008;Pariseau et al., 2019;Reyes et al., 2015). Three studies found a relationship between parental rejection and suicide attempts and two studies state there is a relationship between parental rejection and NSSI. ...
Background
In recent years the rates of young people presenting with self-harming have increased dramatically, with self-harm being a predictor of suicide. Despite evidence suggesting that self-harm is common in young people and that hospital admissions are increasing, research exploring the reasons behind young people’s motivations is not easily accessed. Systematic reviews have explored this from a range of perspectives, but none have drawn all this literature together.
Methods
A systematic review of systematic reviews was conducted in accordance with PRISMA guidelines. Seven databases were searched using a peer reviewed search strategy, with a focus on the factors of child and adolescent self-harming. All English language articles, published between 2008 and 2021, were considered, and screened against inclusion criteria. References of included articles were also searched for eligible articles.
Results
Twenty-two systematic reviews were included after screening against eligibility criteria. Narrative synthesis identified eight themes for motivation or reasons for self-harming: identity and subcultures, peer influences, educational stressors, mental ill health, cognitive and neuropsychological factors, trauma and attachment, internet influences and social media.
Conclusion
Reasons for self-harming in adolescents are complex and multifactorial. Many studies focus on single causes or associations with self-harm rather than open-mindedly exploring a range of factors or the interactions between them. This leaves gaps in the research where hypothetical reasons for self-harm have not been systematically explored. The themes identified here could help in the clinical assessment process and guide future research in this area including the development of potential differentiated prevention and treatment approaches.
... Specific distal minority stress experiences have unique impacts on transgender/nonbinary mental health. Family rejection (Delozier et al., 2020;McGuire et al., 2016;Pariseau et al., 2019) and physical forms of victimization (Beckman et al., 2018;dickey et al., 2017;Kolp et al., 2020;Reisner et al., 2016;White Hughto et al., 2017) due to one's gender identity contributes to mental health concerns, such as anxiety and depressive symptoms. Further, identity invalidation (e.g., misgendering, deadnaming, being referred to with language not aligned with one's gender identity), is noted in past research as an especially prevalent distal minority stressor that can impact body image and eating behaviors (Mitchell et al., 2021), substance use (Ehlinger et al., 2021), posttraumatic stress symptoms (Barr et al., 2021), suicidality (Pollitt et al., 2021), and other mental health (James et al., 2016;Pollitt et al., 2021;Testa et al., 2015). ...
People whose gender does not align with assigned sex often experience negative mental health outcomes related to cisnormative societal expectations and oppression, including familial rejection, threat of harm, and identity invalidation (e.g., misgendering). This study merged two cross-sectional data sets of trans and gender-diverse people (N = 363; Mage = 22.02) investigating how various types of distal minority stress experiences impact psychological distress. We tested the associations between three minority stressors (i.e., family rejection, threat of harm, and identity invalidation) and psychological distress using unadjusted and adjusted regression models, including gender-stratified models. In the overall unadjusted model, all three stressors were significantly, positively associated with psychological distress, with identity invalidation having the highest standardized β value. In the adjusted overall model, only identity invalidation was significantly associated with distress. Results varied in gender-stratified models. Additionally, participants who experienced any of the three stressors had predicted mean distress scores at or above the cutoff for severe psychological distress, while those who did not fell below that cutoff. Results highlight the differential impact of minority stress experiences on gender-diverse young adults and provide directions for clinical competency, interventions, and future research toward understanding mental health disparities for trans people. (PsycInfo Database Record (c) 2022 APA, all rights reserved)
... Based on previous studies where gender incongruent children showed to be at risk for developing a negative self-concept (Alberse et al., 2019;Balleur-van Rijn, 2013) and other findings where socially transitioned children showed psychological well-being comparable to their peers (Durwoord et al., 2017) one might have expected a difference between children who did and children who did not socially transition. Recent studies, however, show that parental affirmation and family and peer support may be stronger predictors for psychological well-being than going through a social transition (Pariseau et al., 2019;Sievert et al., 2021). Maybe being referred to a specialized gender clinic, like all children in our study, was a reflection of a supportive parental environment. ...
Background: Gender incongruent children report lower self-perception compared to the norm population. This study explored differences in self-perception between children living in their gender role assigned at birth and children living in their experienced gender role.
Method: The self-perception questionnaire was administered to 312 children referred to the Center of Expertise on Gender Dysphoria ‘Amsterdam UMC’. Social transition status was determined by parental interviews. 2 (social transition) by 2 (sex assigned at birth) ANCOVA’s were conducted.
Results: Children living in their assigned gender role reported comparable self-perception to children living in their experienced gender role. Birth assigned girls living in their assigned gender role reported poorer self-perception on ‘athletic competence’, compared to girls living in their experienced gender role. Birth assigned boys living in their assigned gender role reported poorer on ‘scholastic competence’ and ‘behavioral conduct’ compared to boys living in their experienced gender role.
Conclusions: Social transition did not show to affect self-perception. Self-perception was poorer for birth assigned boys living in their experienced gender role. For birth assigned girls this was reversed. Future studies should give more insight in the role of social transitions in relation to child development and focus on other aspects related to self-perception.
... Parental acceptance and support is critical for mitigating the impact of cissexism and heterosexism on TGNC children's development (Pariseau et al., 2019;Spivey & Edwards-Leeper, 2019). Research suggests pre-adolescent TGNC children are often aware of their emerging gender identity, and communicate this awareness to their parents (Grossman et al., 2005). ...
Pre-adolescent transgender and gender non-conforming (TGNC) youth who are supported by their parents have improved psychosocial outcomes. Despite the important role parents play in TGNC youth’s development, there is little research on their experiences. This study explored the early parenting experiences of 34 parents of pre-adolescent TGNC youth. Parents were recruited from online communities and listservs, and interviewed via phone about their early parenting experiences. Data were analyzed via thematic analysis. Findings indicate that parents became aware of their child’s TGNC identity either through observing their child’s gender behaviors, or by their child verbalizing their identity. Parents, on average, became aware of their child’s gender identity exploration when they were just over 3 and a half years old. Parents felt a mix of emotions, with many reporting a lack of concern or positive emotions regarding their child’s rejection of traditional gender roles. Parents without prior knowledge of transgender people or existing connections to lesbian, gay, bisexual, transgender, or queer (LGBTQ+) people sought out information from the Internet. The findings are both consistent with and diverge from prior research with parents, suggesting both new areas for research, and additional ways in which TGNC youth and their parents can be best supported.
... Active support and affirmation from family significantly contributes to positive mental health outcomes and quality of life in TGD young people [10]. Higher levels of parental support, specifically, have been associated with reduced depressive symptoms, lower perceived burden of gender identity on quality of life, and increased life satisfaction among TGD adolescents [17,18]. For families who are early in their child's gender journey, taking proactive steps to support their child (i.e., using proper names and pronouns, acquiring gender-affirming clothes) are important steps that can reduce the mental health DOI: 10.1159/000524030 risks typically associated with TGD young people. ...
Clinicians of all disciplines, including pediatric endocrinologists, are likely to encounter transgender and gender diverse (TGD) young people in their practice regardless of whether they specialize in gender-affirming medical care. Because of this, it is important to be aware of the ways in which medical professionals can affirm these individuals. Although gender-affirming therapy should always include affirmation including proper use of names and pronouns, the transition journey will look different for each patient. The gender-affirming care of TGD young people may include both medical and non-medical interventions (e.g., social transition). Therapies utilized for medical gender-transition such as gonadotropin-releasing hormone agonists and/or gender-affirming hormones have implications for growth, bone health, cardiovascular health, and fertility, although these impacts are not yet completely understood. This review provides an overview of the care of transgender young people as well as a summary of what is known about the outcomes of these therapies. Clinicians should advise TGD young people and their families of the known and unknown risks and work together with patients to decide upon a treatment and follow-up regimen that aligns with their individual gender affirmation and health goals.
