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Sexual and gender minority mental health among children and youth

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Abstract

Sexual and gender minority (SGM) young people are coming of age at a time of dynamic social and political changes with regard to LGBTQ rights and visibility around the world. And yet, contemporary cohorts of SGM youth continue to evidence the same degree of compromised mental health demonstrated by SGM youth of past decades. The authors review the current research on SGM youth mental health, with careful attention to the developmental and contextual characteristics that complicate, support, and thwart mental health for SGM young people. Given a large and rapidly growing body of science in this area, the authors strategically review research that reflects the prevalence of these issues in countries around the world but also concentrate on how mental health concerns among SGM children and youth are shaped by experiences with schools, families, and communities. Promising mental health treatment strategies for this population are reviewed. The chapter ends with a focus on understudied areas in the SGM youth mental health literature, which may offer promising solutions to combat SGM population health disparities and promote mental health among SGM young people during adolescence and as they age across the life course.

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... Studies consistently document health disparities for lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ) youth in the United States (U.S.). These disparities are primarily attributed to stigma and discrimination (Fish et al., 2020a). LGBTQ youth experience poorer mental, behavioral, and sexual health than their heterosexual and cisgender peers (Russell & Fish, 2016;Saewyc, 2014). ...
... Compared to their heterosexual and cisgender peers, LGBTQ youth experience higher rates of bullying and peer harassment (Toomey & Russell, 2016), violence and victimization (Johns et al., 2018(Johns et al., , 2019Poteat et al., 2020), and family rejection (Ryan et al., 2009). These experiences contribute to LGBTQ youths' poorer mental health (Fish et al., 2020a;Russell & Fish, 2016), higher rates of substance misuse (Goldbach et al., 2014), and sexual and reproductive health concerns (Saewyc, 2014). ...
... Research on the experiences of LGBTQ youth has primarily focused on disparities and deficits in their health and social capital (Fish, 2020;Fish et al., 2020a). However, resilience is a core feature of the minority stress model (Meyer, 2015). ...
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There are few psychosocial support programs specifically designed to meet the unique developmental and health needs of LGBTQ youth. Even when available, many youth face significant barriers to accessing LGBTQ-specific services for fear of being “outed” to parents, peers, and community members. The current study assessed the utility, feasibility, and acceptability of a synchronous, adult-facilitated, chat-based Internet community support program for LGBTQ youth aged 13–19. Chat transcripts were analyzed to examine how LGBTQ youth used the chat-based platform to connect with peers and trusted adults. A separate user satisfaction survey was collected to assess the personal (e.g., sexual orientation, gender identity, age) and contextual (e.g., geography, family environment) characteristics of youth engaging in the platform, their preferred topics of discussion, and their satisfaction with the program focus and facilitators. Qualitative data analysis demonstrated the degree to which LGBTQ youth were comfortable disclosing difficult and challenging situations with family, friends, and in their community and in seeking support from peers and facilitators online. Youth also used the platform to explore facets of sexual and gender identity/expression and self-acceptance. Overall, users were very satisfied with the platform, and participants accurately reflect the program’s desired populations for engagement (e.g., LGBTQ youth of color, LGBTQ youth in the South). Together, findings support the feasibility and acceptability of synchronous, adult-facilitated, chat-based Internet programs to connect and support LGBTQ youth, which encourage future research and innovation in service delivery.
... [10][11][12][13] Sexual orientation disparities in health and well-being are well established, including anxiety, depression, suicidality, substance use disorder, sleep, and chronic health conditions. [14][15][16][17][18][19] These disparities are empirically linked to experiences with minority stressors (e.g., stigma, discrimination, and rejection). [19][20][21][22][23][24] Sexual minority populations also face a disproportionate burden of social inequalities, including poverty, unstable housing, unemployment, and lack of access to health insurance and health care. ...
... After adjusting for sociodemographic factors, bisexual adults reported the most consistent and robust changes across all indicators of mental health and well-being when compared to their heterosexual peers. Consistent with previous work, [14][15][16][17][18][19] we observed sexual identity disparities across several indicators of well-being both pre-and postpandemic onset, although these differences were mostly observed between heterosexual and bisexual subgroups, even within nongender-stratified models. For example, bisexual men and women were more likely to report poorer mental health and physical health and greater stress, loneliness, psychological distress, and fatigue both before and after the onset of the pandemic. ...
Article
Purpose: The coronavirus disease 2019 (COVID-19) pandemic has accentuated long-standing population health disparities in the United States. We examined how the pandemic and its social consequences may differentially impact sexual minority adults, relative to heterosexual adults. Methods: Data are from a U.S. national sample of adults (n = 2996; 18.06%) collected from online panels from April to May 2020. We used eight indicators of well-being-mental health, physical health, quality of life, stress, loneliness, psychological distress, alcohol use, and fatigue-to assess the degree to which sexual identity subgroups (i.e., heterosexual, gay/lesbian, bisexual, and "other" sexual minority) varied in retrospective pre- and postpandemic onset indicators of well-being and whether groups varied in their rate of change from pre- and postpandemic onset. Results: The results showed consistent patterns of decline in well-being across sexual identity subgroups, although changes in mental health, physical health, quality of life, stress, and psychological distress were more robust among sexual minority adults in general, relative to heterosexual adults. Adjusted multivariate models testing differences in change in retrospective pre- and postpandemic onset found that well-being among bisexual men and women was most negatively impacted by the pandemic. Conclusion: The COVID-19 pandemic may have distinct health consequences for sexual minority adults in the United States. Our findings support and further legitimize calls for more comprehensive surveillance and cultural responsiveness in emergency preparedness as it relates to sexual minority people and the COVID-19 pandemic.
... Findings are consistent with previous research on the negative effects of victimization on the mental health of SGM young adults, 36,37 as well as recent theorizing about this pathway during COVID-19. 22,38 Study results provide initial evidence revealing a strong impact of SGM-related victimization since the start of the COVID-19 pandemic on psychological distress among sample SGM college students. ...
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Purpose: Existing evidence indicates significant threats against the mental health of sexual and gender minority (SGM) young adults as a result of the COVID-19 pandemic, including elevated rates of substance use, anxiety, depression, and traumatic stress. Therefore, it is imperative to understand the mechanistic identity-related factors that may influence the mental health needs of SGM young adults in the time of COVID-19. This study aims to examine the impact of increases in lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ) identity-related victimization since the start of COVID-19 on psychological distress among SGM college students. Methods: A nonprobability, cross-sectional online survey was conducted between May and August 2020 to explore the psychological impacts of COVID-19 on U.S. SGM college students (N = 565). Previously validated scales were used to measure LGBTQ identity-related victimization and psychological distress. Chi-square tests of independence, independent samples T-tests, and adjusted logistic regression were used to examine the study aim. Results: Adjusted logistic regression findings revealed that reporting past year+more frequent LGBTQ identity-related victimization since the start of COVID-19 (compared to no report) was associated with over four times greater odds of experiencing moderate to severe psychological distress. Conclusion: Findings highlight the importance of research, practice, and policy stakeholders toward addressing the unique identity-related mental health needs and victimization experiences of SGM college students. Mental health, social service, and higher education practitioners have an important opportunity and responsibility toward identifying and intervening on SGM college students and young adults facing identity-related victimization amid the ongoing COVID-19 pandemic.
