Non-binary and binary transgender youth: Comparison of mental health,self-harm,suicidality, substance use and victimization experiences

ABSTRACT

?Background: Little research has compared the mental health and victimization experiences of non-binary youth depending on their sex assigned at birth (SAAB), or compared these two groups with binary transgender youth.

Aims: To compare mental health, self-harm and suicidality, substance use and victimization experiences between non-binary and binary transgender young adults, both male assigned at birth (MAAB) and female assigned at birth (FAAB).

Methods: Online survey data from 677 participants from the “Youth Chances” community study of 16 to 25 year olds in the United Kingdom was analyzed, comparing across binary participants (transgender females (n = 105) and transgender males (n = 210)) and non-binary participants (MAAB (n = 93) and FAAB (n = 269)).

Results: Female SAAB participants (binary and non-binary) were more likely to report a current mental health condition and history of self-harm than male SAAB participants (binary and non-binary). Similarly, female SAAB participants (binary and non-binary) were more likely to report childhood sexual abuse than male SAAB participants (binary and non-binary); the reverse pattern was found for lifetime physical assault relating to being LGBTQ. Non-binary MAAB participants were less likely than the other groups to report past suicide attempts and previous help-seeking for depression/anxiety. Binary participants reported lower life satisfaction than non-binary participants. For all four groups, mental health problems, self-harm, suicidality, alcohol use and victimization experiences were generally higher than that of youth in general population studies.

Conclusions: These findings highlight the importance of considering both non-binary versus binary gender identity and SAAB in relation to mental health problems, self-harm, suicidality and substance use in transgender youth. The roles of sexual abuse, other abuse and discrimination in contributing to increased rates of mental illness and self-harm in non-binary and binary transgender individuals, particularly those who were assigned female at birth, relative to those assigned male, require investigation.     

High school bullying as a risk for later depression and suicidality

This is the first study to examine whether high school students experiencing frequent bullying behaviors are at risk for later depression and suicidality. A total of 236 students who reported frequent bullying behavior without depression or suicidality during a suicide screening were interviewed 4 years later to reassess depression, suicidal ideation, attempts, substance problems, and functional impairment and were compared to at‐risk youth identified during the screen, including 96 youth who also experienced bullying behavior. Youth who only reported frequent bullying behaviors (as bullies, victims, or both) did not develop later depression or suicidality and continued to have fewer psychiatric problems than students identified as at‐risk for suicide. Students who experienced bullying behaviors and depression or suicidality were more impaired 4 years later than those who had only reported depression or suicidality. Thus, assessment of bullying behaviors in screening protocols is recommended.     

It’s my safe space: The life-saving role of the internet in the lives of transgender and gender diverse youth

Abstract

Background: Public awareness of Transgender and Gender Diverse (TGD) identities has grown significantly; however, acceptance and support remain elusive for many TGD youth. Resultant experiences of marginalization and stigmatization contribute to elevated rates of psychological distress and suicidality among TGD youth. Emergent evidence suggests that the internet may offer TGD youth safety, support, and community previously unavailable.

Aim: The primary aim of this qualitative inquiry is to engage in an in-depth exploration of the online experiences and processes which help protect against psychological distress and promote well-being among TGD youth.

Methods: Data were culled from a mixed-methods, online study of sexual and gender minority youth from across the United States and Canada which followed Institutional Review Board approved protocols. Participants for this study represent a sample (n?=?260) of TGD participants aged 14–22 (x? = 17.30). Data were analyzed using Charmaz’ grounded theory strategies.

Results: Data revealed that the internet offers TGD youth affirming spaces that, for the most part, do not exist in their offline lives. Online, TGD youth were able to engage meaningfully with others as their authentic selves, often for the first time. These experiences fostered well-being, healing, and growth through five processes: 1. Finding an escape from stigma and violence, 2. Experiencing belonging, 3. Building confidence, 4. Feeling hope, and 5. Giving back.

Discussion: The unique and innovative ways in which participants use online spaces to foster resilience offer important insights to inform affirmative practices with TGD young people.     

