Expressive writing treatments to reduce PTSD symptom severity and negative alcohol-related outcomes among trauma-exposed sexual minority women and transgender/nonbinary people: Study protocol for a mixed-method pilot trial.

Background: Sexual minority women (SMW) and transgender and/or nonbinary (TNB) individuals report an elevated prevalence of posttraumatic stress disorder (PTSD) symptoms and negative alcohol-related outcomes compared to heterosexual women and cisgender people. SMW and TNB individuals also face barriers to utilizing treatment, which can result in delayed or missed appointments. Accessible, feasible, and effective treatment approaches, such as web-based expressive writing (EW) treatments, are needed to address PTSD and negative alcohol-related outcomes in these populations. Method: We describe the design of a mixed-method pilot randomized controlled trial which will compare an EW treatment adapted for SMW and TNB people (stigma-adapted EW) and trauma (i.e., non-adapted) EW with an active (neutral-event) control to determine acceptability and feasibility of a future fully powered randomized controlled trial. The sample will include 150 trauma-exposed SMW and TNB individuals from across the United States who will be randomly assigned to stigma-adapted EW (n = 50), trauma EW (n = 50), or control (n = 50). Participants will be assessed before treatment, one-week after the first writing session, and three-months after the first writing session. This paper identifies steps for evaluating the acceptability and feasibility of the proposed study and determining changes in outcomes resulting from adapted and non-adapted EW treatments to inform refinements. This paper also highlights our strategy for testing theory-driven mediators and moderators of treatment outcomes. Conclusions: This mixed-method pilot trial will inform the first fully powered, self-administered, brief web-based treatment to reduce PTSD symptom severity and negative alcohol-related outcomes among trauma-exposed SMW and TNB individuals.

High-risk polysubstance use among LGBTQ+ people who use drugs in the United States: An application of syndemic theory.

BACKGROUND: Compared to heterosexual and cisgender people, lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) people are more likely to develop problems with high-risk polysubstance use. According to syndemic theory, this disparity in high-risk polysubstance use is produced by the LGBTQ+ community's increased vulnerability to experiencing psychosocial (e.g., discrimination, unwanted sex) and structural (e.g., food insecurity, homelessness) conditions, greater likelihood of coping with concurrent health problems (e.g., human immunodeficiency virus [HIV]), and decreased opportunities to develop protective factors (e.g., social support, resilience). METHODS: Data from 306 LGBTQ+ participants living in the United States (U.S.) with a lifetime history of alcohol and drug use were analyzed; 21.2% reported lifetime problems with 10 different drugs. Bootstrapped hierarchical multiple regression was used to test demographic correlates and syndemic predictors of high-risk polysubstance use. One-way ANOVA and post-hoc comparison tests were used to test subgroup differences by gender. RESULTS: Results indicated that income, food insecurity, sexual orientation-based discrimination, and social support were associated with high-risk polysubstance use, explaining 43.9% of the variance of high-risk polysubstance use. Age, race, unwanted sex, gender identity-based discrimination, and resilience were not significant. Group comparison tests revealed that, compared to nonbinary people and cisgender sexual minority men and women, transgender individuals experienced significantly higher levels of high-risk polysubstance use and sexual orientation-based discrimination but significantly lower levels of homelessness and social support. CONCLUSION: This study provided further evidence for conceptualizing polysubstance use as an adverse outcome of syndemic conditions. Harm reduction strategies, anti-discrimination laws, and gender-affirming residential treatment options should be considered in U.S. drug policy. Clinical implications include targeting syndemic conditions to reduce high-risk polysubstance use among LGBTQ+ people who use drugs.

Self-Compassion, Minority Stress, and Mental Health in Sexual and Gender Minority Populations: A Meta-Analysis and Systematic Review.

Sexual and gender minority (SGM) populations report numerous mental health disparities relative to heterosexual and cisgender populations, due in part to the effects of minority stress. This article evaluated self-compassion as a coping resource among SGM populations by (a) meta-analyzing the associations between self-compassion, minority stress, and mental health; and (b) synthesizing evidence for the mediating effects of self-compassion between minority stress and mental health. Systematic searches of databases identified 21 papers for the systematic review and 19 for the meta-analysis. Significant meta-analytic associations were found between self-compassion and minority stress (n = 4,296, r = -.29), psychological distress (n = 3,931, r = -.59), and well-being (n = 2,493, r = .50). The research synthesis identified supporting evidence for self-compassion as a coping resource for SGM people. The results of this review warrant further self-compassion research, particularly longitudinal research, for SGM populations.