... However, sexual minority young persons may be at risk for compounding mental health effects of the COVID-19 pandemic due to their existing vulnerabilities for psychological and victimization inequities (Salerno, Williams, & Gattamorta, 2020). For instance, existing research indicates that generally, sexual minority young adults face elevated rates of depression, anxiety, traumatic stress, psychological distress, and suicidal ideation and behavior (Fish, Baams, & McGuire, 2020;Gattamorta, Salerno, & Castro, 2019;Ploderl & Tremblay, 2015;Russell & Fish, 2016). Thus, sexual minority young adults may face exacerbation of existing psychological challenges as a secondary result of the COVID-19 pandemic, which could create distinct vulnerability across the life course. ...
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Sexual minority young persons may be at risk for compounding mental health effects of the COVID-19 pandemic due to their existing vulnerabilities for psychological inequities. Indeed, recent research has documented that sexual minority young persons are experiencing compounding psychiatric effects associated with the COVID-19 pandemic. Further, researchers and practitioners hypothesized that sexual minority youth and young adults may experience unique hardships related to their sexual and gender identities and familial conflict as a result of the COVID-19 pandemic and living arrangement changes with their parents and families. This study aims to investigate whether there are changes in sexual minority (and non-sexual minority) young adults’ (SMYAs) mental health and wellbeing among those living with and living without their parents before and after the start of COVID-19. Among a cross-sectional sample of SMYAs (n=294; Mage=22 years; age range=18-26) and non-SMYAs (n=874; Mage=22 years; age range=18-26) defined by whether they were living with or living without their parents before and after the start of COVID-19, we retrospectively analyzed changes in psychological distress and wellbeing. SMYAs who returned to their parents’ homes during post-onset of COVID-19 reported greater mental distress and lower wellbeing, followed by those who were living with their parents both before and after the start of COVID-19. Patterns were not consistent among non-SMYAs, and lower magnitudes of change were seen. There is a significant public health need for mental health services and family education resources for supporting SMYAs in the context of COVID-19 and beyond.
... 3 Unfortunately, outside select countries (eg, the USA and Australia) populationbased investigations into the health of sexual minority youth have lagged. 4 However, population health surveillance efforts are necessary for identification of national health priorities, which in turn will guide decisions about research and prevention efforts. The need to collect population-based data on sexual (and gender) minority youth is paramount and deserves continued attention and advocacy. ...
Article
Today’s LGBTQ youth come of age at a time of dynamic social and political change with regard to LGBTQ rights and visibility, yet remain vulnerable to compromised mental health. Despite advances in individual-level treatment strategies, school-based programs, and state-level policies that address LGBTQ mental health, there remains a critical gap in large-scale evidence-based prevention and intervention programs designed to support the positive development and mental health of LGBTQ youth. To spur advances in research and translation, I pose six considerations for future scholarship and practice. I begin by framing LGBTQ (mental) health disparities in a life course perspective and discuss how research focused on the timing of events could offer insight into the optimum targets and timing of prevention and intervention strategies. Next, I argue the importance of expanding notions of “mental health” to include perspectives of wellbeing, positive youth development, and resilience. I then consider how research might attend to the complexity of LGBTQ youths’ lived experience within and across the various contexts they traverse in their day-to-day lives. Similarly, I discuss the importance of exploring heterogeneity in LGBTQ youth experiences and mental health. I also offer suggestions for how community partnerships may be a key resource for developing and evaluating evidence-informed programs and tools designed to foster the positive development and mental health of LGBTQ youth. Finally, I acknowledge the potentials of team science for advancing research and practice for LGBTQ youth health and wellbeing. Throughout, these future directions center the urgent needs of LGBTQ youth.
... Some but not all transgender and gender-diverse youths exhibit gender-nonconforming behaviors or assert a desire to be another gender early in childhood, whereas sexual identity development may begin in childhood but is typically understood to be associated with the developmental changes linked to adolescence. 7 Inasmuch as transgender youths may exhibit behaviors that do not conform with their sex assigned at birth in early childhood, they may be susceptible to experiences of SOGICE earlier in the life course and for longer periods of time. Earlier and prolonged exposures likely have differential effects on later mental health and suicide risk. ...
... 3 Unfortunately, outside select countries (eg, the USA and Australia) populationbased investigations into the health of sexual minority youth have lagged. 4 However, population health surveillance efforts are necessary for identification of national health priorities, which in turn will guide decisions about research and prevention efforts. The need to collect population-based data on sexual (and gender) minority youth is paramount and deserves continued attention and advocacy. ...
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Because no measure for sexual orientation-related rejection sensitivity (RS) for adolescents exists, we aimed to develop and validate the Sexual Minority Adolescent Rejection Sensitivity Scale (SMA-RSS). In Study 1, interviews with 22 sexual minority youth were conducted ( M age = 18.86, SD = 3.03). Based on these interviews, 29 scenarios were developed as potential items for the SMA-RSS. In Study 2, exploratory factor analyses were conducted on these 29 scenarios in a sample of 397 sexual minority adolescents ( M age = 16.63, SD = 1.07). The 14 best performing items were selected and a two-factor structure best fit the data. In Study 3, a confirmatory factor analysis was conducted and the test–retest reliability, criterion validity, convergent validity, and incremental validity of the SMA-RSS were assessed in a sample of 499 sexual minority adolescents ( M age = 16.61, SD = 1.34). A bifactor model best fit the data and evidence was provided for a strong enough general factor to justify unidimensionality. For criterion validity, the SMA-RSS evidenced small to moderate correlations with minority stressors and mental health indicators. For convergent validity, we found a moderate correlation with general RS. For incremental validity, the SMA-RSS was associated with mental health indicators over and above minority stressors and general RS. Participants were moderately stable in their scores on the SMA-RSS over a one-month period. Taken together, the SMA-RSS captured unique situations in which sexual minority adolescents anxiously expect rejection and can aid in better understanding health disparities among sexual minority adolescents.
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This study examines the relationship between family rejection and moderate to severe psychological distress during COVID-19 among LGBTQ university students. Data were obtained from a national cross-sectional electronic survey of LGBTQ university students (N = 565) collected in the summer of 2020. Hierarchical logistic regression models were used to examine the predictive association between increased family rejection and moderate to severe psychological distress. Respondents who reported increased rejection were more than twice as likely to report moderate to severe psychological distress, with social isolation and LGBTQ identity concealment being significant covariate predictors in the model. These results demonstrate the importance of public health, medical, mental health, and higher education stakeholders understanding the significance of LGBTQ-identity related family rejection when addressing the mental health and well-being of LGBTQ young people.
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Purpose There is a lack of research on the association between identity concealment and mental health among sexual and gender minority (SGM) adolescents and how social support may attenuate this association. Furthermore, research typically neglects the day-to-day variability in concealment experiences of SGM adolescents. Therefore, we examined the association between daily sexual orientation and gender identity concealment and positive and negative affect and the moderating role of family and peer support on this association among SGM adolescents. Methods A 21-day daily diary study among 94 SGM adolescents (mean [M] age = 16.10, standard deviation [SD] = 1.50; 31.9% gender minority; 44.7% youth of color) was conducted. Multilevel regression analyses tested the association between daily concealment and positive and negative affect and a cross-level interaction was used to assess the moderating effects of social supports. Results Daily concealment was associated with higher negative but not with positive affect. Family support was associated with lower daily negative affect but not with positive affect. Peer support was not significantly associated with negative or positive affect. Moderation results indicated that the association between daily concealment and negative affect was significant for adolescents who reported low or average levels of family support but was no longer significant for adolescents who reported high levels of family support. Discussion Daily identity concealment was positively associated with negative affect and this association was attenuated by family support. Future research and interventions should target families to improve the lives of SGM adolescents and to help reduce and eliminate mental health disparities.
