A Joint Modeling Approach for Longitudinal Outcomes and Non-ignorable Dropout under Population Heterogeneity in Mental Health Studies.

The paper proposes a joint mixture model to model non-ignorable drop-out in longitudinal cohort studies of mental health outcomes. The model combines a (non)-linear growth curve model for the time-dependent outcomes and a discrete-time survival model for the drop-out with random effects shared by the two sub-models. The mixture part of the model takes into account population heterogeneity by accounting for latent subgroups of the shared effects that may lead to different patterns for the growth and the drop-out tendency. A simulation study shows that the joint mixture model provides greater precision in estimating the average slope and covariance matrix of random effects. We illustrate its benefits with data from a longitudinal cohort study that characterizes depression symptoms over time yet is hindered by non-trivial participant drop-out.

Parental Responses to Transgender and Gender Nonconforming Youth: Associations with Parent Support, Parental Abuse, and Youths' Psychological Adjustment.

The purpose of this study was to examine parental responses to transgender and gender nonconforming [TGNC] youths' gender identities and explore associations of parent support with parental abuse, depressive symptoms, and LGBT-identity disclosure stress. TGNC youth (N = 129), ages 15-21 (M = 18.00, SD = 1.74), completed surveys (2011-2012); experiences of transfeminine (TF; n = 58) and transmasculine (TM; n = 71) youth were analyzed separately. Among mothers of TF youth, 42.0% of initial and 45.3% of current responses were positive; among fathers, 30.0% of initial and 36.0% of current responses were positive. Among mothers of TM youth, 26.0% of initial and 53.3% of current responses were positive; among fathers, 24.0% of initial and 44.6% of current responses were positive. Among TM youth, higher levels of parental support were associated with more positive responses from mothers and fathers. Among both TF and TM youth, greater parent support was associated with less parental abuse, depressive symptoms, and LGBTQ-identity disclosure stress. Parental responses to youths' gender identities became more positive with time for TF youth; however, approximately 50% of all TGNC youth continued to experience minority stress related to parent rejection. Limitations and implications for practice and research are discussed.

Gay-Straight Alliances, Inclusive Policy, and School Climate: LGBTQ Youths' Experiences of Social Support and Bullying.

Gay-Straight Alliances (GSA) and school policies focused on support for lesbian, gay, bisexual, transgender, and queer/questioning youth may reduce bias-based bullying and enhance social supports in schools. Using multivariate regression, we tested the relationship between youth reports of the presence of GSAs and LGBTQ-focused policies, independently and mutually, with experiences bullying and perceived support (n = 1,061). Youth reported higher classmate support in the presence of GSAs and higher teacher support in the presence of LGBTQ-focused policies; the presence of both GSAs and LGBTQ-focused policies was associated with less bullying and higher perceived classmate and teacher support. The findings indicate that GSAs and LGBTQ-focused policies are distinctly and mutually important for fostering safer and more supportive school climates for youth.

LGBTQ Youth-Serving Community-Based Organizations: Who Participates and What Difference Does it Make?

LGBTQ youth are at greater risk for compromised health, yet large-scale health promotion programs for LGBTQ young people have been slow to develop. LGBTQ community-based organizations-which provide LGBTQ-focused support and services-have existed for decades, but have not been a focus of the LGBTQ youth health literature. The current study used a contemporary sample of LGBTQ youth (age 15-21; M = 18.81; n = 1045) to examine who participates in LGBTQ community-based organizations, and the association between participation and self-reported mental health and substance use. Youth who participated in LGBTQ community-based organizations were more likely to be assigned male at birth, transgender, youth of color, and accessing free-or-reduced lunch. Participation was associated with concurrent and longitudinal reports of mental health and substance use. LGBTQ community-based organizations may be an underutilized resource for promoting LGBTQ youth health.

Sources of Social Support and Mental Health Among LGB Youth.

