Risk factors for suicide attempt among adolescents reporting suicidal ideation by sexual and gender minority status: Evidence from the 2022 Minnesota Student Survey.

BACKGROUND: Suicide is a leading cause of death among adolescents, yet most adolescents who report suicidal ideation do not attempt nor die by suicide. To prevent injury and death, it is thus vital to explore factors potentiating the transition from suicidal ideation to suicidal attempt, especially in high-risk groups like sexual and gender minority (SGM) adolescents. Guided by an "ideation-to-action" framework, we explored risk factors for suicide attempt (ie, "painful and provocative experiences") among adolescents reporting suicidal ideation by SGM status. METHODS: Data were drawn from the cross-sectional 2022 Minnesota Student Survey and restricted to 10 561 adolescents reporting past-year suicidal ideation (52.3% SGM; 47.7% non-SGM). Analyses first assessed prevalence of exposure to painful and provocative experiences (ie, non-suicidal self-injury, adverse childhood experiences, bullying) by SGM status. Then, in multivariable logistic regression models, analyses probed associations between these risk factors and past-year suicide attempt. RESULTS: Among adolescents reporting recent suicidal ideation, a higher proportion of SGM adolescents reported past-year suicide attempt than non-SGM adolescents (26.7% vs 21.6%, respectively). All examined painful and provocative experiences were more commonly reported among SGM adolescents. In analyses restricted to SGM adolescents, non-suicidal self-injury, sexual abuse by a family member, and bullying demonstrated the largest effect sizes of associations with suicide attempt. DISCUSSION: Guided by an "ideation-to-action" framework, this research identifies risk factors potentiating suicide attempt in SGM adolescents reporting recent suicidal ideation. Structural and clinical interventions focused on mitigating exposure to painful and provocative experiences may help to prevent suicide among SGM adolescents.

The role of sleep duration in suicide risk among sexual and gender minority adolescents.

BACKGROUND: Short sleep duration is linked with suicide risk in adolescence. Sexual and gender minority (SGM) adolescents experience substantially increased risk for suicide compared to their non-SGM peers. METHODS: We investigated the role of sleep duration in SGM adolescent suicide risk using population-based, cross-sectional data from the 2022 Minnesota Student Survey (MSS; N = 85,610, Mage = 14.8). Adolescents reported average school-night sleep duration; those reporting <6 h were classified as having very short sleep duration. The MSS additionally assessed past-year suicidal ideation and suicide attempt. Mediation analyses assessed the role of sleep duration in explaining associations between SGM identity and suicide risk. Further, to examine intervention mechanisms, among SGM adolescents (n = 20,171, 23.6%), a logistic regression model assessed associations among demographic factors, perceived parental care, and very short sleep duration. RESULTS: As compared to non-SGM adolescents, SGM adolescents reported substantially higher prevalence of past-year suicidal ideation and suicide attempt and 2.6× higher prevalence of very short sleep duration (all p < 0.001). Mediation analyses demonstrated that very short sleep duration partially mediated the pathway between SGM identity and past-year suicidal ideation (15.5% mediated) and suicide attempt (17.2% mediated). Among SGM adolescents, a striking positive dose-response relationship was observed between level of perceived parental care and very short sleep duration. As perceived parental care decreased, so too did hours of sleep. DISCUSSION: Sleep duration is a crucial and understudied mechanism underlying suicide risk disparities affecting SGM adolescents. Family-based interventions may improve SGM adolescent sleep and reduce suicide risk.

Toward Cognitive-Behavioral Therapy for Sexual Minority Women: Voices From Stakeholders and Community Members.

