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Gender identity conversion efforts associated with adverse mental health outcomes

Reported exposure to conversion efforts before the age of 10 also was associated with greater lifetime odds of suicide attempts.

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“Conversion efforts” to try to change a person’s gender identity to match their sex assigned at birth were associated with increased likelihood of adverse mental health outcomes, including suicide attempts.

This is according to a study helmed by Jack L. Turban, M.D., M.H.S., of the Massachusetts General Hospital, Boston.

The study, tiled “Association Between Recalled Exposure to Gender Identity Conversion Efforts and Psychological Distress and Suicide Attempts Among Transgender Adults”, and which appeared in JAMA Psychiatry, involved nearly 28,000 transgender adults from across the US. This observational study is based on the results of a survey distributed through community outreach to transgender adults in all 50 states, the District of Columbia, some territories and overseas U.S. military bases.

Of 27,715 transgender adults who responded, 19,741 (71.3%) reported having spoken to a secular or religious professional about their gender identity, and of these, 3,869 (19.6%) reported exposure to gender identity conversion efforts.

That exposure was associated with severe psychological distress during the previous month and prior suicide attempts during their lifetime compared with transgender adults who reported talking about their gender identity with a professional but weren’t exposed to conversion efforts.

Reported exposure to conversion efforts before the age of 10 also was associated with greater lifetime odds of suicide attempts.

Limitations of the study include its inability to determine causation; it didn’t capture conversion efforts by others such as family members; and it’s possible that some adults with worse mental health might have sought conversion therapy.

The study findings support that gender identity conversion efforts should be avoided in children and adults. Professional organizations, including the American Psychiatric Association, have called conversion therapy for gender identity unethical and ineffective, and some countries have already outlawed the practice.

Health & Wellness

Experiencing police violence worsens mental health in distinct ways

Simply put, the experience of police violence puts Black, Latino, Indigenous, and sexual minority communities at higher risk of distinct mental health problems, in addition to greater risk of death at the hands of police.

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The experience of police violence is associated with mental and emotional trauma distinct from that caused by other kinds of violence, creating a public health crisis for communities most affected.

Simply put, the experience of police violence puts Black, Latino, Indigenous, and sexual minority communities at higher risk of distinct mental health problems, in addition to greater risk of death at the hands of police, according to the paper.

The study is authored by a group of researchers at several universities, including UC Riverside, who have been examining the mental health effects of police violence at the population level for several years.

“It’s a public health issue because police violence is not experienced equally in our society but instead has a disproportionate effect on the mental health of racial, ethnic, and sexual minorities,” said Bruce Link, a UC Riverside distinguished professor of sociology and public policy. “The point of our paper is to indicate why the experience of police violence is uniquely stressful and therefore particularly impactful.”

People who have experienced police violence have few options for redress. They must report incidents to the same police departments that abused them in the first place.

Psychologists agree that trauma spurs biological or psychological changes that manifest over time as psychiatric symptoms, particularly when the trauma is sexually or physically violent. Research on stressful life events, especially uncontrollable events, has attempted to provide a broader framework for how stress may affect a person’s usual activities, goals, and values, but until recently this approach has not been applied to police violence.

Link, along with Jordan DeVylder of Fordham University and Lisa Fedina of the University of Michigan, reviewed numerous studies of the effects of police violence on mental health in a paper called “Impact of police violence on mental health: a theoretical framework,” and identified eight factors distinct to police violence.

Police violence is state sanctioned

Unlike most other forms of violence, police violence is embedded in a history of state-enforced practices that permitted cruel, unusual, and dehumanizing punishment of individuals deemed to be from so-called “dangerous classes,” particularly Blacks. Communities of color and LGBTQ communities have been historically subjected to discriminatory laws, such as Jim Crow laws and sodomy laws, which permitted harassment and excessive and fatal force against individuals from these communities.

The police are a pervasive presence

Police are everywhere, especially in low-income communities of color. People who have experienced violent or stressful encounters with police have no way to avoid being around constant reminders of these painful experiences, or the fear of future encounters.