... During this transitional time, it is imperative that individuals are in supportive and safe environments and that youth safety related to their gender and sexual orientation is protected as a basic human right (Colvin et al., 2019;Emetu et al., 2019;Grossman et al., 2019;Johnson et al., 2019;Jones, 2019;Weinhardt et al., 2019). The absence of a supportive and inclusive environment, which is a human rights violation, can lead to greater mental health issues for TGE and LGB individuals (Colvin et al., 2019;Newcomb et al., 2019;Pariseau et al., 2019;Redcay et al., 2019;Weinhardt et al., 2019;Witcomb et al., 2019) and significantly increases the risk of suicide (Hatchel et al., 2019;Ream, 2019;Reisner et al., 2020). ...
This policy brief reviews recent rulings on public accommodations access for transgender and gender-variant students in the school system as well as pending debates within the Supreme Court of the United States. This article opens with a review of current and past policies related to LGBTQ and transgender and gender-expansive adults and youth and the implications of these policies. A discussion related to the protection of the civil and human rights of LGBTQ youth and current advocacy needs follows, with a focus on understanding current educational and mental health issues of queer youth, particularly those who identify as transgender and gender-expansive and the consequences when the basic human and civil rights of this population are not protected. For inclusive and affirmative practice with LGBTQ adults and youth, it is an ethical necessity to understand the trajectory of civil rights and advocate for appropriate policies that will provide the supportive environment required to reduce mental health risks. Implications for practice, future policy development, and advocacy are suggested with a focus on informing and empowering social workers working with gender-variant youth, particularly within the school system.
... Recognizing the added complexity of navigating sexual orientation and gender identity disclosure in cis-normative family contexts among transgender and gender nonbinary adolescents (Jimenez, 2020;Pariseau et al., 2019), we sought to test our hypotheses stratified by: (1) cisgender and (2) transgender and nonbinary participants. ...
Introduction
Our study sought to assess the interplay of family dynamics, namely familial warmth and LGBTQ + specific rejection, and its association to self-esteem in a non-probabilistic sample of LGBTQ + adolescents in the United States.
Methods
Stratified by (1) cisgender and (2) transgender and non-binary LGBTQ + adolescents (N = 8774), we tested multivariable regression analyses to assess the association between familial warmth and LGBTQ + specific family rejection, adjusted for sociodemographic characteristics. We then conducted a sub-analysis with LGBTQ + adolescents who reported being out to any family member about their LGBTQ + identity; specifically, we tested a series of multivariable regression models to assess whether levels of LGBTQ + specific family rejection attenuated the association between familial warmth and self-esteem.
Results
Full sample models indicated a positive association between familial warmth and self-esteem. Findings from our sub-analysis indicated that familial warmth remained positively linked to self-esteem and family rejection was negatively associated with self-esteem. Family rejection was a statistically significant moderator, attenuating the association between familial warmth and self-esteem. With respect to being out about one's sexual orientation, these findings were robust across gender stratification groups.
Conclusions
Families of origin serve as sources of stress and resilience for LGBTQ + adolescents. Our findings contribute support to arguments that familial warmth and LGBTQ + specific rejection are not mutually-exclusive experiences among LGBTQ + adolescents. We provide recommendations for multilevel interventions to leverage activities that support positive family dynamics and self-esteem among LGBTQ + adolescents.
... Fourth, a greater incongruity between self and parent report was associated with higher psychological stress of the adolescents, and the level of congruence could be identified as a predictor for internalizing problems. This finding is consistent with the literature on the role of parental awareness of psychological distress and supportiveness for the mental health of young trans people [32,[57][58][59]. In the present study, we found no differences between the female and male at birth assigned sexes regarding the report discrepancy, which contradicts the literature on both population-based and trans samples [36,38,39,42]. ...
Among trans adolescents, increased psychological distress is reported in the literature. The goal of this study was to examine psychological distress, associated peer relations and parent report congruence among the treatment-seeking sample of the Gender Identity Special Consultation (GISC) for youth at the Charité Berlin. Further, differences between the instruments’ binary gender norms were investigated. Retrospectively, we analyzed clinical data derived from the GISC. By initial interviews and using the Youth Self-Report and Child Behavior Checklist, n = 50 trans adolescents aged 12–18 years (M = 15.5) were examined for psychological problems and peer relations. Congruence between self and parent report was analyzed by correlations. Half of the sample reported suicidality, self-harm and bullying. Trans adolescents showed significantly higher internalizing and total problems than the German norm population. The congruence between self and parent report proved to be moderate to high. The level of congruence and poor peer relations were identified as predictors of internalizing problems. Significant differences between the female vs. male gender norms emerged regarding mean scores and the number of clinically significant cases. Data provide valuable implications for intervention on a peer and family level. There are limitations to the suitability of questionnaires that use binary gender norms, and further research on adequate instruments and assessment is needed.
... For instance, familybased stigma (from biological family), violence, and rejection can result in psychological distress that leads to clinical depression, somatization, and substance use among TGD people generally (Bockting et al., 2013;Bry et al., 2018;Felner et al., 2020). In contrast, familial acceptance is a protective factor associated with lowers rates of depression, anxiety, substance use, HIV acquisition, and suicide attempts among TGD people (Hailey et al., 2020;Human Rights Campaign Foundation [HRC], 2018;Pariseau et al., 2019;Ryan et al., 2010). ...
Black transgender women face nearly universal exposure to violence. Coping behaviors among cisgender women who have survived violence are well delineated; however, there are relatively few studies examining coping strategies for transgender women. The purpose of this qualitative study was to identify and characterize coping behaviors employed by Black transgender women (from Baltimore, MD and Washington, DC metropolitan areas) following an experience of violence. Secondary qualitative data analysis was conducted using framework analysis to explore narratives of 19 Black transgender women. Themes regarding avoidant and approach coping behaviors were developed within the context of existing literature. Approach coping behavior themes included: Help-Seeking, Seeking Guidance and Support, Self- Protecting Behavior, Positive Reappraisal, Self-Affirmation, Self-Care, Connection to a Higher Power, and Acceptance. Avoidant coping behavior themes included: Cognitive Avoidance, Substance, Alcohol, and Tobacco Use, Emotional Discharge, and Seeking Alternative Rewards. Participants employed similar coping behaviors as seen among cisgender women survivors of violence. However, several unique applications of approach coping mechanisms were identified including self-protecting behavior and self-affirming behavior. Culturally informed application of the identified coping behaviors can be taught and integrated into trauma-informed mental health interventions to promote strength and resilience among Black transgender women.
... Outcomes of Acute Residential Psychiatric Treatment in Transgender and Gender Diverse Adolescents An additional limitation was that participants were only included if families were engaged in treatment, as the ART program requires family participation, regardless of family acceptance or awareness of their child's gender identity. Acceptance and rejection play critical roles in the psychosocial health of TGD individuals,29 thus environmental factors are critical to consider, especially as youth return to affirming or nonaffirming home and school environments following treatment. Finally, this study did not have a nontreatment comparison group. ...