Sexual minority women (SMW) experience an elevated risk of mental health problems compared to heterosexual women. However, knowledge gaps remain regarding whether cognitive-behavioral therapy (CBT) interventions meet SMW's mental health needs. Further, virtually no studies have integrated stakeholder (i.e., researchers with content expertise in SMW's health and clinical providers who work with SMW) and community member (i.e., SMW) perspectives to identify CBT approaches that address SMW-specific issues. This study used qualitative data gathered from 39 SMW who reported depression, anxiety, suicidality, and heavy drinking in the past 3 months and 16 content experts and clinical providers to obtain information relevant to enhancing CBT for SMW. In addition, we used thematic analysis to identify themes related to the adaptation and delivery of CBT for SMW. Building on prior literature, this study's findings revealed seven considerations for delivering mental health services to SMW: (1) attending to SMW's diverse gender identities and expressions; (2) focusing on SMW's nonbinary stressors; (3) formulating SMW's gender-based stressors within a feminist framework; (4) applying intersectionality frameworks; (5) incorporating issues of diversity, multiculturalism, and social justice; (6) addressing the role of trauma exposure; and (7) addressing the role of alcohol use in SMW's lives. These considerations are reviewed in terms of their implications for clinical practice, with a focus on enhancing applications of existing CBT interventions, to best respond to the unique needs of this population.

Navigating intimate trans citizenship while incarcerated in Australia and the United States.

Trans women incarcerated throughout the world have been described as "vulnerable populations" due to significant victimization, mistreatment, lack of gender-affirming care, and human rights violations, which confers greater risk of trauma, self-harm, and suicide compared with the general incarcerated population. Most incarceration settings around the world are segregated by the person's sex characteristics (i.e., male or female) and governed by strong cis and gender normative paradigms. This analysis seeks to better understand and appreciate how the "instructions" and the "authorities" that regulate trans women's corporeal representation, housing options and sense of self-determination implicate and affect their agency and actions in handling intimacies related to their personal life. Drawing upon lived incarcerated experiences of 24 trans women in Australia and the United States, and employing Ken Plummer's notion of intimate citizenship, this analysis explores how trans women navigate choices and ways "to do" gender, identities, bodies, emotions, desires and relationships while incarcerated in men's prisons and governed by cis and gender normative paradigms. This critical analysis contributes to understanding how incarcerated trans women through grit, resilience, and ingenuity still navigate ways to embody, express and enact their intimate citizenship in innovative and unique ways.

Sexual orientation-related patterns of 12-month course and severity of suicidality in a longitudinal, population-based cohort of young adults in Sweden.

PURPOSE: We assessed sexual orientation-related patterns in the 1-year longitudinal course (i.e., onset, remittance, persistence) and severity of suicidality. METHOD: Data were obtained from a prospective, population-based cohort representing nearly 2.4 million Swedish young adults. RESULTS: A higher proportion of sexual minorities remitted (14.6%) compared to heterosexuals (9.5%). However, over twice as many sexual minorities (35.1%) experienced persistent suicidality as heterosexuals (15.0%). Plurisexual (e.g., bisexual, pansexual) young adults and sexual minorities aged 17-25 were at greatest risk for persistent and more severe suicidality. CONCLUSION: Findings call for the identification of sexual orientation-related predictors of chronic suicidality to inform responsive clinical interventions.

Early Timing and Determinants of the Sexual Orientation Disparity in Internalizing Psychopathology: A Prospective Cohort Study from Ages 3 to 15.

Knowing the age at which the sexual orientation disparity in depression and anxiety symptoms first emerges and the early determinants of this disparity can suggest optimal timing and targets of supportive interventions. This prospective cohort study of children ages 3 to 15 (n = 417; 10.6% same-sex-attracted; 47.2% assigned female at birth) and their parents sought to determine the age at which the sexual orientation disparity in depression and anxiety symptoms first emerges and whether peer victimization and poor parental relationships mediate this disparity. Same-sex-attracted youth first demonstrated significantly higher depression symptoms at age 12 and anxiety symptoms at age 15 than exclusively other-sex-attracted youth. Age 12 peer victimization mediated the sexual orientation disparity in age 15 depression symptoms. Age 12 poor mother-child relationship mediated the sexual orientation disparity in age 15 anxiety symptoms. The findings are discussed in terms of implications for developmentally appropriate interventions against social stress during early development.

A Critical Discourse Analysis of an Australian Incarcerated Trans Woman's Letters of Complaint and Self-Advocacy.

