Socioeconomic Status and Psychosocial Resources Mediate Racial/Ethnic Differences in Psychological Health Among Gay and Bisexual Men: A Longitudinal Analysis Using Structural Equation Modeling.

A large body of research demonstrates disparities in psychological health attributed to sexual minority identity, racial/ethnic minority identity, and socioeconomic status (SES). Fewer studies have explicated the role of these multiple attributes on psychological health and explored the role of SES and psychosocial resources in determining outcomes. We analyzed data from Project STRIDE, a longitudinal survey involving a diverse sample of gay and bisexual adult men (n = 198). Using structural equation modeling, we tested hypothesized direct and indirect effects of race/ethnicity, SES, and three psychosocial mediational variables (collective self-efficacy, everyday discrimination, internalized homophobia) on two outcome variables-psychological and social well-being-assessed at 1-year follow-up. Our model indicated that: (1) race/ethnicity and SES were significantly associated with each other and with each psychosocial mediator; (2) higher SES was directly and indirectly associated with both measures of well-being; and (3) collective self-esteem and everyday discrimination mediated the association between SES and both measures of well-being. The model also indicated that racial/ethnic associations with psychological mediators and outcomes are evident in the context of SES, but these effects might be suppressed when the model does not consider SES. Findings highlight the critical role of SES and race/ethnicity in determining the psychological and social well-being of sexual minority men. Specification of mediating variables-collective self-efficacy, everyday discrimination, internalized homophobia-indicates potential intervention targets to improve psychological and social health in sexual minority men. Associations between race/ethnicity and SES support the need for intersectional frameworks in addressing the health of sexual minority men.

Psychological wellbeing of middle-aged and older queer men in India: A mixed-methods approach.

Borrowing concepts from public health, we examined the association of several social determinants with the mental health of middle-aged and older queer men in India by combining quantitative and qualitative methodologies. A cross-sectional survey guided by Meyer's Minority Stress Model was carried out to assess the links between minority stressors (internalized homophobia and degree of closetedness), age-related stressors (ageism and fear of ageing) and psychological wellbeing (loneliness, depressive symptoms and sexual compulsivity) among 207 Indian men (aged 40 years and above) who identified themselves as non-heterosexuals. Results from simple and multivariable linear regression models showed significant positive associations of ageism, internalized homophobia, and fear of ageing with loneliness, even after accounting for sociodemographic and stress mitigating factors. Ageism was not significantly related to depressive symptoms. However, fear of ageing and internalized homophobia was positively associated with depressive symptoms after accounting for covariates. Further, regression models demonstrated a consistent and statistically significant inverse association between income and adverse psychological outcomes suggesting the centrality of social class in the lived experience of Indian gay and bisexual men. The qualitative inquiry addressed the same research questions as the quantitative survey through in-depth interviews of thirty middle-aged and older gay and bisexual men in Mumbai. We found that older and midlife gay and bisexual men with higher income (a proxy for social class) found ways to manage their masculinities with no discernible adverse psychological outcomes. Depressive symptoms and loneliness in this population made them further vulnerable to excessive sexual impulses, especially in the older queer men who were passing off as heterosexuals. Overall, the theory-driven empirical findings suggest that even in India, where family and friends are social insurance for later life, the issues of ageism and internalized homophobia have the potential to lead to worse mental health outcomes among older queer men.

Assessment of Couple Relationships Standards in Same-Sex Attracted Adults.

Relationship standards are beliefs about what makes a good romantic relationship. To date, no research on relationship standards in same-sex relationships has been conducted. This paper describes development of the Rainbow Couples Relationship Standards Scale (Rainbow CRSS). In common with measures of relationship standards developed with heterosexuals, the Rainbow CRSS assesses the importance people attach to Couple Bond standards (expression of love, caring, intimacy), Family Responsibility standards (extended family relations, maintenance of face and harmony), Religion, and Relationship Effort standards. The Rainbow CRSS also assesses three standards hypothesized to be of particular importance to same-sex couples: Relationship Outness (public disclosure of the relationship), Sexual Openness (acceptance of open sexual relationship), and Dyadic Coping with Homophobic discrimination. Participants were 414 same-sex attracted men and women who completed the Rainbow CRSS online, plus some validation scales. The Rainbow CRSS showed a coherent two-level factor structure that was similar to that in heterosexual couples for the Couple Bond and Family Responsibility Scales. Same-sex attracted people's standards were similar for men and women, and for singles versus those in a relationship. Same-sex attracted people's standards were very similar in endorsement of Couple Bond, Family Responsibility, Religion, and Relationship Effort standards to those of heterosexuals. The Relationship Outness and Dyadic Coping with Homophobia scales assessed potentially important standards that reflect some distinctive challenges for same-sex couple relationships.