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LGBTQ+ youth experience health disparities compared with heterosexual and cisgender youth. Community-based, positive youth development organizations are an important resource to support and affirm LGBTQ+ youth. This study aimed to identify the opportunities and challenges in supporting LGBTQ+ youth within 4-H. The study took place in one state in the United States within a 4-H program and employed qualitative, community-based methods using SWOT (strengths, weaknesses, opportunities, threats) analyses and focus groups of 4-H staff, support staff, volunteers, and youth participants. The majority of participants were White and middle class with direct connections to the 4-H program. Thematic analyses were conducted by multiple analysts until consensus was reached. Challenges and opportunities emerged in 3 themes: (a) organizational climate; (b) policies and procedures; and (c) training, education, and resources. Two additional themes included opportunities only: (a) community engagement and (b) youth-specific resources. This study has important implications for the 4-H program, rural community practice, and research, including strategies to improve LGBTQ+ inclusivity through education, programs and policies, hiring, and community partnerships. Additionally, this study highlights the opportunity and unique positionality of the 4-H program to amplify youth voices in the creation of youth-specific resources.
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Lesbian, gay, bisexual, transgender, queer, and gender non‐conforming (LGBTQ & GNC) youth experience more economic hardship and social stress than their heterosexual and cisgender peers. However, the ways that LGBTQ & GNC youth resist these damaging social factors and the corresponding implications for their health have not been addressed. Data were analyzed from a national participatory survey of LGBTQ & GNC youth ages 14–24 (N = 5,860) living in the United States. Structural equation models indicated that economic precarity was associated with experiences of health problems. This association was mediated by the negative influence of minority stress on health as well as by activism, which had a positive association with health. Findings suggest that minority stress explanations of health inequalities among LGBTQ & GNC youth can benefit from including a focus on economic precarity; both in terms of its deleterious impact on health and its potential to provoke resistance to structural oppression in the form of activism.
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Objective: Research has suggested that sexual minority young people are more likely to have depressive symptoms or depressive disorder, but to date most studies in the field have relied on convenience-based samples. This study overcomes this limitation by systematically reviewing the literature from population-based studies and conducting a meta-analysis to identify whether depressive disorder and depressive symptoms are elevated in sexual minority youth. Method: A systematic review and meta-analysis were conducted and informed by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement to determine if rates of depressive symptoms or depressive disorder differ for sexual minority youth, relative to heterosexual adolescents. MEDLINE, PsycINFO, EMBASE and ERIC databases were searched. Studies reporting depressive symptom data or the prevalence of depressive disorder in population-based samples of adolescents, which included sexual minority youth and heterosexual young people, were included in the review. A meta-analysis was conducted to examine differences between groups. Results: Twenty-three articles met the inclusion criteria. The proportion of sexual minority youth in the studies ranged from 2.3% to 12%. Sexual minority youth reported higher rates of depressive symptoms and depressive disorder (odds ratio = 2.94, p < 0.001 and standardized mean difference, d = 0.39, p < 0.001) in comparison to heterosexual young people. Female sexual minority youth were more likely to report depressive symptoms when compared to male sexual minority youth (standardized mean difference, d = 0.34, p < 0.001). Limitations included variations in how sexuality was operationalized and how depressive symptoms or depressive disorder was measured. Conclusions: There is robust evidence that rates of depressive disorder and depressive symptoms are elevated in sexual minority youth in comparison to heterosexual young people. Despite the elevated risk of depressive symptoms or depressive disorder for sexual minority youth, the treatment for this group of young people has received little attention.
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Using archival data from a national survey of N=8,891 young Filipina women ages 15 to 24, this paper aimed to examine links between sexual-minority status and thinking about and attempting suicide. Similar to previous results from young Filipino men and to findings in the global LGBT mental health literature, sexual-minority status was associated with both suicide ideation and suicide attempt across measures of same-sex attraction and same-sex romantic relationships. Sexual-minority Filipina youth had higher odds of having thought about suicide and having attempted suicide, compared to heterosexual peers. Following a minority stress framework, this paper explored a number of correlates of suicide ideation and attempt, including normative risk factors such as depression, recent suicide attempt of a friend, and experiences of threat and victimization.
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In this article, we use an ambiguous loss framework to guide a process for decentering cisnormativity (the assumption that biological sex and gender are aligned) within families, specifically for those experiencing the gender identity transitions of family members. Individual family members have varied experiences with regard to gender transition and may or may not experience ambiguous loss depending on their position within the family system. Trans* persons themselves may also experience ambiguous loss as a result of the dialectical tension of acceptance and rejection by family members. We apply resilience processes developed for work with persons facing ambiguous loss to support trans* persons and their families as they navigate gender transitions.
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Attachment-based family therapy (ABFT) is an empirically supported treatment designed to capitalize on the innate, biological desire for meaningful and secure relationships. The therapy is grounded in attachment theory and provides an interpersonal, process-oriented, trauma-focused approach to treating adolescent depression, suicidality, and trauma. Although a process-oriented therapy, ABFT offers a clear structure and road map to help therapists quickly address attachment ruptures that lie at the core of family conflict. Several clinical trials and process studies have demonstrated empirical support for the model and its proposed mechanism of change. This article provides an overview of the clinical model and the existing empirical support for ABFT.
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Purpose: To assess the well-being and substance use of sexual minority adolescents growing up in a tolerant society, we examined differences among same-sex attracted (SSA), those who do not know their attraction yet (not yet attracted [NYA]), and heterosexual Dutch adolescents. Methods: Unadjusted and adjusted logistic and linear multilevel analyses were performed using representative data of the 2013 Health Behaviour in School-Aged Children study (N = 5,995; 11-16 years old). The adjusted analyses controlled for sociodemographics (gender, age, education type, ethnicity, urbanicity, and religion). Results: Adjusted results showed that SSA adolescents substantially more often reported alcohol use (adjusted odds ratio [AOR] = 2.01), tobacco smoking (AOR = 2.37), and cannabis smoking (AOR = 3.52) than their heterosexual peers, while NYA participants less often reported alcohol use (AOR = .57) and equal levels of tobacco (AOR = .71) and cannabis smoking (AOR = .87) compared with heterosexual adolescents. SSA adolescents reported lower levels of life satisfaction (b = -1.25) and higher levels of psychosomatic complaints (b = .61) and emotional problems (b = 1.57) than heterosexual adolescents. NYA adolescents reported equal levels of life satisfaction (b = -.18) and psychosomatic complaints (b = .06) as heterosexual adolescents, but higher levels of emotional problems (b = .51). Conclusions: In Dutch society, with over 20 years of inclusive policies for sexual minorities and generally tolerant population attitudes toward sexual minorities, SSA adolescents are still at increased risk of substance use and have lower levels of well-being compared with peers.