Importance
Transgender and gender diverse (TGD) individuals, who have a gender identity that differs from their sex assigned at birth, are at increased risk of mental health problems, including depression, anxiety, self-injurious behavior, and suicidality, relative to cisgender peers.
Objective
To examine mental health outcomes among TGD vs cisgender adolescents in residential treatment.
Design, Setting, and Participants
This cohort study’s longitudinal design was used to compare groups at treatment entry and discharge, and 1-month postdischarge follow-up. The setting was an adolescent acute residential treatment program for psychiatric disorders. Participants were TGD or cisgender adolescents enrolled in the treatment program. Statistical analysis was performed October 2019 to March 2021.
Exposure
Adolescents participated in a 2-week acute residential treatment program for psychiatric disorders.
Main Outcomes and Measures
Primary outcomes were depressive (the Center for Epidemiologic Studies Depression Scale [CES-D]) and anxiety (the Multidimensional Anxiety Scale for Children [MASC]) symptoms, and emotional dysregulation (the Difficulties in Emotion Regulation Scale [DERS]), measured at treatment entry and discharge, and postdischarge follow-up. Age of depression onset, suicidality, self-injury, and childhood trauma also were assessed at treatment entry.
Results
Of 200 adolescent participants who completed treatment entry and discharge assessments, the mean (SD) age was 16.2 (1.5) years; 109 reported being assigned female at birth (54.5%), 35 were TGD (17.5%), and 66 (49.3%) completed 1-month follow-up. TGD participants had an earlier mean (SD) age of depression onset (TGD: 10.8 [2.4] years vs cisgender: 11.9 [2.3] years; difference: 1.07 years; 95% CI, 0.14-2.01 years; P = .02), higher mean (SD) suicidality scores (TGD: 44.4 [23.1] vs cisgender: 28.5 [25.4]; difference: 16.0; 95% CI, 6.4-25.5; P = .001), more self-injurious behavior (mean [SD] RBQ-A score for TGD: 3.1 [2.5] vs cisgender: 1.7 [1.9]; difference: 1.42; 95% CI, 0.69-2.21; P = .001) and more childhood trauma (eg, mean [SD] CTQ-SF score for emotional abuse in TGD: 12.7 [5.4] vs cisgender: 9.8 [4.7]; difference: 2.85; 95% CI, 1.06-4.64; P = .002). The TGD group also had higher symptom scores (CES-D mean difference: 7.69; 95% CI, 3.30 to 12.08; P < .001; MASC mean difference: 7.56; 95% CI, 0.46 to 14.66; P = .04; and DERS mean difference: 18.43; 95% CI, 8.39 to 28.47; P < .001). Symptom scores were significantly higher at entry vs discharge (CES-D mean difference, −12.16; 95% CI, −14.50 to −9.80; P < .001; MASC mean difference: −3.79; 95% CI, −6.16 to −1.42; P = .02; and DERS mean difference: −6.37; 95% CI, −10.80 to −1.94; P = .05) and follow-up (CES-D mean difference: −9.69; 95% CI, −13.0 to −6.42; P < .001; MASC mean difference: −6.92; 95% CI, −10.25 to −3.59; P < .001; and DERS mean difference: −12.47; 95% CI, −18.68 to −6.26; P < .001).
Conclusions and Relevance
This cohort study found mental health disparities in TGD youth relative to cisgender youth, with worse scores observed across assessment time points. For all participants, primary clinical outcome measures were significantly lower at treatment discharge than at entry, with no significant differences between discharge and 1-month follow-up. Given the substantial degree of mental health disparities reported in TGD individuals, these findings warrant focused clinical attention to optimize treatment outcomes in gender minority populations.
... How parents react, respond to, and advocate for their TGNC children has a significant and long-lasting, and perhaps permanent, impact on children's current and future mental health (Wren, 2002). Both research with TGNC children and adolescents (Pariseau et al., 2019;Weinhardt et al., 2019) and retrospective research with lesbian, gay, bisexual, transgender, queer or questioning (LGBTQ+) college students (Grossman et al., 2005;2006a;2006b; consistently finds that strong parental support is crucial for positive development. ...
There is a need for more research on the experiences of affirming parents of pre-adolescent transgender and gender non-conforming (TGNC) children. This study explores how parents conceptualized advocacy roles. Eleven parents of TGNC children age 13 and under completed semi-structured phone interviews. Ten parents considered themselves advocates, with digital advocacy being the most common. Advocacy motivations centered around parental concerns. Parents were divided on whether advocacy helped or had no impact on the parent-child relationship. The largest-shared concern was over the right to privacy. These findings have implications for mobilizing parents of TGNC youth as advocates.
... Of the five studies assessing the relationship between parental rejection and SI, four were included in meta-analysis, yielding six separate effect sizes (Fotti, Katz, Afifi, & Cox, 2006;Herba et al., 2008;Pariseau et al., 2019;Reyes et al., 2015). The weighted mean OR was 3.91 (95% CI = 2.75-5.58), ...
Self-injurious thoughts and behaviors (SITBs) are significant public health problems in adolescence. The current article provides a comprehensive systematic review examining the relationship between events leading to perceived low relational evaluation (e.g. social rejection) and SITBs among adolescents. Theoretical work posits that low relational evaluation is experienced as psychologically painful, a known correlate of SITBs. Therefore, events leading to low relational evaluation may be particularly informative in understanding the context of SITBs. The current review examines how experiences of low relational evaluation that are hypothesized to elicit psychological pain, such as social rejection, low popularity, and peer victimization are related to engagement in SITBs in adolescence. A total of 56 articles meeting inclusion criteria were identified. The hypothesis of an association between indicators of low relational evaluation and SITBs was generally supported throughout the literature, with more consistency found among studies examining suicidal ideation specifically. However, interpretation of the findings is constrained by various methodological limitations of studies. The present review concludes with a theoretical conceptualization of the relationship between perceived relational value and SITBs, leveraging social and evolutionary psychological theory, to guide future research into this topic.
... Among TGD adults, family support is associated with higher employment, less homelessness, and fewer suicide attempts (James et al., 2016), and emotional closeness to the family system mitigates the impact of discrimination on psychological distress (Fuller & Riggs, 2018). Among TGD youth, family functioning and parental support for youths' gender identity are associated with better mental health outcomes (Katz-Wise, Ehrensaft, Vetters, Forcier, & Austin, 2018;Olson, Durwood, DeMeules, & McLaughlin, 2016;Pariseau et al., 2019;Simons, Schrager, Clark, Belzer, & Olson, 2013). In contrast, lack of caregiver acceptance and support is associated with poorer health and well-being of TGD youth (e.g., lower life satisfaction, lower self-esteem, poorer mental health; Bariola et al., 2015;Travers et al., 2012). ...
