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1.
J Res Adolesc ; 2024 May 27.
Article in English | MEDLINE | ID: mdl-38800850

ABSTRACT

Gender sexuality alliances (GSAs) represent consciousness-raisings that hold potential for critical consciousness development in youth. In this study, we focus on critical reflection-the understanding that oppression is structured and maintained by human action. We engage intersectionality as our analytical framework and analyze both student interview data (n = 38) and advisor closed-ended and open-ended survey data (n = 58) to examine: (1) the nature/content of critically reflective discussions in GSAs and (2) how advisors support critically reflective discussions in GSAs and their role in these discussions. Our findings suggest that (1) conversations centering race and its intersections with other socio-structural axes occur, albeit infrequently; (2) youth recognize and understand the concept of intersectionality in nuanced ways, desire to have critical intersectional conversations, and experience fragmentation from conversations around race, sexuality, and gender if they are situated at privileged locations on those axes; and (3) students want advisors to engage in critically reflective discussions in GSAs. The findings suggest that interventions and programming are needed that could cultivate advisors' and youth leaders' skills in facilitating intersectional dialogues for critical reflection among members.

2.
Child Dev ; 94(4): e215-e230, 2023.
Article in English | MEDLINE | ID: mdl-36967656

ABSTRACT

Hope is considered a marker of resilience among youth facing oppression, including LGBTQ+ youth. This 8-week weekly diary study among 94 LGBTQ+ youth (ages 14-19; Mage  = 15.91, 46% youth of color, 44% transgender or nonbinary) in 2021 considered whether a youth's meeting-to-meeting experiences in Gender-Sexuality Alliances (GSAs; LGBTQ+ affirming school clubs) predicted subsequent hope from week to week. Youth reported greater hope on days following meetings where they felt more group support, greater advisor responsiveness, and had taken on more leadership responsibilities. Group support and advisor responsiveness were stronger predictors of a youth's hope on days closer to GSA meetings; leadership's effect was stronger when more days had elapsed. Findings suggest how GSAs may cultivate hope among LGBTQ+ youth.


Subject(s)
Sexual and Gender Minorities , Transgender Persons , Humans , Adolescent , Sexuality , Sexual Behavior , Social Behavior
3.
J Clin Child Adolesc Psychol ; : 1-13, 2023 Feb 20.
Article in English | MEDLINE | ID: mdl-36803346

ABSTRACT

OBJECTIVE: Depression disparities between heterosexual youth and lesbian, gay, bisexual, queer, and other non-heterosexual (LGBQ+) youth are robust and linked to discrimination in schools. Advocacy by school-based Gender-Sexuality Alliances (GSAs) to raise awareness of LGBQ+ issues and to counteract discrimination may reduce these disparities within schools, yet has not been investigated schoolwide. We considered whether GSA advocacy over the school year moderated sexual orientation differences in depressive symptoms at the school year's end for students in the general school population (i.e., students who were not members of the GSA). METHOD: Participants were 1,362 students (Mage = 15.68; 89% heterosexual; 52.6% female; 72.2% White) in 23 Massachusetts secondary schools with GSAs. Participants reported depressive symptoms at the beginning and end of the school year. Separately, GSA members and advisors reported their GSA's advocacy activities during the school year and other GSA characteristics. RESULTS: LGBQ+ youth reported higher depressive symptoms than heterosexual youth at the school year's beginning. However, after adjusting for initial depressive symptoms and multiple covariates, sexual orientation was a weaker predictor of depressive symptoms at the school year's end for youth in schools whose GSAs engaged in more advocacy. Depression disparities were significant in schools whose GSAs reported lower advocacy, but were statistically non-significant in schools whose GSAs reported higher advocacy. CONCLUSION: Advocacy could be a means by which GSAs achieve school-wide impacts, benefiting LGBQ+ youth who are not GSA members. GSAs may therefore be a key resource for addressing the mental health needs of LGBQ+ youth.

