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Pregnant trans men at risk for depression and lack of care, Rutgers study finds

Older transgender men who become pregnant need better mental health care than female counterparts.

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Transgender men who become pregnant are at increased risk for depression and difficulty getting medical care due to a lack of knowledge among health care providers, a Rutgers study reports.

The study, published in the journal Maturitas, examined health care research on transgender men who become pregnant at or after age 35 to determine their medical and mental health needs.

“Despite the increased visibility of transgender people — there are about 1.4 million who have transitioned in the United States — medical providers are largely unprepared to care for them and most have had limited educational opportunities,” said lead author Justin Brandt, an assistant clinical professor in the Department of Obstetrics, Gynecology and Reproductive Sciences at Rutgers Robert Wood Johnson Medical School.

Transgender men who have transitioned hormonally and are taking testosterone but retain their female reproductive organs have the potential to become pregnant. Since the U.S. medical system has been tracking these patients as female, no data exists on how many transgender men give birth each year, but Brandt said the number is likely higher than people realize. While some plan to become pregnant, the research suggests that unintended pregnancies occur in up to 30 percent of transgender men.

According to the U.S. Transgender Survey, nearly 40 percent of its 28,000 respondents reported attempting suicide — nearly nine times the national average. That risk can be increased in transgender men with the unwanted physical changes resulting from pregnancy, according to Brandt. “The process of transitioning is long and arduous, and pregnancy, which is regarded as a feminine condition, forces these men to almost fully transition back to their sex assigned at birth, which can worsen gender dysphoria,” he said.

Surveys used to screen pregnant and postpartum females for depression are not designed to assess the impact of pregnancy on gender dysphoria in transgender men.

The study also found that nearly 25 percent of transgender people reported negative health care experiences in the last year. This correlates with the finding that about 44 percent of pregnant transgender men seek medical care outside of traditional care with an obstetrician. Rather, they may seek out non-physician providers, such as nurse midwives, with 17 percent delivering outside of hospitals — a higher rate than with women.

Although data is limited on how transgender men give birth, the review found that 64 percent had vaginal births and 25 percent requested cesarean delivery.

The report also noted that transgender men who requested cesarean deliveries reported feeling uncomfortable with their genitalia being exposed for long periods of time while those who went through labor reported that the process of giving birth vaginally overcame any negative feelings that they had with the female gender that they had been assigned at birth.

“Although Rutgers physicians have not yet had a pregnant transgender male patient, our healthcare professionals are trained and ready,” Brandt said.

The researchers also found that about 51 percent of transgender men breast or chest fed their infants even if they had breast surgery.

Brandt recommended that transgender men planning to conceive should visit their doctor before becoming pregnant to address routine issues, such as folic acid supplementation and screening for genetic disorders, and to be counseled on the risks of advanced-age pregnancy, such as infertility, miscarriage, gestational diabetes and pre-term delivery. Transgender men also likely will need to update health screenings that could have lapsed during transition, such as pap smears and, when indicated for those who have not had chest surgery, mammograms.

After delivery, Brandt said doctors should address long-acting and reversible methods of contraception if the individual is at risk for unplanned pregnancy. “Transgender men who intend to restart testosterone after delivery may decide to defer contraception since they perceive that their male hormone therapy induces a state of infertility, which is not always the case,” he said.

Co-authors included Amy Patel, Ian Marshall and Gloria A. Bachmann at Rutgers Robert Wood Johnson Medical School.

Health & Wellness

Evidence supports physical distancing, masks, and eye protection to help prevent COVID-19

A comprehensive review of existing evidence supports physical distancing of two meters or more to prevent person-to-person transmission of COVID-19. Face masks and eye protection decrease the risk of infection, too.

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Image created by Alana Naylor. Submitted for United Nations Global Call Out To Creatives - help stop the spread of COVID-19.

A comprehensive review of existing evidence supports physical distancing of two meters or more to prevent person-to-person transmission of COVID-19, says an international team led by McMaster University and St. Joseph’s Healthcare Hamilton.

Face masks and eye protection decrease the risk of infection, too.

The systematic review and meta-analysis was commissioned by the World Health Organization. The findings were published in The Lancet.

