Enforced home-working under lockdown and its impact on employee wellbeing: a cross-sectional study.

BACKGROUND: The Covid-19 pandemic precipitated a shift in the working practices of millions of people. Nearly half the British workforce (47%) reported to be working at home under lockdown in April 2020. This study investigated the impact of enforced home-working under lockdown on employee wellbeing via markers of stress, burnout, depressive symptoms, and sleep. Moderating effects of factors including age, gender, number of dependants, mental health status and work status were examined alongside work-related factors including work-life conflict and leadership quality. METHOD: Cross-sectional data were collected over a 12-week period from May to August 2020 using an online survey. Job-related and wellbeing factors were measured using items from the COPSOQIII. Stress, burnout, somatic stress, cognitive stress, and sleep trouble were tested together using MANOVA and MANCOVA to identify mediating effects. T-tests and one-way ANOVA identified differences in overall stress. Regression trees identified groups with highest and lowest levels of stress and depressive symptoms. RESULTS: 81% of respondents were working at home either full or part-time (n = 623, 62% female). Detrimental health impacts of home-working during lockdown were most acutely experienced by those with existing mental health conditions regardless of age, gender, or work status, and were exacerbated by working regular overtime. In those without mental health conditions, predictors of stress and depressive symptoms were being female, under 45 years, home-working part-time and two dependants, though men reported greater levels of work-life conflict. Place and pattern of work had a greater impact on women. Lower leadership quality was a significant predictor of stress and burnout for both men and women, and, for employees aged > 45 years, had significant impact on level of depressive symptoms experienced. CONCLUSIONS: Experience of home-working under lockdown varies amongst groups. Knowledge of these differences provide employers with tools to better manage employee wellbeing during periods of crisis. While personal factors are not controllable, the quality of leadership provided to employees, and the 'place and pattern' of work, can be actively managed to positive effect. Innovative flexible working practices will help to build greater workforce resilience.

The terminology of identities between, outside and beyond the gender binary - A systematic review.

Background: Recently, a multitude of terms have emerged, especially within North America and Western Europe, which describe identities that are not experienced within the culturally accepted binary structure of gender which prevails within those cultures. As yet, there is no clear single umbrella term to describe such identities and a mixture of words have been used in scholarly work to date. Aims: To explore the origins and track the emergence of newer terms and definitions for identities between, outside and beyond the gender binary, to outline current trends in descriptors within scholarly work and to suggest a term which is wide enough to encompass all identities. Methods: A comprehensive systematic review was made, following the PRISMA guidelines. Several relevant key terms were used to search Web of Science, ScienceDirect, PubMed, and the International Journal of Transgenderism. The descriptions each title gives for identities outside of the binary are extracted for analysis. Results: Several terms have been used over the years to describe identities outside of the binary. "Non-binary" and "genderqueer" are currently mostly used as umbrella terms. However, "gender diverse" is emerging as a more suitable wide-ranging inclusive term for non-male and non-female identities. Discussion: Identity outside of "male" and "female" is an emerging concept which currently has several identifiers and little academic agreement on which is the most pertinent. The two leading descriptors are "non-binary" and "genderqueer." Gender diverse is emerging as a new term which has the aim of including all other terms outside of male and female within it and this article suggests the increase in its use to describe gender identities outside of the binary.

Risk Factors for Non-Suicidal Self-Injury Among Trans Youth.

INTRODUCTION: Previous research has reported high levels of non-suicidal self-injury (NSSI) in trans populations and younger age has been identified as a risk factor. AIMS: To explore the prevalence of NSSI in a large group of young trans people and to identify risk factors for this group. MAIN OUTCOME MEASURES: Sociodemographic variables and measurements of NSSI (Self-Injury Questionnaire), psychopathology (Symptom Checklist-90-Revised), self-esteem (Rosenberg Self-Esteem Scale), victimization (Experiences of Transphobia Scale), interpersonal functioning (Inventory of Interpersonal Problems), and social support (Multidimensional Scale of Perceived Social Support). METHODS: Two hundred sixty-eight young people attending a national gender clinic completed questionnaires assessing presence and frequency of NSSI and levels of general psychopathology, depression, anxiety, interpersonal problems, self-esteem, social support, transphobia, and information on hormone treatment. RESULTS: A lifetime presence of NSSI was identified in 46.3% of patients and 28.73% reported currently engaging in NSSI (within at least the past few months). Analyses showed that those with a lifetime presence of NSSI had significantly greater general psychopathology, lower self-esteem, had suffered more transphobia, and experienced greater interpersonal problems than those without NSSI. Findings were similar when comparing current with non-current NSSI. Overall, natal male patients reported less social support than natal female patients, but current NSSI was more common in natal female patients. Regression analyses confirmed that natal female gender and greater general psychopathology predicted current and lifetime NSSI. Further analyses confirmed that general psychopathology itself could be predicted by transphobic experiences, low self-esteem, and interpersonal problems, but not by the use of cross-sex hormones. CONCLUSION: These findings confirm that NSSI is common in trans youth and emphasize the need for interventions that decrease transphobia, increase social support, and help trans youth navigate their relationships with others to decrease psychopathology and NSSI.