4.
J Youth Adolesc ; 52(1): 1-14, 2023 Jan.
Article in English | MEDLINE | ID: mdl-36303090

ABSTRACT

Gender-Sexuality Alliances (GSAs) are school clubs for LGBTQ + youth and peer allies to support one another. This 8-week weekly diary study considered whether a youth's positive and negative affect during a given week could be predicted by experiences in their most recently attended GSA meeting. Ninety-nine GSA members (Mage = 15.90, SD = 1.33; 79% LGBQ + ; 41% trans/non-binary; 59% youth of color) in 11 states completed weekly surveys between January and May 2021. On average, some youth reported higher positive and negative affect than others. Youth also varied notably in their own positive and negative affect from week to week. Youth reported relatively higher positive affect on days following GSA meetings where they were more engaged than in other meetings and had spent time socializing in the meeting. Youth reported relatively higher negative affect on days following GSA meetings where they had discussed personal concerns, and relatively lower negative affect on days following meetings where they were more engaged and perceived greater advisor responsiveness. These findings offer a dynamic portrayal of youth's varied experiences across GSA meetings and the more immediate predictive effects of GSA experiences.


Subject(s)
Interpersonal Relations , Social Behavior , Humans , Adolescent , Sexual Behavior , Heterosexuality , Affect
5.
Health Educ Res ; 36(3): 295-308, 2021 07 12.
Article in English | MEDLINE | ID: mdl-33544834

ABSTRACT

Belonging to a school Gender and Sexuality Alliance (GSA) is associated with lower substance use among LGBTQ+ youth. However, it is unknown whether GSA participation facilitates access to resources for substance use concerns. Using longitudinal data from 38 Massachusetts high schools, we compared sources of support for substance use concerns listed by GSA members (n = 361) and nonmembers (n = 1539). Subsequently, we tested whether GSA membership was associated with comfort, confidence and awareness regarding substance use resources in school and the community. Finally, we assessed whether specific GSA activities and discussions (e.g. social support) were associated with these outcomes. Among students with recent substance use, GSA membership was associated with greater comfort, confidence and awareness regarding school-based substance use resources in the spring semester, adjusted for fall semester levels and non-GSA club involvement. Furthermore, students in GSAs where members reported more advocacy and social support activities reported higher levels of comfort, confidence and awareness regarding community-based substance use resources. These results indicate that among students using alcohol or nicotine products, GSA members may be more receptive to school-based substance use prevention efforts. Furthermore, GSA-based social support and activism experiences may promote access to community-based substance use resources.


Subject(s)
Sexual and Gender Minorities , Substance-Related Disorders , Adolescent , Humans , Schools , Sexuality , Students
6.
Prev Sci ; 22(2): 237-246, 2021 02.
Article in English | MEDLINE | ID: mdl-33410118

ABSTRACT

Schools can be a setting to address mental health needs of sexual and gender minority (SGM) youth. Gender-Sexuality Alliances (GSAs), as extracurricular support groups, provide an existing structure that could be leveraged to reach SGM youth and deliver services. Nevertheless, limited data indicate the prevalence of depression and anxiety among GSA members, how often GSAs discuss mental health, or their receptivity to resources. Participants in the current study were 580 youth (Mage = 15.59; 79% sexual minority, 57% cisgender female; 68% White) and 58 advisors in 38 GSAs purposively sampled across Massachusetts. Youth completed established measures of depression and anxiety; advisors reported how frequently their GSAs discussed mental health; and both reported their interest in mental health materials. Among youth, 70.1% scored above the threshold indicating probable mild depression, and 34.4% scored above the threshold suggesting concerning anxiety. Adjusted odds ratios indicated that the odds of depression and anxiety were higher for SGM members relative to heterosexual and cisgender members, particularly among youth reporting SGM identities that have been underrepresented. GSAs discussed mental health with some frequency over the school year. Youth and advisors expressed strong interest in resources. Findings support the case for developing selective and indicated school-based prevention programming for youth in GSAs to address their mental health needs.


Subject(s)
Anxiety , Depression , Mental Health Services , Sexual and Gender Minorities , Adolescent , Anxiety/epidemiology , Depression/epidemiology , Female , Health Promotion , Health Resources , Heterosexuality , Humans , Male , Massachusetts , Schools
7.
Prev Sci ; 22(5): 590-601, 2021 07.
Article in English | MEDLINE | ID: mdl-33609259

ABSTRACT

Although scholarship continues to document higher rates of alcohol use for sexual and gender minority (SGM) youth compared with heterosexual and cisgender youth, research identifying factors that mitigate SGM youths' risk is nascent. Youth spend substantial time in schools; therefore, teachers could play significant roles in attenuating these health concerns. We used data from a nationwide survey of 11,189 SGM youth (Mage = 15.52; 67.7% White) to explore whether perceived teacher social-emotional support attenuated the association between victimization and alcohol use, further conditioned by youths' specific ethnoracial identity. As expected, victimization was associated with more frequent alcohol use; however, greater perceived teacher support attenuated this association. The attenuating effect of perceived teacher support was significantly stronger for Hispanic/Latinx youth than White youth. Our findings have implications for alcohol use prevention among SGM youth, who face significant marginalization in schools and society. If we are to prevent alcohol use disparities among SGM youth, scholars and stakeholders (e.g., school administrators, teachers) should invest in building teacher efficacy to intervene in SGM-specific victimization.


