Mental health practitioners' attitudes towards transgender people: A systematic review of the literature

Background: A systematic review was conducted to critically evaluate and synthesize literature investigating mental health practitioners' attitudes towards transgender people.

Objective: Three primary objectives were outlined; first, establish whether overall attitudes are positive or negative. Second, explore whether training, education or experience influences attitudes and finally, examine participant demographics in relation to attitude trends.

Method: A systematic electronic search was carried out in March 2017 using Medline, PsycINFO, PsycArticles, CINAHL, ASSIA, and Web of Science electronic databases. Manual citation and ancestral searches were conducted on identified papers. Qualitative, quantitative and mixed method studies were eligible for inclusion. A total of 13 papers of mixed quality were identified.

Results: Existing literature is limited to cross-sectional, quantitative data and fails to investigate differences between implicit and explicit attitudes. Small to moderate convenience samples reduce the generalizability of data. Overall attitudes were positive although negative attitudes were more frequent in male, Caucasian, heterosexual, religious, conservative mental health professionals.

Conclusions: Refined scales are needed to address the unique heterogeneity within transgender populations. Future research should focus on how attitudes impact care provided and employ longitudinal designs to explore the sustainability of targeted attitudinal training.     

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.     

学校正念干预的应用与特点

“学校正念干预”(School-Based Mindfulness Intervention)是将正念理论及技术应用到教育领域而形成的非医疗健康干预新策略。一方面,学校正念干预能有效帮助学生改善身心行为问题,提高认知能力;另一方面,它能够增强教师压力管理能力和幸福感。总的来说,学校正念干预是以“大健康”为目标、以“非评判接纳”为视角、以校园为干预情境、以传统学校项目为基础的校园非医疗健康干预,是学校心理健康工作者、学校专业社工可采取的策略。未来研究应注重其成效评估和测量、理论机制及应用问题的研究。     

A case-controlled field study evaluating ICD-11 proposals for relational problems and intimate partner violence

Background/Objective: Intimate partner relationship problems and intimate partner abuse and neglect — referred to in this paper as “relational problems and maltreatment” — have substantial and well-documented impact on both physical and mental health. However, classification guidelines, such as those found in the International Classification of Diseases (ICD-10), are vague and unlikely to support consistent application. Revised guidelines proposed for ICD-11 are much more operationalized. We used standardized clinical vignette conditions with an international panel of clinicians to test if ICD-11 changes resulted in improved classification accuracy. Method: English-speaking mental health professionals (N = 738) from 65 nations applied ICD-10 or ICD-11 (proposed) guidelines with experimentally manipulated case presentations of presence or absence of (a) individual mental health diagnoses and (b) relational problems or maltreatment. Results: ICD-11, compared with ICD-10, guidelines resulted in significantly better classification accuracy, although only in the presence of co-morbid mental health problems. Clinician factors (e. g., gender, language, world region) largely did not impact classification performance. Conclusions: Despite being considerably more explicated, raters’ performance with ICD-11 guidelines reveals training issues that should be addressed prior to the release of ICD-11 in 2018 (e. g., overriding the guidelines with pre-existing archetypes for relationship problems and physical and psychological abuse).     

Perceived stigma of caregivers: Psychometric evaluation for Devaluation of Consumer Families Scale

Background/Objective: The Devaluation of Consumer Families Scale (DCFS) is commonly used to measure perceived stigma towards family members of people with mental illness. However, its factorial structure has never been confirmed using confirmatory factor analysis (CFA). This study aimed to test the psychometric properties of the DCFS Taiwan version (DCFS-TW). Method: Family caregivers (N=511) completed the DCFS-TW (97 completed the DCFS again after 2 to 4 weeks) and other instruments. CFA, test-retest reliability, internal consistency, concurrent validity, and known-group validity were analyzed. Results: The three-factor structure of the DCFS-TW performed better than the one-factor structure. Test-retest reliability (r = .66) and internal consistency were satisfactory (α = .85); concurrent validity (absolute r = .20 to .58) was acceptable; known-group validity was supported by the significantly different DCFS-TW scores in clinical characteristics (had been vs. had not been hospitalized; had been vs. had not been compulsorily admitted). Conclusions: The DCFS-TW has decent psychometric properties and is suitable for health professionals to measure perceived stigma towards family members of people with mental illness.     