La terapia familiar generalmente se ha conceptualizado como un proceso conversacional por medio del cual los terapeutas y los pacientes generan nuevos significados. Basándose en un estudio de tres años de prácticas conversacionales observables en procesos satisfactorios de terapia familiar de familias chilenas con un niño/adolescente que tiene comportamientos disruptivos, buscamos ejemplos clínicos de patrones interpersonales transformadores (PIT). Estos patrones son un aspecto clave del "IPscope" o instrumento de evaluación de los patrones interpersonales (Tomm, St. George, Wulff, & Strong, 2014), un marco que usamos para analizar los procesos de creación de significado en la terapia familiar. Los patrones interpersonales transformadores constituyen un enfoque innovador para analizar los procesos terapéuticos mediante el reconocimiento de prácticas conversacionales fáciles de seguir empíricamente que participan en la generación de "significados nuevos". Los patrones interpersonales transformadores intervienen en la presentación y la articulación discursiva ("convencer de crear") de las manersa preferidas de los pacientes de relacionarse y vivir (p. ej.: preferencias relacionales o PR). Analizamos datos conversacionales de sesiones/tratamientos satisfactorios de terapia familiar y presentamos un modelo emergente de cinco categorías de prácticas conversacionales que constituyen patrones interpersonales transformadores, por ejemplo: PIT preparatorios, PIT identificadores, PIT localizadores, PIT transformadores y PIT consolidadores. Los hemos llamado "realizadores" porque estas prácticas conversacionales ayudan a las familias a convencerlas de crear (o a "hacer realidad") preferencias relacionales particulares. También ofrecemos descriptores fáciles de usar de las subcategorías de los realizadores (p. ej.: PIT de medición) que pueden ayudar a los profesionales a reconocer, aprender y llevar a cabo estas invitaciones conversacionales. Se debaten las consecuencias teóricas y las futuras líneas de investigación.

"We Live in a Wonderful Country, Canada, but ": Perspectives From Older LGBTQ Ontarians on Visibility, Connection, and Power in Care and Community.

This research investigated the health and aging experiences of 21 lesbian, gay, bisexual, trans, and queer (LGBTQ) adults, aged 60 to 79 years, to identify their service and support needs. Participants engaged in focus groups in four locations in Ontario, Canada. Data were analyzed using inductive thematic approach. Participants anticipated age-related losses and expected a greater use of and dependence on health/social care services. Despite greater LGBTQ visibility and inclusive care, participants perceived care services and facilities as unsafe and without competent support. Participants described employing positive strategies to overcome discrimination, contributing to participants' health and aging experiences.

Internalized Homophobia, Depressive Symptoms, and Suicidal Ideation Among Lesbian, Gay, and Bisexual Adults in South Korea: An Age-Stratified Analysis.

Purpose: Little research on internalized homophobia (IHP) and mental health among lesbian, gay, and bisexual (LGB) individuals has been done in South Korea, a context in which LGB populations widely experience societal stigma. This study examined the association between IHP and depressive symptoms and suicidal ideation among Korean LGB adults and investigated whether the association differed by participants' age. Methods: Cross-sectional data from the "Rainbow Connection Project I - Korean Lesbian, Gay, & Bisexual Adults' Health Study" were used for this study (N = 2178). Descriptive analyses were conducted to explore the distribution of IHP, depressive symptoms, and suicidal ideation across all covariates. Multivariate analyses were also used to investigate the overall and age-stratified associations between IHP and depressive symptoms and suicidal ideation. Results: The prevalence of high IHP was greater among older LGB adults, whereas the prevalence of depressive symptoms and suicidal ideation was higher among younger LGB adults. LGB individuals with high IHP levels had significantly greater risk of depressive symptoms than those with low IHP levels. In the age-stratified analyses, the associations between IHP and depressive symptoms were statistically significant only among older LGB adults with high IHP levels. Regarding suicidal ideation, the overall association was statistically significant in the full sample, but not in the age-stratified analyses. Conclusion: These findings suggest that mental health interventions are needed for LGB adults who have high IHP levels, especially among older generations. Furthermore, greater efforts are needed to enact protective legislation for sexual minority individuals in South Korea.