Subject(s)
Bullying , Crime Victims , Sexual and Gender Minorities , Adolescent , Gender Identity , Humans , Sexual Behavior
8.
J Adolesc Res ; 36(2): 154-182, 2021 Mar 01.
Article in English | MEDLINE | ID: mdl-34393353

ABSTRACT

Research among sexual and gender minority (SGM) youth has suggested associations between Gender-Sexuality Alliance (GSA) involvement and better health. Emergent research has similarly demonstrated associations between family support and general well-being among SGM youth. However, the trait of bravery has received little attention in this literature, despite its relevance for youth in marginalized positions. We examined the association between level of GSA involvement, family support, and bravery among GSA members (n = 295; M age = 16.07), and whether those associations differed based on sexual orientation or gender identity. We then conducted one-on-one interviews with SGM youth (n = 10), to understand how they understood bravery and experienced support in both GSA and family contexts. Greater GSA involvement significantly predicted greater bravery for all youth, whereas greater family support predicted greater bravery only for heterosexual youth. No significant moderation was found for gender minority youth. Our qualitative findings clarified how SGM youth conceptualized bravery and how they experienced it within their GSA and family settings. GSAs were associated with more frequent displays of explicit support for SGM identity, while families were perceived as providing less explicit support.

9.
J Youth Adolesc ; 50(8): 1634-1648, 2021 Aug.
Article in English | MEDLINE | ID: mdl-34046840

ABSTRACT

Lesbian, gay, bisexual, queer, and youth with other minority sexual orientations (LGBQ+) who are more out to others about their sexual orientation identity may experience greater victimization at school based on sexual orientation, gender identity or expression, with negative implications for academic performance. Teacher support, however, may buffer these associations. Among a national US sample of cisgender and trans/non-binary LGBQ+ youth (n = 11,268; 66.1% White, 66.8% cisgender, Mage = 15.5 years, SDage = 1.3), latent moderated-mediation models were tested in which perceived teacher support and affirmation moderated the extent to which sexual orientation identity outness was associated with poorer reported academic performance in part through its association with greater victimization. As hypothesized, greater perceived teacher support and affirmation buffered (a) the association between sexual orientation identity outness and victimization, (b) the association between victimization and reported academic performance, and (c) the indirect association between sexual orientation identity outness and reported academic performance through victimization. These findings underscore the important protective role of supportive teachers for LGBQ+ youth in schools.


Subject(s)
Academic Performance , Bullying , Crime Victims , Adolescent , Female , Gender Identity , Humans , Infant , Male , Sexual Behavior
10.
Child Dev ; 91(5): 1509-1528, 2020 09.
Article in English | MEDLINE | ID: mdl-31762010

ABSTRACT

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.


Subject(s)
Empowerment , Mental Disorders/prevention & control , Psychosocial Support Systems , Sexual and Gender Minorities/psychology , Social Participation , Adolescent , Adult , Child , Female , Hope/physiology , Humans , Male , Massachusetts , Mental Disorders/epidemiology , Mental Disorders/etiology , Mental Disorders/psychology , Mental Health , Neurodevelopmental Disorders/epidemiology , Neurodevelopmental Disorders/etiology , Neurodevelopmental Disorders/prevention & control , Neurodevelopmental Disorders/psychology , Peer Group , Risk Factors , School Mental Health Services/organization & administration , School Mental Health Services/supply & distribution , Self Efficacy , Social Environment , Social Justice/psychology , Social Participation/psychology , Surveys and Questionnaires , Young Adult
11.
J Res Adolesc ; 30 Suppl 1: 158-176, 2020 01.
Article in English | MEDLINE | ID: mdl-30260054

ABSTRACT

Drawing from a person-environment fit framework, we identified profiles of youth in gay-straight alliances (GSAs) based on the extent to which they received information/resources, socializing/support, and advocacy opportunities in their GSAs and the extent to which this matched what they desired from their GSA along these three functions. Further, we examined profile differences in positive developmental competencies while accounting for community-contextual factors. In a sample of 290 youth from 42 Massachusetts GSAs, latent profile analyses identified five subgroups. Overall, youth receiving less from their GSAs than they desired, particularly regarding opportunities for advocacy, reported lower levels of self-reflection, bravery, civic engagement, and agency than youth who received information, socializing/support, and advocacy that matched or exceeded what they desired.