Probable PTSD, PTSD symptom severity, and comorbid PTSD and hazardous drinking among sexual minority women compared to heterosexual women: A meta-analysis.

Posttraumatic stress disorder (PTSD) is more prevalent among sexual minority women (SMW) than among heterosexual women. PTSD risk varies among SMW, but no meta-analysis has clarified sexual identity-related disparities in probable PTSD among women or SMW's heterogeneity in PTSD risk. SMW are also at pronounced risk of comorbid PTSD and hazardous drinking (HD). However, the difference in comorbid PTSD/HD between SMW and heterosexual women is understudied. This meta-analysis aimed to provide a comprehensive understanding of differences between SMW and heterosexual women and among SMW across demographic characteristics. Peer-reviewed publications that were written in English and reported quantitative data on PTSD specific to SMW were included. Eligible publications (n = 45) were identified through a systematic search of 11 electronic databases, supplemented by a search of reference lists of relevant papers. We found that probable PTSD, PTSD symptom severity, and probable comorbid PTSD/HD are highly prevalent among SMW, with SMW of color, transgender and gender diverse people, and bi+ women (e.g., bisexual, pansexual, queer) being at greatest risk. These results emphasize the need to improve accurate assessment of trauma-related sequelae among SMW and to develop, disseminate, and implement culturally sensitive treatments to reduce PTSD and comorbid PTSD/HD among at-risk SMW.

Cardiovascular, self-report, and behavioral stress reactivity to the group-based Trier Social Stress Test with pandemic-related protocol adaptations.

Research using stress induction protocols such as the Trier Social Stress Test (TSST) and the TSST for groups (TSST-G) during the coronavirus disease (COVID-19) pandemic has been challenging. While institutional review boards have provided guidance on returning to face-to-face research using COVID-19 adaptations (e.g., masking, social distancing), whether these adaptations influence the effectiveness of social-evaluative stress induction remains unknown. We conducted a secondary data analysis from a randomized controlled trial to establish whether using COVID-19 adaptations (i.e., masking, social distancing, and using a single large conference room for the duration of the experiment) to the TSST-G protocol was able to reliably induce stress across cardiovascular, self-report, and behavioral indices of stress. Young adults (N = 53) underwent the TSST-G with COVID-19 adaptations. We measured systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), self-reported, and behavioral responses to the TSST-G, and all variables indicated successful stress induction. Increases in SBP (18 mmHg) and DBP (14 mmHg) were similar in magnitude as those in standard in-person TSST protocols. Increases in HR (9 beats per minute) were smaller in magnitude than standard in-person TSST protocols, but slightly larger than increases documented in remote TSST protocols. The cardiovascular, self-report, and behavioral indices of stress reactivity provide confidence in the effectiveness of TSST-G with COVID-19 adaptations to reliably induce stress. In-person TSST protocols with COVID-19 adaptations represent an alternate option to remote TSST protocols for stress induction researchers to use during times when masking or social distancing are necessary.

Associations Between Latent Classes of Trauma Exposure and Minority Stressors and Substance Use Among Cisgender Sexual Minority Women.

Psychosocial stressors (e.g., minority stressors, trauma exposure) profoundly impact sexual minority women's (SMW's) risk of alcohol and other drug (AOD) use. However, research has not examined whether there are distinct typologies (i.e., patterns) of psychosocial stressors and whether these vary based on sociodemographic characteristics or are differentially associated with AOD outcomes (e.g., alcohol dependence) among SMW. This study aimed to identify latent classes of SMW reporting distinct typologies of psychosocial stressors and examine predictors and outcomes of latent classes of psychosocial stressors among SMW. Participants included a community sample of 602 SMW (Mage = 39.9, SD = 14.0; 74.0% lesbian; 37.4% White, 36.6% Black, 22.3% Latinx; 26.6% annual income ≤$14,999). Latent class analysis was used to identify typologies of psychosocial stressors. Regression analyses were employed to examine sociodemographic predictors and AOD outcomes of class membership. Three classes of psychosocial stressors emerged. Participants in Class 1 were likely to report relatively low adversity. SMW in Class 2, who reported childhood physical abuse (CPA), severe childhood sexual abuse, and adult physical assault, were vulnerable to discrimination and stigma consciousness. A distinct subgroup of SMW (Class 3) was at heightened risk of CPA, adult sexual assault (ASA), and stigma consciousness. Older SMW, Black SMW, and SMW with lower social support were more likely to be in classes characterized by higher adversity. Older SMW were at disproportionate risk of CPA and ASA. Different combinations of psychosocial stressors were uniquely associated with AOD outcomes. Findings underscore the importance of considering within-group heterogeneity in SMW's differential risk of psychosocial stressors and AOD outcomes. Routine screening of psychosocial stressors across several dimensions, brief interventions targeting AOD outcomes, and policies mitigating structural drivers of SMW's increased risk of trauma and minority stressors may be especially important for older SMW, Black SMW, and SMW who lack social support.