Primary Care Clinician and Clinic Director Experiences of Professional Bias, Harassment, and Discrimination in an Underserved Agricultural Region of California.

Importance: Many rural and agricultural communities experience hardship from a shortage of clinicians. The aging of the clinician population threatens future supply in these areas. Developing policies to build a sustainable workforce requires the understanding of experiences from those currently in medical practice. Previous research about rural clinicians has primarily sampled non-Latinx white men, and to a lesser extent, non-Latinx white women; to date, no study has examined differences by race/ethnicity, sexual orientation, or gender identity. Objective: To describe the professional experiences of a diverse group of primary care clinicians and clinic directors in an underserved rural and agricultural region of California. Design, Setting, and Participants: In this qualitative study, semistructured in-depth qualitative interviews were performed with clinicians and clinic directors from December 1, 2017, to December 31, 2018, with a present or recent medical practice in the central San Joaquin Valley region of California. Participants (N = 26) consisted of physicians, nurse practitioners, and clinic directors practicing in primary care settings. Settings included solo and group private practice, academic training programs, community health centers, and rural health clinics. Main Outcomes and Measures: Personal experiences as primary care clinicians and clinic directors, and perceived associations with gender, race/ethnicity, sexual orientation, and gender identity. Results: Of 26 primary care clinicians and clinic directors interviewed, 16 (62%) identified as female, 12 (46%) identified as non-Latinx white, and 3 (12%) identified as a member of a sexual and gender minority group. Participants who self-identified as female, nonwhite, and of certain sexual orientation and gender identity minority groups described burnout from bias, harassment, and hostility in their professional relationships with colleagues and health care staff. These experiences intensified their feelings of community isolation and professional isolation. Harassment and institutional discrimination were factors in the decision of participants to change practices or exit the region entirely. Discriminatory acts against members of sexual and gender minority groups were the most severe, including threats to licensure and denial of hospital admitting privileges. In contrast to the minority group participants, the remaining participants expressed little to no awareness of these negative experiences, or the association between these experiences and retention. Conclusions and Relevance: Professional harassment and discrimination may hamper efforts to improve clinician and clinic director recruitment and retention in underserved rural and agricultural areas and may pose barriers to addressing health disparities within those communities. Additional investigation appears to be needed to assess the extent to which professional harassment and discrimination affect clinicians and clinic directors in similar communities across the United States.

Homophobia and heteronormativity as dimensions of stigma that influence sexual risk behaviors among men who have sex with men (MSM) and women (MSMW) in Lima, Peru: a mixed-methods analysis.

BACKGROUND: Stigma differentially influences HIV and STI care among MSM, especially regarding partner notification practices. Recognizing the heterogeneous behaviors/identities within the category "MSM," we used mixed-methods to assess sexual risk behaviors among men who have sex with men only (MSMO) and behaviorally bisexual MSM (MSMW) with HIV and/or other STIs. METHODS: MSMO/MSMW recently diagnosed (< 30 days) with HIV, syphilis, urethritis, or proctitis completed a cross-sectional survey assessing sexual risk behaviors, anticipated disclosure, and sexual partnership characteristics (n = 332). Multivariable generalized estimating equation models assessed characteristics associated with female compared to male partners in the last three partnerships. Follow-up qualitative interviews (n = 30) probed partner-specific experiences (e.g., acts and disclosure). RESULTS: Among all participants, 13.9% (n = 46) described at least one of their last three sex partners as female (MSMW). MSMW (mean age of 31.8) reported a mean of 3.5 partners (SD = 4.5) in the past 3 months and MSMO (mean age 30.6) reported a mean of 4.6 partners (SD = 9.7) in the past 3 months. MSMW were more likely to report unprotected insertive anal sex (77.9%) than MSMO (43.1%; p < 0.01). Cisgender female partners were associated with condomless insertive sex in the last 3 months (aPR: 3.97, 95%CI: 1.98-8.00) and classification as a "primary" partnership (2.10, 1.34-3.31), and with lower prevalence of recent HIV diagnosis (0.26, 0.11-0.61). Planned notification of HIV/STI diagnoses was less common for female than for male partners (0.52, 0.31-0.85). Narratives illustrate internal (e.g., women as 'true' partners) and community-level processes (e.g., discrimination due to exposure of same-sex behavior) that position homosexual behavior and bisexual identity as divergent processes of deviance and generate vulnerability within sexual networks. CONCLUSIONS: MSMW recently diagnosed with HIV/STI in Peru report varying partnership characteristics, with different partner-specific risk contexts and prevention needs. Descriptions highlight how behaviorally bisexual partnerships cut across traditional risk group boundaries and suggest that HIV/STI prevention strategies must address diverse, partnership-specific risks.

