The experiences of gender diverse and trans children and youth considering and initiating medical interventions in Canadian gender-affirming speciality clinics

Abstract

Background: Canadian specialty clinics offering gender-affirming care to trans and gender diverse children and youth have observed a significant increase in referrals in recent years, but there is a lack of information about the experiences of young people receiving care. Furthermore, treatment protocols governing access to gender-affirming medical interventions remain a topic of debate.

Aims: This qualitative research aims to develop a deeper understanding of experiences of trans youth seeking and receiving gender-affirming care at Canadian specialty clinics, including their goals in accessing care, feelings about care and medical interventions they have undergone, and whether they have any regrets about these interventions.

Methods: The study uses an adapted Grounded Theory methodology from social determinants of health perspective. Thirty-five trans and gender diverse young people aged 9 to 17?years were recruited to participate in semi-structured interviews through the specialty clinics where they had received or were waiting for gender-affirming medical interventions such as puberty blockers, hormone therapy, and surgery.

Results: Young people felt positively overall about the care they had received and the medical interventions they had undergone, with many recounting an improvement in their well-being since starting care. Most commonly shared frustrations concerned delays in accessing interventions due to clinic waiting lists or treatment protocols. Some youth described unwanted medication side-effects and others said they had questioned their transition trajectory at certain moments in the past, but none regretted their choice to undergo the interventions.

Discussion: The results suggest that trans youth and gender diverse children are benefiting from medical gender-affirming care they receive at specialty clinics, providing valuable insight into their decision-making processes in seeking care and specific interventions. Providers might consider adjusting aspects of treatment protocols (such as age restrictions, puberty stage, or mental health assessments) or applying them on a more flexible, case-by-case basis to reduce barriers to access.     

Health disparities between binary and non binary trans people: A community-driven survey

Abstract

Background: Genderqueer and nonbinary () people have remained largely invisible in health research. Previous research shows worse outcomes on health indicators for trans people when compared with cisgender controls, but the differences between binary trans and GQNB individuals are inconclusive.

Aims: To compare overall health and well-being of GQNB people with controls of trans men and trans women, taking into account the impact of the additive effect of their socio-economic position, as well as their current need for gender affirming medical interventions.

Methods: A community-driven survey was conducted in 2016 in five countries (Georgia, Poland, Serbia, Spain, and Sweden). Self-reported health and general well-being were analysed for differences between binary trans and GQNB respondents. The effects of multiple control variables (age, economic situation, educational level, belonging to an ethnic, religious, sexual or ability minority group, sex assigned at birth) as well as the current need for gender affirming medical interventions were controlled for.

Results: The sample consisted of 853 respondents aged 16 and older, with 254 trans women (29.8%), 369 trans men (43.2%), and 230 GQNB people (26%). GQNB respondents showed significantly worse self-reported health and worse general well-being in comparison to binary trans respondents. Additional negative impacts of having a lower educational level, having more economic stress, and belonging to a disability minority group were found. Being in need of gender affirming medical interventions contributed significantly to worse self-reported health, whereas being younger contributed to worse general well-being.

Discussion: In understanding health disparities between binary trans and GQNB people, it is necessary to take into account the additive effect of multiple socio-economic positions, and the current need for gender affirming medical interventions. The high proportion of GQNB respondents who report worse health outcomes highlights the need for policy makers and health-care providers in creating nonbinary-inclusive environments.     

Blood and organ donation: health impact,prevalence, correlates,and interventions

Abstract

Objective: Without a supply of blood, health services could not meet their clinical needs. Similarly, organs for transplantation save and transform lives. Donations are acts of generosity that are traditionally seen as altruistic, and accordingly, interventions to recruit and retain blood and organ donors have focused on altruism. We review the predictors, prevalence and correlates of these two behaviours, how effective interventions have been, and draw common themes.

Design: Narrative review.