There are limited options for recourse

People who have experienced police violence have few options for redress. They must report incidents to the same police departments that abused them in the first place. Police are authorized to use force in a wide variety of situations and survivors have to prove that the violence was not legitimate. Because they have few options for reporting an incident, for legal recourse, or for advocacy services and referrals to mental health treatment, any mental health symptoms they have may worsen over time.

Police culture deters internal accountability

Violence committed through institutions, rather than interpersonal relationships, is supported by organizational cultures that condone it. Police often maintain a code of silence around violence and therefore often fail to hold each other accountable. This amounts to gaslighting survivors who do report incidents, potentially worsening mental health symptoms.

Police violence alters deeply held beliefs

Many are taught that police protect them and their communities from various dangers and help in emergencies. A single violent encounter can shatter this belief for an individual, but when police violence is the norm, instead of an isolated incident, the community at large loses trust in the police as an institution and, often correctly, comes to regard them as part of the problem.

Racial and economic disparities in exposure

Police violence is disproportionately directed at people of color, especially Blacks and Latinos, potentially leading to diminished feelings of self-worth and value within American society.

Police violence is stigmatizing

Because police are allowed to use force in many situations, survivors of police violence are often blamed for the encounter. Their actions are heavily scrutinized and faulted to justify the officers’ actions, especially by members of groups that benefit from the social order policing upholds. Moreover, many people have friends and relatives who work as police officers, making it feel like a betrayal to report incidents of police violence.

Police are typically armed

Unlike police in many countries, American police carry firearms and police departments have become heavily militarized. Police are given broad latitude to determine when and how to deploy force. Every interaction with police holds the possibility of violence, and for communities subjected to routine overpolicing, this threat brings additional challenges for mental health.

The researchers call for a framework to examine the mental health consequences of police violence that takes into account these points. However, implicit in their analysis are solutions for the public health crisis caused by police violence, such as demilitarizing police, holding police accountable when untoward events occur, ending the overpolicing of communities of color, providing better reporting options and support for survivors of police violence, and policies that build mutual trust between police and the communities they are meant to serve.

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Health & Wellness

Lesbian, gay and bisexual people more likely to suffer migraines; discrimination may be to blame

Many members of sexual minority groups experience prejudice, stigma, and discrimination termed sexual minority stress, which could trigger or exacerbate migraine. Furthermore, members of sexual minority groups may encounter barriers to health care and experience greater physical and mental health problems, which could contribute to migraine.

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Members of the LGBTQIA community may have migraines at a higher rate than their straight counterparts, according to a study that suggested that this may be due to sexual minority stress brought about by prejudice, stigma and discrimination.

The study – “Disparities Across Sexual Orientation in Migraine Among US Adults” – was published in the journal JAMA.

Dr. Jason Nagata, lead author of the study, told Insider that the study was actually not able to evaluate why sexual minorities might experience migraines at a higher rate than straight people. However, “lesbian, gay and bisexual people may experience prejudice and discrimination which can lead to stress and trigger a migraine… They may also face barriers to accessing health care which can lead to worsened health,” he was quoted as saying.

For this study, the sample consisted of 9,894 adults, with a mean age of 37.33 years, of whom 51.0% (n = 5705) were women and 49.0% men (n = 4189). Participants identified as exclusively heterosexual (n = 8426 [85.8%]), mostly heterosexual (n = 1062 [10.0%]), or lesbian, gay, or bisexual (n = 406 [4.2%]).

Migraine was measured based on self-report in response to the interview question, “Have you ever had five or more headaches that were at least four hours long; one-sided, pulsating, intense, or worsened by activity; and associated with nausea, vomiting, or sensitivity to light or sound?”. This was consistent with the International Classification of Headache Disorders, third edition diagnostic criteria for migraine without aura.

Sexual orientation was categorized into three categories: exclusively heterosexual; mostly heterosexual but somewhat attracted to people of one’s own sex; or lesbian, gay, or bisexual, as has been previously categorized.