Does self-compassion covary with minority stress? Examining group differences at the intersection of marginalized identities

ABSTRACT

Informed by the minority-stress hypothesis and intersectionality theory, this study examines differences in dispositional self-compassion across diverse youth subject to varying levels of structural and interpersonal discrimination. A secondary analysis of survey data from two suburban high schools in a Midwestern state (n = 1872) found significant differences in rates of exposures to stigma processes in accordance to rates of marginalization as estimated by sexual and/or gender status and racial category (minority vs majority), with a large effect. Sexual and/or gender minority students of color (SGmin) reported the highest rates of stigma experiences including exposure to economic hardship, having an incarcerated parent, not trusting the police, assignment of an IEP and exclusionary discipline. However, white SGmin students reported the highest rates of mental health concerns. Sexual gender majority (SGmaj) students of color reported the highest rates of self-compassion while white SGmin students reported the lowest and the negative relation between bullying and self-compassion was stronger for white SGmin students than for SGmin students of color, suggesting that the latter may have developed ways of coping with multiple stigmatized identities that reflect kindness to the self. As scholars seek to understand the role of self-compassion in resilience processes, we suggest emphasizing the strengths of marginalized youth as well as protecting them from the ill effects of bullying.     

Bullying,Cyberbullying, Student Life Satisfaction and the Community of Chilean Adolescents

Feeling support from the community is a vital aspect of adolescents’ quality of life. Negative experiences at school, such as bullying and cyberbullying can have an adverse impact on adolescents’ life satisfaction that can expand to different domains of their lives including community variables. The goal of the present study was to examine the association between peer victimization, life satisfaction and community support among Chilean adolescents. We used a sample of 497 youths enrolled in grades 9 to 12 of public and private schools in different Chilean districts. Results indicate a negative association between bullying and cyberbullying behavior on community support through life satisfaction. Peer victimization can have negative consequences for youths at a personal level on their assessments of life satisfaction, which can expand to feeling less support from the community. Feeling less support from the community can be detrimental to healthy youth development and adolescents’ quality of life. Community prevention efforts can thus provide emotional support for youth victims of bullying and cyberbullying.

     

Digging beneath the surface: Results from stage one of a qualitative analysis of factors influencing the well-being of trans youth in Quebec

ABSTRACT

Background: The literature on trans youth has been dominated by etiological studies interested in trans experience as a medical phenomenon. An emerging body of literature has begun to document that trans youth are a diverse, vulnerable, yet resilient population, and to investigate the role of various sites of support such as the family, peer groups, institutions, and community spaces in contributing to or impeding trans youth's well-being.

Method: This article presents the results of Stage One of interviews (n = 24) conducted for a Community-Based Participatory Action Research (CBPAR) qualitative research project based in Quebec. It studies the factors that enhance trans youth's well-being as well as the factors of oppression that negatively affect it. This paper offers a brief overview of the anti-oppressive methodology used for this project, emphasizing how CBPAR was combined with Grounded Theory (GT) methods to encourage the direct involvement of communities and the translation of knowledge into action.

Results: We present preliminary categories emerging through the ongoing axial coding process. These categories address trans youth's experiences in and perceptions of various “sites”: 1) healthcare services both for gender-related and general care, 2) other institutional spaces, 3) the family and other social circles, and 4) community spaces.

Conclusion: While much of this study's results support existing evidence on trans youth's experiences, they also provide a more nuanced portrayal of the complex ways in which recognition, as well as non-, mis-, or mal-recognition, influence trans youth's well-being at different sites. We also argue that recognition itself must be considered through the lens of intersectionality.     

Social emotional learning (SEL) practices in schools: Effects on perceptions of bullying victimization

The direct and indirect effects of student perceptions of the extent to which social emotional learning (SEL) instruction is provided on bullying at school and student victimization experiences were examined for 2832 public school students. Students in grades 4–12 completed several subscales of the Delaware School Climate Survey (Bear et al., 2016) at a single timepoint to assess their perceptions of the extent to which SEL instruction is used at their school, their own SEL skills, bullying at school, and personal victimization experiences. Structural equation modeling revealed that students' perceptions of SEL instruction were inversely related to their perceptions of bullying at school and students' personal experiences of victimization. Effects were direct and indirect, through students' self-reported perceptions of their SEL skills. Effects were stronger in late elementary and middle school than in high school. The indirect effects of student perceptions of the extent of SEL instruction on perceived bullying at school through students' SEL skills varied as a function of victimization severity. For students with low self-reported victimization, there was a negative relation between student self-reported SEL skills and perceptions of bullying at school. In contrast, for students who reported experiencing high levels of victimization, students' self-reported SEL skills related positively to perceptions of bullying at school; there was no significant relation between SEL skills and perceptions of bullying at school for students who reported moderate levels of victimization. Implications for teachers' inclusion of SEL instruction and its effects on positive youth development are discussed.     