"I Know Myself Again, Which Makes Me Motivated for Life": Feasibility and Acceptability of Using Experience Sampling Methods With Trauma-Exposed Sexual Minority Women.

Intensive longitudinal designs (e.g., experience sampling methods [ESMs]) hold promise for examining the dynamic interplay between daily adversity, coping strategies, and behavioral and mental health issues among marginalized populations. However, few studies have used intensive longitudinal designs with sexual minority women (SMW), an understudied and at-risk population. We assessed feasibility and acceptability of using once-daily, interval-contingent ESM with 161 trauma-exposed SMW (Mage = 29.1, SD = 7.57); 20.5% nonbinary; 32.3% queer; 52.2% people of color; 14.3% with annual incomes ≤$9,999; and 30.4% in Southern United States (U.S.). SMW completed one comprehensive online baseline assessment and once-daily brief online assessments for 14 days. Daily surveys assessed past-24-hour stressors, stress responses, and behavioral and mental health symptoms. At the end of the 14-day ESM period, SMW answered three open-ended questions about participating in this study and about research with SMW. Regarding feasibility, 151 participants (94.0%) initiated the post-baseline ESM study portion and 72 (45.0%) completed all 14 daily surveys. An average of 11.70 (median = 13, SD = 3.31) daily surveys (83.5%) were completed by those who initiated the ESM. ESM completion level varied by race/ethnicity and U.S. region. Qualitative acceptability data revealed several themes, namely that SMW (1) enjoyed participating and felt positively about the ESM experience, (2) felt supported to reflect on impacts of early and ongoing stressors, (3) appreciated the chance to self-reflect and challenge existing thought patterns and coping behaviors, (4) recognized their capacity to tolerate trauma-related distress, (5) recommended that researchers focus on SMW's diverse stressors and daily experiences, (6) wanted a rationale for providing sensitive information and more space to narrate their experiences, and (7) recognized the need for affirmative treatment and policies. Findings could inform modifications to ESM protocols to improve their feasibility and acceptability among trauma-exposed SMW and promote ongoing utility of this valuable method.

Teachers' anti-black biases in disciplinary decisions: The role of mindfulness.

Research suggests that disparities in exclusionary discipline can be explained, in part, by teachers' anti-Black biases in disciplinary decision-making. An emerging body of literature also speaks to the benefits of cultivating mindfulness for bias reduction. The present study adds to the literature by assessing whether mindfulness is associated with differences in teachers' responses to student disciplinary infractions as a function of student signaled race, which was manipulated as a between-subjects factor. We predicted that teachers with lower levels of mindfulness, as measured via self-report, would demonstrate greater anti-Black bias in response to students' disciplinary files than teachers with higher levels of mindfulness. Teachers (N = 179) completed the study via an online research participant platform. Consistent with hypothesis, we found that participants' self-reported mindfulness in teaching moderated their responses to a disciplinary file as a function of student signaled race, b = -1.05, F(1, 175) = 4.50, p = 0.035, ηp2 = 0.03, 95% CI [-2.03, -0.07]. Specifically, participants with lower levels of mindfulness rated the disciplinary infraction as more severe if it was enacted by a Black boy compared to a White boy. At higher levels of mindfulness, however, the opposite pattern emerged; participants demonstrated more leniency if the infraction was perpetrated by a Black boy, relative to a White boy. Our research adds to the literature and suggests that improving teachers' ability to remain present in the classroom may improve their ability to make more equitable decisions in managing students' misbehavior.

Discrimination, Depression, and Anxiety Among Sexual Minority and Heterosexual Young Adults: The Role of Self-Compassion.

