Identifying 2SLGBTQ+ individuals experiencing homelessness using Point-in-Time counts: Evidence from the 2021 Toronto Street Needs Assessment survey.

INTRODUCTION: The objective of this study was to utilize the data generated by the City of Toronto, Street Needs Assessment conducted in 2021 to explore the prevalence, causes, experiences, and characteristics of 2-spirit, lesbian, gay, bisexual, transgender, queer, and questioning (2SLGBTQ+) individuals experiencing homelessness in Toronto, Ontario, Canada. METHODS: Data was collected by the City of Toronto during its Street Needs Assessment in April 2021. The Street Needs Assessment is a needs assessment survey and Point-in-Time count of people experiencing homelessness across the city of Toronto. Homelessness included any individual who was sleeping outdoors or staying in City-administered emergency/transitional shelters and shelter motels/hotels on the night of data collection. The Street Needs Assessment survey was administered to clients by trained shelter and outreach staff using a computer or mobile device. To ensure that survey questions were 2SLGBTQ+ inclusive, questions on sexual orientation, gender identity, and 2SLGBTQ+ identity were included in the survey. RESULTS: Two hundred and eighty-eight 2SLGBTQ+ individuals completed the survey. Compared to non-2SLGBTQ+ individuals experiencing homelessness, 2SLGBTQ+ respondents were younger at the time of survey completion and when they first experienced homelessness, were more likely to have been in foster care or a group home, reported higher rates of conflict with and/or abuse by a parent/guardian as their main pathway into homelessness, and were more likely to experience chronic homelessness. CONCLUSION: Our study results demonstrate that Street Needs Assessments and Point-in-Time counts can be used to examine homelessness in marginalized populations, including 2SLGBTQ+ individuals and that sexual orientation and gender identity questions need to be included on future government surveys. The consistency of findings from this study and previous research suggests that 2SLGBTQ+ individuals experience a significant need for population-based housing and social support services aimed at meeting the needs of 2SLGBTQ+ populations.

Fluid face but not gender: Enfacement illusion through digital face filters does not affect gender identity.

It has been shown that observing a face being touched or moving in synchrony with our own face increases self-identification with the former which might alter both cognitive and affective processes. The induction of this phenomenon, termed enfacement illusion, has often relied on laboratory tools that are unavailable to a large audience. However, digital face filters applications are nowadays regularly used and might provide an interesting tool to study similar mechanisms in a wider population. Digital filters are able to render our faces in real time while changing important facial features, for example, rendering them more masculine or feminine according to normative standards. Recent literature using full-body illusions has shown that participants' own gender identity shifts when embodying a different gendered avatar. Here we studied whether participants' filtered faces, observed while moving in synchrony with their own face, may induce an enfacement illusion and if so, modulate their gender identity. We collected data from 35 female and 33 male participants who observed a stereotypically gender mismatched version of themselves either moving synchronously or asynchronously with their own face on a screen. Our findings showed a successful induction of the enfacement illusion in the synchronous condition according to a questionnaire addressing the feelings of ownership, agency and perceived similarity. However, we found no evidence of gender identity being modulated, neither in explicit nor in implicit measures of gender identification. We discuss the distinction between full-body and facial processing and the relevance of studying widely accessible devices that may impact the sense of a bodily self and our cognition, emotion and behaviour.

Exploring differences in substance use behaviours among gender minority and non-gender minority youth: a cross-sectional analysis of the COMPASS study. / Exploration des différences dans les comportements liés à la consommation de substances chez les jeunes faisant partie de minorités de genre et les jeunes ne faisant pas partie de minorités de genre : analyse transversale de l'étude COMPASS.