Well-being in major depression and social phobia with and without comorbidity

Background/Objective: Lower levels in well-being have been observed in individuals with Major Depression (MDD) and Social Phobia (SP), but well-planned direct comparisons with control individuals, not suffering from a mental disorder, are lacking. Furthermore, MDD is highly comorbid with anxiety disorders, and SP with depressive disorders. This study is among the first to examine differences in well-being in individuals with a clinical diagnosis of MDD or SP compared to individuals with no such diagnosis and to test differences in well-being within the combined diagnostic categories respective with and without anxiety-depressive comorbidity. Method: Participants were 119 individuals with a diagnosis of MDD, 47 SP and 118 controls. Results: Results revealed that overall well-being as well as emotional, psychological, and social well-being were lower in the MDD and SP group compared to the control group. Individuals with comorbidity reported lower well-being than individuals without comorbidity. Conclusions: These findings have clinical implications as presence of comorbidity may require a different therapeutic approach than with no comorbidity.     

压力对“蚁族”群体心理健康的影响:希望的调节作用

以广州市棠下、上社、岑村、赤沙等地340名"蚁族"(高校毕业生低收入聚居群体)为被试,采用成人希望特质量表(ADHS)、压力知觉量表(CPSS)、一般心理健康问卷(GHQ),考察了"蚁族"群体的希望水平,并分析了希望在压力和心理健康之间的调节作用。结果发现:①从整体上看,该群体的希望处于中等偏上水平。②压力对于心理健康水平有显著的负向影响;希望能够起到压力缓冲作用,调节压力与一般健康问题、忧郁情绪和自我肯定感之间的关系。③希望对心理健康的忧郁、自我肯定维度的调节作用大小不同,对于忧郁情绪的调节作用更大,而对自我肯定调节作用较小。     

高血压患者应激反应特点及行为人格的关系研究

为了解高血压患者心血管反应的特征及与健康人群的差异,使用实验和问卷调查的方法对高血压患者和健康居民进行研究。结果显示,两组在任务期和恢复期的心血管反应差异显著（P〈0．05）;病例组的健康实践行为和消极应对方式水平较高,积极应对方式有待提升;健康实践行为和恢复期舒张压呈负相关,积极应对方式和任务期收缩压呈正相关（P〈0...     

New students' psychological well‐being and its relation to first year academic performance in a UK university

Aims: This study (1) profiled the well‐being of first year students entering one UK university, and (2) explored whether initial well‐being and year end academic performance were correlated. Method: A total of 117 students (mean age 21, 67% female) completed the Rosenberg Self‐Esteem Scale, Clinical Outcomes in Routine Evaluation‐General Population, and Liebowitz Social Anxiety Scale; academic achievement data were collected from academic records. Results: Almost a quarter of the sample reported quasi‐clinical levels of psychological distress and moderate to very severe social anxiety. Quasi‐clinical levels of psychological distress were associated with low self‐esteem and social anxiety. No statistically significant links were found between well‐being as assessed at the beginning of the first year and academic achievement at the end of the first year. Discussion: The failure to find a link in this study between initial well‐being and academic performance at the end of the first year suggests that further investigation is required to understand how academic achievement is related to student well‐being.     

大学生经济信心和心理健康的关系:生涯自我效能感的中介作用

采用经济信心问卷、生涯自我效能感量表、总体主观幸福感量表、贝克焦虑和抑郁量表,对237名大学生进行调查,考察大学生经济信心对其心理健康的影响,以及生涯自我效能感在两者之间可能的中介作用。结果表明,经济信心与生涯自我效能感和主观幸福感呈显著的正相关,与抑郁显著负相关,生涯自我效能感与主观幸福感显著正相关,与焦虑、抑郁显著负相关。大学生经济信心对其主观幸福感和抑郁具有显著的预测作用。大学生生涯自我效能感在经济信心与主观幸福感之间起到部分中介作用,其在经济信心和抑郁之间起到完全中介作用。此外,大学生生涯自我效能感传递了经济信心对焦虑的间接影响。