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Purpose: Few transgender youth eligible for gender-affirming treatments actually receive them. Multidisciplinary gender clinics improve access and care coordination but are rare. Although experts support use of pubertal blockers and cross-sex hormones for youth who meet criteria, these are uncommonly offered. This study's aim was to understand barriers that transgender youth and their caregivers face in accessing gender-affirming health care. Methods: Transgender youth (age 14-22 years) and caregivers of transgender youth were recruited from Seattle-based clinics, and readerships from a blog and support group listserv. Through individual interviews, focus groups, or an online survey, participants described their experiences accessing gender-affirming health care. We then used theoretical thematic analysis to analyze data. Results: Sixty-five participants (15 youth, 50 caregivers) described barriers spanning six themes: (1) few accessible pediatric providers are trained in gender-affirming health care; (2) lack of consistently applied protocols; (3) inconsistent use of chosen name/pronoun; (4) uncoordinated care and gatekeeping; (5) limited/delayed access to pubertal blockers and cross-sex hormones; and (6) insurance exclusions. Conclusions: This is the first study aimed at understanding perceived barriers to care among transgender youth and their caregivers. Themed barriers to care led to the following recommendations: (1) mandatory training on gender-affirming health care and cultural humility for providers/staff; (2) development of protocols for the care of young transgender patients, as well as roadmaps for families; (3) asking and recording of chosen name/pronoun; (4) increased number of multidisciplinary gender clinics; (5) providing cross-sex hormones at an age that permits peer-congruent development; and (6) designating a navigator for transgender patients in clinics.
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Background: Sex differences in performance and regional brain activity during mental rotation have been reported repeatedly and reflect organizational and activational effects of sex hormones. We investigated whether adolescent girls with gender dysphoria (GD), before and after 10 months of testosterone treatment, showed male-typical brain activity during a mental rotation task (MRT). Methods: Girls with GD underwent fMRI while performing the MRT twice: when receiving medication to suppress their endogenous sex hormones before onset of testosterone treatment, and 10 months later during testosterone treatment. Two age-matched control groups participated twice as well. Results: We included 21 girls with GD, 20 male controls and 21 female controls in our study. In the absence of any group differences in performance, control girls showed significantly increased activation in frontal brain areas compared with control boys (pFWE = 0.012). Girls with GD before testosterone treatment differed significantly in frontal brain activation from the control girls (pFWE = 0.034), suggesting a masculinization of brain structures associated with visuospatial cognitive functions. After 10 months of testosterone treatment, girls with GD, similar to the control boys, showed increases in brain activation in areas implicated in mental rotation. Limitations: Since all girls with GD identified as gynephilic, their resemblance in spatial cognition with the control boys, who were also gynephilic, may have been related to their shared sexual orientation rather than their shared gender identity. We did not account for menstrual cycle phase or contraceptive use in our analyses. Conclusion: Our findings suggest atypical sexual differentiation of the brain in natal girls with GD and provide new evidence for organizational and activational effects of testosterone on visuospatial cognitive functioning.
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Lesbian, gay, and bisexual (LGB) youth experience elevated levels of depressive symptoms compared to heterosexual youth. This study examined how differences in depressive symptoms between heterosexual and LGB youth developed from late childhood to early adulthood. The association between sexual orientation and depressive symptoms was estimated from age 11 to 22 using data from the TRacking Adolescents’ Individual Lives Survey, a longitudinal Dutch cohort study. Of the 1738 respondents (54.8 % girls) that provided information on sexual orientation, 151 self-identified as LGB. In line with the Minority Stress Framework, it was tested whether self-reported peer victimization and parental rejection mediated the association between sexual orientation and depressive symptoms. Results indicated that LB girls and bisexuals were at increased risk of depressive symptoms already at age 11. The difference increased over time and was related to pubertal development in girls and bisexual individuals. Furthermore, self-reported peer victimization (for both boys and girls), as well as parental rejection (for girls/bisexuals), mediated the association between sexual orientation and depressive symptoms. The authors conclude that already in late childhood, associations between sexual orientation and depressive symptoms are found, partly due to minority stress mechanisms. Electronic supplementary material The online version of this article (doi:10.1007/s10964-015-0403-0) contains supplementary material, which is available to authorized users.
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Rationale Transgender people in the United States experience widespread prejudice, discrimination, violence, and other forms of stigma. Objective This critical review aims to integrate the literature on stigma towards transgender people in the US. Results This review demonstrates that transgender stigma limits opportunities and access to resources in a number of critical domains (e.g., employment, healthcare), persistently affecting the physical and mental health of transgender people. The applied social ecological model employed here elucidates that transgender stigma operates at multiple levels (i.e., individual, interpersonal, structural) to impact health. Stigma prevention and coping interventions hold promise for reducing stigma and its adverse health-related effects in transgender populations. Conclusion Additional research is needed to document the causal relationship between stigma and adverse health as well as the mediators and moderators of stigma in US transgender populations. Multi-level interventions to prevent stigma towards transgender people are warranted. DOI: http://dx.doi.org/10.1016/j.socscimed.2015.11.010
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Many studies, reviews, and meta-analyses have reported elevated mental health problems for sexual minority (SM) individuals. This systematic review provides an update by including numerous recent studies, and explores whether SM individuals are at increased risk across selected mental health problems as per dimensions of sexual orientation (SO), genders, life-stages, geographic regions, and in higher quality studies. A systematic search in PubMed produced 199 studies appropriate for review. A clear majority of studies reported elevated risks for depression, anxiety, suicide attempts or suicides, and substance-related problems for SM men and women, as adolescents or adults from many geographic regions, and with varied SO dimensions (behaviour, attraction, identity), especially in more recent and higher quality studies. One notable exception is alcohol-related problems, where many studies reported zero or reversed effects, especially for SM men. All SM subgroups were at increased risk, but bisexual individuals were at highest risk in the majority of studies. Other subgroup and gender differences are more complex and are discussed. The review supports the long-standing mental health risk proposition for SM individuals, overall and as subgroups.
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This chapter describes the negative impact that ongoing parental rejection can have on sexual and gender minority individuals and the importance of promoting parental acceptance. It then introduces and describes the structure and intervention strategies of relationship-focused therapy—a time-limited, experiential, family-based treatment specifically designed to increase parental acceptance, reduce parental rejection, and help sexual and gender minority individuals and their parents re-establish or develop loving, supportive, mutually respectful, meaningful relationships. Then, research findings supporting the model are summarized, a clinical vignette illustrating the treatment is presented, and some of the constraints and limitations of the model are noted.
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In 2015, marriage equality in the United States was a big win for the gay and lesbian movement. Marriage equality as a primary focus of the movement, however, was not without its critiques, particularly as an issue affecting mostly white, gay, economically secure individuals. Given the history of the movement, it is essential to ask what is next. Young queer and trans people represent the next generation of potential activists and advocates for queer and trans liberation, yet little empirical attention has been paid to their goals for the movement and motivations to be actively involved, particularly among young adults in rural, conservative states. Therefore, this study sought to understand the social, economic, and environmental issues deemed important by queer and trans young adults (aged 18–29), as well as their motivations to get involved in activism efforts. Data came from a mixed-methods program evaluation, which presents a picture of the issues and motivations that led study participants (n = 65) toward activism in one conservative, highly rural, Southwestern state in the United States. The findings of this study are discussed in light of theoretical and empirical literature and then implications for the queer and trans movement, activists, and organizers are offered.
