Structural transphobia is associated with psychological distress and suicidality in a large national sample of transgender adults.

PURPOSE: Transgender adults face increasingly discriminatory laws/policies and prejudicial attitudes in many regions of the United States (US), yet research has neither quantified state-level transphobia using indicators of both, nor considered their collective association with transgender adults' psychological wellbeing, hindering the identification of this potential social determinant of transgender mental health inequity. METHODS: We therefore used factor analysis to develop a more comprehensive structural transphobia measure encompassing 29 indicators of transphobic laws/policies and attitudes at the state level, which we linked to individual-level mental health data from a large national sample of 27,279 transgender adults (ages 18-100) residing in 45 US states and the District of Columbia (DC). RESULTS: Controlling for individual- (i.e., demographics), interpersonal- (i.e., perceived discrimination), and state- (i.e., income inequality, religiosity) level covariates, transgender adults from US states with higher (vs. lower) levels of structural transphobia reported more severe past-month psychological distress and were more likely to endorse past-year and lifetime suicidal thoughts, plans, and attempts. CONCLUSION: Findings provide novel evidence that state-level transphobic laws/policies and attitudes collectively shape a range of important mental health outcomes among transgender adults in the US. Multilevel intervention strategies, such as affirming mental health treatments, provider-training interventions, and supportive legislation, are needed to address structural transphobia's multifaceted nature and negative mental health consequences.

Lamotrigine Therapy and Biomarkers of Cerebral Energy Metabolism in Older Age Bipolar Depression.

OBJECTIVE: This study compared brain energy metabolism, as measured by cerebral concentrations of glutamate (Glu), glutamine (Gln), and N-acetyl aspartate (NAA), in older age bipolar depression (OABD) to that of psychiatrically healthy comparison subjects using proton (1H) magnetic resonance spectroscopy imaging at 4-Tesla. Metabolite levels were assessed in OABD subjects before and after 8 weeks of lamotrigine therapy with the goal of determining relationships between cerebral energy metabolism, depression symptom severity, and changes in depression symptom response. METHODS: Individuals (n = 21, mean age: 62.0 ± 5.9 years) with bipolar disorder, current episode depressed, and a healthy comparison group (n = 14, mean age: 67.5 ± 8.8 years) were selected. Participants with bipolar disorder, current episode depressed, were treated in open label fashion with lamotrigine monotherapy for 8 weeks. All subjects were scanned with 1H magnetic resonance spectroscopy at 4T at baseline and again after 8 weeks to assess levels of cerebral metabolites in the anterior cingulate cortex and parieto-occipital cortex. Metabolite levels were examined as ratios relative to creatine (Cr). Response to 8 weeks of lamotrigine treatment in the bipolar disorder, current episode depressed group, was assessed as a continuous measure on the Montgomery-Asberg Depression Rating Scale. RESULTS: NAA/Cr ratio in OABD was significantly lower by 14% (95% confidence interval: [1%, 26%]) than in comparison subjects at baseline. However, there were no associations between NAA/Cr, Glu/Cr, or Gln/Cr and either depression severity or lamotrigine treatment. CONCLUSION: Group differences in NAA suggest evidence for a deficit in cerebral energy metabolism in OABD.

Sexual Violence-Related Stigma, Mental Health, and Treatment-Seeking: A Multimodal Assessment in a Population-Based Study of Young Adults.

Sexual violence (SV) is a stigmatized form of trauma, yet the stigma experiences of those reporting SV are often assumed rather than explicitly measured. We adapted a measure that quantified three key features of SV stigma across three levels: negative self-image (individual), disclosure concerns (interpersonal), and concerns about public attitudes (structural). We administered this measure to a population-based sample of Swedish young adults (N = 453) who reported a history of either sexual assault (SA) or intimate partner sexual violence (IPSV). Among both groups, 89% endorsed at least one item on the stigma scale. Experiences of SV-related stigma were associated with significantly higher symptoms of generalized anxiety, depression, and posttraumatic stress disorder, with greater perceived need for mental health treatment, and with more shame (measured implicitly via a reaction-time task). Experiences of stigma were negatively associated with symptoms of alcohol misuse. Results suggest that exposure to SV stigma may be a critical, but often overlooked, correlate of post-assault recovery.

Self-triggering: Does function determine pathogenesis?

OBJECTIVE: Research suggests six motives for exposing oneself to painful reminders of a trauma outside of a therapeutic context (self-triggering). These include provoking arousal, escaping emotional numbness, self-punishment, controlling symptoms of posttraumatic stress disorder (PTSD), making meaning of one's trauma, and generating an experience that matches one's emotions. The goal of the current study is to examine if these motives subserve broader functions of self-triggering behavior that differentially relate to PTSD symptoms. METHOD: We conducted an exploratory factor analysis on the self-reported reasons for self-triggering collected from 360 adults who endorsed lifetime self-triggering. We then theorized higher-order factors and tested both their fit to the data with a confirmatory factor analysis and whether they moderated the relationship between self-triggering and PTSD symptoms. RESULTS: We found that five factors best described the reasons for self-triggering. We theorized one higher-order factor (function) of "emotional modification" that encompasses sensation-seeking, antinumbing, self-punishment, and affect-matching. The "meaning-making" function consists of efforts to make meaning of one's trauma. This structure fit the data well in a confirmatory factor analysis. Self-triggering frequency no longer predicted symptom severity when meaning-making was highly endorsed as a function of self-triggering. Emotional modification did not affect this relationship. CONCLUSIONS: Generalizability may be limited by the sample's high symptom levels, limited demographic diversity, and high proportion of interpersonal trauma. These findings suggest that the degree to which individuals self-trigger to make meaning of trauma may affect how pathogenic the behavior is, underscoring the clinical importance of identifying the function of patients' self-triggering. (PsycInfo Database Record (c) 2023 APA, all rights reserved).