Family support and acceptance are protective for transgender and gender diverse (TGD) youths' mental health and identity development. Although some studies have examined the role of supportive family relationships for TGD youth, prior research has not fully explored how TGD youth and their caregivers understand or characterize these relationships within the family system. In this qualitative study, we explored perspectives of TGD youth and their caregivers regarding youth-caregiver and caregiver-caregiver relationships within the family system. We recruited a community-based sample of 20 families (20 TGD youth, ages 7 to 18 years, and 34 caregivers) from 3 U.S. geographic regions. TGD youth represented multiple gender identities; caregivers included mothers (n = 21), fathers (n = 12), and 1 grandmother. Each family member completed an individual semistructured interview that included questions about family relationships. Interviews were transcribed verbatim and transcripts were analyzed using a thematic analysis approach. Analyses revealed complex bidirectional family relationships, highlighting 5 contextual factors influencing these relationships: school, community, workplace, religion, and extended family. TGD youths' identity development was inextricably linked to how caregivers respond to, adjust to, and learn from their children, and how caregivers interact with one another. Findings illustrate how caregiver acceptance and family cohesion may be linked and how youth and caregivers identified shared contextual factors impacting the family system. This research highlights the importance of situating TGD youth and caregivers as equal partners in family level approaches to affirm and support TGD identity development. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
... On the other hand, family support can promote self-esteem (Katz-Wise et al., 2018) and lead to higher quality of life, and less perceived burden of being transgender (Simons et al., 2013). Another recent study on transgender adolescents and their caregivers indicates that family functioning should not be assessed as a general construct, but as a more detailed pattern, as there can be differences in acceptance and rejection towards transgender adolescents between family members (Pariseau et al., 2019). ...
Research provides inconclusive results on whether a social gender transition (e.g. name, pronoun, and clothing changes) benefits transgender children or children with a Gender Dysphoria (GD) diagnosis. This study examined the relationship between social transition status and psychological functioning outcomes in a clinical sample of children with a GD diagnosis. Psychological functioning (Child Behavior Checklist; CBCL), the degree of a social transition, general family functioning (GFF), and poor peer relations (PPR) were assessed via parental reports of 54 children (range 5-11 years) from the Hamburg Gender Identity Service (GIS). A multiple linear regression analysis examined the impact of the social transition status on psychological functioning, controlled for gender, age, socioeconomic status (SES), PPR and GFF. Parents reported significantly higher scores for all CBCL scales in comparison to the German age-equivalent norm population. Peer problems and worse family functioning were significantly associated with impaired psychological functioning, whilst the degree of social transition did not significantly predict the outcome. Therefore, claims that gender affirmation through transitioning socially is beneficial for children with GD could not be supported from the present results. Instead, the study highlights the importance of individual social support provided by peers and family, independent of exploring additional possibilities of gender transition during counseling.
... While TGE youth have a high co-occurrence of mental health concerns overall, TGE youth who report higher levels of family support experience fewer mental health concerns and engage in fewer risky behaviors than youth not supported by their families (Pariseau et al., 2019), including less alcohol and drug use, decreased suicidal ideation, and fewer suicide attempts (Ryan, Russell, Huebner, Diaz, & Sanchez, 2010). Youth also report engaging in more safe-sex practices (Wilson, Iverson, Garofalo, & Belzer, 2012), and experience greater life satisfaction and feel less burdensome to others (Simons, Schrager, Clark, Belzer, & Olson, 2013) when they perceive support from their families. ...
Transgender and gender expansive (TGE) youth represent a very vulnerable population. Research suggests high levels of anxiety, depression, disordered eating, substance abuse, self-injurious behaviors, and suicidal ideation and attempts in TGE youth. One of the most important protective factors for TGE youth is family support. In the current article, we discuss the evidence-based relationship variables such as alliance, cohesion, and empathy that can impact treatment. We then underscore how each of these evidence-based relationship variables play a role in family based treatment for TGE youth. We conclude with a discussion of how evidence-based relationship variables are extremely important to be aware of when working with transgender and gender expansive youth and families, and how researchers and clinicians can focus on the inclusion of these variables to optimize clinical care and assess clinical change, given the lack of evidence-based treatments for this population.
... For some people this mental illness may be resolved by social or medical transition to live in ways which are gender affirming (Bouman, Claes, Marshall, Pinner, Longworth et al, 2016). There is increasingly strong evidence that being affirmed and supported, by those people closest to the individual, protects against mental illness in the presence of gender dysphoria (Pariseau, Chevalier, Long, Clapham, Edwards-Leeper and Tishelman (2019), Puckett, Matsuno, Dyar, Mustanski and Newcomb (2019), Medico and Zufferey, (2018)). ...
Background: Gender dysphoria is usually defined as the experience of distress or discomfort caused by a sense of the mismatch between a person's gender identity and their sex assigned at birth. This goes some way to explaining the experience of gender dysphoria but misses important aspects. Nor does it explain why medical interventions to change bodily characteristics, to bring them into line with a person's gender identity, do not remove gender dysphoria completely. Proposal: This article proposes a new model of gender dysphoria which suggests how it might develop, and be maintained, across three different domains of relating. Namely, Self to Self, Self to Other and Community to Culture. The author proposes that this model will bring a clearer understanding of the experience of gender dysphoria and provide a framework from which explorations and dialogue can take place in therapy and other healthcare settings.
... Furthermore, parental attitudes toward gender nonconformity did not correlate with total, internalizing or externalizing behavior problems, suggesting that parental acceptance alone may not be sufficient to attenuate risks to psychological well-being. These findings require replication, however, as they contrast with other research highlighting the critical importance of parental acceptance and support (Simons, Schrager, Clark, Belzer, & Olson, 2013), including in the current Special Issue (Pariseau et al., 2019). In Wong et al. (2019), there was low variability in parental self-ratings of support for their child's gender diversity (i.e., most parents rated themselves as highly supportive), suggesting a skewed group of parental participants and/or a tendency for parents to perceive themselves as supportive, regardless of potential variability in actual support or their child's perception of support. ...
Purpose
The purpose of the study reported in this paper was to explore the role of animals in buffering against cisgenderist violence experienced by trans young people.
Method
Interviews were conducted with 17 Australian trans young people and one of their parents who spoke with us about their relationships with their animals living in the home, including in terms of animals providing a protective function against the negative effects of cisgenderism. The transcribed interviews were analyzed thematically.
Results
Thematic analysis resulted in the development of three themes. First, at the psychological level, animals helped young people to combat feelings of dysphoria, wrought by the violent effects of social norms about gender. Second, at the interpersonal level, animals helped to soothe young people when they were faced with less than supportive or indeed hostile responses from family members and other people in their lives. Third, at the community level, the companionship provided by animals offered a buffer against feelings of marginalization premised on cisgenderist social norms.
Conclusions
All three themes speak to the importance of conceptualizing violence in family contexts as more than just the obvious: as encompassing more subtle forms of marginalization that in their net effect may constitute forms of violence or microaggressions. As a counter to these subtle forms of violence, animals are thus perceived as playing an important role as confidantes, as offering a place of non-judgemental safety, and as a touchstone to the more-than-human.
In the past few decades, research on sexual and gender minority youth (SGMY) has increased rapidly. Professional health organizations such as the American Academy of Pediatrics, the American Public Health Association, and the American Psychological Association have issued statements and dedicated resources to support the health needs of SGMY. The National Institutes of Health and the Centers for Disease Control have also indicated the health risks for SGMY and the United States has declared sexual and gender minority health a national priority. Although health disparities between SGMY and the general population have been well-documented, the role of families remains underdeveloped in research contend that families are an often “underrecognized and underutilized” factor in health (p. 1). Given that most SGMY disclose their sexual or gender identity to their family during childhood and adolescence, families can be a salient source of strain and support for youth with these minoritized identities. This chapter seeks to summarize how families contribute to the health risks and resilience of SGMY and where research in this area is headed.