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Few societal attitudes and opinions have changed as quickly as those regarding sexual minority people and rights. In the context of dramatic social change, there have been multiple policy changes toward social inclusion and rights for lesbian, gay, and bisexual (LGB) people, and perceptions that the sociocultural context for LGB people—perhaps particularly for youth—has improved. Yet recent evidence from the developmental sciences points to paradoxical findings: in many cases there have been growing rather than shrinking health disparities. The authors suggest that there is a developmental collision between normative adolescent developmental processes and sexual minority youth identities and visibility.
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BACKGROUND AND OBJECTIVES: Lesbian, gay, bisexual, transgender, and questioning (LGBTQ) youth are suggested to be overrepresented in unstable housing and foster care. In the current study, we assess whether LGBTQ youth are overrepresented in unstable housing and foster care and examine disparities in school functioning, substance use, and mental health for LGBTQ youth versus heterosexual youth in unstable housing and foster care. METHODS: A total of 895 218 students (10–18 years old) completed the cross-sectional California Healthy Kids Survey from 2013 to 2015. Surveys were administered in 2641 middle and high schools throughout California. Primary outcome measures included school functioning (eg, school climate, absenteeism), substance use, and mental health. RESULTS: More youth living in foster care (30.4%) and unstable housing (25.3%) self-identified as LGBTQ than youth in a nationally representative sample (11.2%). Compared with heterosexual youth and youth in stable housing, LGBTQ youth in unstable housing reported poorer school functioning (Bs = −0.10 to 0.40), higher substance use (Bs = 0.26–0.28), and poorer mental health (odds ratios = 0.73–0.80). LGBTQ youth in foster care reported more fights in school (B = 0.16), victimization (B = 0.10), and mental health problems (odds ratios = 0.82–0.73) compared with LGBTQ youth in stable housing and heterosexual youth in foster care. CONCLUSIONS: Disparities for LGBTQ youth are exacerbated when they live in foster care or unstable housing. This points to a need for protections for LGBTQ youth in care and care that is affirming of their sexual orientation and gender identity.
Article
Background: Preliminary evidence suggests that sexual minority (e.g. lesbian, gay, bisexual, and same-sex attracted) youth are overrepresented in child welfare services. Yet, no study to date has been able to test this hypothesis with national data. Objective: Using a two-study design, we test whether sexual minority youth are overrepresented in child welfare, foster care, and out-of-home placement using nationally representative data from the United States. Participants and setting: Study 1 data are from the National Longitudinal Study of Adolescent to Adult Health (n = 14,154; Mean age = 15.4). Study 2 data are from wave three of the National Survey of Child and Adolescent Well-Being II (n = 1309; Mean age = 15.0). Methods: For Study 1, we use adjusted logistic regression models to test differences in lifetime foster care involvement between sexual minority and heterosexual youth. In Study 2, we calculate a Disproportionality Representation Index (DRI) - a ratio of sample prevalence relative to the general population - to estimate whether sexual minority youth were overrepresented in child welfare and out-of-home care. Results: Study 1 results indicate that sexual minority youth are nearly 2.5 times as likely as heterosexual youth to experience foster care placement (aOR = 2.43, 95% CI 1.40, 4.21, p = .002). Results from Study 2 show that sexual minority youth were largely overrepresented in child welfare services (DRI = 1.95-2.48) and out-of-home placement (DRI = 3.69-4.68). Conclusions: Findings are the first to demonstrate sexual minority youth's overrepresentation in child welfare, foster care, and out-of-home placement using nationally representative data and emphasizes the need for focused research on sexual minority youth involved in the child welfare system.
Article
Studies of adults who experienced sexual orientation change efforts (SOCE) have documented a range of health risks. To date, there is little research on SOCE among adolescents and no known studies of parents’ role related to SOCE with adolescents. In a cross-sectional study of 245 LGBT White and Latino young adults (ages 21–25), we measured parent-initiated SOCE during adolescence and its relationship to mental health and adjustment in young adulthood. Measures include being sent to therapists and religious leaders for conversion interventions as well as parental/caregiver efforts to change their child’s sexual orientation during adolescence. Attempts by parents/caregivers and being sent to therapists and religious leaders for conversion interventions were associated with depression, suicidal thoughts, suicidal attempts, less educational attainment, and less weekly income. Associations between SOCE, health, and adjustment were much stronger and more frequent for those reporting both attempts by parents and being sent to therapists and religious leaders, underscoring the need for parental education and guidance.
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Turban and van Schalkwyk assert in their Translations article, “‘Gender Dysphoria’ and Autism Spectrum Disorder: Is the Link Real?,”¹ that an over-representation of autism spectrum disorder (ASD) in gender dysphoria is unsupported based on current evidence. They suggest that increases on ASD-related measures in transgender and gender-diverse groups are likely due to the nonspecificity of ASD screening tools (ie, false positives). They posit that findings of apparent ASD increases in gender-diverse youth might stem from “environmental factors related to social deprivation,” namely “a high prevalence of minority stress, poor peer relationships, and familial non-acceptance.” They suggest that in this context these social characteristics “could represent a reversible condition, because these patients do not have the intrinsic social cognitive deficits that underlie ASD.”
Article
Purpose: The current study examines differences between lesbian, gay, bisexual, and questioning (LGBQ) students and heterosexual students in terms of counseling and mental health services received (healthcare utilization), from whom students would seek help, and who contributed positively to students' ability to cope during a stressful period. Methods: An online survey was administered among 25,844 college students, enrolled in 76 schools (mean age = 25.52). The majority of participants was graduate students (42.81%) and reported their race/ethnicity as non-Hispanic White (70.49%). Results: Compared with their heterosexual counterparts, gay males and lesbian/gay and bisexual females reported receiving more counseling or mental health services, most notably from counselors, therapists, psychologists, and/or social workers. Bisexual males and LGBQ females were less likely to seek help from a parent or family member compared with heterosexual males and females, respectively. Racial/ethnic minority bisexual females were less likely to seek help from a friend or roommate than non-Hispanic White bisexual females. Compared with their heterosexual counterparts, gay and questioning males and LGBQ females were more likely to report that religion reduced their ability to cope. Conclusion: The current findings illuminate important differences by sexual orientation in terms of seeking and receiving mental health services. Although we found that lesbian/gay and bisexual college students were more likely to receive counseling and mental healthcare, we cannot ascertain whether they were satisfied with the services they received. The findings also suggest that certain groups of LGBQ students do not find support with their clergy and family, which may indicate a lack of understanding or acceptance of LGBQ issues.
Article
Sexual and gender minority (SGM) youth in nonmetropolitan communities face marginalization due to their SGM identities. Community support may mitigate the negative outcomes associated with marginalization. Using the strengths perspective, this study investigated the factors SGM youth identify as making their communities supportive. Interviews were conducted with SGM youth to explore their perceptions of their community, community climate, and the factors that contribute to making communities supportive to SGM youth. Findings revealed four supportive community factors: supportive people, SGM visibility, SGM resources and education, and SGM-inclusive policies. Implications include creating SGM resources and providing professional training on SGM issues.