Purpose: The objectives of this study were to examine whether self-compassion may be a protective coping resource against depression and anxiety symptoms for young adults experiencing discrimination and to explore the protective influence of self-compassion among sexual minority young adults (SMYAs) relative to heterosexual peers. Methods: Undergraduate college students (N = 251; 189 heterosexual and 62 sexual minority individuals) completed online self-report questionnaires related to discrimination experiences, depression, anxiety, and self-compassion. Two moderated moderation analyses were conducted to (1) identify whether self-compassion buffered the relationship between discrimination and depression and between discrimination and anxiety and (2) whether this buffering effect varied by sexual identity (i.e., heterosexual vs. sexual minority). Results: Self-compassion significantly moderated the relationship between discrimination and depression for the full sample. Further examination revealed that self-compassion significantly moderated the relationship between discrimination and depression among SMYAs, but not among heterosexual young adults. SMYAs with higher self-compassion reported fewer depression symptoms than SMYAs with lower self-compassion, even when reporting more frequent experiences of discrimination. Self-compassion did not moderate the relationship between discrimination and anxiety for the full sample, nor did this relationship vary by sexual identity. Conclusions: Self-compassion may be a particularly important coping resource to protect against depression symptoms among SMYAs experiencing discrimination. These findings provide an impetus for SMYA-tailored intervention and prevention efforts that incorporate cultivating self-compassion as a protective coping resource to buffer deleterious effects of discrimination.

PTSD Symptoms and Hazardous Drinking Indicators among Trauma-Exposed Sexual Minority Women during Heightened Societal Stress.

Trauma-exposed sexual minority women (SMW) are at elevated risk of posttraumatic stress disorder (PTSD) and hazardous drinking compared to trauma-exposed heterosexual women. To understand whether these problems might be exacerbated during times of elevated societal stress, we collected data from a New York-based sample of trauma-exposed SMW between April 2020 and August 2020, a period of notable, compounding societal stressors, including: (a) living in or near one of the first epicenters of the coronavirus disease 2019 (COVID-19) epidemic in the United States and (b) living through multiple high-profile occurrences of racism-related police violence and subsequent racial unrest. SMW (n = 68) completed online self-report questionnaires related to trauma, PTSD symptoms, and alcohol use, and a subset (n = 29) completed semi-structured qualitative interviews. PsycINFO was searched with terms related to SMW, PTSD, and alcohol use to identify studies with samples of SMW from articles published within the last 10 years to which we could compare our sample; this produced nine studies. Welch's t-tests and Chi-square analyses revealed that SMW within our sample reported significantly higher PTSD symptom severity, probable PTSD, and hazardous drinking indicators (i.e., alcohol use disorder and heavy episodic drinking) between April 2020 and August 2020 compared to similar samples (i.e., trauma-exposed SMW and general samples of SMW) assessed previously. Qualitative reports also indicated that the societal stressors of 2020 contributed to mental and behavioral health concerns. These results underscore the need for integrated PTSD and alcohol use prevention and intervention efforts for trauma-exposed SMW during times of heightened societal stress.Supplemental data for this article is available online at https://doi.org/10.1080/08964289.2021.2006132 .

Nonmedical Social Determinants, Syndemic Conditions, and Suicidal Thoughts and Behaviors in a Treatment-seeking Community Sample: A Latent Class Analysis.

OBJECTIVE: Knowledge gaps remain regarding whether syndemic conditions identify treatment-seeking individuals most at risk for suicidal thoughts and behaviors (STB). We employed latent class analysis to: (1) model treatment-seeking individuals' syndemic conditions, (2) examine latent classes across nonmedical social determinants, and (3) assess associations between class membership and STB. METHOD: Participants were 982 individuals presenting at a community mental health clinic between October 2014 and February 2020. The three-step latent class analytic approach was used. Regression analyses were employed to examine nonmedical social determinants and STB outcomes associated with class membership. RESULTS: Participants were aged 18 to >72 (75.8% White; 76.7% heterosexual; 53.7% cisgender woman; 73.8% earned ≥$20,000 annually). Latent class analysis resulted in a three-class solution. Participants in Class 1 were characterized by low probabilities across syndemic conditions. Class 2 was characterized by high probabilities of anxiety and depression. Class 3 was characterized by high probabilities of eating disorders, anxiety, and depression. Participants of color, sexual minority participants, cisgender women, and those experiencing financial distress were more likely to be in classes characterized by syndemic conditions. Classes characterized by syndemic conditions, relative to no syndemic conditions, were associated with greater risk of STB. CONCLUSION: Findings confirm the concentrated clustering of co-occurring syndemic conditions among marginalized groups and highlight differing risks for those considering suicide or who have attempted suicide vs. those engaging in self-harm. Results underscore the need for resource allocation and multilevel interventions targeting syndemic conditions and suicidality for minority populations and those experiencing financial distress.