Transgender and gender-expansive youth often fail to receive equitable treatment in educational settings. School counselors are in a privileged position to advocate for students belonging to this underserved group. To increase understanding of advocacy efforts in school settings, the authors conducted a multi-case cross-case analysis focusing on the phenomenon of advocacy efforts for transgender and gender-expansive youth. Themes align with the categories of macro, systems, micro, inter-personal and intra-personal levels of advocacy. Original themes emerging from the data include increasing awareness and facilitating conversation (macro-level advocacy), community collaboration and district wide policies (systems-level advocacy), and affirming students and cultivating positive school culture (micro-level advocacy). The unique needs and challenges faced by transgender and gender-expansive students, and the role of school counselors in supporting, affirming, and advocating for these students are further discussed.
In the recent past, there has been a strong interest in the use of information and communication technology (ICT) to deliver healthcare to 'hard-to-reach' populations. This scoping review aims to explore the types of ICT-based health interventions for transgender people, and the concerns on using these interventions and ways to address these concerns. Guided by the scoping review frameworks offered by Arksey & O'Malley and the PRISMA-ScR checklist, literature search was conducted in May 2021 and January 2022 in three databases (PubMed, CINAHL and Scopus). The two searches yielded a total of 889 non-duplicated articles, with 47 of them meeting the inclusion criteria. The 47 articles described 39 unique health projects/programs, covering 8 types of ICT-based interventions: videoconfer-encing, smartphone applications, messaging, e-coaching, self-learning platforms, telephone , social media, and e-consultation platforms. Over 80% of the health projects identified were conducted in North America, and 62% focused on HIV/sexual health. The findings of this review suggest that transgender people had often been regarded as a small subsample in ICT-based health projects that target other population groups (such as 'men who have sex with men' or 'sexual minority'). Many projects did not indicate whether trans-gender people were included in the development or evaluation of the project. Relatively little is known about the implementation of ICT-based trans health interventions outside the context of HIV/sexual health, in resource limiting settings, and among transgender people of Asian, Indigenous or other non-White/Black/Hispanic backgrounds. While the range of interventions identified demonstrate the huge potentials of ICT to improve healthcare access for transgender people, the current body of literature is still far from adequate for making comprehensive recommendations on the best practice of ICT-based interventions for transgender people. Future ICT-based interventions need to be more inclusive and PLOS GLOBAL PUBLIC HEALTH PLOS Global Public Health | https://doi.org/10.1371/journal.pgph.
Background: Transgender healthcare is a rapidly evolving interdisciplinary field. In the last decade, there has been an unprecedented increase in the number and visibility of transgender and gender diverse (TGD) people seeking support and gender-affirming medical treatment in parallel with a significant rise in the scientific literature in this area. The World Professional Association for Transgender Health (WPATH) is an international, multidisciplinary, professional association whose mission is to promote evidence-based care, education, research, public policy, and respect in transgender health. One of the main functions of WPATH is to promote the highest standards of health care for TGD people through the Standards of Care (SOC). The SOC was initially developed in 1979 and the last version (SOC-7) was published in 2012. In view of the increasing scientific evidence, WPATH commissioned a new version of the Standards of Care, the SOC-8.
Aim: The overall goal of SOC-8 is to provide health care professionals (HCPs) with clinical guidance to assist TGD people in accessing safe and effective pathways to achieving lasting personal comfort with their gendered selves with the aim of optimizing their overall physical health, psychological well-being, and self-fulfillment.
Methods: The SOC-8 is based on the best available science and expert professional consensus in transgender health. International professionals and stakeholders were selected to serve on the SOC-8 committee. Recommendation statements were developed based on data derived from independent systematic literature reviews, where available, background reviews and expert opinions. Grading of recommendations was based on the available evidence supporting interventions, a discussion of risks and harms, as well as the feasibility and acceptability within different contexts and country settings.
Results: A total of 18 chapters were developed as part of the SOC-8. They contain recommendations for health care professionals who provide care and treatment for TGD people. Each of the recommendations is followed by explanatory text with relevant references. General areas related to transgender health are covered in the chapters Terminology, Global Applicability, Population Estimates, and Education. The chapters developed for the diverse population of TGD people include Assessment of Adults, Adolescents, Children, Nonbinary, Eunuchs, and Intersex Individuals, and people living in Institutional Environments. Finally, the chapters related to gender-affirming treatment are Hormone Therapy, Surgery and Postoperative Care, Voice and Communication, Primary Care, Reproductive Health, Sexual Health, and Mental Health.
Conclusions: The SOC-8 guidelines are intended to be flexible to meet the diverse health care needs of TGD people globally. While adaptable, they offer standards for promoting optimal health care and guidance for the treatment of people experiencing gender incongruence. As in all previous versions of the SOC, the criteria set forth in this document for gender-affirming medical interventions are clinical guidelines; individual health care professionals and programs may modify these in consultation with the TGD person.
De mentale gezondheid en identiteitsontwikkeling van transgender en genderdiverse jongeren (TGD) worden beschermd door steun en acceptatie vanuit het gezin. Hoewel in sommige studies wel is gekeken naar de rol van steunende gezinsrelaties voor TGD-jongeren, is nog niet eerder diepgaand onderzocht hoe TGD-jongeren en hun verzorgers aankijken tegen deze relaties binnen het gezinssysteem of naar hoe ze die karakteriseren. In deze kwalitatieve studie onderzochten we de perspectieven van TGD-jongeren en hun verzorgers op de relaties jongere-verzorger en verzorger-verzorger binnen het gezinssysteem. We wierven daarvoor een steekproef uit de algemene bevolking van twintig gezinnen (20 TGD-jongeren, leeftijd 7–18 jaar, en 34 verzorgers), afkomstig uit drie regio’s in de Verenigde Staten. In de groep TGD-jongeren waren meerdere genderidentiteiten vertegenwoordigd; de verzorgers waren moeders (n = 21), vaders (n = 12) en één oma. Bij alle deelnemende gezinsleden werd individueel een semigestructureerd interview afgenomen, met onder andere vragen over de gezinsrelaties. Van de interviews werden woordelijke transcripties gemaakt, die met een thematische-analysebenadering werden geanalyseerd. De analyses leverden een beeld op van complexe wederzijdse gezinsrelaties, met vijf contextuele factoren die deze relaties beïnvloedden: school, gemeenschap, werkplek, religie en familie. De identiteitsontwikkeling van de TGD-jongeren bleek sterk verbonden met de manier waarop verzorgers op hun kinderen reageren, van ze leren en zich aan hen aanpassen; en de identiteitsontwikkeling van de TGD-jongeren bleek ook sterk verbonden met hoe de verzorgers met elkaar omgaan. De bevindingen illustreren hoe acceptatie door verzorgers en gezinscohesie mogelijk hand in hand gaan, en dat de jongeren en hun verzorgers dezelfde contextuele factoren noemden als het gaat om factoren die een impact hebben op hun gezinssysteem. Dit onderzoek laat zien dat het in gezinsbehandelingen belangrijk is om TGD-jongeren en hun verzorgers gelijkwaardige posities te geven, om op die manier de TGD-identiteitsontwikkeling te bevestigen en ondersteunen.
The majority of studies attempting to address the healthcare needs of the millions of transgender, non-binary, and/or gender diverse (TNG) individuals rely on human subjects, overlooking the benefits of translational research in animal models. Researchers have identified many ways in which gonadal steroid hormones regulate neuronal gene expression, connectivity, activity, and function across the brain to control behavior. However, these discoveries primarily benefit cisgender populations. Research into the effects of exogenous hormones such as estradiol, testosterone, and progesterone has direct translational benefit for TNG individuals on gender affirming hormone therapies (GAHT). Despite this potential, endocrinological healthcare for TNG individuals remains largely unimproved. Here, we outline important areas of translational research that could address the unique healthcare needs of TNG individuals on GAHT. We highlight key biomedical questions regarding GAHT that can be investigated using animal models. We discuss how contemporary research fails to address the needs of GAHT-users and identify equitable practices for cisgender scientists engaging with this work. We conclude that if necessary and important steps are taken to address these issues, translational research on GAHT will greatly benefit the healthcare outcomes of TNG people.