This case study provides a critical discourse analysis of 121 letters of complaint and self-advocacy authored by Natasha Keating, a trans woman incarcerated in two Australian male correctional facilities from 2000 to 2007. During her incarceration, Natasha experienced victimization, misgendering, microaggression, and institutional discrimination. Despite this, Natasha embodied and "fought" against the injustices she experienced, whilst seeking to speak for other trans incarcerated persons also silenced and treated with indifference, contributing to changes in the carceral system. This original case study analyzes the discursive strategies Natasha employed to construct and reclaim an affirming self-identity through a deliberate campaign to effect social change and policy concessions within a system designed to curtail self-determination. Through her empathic and impassioned letter-writing approach, leveraging a military metaphor, this novel analysis showcases the significant implications her activism/agentism and determination had in naming and seeking to dismantle the systems of oppression trans incarcerated women experience.

Psychological Distress, Suicidal Ideation, and Suicide Attempt Among Lesbian, Gay, and Bisexual Immigrants: Population-Based Findings from the Stockholm Public Health Cohort.

In a large, population-based sample in Sweden, we sought to examine mental health disparities between lesbian, gay and bisexual (LGB) and heterosexual individuals with different immigration statuses. We conducted a population-based study including 1799 LGB and 69,324 heterosexual individuals, recruited in 2010 and 2014 as part of the Stockholm Public Health Cohort. Data were obtained from self-administered surveys that were linked to nationwide registers. We examined associations between mental health outcomes (i.e., psychological distress, suicidal ideation, and suicide attempt) and sexual orientation (LGB versus heterosexual), immigration status (immigrant versus Nordic-born), and their interaction. Sex-stratified weighted multivariable logistic regression analyses were used to calculate adjusted odds ratios with 95% confidence intervals. LGB individuals demonstrated substantially elevated odds of all mental health outcomes compared to heterosexuals; immigrants reported moderately elevated odds of psychological distress and suicide attempt, but not suicidal ideation, compared to Nordic-born individuals. Interaction terms between sexual orientation and immigration status were significant at p < 0.05 for psychological distress for both sexes and for suicidal ideation and attempt among women. Unexpectedly, models probing interactions generally demonstrated that Nordic-born LGB individuals demonstrated greater risk of psychological distress, suicidal ideation, and suicide attempt than did immigrant LGB individuals, especially among women. Supplemental analyses showed that Nordic-born bisexual women demonstrated the highest risk of all studied outcomes. Being LGB in Sweden is generally a stronger risk factor for poor mental health among Nordic-born than immigrant populations. These findings call for future intersectionality-focused research to delineate the unique cultural, social, and psychological factors associated with mental health and resilience among LGB immigrants.

Syndemic Profiles and Sexual Minority Men's HIV-Risk Behavior: A Latent Class Analysis.

Syndemic theory posits that "syndemic conditions" (e.g., alcohol misuse, polydrug use, suicidality) co-occur among sexual minority men and influence HIV-risk behavior, namely HIV acquisition and transmission risk. To examine how four syndemic conditions cluster among sexual minority men and contribute to HIV-risk behavior, we conducted latent class analysis (LCA) to: (1) classify sexual minority men (n = 937) into subgroups based on their probability of experiencing each syndemic condition; (2) examine the demographic (e.g., race/ethnicity) and social status (e.g., level of socioeconomic distress) characteristics of the most optimally fitting four syndemic classes; (3) examine between-group differences in HIV-risk behavior across classes; and (4) use syndemic class membership to predict HIV-risk behavior with sexual minority men reporting no syndemic conditions as the reference group. The four classes were: (1) no syndemic, (2) alcohol misuse and polydrug use syndemic, (3) polydrug use and HIV syndemic, and (4) alcohol misuse. HIV-risk behavior differed across these latent classes. Demographic and social status characteristics predicted class membership, suggesting that syndemic conditions disproportionately co-occur in vulnerable subpopulations of sexual minority men, such as those experiencing high socioeconomic distress. When predicting HIV-risk behavior, men in the polydrug use and HIV syndemic class were more likely (Adjusted Risk Ratio [ARR] = 2.93, 95% CI: 1.05, 8.21) and men in the alcohol misuse class were less likely (ARR = 0.17, 95% CI: 0.07, 0.44) to report HIV-risk behavior than were men in the no syndemic class. LCA represents a promising methodology to inform the development and delivery of tailored interventions targeting distinct combinations of syndemic conditions to reduce sexual minority men's HIV-risk behavior.