Results: We highlight that both recipients and donors benefit, and as such neither blood nor organ donation is purely altruistic. We also highlight health problems associated with both types of donation. In evaluating interventions, we highlight that a move to an opt-out policy for organ donation may not be the simple fix it is believed to be, and propose interventions to enhance the effectiveness of an opt-in policy (e.g. social media updates). We show that incentives, text messaging, feedback and a focus on prosocial emotions (e.g. ‘warm-glow’, ‘gratitude’) may be effective interventions for both blood and organ donation. Interventions designed to reduce fainting (e.g. water pre-loading) are also effective for blood donation.

Conclusions: We conclude that affect is key to understanding both types of donation and in designing effective interventions.     

Systematic review of the effectiveness of interpersonal coach education interventions on athlete outcomes

ObjectivesTo systematically review and evaluate the literature on the effectiveness of coach education interventions. Specifically, we aimed to: (a) describe the non-formal coach education interventions aimed at coaches' interpersonal knowledge base, (b) highlight underpinning theoretical models, (c) assess the methodological quality of articles evaluating these interventions, (d) identify participant characteristics, and (e) establish the effect of these interventions on athletes' cognitive, affective, and behavioural outcomes.DesignSystematic review of published empirical research.MethodPublished English language articles were identified using electronic databases and manual searches of reference lists. The quality of the identified articles was assessed using the Effective Public Health Practice Project (EPHPP) tool.ResultsFour interventions fulfilled the inclusion criteria and were thus systematically reviewed. Overall, education interventions based on coach effectiveness training and achievement goal theory produced mixed effects on a variety of athlete outcomes, such as anxiety, self-esteem, fear of failure, and motivational orientation.ConclusionsDue to the diversity in athlete outcomes and intervention design, it is difficult to draw firm conclusions around the effectiveness of coach education interventions. The small number of identified interventions highlights the current paucity of empirical data on coach education intervention effectiveness. More research is needed to further our understanding of intervention effectiveness to allow for growth and improvement in coach education. Furthermore, theory-based, rather than “theory inspired” coach education interventions are required.     

Resilience Processes in Context

Abstract

This article considers resilience as a multiplicity of psychological characteristics that are shaped by the ecological interplay of relational, social, and cultural contexts. Bronfenbrenner's (1979) person-process-context model of human development is examined in terms of its implications for research and for both micro- and macro-level interventions. Attention is given to “the first context” and to the role of early attachment in the cultivation of resilient functioning. Attachment theory and research are reviewed. Themes are extracted from this research to suggest how psychotherapy with trauma survivors can mobilize the resilient capacities of trauma survivors and function as a reparative context. Implications of an ecological perspective and attachment theory and research for national and community-level interventions are considered.     

Psychological intervention with couples coping with breast cancer: A systematic review

Objective: Information about psychological intervention with couples coping with breast cancer is not well-disseminated. This can be explained, at least in part, by the absence of knowledge about the efficacy of this kind of intervention. The aim of the present systematic review is to identify and describe psychological interventions for couples coping with breast cancer and evaluate their efficacy.

Design: Studies identified by a searching multiple literature databases related to health and psychology between 1975 and 2013. Rigorous inclusion and exclusion criteria were utilised.

Results: Of 129 abstracts, 13 were extracted for further analysis and a final ten studies were deemed eligible for inclusion. Data were extracted from each study regarding study sample characteristics, design, results and methodological limitations. The results obtained were mixed in regard to efficacy, although the overwhelming majority of studies (eight studies) found benefits for both women and their partners in some dimensions, such as quality of life, psychological distress, relationship functioning and physical symptoms associated with cancer.

Conclusion: Psychological interventions for couples coping with breast cancer appear to be effective for both women and their partners. However, further studies are needed to evaluate the efficacy of couple-based interventions and, to identify for whom and how they are more effective.     