Introduction
In recent years, there has been strong interest in making digital health and social tools more accessible, particularly among vulnerable and stigmatised groups such as transgender people. While transgender people experience unique physical, mental and sexual health needs, not much is currently known about the extent to which they use information and communication technologies such as short messaging service and videoconferencing to access health services. In this paper, we discuss our protocol for a scoping review of the literature about the delivery and utilisation of digitally mediated health services for transgender populations.
Methods and analysis
This scoping review of the provision and experience of telemedicine among transgender people will follow the methodological framework developed by Arksey and O’Malley. The search will be conducted using three online databases, namely PubMed, CINAHL and Scopus, with additional literature explored using Google Scholar to identify grey literature. Relevant English-language studies will be shortlisted after completing a title and abstract review based on defined inclusion criteria. Following that, a final list of included studies will be compiled after a full-text review of the shortlisted articles has been completed. To enable the screening process, a team of researchers will be assigned refereed publications explicitly referring to the provision and experience of transgender healthcare through telemedicine. Screening performed independently will then collaboratively be reviewed to maintain consistency.
Ethics and dissemination
The research is exempt from ethics approval since our analysis is based on extant research into the use of digital technologies in providing healthcare to transgender people. The results of this study will be disseminated through peer-reviewed academic publications and presentations. Our analysis will guide the design of further research and practice relating to the use of digital communication technologies to deliver healthcare services to transgender people.
Minority stress theory posits that transgender and gender diverse (TGD) individuals exhibit greater rates of depression and suicidality due to internal (proximal) and external (distal) stressors related to their TGD identity. Yet, the magnitude of the relationship between minority stress processes and mental health outcomes has not been quantitatively summarized. The current research meta-analyzed the relationship between minority stress constructs and depression, suicidal ideation, and suicide attempt. Results from 85 cross-sectional quantitative studies indicate that distal stress, expectations of rejection, internalized transphobia, and concealment are significantly associated with increased depression, suicidal ideation, and suicide attempt. Greater effect sizes were observed for expectations of rejection and internalized transphobia when compared to distal stress and concealment. Future research on the relationship between minority stress, depression, and suicide would benefit from longitudinal designs and more diverse and representative samples of TGD individuals.
Purpose: We aimed to assess the Minority Stress Model which proposes that the stress of experiencing stigma leads to adverse mental health outcomes, but social supports (e.g., school and family connectedness) will reduce this negative effect.
Methods: We measured stigma-related experiences, social supports, and mental health (self-injury, suicide, depression, and anxiety) among a sample of 923 Canadian transgender 14- to 25-year-old adolescents and young adults using a bilingual online survey. Logistic regression models were conducted to analyze the relationship between these risk and protective factors and dichotomous mental health outcomes among two separate age groups, 14- to 18-year-old and 19- to 25-year-old participants.
Results: Experiences of discrimination, harassment, and violence (enacted stigma) were positively related to mental health problems and social support was negatively associated with mental health problems in all models among both age groups. Among 14–18 year olds, we examined school connectedness, family connectedness, and perception of friends caring separately, and family connectedness was always the strongest protective predictor in multivariate models. In all the mental health outcomes we examined, transgender youth reporting low levels of enacted stigma experiences and high levels of protective factors tended to report favorable mental health outcomes. Conversely, the majority of participants reporting high levels of enacted stigma and low levels of protective factors reported adverse mental health outcomes.
Conclusion: While these findings are limited by nonprobability sampling procedures and potential additional unmeasured risk and protective factors, the results provide positive evidence for the Minority Stress Model in this population and affirm the need for policies and programs to support schools and families to support transgender youth.
Interpersonal acceptance–rejection theory (IPARTheory) proposes that across cultures and other sociodemographic groups, interpersonal acceptance and rejection consistently predict the psychological and behavioral adjustment of children and adults (Rohner, 1986, 2004). The goals of this article are to provide a description of the major tenets of IPARTheory, summarize findings from empirical tests of the theory, and suggest future directions tied to the other articles in this special collection as well as for the field moving forward.
This article is an overview of 12 meta-analyses conducted to test the basic postulates of interpersonal acceptance–rejection theory (IPARTheory). These meta-analyses are based on a total of 551 (48% unpublished and 52% published) studies on the theory. The studies were conducted over period of 42 years, from 1975 through 2016. They represent an aggregate sample of 149,440 respondents, including males and females, children and adults. Respondents were taken from 31 countries on five continents. The findings show that interpersonal acceptance and rejection have significant pan-cultural associations with the psychological adjustment and personality dispositions of children and adults everywhere. The results reviewed also show that the principal measures used so far in IPARTheory research are reliable for cross-cultural application.
Purpose: Parental acceptance of gender identity/expression in lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ+) youth moderates the effects of minority stress on mental health outcomes. Given this association, mental health clinicians of gender-expansive adolescents often assess the degree to which these youth perceive their parents/primary caregivers as accepting or nonaffirming of their gender identity and expression. While existing measures may reliably assess youth's perceptions of general family support, no known tool aids in the assessment an adolescent's perceived parental support related to adolescent gender-expansive experiences.
Methods: To provide both clinicians and researchers with an empirically derived tool, the current study used factor analysis to explore an underlying factor structure of a brief questionnaire developed by subject-matter experts and pertaining to multiple aspects of perceived parental support in gender-expansive adolescents and young adults. Respondents were gender-expansive adolescents and young adults seeking care in an interdisciplinary gender-health clinic within a pediatric academic medical center in the Midwestern United States.
Results: Exploratory factor analysis resulted in a 14-item questionnaire comprised of two subscales assessing perceived parental nonaffirmation and perceived parental acceptance. Internal consistency and construct validity results provided support for this new questionnaire.
Conclusion: This study provides preliminary evidence of the factor structure, reliability and validity of the Parental Attitudes of Gender Expansiveness Scale for Youth (PAGES-Y). These findings demonstrate both the clinical and research utility of the PAGES-Y, a tool that can yield a more nuanced understanding of family-related risk and protective factors in gender-expansive adolescents.
Abstract
The purpose of this study was to describe the common psychological concerns of the first group of transgender youth to seek medical interventions in the first U.S. interdisciplinary pediatric gender clinic. The data reported were obtained during the psychological evaluations required by the clinic’s protocol. Participants included 56 gender dysphoric youth, aged 8.9 to 17.9, who were largely Caucasian. Data were obtained via archival chart review. Standard descriptive statistics were used to characterize the distribution of each measure. Student t tests were used to compare mean levels between genders, and Pearson correlation coefficients were used to assess the association of each measure with age, parent and child agreement, and the correlation between measures. Findings revealed that most mean scores fell in the “average” range; however, the percentage of patients with scores in the clinical range was notable for several variables. In terms of gender differences, transgender girls revealed more “worry” than transgender boys. Further, older youth experienced poorer self-competence, higher levels of anxiety, and decreased happiness and satisfaction than the younger patients. The results provide further evidence of the resiliency of a significant number of transgender youth, as well as the severity of mental health concerns for others. New to the existing literature are the results showing older transgender teenagers as more distressed, supporting the clinical recommendation to consider earlier medical intervention for appropriate youth, and to always incorporate mental health support and assessment. (PsycINFO Database Record (c) 2017
This study investigates self-harm among young lesbian, gay, bisexual, and trans (LGBT) people. Using qualitative virtual methods, we examined online forums to explore young LGBT people’s cybertalk about emotional distress and self-harming. We investigated how youth explained the relationship between self-harm and sexuality and gender. We found that LGBT youth may articulate contradictory, ambiguous, and multiple accounts of the relationship but there were three strong explanations: (a) self-harm was because of homophobia and transphobia; (b) self-harm was due to self-hatred, fear, and shame; (c) self-harm was emphatically not related to sexuality or gender. There was evidence of youth negotiating LGBT identities, managing homophobia, resisting pathologization, and explaining self-harm as a way of coping.