“Physical distancing likely results in a large reduction of COVID-19,” said lead author Holger Schünemann, professor of the departments of health research methods, evidence, and impact, and medicine at McMaster.

Schünemann is co-director of the World Health Organization (WHO) Collaborating Centre for Infectious Diseases, Research Methods and Recommendations. He also is director of Cochrane Canada and McMaster GRADE Centre.

“Although the direct evidence is limited, the use of masks in the community provides protection, and possibly N95 or similar respirators worn by health-care workers suggest greater protection than other face masks,” Schünemann said. “Availability and feasibility and other contextual factors will probably influence recommendations that organizations develop about their use. Eye protection may provide additional benefits.”

The systematic review was conducted by a large, international collaborative of researchers, front-line and specialist clinicians, epidemiologists, patients, public health and health policy experts of published and unpublished literature in any language.

They sought direct evidence on COVID-19 and indirect evidence on related coronaviruses causative of Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS). The team used Cochrane methods and the Grading of Recommendations, Assessment, and Evaluation (GRADE) approach which is used world-wide to assess the certainty of evidence.

They identified no randomized control trials addressing the three coronaviruses but 44 relevant comparative studies in health-care and non-health-care (community) settings across 16 countries and six continents from inception to early May 2020.

The authors noted more global, collaborative, well-conducted studies of different personal protective strategies are needed. For masks, large randomized trials are underway and are urgently needed.

The scientific lead is Derek Chu, a clinician scientist in the departments of health research methods, evidence, and impact, and medicine at McMaster and an affiliate of the Research Institute of St. Joe’s Hamilton.

“There is an urgent need for all caregivers in health-care settings and non-health-care settings to have equitable access to these simple personal protective measures, which means scaling up production and consideration about repurposing manufacturing,” said Chu.

“However, although distancing, face masks, and eye protection were each highly protective, none made individuals totally impervious from infection and so, basic measures such as hand hygiene are also essential to curtail the current COVID-19 pandemic and future waves.”

The work was funded by the World Health Organization and involved close collaboration with the American University of Beirut, Lebanon and many international partners.

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Health & Wellness

Bullying is common factor in LGBTQ youth suicides, Yale study finds

Death records of LGBTQ youth who died by suicide were substantially more likely to mention bullying as a factor than their non-LGBTQ peers.

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Researchers at the Yale School of Public Health have found that death records of LGBTQ youth who died by suicide were substantially more likely to mention bullying as a factor than their non-LGBTQ peers. The researchers reviewed nearly 10,000 death records of youth ages 10 to 19 who died by suicide in the United States from 2003 to 2017.

The findings are published in the current issue of JAMA Pediatrics.

While LGBTQ youth are more likely to be bullied and to report suicidal thoughts and behaviors than non-LGBTQ youth, this is believed to be the first study showing that bullying is a more common precursor to suicide among LGBTQ youth than among their peers.

“We expected that bullying might be a more common factor, but we were surprised by the size of the disparity,” said lead author Kirsty Clark, a postdoctoral fellow at Yale School of Public Health. “These findings strongly suggest that additional steps need to be taken to protect LGBTQ youth — and others — against the insidious threat of bullying.”

Death records from LGBTQ youths were about five times more likely to mention bullying than non-LGBTQ youths’ death records, the study found. Among 10- to 13-year-olds, over two-thirds of LGBTQ youths’ death records mentioned that they had been bullied.

Bullying is a major public health problem among youth, and it is especially pronounced among LGBTQ youth, said the researchers. Clark and her co-authors used data from the National Violent Death Reporting System, a Centers for Disease Control and Prevention (CDC)-led database that collects information on violent deaths, including suicides, from death certificates, law enforcement reports, and medical examiner and coroner records.

Death records in the database include narrative summaries from law enforcement reports and medical examiner and coroner records regarding the details of the youth’s suicide as reported by family or friends, the youth’s diary, social media posts, and text or email messages, as well as any suicide note. Clark and her team searched these narratives for words and phrases that suggested whether the individual was LGBTQ. They followed a similar process to identify death records mentioning bullying.

“Bullies attack the core foundation of adolescent well-being,” said John Pachankis, the Susan Dwight Bliss Associate Professor of Public Health at the Yale School of Public Health and study co-author. “By showing that bullying is also associated with life itself for LGBTQ youth, this study urgently calls for interventions that foster safety, belonging and esteem for all young people.”