The State of Dyadic Methodology: An Analysis of the Literature on Interventions for Military Couples

ABSTRACT

Military members and their spouses experience unique stressors compared with civilian couples, making them distinctively vulnerable to a number of marital and mental health concerns. However, the amount and quality of intervention research to guide treatment for military couples are unknown. Therefore, a systematic literature search of interventions for military couples was completed resulting in 10 articles that met the study's inclusion and exclusion criteria. Further, a rubric to assess dyadic methodology was created and utilized to determine the dyadic quality of the methodology of the sampled articles. The results of the systematic literature review revealed that (a) there are few evidence-based interventions for military couples in which both members of the dyad are included and (b) the methodology by which treatments are evaluated largely do not employ systemic or dyadic measures. Recommendations for future research with military couples includes the need for couple-focused interventions using experimental methodology, systemic theories to guide intervention and research, and appropriate dyadic assessment and analysis tools to determine the effectiveness of couple's interventions for military, reserve, and veteran populations.     

Research Concerning Children of Battered Women

SUMMARY

Although the negative impact on children exposed to spouse abuse is well documented, little empirical research is available to guide clinical interventions. A brief review of the research literature describing these detrimental influences on children's adjustment is presented. Factors are discussed which mediate the consequences for children exposed to spouse abuse. These variables include those that are child-related as well as factors which are situational/contextual. Next, several theoretical/conceptual models are presented to assist with an understanding of how this impact on youngsters' psychological and emotional functioning takes place. These models suggest both direct and indirect mechanisms of influence. Finally, recommendations regarding clinical interventions are delineated based on these models as well as the available literature on the treatment of children of battered women. Suggestions related to appropriate types of treatment, including symptom-and mechanism-specific interventions, are made.     

Interventions for children and adolescents who stutter: A systematic review,meta-analysis,and evidence map

PurposeThis systematic review critically appraises and maps the evidence for stuttering interventions in childhood and adolescence. We examine the effectiveness of speech-focused treatments, the efficacy of alternative treatment delivery methods and identify gaps in the research evidence.MethodsNine electronic databases and three clinical trial registries were searched for systematic reviews, randomised controlled trials (RCTs) and studies that applied an intervention with children (2–18 years) who stutter. Pharmacological interventions were excluded. Primary outcomes were a measure of stuttering severity and quality assessments were conducted on all included studies.ResultsEight RCTs met inclusion criteria and were analysed. Intervention approaches included direct (i.e. Lidcombe Program; LP) and indirect treatments (e.g. Demands and Capacities Model; DCM). All studies had moderate risk of bias. Treatment delivery methods included individual face-to-face, telehealth and group-based therapy. Both LP and DCM approaches were effective in reducing stuttering in preschool aged children. LP had the highest level of evidence (pooled effect size=-3.8, CI -7.3 to -0.3 for LP). There was no high-level evidence for interventions with school-aged children or adolescents. Alternative methods of delivery were as effective as individual face-to-face intervention.ConclusionThe findings of this systematic review and evidence mapping are useful for clinicians, researchers and service providers seeking to understand the existing research to support the advancement of interventions for children and adolescence who stutter. Findings could be used to inform further research and support clinical decision-making.     

The added value of the positive: A literature review of positive psychology interventions in organizations

This paper systematically reviews research investigating the effects of positive psychology interventions applied in the organizational context. We characterize a positive psychology intervention as any intentional activity or method that is based on (a) the cultivation of positive subjective experiences, (b) the building of positive individual traits, or (c) the building of civic virtue and positive institutions. A systematic literature search identified 15 studies that examined the effects of such an intervention in organizational contexts. Subsequent analyses of those studies revealed that positive psychology interventions seem to be a promising tool for enhancing employee well-being and performance. As a side-effect, positive psychology interventions also tend to diminish stress and burnout and to a lesser extent depression and anxiety. Implications of those findings for theory and praxis and recommendations for future research on positive psychology interventions in organizations are discussed.     