Gender differences in the stress-buffering effects of mindfulness facets on substance use among low-income adolescents.

Problematic substance use during adolescence predicts numerous adverse outcomes, including increased risk of substance use disorders in adulthood. Adolescents often use substances to cope with stress, particularly adolescents who have experienced environmental stress in childhood (e.g., low-income environments), but research indicates stress-related substance use disorders may develop differently across gender. This highlights a need to identify coping resources for stress-related substance use and understand whether these coping resources are differentially effective across gender. Mindfulness has garnered evidence as a coping resource for stress-related problematic substance use; however, there is limited research on how specific mindfulness facets (e.g., nonjudgment) may buffer against stress-related substance use among adolescents. This study examined whether overall mindfulness and specific facets buffered the association between stress and substance use differentially across gender in a predominantly low-income, racially-diverse (42 % Black, 24 % White, 15 % Hispanic/Latinx, 13 % Asian, 3 % American Indian/Alaskan Native, and 3 % multiracial) sample of adolescents (n = 212) using moderated moderation models. Girls with lower levels of two mindfulness facets (i.e., acceptance/nonjudgement, decentering/nonreactivity), relative to girls with higher levels, demonstrated a greater probability of substance use with increased stress. Conversely, boys with higher levels of acceptance/nonjudgement and decentering/nonreactivity, relative to boys with lower levels, reported a greater probability of substance use with increased stress. Results suggest that acceptance/nonjudgment and decentering/nonreactivity may be protective against stress-related substance use for girls and potentially contraindicated for boys, indicating that adolescent substance use prevention and intervention efforts may need to be tailored by gender.

Structural determinants of tailored behavioral health services for sexual and gender minorities in the United States, 2010 to 2020: a panel analysis.

BACKGROUND: Research indicates that tailored programming for sexual and gender minority (SGM; e.g., lesbian, gay, bisexual, transgender, queer) people, compared to non-tailored programming, is effective for reducing the disproportionate health burden SGM people experience relative to the general population. However, the availability of SGM-tailored programming is often over-reported and inconsistent across behavioral health (i.e., substance use and mental health) facilities in the United States (U.S.). METHODS: Using panel analysis, the National Survey of Substance Abuse Treatment Services (N-SSATS), and the National Mental Health Services Survey (N-MHSS), this study examines structural stigma and government funding as two structural determinants affecting the availability of SGM-tailored programming in the U.S. RESULTS: Results indicated that from 2010 to 2020, reductions in structural stigma (i.e., increases in state-level supportive SGM policies) were positively associated with increases in the proportion of substance use treatment facilities offering SGM-tailored programming. This effect was significant after controlling for over-reporting of SGM-tailored programming and time- and state-specific heterogeneity. On average, the effect of reduced structural stigma resulted in approximately two new SGM-tailored programs in the short term and about 31 new SGM-tailored programs in the long term across U.S. substance use treatment facilities. Structural stigma did not predict the availability of SGM-tailored programming in mental health treatment facilities. Government funding was not significant in either data set. However, without correcting for over-reporting, government funding became a significant predictor of the availability of SGM-tailored programming at substance use treatment facilities. CONCLUSIONS: Because SGM-tailored programming facilitates access to healthcare and the current study found longitudinal associations between structural stigma and the availability of SGM-tailored programming in substance use treatment facilities, our findings support claims that reducing structural stigma increases access to behavioral health treatment specifically and healthcare generally among SGM people. This study's findings also indicate the importance of correcting for over-reporting of SGM-tailored programming, raising concerns about how respondents perceive the N-SSATS and N-MHSS questions about SGM-tailored programming. Implications for future research using the N-SSATS and N-MHSS data and for public health policy are discussed.

A latent class analysis of tailored substance use treatment programs: Implications for treating syndemic conditions facing sexual and gender minority populations.

