Gender-affirming care in the assessment and treatment of psychosis risk: Considering minority stress in current practice and future research.

INTRODUCTION: Although research has documented the marked disparities in rates of psychosis-spectrum diagnoses in various socially marginalized populations, there is limited research addressing the needs of gender expansive individuals in the context of psychosis-spectrum illnesses using a minority stress lens. As clinical high-risk for psychosis (CHR-p) assessment and treatment becomes accessible to increasingly diverse populations, there is a need for clinicians to demonstrate greater clinical competency working with individuals across diverse social backgrounds and identities. METHODS: We examined rates of gender expansive (GE) patients seeking evaluation at an urban-based CHR-p clinic and compared the diagnostic profile of GE individuals to cisgender patients. Post-hoc analyses were conducted on clinical variables with significant differences between the cisgender and GE groups. RESULTS: The proportion of GE patients seeking evaluation increased from 2017 (9.3%) to 2021 (16.7%). Compared to cisgender youth, GE patients had significantly higher depressive, social anxiety, borderline personality disorder symptoms, higher levels of suicidality and non-suicidal self-injurious behaviour, and lower role functioning. Gender identity was predictive of suicidality controlling for social anxiety, borderline symptoms, and role functioning. CONCLUSIONS: We review implications for CHR-p treatment and discuss ways to integrate minority stress theory and gender-affirming practices into coordinated specialty care for CHR-p patients.

Greater Engagement in Gender-Sexuality Alliances (GSAs) and GSA Characteristics Predict Youth Empowerment and Reduced Mental Health Concerns.

Extracurricular groups can promote healthy development, yet the literature has given limited attention to indirect associations between extracurricular involvement and mental health or to sexual and gender minority youth. Among 580 youth (Mage  = 15.59, range = 10-20 years) and adult advisors in 38 Gender-Sexuality Alliances (GSAs), multilevel structural equation models showed that greater engagement in GSAs over the school year predicted increased perceived peer validation, self-efficacy to promote social justice, and hope (baseline adjusted). Through increased hope, greater engagement indirectly predicted reduced depressive and anxiety symptoms at the year's end (baseline adjusted). GSAs whose members had more mental health discussions and more meetings reported reduced mental health concerns. Findings suggest how groups addressing issues of equity and justice improve members' health.

Extracurricular Settings as a Space to Address Sociopolitical Crises: The Case of Discussing Immigration in Gender-Sexuality Alliances Following the 2016 U.S. Presidential Election.

School-based extracurricular settings could promote dialogue on sociopolitical crises. We considered immigration discussions within Gender-Sexuality Alliances (GSAs), which address multiple systems of oppression. Among 361 youth and 58 advisors in 38 GSAs (19 in 2016-2017/Year 1; 19 in 2017-2018/Year 2), youth in Year 1 reported increased discussions from baseline throughout the remaining school year; differences were non-significant in Year 2. In both years, youth reporting greater self-efficacy to promote social justice, and GSAs with advisors reporting greater self-efficacy to address culture, race, and immigration discussed immigration more over the year (adjusting for baseline). In interviews, 38 youth described circumstances promoting or inhibiting discussions: demographic representation, open climates, critical reflection, fear or consequences of misspeaking, discomfort, agenda restrictions, and advisor roles.