Internalized transphobia and mental health among transgender adults: A nationwide cross-sectional survey in South Korea

Abstract

Introduction: Transgender people are stigmatized in South Korea (hereafter Korea), where cultural expectations of a biologically-based, binary sex and gender system present fundamental challenges to those whose gender identity does not align with their birth-assigned sex. A growing international body of literature implicates gender minority stress as a key contributor to transgender mental health disparities, but little research has been conducted on this topic in Korea. As in other cultural settings, depression and suicidality are urgent public health concerns for transgender people in Korea, primarily for those who have not initiated gender affirming medical treatment (GAMT), such as cross-sex hormone therapy. In the current study, an international and interdisciplinary team of authors apply the lens of gender minority stress to elucidate the relationships between a key facet of gender minority stress, internalized transphobia (ITP), and outcomes of depressive symptoms and suicidality.

Methods: Based on a cross-sectional survey of 207 Korean transgender adults, the current study evaluates the relationships between ITP and depressive symptoms, suicidal ideation, and suicide attempts. ITP was measured with an eight-item, Korean-language questionnaire adapted from the Gender Minority Stress and Resilience Measure through a translation and back-translation process.

Results: Korean trans women and trans men mean (mean age?=?26.4) were included in the analysis, most of whom had at least one experience of any GAMT. The findings of this study show that Korean transgender adults face similar public health concerns such as high prevalence of depressive symptoms, suicidal ideation, and suicide attempts. As predicted, ITP was significantly related to depressive symptoms, suicidal ideation, and suicide attempts.

Conclusion: The authors suggest potential clinical, policy, and research applications, including institutional interventions, to address structural and cultural barriers to optimal mental health and GAMT as well as mental health interventions to reduce Korean transgender people’s internalized negative beliefs about their gender identity.     

Exploring the retirement from sport decision-making process based on the transtheoretical model

ObjectivesThe purpose of this study was to complement and extend the current knowledge of the particular stages of athletes’ career transition process through employing the transtheoretical model (Prochaska & DiClemente, 1984) as a theoretical framework. More specifically, the current study aimed to explore Korean elite tennis players’ career transition process through focusing on their retirement decision-making process, including their cognitive and behavioral changes and internal and external influences for their decisions during the final stages of their sport careers and the retirement decision-making process.DesignWe employed focus groups.MethodsA total of 12 participants took part in one of three focus groups (i.e., four current players, five retired players, and three coaches) that focused on the process of athletes' retirement decision-making. All participants (seven males and five females; Mean age = 31.25, SD = 3.49 years) were either current or former Korean elite-level tennis players. The data were thematically content analyzed.ResultsThe results revealed three themes: (a) readiness for retirement, (b) psychological and emotional responses during the decision-making process, and (c) coping strategies; and showed that athletes’ decision-making at the end of their sports careers is a dynamic process, accompanied by various emotional responses requiring different coping strategies at different stages.ConclusionFindings indicated that the transtheoretical model helped to explain athletes’ decision-making in retiring from sport and suggested to the need to provide different interventions at different stages. Identifying detailed aspects of readiness for retirement and examining the effectiveness of interventions grounded in the transtheoretical model are recommended as future research directions.     

Stimulated brains and meditative minds: A systematic review on combining low intensity transcranial electrical stimulation and meditation in humans

BackgroundLow intensity transcranial electrical stimulation (tES) and meditation are two promising, yet variable, non-pharmacological interventions. Growing research is investigating combined effects of both techniques on one's cognitive, emotional, and physical health.ObjectiveThis article reviews the current research that combines tES and meditation interventions in healthy and diseased participants. The review considers the intervention parameters and their effects in a well-organized manner.MethodA systematic search for clinical and experimental published studies was conducted in the PubMed, Cochrane, and transcranial direct current stimulation (tDCS) databases using common keywords for tES and for meditation techniques well defined by previous studies. Unpublished ongoing studies were identified with the ClinicalTrials.gov and DRKS.de clinical trial websites.Results20 published studies and 13 ongoing studies were included for qualitative analysis. 13 published articles studied patients with chronic pain, psychological disorders, cognitive impairment, and movement disorders. Anodal tDCS was the only tES technique while mindfulness meditation was the most common meditation type. Eight studies had a main group effect, with outcome improvement in the active combined intervention. However, most published studies showed improvements after at least one combined intervention with variable effects.ConclusionPairing anodal tDCS with meditation shows promising improvements of the physical, mental, and emotional aspects of daily life. Further studies are required to confirm the relevance of this combination in the clinic.     