Disparities in psychosocial adjustment have been identified for lesbian, gay, and bisexual (LGB) youth, yet research that explores multiple sources of social support among subgroups of LGB youth is sparse. Social support theory is used as a framework to analyze the ways that different sources of support might promote better psychosocial adjustment for LGB youth. Data from a diverse sample among LGB youth (N = 835) were used to understand how social support from a close friend, teachers, classmates, and parents might be differently associated with depression and self-esteem. We found that parent support and its importance to the participant were consistently related to higher self-esteem and lower depression for all youth, except for lesbians for whom no forms of social support were associated with self-esteem. Teacher and classmate support influenced some subgroups more than others. These results provide parents, clinicians, and schools a roadmap to assist youth navigate supports.

Predictors and Mental Health Benefits of Chosen Name Use among Transgender Youth.

Chosen name use among transgender youth (youth whose gender identities are different than their sex assigned at birth) can be part of the complex process of aligning gender presentation with gender identity and can promote mental health. However, little is known about the factors that predict whether or not transgender youth have a chosen name and outcomes of chosen name use, especially in specific social contexts. We examined, among a sample of 129 transgender youth from three cities in the United States, differences in sociodemographic characteristics and mental health outcomes between transgender youth with and without a chosen name and, among those with a chosen name, predictors and mental health benefits of being able to use a chosen name at home, school, and work. There were few differences between transgender youth with and without a chosen name. Among transgender youth with a chosen name, disclosure of gender identity to supportive family and teachers predicted chosen name use at home and school, respectively. Chosen name use was associated with large reductions in negative health outcomes and relatively smaller improvements in positive mental health outcomes. Our results show that chosen name use is part of the gender affirmation process for some, but not all, transgender youth and is associated with better mental health among transgender youth who adopt a chosen name.

Chosen Name Use Is Linked to Reduced Depressive Symptoms, Suicidal Ideation, and Suicidal Behavior Among Transgender Youth.

PURPOSE: This study aimed to examine the relation between chosen name use, as a proxy for youths' gender affirmation in various contexts, and mental health among transgender youth. METHODS: Data come from a community cohort sample of 129 transgender and gender nonconforming youth from three U.S. cities. We assessed chosen name use across multiple contexts and examined its association with depression, suicidal ideation, and suicidal behavior. RESULTS: After adjusting for personal characteristics and social support, chosen name use in more contexts was associated with lower depression, suicidal ideation, and suicidal behavior. Depression, suicidal ideation, and suicidal behavior were lowest when chosen names could be used in all four contexts. CONCLUSION: For transgender youth who choose a name different from the one given at birth, use of their chosen name in multiple contexts affirms their gender identity and reduces mental health risks known to be high in this group.

Disclosure Stress, Social Support, and Depressive Symptoms Among Cisgender Bisexual Youth.

Bisexual youth are at elevated risk for depression compared to lesbians and gay men. Research on bisexual stigma suggests these youth are uniquely vulnerable to stress related to sexual identity disclosure. Depression associated with this stress may be buffered by social support from parents and friends. We examined the differential influence of social support from parents and friends (Child and Adolescent Social Support Scale) on the relation between disclosure stress (LGBTQ Coming Out Stress Scale) and depressive symptoms (Beck Depression Inventory) and differences by gender in a sample of cisgender bisexual youth (n = 383) using structural equation modeling. Parental support buffered the association between stressful disclosure to family and depressive symptoms, especially for bisexual men; bisexual women seemed not to benefit from such support when disclosure stress was high. This nuanced examination elucidates the ways family members and clinicians can best support bisexual youth sexual identity disclosure.

The Protective Role of Gay-Straight Alliances for Lesbian, Gay, Bisexual, and Questioning Students: A Prospective Analysis.