Article
Background: Non-binary gender measurement has grown out of a need for accurate representation in scholarship and public health services available to a diverse gender population. Aims: The Genderqueer Identity Scale (GQI) was developed to allow for a multidimensional assessment of genderqueer identity, including non-binary identity, socially constructed versus essentialist gender, theoretical awareness of gender concepts, and gender fluidity. The GQI was designed to assess gender identity across a full spectrum of gender, at any age after mid-adolescence, and at various stages of gender identity development, including prior to, during, and after a gender transition, where applicable. Two of the GQI subscales focus on intrapersonal processes, while two focus on interpersonal processes. Methods: The measure was piloted and refined across four distinct samples: a U.S. university based LGBT sample, consecutive clinical referrals at the Center of Expertise on Gender Dysphoria in Amsterdam, the Netherlands, a Dutch LGB community sample, and an online survey forum (LGBTQ). Results: The first exploratory factor analysis identified minor potential adjustments, which were refined and retested. Researchers evaluated and cross-validated the hypothesized factor structure and determined that the three factor GQI subscales and the unidimensional Gender Fluidity measure yielded internally consistent and valid scores among transgender individuals seeking clinical treatment and LGB individuals within a community setting. The exploratory and confirmatory factor analyses provide evidence of good reliability, construct validity, and internal consistency of all four subscales. Discussion: The subscales were appropriate across a spectrum of gender identities and can be taken in the same form over time and across gender transition statuses, making them suitable for clinical evaluation and community based longitudinal research with trans-identified or gender nonconforming persons. The development of the GQI fills critical gaps in gender-related measurement including the ability to assess multiple dimensions of gender identity, and to assess gender identity across time.
Article
Objectives: To identify patterns of childhood adversity in a sample of adolescents and assess disparities in these experiences for lesbian, gay, bisexual, transgender, and questioning adolescents and by level of gender nonconformity. Method: By using the cross-sectional, statewide, anonymous 2016 Minnesota Student Survey, 81 885 students were included in the current study (50.59% male; mean age = 15.51). Participants were enrolled in grades 9 and 11 in a total of 348 schools. Results: Four patterns of childhood adversity were identified with sex-stratified latent class analyses (entropy = 0.833 males; 0.833 females), ranging from relatively low levels of abuse (85.3% males; 80.1% females) to polyvictimization (0.84% males; 1.98% females). A regression analysis showed that compared with heterosexual adolescents, gay, lesbian, bisexual, and questioning adolescents were more likely to be classified into profiles characterized by polyvictimization (odds ratio [OR] 1.81-7.53) and psychological and/or physical abuse (OR 1.29-3.12), than no or low adversity. Similarly, compared with nontransgender adolescents, transgender adolescents were more likely to be classified into profiles characterized by patterns of polyvictimization (OR 1.49-2.91) and psychological and/or physical abuse (OR 1.23-1.96). A higher level of gender nonconformity predicted a higher likelihood of being classified into each adversity profile compared with the no or low adversity profile (OR 1.14-1.45). Conclusions: Sexual minority adolescents and adolescents with high levels of gender nonconformity are vulnerable to experience adversity. The disparities for lesbian, gay, bisexual, transgender, and questioning adolescents and adolescents with high gender nonconformity highlight the variation in patterns of childhood adversity that these youth are at risk of experiencing. The findings reveal the need for further research on the benefits and harm of screening for childhood adversity by physicians and pediatricians.
Article
Purpose: This study aimed to examine the relation between chosen name use, as a proxy for youths' gender affirmation in various contexts, and mental health among transgender youth. Methods: Data come from a community cohort sample of 129 transgender and gender nonconforming youth from three U.S. cities. We assessed chosen name use across multiple contexts and examined its association with depression, suicidal ideation, and suicidal behavior. Results: After adjusting for personal characteristics and social support, chosen name use in more contexts was associated with lower depression, suicidal ideation, and suicidal behavior. Depression , suicidal ideation, and suicidal behavior were lowest when chosen names could be used in all four contexts. Conclusion: For transgender youth who choose a name different from the one given at birth, use of their chosen name in multiple contexts affirms their gender identity and reduces mental health risks known to be high in this group.
Article
The purpose of this study was to examine rural versus non-rural differences in the following risk factors among sexual minority adults: victimization/discrimination, fundamental religiosity, identification and involvement in the lesbian, gay, bisexual, and transgender (LGBT) community, social support, and level of comfort disclosing sexual identity to others. The study recruited sexual minority individuals via online communications to LGBT organizations. Of the total sample (N = 699), 23.3% resided in rural areas and 76.7% resided in non-rural areas. A MANCOVA was conducted to determine if there was a significant overall relation of rural versus non-rural location to the five risk factors of interests, while controlling for age, sex, race, relationship status, and sexual identity. Post hoc ANCOVAs were then conducted to explore the specific directionality of the significant differences. Results revealed rural sexual minorities reported greater identification with fundamental religious beliefs, less comfort in disclosing their sexual identity to others, more experiences of victimization and discrimination, less identification with and involvement in the LGBT community, and less perceived social support when compared to their non-rural counterparts. These findings suggest sexual minorities residing in rural areas may experience increased exposure to negative risk factors. Implications for mental health providers working with rural sexual minorities are discussed.
Article
Outside the immediate classroom setting, efforts within other school spaces also can shape school climate, address inequality, and affect student performance. Nevertheless, in this respect there has been little research on school-based extracurricular groups focused on issues of social inclusion and justice. An exception to this lack of focus has been Gay-Straight Alliances (GSAs), which promote social inclusion and justice for sexual and gender minority youth (e.g., lesbian, gay, bisexual, transgender, or questioning youth; LGBTQ) through support, socializing, education, and advocacy. As this literature has matured, we detail and provide examples of the following conceptual and methodological recommendations to address emerging research needs for GSAs: (1) Move from a monolithic to contextualized treatment of GSAs, (2) attend to heterogeneity among members, (3) utilize multiple data sources for triangulation, (4) apply a range of methodological approaches to capitalize on strengths of different designs, (5) collect longitudinal data over short-term and extended time periods, and (6) consider GSAs within a broader umbrella of youth settings. Further, we note ways in which these recommendations apply to other student groups organized around specific sociocultural identities. These advances could produce more comprehensive empirically supported models to guide GSAs and similar groups on how to promote resilience among their diverse members and address broader social issues within their schools.
Article
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.
Article
Objective No representative population-based studies of youth in the US exist on gender identity-related disparities in suicidal ideation or on factors that underlie this disparity. To address this, we: (1) examined gender identity-related disparities in the prevalence of suicidal ideation; (2) evaluated whether established psychosocial factors explained these disparities; and (3) identified correlates of suicidal ideation among all youth and stratified by gender identity. Method Data were derived from the 2013-2015 California Healthy Kids Survey (CHKS; N=621,189) and a weighted subsample representative of the Californian student population (Biennial Statewide California Student Survey [CSS; N = 28,856]). Results Prevalence of past 12-month self-reported suicidal ideation was nearly twice as high for transgender compared to non-transgender youth (33.73% versus 18.85%; χ² = 35.48, p <.001). In fully adjusted models within the representative sample, transgender youth had 2.99 higher odds (95% CI: 2.25, 3.98) of reporting past-year suicidal ideation compared to non-transgender youth. Among transgender youth, only depressive symptoms (AOR: 5.44, 95% CI:1.81, 16.38) and victimization (AOR: 2.66, 95 CI%: 1.26, 5.65) remained significantly associated with higher odds of suicidal ideation in fully adjusted models. In multiple mediation analyses, depression attenuated the association between gender identity and suicidal ideation by 17.95%, and victimization by 14.71%. Conclusion This study uses the first representative population-based sample of youth in the US that includes a measure of gender identity to report on gender identity-related disparities in suicidal ideation and to identify potential mechanisms underlying this disparity in a representative sample.