INTRODUCTION: Research characterizing substance use disparities between gender minority youth (GMY) and non-GMY (i.e. girls and boys) is limited. The aim of this study was to examine the differences in substance use behaviours among gender identity (GI) groups and identify associated risk and protective factors. METHODS: Cross-sectional data from Canadian secondary school students (n = 42 107) that participated in Year 8 (2019/20) or Year 9 (2020/21) of the COMPASS study were used. Hierarchal logistic regression models estimated current substance use (cigarettes, e-cigarettes, binge drinking, cannabis and nonmedical prescription opioids [NMPOs]). Predictor variables included sociodemographics, other substances, mental health outcomes, school connectedness, bullying and happy home life. Interaction terms were used to test mental health measures as moderators in the association between GI and substance use. RESULTS: Compared to non-GMY, GMY reported a higher prevalence for all substance use outcomes. In the adjusted analyses, GMY had higher odds of cigarette, cannabis and NMPO use and lower odds for e-cigarette use relative to non-GMY. The likelihood of using any given substance was higher among individuals who were involved with other substances. School connectedness and happy home life had a protective effect for all substances except binge drinking. Bullying victimization was associated with greater odds of cigarette, e-cigarette use and NMPOs. Significant interactions between GI and all mental health measures were detected. CONCLUSION: Findings highlight the importance of collecting a GI measure in youth population surveys and prioritizing GMY in substance use-related prevention, treatment and harm reduction programs. Future studies should investigate the effects of GI status on substance use onset and progression among Canadian adolescents over time.

Comparison of Clinical Characteristics, Gender Perceptions, and Rape-Related Beliefs of People Assessed for Criminal Liability for Rape Against Children and Adults. / Çocuga ve Eriskine Yönelik Tecavüz Suçu Nedeniyle Ceza Sorumlulugu Degerlendirilen Kisilerin Klinik Özelliklerinin, Toplumsal Cinsiyet Algilarinin ve Tecavüze Iliskin Inançlarinin Karsilastirilmasi.

OBJECTIVE: This study aimed to compare the criminal, sociodemographic and clinical characteristics, paraphilic behaviors, sexual attitudes, gender perceptions, and rape-related beliefs of people assessed for criminal liability for rape against adults and children. METHOD: The study compared 40 people investigated for criminal liability for rape against an adult (RAA) with 40 individuals investigated for criminal liability for crime of rape against a child (RAC), and 43 age, sex and education matched individuals without any sexual crime history using the Structured Clinical Interview form for DSM-5 disorders, Hendrick Brief Sexual Attitude Scale, Gender Perception Scale, Illinois Rape Myth Acceptance Scale, and Barratt Impulsiveness Scale-11. RESULTS: All participants were male. There was no difference between the groups in terms of lifelong or existing psychiatric diseases. All participants had full criminal responsibility during the crime. No participant in any group was diagnosed with a paraphilic disorder. It was determined that people in both RAC and RAA groups tended to use sexuality as a tool, paid less attention to birth control methods, had a far less egalitarian perception of gender, and their myths about rape were significantly higher compared to the control group. The control group was much more impulsive than the sex offenders. CONCLUSION: Our results show that the act of sexual assault should not be explained only by impulsivity or psychiatric disorders, and that gender perception and sexual myths may also be influential. The fact that all individuals had full criminal responsibility emphasizes the need for more research on the social and cultural origins of sexual violence.

Online Group Psychotherapy to Increase Self-acceptance and Reduce Shame Among Transgender Migrants: An Observational Report. / Transgender Göçmenler Arasinda Öz Kabulü Arttirmak ve Çekimserligi Azaltmak için Çevrimiçi Grup Psikoterapisi: Bir Gözlemsel Rapor.

OBJECTIVE: Transgender and gender diverse (TGD) people experience higher levels of stigma, discrimination, and interpersonal violence due to their gender identity and/or expression, particularly TGD people with a migration background. This study aimed to conduct and evaluate group psychotherapy for TGD migrants to provide opportunities for exploring and developing interpersonal skills and relationships. METHOD: The group therapy included five individuals who identified as TGD and originated from the Middle East. The TGD group therapy consisted of 12 weekly sessions of 90 minutes each and was facilitated by a psychiatrist. All sessions were conducted online and in Turkish. The sessions were guided by the group process and discussions. RESULTS: After completing 12 group therapy sessions, members of the group reported benefiting from observing and emulating others who shared their problem constellation. Through the interpersonal skills that they built up throughout the sessions, they became more open to share their feelings experiencing fewer social barriers, and reduced anxiety. CONCLUSION: This observational study indicates the significance of offering group-based psychotherapy to enhance affirmation and social connection within gender minority groups and emphasizes the need to empirically evaluate the effectiveness of group psychotherapy with TGD individuals, with special attention to the unique needs of TGD migrants.