Depression and HIV Transmission Risk among Methamphetamine-Using Men who have Sex with Men.

BACKGROUND: Methamphetamine use is associated with disproportionate risk of HIV infection and increased risk of depression among sexual minority men. The purpose of the study was to estimate the association between clinical depression diagnoses and sexual risk-taking among cisgender men who have sex with men (MSM) who use methamphetamine. METHOD: From March 2014 through January 2016, 286 MSM who use methamphetamine but were not seeking treatment for methamphetamine use disorder were enrolled to participate in a technology-based randomized controlled trial to reduce methamphetamine use and HIV sexual risk behaviors; participants were assessed for major depressive episodes (MDE) and persistent depressive disorder (PDD) at baseline. Multivariate clustered zero-inflated negative binomial regression analyses of condomless anal intercourse (n=282; 1,248 visits) estimated the association between this baseline diagnostic result and engagement in sexual risk-taking over time. RESULTS: Participants predominantly identified as non-white (80%), averaged 42 years of age, and reported a HIV prevalence rate of 46%. Engagement in sexual risk-taking consistently demonstrated a positive curvilinear relationship with clinical depression severity, such that, for example, participants without clinical depression (59% of the sample; coef.=1.16) and those with MDE (36% of the sample; coef.=1.45) both demonstrated elevated rates of condomless anal sex with anonymous partners relative to participants with PDD (5% of the sample; analytical reference category; both coef. p<0.05). Data also demonstrated a trend (p = 0.053) of reduced sexual risk-taking with main partners among participants diagnosed with MDE (coef.=-0.94). CONCLUSIONS: Methamphetamine use among participants in this study inverted the functional form of the relationship between depression and sexual risk among MSM observed in prior studies. Whereas low-grade depression has been associated with increased sexual risk-taking in prior samples of MSM, methamphetamine upends this relationship, such that the greatest engagement in sexual risk-taking occurred among those diagnosed with MDE at baseline. Additional research is warranted to clarify how methamphetamine influences sexual risk-taking among MSM with/without comorbid depression.

Risk From Within: Intraminority Gay Community Stress and Sexual Risk-Taking Among Sexual Minority Men.

BACKGROUND: Sexual minority men remain highly impacted by the human immunodeficiency virus (HIV) with social stress being a clear predictor of their risk for infection. The past several decades of stress research regarding sexual minority men's HIV-risk behaviors has almost exclusively focused on the influence of stress emanating from outside the gay community (e.g., stigma-related stress, or minority stress, such as heterosexist discrimination). However, recent evidence suggests that sexual minority men also face stress from within their own communities. PURPOSE: We sought to examine whether stress from within the gay community, or intraminority gay community stress, might influence sexual minority men's risk behaviors, including HIV-risk behaviors, over-and-above more commonly examined stressors affecting this risk. METHODS: We tested whether intraminority gay community stress was associated with sexual minority men's HIV-risk behaviors in a large national survey of sexual minority men (Study 1), and experimentally tested intraminority gay community stress's impact on behavioral risk-taking and attitudes toward condom use (Study 2). RESULTS: Self-reported exposure to intraminority gay community stress was positively associated with HIV-risk behaviors when accounting for the effects of several commonly examined minority stressors and general life stress (Study 1). Participants who were rejected from an online group of other sexual minority men evidenced greater risk-taking in a subsequent task and reported fewer benefits of condom use than participants who were accepted by the online group, when accounting for state affect (Study 2). CONCLUSIONS: Sexual minority men's experiences of stress and rejection stemming from their own community may be an important and overlooked predictor of HIV infection and transmission.