Article
Background and aims: Although sexual orientation-related alcohol use disparities are well established, researchers have not identified whether disparities are diminishing as societal attitudes towards lesbian/gay and bisexual (LGB) people become more accepting. We examined changes in four alcohol-related disparities between heterosexual and LGB youth from 1998 to 2013 by (1) estimating the prevalence of these behaviors; (2) estimating disparities in alcohol-related outcomes between heterosexual and LGB youth within each wave year; and (3) testing whether the degree of difference in alcohol-related disparities between heterosexual and LGB youth has changed. Design: Logistic regression models and year × sexual orientation interactions with repeated, cross-sectional, provincially representative data. Setting: British Columbia, Canada. Participants: Students (ages 12-19) from the 1998 (n = 22 858), 2003 (n = 29 323), 2008 (n = 25 254) and 2013 (n = 21 938) British Columbia Adolescent Health Survey (total n = 99 373, 48.7% male, mean age = 14.84). Measurements: We modeled age-adjusted differences in life-time alcohol use, age of onset, past 30-day drinking and past 30-day heavy episodic drinking between heterosexual and three subgroups of sexual minority youth (i.e. mostly heterosexual, bisexual and lesbian/gay). Findings: Generally, alcohol use declined for all youth, although less so among LGB youth [average adjusted odds ratio (aOR) = 0.58 and aOR = 0.53 for heterosexual males and females and aOR = 0.71 and aOR = 0.57 for sexual minority males and females, respectively). Within-year comparisons demonstrated elevated rates of alcohol use among LGB compared with heterosexual youth for each of the four survey years, especially among females. Findings indicate few changes over time; however, results show an increase in risky alcohol use from 1998 to 2013 among mostly heterosexual (aOR = 1.58 for life-time alcohol use, aOR = 1.58 for 30-day alcohol use and aOR = 1.34 for 30-day heavy episodic drinking), and bisexual (aOR = 1.95 for life-time alcohol use) females. Conclusion: Despite the general decline in the prevalence of alcohol use among young people in Canada since 1998, lesbian/gay and bisexual youth in Canada continue to show elevated rates of alcohol use compared with heterosexual youth.
Article
Sexual minority youth are more likely to run away from home or experience homelessness, leaving them at increased risk of victimization and negative health outcomes. In this study, the authors use a developmental perspective that considers both vulnerable beginnings in families and the risky trajectories that follow to explore the connections between running away or being thrown out by parents and sexual minority women's and men's health in adulthood. Using four waves of data from the National Longitudinal Study of Adolescent to Adult Health (Add Health), the authors consider multiple dimensions of health and several potential intervening mechanisms. Findings suggest that runaway and thrownaway experiences have persistent negative effects on health into adulthood, in part because of their association with sexual victimization, educational attainment, and relationships with parents. Sexual minority men who have been thrown out by parents report a greater likelihood of suicidal ideation, smoking, and substance use into adulthood. Sexual minority women with runaway experiences have poorer health and increased depressive symptoms, while women with thrownaway experiences engage in more health risk behaviors. Sexual victimization stands out as a key mechanism for sexual minority women's health, as more than half of these young women report experiences of sexual victimization.
Article
Purpose: This study documented the prevalence of mental health problems among transgender youth in Canada and made comparisons with population-based studies. This study also compared gender identity subgroups and age subgroups (14-18 and 19-25). Methods: A nonprobability sample of 923 transgender youth from Canada completed an online survey. Participants were recruited through community organizations, health care settings, social media, and researchers' networks. Mental health measures were drawn from the British Columbia Adolescent Health Survey and the Canadian Community Health Survey. Results: Transgender youth had a higher risk of reporting psychological distress, self-harm, major depressive episodes, and suicide. For example, 65% of transgender 14- to 18-year olds seriously considered suicide in the past year compared with 13% in the British Columbia Adolescent Health Survey, and only a quarter of participants reported their mental health was good or excellent. Transgender boys/men and nonbinary youth were most likely to report self-harm and overall mental health remained stable across age subgroups. Conclusions: Although a notable minority of transgender youth did not report negative health outcomes, this study shows the mental health disparities faced by transgender youth in Canada are considerable.
Article
Sexual minority adolescents (lesbian, gay, bisexual) experience disparities in behavioral health outcomes compared to their heterosexual peers, generally attributed to minority stress. Although evidence of the applicability of the minority stress model among adolescents exists, it is based on a primarily adult literature. Developmental and generational differences demand further examination of minority stress to confirm its applicability. Forty-eight life history interviews with sexual minority adolescents in California (age 14–19; M = 19.27 SD = 1.38; 39.6% cismale, 35.4% cisfemale, 25% other gender) were completed, recorded, transcribed, and analyzed using thematic analysis in QSR NVivo. Following a consensus model, all transcripts were double coded. Results suggest that minority stress is appropriate for use with adolescents; however, further emphasis should be placed on social context, coping resources, and developmental processes regarding identity development. A conceptual model is provided, as are implications for research and practice.
Article
Objectives: Despite evidence from numerous studies that document disparities in suicidality for sexual minorities, few have investigated whether or not these trends have improved over time, which is the objective of the current study. Methods: Using school-based population data over a 15-year period (1998 to 2013), multivariate logistic regressions were used to calculate age-adjusted odds ratios separately by gender. Interactions were included to test widening or narrowing disparities within orientation groups, which makes this one of the first studies to test whether gaps in disparities between heterosexual and sexual minorities have widened or narrowed over time. Results: Results show that sexual minority youth are persistently at a greater risk for suicidal behaviour, a trend that has continued particularly for bisexual youth of both sexes. Results also suggest that the gap in suicidal behaviour is widening among some female sexual orientation groups, yet narrowing for other male sexual orientation groups. Conclusions: These findings have important public health implications, especially since we see decreases in suicidal behaviour for heterosexual adolescents, but not in the same way for many sexual minority youth, despite advances in social acceptance of gay, lesbian, and bisexual issues in North America.
Article
Objective: Social transitions are increasingly common for transgender children. A social transition involves a child presenting to other people as a member of the "opposite" gender in all contexts (e.g., wearing clothes and using pronouns of that gender). Little is known about the well-being of socially transitioned transgender children. This study examined self-reported depression, anxiety, and self-worth in socially transitioned transgender children compared with 2 control groups: age- and gender-matched controls and siblings of transgender children. Method: As part of a longitudinal study (TransYouth Project), children (9-14 years old) and their parents completed measurements of depression and anxiety (n = 63 transgender children, n = 63 controls, n = 38 siblings). Children (6-14 years old; n = 116 transgender children, n = 122 controls, n = 72 siblings) also reported on their self-worth. Mental health and self-worth were compared across groups. Results: Transgender children reported depression and self-worth that did not differ from their matched-control or sibling peers (p = .311), and they reported marginally higher anxiety (p = .076). Compared with national averages, transgender children showed typical rates of depression (p = .290) and marginally higher rates of anxiety (p = .096). Parents similarly reported that their transgender children experienced more anxiety than children in the control groups (p = .002) and rated their transgender children as having equivalent levels of depression (p = .728). Conclusion: These findings are in striking contrast to previous work with gender-nonconforming children who had not socially transitioned, which found very high rates of depression and anxiety. These findings lessen concerns from previous work that parents of socially transitioned children could be systematically underreporting mental health problems.