Combined effects of workplace bullying and perceived organizational support on employee behaviors: does resource availability help?

Background and Objective: This research examines the detrimental effects of workplace bullying as a social stressor on employees’ job performance, organizational retaliatory behaviors, and organizational citizenship behaviors and how the availability of support can reduce the negative impact of bullying. Using social exchange theory and the conservation of resources theory as theoretical frameworks, we propose that workplace bullying drains personal resources, leading to reduced job performance, low citizenship behaviors, and increased organizational retaliatory behaviors. We also propose that perceived organizational support acts as moderator, such that it reduces the detrimental effects of bullying on employee behaviors.

Research Design and Methods: We tested our hypotheses in two field studies (N?=?478 and N?=?395) conducted in Pakistan.

Results: The results of both studies supported the assertion that workplace bullying exacerbates employees’ job performance, reduces organizational citizenship behaviors and intensifies organizational retaliatory behaviors. The idea that perceived organizational support would moderate the bullying-work behavior relationships found mixed support. While perceptions of organizational support reinforced the bullying-job performance and bullying-retaliatory behaviors relationships, it did not moderate the bullying-citizenship behaviors relationship in the suggested direction.

Conclusion: The findings show that workplace bullying leads to more organizational citizenship behaviors when employee’s perceptions of organizational support is high.     

Suicidality Among Gay and Bisexual Men in Taiwan: Its Relationships with Sexuality and Gender Role Characteristics,Homophobic Bullying Victimization,and Social Support

This study aimed to examine the associations of suicidality in emerging adulthood with time of coming out, gender role nonconformity, sexual orientation, traditional and cyber homophobic bullying victimization, and family and peer support during childhood in gay and bisexual men in Taiwan. The frequency of “experiencing suicide ideation” and “attempting suicide” in the past year among 500 gay or bisexual men was examined. The participants’ time of coming out, level of subjective masculinity, sexual orientation, experiences of traditional and cyber homophobic bullying victimization, and levels of family and peer support during childhood were also evaluated. In total, 31% (n = 155) of participants reported experiencing suicide ideation (n = 82) or attempting suicide (n = 73). Early coming out, traditional homophobic bullying victimization, and low family support during childhood increased the risk of suicidality in emerging adulthood; by contrast, family support did not moderate the association of early coming out or traditional bullying victimization with current suicidality. A high proportion of participants reported experiencing suicide ideation and attempt in emerging adulthood. Hence, effective suicide prevention is required for gay and bisexual men. Suicide prevention programs should consider time of coming out, traditional homophobic bullying victimization, and level of family support.     

Using circular questions to explore individual family member experiences of youth gender dysphoria in Australia

Abstract

Background: The number of young people reporting gender dysphoria is increasing worldwide, with gender dysphoria known to affect everyone in the family in unique ways. Previous research has highlighted the importance of family support and understanding; however, much less is known about individual and collective family member experiences, particularly for siblings under the age of 18?years.

Aims: This study sought to identify, describe and interpret individual family member experiences of youth gender dysphoria using semi-structured interviews, incorporating circular questioning, within a whole of family, clinical and wider social context.

Methods: Thirty-five individual family members living in Australia (nine young people aged 12-17?years experiencing gender dysphoria, 10 mothers, eight fathers, and eight siblings aged 11-17?years) were interviewed, exploring positive and negative experiences of youth gender dysphoria, within and outside of the family. Family relationships, support and healthcare experiences were also explored.