A Multilevel Analysis of Social Network Characteristics and Technology Use on HIV Risk and Protective Behaviors Among Transgender Women.

This study examined the empirical structure (i.e., size, density, duration) of transgender women's social networks and estimated how network alters' perceived HIV risk/protective behaviors influenced transgender women's own HIV risk/protective behaviors. From July 2015 to September 2016, 271 transgender women completed surveys on sociodemographic characteristics, HIV risk/protective behaviors, and social networks. Hierarchical generalized linear models examined the associations of social network alter member data 'nested' within participant data. Analyses revealed that social network factors were associated with HIV risk/protective behaviors, and that the gender identity of the alters (cisgender vs. transgender), and social network sites and technology use patterns ("SNS/tech") moderated these associations. Among network alters with whom the participant communicated via SNS/tech, participants' HIV risk behavior was positively associated with alters' HIV risk behavior (cisgender alters aOR 4.10; transgender alters aOR 5.87). Among cisgender alters (but not transgender alters) with whom the participant communicated via SNS/tech, participants' HIV protective behavior was positively associated with alters' HIV protective behavior (aOR 8.94).

A Promising PrEP Navigation Intervention for Transgender Women and Men Who Have Sex with Men Experiencing Multiple Syndemic Health Disparities.

Transgender women and MSM experience many stigma-related syndemic conditions that exacerbate HIV incidence and prevalence rates. While PrEP is an effective biomedical intervention to reduce HIV transmission, uptake and adherence of PrEP is low among transgender women and MSM experiencing multiple syndemic health disparities. This study tested the feasibility, acceptability and effectiveness of A.S.K.-PrEP (AssistanceServicesKnowledge-PrEP), a five-session peer navigator program, designed to link transgender women and MSM to PrEP. From September 2016 to March 2018, 187 participants (transgender women = 58; MSM = 129) enrolled. Results demonstrated that approximately 90% of transgender women and MSM were linked to PrEP; MSM linked more quickly [KW χ2(1) = 10.9, p < .001]. Most transgender women (80%) and MSM (70%) reported they were still taking PrEP at the 90-day follow-up evaluation. Findings indicated that A.S.K.-PrEP is a promising intervention for PrEP linkage, uptake and preliminary adherence among transgender women and MSM.

Designing a Transgender Health Training for Correctional Health Care Providers: A Feasibility Study.

Limited provider knowledge on transgender health contributes to stigmatizing interactions and access-to-care challenges for incarcerated transgender people. Drawing on interviews with recently incarcerated transgender individuals and correctional staff, we developed and piloted a transgender health training for correctional healthcare providers. Providers indicated that the training provided them with the requisite competencies to provide gender-affirming care to transgender patients. Participants also found the intervention to be highly acceptable and feasible and recommended that the training be provided to others. Additionally, results suggested that the training may be able to increase providers' transgender-related knowledge. Further testing of the intervention is warranted.

Motivations for a Casual or Occasional Sexual Encounter with a Man and/or Transgender Woman among Heterosexual Men: Toward a Better Understanding of Atypical Sexual Partnering.

Little is known about the motivations for an occasional sexual encounter with a man or a transgender woman among heterosexual men. This study employed qualitative methods to better understand occasional atypical sexual partnering. Open-ended interviews were conducted with 31 heterosexual men who reported at least one sexual encounter with a man or a transgender woman in the previous 12 months. Using the principles of Grounded Theory, three themes emerged: Participants were motivated by (1) the easy, uncomplicated nature of a sexual encounter with a man and/or a trans woman that often circumvented the sexual politics of a typical male-female interaction and/or, (2) the sexual experimentation that took place with these partners; and/or, (3) the default nature of such encounters when a cisgender woman sexual partner was unavailable or perceived to be unattainable. These findings indicated that, among this sample of heterosexual men, the motivations for occasional atypical sexual partnering with a man or a transgender woman were varied, complex and could be multifaceted. Furthermore, these findings support prior studies that have demonstrated that sexual behavior can span beyond sexual identity.