Minority Stress, Activism, and Health in the Context of Economic Precarity: Results from a National Participatory Action Survey of Lesbian, Gay, Bisexual, Transgender, Queer, and Gender Non-Conforming Youth.

Lesbian, gay, bisexual, transgender, queer, and gender non-conforming (LGBTQ & GNC) youth experience more economic hardship and social stress than their heterosexual and cisgender peers. However, the ways that LGBTQ & GNC youth resist these damaging social factors and the corresponding implications for their health have not been addressed. Data were analyzed from a national participatory survey of LGBTQ & GNC youth ages 14-24 (N = 5,860) living in the United States. Structural equation models indicated that economic precarity was associated with experiences of health problems. This association was mediated by the negative influence of minority stress on health as well as by activism, which had a positive association with health. Findings suggest that minority stress explanations of health inequalities among LGBTQ & GNC youth can benefit from including a focus on economic precarity; both in terms of its deleterious impact on health and its potential to provoke resistance to structural oppression in the form of activism.

The Palliative Effects of System Justification on the Health and Happiness of Lesbian, Gay, Bisexual, and Transgender Individuals.

Across three studies, we examine the correlates of subjective well-being and mental and physical health among members of a historically disadvantaged group, namely, lesbian, gay, bisexual, and transgender (LGBT) individuals. Results show those who minimize (vs. acknowledge) the extent to which their group is the target of discrimination report better well-being across myriad indicators (Studies 1-3). We also demonstrate that this effect is mediated by perceived system fairness (Study 1); holds above and beyond internalized homonegativity (Studies 1 and 3) and ingroup identification (Studies 2-3); and is true regardless of whether individuals reside in hostile or accepting environments (Study 2), and regardless of whether individuals had personally experienced discrimination (Study 3). For some indicators (namely, body mass index [BMI], social well-being, self-esteem, depression, and mental illness diagnosis), the relationship between minimization of discrimination and well-being was stronger among those who had frequent (vs. rare) discriminatory experiences.

Survival now versus survival later: immediate and delayed HIV risk assessment among young Jamaican men who have transactional sex with men.

This study explored the experiences of young Jamaican men who have sex with men who engaged in transactional sex as a result of homelessness, family neglect or limited financial resources. It further examined the circumstances that affect their immediate or delayed decisions around sexual risk and increased vulnerability for HIV infection. Barriers experienced when accessing condoms, healthcare, HIV testing and other prevention services are also described. Twenty in-depth interviews and one focus group with 10 participants in various parishes in Jamaica were conducted. Findings from this study reveal how stigma and discrimination in the form of pervasive homophobia-influenced participation in the street economy via transactional sex. Socio-structural factors at family and commity level led to diminished social/economic prospects, which extended into adulthood. Sexual decision making was based on immediate needs for protection, food or shelter; concerns about acquiring HIV were considered only after meeting those immediate needs. Future HIV prevention strategies must take seriously the socio-structural factors that influence HIV risk behaviours among young men who have sex with men in Jamaica.

Association of State Laws Permitting Denial of Services to Same-Sex Couples With Mental Distress in Sexual Minority Adults: A Difference-in-Difference-in-Differences Analysis.