Article
In this article, we review theory and evidence on stigma and minority stress as social/structural determinants of health among lesbian, gay, bisexual, and transgender (LGBT) youth. We discuss different forms of stigma at individual (eg, identity concealment), interpersonal (eg, victimization), and structural (eg, laws and social norms) levels, as well as the mechanisms linking stigma to adverse health outcomes among LGBT youth. Finally, we discuss clinical (eg, cognitive behavioral therapy) and public health (eg, antibullying policies) interventions that effectively target stigma-inducing mechanisms to improve the health of LGBT youth.
Article
Although use of social networking sites has been linked to both positive and negative changes in young people's mental health, it is likely that these contributions may vary based on users' motivations and social status. For sexual minority youth, for example, the sites could provide means for social support and connections with like-minded others. Accordingly, our study sought to examine the relations between sexual minority youth's social networking site use and their social support, sexual identity strength, and mental health. We conducted an online survey, sampling 146 sexual minority youth respondents (M = 21 years; SD = 2.87 years) and 477 heterosexual youth respondents (M = 20 years; SD = 2.76 years). Results indicated that although both sexual minority and heterosexual youth use social networking sites at equal rates, sexual minority youth indicated that they use sites more for identity development and social communication. Moreover, using sites for general identity expression or exploration predicted negative mental health outcomes, whereas using sites specifically for sexual identity development predicted positive mental health outcomes. These results provide greater insight into how social networking sites may impact the mental health of marginalized groups, and provide a framework for understanding differences in social networking site use by sexuality.
Article
Homophobic bullying is a pervasive issue in U.S. schools. Broadly, two distinct approaches to address bullying include punitive versus supportive practices. Few studies have considered these approaches in the context of school connectedness in relation to homophobic bullying. Drawing from theories of social support and control, we argue that supportive practices should reduce homophobic bullying and promote school connectedness. Further, although punitive practices may deter homophobic bullying, they also compromise school connectedness, except perhaps among students who have been bullied. Supportive practices could be especially important for promoting school connectedness for students who experience homophobic bullying. Using teacher (n = 62,448) and student (n = 337,945) data from 745 high schools that participated in the California School Climate Survey and the California Healthy Kids Survey, our study examines the association between teacher reports of punitive versus supportive practices, and student experiences of homophobic bullying and school connectedness. We also interrogate differential effects of punitive and supportive practices on school connectedness for students who have and have not experienced homophobic bullying. Results indicate that supportive, but not punitive, practices are associated with less homophobic bullying and higher school connectedness. Supportive practices also serve as a protective factor for students who have experienced homophobic bullying. Additionally, students in schools with less supportive practices, and who have not experienced homophobic bullying, report low levels of school connectedness comparable with students who have been bullied. Implications for school policy related to supporting students at risk for being bullied and school disconnectedness are discussed.
Article
This study analyzed the content of 125 unique reports published since 1990 that have examined the health and well-being—as well as the interpersonal and contextual experiences—of sexual minority youth of color (SMYoC). One-half of reports sampled only young men, 73% were non-comparative samples of sexual minority youth, and 68% of samples included multiple racial-ethnic groups (i.e., 32% of samples were mono-ethnic/racial). Most reports focused on health-related outcomes (i.e., sexual and mental health, substance use), while substantially fewer attended to normative developmental processes (i.e., identity development) or contextual and interpersonal relationships (i.e., family, school, community, or violence). Few reports intentionally examined how intersecting oppressions and privileges related to sexual orientation and race-ethnicity contributed to outcomes of interest. Findings suggest that research with SMYoC has been framed by a lingering deficit perspective, rather than emphasizing normative developmental processes or cultural strengths. The findings highlight areas for future research focused on minority stress, coping, and resilience of SMYoC.
Article
Homophobic and transphobic bullying, through teasing, physical violence, and other forms of aggression, is a problem that affects lesbian, gay, bisexual, and transgender students at all levels of education. Even though there have been legal changes in Mexico to protect human rights of lesbian, gay, bisexual, and transgender people, schools are spaces where discrimination and violence toward them are still common. In 2012, using an online survey asking participants about their experiences with bullying, its consequences, and responses from adults, the authors collected responses from 912 participants younger than 30 years of age who self-identified as lesbian, gay, bisexual, or transgender and who lived in the 32 states of Mexico. Two thirds of participants said that they were victims of bullying during their school years; the majority of these students indicated that they did not have support from teachers or parents to avoid or stop the violence. The consequences of bullying were truancy, dropouts, depression, and suicide attempts. Attitudes that normalize bullying may impede the effective prevention of or response to homophobic and transphobic bullying by teachers and parents. To eliminate homophobic bullying in school, there is a need for sexual diversity trainings for teachers and media campaigns for the general public.
Article
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.
Article
Today's lesbian, gay, bisexual, and transgender (LGBT) youth come out at younger ages, and public support for LGBT issues has dramatically increased, so why do LGBT youth continue to be at high risk for compromised mental health? We provide an overview of the contemporary context for LGBT youth, followed by a review of current science on LGBT youth mental health. Research in the past decade has identified risk and protective factors for mental health, which point to promising directions for prevention, intervention, and treatment. Legal and policy successes have set the stage for advances in programs and practices that may foster LGBT youth mental health. Implications for clinical care are discussed, and important areas for new research and practice are identified. Expected final online publication date for the Annual Review of Clinical Psychology Volume 12 is March 28, 2016. Please see http://www.annualreviews.org/catalog/pubdates.aspx for revised estimates.
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In Feminist, Queer, Crip Alison Kafer imagines a different future for disability and disabled bodies. Challenging the ways in which ideas about the future and time have been deployed in the service of compulsory able-bodiedness and able-mindedness, Kafer rejects the idea of disability as a pre-determined limit. She juxtaposes theories, movements, and identities such as environmental justice, reproductive justice, cyborg theory, transgender politics, and disability that are typically discussed in isolation and envisions new possibilities for crip futures and feminist/queer/crip alliances. This bold book goes against the grain of no.
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Bullying is common in U.S. schools and is linked to emotional, behavioral, and academic risk for school-aged students. School policies and practices focused on sexual orientation and gender identity (SOGI) have been designed to reduce bullying and show promising results. Most studies have drawn from students' reports: We examined teachers' reports of bullying problems in their schools along with their assessments of school safety, combined with principals' reports of SOGI-focused policies and practices. Merging two independent sources of data from over 3000 teachers (California School Climate Survey) and nearly 100 school principals (School Health Profiles) at the school level, we used multi-level models to understand bullying problems in schools. Our results show that SOGI-focused policies reported by principals do not have a strong independent association with teachers' reports of bullying problems in their schools. However, in schools with more SOGI-focused policies, the association between teachers' assessments of school safety and bullying problems is stronger. Recent developments in education law and policy in the United States and their relevance for student well-being are discussed.