Prior studies show a strong association between gay-straight alliances (GSAs) and the well-being and safety of sexual minority students at school. However, nearly all existing literature has relied on cross-sectional data. Using data from the first two panels of a multi-site longitudinal study on risk and protective factors for suicide among lesbian, gay, bisexual, and questioning (LGBQ) youth in three U.S. cities, we examined the influence of presence of and participation in a GSA on perceptions of safety at school, homophobic bullying experiences, and psychosocial adjustment (depression and self-esteem) in 327 LGBQ students across two school years. LGBQ students who had GSAs in their schools or were members of GSAs in the prior year showed no differences in psychological adjustment, but they reported perceptions of more school safety and less homophobic bullying in the following school year. Further, changes in GSA presence (gaining a GSA) and changes in participation (from non-participation to participation) were independently associated with stronger perceived safety in the subsequent school year. This study provides the first prospective evidence of the lasting positive role of GSAs for high school students, and documents that changes in GSA presence and participation are associated with safety at school. Education policy and practice implications are discussed.

Transgender Youth and Suicidal Behaviors: Applying the Interpersonal Psychological Theory of Suicide.

The interpersonal psychological theory of suicide (IPTS) was used to examine suicidal thoughts and behaviors among 129 transgender and gender nonconforming (TGNC) youth. Youth were categorized according to their gender identities: female-to-male (FTM), male-to-female (MTF), female-to-different-gender (FTDG), and male-to-different gender (MTDG). Higher percentages of suicidal ideation were reported by FTDG and FTM youth; and higher percentages of suicide attempts by FTDG and MTDG youth. Perceived burdensomeness and thwarted belongingness were significantly related to suicidal ideation and/or suicide attempts. Experiences of painful, provocative and harmful events and acquired capability significantly predicted suicide attempts. The findings support IPTS in explaining suicidal behaviors among TGNC youth. Implications for prevention and intervention efforts are discussed.

Minority stress and mechanisms of risk for depression and suicidal ideation among lesbian, gay, and bisexual youth.

The experience of minority stress is often named as a cause for mental health disparities among lesbian, gay, and bisexual (LGB) youth, including higher levels of depression and suicidal ideation. The processes or mechanisms through which these disparities occur are understudied. The interpersonal-psychological theory of suicide posits 2 key mechanisms for suicidal ideation: perceived burdensomeness and thwarted belongingness (Joiner et al., 2009). The aim of the current study is to assess the mental health and adjustment among LGB youth emphasizing the minority stress model (Meyer, 2003) and the interpersonal-psychological theory of suicide (Joiner et al., 2009). With a survey of 876 LGB self-identified youth, levels of coming-out stress, sexual orientation victimization, perceived burdensomeness, thwarted belongingness, depression, and suicidal ideation were examined. The results of a multigroup mediation model show that for all gender and sexual identity groups, the association of sexual orientation victimization with depression and suicidal ideation was mediated by perceived burdensomeness. For gay, lesbian, and bisexual girls coming-out stress was also found to be related to depression and suicidal ideation, mediated by perceived burdensomeness. The results suggest that feeling like a burden to "people in their lives" is a critical mechanism in explaining higher levels of depression and suicidal ideation among LGB youth. These results have implications for community and social support groups, many of which base their interventions on decreasing social isolation rather than addressing youths' beliefs of burdensomeness. Implications for future research, clinical and community settings are discussed.

Domestic harm and neglect among lesbian, gay, and bisexual older adults.

This study examined harm, hurt, and neglect by caregivers as well as self-neglect and physical and mental health status among 113 lesbian, gay, and bisexual (LGB) older adults aged 60-88 years, who attended community-based social and recreation programs or groups in the United States. Reporting on their experiences with caregivers, 22.1% of the participants experienced at least one type of harm, including physical, emotional, verbal, sexual, financial, and neglectful; additionally, 25.7% of the participants reported they knew LGB older adults who experienced at least one type of harm from his or her caregiver. With regard to self-neglect, 62.8% reported experiencing it; those indicating positive psychological health reported fewer experiences with self-neglect.

Relationship trajectories and psychological well-being among sexual minority youth.