Importance: Recent evidence suggests that state policies affecting sexual minorities are associated with health disparities. Twelve states have laws permitting the denial of services to same-sex couples, and the US Supreme Court is considering whether states can prohibit the denial of services to same-sex couples. Objective: We investigated whether state laws permitting individuals to refuse services to sexual minorities were associated with changes in the proportion of sexual minority adults reporting mental distress. Design, Setting, and Participants: This difference-in-difference-in-differences linear regression analysis with state fixed effects used Behavioral Risk Factor Surveillance System (BRFSS) data from 2014 through 2016 from adults aged 18 to 64 years in 3 states that implemented laws permitting the denial of services to same-sex couples (Utah, Michigan, and North Carolina) and 6 nearby control states (Idaho and Nevada, Ohio and Indiana, and Virginia and Delaware, respectively). Sexual minority adults were defined as those who identified as gay, lesbian, bisexual, or not sure of their sexual orientation under a module on sexual orientation that BRFSS implemented in 2014 and each state could opt to include. Analysis controlled for year and individual-level sex, race, ethnicity, age group, educational attainment, income, employment, and marital status. A permutation test was conducted to precisely estimate statistical significance. Exposures: An interaction term indicating whether individuals identified as a sexual minority and lived in a state with a law permitting denial of services to same-sex couples in 2015. Main Outcomes and Measures: Mental distress, defined as poor mental health on 14 or more of the past 30 days. Results: Of 109 089 participants, 4656 (4.8%; all percentages incorporate survey weights) identified as sexual minorities, 86141 (72.1%) were non-Hispanic white, and ages were uniformly distributed between 18 and 64 years. In 2014, 2038 of 16637 heterosexual adults (12.6%) and 156 of 815 sexual minority adults (21.9%) in the 3 same-sex denial states reported mental distress. The proportion of sexual minority adults reporting mental distress increased by 10.1 percentage points (95% CI, 1.8 to 18.5 percentage points, permutation-adjusted P value = .046) between 2014 and 2016 in states that passed laws permitting denial of services to same-sex couples compared with control states, a 46% relative increase in sexual minority adults experiencing mental distress. Laws permitting denial of services to same-sex couples were not associated with significant changes in heterosexual adults experiencing mental distress (-0.36 percentage points, 95% CI, -1.73 to 1.01 percentage points). Conclusions and Relevance: Laws permitting denial of services to same-sex couples, which exist in 12 states and are under consideration by the US Supreme Court, are associated with a 46% increase in sexual minority adults experiencing mental distress.

A socioecological measurement of homophobia for all countries and its public health impact.

Background: Measuring homophobia at country level is important to guide public health policy as reductions in stigma are associated with improved health outcomes among gay men and other men who have sex with men. Methods: We developed a Homophobic Climate Index incorporating institutional and social components of homophobia. Institutional homophobia was based on the level of enforcement of laws that criminalise, protect or recognise same-sex relations. Social homophobia was based on the level of acceptance and justifiability of homosexuality. We estimated the Index for 158 countries and assessed its robustness and validity. Results: Western Europe is the most inclusive region, followed by Latin America. Africa and the Middle East are home to the most homophobic countries with two exceptions: South Africa and Cabo Verde. We found that a 1% decrease in the level of homophobia is associated with a 10% increase in the gross domestic product per capita. Countries whose citizens face gender inequality, human rights abuses, low health expenditures and low life satisfaction are the ones with a higher homophobic climate. Moreover, a 10% increase in the level of homophobia at country level is associated with a 1.7-year loss in life expectancy for males. A higher level of homophobia is associated with increased AIDS-related death among HIV-positive men. Conclusion: The socioecological approach of this index demonstrates the negative social, economic and health consequences of homophobia in low- and middle-income countries. It provides sound evidence for public health policy in favour of the inclusion of sexual minorities.

Psychosocial Obstacles to Smoking Cessation Attempts Among Young Adult Sexual Minority Women Who Smoke.

Sexual minority women (SMW; i.e., women who identify their sexuality as lesbian, bisexual, or something other than heterosexual) report greater smoking behaviors than their heterosexual counterparts across all ages. We conducted a multivariable regression to examine the correlates of prior smoking cessation attempts and smoking cessation intentions in a sample of young SMW who smoke (N = 338; aged 18-24 years). Covariates included sociodemographic characteristics (i.e., race/ethnicity, sexual identity, age, urbanity), general (i.e., perceived stress), and sexuality-specific (i.e., internalized homophobia) stressors, as well as smoking attitudes and subjective norms. Bisexual women (OR = 1.92, 95% CI: 1.11, 3.31) were more likely than lesbian counterparts to report a prior smoking cessation attempt. Prior cessation attempts were associated with less internalized homophobia (OR = 0.44, 95% CI: 0.27, 0.69) and positive attitudes toward smoking (OR = 2.17, 95% CI: 1.27, 3.70). Smoking cessation intentions in the next month were negatively associated with being a daily smoker (ß = -0.14) and attitudes toward smoking (ß = -0.19). Based on these findings, we underscore the need to address the risk correlates associated with SMW's quit attempts and include these in cessation interventions.

Muslim gay men: identity conflict and politics in a Muslim majority nation.

