Prevalence of anxiety symptoms and disorders in the transgender population: A systematic review of the literature

Introduction: Anxiety disorders are the most common mental illness in the general population, affecting 18% of the population in the United States (12 months prevalence) and 13.6% in Europe (life time prevalence). Several studies have also described high rates of anxiety disorders and symptoms of anxiety among the transgender population. There is, however, a great variation of results (particularly related to gender prevalence), and few studies have described the type of anxiety disorders specific to the transgender population.

Aim: To collect and critically appraise the information from the available studies describing prevalence rates of anxiety disorders and symptoms.

Results: A total of 25 cross-sectional (n = 17) and longitudinal (n = 8) studies were found. Cross-sectional studies described higher prevalence rates of anxiety symptoms in the transgender group than in the cis population. The prevalence of anxiety disorders range from 17% to 68%. The most common anxiety disorders found were specific phobias, social phobias, panic disorders, and obsessive-compulsive disorders. Most of the large studies suggest higher levels of anxiety symptoms and disorders in transgender men compared with transgender women; however, considerable variation in results was found.

Conclusions: The findings identified that there is considerable variation in anxiety disorders and symptoms among transgender people attending transgender health services. These findings are likely to be the result of the tools used, the lack of matching controls, and the lack of homogeneity of the group studied. Overall this review indicates high levels of anxiety symptoms and disorders among transgender people attending gender services, primarily (but not exclusively) before commencement of cross-sex hormone treatment. Anxiety disorders related to social interaction (such as social anxiety) and panic attack appear to be particularly common, however more rigorous studies to confirm those findings are needed.     

A qualitative exploratory study on gender identity and the health risks and barriers to care for transgender women living in a U.S.–Mexico border city

This exploratory, qualitative study examined the health risks and barriers to care for transgender women who live in a U.S.–Mexico border city. Individual in-depth interviews were conducted with 13 self-identified transgender women in El Paso, Texas, seven of whom identified as Latina. The interviews were recorded, transcribed, and coded for analysis of emerging themes, using the qualitative analysis software Atlas.ti (v.7.0). The themes that emerged are (1) self-acceptance of transgender identity; (2) acceptance of transgender identity within social networks; and (3) health risks, including body modifications and barriers to health care. The findings reveal phases of self-acceptance of transgender identity, a high level of health risks, scarce health services resources, and low levels of acceptance from family, friends, and partners. This study provides an important contribution to the health disparities literature on gender identity and health risks and the needs of transgender women, particularly in a U.S.–Mexico border context.     

多维计算机化自适应测验选题策略的开发及比较

本研究提出一种新的多维计算机化自适应测验(MCAT)选题策略,并将现有及本研究新提出的MCAT选题策略归纳为三类进行了较为系统全面的Monte Carlo模拟实验比较。结果表明:A-优化方法、后验期望KL信息方法 (KB)和本文提出的修正的连续熵方法 (MCEM)在各自类别中估计精度最高;结合题库安全性来看,MCEM综合表现最好。     

Additive and synergistic relations of early mother–child and caregiver–child interactions and socioeconomic outcomes in adulthood

Prior theoretical and empirical studies have linked the first 3 years of children's life with later life outcomes. One primary explanation is the critical role these experiences play in children's early brain development (including their early language and cognitive abilities) and subsequent schooling achievement. The current study is a registered report with two complementary research objectives: (1) examine to what extent stimulating and responsive interactions with mothers and nonparental caregivers during the first 3 years of life show additive or synergistic associations with key socioeconomic outcomes in adulthood (i.e., educational attainment, salary, and employment status), and (2) examine to what extent academic skills (i.e., mathematics, vocabulary, and literacy) during childhood and adolescence mediate these associations. The sample included 1364 individuals from a birth cohort study who were followed until age 26. Mother–child interactions had positive associations with educational attainment and negative associations with full-time employment, though no synergistic associations were found for the socioeconomic outcomes. In addition, the indirect effects of mother–child interactions on educational attainment through mathematics were strongest for children with less stimulating and responsive caregiver–child interactions. Potential implications of these findings for developmental theory are discussed.     