Other authors on the study include Anthony J. Maiolatesi, doctoral student at Yale School of Public Health, and Susan Cochran, professor at UCLA Fielding School of Public Health.

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Health & Wellness

Gender affirmation linked with trans, gender nonbinary youth mental health improvement

Having accessed multiple steps of gender affirmation (social, legal, and medical/surgical) was associated with fewer symptoms of depression and less anxiety. Furthermore, engaging in gender affirmation processes helped youth to develop a sense of pride and positivity about their gender identity and a feeling of being socially accepted.

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Enabling transgender and gender nonbinary youth to access gender affirmation processes is good.

This is according to a study – “Gender Affirmation Is Associated with Transgender and Gender Nonbinary Youth Mental Health Improvement” – done by Anna Martha Vaitses Fontanari, Felipe Vilanova, Maiko Abel Schneider, Itala Chinazzo, Bianca Machado Soll, Karine Schwarz, Maria Inês Rodrigues Lobato, and Angelo Brandelli Costa; and which appeared in LGBT Health.

The study aimed to evaluate the impact of each domain of gender affirmation (social, legal, and medical/surgical) on the mental health of transgender and gender nonbinary youth. To do this, 350 transgender boys, transgender girls, and gender nonbinary Brazilian youth, aged from 16 to 24 years old, were asked to answer an online survey.

Among the 350 participants, a total of 149 (42.64%) youth identified as transgender boys, 85 (24.28%) identified as transgender girls, and 116 (33.14%) identified as gender nonbinary youth. The mean age was 18.61 (95% confidence interval 18.34–18.88) years. Having accessed multiple steps of gender affirmation (social, legal, and medical/surgical) was associated with fewer symptoms of depression and less anxiety. Furthermore, engaging in gender affirmation processes helped youth to develop a sense of pride and positivity about their gender identity and a feeling of being socially accepted.

“Enabling transgender and gender nonbinary youth to access gender affirmation processes more easily should be considered as a strategy to reduce depression and anxiety symptoms, as well as to improve gender positivity,” the researchers stated.

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Health & Wellness

Impact of children’s loneliness today could manifest in depression for years to come

Young people who are lonely might be as much as three times more likely to develop depression in the future, and that the impact of loneliness on mental health could last for at least 9 years.

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Children and adolescents are likely to experience high rates of depression and anxiety long after current lockdown and social isolation ends and clinical services need to be prepared for a future spike in demand, according to the authors of a new rapid review into the long-term mental health effects of lockdown.

The research, which draws on over 60 pre-existing, peer-reviewed studies into topics spanning isolation, loneliness and mental health for young people aged 4 – 21, is published in the Journal of the American Academy of Child and Adolescent Psychiatry.

According to the review, young people who are lonely might be as much as three times more likely to develop depression in the future, and that the impact of loneliness on mental health could last for at least 9 years.

The studies highlight an association between loneliness and an increased risk of mental health problems for young people. There is also evidence that duration of loneliness may be more important than the intensity of loneliness in increasing the risk of future depression among young people.

This, say the authors, should act as a warning to policymakers of the expected rise in demand for mental health services from young people and young adults in the years to come – both here in the UK and around the world.

Dr Maria Loades, clinical psychologist from the Department of Psychology at the University of Bath who led the work, explained: “From our analysis, it is clear there are strong associations between loneliness and depression in young people, both in the immediate and the longer-term. We know this effect can sometimes be lagged, meaning it can take up to 10 years to really understand the scale of the mental health impact the covid-19 crisis has created.”

For teachers and policymakers currently preparing for a phased re-start of schools in the UK, scheduled from today, Monday 1 June, Dr Loades suggests the research could have important implications for how this process is managed too.

She adds: “There is evidence that it’s the duration of loneliness as opposed to the intensity which seems to have the biggest impact on depression rates in young people. This means that returning to some degree of normality as soon as possible is of course important. However, how this process is managed matters when it comes to shaping young people’s feelings and experiences about this period.

“For our youngest and their return to school from this week, we need to prioritise the importance of play in helping them to reconnect with friends and adjust following this intense period of isolation.”