Logistic regression analysis was conducted using Stata version 15.1 (StataCorp) with sexual orientation as the independent variable and migraine as the dependent variable, adjusting for sex, race/ethnicity, age, education, income, smoking, and alcohol use1 and incorporating national sample weighting.

The study noted that prevalence of migraine was higher among individuals who reported being mostly heterosexual (n = 327 [30.3%]) and lesbian, gay, or bisexual (n = 112 [30.7%]) compared with those who reported being exclusively heterosexual (n = 1631 [19.4%]).

In its analysis, the researchers noted that “many members of sexual minority groups experience prejudice, stigma, and discrimination termed sexual minority stress, which could trigger or exacerbate migraine. Furthermore, members of sexual minority groups may encounter barriers to health care and experience greater physical and mental health problems, which could contribute to migraine.”

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Health & Wellness

With childhood sexual abuse, mental and physical after-effects closely linked

The key takeaway from this study is that one-sided treatment – one that addresses just the psychological after-effects or just the physical trauma – is inadequate. There is a need to follow a combined approach to treatment that doesn’t view these issues as separate.

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A Canadian study reveals that the psychological and physical effects of childhood sexual abuse are closely tied. The finding could help healthcare professionals develop more effective interventions and ultimately improve mental and physical health outcomes for survivors of abuse in childhood.

Authored by Pascale Vézina-Gagnon, a PhD candidate at Université de Montréal’s Department of Psychology, under the supervision of Professor Isabelle Daigneault, the study is published today in Health Psychology.

Twice as many diagnoses

The long-term consequences of childhood sexual abuse on survivors’ health have only been recognized recently.

An initial study of 1,764 children and adolescents, published in 2018, showed that girls who survived substantiated cases of sexual abuse received 2.1 times as many diagnoses of urinary health issues and 1.4 times as many diagnoses of genital health issues than girls in the general population.

This finding prompted a subsequent study to determine why and how sexual-abuse survivors suffered from genitourinary problems more often than their peers in the general population.

Specifically, the second study aimed to gain a better understanding of this phenomenon by testing the theory that increased psychological distress is partly responsible for the higher incidence of genitourinary issues – such as urinary tract infections, vaginitis and pain during sex or menstruation – among childhood sexual-abuse survivors.

‘A combined approach to treatment’

“The key takeaway from this study is that one-sided treatment – one that addresses just the psychological after-effects or just the physical trauma – is inadequate,” said Vézina-Gagnon. “We need to follow a combined approach to treatment that doesn’t view these issues as separate.”

She added: “Interdisciplinary care is increasingly becoming the standard, and that’s the message we hope our research sends to general practitioners, pediatricians, urologists, gynecologists, psychologists and psychiatrists so that they can help children recover as much as possible.”

This is the first study to look at the relationship between genitourinary and psychological issues over such a long period of time – more than a decade – in such a large sample of child survivors of substantiated sexual abuse versus a comparison group.

1,322 girls studied

The researchers used medical data provided by Quebec’s public health insurance agency, the Régie de l’assurance maladie du Québec, and the Quebec Ministry of Health and Social Services. The study involved 661 girls between the ages of 1 and 17 who survived one or more instances of substantiated sexual abuse and a comparison group of 661 girls from the general population.

The researchers had access to anonymized data on genitourinary and mental health diagnoses received following medical consultations or hospital stays the girls went through between 1996 and 2013. Several variables were taken into account, such as socioeconomic status, the number of years of access to medical data, and individual predispositions to genitourinary health problems before the sexual abuse occurred.

Childhood sexual abuse includes fondling and petting, oral sex, actual or attempted penetration, voyeurism, indecent exposure, inducement to engage in sexual activity and sexual exploitation (prostitution).

‘A wider range of psychiatric issues’

“The results show that girls who were sexually abused were more likely to see a health professional for a wider range of psychiatric issues–anxiety, mood disorders, schizophrenia or substance abuse–than girls in the comparison group,” said Vézina-Gagnon. “These consultations were also associated with more frequent medical appointments or hospitalizations for genital and urinary issues in the years after the sexual abuse was reported.”

