Epidemiological considerations in transgender health: A systematic review with focus on higher quality data

Abstract

Background: High quality data pertaining to the size of the transgender and gender diverse (TGD) population are scant, however, several recently published studies may provide more reliable contemporary estimates.

Aims: To summarize the estimated number and proportion of TGD individuals overall and across age groups, based on most accurate data.

Methods: This systematic review focused on recent studies (published from 2009 through 2019) that utilized sound methodology in assessing the proportion of TGD people in the general population. Publications were included if they used clear definitions of TGD status, and calculated proportions based on a well-defined sampling frame. Nineteen eligible publications represented two broad categories of studies: those that used data from large health care systems; and those that identified TGD individuals from population surveys.

Results: Among health system-based studies, TGD persons were identified using relevant diagnostic codes or clinical notes. The proportions of individuals with a TGD-relevant diagnosis or other recorded evidence ranged between 17 and 33 per 100,000 enrollees. In population surveys TGD status was ascertained based on self-report with either narrow or broad definitions. The survey-based estimates were orders of magnitude higher and consistent across studies using similar definitions. When the surveys specifically inquired about ‘transgender’ identity, the estimates ranged from 0.3% to 0.5% among adults, and from 1.2% to 2.7% among children and adolescents. When the definition was expanded to include broader manifestations of ‘gender diversity’, the corresponding proportions increased to 0.5-4.5% among adults and 2.5-8.4% among children and adolescents. Upward temporal trends in the proportion of TGD people were consistently observed.

Conclusions: Current data indicate that people who self-identify as TGD represent a sizable and increasing proportion of the general population. This proportion may differ, depending on inclusion criteria, age, and geographic location, but well-conducted studies of similar type and design tend to produce comparable results.     

Breeding cycle aggression in domesticated zebra finches (Poephila guttata)

Patterns of breeding cycle aggressive behavior were examined in colonies of domesticated zebra finches (Poephila guttata). Aggressive behaviors of zebra finch pairs were low during non-nesting periods but were maintained at high levels during the three nesting periods: the incubating, hatching, and nestling periods. Defense of the nest site was the prominent functional category of aggression, followed by defense of individual distance. Defense of mate, defense of young, and defense of nesting material rarely occurred. Male and female members of pair bonds shared the duties of defense of the nest site and parental care. During observation times males exhibited greater frequencies of aggressive actions throughout the breeding cycle and females spent a greater amount of time in the nest during the three nesting periods. The pattern and functional categories of aggressive behavior in the zebra finch colonies correspond most closely to the nest site defense hypothesis for the evolution of breeding season aggression.     

Strong body,clear mind: Physical activity diminishes the effects of supervisor interpersonal injustice

We integrate exercise physiology tenets with self-regulation theory to explain how physical activity diminishes the effects of supervisor interpersonal injustice. We posit that individuals can help prevent self-regulation depletion from interpersonal injustice when they engage in physical activity. In Study 1, we manipulated physical activity and interpersonal injustice in a laboratory setting, and in Study 2, utilizing a two-week experience sampling method we examined how employees reacted differently to daily interpersonal injustice as a function of their general level of physical activity engagement. Our results demonstrate that both acute and chronic levels of physical activity attenuate the effects of supervisor interpersonal injustice episodes on self-regulation depletion, which subsequently reduces social undermining directed toward the supervisor. Our findings highlight the theoretical and practical significance of physical activity for interpersonal injustice and for organizations in general.     

Qualitative Investigation of Student Reflections on a Spiritual/Religious Diversity Experience

Twenty‐six master's‐level counselor education students participated in a spiritual and religious diversity assignment, which involved participation in a spiritual or religious activity for 5 weeks. Participants then discussed these experiences in reflection papers. After analysis of the student papers, the authors identified the following themes: (a) discomfort related to the experience, (b) initial assumptions regarding spirituality and religion, (c) movement toward appreciation of spiritual and religious diversity, (d) increases in self‐understanding, (e) the value of experiential learning, and (f) motivation for additional learning. The authors provide suggestions for counselor training on spirituality and religion.     

Depressive symptomatology and coronary heart disease in Type I diabetes mellitus: a study of possible mechanisms.

Recent evidence has suggested that depressive symptomatology is a risk factor for the development of coronary heart disease (CHD) in patients with diabetes mellitus, although little is understood about mechanisms that may explain this association. The Pittsburgh Epidemiology of Diabetes Complications (EDC) Study is a natural history study of 658 men and women with childhood-onset Type I diabetes. Participants from the EDC Study who reported the fewest depressive symptoms on the Beck Depression Inventory at baseline examination were least likely to develop CHD over 10 years. Differences in insulin resistance, autonomic dysregulation, inflammation, smoking, and complications associated with Type I diabetes appear to help explain this relationship. Future research should clarify causal pathways between depressive symptomatology, behavioral and physiological processes, and CHD.     

Should They Be Recruited? Fan Perceptions of Deviant Student-Athletes

The purpose of this study was to examine fan opinion toward the active recruitment of prospective student-athletes with deviant pasts. College football fans were surveyed to determine to what extent the deviant behavior of a prospective student-athlete impacted how much they would support their favorite team recruiting that athlete. There were three primary findings: (a) deviant behavior negatively impacts a prospective student-athlete’s fan support score, (b) assault of a female student is the most severe deviant behavior in which an athlete could engage, and (c) White recruits were judged more harshly for using illegal drugs when compared to Black recruits.     

Animation and the location of beauty

This paper discusses the development of animation and imaginative activity in a case in which there has been previous severe deprivation. Clinical material from work with an 8-year-old boy will illustrate how omnipotent behaviour, which has the function of keeping fear and feeling from consciousness, can give way to imaginative interaction with the environment. I suggest that, when internal objects have been frozen, it may be safer for the child to see animation outside the room. This may be a necessary stage before a child can begin to play with the therapist inside the room. I am using the term 'animation' in the sense of new imaginative play that has been stimulated by an apprehension of beauty in nature. This is contrasted with driven manic defending against awareness of self and others.