Results: All participants reported a mixture of positive and negative experiences of youth gender dysphoria. Levels of acceptance tended to change with the duration of transition, with most family members adapting with time. Siblings reported mixed experiences within the same family, with some struggling to adapt. Most family members felt that including the whole family in the healthcare of the young person was important, although dependent on individual circumstances and family context. Specialist gender care experiences were unanimously positive, although services were considered difficult to access.

Discussion: Family members reported shared and individual positive and negative experiences of youth gender dysphoria across social contexts. Accepting and facilitating gender transition for young people appeared to improve individual and family functioning. Most participants valued a whole of family approach within specialist healthcare. The use of circular questioning in the study helped dispel assumptions and facilitated curiosity for others’ experiences in the family.     

Moral transgression during the Vietnam War: a path analysis of the psychological impact of veterans’ involvement in wartime atrocities

Background and Objectives: Involvement in wartime combat often conveys a number of deleterious outcomes, including posttraumatic stress disorder (PTSD), depression, hostility, aggression, and suicidal ideation. Less studied is the effect of engagement in wartime atrocities, including witnessing and perpetrating abusive violence.

Design and Methods: This study employed path analysis to examine the direct effects of involvement in wartime atrocities on hostility, aggression, depression, and suicidal ideation independent of combat exposure, as well as the indirect effects via guilt and PTSD symptom severity among 603 help-seeking male Vietnam War veterans.

Results: Involvement in wartime atrocities was predictive of increased guilt, PTSD severity, hostility, aggression, depressive symptoms, and suicidal ideation after controlling for overall combat exposure. Combat-related guilt played a minor role in mediating the effect of atrocity involvement on depression and suicidal ideation. PTSD severity had a larger mediational effect. However, it still accounted for less than half of the total effect of involvement in wartime atrocities on hostility, aggression, and suicidal ideation.

Conclusions: These findings highlight the heightened risk conveyed by involvement in wartime atrocities and suggest that the psychological sequelae experienced following atrocity involvement may extend well beyond guilt and PTSD.     

Experiences with stigmatization among transgender individuals after transition: A qualitative study in the Netherlands

Abstract

Background: Transgender individuals belong to one of the most stigmatized groups in society. Although the social stigma of transgender individuals has been examined many times, post transition stigma experiences among transgender individuals have received limited research attention. The aim of this study was to examine experiences with stigmatization among Dutch transgender individuals after their transition.

Method: Ten trans women (age: M?=?58.50, SD?=?9.49) and 10 trans men (age: M?=?42.90, SD?=?13.62) participated in face-to-face semistructured interviews. Grounded theory was used to conceptualize and analyze the data. We examined the positive and negative reactions that transgender individuals experienced in the period after their transition. Furthermore, we explored differences between experiences of trans men and trans women. Finally, we examined differences between cisgender men and women regarding their reactions toward transgender individuals.

Results: Participants reported improved psychological well-being since transition. However, they still experienced different forms of stigmatization. Trans women appeared to experience stronger social stigma than trans men. Trans women also experienced lower social status after their transition. They mainly experienced negative responses from cisgender men. Participants emphasized the importance of social and peer support.

Conclusion: The current study findings demonstrate the presence of stigmatization after transition and argue for psychological aftercare. Social and peer support appeared to be important for coping with stigmatization, and improving the social network of transgender individuals is beneficial. Health providers and researchers are recommended to promote the development of constructive coping skills for transgender individuals with interventions especially targeting trans women.     

Perceptions and Attitudes Toward Bullying in Middle School Youth

ABSTRACT

We examined middle school students' attitudes and perceptions of bullying during their middle school years. Participants were categorized along the bully/victim continuum as bullies, victims, bully-victims, and no-status students based on their self-nomination from a survey that queries students about their experiences with bullying (either as a bully, victim, or both), their observations of bullying, and their attitudes toward bullying. The majority of participants were classified as bullies, victims, and bully-victims as 70% of the participants reported involvement with bullying and/or victimization during their middle school years. Participants' perceptions about bullying and attitudes toward bullying were examined at three points in time. Participants' attitudes toward bullying became more supportive of bullying as students progressed through middle school. Additionally, external attributes for bullying were cited across all four status groups as reasons for involvement in bullying. Implications for prevention and intervention programs that address bullying are discussed.     