While a number of investigations have examined how gay Muslim men view homosexuality in relation to religious Western homophobia, this research constitutes the first account of the experiences of self-identified gay men living in an African, Muslim nation, where same-sex sex is both illegal and actively persecuted. We interviewed 28 gay men living in Tunisia in order to understand how they assimilate their sexual, religious and ethnic identities within a highly homophobic culture. Utilizing notions of homoerasure and homohysteria (McCormack and Eric Anderson ,b), and examining the intersection of identity conflict and new social movement theory, we highlight four strategies that participants use to negotiate the dissonance of living with conflicting identities in a context of religious homophobia: (1) privileging their Islamic identities and rejecting homosexuality as a legitimate sexual identity; (2) rejecting Islam and accepting homosexuality as a legitimate sexual identity; (3) interpreting Islam to be supportive of homosexuality; and (4) creating a non-penetrative homosexuality to be compatible with literal Qur'anic interpretations. We discuss the multiple difficulties these men face in relation to religious intolerance and ethnic heteronormativity, and reflect upon the possibilities and obstacles of using Western identity politics towards the promotion of social justice within a framework of growing homohysteria.

Childhood Maltreatment, Bullying Victimization, and Psychological Distress Among Gay and Bisexual Men.

Sexual minority men report higher psychological distress than heterosexual men, including depression and anxiety. Research suggests that these health disparities may be due to the heightened stressors that gay, lesbian, and bisexual individuals experience. Some of these stressors occur early on in life, such as childhood abuse and bullying, and may include stressors that are topically related to sexual minority status, such as anti-gay bullying and teasing for gender nonconformity to masculine gender norms. We tested a structural equation model on the association between negative childhood experiences and adult psychological distress among 304 gay and bisexual men. The model fit the data well, and demonstrated an indirect effect of negative childhood experiences on adult psychological distress via dysfunctional thoughts toward oneself. The results integrate the childhood abuse and anti-gay bullying victimization literatures by showing that both forms of adverse childhood experiences are associated with adult psychological distress. The findings suggest the benefit of treatments to reduce negative, dysfunctional thoughts among gay and bisexual men who have experienced adverse childhood events.

Structural Validation and Multiple Group Assessment of the Short Internalized Homonegativity Scale in Homosexual and Bisexual Men in 38 European Countries: Results From the European MSM Internet Survey.

Internalized homonegativity (IH) is the internalization of negative attitudes and assumptions about homosexual people by homosexual people themselves. To measure IH, Smolenski, Diamond, Ross, and Rosser (2010) and Ross, Rosser, and Smolenski (2010) revised the Reactions to Homosexuality Scale (RHS) to develop the Short Internalized Homonegativity Scale (SIHS) with eight items. Using the European Men Who Have Sex With Men Internet Survey (EMIS) data, with an analytic sample of 130,718 gay and bisexual men in 38 European countries, we confirmed the validity of the SIHS scale in both training and validation data, in strata of Ross, Berg, et al.'s (2013) three "homosexual discrimination" country clusters, of age, and of education level. However, the performance was less adequate in comparison of gay versus bisexually identified individuals. The latent SIHS structure contains only minor variations across these three strata. The seven-item scale performed as well as the eight-item scale. The SIHS is a promising candidate for standard IH measures, which is invariant across cultural, age, and educational strata.

The social determinants of lesbian, gay, bisexual and transgender youth suicidality in England: a mixed methods study.

Background: Lesbian, gay, bisexual and transgender (LGBT) youth have a higher risk of suicidality and self-harm than heterosexual youth populations but little is known about the underlying mechanisms. We aimed to investigate the social determinants of this mental health inequality. Methods: A two-stage sequential mixed method study was conducted. Firstly, 29 semi-structured interviews with LGBT youth (aged 13-25 years old) were completed. Data was analysed thematically. Stage 2 involved a self-completed questionnaire employing an online community-based sampling strategy (n = 789). Logistic regression analysis was performed to predict suicidality. Results: Five social determinants explained suicidal risk: (i) homophobia, biphobia or transphobia; (ii) sexual and gender norms; (iii) managing sexual and gender identities across multiple life domains; (iv) being unable to talk; (v) other life crises. Youth who were transgender (OR = 1.50, P < 0.022), disabled (OR = 2.23, P < 0.000), had self-harmed (OR = 7.45, P < 0.000), were affected by abuse (OR = 2.14, P < 0.000), and affected by not talking about their emotions (OR = 2.43, P < 0.044) were most likely to have planned or attempted suicide. Conclusions: Public health universal interventions that tackle bullying and discrimination in schools, and selected interventions that provide specific LGBT youth mental health support could reduce LGBT mental health inequalities in youth suicidality.