Mental health impact of multiple sexually minoritized and gender expansive stressors among LGBTQ+ young adults: a latent class analysis.

AIMS: In the United States, lesbian, gay, bisexual, transgender, queer, intersex, asexual and other sexually minoritized and gender expansive (LGBTQ+) young adults are at increased risk for experiencing mental health inequities, including anxiety, depression and psychological distress-related challenges associated with their sexual and gender identities. LGBTQ+ young adults may have unique experiences of sexual and gender minority-related vulnerability because of LGBTQ+-related minority stress and stressors, such as heterosexism, family rejection, identity concealment and internalized homophobia. Identifying and understanding specific LGBTQ+-related minority stress experiences and their complex roles in contributing to mental health burden among LGBTQ+ young adults could inform public health efforts to eliminate mental health inequities experienced by LGBTQ+ young adults. Therefore, this study sought to form empirically based risk profiles (i.e., latent classes) of LGBTQ+ young adults based on their experiences with familial heterosexist experiences, LGBTQ+-related family rejection, internalized LGBTQ+-phobia and LGBTQ+ identity concealment, and then identify associations of derived classes with psychological distress. METHODS: We recruited and enrolled participants using nonprobability, cross-sectional online survey data collected between May and August 2020 (N = 482). We used a three-step latent class analysis (LCA) approach to identify unique classes of response patterns to LGBTQ+-related minority stressor subscale items (i.e., familial heterosexist experiences, LGBTQ+-related family rejection, internalized LGBTQ+-phobia and LGBTQ+ identity concealment), and multinomial logistic regression to characterize the associations between the derived classes and psychological distress. RESULTS: Five distinct latent classes emerged from the LCA: (1) low minority stress, (2) LGBTQ+ identity concealment, (3) family rejection, (4) moderate minority stress and (5) high minority stress. Participants who were classified in the high and moderate minority stress classes were more likely to suffer from moderate and severe psychological distress compared to those classified in the low minority stress class. Additionally, relative to those in the low minority stress class, participants who were classified in the LGBTQ+ identity concealment group were more likely to suffer from severe psychological distress. CONCLUSION: Familial heterosexist experiences, LGBTQ+-related family rejection, internalized LGBTQ+-phobia and LGBTQ+ identity concealment are four constructs that have been extensively examined as predictors for mental health outcomes among LGBTQ+ persons, and our study is among the first to reveal nuanced gradients of these stressors. Additionally, we found that more severe endorsement of minority stress was associated with greater psychological distress. Given our study results and the previously established negative mental health impacts of minority stressors among LGBTQ+ young adults, findings from our study can inform research, practice, and policy reform and development that could prevent and reduce mental health inequities among LGBTQ+ young adults.

Does Pollyanna hypothesis hold true in death narratives? A sentiment analysis approach.

Pollyanna hypothesis claims that human beings have a universal tendency to use positive words more frequently and broadly than negative words. The present study aims to test Pollyanna hypothesis in medical death narratives at both lexical and text levels by using sentiment analysis and emotion detection methods, and to qualitatively analyze the contextual use of emotion words to deepen the understanding of doctors' emotions. Sentiment analysis showed a strong token-based linguistic positivity and a weak type-based negativity bias at the lexical level, and a general positivity bias at the text level, despite the gender of the doctors. Emotion detection discovered three prominent emotions of "joy", "sadness", and "anger", and a greater diversity of negative emotions in contrast to positive emotions in medical death narratives. Contextual analysis revealed that emotion words associated with joy were primarily observed in contexts related to doctors' actions and behaviors aiming to benefit others and promote social wellbeing. Emotion words associated with sadness and anger were chiefly employed to describe situations involving patients' death and doctors' attitudes towards death. The results confirm Pollyanna hypothesis at both token-based lexical level and text level and falsify the hypothesis at type-based lexical level. Possible explanations are explored by contextual analysis, and theoretical analysis from the perspectives of cognitive linguistics and social psychology. The findings are expected to enrich the understanding of Pollyanna hypothesis as well as the junior doctors' emotional responses to clinical deaths.