Trans,gender diverse and non-binary adult experiences of social support: A systematic quantitative literature review

Abstract

Background: Trans, gender diverse and non-binary (TGDNB) adults experience significant health disparities relative to their cisgender peers. While social support is a known health-protective factor within the general population, no systematic reviews of TGDNB experiences of social support exist.

Aim: To systematically review prior research of social support for TGDNB adults. We sought to assess the defining characteristics of the research, the participants and the research findings, mapping emerging trends across disciplines.

Methods: Six electronic databases (PubMed, MEDLINE, CINAHL, Web of Science, LGBT Life and PsycNet) were searched for literature pertaining to TGDNB adults, social support, and health or well-being published in the past decade.

Results: The findings illustrate a predominance of USA-based quantitative research that measures social support of friends, family and a singular intimate partner. The majority of participants were white, binary-identified transgender women and TGDNB people living in metropolitan settings. Social support was commonly reported as a protective factor, with TGDNB peer support the most frequently reported correlate of health and well-being for TGDNB adults.

Discussion: The results suggest standardized inventories do not capture the emic nature of social support for TGDNB adults. A key opportunity lies in an inductive, hypothesis-forming approach to the study of what is socially supportive for TGDNB adults. In turn, this knowledge will enable the appropriate measurement, implementation and interpretation of social support studies.     

Non-binary youth: Access to gender-affirming primary health care

ABSTRACT

Background: Transgender (trans) youth who identify outside the gender binary are a growing subpopulation. In this article, we document differences in access to gender-affirming health care between binary and non-binary identified trans youth and explore ways of meeting the health needs of non-binary youth within primary care settings.

Methods: The Canadian Trans Youth Health Survey is a national online survey of trans youth, 14–25 years, conducted in 2013–2014. Among the 839 participants who responded to gender identity items in the survey, 41% identified as non-binary. We compared demographic, health outcome, and health care access responses between non-binary and binary (trans girls/women and trans boys/men) youth.

Results: Non-binary and binary youth were similar in most demographics, including age, geographic distribution, and ethnocultural backgrounds, however a larger proportion (82%) of non-binary youth were assigned female at birth. Older non-binary youth (aged 19–25) were significantly more likely to forego needed healthcare than older binary youth; no significant differences were found between younger (14–18) non-binary and binary youth in foregoing healthcare. Overall, non-binary youth (13%) were significantly less likely than binary youth (52%) to access hormone therapy, but they were more likely than binary youth to report experiencing barriers to accessing hormone therapy when needed.

Conclusions: Non-binary trans youth in Canada report challenges in accessing needed gender-affirming healthcare. Primary care providers are well-situated to integrate a broad range of gender-affirming care services into practice in order to address the unique needs of non-binary youth. Future research is warranted to explore experiences of non-binary youth related to barriers to care and to explore how services can be designed and delivered to better meet the needs of non-binary youth seeking gender-affirming primary care.     

Bullies,blades, and barricades: Practical considerations for working with adolescents expressing concerns regarding gender and identity

ABSTRACT

Background: Adolescents, by their very nature and need for maturity, struggle with issues of the self and identity, while challenging the very systems that are there to support them. However, gender diverse adolescents may become detached and overwhelmed as a trans identity solidifies during this time. Bullies, blades and barricades describes the challenges, hardship and dispossession that some gender diverse adolescents face from interpersonal and intrapersonal conflicts, societal pressure and hostility.

Method: This paper utilizes the current research on safety and risks affecting trans youth, the authors clinical experience of trans and gender diverse adolescents, and recommendations in the literature for professional care and support of gender diverse adolescents to identify the various ways gender diverse adolescents are negatively affected by their experiences.

Results: Bullying is not limited to school or peer environments and may be present in adolescents' homes, in local communities, in professional services or from sources of information such as the media. The physical dangers gender diverse adolescents face may arise from victimization, violence or rejection, or self-harming behaviors due to negative beliefs, fear or frustration. Barriers preventing disclosure and expression of gender and/or identity may stem from negative experiences, rejection, pubertal changes, imposed limitations, dependence upon school, home or legal environments, or other spheres of influence.