Sociodemographic Variables, Clinical Features, and the Role of Preassessment Cross-Sex Hormones in Older Trans People.

INTRODUCTION: As referrals to gender identity clinics have increased dramatically over the last few years, no studies focusing on older trans people seeking treatment are available. AIMS: The aim of this study was to investigate the sociodemographic and clinical characteristics of older trans people attending a national service and to investigate the influence of cross-sex hormones (CHT) on psychopathology. METHODS: Individuals over the age of 50 years old referred to a national gender identity clinic during a 30-month period were invited to complete a battery of questionnaires to measure psychopathology and clinical characteristics. Individuals on cross-sex hormones prior to the assessment were compared with those not on treatment for different variables measuring psychopathology. MAIN OUTCOME MEASURES: Sociodemographic and clinical variables and measures of depression and anxiety (Hospital Anxiety and Depression Scale), self-esteem (Rosenberg Self-Esteem Scale), victimization (Experiences of Transphobia Scale), social support (Multidimensional Scale of Perceived Social Support), interpersonal functioning (Inventory of Interpersonal Problems), and nonsuicidal self-injury (Self-Injury Questionnaire). RESULTS: The sex ratio of trans females aged 50 years and older compared to trans males was 23.7:1. Trans males were removed for the analysis due to their small number (n = 3). Participants included 71 trans females over the age of 50, of whom the vast majority were white, employed or retired, and divorced and had children. Trans females on CHT who came out as trans and transitioned at an earlier age were significantly less anxious, reported higher levels of self-esteem, and presented with fewer socialization problems. When controlling for socialization problems, differences in levels of anxiety but not self-esteem remained. CONCLUSION: The use of cross-sex hormones prior to seeking treatment is widespread among older trans females and appears to be associated with psychological benefits. Existing barriers to access CHT for older trans people may need to be re-examined.

Non-suicidal self-injury and suicidality in trans people: A systematic review of the literature.

Literature has described high levels of mental health problems among trans people, such as depression, resulting in increased levels of non-suicidal self-injury (NSSI) behaviour and suicidality (suicidal thoughts, suicide attempts and suicide rates). With the aim of systematically reviewing the available literature in this field, this study identifies 31 papers that explore the rates of NSSI and suicidality in trans people. From reviewing the literature, it was revealed that trans people have a higher prevalence of NSSI and suicidality compared to the cisgender (non-trans) population. There appear to be some gender differences within these rates, with trans men at a greater risk for NSSI behaviour. Prevalence rates differ depending on the different stages of transition, but they are still overall greater than the cisgender population. The study concludes that trans individuals are at a greater risk of NSSI behaviour and suicidality than the cisgender population, and discusses risk factors and the need to develop effective preventative interventions.

'I Didn't Have the Language Then'-A Qualitative Examination of Terminology in the Development of Non-Binary Identities.

INTRODUCTION: Identities that lie outside of exclusively male and female, such as non-binary and genderqueer, have become increasingly more prevalent and visible within recent years. However, to date, the role of terminology in the development of such gender identities has been under-researched. This study aims to: (1) Examine what role terminology plays in coming to identify as non-binary. (2) Explore the continuing importance of terminology once a non-binary identity is established. METHODS: This study uses thematic analysis on data produced from interviews with 16 participants who self-selected for the study and were recruited from several transgender and LGBTQ+ organisations on the basis that they identified outside the gender binary of male and female. RESULTS: The analysis uncovered several key themes and sub-themes relating to terminology choice, encountering new terms and the process of identifying with new terminology, as well as becoming visible and understood by others. CONCLUSIONS: This study found that terminology is not only central in coming to identify as something other than exclusively male and female, it also remains an important factor when it comes to making a non-binary identity visible to others.