Members of the review team were also involved in a recent open letter to UK Education Secretary, Gavin Williamson MP, focusing on support for children’s social and emotional wellbeing during and after lockdown.

In their letter they suggested that:

  • The easing of lockdown restrictions should be done in a way that provides all children with the time and opportunity to play with peers, in and outside of school, and even while social distancing measures remain in place;
  • Schools should be appropriately resourced and given clear guidance on how to support children’s emotional wellbeing during the transition period as schools reopen and that play – rather than academic progress – should be the priority during this time;
  • The social and emotional benefits of play and interaction with peers must be clearly communicated, alongside guidance on the objective risks to children.

Acknowledging the trade-offs that need to be struck in terms of restarting the economy and reducing educational disparities, their letter to the Education Secretary concludes: ‘Poor emotional health in children leads to long term mental health problems, poorer educational attainment and has a considerable economic burden.’

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Health & Wellness

Binge drinkers beware, ‘Drunkorexia’ is calling

Excess alcohol consumption combined with restrictive and disordered eating patterns is extremely dangerous and can dramatically increase the risk of developing serious physical and psychological consequences, including hypoglycaemia, liver cirrhosis, nutritional deficits, brain and heart damage, memory lapses, blackouts, depression and cognitive deficits.

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Mojito, appletini or a simple glass of fizz – they may take the edge off a busy day, but if you find yourself bingeing on more than a few, you could be putting your physical and mental health at risk according new research at the University of South Australia.

Examining the drinking patterns of 479 female Australian university students aged 18-24 years, the world-first empirical study explored the underlying belief patterns than can contribute to “Drunkorexia” – a damaging and dangerous behavior where disordered patterns of eating are used to offset negative effects of consuming excess alcohol, such as gaining weight.

Concerningly, researchers found that a staggering 82.7 per cent of female university students surveyed had engaged in “Drunkorexic” behaviors over the past three months. And, more than 28 per cent were regularly and purposely skipping meals, consuming low-calorie or sugar-free alcoholic beverages, purging or exercising after drinking to help reduce ingested calories from alcohol, at least 25 per cent of the time.

Clinical psychologist and lead UniSA researcher Alycia Powell-Jones says the prevalence of Drunkorexic behaviours among Australian female university students is concerning.

“Due to their age and stage of development, young adults are more likely to engage in risk-taking behaviors, which can include drinking excess alcohol,” Powell-Jones says. “Excess alcohol consumption combined with restrictive and disordered eating patterns is extremely dangerous and can dramatically increase the risk of developing serious physical and psychological consequences, including hypoglycaemia, liver cirrhosis, nutritional deficits, brain and heart damage, memory lapses, blackouts, depression and cognitive deficits.”

She added that “certainly, many of us have drunk too much alcohol at some point in time, and we know just by how we feel the next day, that this is not good for us, but when nearly a third of young female uni students are intentionally cutting back on food purely to offset alcohol calories; it’s a serious health concern.”

The harmful use of alcohol is a global issue, with excess consumption causing millions of deaths, including many thousands of young lives.

In Australia for instance, one in six people consume alcohol at dangerous levels, placing them at lifetime risk of an alcohol-related disease or injury. The combination of excessive alcohol intake with restrictive eating behaviors to offset calories can result in a highly toxic cocktail for this population.

The study was undertaken in two stages. The first measured the prevalence of self-reported, compensative and restrictive activities in relation to their alcohol consumption.

The second stage identified participants’ Early Maladaptive Schemes (EMS) – or thought patterns – finding that that the subset of schemas most predictive of Drunkorexia were ‘insufficient self-control’, ’emotional deprivation’ and ‘social isolation’.

Powell-Jones says identifying the early maladaptive schemas linked to Drunkorexia is key to understanding the harmful condition.

These are deeply held and pervasive themes regarding oneself and one’s relationship with others, that can develop in childhood and then can influence all areas of life, often in dysfunctional ways. Early maladaptive schemas can also be influenced by cultural and social norms.

Drunkorexic behaviour appears to be motivated by two key social norms for young adults – consuming alcohol and thinness.

“This study has provided preliminary insight into better understanding why young female adults make these decisions to engage in ‘Drunkorexic’ behaviors,” Powell-Jones says. “Not only may it be a coping strategy to manage social anxieties through becoming accepted and fitting in with peer group or cultural expectations, but it also shows a reliance on avoidant coping strategies.”