Making sense of COVID-19: manifestations of health capital during the pandemic.

BACKGROUND: Grounded in Bourdieu's theory of human practice, this study aims to examine how individuals as social agents made sense of and acted upon their COVID-19 experiences. A recent conceptualization of health capital is utilized to explain the practices of patients in the pandemic, in relation to their biographical background. METHODS: This is a qualitative research in which the data were collected by biographical narrative interviews through a theoretical sampling approach. Eighteen interviews with COVID-19 patients were conducted and 8 of them were analyzed by the Documentary Method. RESULTS: The informants made sense of their illness experiences through their health capital, which is manifested in their self-perception of health, their attitudes towards the healthcare system, their conception of terms such as luck, their work status, and the gendered division of labour at home in the COVID-19 pandemic. All the manifestations are mediated by the social, cultural, and economic capital of the informants, and their habitual practices are based on their symbolic capital. CONCLUSION: The study depicts how social agents' health capital manifested in the pandemic, relying on their symbolic capital, and shaping their practices. Further research across diverse contexts is needed to fully understand extra dimensions of health capital as a descriptor of the social determinants of health.

Black Young Adult Superwomen in the Face of Gendered Racial Microaggressions: Contextualizing Challenges With Acceptance and Avoidance and Emotional Eating.

BACKGROUND: Black young adult women (ages 18-35) are at disproportionate risk for obesity and emotional eating. Emotional eating interventions target psychological flexibility, such as reducing experiential avoidance and increasing acceptance of food-related thoughts. Yet Black women face gendered racism, and some endorse roles that reduce psychological flexibility, such as the superwoman schema role. Culturally centered stress and coping has often been overlooked, leading to an incomplete understanding of processes that engender emotional eating and the implications for appropriate and effective interventions for Black young adult women. PURPOSE: We investigated direct and indirect pathways of associations between stress from gendered racial microaggressions to emotional eating through the endorsement of superwoman schema and two aspects of psychological flexibility. METHODS: Black young adult women (N = 504; Mage = 24.72; 75.2% African American; 98.4% cisgender) participated in an online survey wherein they reported demographics, stress from gendered racial microaggressions, superwoman schema, experiential avoidance, acceptance of food-related thoughts, and emotional eating. Path analysis was conducted to examine direct and indirect effects. RESULTS: Results provided evidence for indirect associations between more stress from gendered racial microaggressions and more emotional eating. More stress was associated with greater endorsement of the superwoman schema which was associated with more experiential avoidance and less acceptance of food-related thoughts, which were each associated with more emotional eating. CONCLUSIONS: Endorsement of superwoman schema and concomitant avoidance and less acceptance may be one way that gendered racial stress propels emotional eating. Future research could test intervention components that disrupt this path.

Emotional eating is eating in order to alleviate negative emotions, like those from stress. Black young adult women face particular forms of stress from being mistreated at the intersection of their race and gender. This research was needed to better understand processes that engender emotional eating for Black young adult women so that appropriate and effective interventions can be developed for this group. In this correlational study, Black young adult women (ages 18­35) completed an online survey wherein they answered questions about their experiences, thoughts, and behaviors. The study results indicated that stress from mistreatment due to being a Black woman was associated with endorsing a need to be strong. This need to be strong was associated with avoiding experiences that may lead to negative emotional states and being less accepting of distressing thoughts about food. More avoidance and less acceptance were each associated with more emotional eating. Therefore, if emotional eating or obesity-related interventions already target acceptance and avoidance, but do not reference or contextualize them for Black young adult women­particularly in terms of stress from mistreatment as a Black woman and the need to be strong­such interventions may be less effective.