“All I have to do is pass”: A discursive analysis of student athletes' talk about prioritising sport to the detriment of education to overcome stressors encountered in combining elite sport and tertiary education

ObjectivesIncreasingly, athletes are expected to undertake tertiary education contemporaneously with their sporting careers. However, to do so may prove difficult and stressful. Exploration of the stressors encountered by student-athletes in combining the two pursuits is limited. There is also limited research examining whether combining the two pursuits impacts upon sporting or educational success.Design and methodA discursive psychological approach was employed, examining twenty interviews conducted with Australian athletes enrolled in tertiary education, exploring how athletes integrated sport and education.ResultsWithin the interviews, athletes constructed their primary academic goal as to ‘just pass’. Athletes repeatedly presented themselves as sacrificing educational success to integrate the two pursuits. Moreover, athletes constructed accounts of themselves as prioritising sport, but as passive in decision-making around priorities. In doing so, athletes produced accounts that removed their own agency for their sacrificed academic success. The interviewees also constructed time as a barrier to the successful integration of sport and education. In the dataset time was constructed either as fixed, limited and externally controlled, or as flexible and controllable.ConclusionsThese alternate constructions allowed athletes to remove agency for poor educational outcomes, or conversely, enabled them to present themselves as successfully able to integrate sport and education. Thus, differing constructions of time were used to achieve different rhetorical ends. Implications and interventions for supporting student athletes successfully to combine sport and education are discussed.     

Evaluating complex interventions: Perspectives and issues for health behaviour change interventions

Objective: Health behaviour change interventions (HBCIs), used in health education, health promotion, patient education and psychotherapy areas, are considered complex interventions. The objective of this article is to discuss the value and limitations of using randomised clinical trials (RCTs) to asses HBCIs.

Methods: A scoping review of the literature was conducted to identify the main challenges of using RCTs for evaluating HBCIs. The issues were illustrated by case studies selected from research conducted by our multidisciplinary team.

Results: In complex interventions, effects are produced not only by the intervention, but are strongly linked to context. Issues relating to transferability of results are therefore critical, and require adjustments to the RCT model. Sampling bias, biases related to the experimental conditions and biases due to the absence of double-blindness were examined and illustrated by case studies.

Conclusion: The results underline the importance of a multidisciplinary approach. They call for adapted or alternative evaluation models that overcome the limitations of RCTs.     

“Normally I’d get really agitated,but I just laughed!”: what do participants reflect upon in a transactional analysis/mindfulness based anger management programme?

ABSTRACT

Most anger management group programmes utilise Cognitive Behaviour Therapy (CBT) and Mindfulness Based Treatments (MBTs) in their interventions. This study uses Transactional Analysis (TA) and mindfulness to help promote behavioural change. We explored participants' phenomenological change throughout a 10-week anger management programme. The research examines participants' weekly “check-ins” as they reflected on their angry behaviours, their interpersonal relationships and the development of mindfulness techniques as a way to regulate their angry emotions. The research suggests participants engage in a group learning process of sharing their angry behaviours, reflecting upon the taught content of the programme before acting to change their behaviour, utilising the group for encouragement and support.     

Exercise psychology: A view from Europe

ObjectiveTo provide a review and commentary on developments and key issues in the psychology of health-related physical activity (‘exercise psychology’).Design and MethodNarrative review and commentary.ResultsA view from Europe is provided, with an emphasis on European influence and research. Summary commentaries are provided using the behavioural epidemiological framework as an organisational tool. The role of psychology is discussed in the study of physical activity correlates, theory, and interventions.ConclusionsThe European influence in exercise and health psychology has been significant. However, more needs to be known about pre-intentional motivation processes and post-intentional volition, as well as clarifying and extending theories (e.g., translating intentions into behaviour). There is also a need to do more intervention work, and to improve how we conduct, evaluate and report interventions. New issues are emerging, including the study of sedentary behaviour.