Historically, many gender variant individuals have lived in a chronic state of conflict between self-understanding and physical being, one in which there was a continual misalignment between others' perceptions of them and their internal self-perception of gender. Only recently have professionals from mental health and medical realms come together to provide services to these youth. This paper describes an innovative program: the first mental health and medical multidisciplinary clinic housed in a pediatric academic center in North America to serve the needs of gender variant youth. We describe our model of care, focusing on the psychologist's role within a multidisciplinary team and the mental health needs of the youth and families assisted. We highlight clinical challenges and provide practice clinical vignettes to illuminate the psychologist's critical role.
Family support is protective against health risks in sexual minority individuals. However, few studies have focused specifically on transgender youth, who often experience rejection, marginalization, and victimization that place them at risk for poor mental health. This study investigated the relationships among parental support, quality of life, and depression in transgender adolescents.
A total of 66 transgender youth presenting for care at Children's Hospital Los Angeles completed a survey assessing parental support (defined as help, advice, and confidante support), quality of life, and depression. Regression analyses assessed the associations between parental support and mental health outcomes.
Parental support was significantly associated with higher life satisfaction, lower perceived burden of being transgender, and fewer depressive symptoms.
Parental support is associated with higher quality of life and is protective against depression in transgender adolescents. Interventions that promote parental support may significantly affect the mental health of transgender youth.
This study explores the differential contribution of elder siblings' versus parents' acceptance and behavioral control to the psychological adjustment of younger siblings in Turkey. One hundred eighty younger siblings (M = 12.38 years) in intact nuclear families with at least one older sibling (M = 15.79 years) responded to four self-reports. Results of simple regression analyses showed that younger siblings' perceptions of odler siblings, mothers', and fathers' acceptance (but not behavioral control) each made a unique contribution to the psychological adjustment of the younger siblings. Hierarchical regression analyses, however, showed that younger brothers' perceptions of older sisters' acceptance did not make a unique contribution to the boys' adjustment. But all other sibling pairs did contribute uniquely to the adjustment of younger siblings.
This study examines how the compensatory effects of social support received from siblings relate to psychological adjustment in emerging adulthood. Participants completed measures of social support from a variety of sources and several indicators of well-being. Sibling support was associated with lower loneliness and depression and with higher self-esteem and life satisfaction. Also, sibling support compensated for low parental and peer support. Sibling support compensated for low support from mothers for depression and self-esteem. Sibling support compensated for low support from fathers for loneliness, self-esteem, and life satisfaction. Finally, sibling support partially compensated for low support from friends for all of the well-being measures and completely compensated for self-esteem, depression, and life satisfaction. The potential benefits of sibling support warrant a closer examination of the wide-ranging issues involved in sibling relations.
We assessed whether mothers' and fathers' self-reports of acceptance-rejection, warmth, and hostility/rejection/neglect (HRN) of their pre-adolescent children differ cross-nationally and relative to the gender of the parent and child in 10 communities in 9 countries, including China, Colombia, Italy, Jordan, Kenya, the Philippines, Sweden, Thailand, and the United States (N = 998 families). Mothers and fathers in all countries reported a high degree of acceptance and warmth, and a low degree of HRN, but countries also varied. Mothers reported greater acceptance of children than fathers in China, Italy, Sweden, and the United States, and these effects were accounted for by greater self-reported warmth in mothers than fathers in China, Italy, the Philippines, Sweden, and Thailand and less HRN in mothers than fathers in Sweden. Fathers reported greater warmth than mothers in Kenya. Mother and father acceptance-rejection were moderately correlated. Relative levels of mother and father acceptance and rejection appear to be country specific.
The purpose was to determine the degree to which experienced mental health professionals would judge particular CBCL/6-18, TRF, and YSR items as being consistent with particular DSM-IV categories. Child psychiatrists and psychologists who had published research on children's be-havioral/emotional problems rated the consistency of each CBCL, TRF, and YSR problem item with DSM categories that are potentially relevant to school-age children. The 22 raters came from 16 cultures. Items that were rated by at least 14 of the 22 (64%) raters as being very consistent with a diagnostic category were assigned to that category. After combining some categories that had overlaps in DSM criteria, we constructed scales for the following categories: Affective Problems (including Dysthymia and Major Depression); Anxiety Problems (including GAD, SAD, and Spe-cific Phobia); Somatic Problems (including Somatization and Somatoform); Attention Deficit/Hy-peractivity Problems (including Hyperactive-Impulsive and Inattentive types); Oppositional Defi-ant Problems, and Conduct Problems. For each instrument, a DSM-oriented scale comprises the items from that instrument that were rated as being very consistent with the respective diagnostic category. The scales are displayed on profiles for scoring children in relation to normative samples of peers. The profiles show raw scale scores (sum of the 0-1-2 ratings of items comprising a scale); T scores; percentiles; and cutpoints for normal, borderline, and clinical ranges. Windows software for scoring the profiles can provide comparisons among DSM-oriented scale scores obtained from up to 8 CBCL/6-18, TRF, and YSR forms per child.
Transgender and gender-nonconforming (TGN) youth are at increased risk for adverse mental health outcomes, but better family functioning may be protective. This study describes TGN youth’s mental health and associations with family functioning in a community-based sample. Participants were from 33 families (96 family members) and included 33 TGN youth, ages 13 to 17 years; 48 cisgender (non-transgender) caregivers; and 15 cisgender siblings. Participants completed a survey with measures of family functioning (family communication, family satisfaction) and mental health of TGN youth (suicidality, self-harm, depression, anxiety, self-esteem, resilience). TGN youth reported a high risk of mental health concerns: suicidality (15% to 30%), self-harm (49%), clinically significant depressive symptoms (61%); and moderate self-esteem (M = 27.55, SD = 7.15) and resiliency (M = 3.67, SD = 0.53). In adjusted models, better family functioning from the TGN youth’s perspective was associated with better mental health outcomes among TGN youth (β ranged from −0.40 to −0.65 for self-harm, depressive symptoms, and anxious symptoms, and 0.58 to 0.70 for self-esteem and resiliency). Findings from this study highlight the importance of considering TGN youth’s perspectives on the family to inform interventions to improve family functioning in families with TGN youth.