"Extremely toxic and evil" reflections on gender identity change efforts by Christian religious leaders: Implications for therapy with transgender and nonbinary clients.

Given the religious groundings that support the practice of gender identity change efforts (GICE), we sought to explore the beliefs of Christian religious leaders about this practice and their understanding of marginalized gender identities. Nineteen religious leaders mainly from diverse Mainline Christian Protestant traditions were interviewed. Queer theory-informed thematic analysis revealed two themes related to participants' beliefs about transgender and nonbinary identities: (1) Transgender and nonbinary identities are normative and authentic and (2) God created gender diversity. The analyses also highlighted two themes reflecting the pastors' beliefs about GICE: (1) GICE is harmful and (2) Therapy should affirm transgender and nonbinary identities. Finally, the thematic analysis exploring participants' messages for couple and family therapists could be organized into two themes: (1) Christian religious beliefs do not justify the use of GICE and (2) Therapists should be helpful and not harmful. Implications for couple and family therapists are also discussed.

Medical Issues Affecting Older Lesbian and Bisexual Women.

Lesbian and bisexual (LB) women are a growing and understudied population in the United States. LB women have unique histories and health experiences and encounter numerous resource and health care disparities that impact healthy aging. Despite LB population growth, little research has investigated the experiences of LB women separately from the broader lesbian, gay, bisexual, transgender, queer or questioning, or another diverse gender identity (LGBTQ+) community. The research that does exist largely focuses on the experiences of younger LB women. Nonetheless, there are unique care considerations providers can enact to improve clinical care and address lifetimes of disparities and discrimination.

Affirming Care for LGBTQ+ Patients.

The lesbian, gay, bisexual, transgender, and queer(LGBTQ +) community is a marginalized minority group who continues to face and experience significant discrimination, prejudice, stigma, oppression, and abuse in various societal domains including health care. The older adult LGBTQ + community is an especially vulnerable group as they have unique minority stressors attributed to intersectional identities of age, ableism, ethnicity, and employment, among other factors. It is critical for health care providers to recognize and mitigate disproportionate care by engaging in strategies that promote inclusion and affirmation of their sexual orientation and gender identity. The biopsychosocial, cultural, and spiritual framework is a useful tool to care for this community in a holistic and compassionate way.

Home-Based Care for Lesbian, Gay, Bisexual, Transgender, Queer or Questioning, or another diverse gender identity Older Adults.

The home-based medicine ecosystem is rapidly expanding. With this expansion, it is increasingly important to understand the unique needs of homebound older adults. There is likely significant intersectionality across the lesbian, gay, bisexual, transgender, queer or questioning, or another diverse gender identity (LGBTQ+) older adult population and the homebound population. This article begins to outline some strategies and approaches to entering the home of LGBTQ+ older adults in inclusive and trauma-informed ways and encourages home-based care teams, organizations, and health systems to utilize existing resources created by the LGBTQ+ aging community to provide universal skills training for the workforce.

End-Of-Life and Palliative Care for Lesbian, Gay, Bisexual, Transgender, Queer or Questioning, or Another Diverse Gender Identity Older Adults.

Palliative care focuses on improving the quality of life for people with serious illnesses and their loved ones. This article introduces considerations including barriers to care, intersectionality, minority stress, microaggressions, and social safety that may impact the experience and openness of people to receive this care. The authors outline tools to address these challenges including trauma-informed care and how to recognize bias and earn trust. The authors conclude by offering a model for incorporating these assessments and tools with sample scripts to provide patient-centered and holistic palliative care.

Federal and State Policy Issues Affecting Lesbian, Gay, Bisexual, Transgender, and Queer Older Adults.