It is recommended for clinicians, educators, parents and friends to be aware of the factors that motivate young women to engage in this harmful and dangerous behavior, including cultural norms, beliefs that drive self-worth, a sense of belonging, and interpersonal connectedness.

“By being connected, researchers and clinicians can develop appropriate clinical interventions and support for vulnerable young people within the youth mental health sector,” Powell-Jones says.

Worth highlighting: Alcoholism is a big issue in the LGBTQIA community.

A 2017 study found that bisexual people had higher odds of engaging in alcohol use behaviors when compared with people from the sexual majority. This study also found that bullying mediated sexual minority status and alcohol use more particularly among bisexual females.

Still in 2017, another study noted higher levels of alcohol use among men who have sex with men (MSM), which is closely associated with intimate partner violence (IPV). The same study found that over half of MSM experienced IPV, and just under half of MSM perpetrating IPV themselves, including physical, sexual, emotional or HIV-related IPV.

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Health & Wellness

Greater availability of non-alcoholic drinks may reduce alcohol consumption

The findings suggest that interventions to encourage healthier food and drink choices may be most effective when changing the relative availability of healthier and less-healthy options.

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People are more likely to opt for non-alcoholic drinks if there are more of them available than alcoholic drinks, according to a study published in the open access journal BMC Public Health.

A team of researchers at the NIHR Bristol Biomedical Research Centre, and the Universities of Bristol and Cambridge, UK found that when presented with eight drink options, participants were 48% more likely to choose a non-alcoholic drink when the proportion of non-alcoholic drink options increased from four (50%) to six (75%). When the proportion of non-alcoholic drink options decreased from four to two (25%), participants were 46% less likely to choose a non-alcoholic drink.

Dr Anna Blackwell, the corresponding author said: “Alcohol consumption is among the top five risk factors for disease globally. Previous research has shown that increasing the availability of healthier food options can increase their selection and consumption relative to less healthy food. To our knowledge, this is the first study to demonstrate that increasing the availability of non-alcoholic drinks, relative to alcoholic drinks in an online scenario, can increase their selection.”

Participants in the study completed an online task in which they were presented with a selection of alcoholic beer, non-alcoholic beer and soft-drinks. The drink selections included four alcoholic and four non-alcoholic drinks, six alcoholic and two non-alcoholic drinks or two alcoholic and six non-alcoholic drinks. 808 UK residents with an average age of 38 years who regularly consumed alcohol participated in the study.

When presented with mostly non-alcoholic drinks, 49% of participants selected a non-alcoholic drink, compared to 26% of participants who selected a non-alcoholic drink when presented with mostly alcoholic drinks. These results were consistent regardless of the time participants had to make their decision, indicating that the findings were not dependent on the amount of time and attention participants were able to devote to their drink choice. The findings suggest that interventions to encourage healthier food and drink choices may be most effective when changing the relative availability of healthier and less-healthy options.

Anna Blackwell said: “Many licensed venues already offer several non-alcoholic options but these are often stored out of direct sight, for example in low-level fridges behind the bar. Our results indicate that making these non-alcoholic products more visible to customers may influence them to make healthier choices. The market for alcohol-free beer, wine and spirit alternatives is small but growing and improving the selection and promotion of non-alcoholic drinks in this way could provide an opportunity for licensed venues to reduce alcohol consumption without losing revenue.”

The authors caution that as the study measured hypothetical drink selection online, results may differ in real-world settings. Further studies are needed to determine how the relative availability of non-alcoholic and alcoholic drinks impacts the purchasing and consumption of alcohol in real life.

Alcoholism is a big issue in the LGBTQIA community.

In 2017, a study found that bisexual people had higher odds of engaging in alcohol use behaviors when compared with people from the sexual majority. This study also found that bullying mediated sexual minority status and alcohol use more particularly among bisexual females.

Still in 2017, another study noted higher levels of alcohol use among men who have sex with men (MSM), which is closely associated with intimate partner violence (IPV). The same study found that over half of MSM experienced IPV, and just under half of MSM perpetrating IPV themselves, including physical, sexual, emotional or HIV-related IPV.

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