To explore family boundary ambiguity in the parent–child relationships of transgender youth. Transgender youth may perceive a lack of clarity about whether parents will accept their authentic gender expression, continue to support them physically and emotionally, and regard them as a member of the family. Uncertainty about being in or out of the family and whether family relationships endure is stressful and can lead to psychological distress, a sense of ambiguous loss, and frozen grief. Ethnographic content analysis was conducted based on interviews with 90 transgender youth recruited from community centers in 10 regions across 3 countries. Narratives revealed that transgender youth experienced family boundary ambiguity related to relational ambiguity, structural ambiguity, and identity ambiguity. Each experience of ambiguity obscured whether participants remained in the family and interpersonally connected to their parents. Transgender youth actively navigated complex and ambiguous parent–child relationships whereby participants attempted to reconcile their need for authentic gender expression combined with their need for family connectedness and acceptance. Family clinicians, educators, and policymakers are urged to consider family and transgender resilience through a lens of ambiguous loss and to promote a gender-affirmative life-span approach to clinical care for transgender individuals and their families.
Despite a dramatic increase in the number of socially transitioned transgender children (children who identify with the gender opposite their natal sex and who change their appearance and pronouns to align with that gender identity), few studies have examined transgender children's gender development. Findings from the TransYouth Project, the first large, longitudinal study of socially transitioned transgender children, suggest that the gender development of socially transitioned children looks similar to the gender development of their gender-typical, gender-matched peers and gender-typical siblings. In this article, we review findings from the few studies that have addressed this topic, connect these studies to past research, and discuss ways to foster deeper understanding of gender development among transgender children.
Objective:
Transgender children who have socially transitioned, that is, who identify as the gender "opposite" their natal sex and are supported to live openly as that gender, are increasingly visible in society, yet we know nothing about their mental health. Previous work with children with gender identity disorder (GID; now termed gender dysphoria) has found remarkably high rates of anxiety and depression in these children. Here we examine, for the first time, mental health in a sample of socially transitioned transgender children.
Methods:
A community-based national sample of transgender, prepubescent children (n = 73, aged 3-12 years), along with control groups of nontransgender children in the same age range (n = 73 age- and gender-matched community controls; n = 49 sibling of transgender participants), were recruited as part of the TransYouth Project. Parents completed anxiety and depression measures.
Results:
Transgender children showed no elevations in depression and slightly elevated anxiety relative to population averages. They did not differ from the control groups on depression symptoms and had only marginally higher anxiety symptoms.
Conclusions:
Socially transitioned transgender children who are supported in their gender identity have developmentally normative levels of depression and only minimal elevations in anxiety, suggesting that psychopathology is not inevitable within this group. Especially striking is the comparison with reports of children with GID; socially transitioned transgender children have notably lower rates of internalizing psychopathology than previously reported among children with GID living as their natal sex.
Transgender youth represent a vulnerable population at risk for negative mental health outcomes including depression, anxiety, self-harm, and suicidality. Limited data exist to compare the mental health of transgender adolescents and emerging adults to cisgender youth accessing community-based clinical services; the present study aimed to fill this gap.
A retrospective cohort study of electronic health record data from 180 transgender patients aged 12-29 years seen between 2002 and 2011 at a Boston-based community health center was performed. The 106 female-to-male (FTM) and 74 male-to-female (MTF) patients were matched on gender identity, age, visit date, and race/ethnicity to cisgender controls. Mental health outcomes were extracted and analyzed using conditional logistic regression models. Logistic regression models compared FTM with MTF youth on mental health outcomes.
The sample (N = 360) had a mean age of 19.6 years (standard deviation, 3.0); 43% white, 33% racial/ethnic minority, and 24% race/ethnicity unknown. Compared with cisgender matched controls, transgender youth had a twofold to threefold increased risk of depression, anxiety disorder, suicidal ideation, suicide attempt, self-harm without lethal intent, and both inpatient and outpatient mental health treatment (all p < .05). No statistically significant differences in mental health outcomes were observed comparing FTM and MTF patients, adjusting for age, race/ethnicity, and hormone use.
Transgender youth were found to have a disparity in negative mental health outcomes compared with cisgender youth, with equally high burden in FTM and MTF patients. Identifying gender identity differences in clinical settings and providing appropriate services and supports are important steps in addressing this disparity.
Copyright © 2015 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.
Purpose:
The Bonferroni correction adjusts probability (p) values because of the increased risk of a type I error when making multiple statistical tests. The routine use of this test has been criticised as deleterious to sound statistical judgment, testing the wrong hypothesis, and reducing the chance of a type I error but at the expense of a type II error; yet it remains popular in ophthalmic research. The purpose of this article was to survey the use of the Bonferroni correction in research articles published in three optometric journals, viz. Ophthalmic & Physiological Optics, Optometry & Vision Science, and Clinical & Experimental Optometry, and to provide advice to authors contemplating multiple testing.
Recent findings:
Some authors ignored the problem of multiple testing while others used the method uncritically with no rationale or discussion. A variety of methods of correcting p values were employed, the Bonferroni method being the single most popular. Bonferroni was used in a variety of circumstances, most commonly to correct the experiment-wise error rate when using multiple 't' tests or as a post-hoc procedure to correct the family-wise error rate following analysis of variance (anova). Some studies quoted adjusted p values incorrectly or gave an erroneous rationale.
Summary:
Whether or not to use the Bonferroni correction depends on the circumstances of the study. It should not be used routinely and should be considered if: (1) a single test of the 'universal null hypothesis' (Ho ) that all tests are not significant is required, (2) it is imperative to avoid a type I error, and (3) a large number of tests are carried out without preplanned hypotheses.
The purpose of this study was to examine the relationships of sexual minority youth and their siblings. The participants were 56 lesbian, gay, bisexual, or transgender individuals ranging in age from 18 to 24 years, who reported information about a total of 107 siblings. Respondents completed a demographic data questionnaire as well as adapted versions of the Sibling Closeness Scale (SCS) and the Sibling Approval of Sexual Behavior Scale (SASBS) to describe their relationship with each of their siblings. Analyses examined birth order and gender in relation to outness to siblings as well as sibling closeness and approval. Results provide information about disclosure of LGBT status to siblings, elements of closeness and acceptance in sibling relationships of sexual minority youth, and the significance of gender and birth order in these sibling relationships.
Test-retest reliabilities of the Revised Children's Manifest Anxiety Scale over 1- and 5-wk. intervals were examined for two samples of students, 73 boys and 88 girls in regular sixth, seventh and eighth grade classrooms (11 yr. to 14 yr.). For raw scores the test-retest Pearson r was .88 (1-wk.) and .77 (5-wk.), indicating good reliability. For both samples there was a small difference between test (12.2 for 1-wk. sample; 11.4 for 5-wk. sample) and retest (11.2 for 1-wk. sample; 9.8 for 5-wk. sample) mean raw scores. Implications for test use are discussed.
Physicians, nurses, and other health care professionals can exert a powerful influence in support of gay and lesbian parents and their children, and of both gay and nongay adolescents and parents of teenagers in their community. We can do this by avoiding and challenging assumptions of heterosexuality in the process of clinical care for children of all ages; by helping children and their families to understand the wide range of normal variation in sexual orientation; by helping schools and community organizations in their efforts to provide information and support to all children and families whatever their particular constellation. Within our own professional organizations we can work against homonegative attitudes that reinforce discrimination and the personal and professional limitations caused by stigma. Expansion of medical education and research regarding issues central to gay and lesbian individuals and their families requires the creation of a context of support, visibility, and concern within medical centers and schools of medicine, nursing, and allied health professions.
Transgender youth and life-threatening behaviors. Suicide and Life-Threatening Behavior
- A H Grossman
- A R Augelli
Grossman, A. H., & D'Augelli, A. R. (2007). Transgender youth and life-threatening behaviors. Suicide and Life-Threatening Behavior, 37, 527-537.
http://dx.doi.org/10.1521/suli.2007.37.5.527