BACKGROUND: Syndemics (i.e., multiple, co-occurring, and synergistic conditions) contribute to elevated substance use among sexual and gender minority (SGM) people relative to heterosexual, cisgender people. Research suggests that syndemic-informed and SGM-tailored treatments are effective in substance use treatment among SGM people. However, few studies have examined 1) the proportion of substance use treatment facilities offering syndemic-informed, SGM-tailored treatment programming; and 2) the availability and accessibility of syndemic-informed, SGM-tailored treatment programs across the U.S. METHODS: We used the 2020 National Survey of Substance Abuse Treatment Services (N-SSATS) dataset to perform a latent class analysis examining whether substance use treatment facilities' tailored treatment programs cluster together to form distinct classes indicating whether facilities offer syndemic-informed and SGM-tailored programming. We then used multinomial logistic regression to examine associations between class membership and facility availability and accessibility. RESULTS: Analyses revealed four classes of substance use treatment facilities' tailored programs. Facilities with syndemic-informed and SGM-tailored treatment programs compared to facilities with no tailored programs were more likely to be in the Northeast compared to the Midwest and South; to offer payment assistance versus not offer payment assistance; and to be private, for-profit facilities versus public or non-profit facilities. CONCLUSIONS: This study's findings identify the need for more facilities with syndemic-informed and SGM-tailored treatment, particularly in the Midwestern and Southern U.S. regions. Facilities offering syndemic-informed and SGM-tailored treatment might present accessibility barriers for low-income SGM people, as they were more likely to be private, for-profit facilities; however, they were more likely to offer payment assistance.

Adverse childhood experiences exacerbate the association between day-to-day discrimination and mental health symptomatology in undergraduate students.

BACKGROUND: Adverse childhood experiences (ACEs) and day-to-day discrimination (hereafter, "discrimination") both contribute to mental health symptomatology in young adulthood, but how these constructs interact and whether they are associated with mental health remains unclear. This study evaluated whether the relation between discrimination in young adulthood and mental health symptomatology varied as a function of ACEs exposure. METHODS: Undergraduates (n = 251) completed self-report measures related to ACEs, discrimination, and mental health symptomatology (i.e., depression, anxiety, somatization, and psychological distress). Linear and logistic regression models were implemented to test for potential exacerbation effects of ACEs on the relation between discrimination and mental health symptomatology. RESULTS: Participants with greater discrimination exposure and ACEs reported significantly more depression, anxiety, and somatic symptoms, along with more psychological distress, relative to those with less discrimination exposure and few or no ACEs. LIMITATIONS: Data were cross-sectional, thus, causality cannot be inferred. ACEs and discrimination measures examined ACE counts and general discrimination, respectively, which did not allow for examination of possible differences across specific ACEs (e.g., childhood sexual abuse vs. neglect) or specific types of discrimination (e.g., sexual-orientation-based discrimination vs. race-based discrimination). CONCLUSIONS: These results are among the first to inform the conceptualization of ACEs and discrimination in etiological models of young adults' mental health. Both ACEs and discrimination, rather than exposure to only one of these stressors, may be synergistically associated with young adults' mental health symptomatology. Clinicians could address stress-sensitive mental health issues by assessing for both ACEs and discrimination exposure.

Victimization Typologies Among a Large National Sample of Sexual and Gender Minority Adolescents.

Purpose: The overall objective of this study was to examine the hypothesis that victimization exposure among sexual and gender minority (SGM) youth would result in different latent classes and that victimization exposure class membership would relate to demographic, SGM-specific risk and protective factors, and health variables. Methods: Between April 2017 and December 2017, SGM youth (N = 17,112) aged 13-17 years completed self-report online surveys as part of the LGBTQ National Teen Survey. Data were analyzed between August 2020 and November 2020. Results: Three classes emerged: (1) no victimization exposure, (2) sexual harassment and bullying, and (3) poly-victimization (sexual victimization, sexual harassment, SGM-based bullying, and non-SGM bullying). The results demonstrated that victimization experiences co-occur disproportionately in vulnerable subpopulations of SGM youth, including those who identify as transgender or other gender minority, who are experiencing stigma-related stress and family rejection, and who had disclosed their sexual orientation to family members/parents. SGM youth who reported a diversity of strengths seemed to be protected against victimization. Finally, SGM youth in the sexual harassment and bullying class and the poly-victimization class were more likely to report depressive symptoms, self-perceived stress, and substance use than were SGM youth in the no victimization class, regardless of sex assigned at birth. Conclusion: These findings underscore the urgency with which affirmative prevention and intervention initiatives are needed for SGM youth to reduce risk factors for and correlates of victimization experiences. The data also underscore the importance of addressing SGM-specific risk and protective factors as part of comprehensive violence-related initiatives.