The researchers also found that the more girls consulted their doctors or were hospitalized for multiple psychiatric issues (so-called comorbid psychiatric disorders) after experiencing abuse, the more importantly this explained subsequent genital health issues (62%) and urinary health issues (23%). This difference observed between genital and urinary health (62% vs. 23%) may be explained by factors not included in this study, said Vézina-Gagnon.

The key takeaway from this study is that one-sided treatment – one that addresses just the psychological after-effects or just the physical trauma – is inadequate. There is a need to follow a combined approach to treatment that doesn’t view these issues as separate.

“Additional studies are needed to investigate this difference and determine whether other important variables – ones that we didn’t have information on, such as the severity, length and frequency of the abuse -could be associated with more severe genitourinary health outcomes,” she said.

Two hypotheses offered

“On an emotional and behavioural level, two hypotheses can be formulated to explain these findings,” said Vézina-Gagnon. The first is that the association is due to a hypervigilant response. Survivors of sexual abuse who are affected by several mental health issues – such as anxiety, depression and post-traumatic stress disorder – may become hypervigilant or more likely to notice symptoms related to their genital or urinary health, which would lead them to see their doctor more frequently.

“In contrast,” she continued, “the second hypothesis is that the association is caused by avoidant behaviour. Survivors may put off or avoid asking for help or seeing a doctor for genitourinary issues, thereby increasing the risk that such problems deteriorate or become chronic conditions. Gynecological care may trigger memories of past abuse (due to the imbalance of power between patients and doctors, the removal of clothing, feelings of vulnerability and physical pain) and it may therefore be especially difficult for these girls.”

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Toward a holistic approach

The study’s findings align with the scientific literature on health psychology and abuse, and once again highlight how important it is to consider the relationship between physical and mental health,” said Vézina-Gagnon. A holistic approach (body-mind approach) is therefore needed to help girls recover from sexual trauma, she maintains.

“In light of these findings, healthcare practitioners should assess the level of psychological distress experienced by survivors of childhood sexual abuse who report genitourinary issues and direct them to the right mental health resources” Vézina-Gagnon said.

“The researchers behind this study believe that early and targeted intervention to reduce psychological distress among survivors may be helpful in preventing genitourinary issues from deteriorating or turning into chronic conditions.”

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Health & Wellness

Transgender people who experience discrimination likelier to have poor mental health

Protective factors, such as support from friends, family, and the community, appeared to mitigate the negative impact of discrimination and stigma.

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Transgender people who experienced stigma, including harassment, violence and discrimination because of their identity are more likely to have poor mental health outcomes. Sadly, the study also shows that over half (51%) of transgender people experienced discrimination for being transgender.

This is according to a study from the University of Waikato, via a study involving 1,178 people who completed a national Aotearoa/New Zealand survey. The findings were published in the International Journal of Transgender Health,.

For this study, a team of experts from Waikato, and the University of Otago, assessed the results of the 2018 ‘Counting Ourselves’ survey – a community-based questionnaire of transgender people living in Aotearoa/New Zealand. They specifically analyzed the extent that stigma and discriminatory experiences alongside protective factors such as the support of friends, family, neighbors and communities, are related to the mental health of transgender people in Aotearoa/New Zealand.

The results show that 23% of transgender people had been verbally harassed in public venues, including public transport, retail stores and restaurants for being transgender. Also, more than one-third (39%) had been victimized through cyberbullying.

According to the study’s lead author, Kyle Tan, the findings show that experiences of gender minority stress are strongly associated with mental health, including suicide; and that positive, protective factors appear to act as a buffer against this.

“One quarter (25%) of transgender participants who had high levels of discrimination, harassment and violence, and low levels of support from friends, family and community, had attempted suicide in the last year. However, only 3% of those who with low levels of discrimination, harassment, and violence and high levels of protective factors had attempted suicide. This means that those with lower risk factors and higher protective factors were more than eight times less likely to have attempted suicide,” Tan said.