Evaluation of early relational disturbance in high-risk populations: Borderline personality disorder features,maternal mental state,and observed interaction

Despite the longstanding theoretical association in the attachment literature between maternal trauma history and disturbances in the mother–infant interaction, few studies have investigated mechanisms of transmission of traumatogenic relational patterns in high-risk mother–infant dyads. This study investigated interrelationships among maternal trauma history, distorted maternal representations (DMRs, i.e. disturbed thoughts and feelings about the infant and self-as-parent), maternal mentalisation (i.e. capacity to conceive of self and other's intentions in terms of mental states including thoughts, feelings, and desires), and quality of interaction in a clinical sample of mothers with Borderline Personality Disorder (BPD) features and their infants (N = 61). Measures used included the Childhood Trauma Questionnaire, Parent Development Interview, Mother–Infant Relationship Scale, Borderline Symptom Checklist-23, and the Emotional Availability Scales. The results indicated BPD features mediated the relationship between maternal trauma history and DMRs predicting disturbance in interaction. In addition, analyses showed that maternal mentalisation had a buffering effect between DMRs and maternal non-hostility and yet the severity of BPD features moderated the relationship between mentalisation and DMRs. The findings suggest postpartum borderline pathology may adversely impact the experience of being a parent for women with a relational trauma history including deficits in mentalisation (i.e. hypermentalising) and disturbances in the mother–infant interaction. Implications for research and clinical practice are discussed.     

Predictors and moderators of improved social-emotional functioning in mothers with substance use disorders and their young children enrolled in a relationship-based case management program

Mothers with substance use disorders (SUDs) typically have trauma histories and psychosocial difficulties that lead to poor social-emotional functioning and disrupted mother–child relationships. This 12-month study explored associations of family adverse circumstances and services (case management, therapeutic, and community-based) received by 57-mothers with SUDs and their infants (less than 24-months-old) with changes in social-emotional functioning. All mothers were enrolled in a relationship-based case management program (Parent–Child Assistance Program [PCAP]) that emphasized connecting mothers to appropriate community services. A subset of mothers was additionally provided a trauma-focused psychotherapeutic intervention (infant–parent psychotherapy [IPP]). Dyads in both treatment groups improved in overall social-emotional functioning as assessed by the Functional Emotional Assessment Scale (FEAS). A combined-sample regression analysis revealed that improved FEAS scores were significantly predicted by the number of community services received but not by PCAP case management hours (IPP was not included in this analysis). More adverse circumstances were associated with less improvement in social-emotional functioning in the children; but among the mothers trauma level did not predict FEAS scores. We also found a moderating effect of trauma: Dyads with relatively more adversity showed a significantly greater association of community services received with improvement in FEAS scores than did those with relatively less adversity.     

Effectiveness of the Visual–Auditory Shadowing Method on Learning the Pronunciation of Kanji

This study investigates whether the visual–auditory (VA) shadowing method can better facilitate vocabulary learning for learners of Japanese as a second language (JSL) than the visual–visual (VV) shadowing method in K-8 immersion education. Learning vocabulary involves three aspects: meaning, orthography, and pronunciation. The Japanese language has complex orthography and pronunciation. Learners of Japanese need to learn three kinds of orthographic characters: ideographs (kanji) and two kinds of syllabic characters (hiragana and katakana). In addition, because the pronunciation of kanji can vary by context, learners must learn several pronunciations for a single kanji character. This study explores a reasonable way to learn pronunciations of kanji and compares VA shadowing (n = 48) and VV shadowing (n = 47) to investigate which condition better facilitates learning the pronunciation of Japanese ideographs. The analysis suggests that compared to the VV shadowing condition (p < .05), the VA shadowing condition is more effective for Level 3 learners but not for Level 2 or Level 1 learners.