Stress Reactivity to the Trier Social Stress Test in Traditional and Virtual Environments: A Meta-Analytic Comparison.

OBJECTIVE: The traditional Trier Social Stress Test (TSST) is a widely used standardized stress induction protocol and has recently been adapted in a variety of virtual reality environments (V-TSST). Research has demonstrated the ability of the V-TSST to induce a stress reactivity response measured via cortisol, heart rate, and self-report. However, research comparing stress reactivity induced via the V-TSST to the traditional TSST across neuroendocrine, cardiovascular, and self-report variables has not yet been systematically and quantitatively reviewed. METHODS: In this meta-analytic review, the existing studies that used V-TSST were gathered, and each was age and sex matched with samples using the traditional TSST. These studies were then meta-analytically synthesized to determine if there was a moderating effect of TSST type (traditional TSST or V-TSST) on multiple measures of stress reactivity (i.e., cortisol, heart rate, and self-report). RESULTS: Examining the pre-post stress induction, the V-TSST studies demonstrated comparable effect sizes (ESs) for stress reactivity (cortisol ES = 0.61, heart rate ES = 0.98, self-reported stress ES = 0.94) to traditional TSST study ESs (cortisol ES = 0.79, heart rate ES = 0.85, self-reported stress ES = 0.85). CONCLUSIONS: The TSST type differences between ESs were not statistically significant, indicating that the V-TSST is as effective as the traditional TSST at eliciting a physiological and self-reported stress reactivity response. Implications and limitations of this meta-analysis are discussed, and recommendations for future research are provided.

Evidence for similar structural brain anomalies in youth and adult attention-deficit/hyperactivity disorder: a machine learning analysis.

Attention-deficit/hyperactivity disorder (ADHD) affects 5% of children world-wide. Of these, two-thirds continue to have impairing symptoms of ADHD into adulthood. Although a large literature implicates structural brain differences of the disorder, it is not clear if adults with ADHD have similar neuroanatomical differences as those seen in children with recent reports from the large ENIGMA-ADHD consortium finding structural differences for children but not for adults. This paper uses deep learning neural network classification models to determine if there are neuroanatomical changes in the brains of children with ADHD that are also observed for adult ADHD, and vice versa. We found that structural MRI data can significantly separate ADHD from control participants for both children and adults. Consistent with the prior reports from ENIGMA-ADHD, prediction performance and effect sizes were better for the child than the adult samples. The model trained on adult samples significantly predicted ADHD in the child sample, suggesting that our model learned anatomical features that are common to ADHD in childhood and adulthood. These results support the continuity of ADHD's brain differences from childhood to adulthood. In addition, our work demonstrates a novel use of neural network classification models to test hypotheses about developmental continuity.

A meta-analysis of cortisol reactivity to the Trier Social Stress Test in virtual environments.

BACKGROUND: Maladaptive responses to stressors can lead to poor physical and psychological health outcomes. Laboratory studies of stress induction commonly use the Trier Social Stress Test (TSST). The TSST has been shown to reliably induce a stress response, most commonly measured via cortisol reactivity. Recently, researchers have used virtual environment versions of the TSST (V-TSST) in place of the traditional TSST. The V-TSST has many advantages over the traditional TSST, including increased standardization and use of fewer resources, but V-TSST has yet to be quantitatively reviewed and compared to the traditional TSST. This review aims to quantifying the effectiveness of V-TSST with a meta-analysis of cortisol response effects and identify potential moderating variables that are more likely to induce a cortisol response with V-TSST. METHODS: Literature searches were conducted including the key words Trier Social Stress Test, TSST, and virtual reality. Thirteen studies were included in this meta-analysis after meeting the inclusion criteria of utilizing a V-TSST and having cortisol measurements at baseline and peak stress to assess cortisol reactivity. The standardized mean gain effect size was used. RESULTS AND DISCUSSION: There was a medium average effect size (ESsg = 0.65) across all studies for increase in cortisol from baseline to peak measurement. Significant moderating effects were seen for participant age, sex, and level of immersivity of the virtual environment. Studies in which participants were under 25 years old, or all male, showed greater effect sizes for cortisol reactivity. Virtual environments that were more immersive also evidenced greater effect sizes. Although the V-TSST is effective at inducing psychosocial stress, the magnitude of this response is less than the traditional TSST. Based on these results, recommendations for future research are provided.