Principal investigator Dr. Jaimie Veale added that these mental health inequities mean that transgender people should be a named priority in mental health and addiction policies. “To improve the mental health and wellbeing of transgender people, we need to address the stigma and discrimination that they face. We also need to protect transgender people from violence, as a priority in sexual and domestic violence work.”

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Health & Wellness

LBG individuals use stimulants at higher rates than heterosexuals

Higher drug use among LGB individuals is likely a result of minority stress – that is, the fact that exposure to stigma and discrimination based on sexual orientation results in health disparities. Structural stigma (e.g. employment or housing discrimination) drives psychological and physical health morbidities among LGB populations, and perceived stigma is associated with cocaine use.

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Lesbian, gay and bisexual (LGB) individuals report higher rates of medical, non-medical, and illegal stimulant use compared to heterosexuals, mirroring patterns seen in other substance use.

The study by Columbia University Mailman School of Public Health researchers provides the most detailed picture to date on stimulant use by LGB subgroups and gender. Findings are published in the American Journal of Preventive Medicine.

The researchers analyzed data from the 2015-2017 National Survey on Drug Use and Health to examine associations between sexual identity and past-year use of medical and non-medical stimulants (i.e., Adderall, Ritalin) and illegal stimulants (i.e. cocaine, crack, methamphetamine). They found that bisexual women’s illegal stimulant use in the past year was fivefold that of heterosexual women (7.8% vs. 1.5%), while gay men’s use was threefold that of heterosexual men (9.2% vs. 3.2%).

Non-medical use of prescription stimulants was higher among gay and bisexual men than heterosexual men (5.4% and 6.6% vs. 2.4%) and among gay/lesbian and bisexual women versus heterosexual women (3.3% and 6.8% vs. 1.6%). Past-year medical use of prescription stimulants was higher among gay men than heterosexual men (6.6% vs. 4.1%) and bisexual women than heterosexual women (7.9% vs. 4.9%). There were no differences between bisexual men and women compared to their gay/lesbian counterparts.

Potential consequences of stimulant include substance use disorder and overdose, particularly given increases in fentanyl contamination in illegally produced pills and cocaine and methamphetamine. As many as half of LGB individuals who reported nonmedical and illegal stimulant use also reported nonmedical prescription opioid use.

“This study highlights the need for future interventions to target stimulant use among LGB populations, with a particular focus on harm reduction approaches,” says first author Morgan Philbin, PhD, assistant professor of sociomedical sciences. “The findings have important implications across sexual identities, and demonstrate the need to disaggregate stimulant use by subgroup and gender, particularly related to polysubstance use.”

Higher drug use among LGB individuals is likely a result of minority stress – that is, the fact that exposure to stigma and discrimination based on sexual orientation results in health disparities. Structural stigma (e.g. employment or housing discrimination) drives psychological and physical health morbidities among LGB populations, and perceived stigma is associated with cocaine use.

Bisexuals can also experience “double discrimination” from heterosexuals and lesbian and gay communities, which the researchers say may account for the particularly high substance use among bisexual individuals.

The paper outlines several avenues to address stimulant use, including by educating healthcare providers who focus on LGB communities to screen for and discuss substance use, including stimulants. Communities and providers can also scale-up access to medication disposal and harm reduction services.

The researchers note that their dataset started assessing sexual identity among adults in 2015, so these relationships could not be examined in earlier years or among adolescents. The options for gender included only “male” or “female” and thus did not allow researchers to differentiate between transgender and cis-gender individuals. The dataset does not assess sexual behavior, so this study only captured associations based on individuals’ sexual identity.

Authors include Morgan M. Philbin, Emily R. Greene, Silvia S. Martins, and Pia M. Mauro of the Columbia Mailman School; and Natalie LaBossier of Boston University School of Medicine.

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Health & Wellness

Gender harassment and institutional betrayal in high school take toll on mental health

97% of women and 96% of men from a pool of 535 undergraduate college students had endured at least one instance of gender harassment during high school. Experiences of gender harassment, especially for those who encountered it repeatedly, were associated with clinically relevant levels of trauma-related symptoms in college.