Dating in adolescence plays an integral part in the development of sexual and social identities. This process is particularly salient for sexual minority youth who face additional obstacles to their identity formation due to their marginalized status. We investigated the influence of participating in a same-sex relationship (SSR) or an opposite-sex relationship (OSR) on sexual minority youths' psychological well-being (i.e., symptoms of depression, anxiety and internalized homophobia, and self-esteem) in an ethnically-diverse sample of 350 youth (55% male) between the ages of 15-19 years, recruited from three GLBT drop-in centers in the New York City area. Using longitudinal data, we examined youths' SSR and OSR over time. Multivariate regression analyses suggest that involvement in a SSR was positively associated with changes in self-esteem in males, and negatively correlated with changes in internalized homophobia in females. We discuss the implications for positive development in sexual minority adolescent populations.

Transgender youth and life-threatening behaviors.

Sexual minority status is a key risk factor for suicide among lesbian, gay, and bisexual youth; however, it has not been studied among transgender youth. Fifty-five transgender youth reported on their life-threatening behaviors. Nearly half of the sample reported having seriously thought about taking their lives and one quarter reported suicide attempts. Factors significantly related to having made a suicide attempt included suicidal ideation related to transgender identity; experiences of past parental verbal and physical abuse; and lower body esteem, especially weight satisfaction and thoughts of how others evaluate the youths' bodies. Sexual minority status is a key risk factor for life-threatening behaviors among transgender youth.

Childhood gender atypicality, victimization, and PTSD among lesbian, gay, and bisexual youth.

This study examined childhood gender atypicality, lifetime victimization based on sexual orientation, and current mental health, including trauma symptoms and posttraumatic stress disorder (PTSD), among 528 lesbian, gay, and bisexual youth. Nearly 80% reported verbal victimization, 11% physical, and 9% sexual, with males reporting significantly more victimization. Victimization began, on average, at age 13. Verbal attacks occurred as early as age 6, physical attacks at 8, and sexual attacks at 9. Youth who were considered gender atypical in childhood reported more victimization and more current mental health symptoms. PTSD was found in 9% of youth and was associated with past physical victimization.

Transgender youth: invisible and vulnerable.

This study used three focus groups to explore factors that affect the experiences of youth (ages 15 to 21) who identify as transgender. The focus groups were designed to probe transgender youths' experiences of vulnerability in the areas of health and mental health. This involved their exposure to risks, discrimination, marginalization, and their access to supportive resources. Three themes emerged from an analysis of the groups' conversations. The themes centered on gender identity and gender presentation, sexuality and sexual orientation, and vulnerability and health issues. Most youth reported feeling they were transgender at puberty, and they experienced negative reactions to their gender atypical behaviors, as well as confusion between their gender identity and sexual orientation. Youth noted four problems related to their vulnerability in health-related areas: the lack of safe environments, poor access to physical health services, inadequate resources to address their mental health concerns, and a lack of continuity of caregiving by their families and communities.

Predicting the suicide attempts of lesbian, gay, and bisexual youth.

In this study predictors of serious suicide attempts among lesbian, gay, and bisexual (LGB) youth were examined. Three groups were compared: youth who reported no attempts, youth who reported attempts unrelated to their sexual orientation, and youth whose attempts were considered related to their sexual orientation. About one third of respondents reported at least one suicide attempt; however, only half of the attempts were judged serious based on potential lethality. About half of all attempts were related to youths' sexual orientation. Factors that differentiated youth reporting suicide attempts and those not reporting attempts were greater childhood parental psychological abuse and more childhood gender-atypical behavior. Gay-related suicide attempts were associated with identifiability as LGB, especially by parents. Early openness about sexual orientation, being considered gender atypical in childhood by parents, and parental efforts to discourage gender atypical behavior were associated with gay-related suicide attempts, especially for males. Assessment of past parental psychological abuse, parental reactions to childhood gender atypical behavior, youths' openness about sexual orientation with family members, and lifetime gay-related verbal abuse can assist in the prediction of suicide attempts in this population.