Discussion: Affirmative approaches, individual focus, recognition of family dynamics, inclusion of significant others, advocacy in school and local community environments as well as professional training are the most commonly recommended interventions. This paper provides an inclusive review of the myriad of challenges confronting gender diverse adolescents including often unrecognized forms of pressure, oppression and restrictions. This paper aims to support clinicians by contextualizing the adversity that gender diverse adolescents face and offers strategies for engagement and intervention.     

Trust in higher guidance and suicidality in Afghan students under the Taliban regime

Background/ObjectiveAfter years of war, political instability and natural catastrophes high rates of PTSD and depression have been found in the Afghan population. On this background, it was investigated whether religious beliefs (trust in higher guidance; TIHG) moderated the association between PTSD symptoms and/or depression and suicidal ideation.MethodA total of 279 Afghan university students (61.6% women; aged 18 to 30 years) took part in this cross-sectional study between July and November 2022. Self-report measures of PTSD, depression, suicidal ideation, trust in higher guidance were used.ResultsSevere PTSD symptoms were reported by 58.4%, clinically relevant depression symptoms were reported by 55.2% and current suicidal ideation was reported by 44.4% of the sample. TIHG moderated the impact of PTSD symptoms, on suicidal ideation. TIHG and depression were unrelated.ConclusionPTSD symptoms, depression and suicidal ideation show an alarmingly high prevalence in this specific sample of Afghan students. TIHG seems to be a resilience factor of special importance.     

Exposure to parental and community violence and the relationship to bullying perpetration and victimization among early adolescents: A parallel process growth mixture latent transition analysis

This study examined heterogeneity in parental and community violence exposure during middle school and its association with bullying perpetration and victimization in high school. Youth (N = 1,611) in four Midwestern middle schools participated. Parallel process growth mixture latent transition analysis was used to understand how trajectory profiles of middle school violence exposure was associated with high school bullying profiles. Impulsivity, depression, school belonging, and delinquency were assessed as moderators of the transition probabilities. A three class solution was found for violence exposure: decreasing parental violence/increasing community violence (n = 103; 6.4%), stable high parental violence and low community violence (n = 1,027; 63.7%), and increasing parental violence and stable high community violence (n = 481; 29.8%). Similarly, a three class solution was found for high school bullying: High Bullying Perpetration and High Victimization class (n = 259; 16%), Victimization only (n = 1145; 71%), and low all class (n = 207; 13%). The largest proportion of youth transitioning into the high bullying and high victimization class were from the decreasing parental violence/increasing community violence. Depression, impulsivity, school belonging, and delinquency all had various moderating effects on transition probabilities. Our findings make it apparent that early forms of parental and community violence are associated with aggressive behaviors and experiences with victimization during high school. Prevention and intervention efforts should target individuals who display early and chronic patterns of exposure to violence as these individuals have the greatest risk of later aggressive and victimization in high school.     

Transactional pathways of transgender identity development in transgender and gender-nonconforming youth and caregiver perspectives from the Trans Youth Family Study

Background: A growing body of research has examined transgender identity development, but no studies have investigated developmental pathways as a transactional process between youth and caregivers, incorporating perspectives from multiple family members. The aim of this study was to conceptualize pathways of transgender identity development using narratives from both transgender and gender-nonconforming (TGN) youth and their cisgender (nontransgender) caregivers.

Methods: The sample included 16 families, with 16 TGN youth, ages 7 to 18 years, and 29 cisgender caregivers (N = 45 family members). TGN youth represented multiple gender identities, including trans boy (n = 9), trans girl (n = 5), gender-fluid boy (n = 1), and girlish boy (n = 1). Caregivers included mothers (n = 17), fathers (n = 11), and one grandmother. Participants were recruited from LGBTQ community organizations and support networks for families with transgender youth in the Midwest, Northeast, and South regions of the United States. Each family member completed a one-time, in-person semistructured qualitative interview that included questions about transgender identity development.

Results: Analyses revealed seven overarching themes of transgender identity development, which were organized into a conceptual model: Trans identity development, sociocultural influences/societal discourse, biological influences, family adjustment/impact, stigma/cisnormativity, support/resources, and gender affirmation/actualization.

Conclusions: Findings underscore the importance of assessing developmental processes among TGN youth as transactional, impacting both youth and their caregivers.