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High school students who endure gender harassment in schools that don’t respond well enter college and adulthood with potential mental health challenges, according to a University of Oregon study.

The study, published last month in PLOS ONE, found that 97% of women and 96% of men from a pool of 535 undergraduate college students had endured at least one instance of gender harassment during high school.

Experiences of gender harassment, especially for those who encountered it repeatedly, were associated with clinically relevant levels of trauma-related symptoms in college.

“We found that the more gender harassment and institutional betrayal teens encounter in high school, the more mental, physical and emotional challenges they experience in college,” said lead author Monika N. Lind, a UO psychology doctoral student. “Our findings suggest that gender harassment and institutional betrayal may hurt young people, and educators and researchers should pay more attention to these issues.”

The study, the three-member UO team noted, served to launch academic research into the responses of high schools to gender harassment, beyond media reports of institutional betrayal by schools since the #MeToo movement began.

Gender harassment, a type of sexual harassment, is characterized by sexist remarks, sexually crude or offensive behavior and the enforcement of traditional gender roles.

Institutional betrayal, a label coined previously by the study’s co-author UO psychologist Jennifer Freyd, is the failure of an institution, such as a school, to protect people who depend on it. A high school mishandling a case of gender harassment reported by a student is an example of institutional betrayal.

“The more gender harassment and institutional betrayal teens encounter in high school, the more mental, physical and emotional challenges they experience in college,” said lead author Monika N. Lind.

Participants included 363 females, 168 males, three non-binary and one who did not report gender; they were initially not aware of the study’s focus.

They completed a 20-item gender harassment questionnaire about their high school experiences and a 12-item questionnaire about their schools’ actions or inactions. Trauma symptoms were assessed with a 40-item checklist that explores common posttraumatic symptoms such as headaches, memory problems, anxiety attacks, nightmares, sexual problems and insomnia.

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An analysis that considered gender, race, age, gender harassment, institutional betrayal, and the interaction of gender harassment and institutional betrayal significantly predicted trauma-related symptoms, but, Lind said, a subtle surprise emerged.

“We expected to find an interaction effect showing that the relationship between gender harassment and trauma-related symptoms depends on institutional betrayal, such that people who experience high gender harassment have different levels of symptoms depending on how much institutional betrayal they experience,” she said. “Instead we found that gender harassment and institutional betrayal are independently related to trauma-related symptoms.”

That issue, Lind said, needs to be further explored. It’s possible, she said, that the pool of students wasn’t large enough or that the measures used were not robust enough. Another factor may be that the study focused more on institutional betrayal than impacts of institutional courage.

“This is like measuring mood and only letting respondents report negative to neutral mood – you’re missing a bunch of variability that might be captured if you extended the scale to go from negative to positive,” she said. “Expanding the scale to capture institutional courage might increase the likelihood of identifying a meaningful interaction.”

Experiences of gender harassment, especially for those who encountered it repeatedly, were associated with clinically relevant levels of trauma-related symptoms in college.

How schools might respond to the issues identified in the study should begin with listening to students, Lind said. Asking about problems and listening to responses is an example of institutional courage. Interventions that do not do so often fail.

“Schools should engage in self-study, including interviews, focus groups and anonymous surveys of students, and they should take students’ reports and suggestions seriously,” Lind said. “When you’re trying to intervene in adolescence, you’ll do better if you demonstrate respect for teens’ autonomy and social status.”

Researchers have not focused on such issues in high schools, where students are emerging into early adulthood from the physical, neurological and psychological changes occurring in adolescence, said Freyd, a pioneer in academic research on issues of sexual harassment, institutional betrayal and institutional courage.

“Until now, all of the education-focused institutional betrayal research has considered the experiences of undergraduate and graduate-level college students, as well as those of faculty members,” she said. “There also has been work on these issues in the military and workplaces, but we don’t know a lot about gender harassment or institutional betrayal in adolescence.”

UO doctoral student Alexis A. Adams-Clark, a member of Freyd’s lab, was the study’s third co-author.

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