Assessing the impact of university students' involvement in the first year of Nurture-U: a national student wellbeing research project.

BACKGROUND: Students experience lower levels of wellbeing than the general, age-matched population. A whole-university approach to mental health is encouraged, which must work for individuals from all backgrounds and experiences. Student input is vital in researching and designing these solutions. Nurture-U is a national, large-scale research project exploring better ways to support student wellbeing, with a Student Advisory Group (SAG) that feeds into project decision making. With the first year of the project now completed, we now critically review the processes and effectiveness of the SAG and how well the project is engaging and working with students. METHODS: Assessment of the SAG's impact on the project, the student advisors, and the researchers was undertaken through a content analysis of team meetings and collection of advisor and researcher feedback using the Patient Engagement Quality Guidance Tool. RESULTS: 142 students worked on different tasks in the first year of the Nurture-U project. The SAG was involved in the project branding and marketing, and in the development and co-design of interventions and tools. They reported a positive experience, with involvement boosting confidence. They felt valued but reported not always knowing whether their input was implemented in final decisions. They also recommended different methods of providing feedback. Researchers found student input beneficial to communicate the viewpoint of a different generation and increase the relevance of the study, but also suggested improvements for communication between the research team and the student group. CONCLUSIONS: This critical reflection of the SAG's public advisor role in this large-scale research project was important in highlighting what worked well and areas to improve. As the project unfolds, we aim to adapt our methods of student input, increase the transparency of decision-making processes, and in turn increase student-led decision making within the project.

University students face many challenges to their wellbeing, including academic stress, frequent changes of location, distancing of support systems, and new social and cultural surroundings. The Nurture-U research project is looking at how universities can support student wellbeing. It is supported by a Student Advisory Group (SAG) that is helping us design the research. The aim of this paper is to reflect on the input of the SAG in the first year of the 4-year Nurture-U project. 142 students worked on different tasks in the first year of the Nurture-U project, including marketing and designing therapeutic apps. The SAG described feeling valued, gaining confidence and an understanding of mental health and research. Researchers felt the SAG improved Nurture-U, making it more relevant to students. However, all were concerned that final decisions were researcher-led, not student-led. There was also a lack of diversity, with most of the SAG being female. The SAG advised different ways for researchers and students to work together. This included having different ways for student advisors to voice their opinions, for example in smaller or face-to-face groups, or on online boards. Also, researchers could engage with the SAG differently, through newsletters or videos, to make it clearer how final decisions are made. This formal reflection activity has helped the Nurture-U team consider ways to improve working with the SAG for the rest of the project, which we hope will ensure that student voices guide how the project unfolds.

The quality and satisfaction of romantic relationships in transgender people: A systematic review of the literature.

INTRODUCTION: Romantic relationships are often a significant area of individuals' lives and can have a positive impact on wellbeing. There is often a belief within society of romantic relationships ending upon the start of gender affirming transition, however this is often not reflected within clinical work or research studies. Despite this, currently not enough is known about romantic relationships for transgender individuals and their partners, and the impact gender affirming transition can have on the quality and satisfaction of these relationships. AIM: To critically and systematically review the available literature examining quality and satisfaction of romantic relationships for transgender individuals and their partners. METHODS: Using PRISMA guidelines, major databases (Pubmed, PsycINFO and Web of Science) and relevant reference lists were searched for suitable articles up to January 2020. Each included article was assessed for methodological quality and the demographic data, methods and findings linked to relationship quality and satisfaction was extracted for analysis. RESULTS: From 151 potentially relevant articles, 14 studies (six quantitative, eight qualitative) were included within the review. Most studies displayed moderate risk of bias due to cross-sectional designs and lack of reflexivity. Findings from quantitative studies suggest a bi-directional relationship between transition, relationship quality and satisfaction and wellbeing. Qualitative studies suggest transition can cause personal challenges for both transgender individuals and partners. Maintenance activities help buffer the impact of these challenges on relationship satisfaction and ensure positives are possible from relationships. DISCUSSION: Gender affirming transition can impact on the quality and satisfaction of romantic relationships. Due to additional challenges transgender individuals and their partners may face, adequate support is required at personal, community and clinical level. There is a paucity of research in this area and current studies lack methodological rigor. Future research is essential to gain a further understanding of transgender relationships and the support required.