Minorias no contexto de trabalho: uma análise das representações socais de estudantes universitários / Minorities in the work context: an analysis of the social representations of university students

O trabalho objetiva identificar como estudantes universitários representam a participação de minorias sociais no contexto de trabalho. Dados oficiais revelam que alguns grupos sociais são discriminados, considerando as oportunidades de trabalho, os espaços que ocupam e os salários que recebem. Pesquisas apontam que boa parte desse problema pode ser analisado a partir das representações sociais que sustentam o preconceito contra esses grupos. O preconceito pode ser compreendido como uma forma de relação que se manifesta por atitudes negativas, por comportamentos hostis e discriminatórios dirigidos a membros de minorias sociais. Realizou-se uma pesquisa com 83 estudantes universitários, por meio da Técnica de Associação Livre de Palavras, com os termos indutores "mulher", "negro", "homossexual", "egresso do sistema prisional", "pessoa com deficiência" e "pessoa com transtorno mental", todos seguidos da expressão "no contexto de trabalho". Para análise, utilizou-se o Iramuteq, especificamente a análise prototípica, considerando separadamente cada minoria. Os resultados são apresentados tendo em vista os elementos do Núcleo Central (NC) e das Zonas Periféricas (ZP). No NC, o preconceito parece ser reconhecido de forma flagrante para negros, homossexuais, pessoas com transtornos mentais, egressos do sistema prisional. Em contrapartida, para mulheres e pessoas com deficiência, as representações sugerem um preconceito velado. Nas zonas periféricas observam-se mudanças graduais que ficam mais claras na zona de contraste, indicando a emergência de representações que reconhecem a discussão e a luta por igualdade de direitos para alguns grupos. Não obstante, para outros, as representações ainda expressam os obstáculos à inclusão social. (AU)

This paper aims to identify how university students represent minorities participation in the work context. Data reveals that some social groups are discriminated against, considering job opportunities, positions and the salaries received by them. Research indicates that much of the problem can be analyzed from the social representations that have sustained prejudice on minority groups. Prejudice can be understood as a form of relationship manifested by negative and derogatory attitudes and by hostile and discriminatory behavior. We had an 83 university students study, using the Free Words Association Technique, with the terms "woman", "black", "homosexual", "egress from the prison system", "person with disability" and "person with mental disorder", all followed by the expression "in the work context". To the analysis, we used Iramuteq, specifically, a prototypical analysis, considering separately each minority. The results are presented in elements of Central Core (CC) and Peripheral Zones (PZ). In the CC, prejudice seems to be blatantly recognized to black people, homosexuals, people with mental disorders, egresses from the prison system. By contrast, for women and people with disabilities, the representations suggested a subtle prejudice. In the periphery zones, there were gradual changes, clearer in the contrast zone, indicating an emergence of representations that recognize a discussion and a struggle for equal rights for some of the groups. Nevertheless, to other groups the representations still express the obstacles to social inclusion. (AU)

Prospective effects of social support on internalized homonegativity and sexual identity concealment among middle-aged and older gay men: a longitudinal cohort study.

BACKGROUND AND OBJECTIVES: Middle-aged and older gay men experience higher rates of depression and anxiety compared to their heterosexual counterparts, with internalized homonegativity and sexual identity concealment known to be major stress-related contributors. This study examined the prospective effect of different types and sources of social support on internalized homonegativity and sexual identity concealment experienced among middle-aged and older gay men. METHODS: A longitudinal survey involving two waves of data collection separated by 12 months was conducted among a cohort of 186 gay-identified men aged 40 years and older. RESULTS: Two types of social support were found to be important. Greater baseline tangible or practical support independently predicted lower internalized homonegativity at 12-month follow-up, while greater baseline emotional or psychological support independently predicted a lower tendency toward sexual identity concealment at 12-month follow-up. Greater baseline support from community or government agencies, such as health services and support organizations, predicted higher internalized homonegativity at 12-month follow-up. CONCLUSIONS: These findings suggest that tangible and emotional support may be beneficial in reducing internalized homonegativity and sexual identity concealment among middle-aged and older gay men. Ensuring that services provide environments that do not compound the stressful impact of stigma also appears to be important.