Anti-lesbian, gay, bisexual, transgender, and queer (LGBTQ) + discrimination is widespread, harming the health of LGBTQ + people and constituting a barrier to care. This contributes to higher rates of poverty among LGBTQ + people, especially among people of color, and lower insurance coverage rates. The Affordable Care Act's expansion of insurance access has reduced uninsurance rates among LGBT people and people living with human immunodeficienc virus (HIV). Systemic improvements in culturally responsive health care have occurred over the past decade, including increased collection and use of sexual orientation and gender identity data to improve quality of care. As older LGBTQ + people enter elder service systems, reforms are needed to ensure equitable access.

The Spillover Effects of the Spouse's Retirement on Depression: Evidence From Chinese Middle-Aged and Older Adult Couples.

OBJECTIVES: The present study expands on previous research by examining whether the spouse's retirement affects individual depression both directly, by the changes in individual health investment, and indirectly, through the social interaction effect of the couples' depression. METHODS: Using the panel data from the 2010-2018 China Family Panel Studies, we investigate the direct and indirect spillover effects of the spouse's retirement on depression among Chinese urban-worker couples (men aged 50-70, women aged 40-60; n = 10,466). To address the potential endogeneity and reflect the social interaction effect of the couples' depression, we combine the Fuzzy Regression Discontinuity method with simultaneous equations. RESULTS: Overall, a spouse's retirement would improve an individual's depression, with the direct spillover dominating compared to the indirect spillover. Gender heterogeneity indicates that husbands' depression is improved by wives' retirement mainly because husbands might receive more healthcare and companionship provided by their retired wives, while wives' depression is aggravated by husbands' retirement because of the decline in household income and the lesser health investment. This difference is more evident when wives retire earlier and both spouses retire in the same year. With the spouse's retirement years increasing, husbands' depression improves and wives' depression declines each year. Moreover, spouses' depression is significantly interactive, and wives' depression is more vulnerable to husbands' depression. DISCUSSION: The results highlight that the health spillover effects of the spouse's retirement need greater attention in future research and retirement reform.

"We're still alive, much to everyone's surprise": The experience of trans older adults living with dementia in an ageist, cisgenderist, and cogniticist society.

Trans and non-binary older adults living with dementia experience forms of marginalization, pathologization, and discrimination embedded in epistemic violence that leads them to be mistreated and dismissed as knowledgeable subjects. Based on empirical findings from a Canadian study examining the experiences of trans and non-binary people living with dementia and their carers, we combat this epistemic violence by focusing on the first-hand narratives of this population and their carers. Narrative interviews were conducted with six participants (N = 6): four carers of trans and non-binary adults living with dementia and two trans (binary) people living with dementia. Through a thematic analysis, we examine the unique aspects of living with dementia as a trans or non-binary person. First, the findings show how cogniticism impacts the experience of gender identity and cisgenderism, for example through blocked surgeries, excessive gatekeeping, and not being taken seriously by practitioners. Second, the findings discuss how dementia impacts gender identity and cisgenderism, for example, by increasing the need for formal care that can in turn increase vulnerability to structural violence. Third, the findings illustrate how cisgenderism and gender identity impact the experience of dementia and cogniticism, for example by limiting care options and the ability to advocate for oneself. Fourth, the findings highlight the silo mentality among practitioners, since most of them do not work with an intersectional lens. The article concludes by offering recommendations.

'Robbed out of mind': Reflections on Alzheimer's and gendered subjectivity in select Indian literary narratives.

Neurological degeneration is a potent signifier molding older lives, divesting them of 'personhood' and making them a 'target of care'. This article delineates the depictions of Alzheimer's and its associated losses in select Indian literary narratives- Jalsobi: In the Shadow of Light (2018) and Girl in White Cotton (2019) and seeks to understand how 'ageing into disability' for older women has severe implications that marginalize their embodied existence, foisting a symbolic death. Through the fictional accounts, the article explores two primary threads of consideration - how the 'selfhood' gets eroded/reclaimed while experiencing cognitive impairment and how the shift from the patient-centric to the person-centric approach alters the relational care dynamics in the Indian context. It also attempts to situate the conception and representation of age-induced cognitive loss within the framework of critical disability studies, which understates the reductionist biomedical perspective and fosters an alternative, inclusive, and empathetic understanding of dysfunctionality.