Health Disparities, Risk Behaviors and Healthcare Utilization Among Transgender Women in Los Angeles County: A Comparison from 1998-1999 to 2015-2016.

Data from two studies of transgender women in Los Angeles County that used the same methodology and survey assessment (Study 1: 1998-1999, N = 244; Study 2: 2015-2016, N = 271), compared structural determinants of health, HIV/STI prevalence, HIV risk behaviors, substance use, gender confirmation procedures, and perceived discrimination and harassment/abuse across a 17-year time period. Findings demonstrated that participants in the latter study reported significantly higher access to healthcare insurance and prescription hormones. However, participants in the latter study also reported lower levels of income; and, elevated prevalence of homelessness, HIV and lifetime STIs, receptive condomless anal intercourse with casual partner(s), and reported physical harassment/abuse. Given the timeframe of these results, these findings elucidate specific areas of transgender women's health and risk profiles that improved or worsened across 17 years. While healthcare access has improved, transgender women continue to face significant barriers to good health, indicating the need for increased attention to this population.

Structural Inequities and Social Networks Impact Hormone Use and Misuse Among Transgender Women in Los Angeles County.

In order to reduce gender dysphoria and combat stigma, transgender women often affirm their gender through social and medical transition, which may include cross-sex hormone therapy. This study examined associations between medically monitored hormone use and hormone misuse (non-prescribed hormone use including "fillers"), structural inequities (access to housing, health insurance, and income), and social network dynamics among 271 transgender women in Los Angeles. Hormone use status was coded trichotomously (hormone use, hormone misuse, no hormone use), and robust multinomial logistic regression as well as novel social network analysis was conducted to examine associations. Results demonstrated that younger, African-American/Black transgender women were most likely to engage in hormone misuse compared to transgender women who were older or non-African-American/Black. One-third of the sample reported sex work as a main source of income, and this group was more likely to misuse hormones than those with another primary source of income. Transgender women with access to stable housing and health insurance were most likely to engage in medically monitored hormone use. Social network analysis revealed that transgender women with a greater number of hormone-using network alters were most likely to misuse hormones, but that using the Internet to find transgender friends mitigated this association. Results demonstrate the multifaceted risk profile of transgender women who use and misuse hormones, including that social networks play an important role in hormone usage among transgender women.

A qualitative analysis of multi-level barriers to HIV testing among women in Lebanon.

While the number of HIV cases in the Middle East and North Africa region is low compared to other regions, recent studies show that incidence is increasing especially among high-risk populations; in particular, little is known about women and HIV in the region. Through semi-structured interviews with sexual healthcare providers and staff at non-governmental organisations, we sought to understand barriers to HIV testing among women in Lebanon. Using snowball sampling, key informants were recruited from greater Beirut (12 physicians, 9 non-governmental organisation staff). Data were analysed using a grounded theory framework. Findings identified barriers to HIV testing among women at each level of an adapted social-ecological model (i.e. social-cultural barriers, policy barriers, interpersonal healthcare provider barriers and intrapersonal barriers). Primary findings include the culture of sex as taboo; lack of sexual health education among women; fear of disclosing HIV testing and diagnosis; financial barriers linked to stigmatising insurance policies; and provider attitudes towards women. Findings can be used to inform HIV-related sexual health interventions at multiple levels for women in Lebanon and the greater region.

Limitations of Sexual Orientation and Gender Identity Information as Reported in the National Violent Death Reporting System.

The National Violent Death Reporting System (NVDRS) is a Centers for Disease Control and Prevention (CDC) restricted-access database detailing precipitating circumstances to U.S. violent deaths. In 2013 and 2015, the CDC added codes denoting sexual orientation and gender identity (SOGI) and sex of partner. In the past decade, researchers have leveraged NVDRS data to document SOGI-related patterns and characteristics of violent death including suicide. Yet, there are substantial limitations to NVDRS SOGI information that should be considered in responsible reporting by researchers and informed assessment by reviewers. In this perspective, we summarize some of these challenges and offer recommendations for using NVDRS SOGI data responsibly.