Subject(s)
Schools/organization & administration , Sexual and Gender Minorities/psychology , Social Identification , Adolescent , Adult , Female , Humans , Latent Class Analysis , Male , Massachusetts , Peer Group , Young Adult
12.
Am Educ Res J ; 56(6): 2262-2294, 2019 Dec 01.
Article in English | MEDLINE | ID: mdl-34385714

ABSTRACT

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.

13.
J Youth Adolesc ; 48(12): 2403-2417, 2019 Dec.
Article in English | MEDLINE | ID: mdl-31605292

ABSTRACT

Sexual and gender minority (SGM) youth are more likely to use alcohol than their heterosexual cisgender peers. At the same time, SGM youth experience sexuality- and gender identity-specific stressors known to exacerbate negative health outcomes. Though scholars have established a link between minority stressors (e.g., internalized stigma and victimization) and increased alcohol use for SGM youth as a whole, there is little indication of whether internalized stigma and victimization are more strongly associated with alcohol use for specific groups of SGM youth. A United States sample of 11,811 racially and geographically diverse 13-17 year old SGM youth was used to employ a series of gender-stratified multivariable regression models to examine the association among internalized stigma, victimization, and alcohol-related behaviors, and whether they differed for specific groups of sexual minority youth. Sexual orientation moderated several associations between sexual minority stressors (i.e., victimization and stigma) and youth's alcohol use (i.e., recent use and heavy episodic drinking) across models stratified by gender (i.e., male, female, and non-binary). For example, bisexual boys had stronger associations between SGM-specific victimization and alcohol use frequency and heavy episodic drinking relative to gay boys; conversely, victimization and alcohol use frequency were more weakly associated among bisexual girls relative to lesbian/gay girls. Pansexual girls showed weaker associations between internalized stigma and alcohol use frequency compared to lesbian/gay girls. This paper demonstrates who among SGM youth are more likely to engage in alcohol-related behaviors as a function of differential forms of SGM-related victimization and stigma. These findings can inform substance use interventions that are tailored to youth of diverse sexual orientations and gender identities.


Subject(s)
Alcohol Drinking/psychology , Crime Victims/psychology , Sexual Behavior/psychology , Sexual and Gender Minorities/psychology , Social Stigma , Adolescent , Alcohol Drinking/epidemiology , Bullying/psychology , Crime Victims/statistics & numerical data , Defense Mechanisms , Female , Gender Identity , Humans , Male , Sexual Behavior/statistics & numerical data , Sexual and Gender Minorities/statistics & numerical data , United States
14.
J Appl Dev Psychol ; 56: 13-20, 2018.
Article in English | MEDLINE | ID: mdl-29805190

ABSTRACT

Civic engagement among lesbian, gay, bisexual, transgender, or questioning (LGBTQ) youth and heterosexual cisgender allies can challenge oppressive systems. Among 295 youth in 33 Gay-Straight Alliances (GSAs; 69% LGBQ, 68% cisgender female, 68% white, Mage = 16.07), we examined whether greater GSA involvement was associated with greater general civic engagement, as well as participation in greater LGBTQ-specific advocacy and awareness-raising efforts. Further, we tested whether these associations were partly mediated through members' sense of agency. Greater GSA involvement was associated with greater civic engagement, advocacy, and awareness-raising; associations did not differ based on sexual orientation or gender identity. Finally, the association between GSA involvement and civic engagement was partially mediated through youths' greater sense of agency. Agency did not mediate the association between GSA involvement and engagement in advocacy or awareness-raising efforts. The results suggest GSAs are settings with potential to foster students' capacity to be active and engaged citizens.

15.
Am Educ Res J ; 53(6): 1732-1758, 2016 12.
Article in English | MEDLINE | ID: mdl-28757649

ABSTRACT

Using youth program models to frame the study of Gay-Straight Alliances (GSAs), we identified individual and structural predictors of greater engagement in these settings with a cross-sectional sample of 295 youth in 33 GSAs from the 2014 Massachusetts GSA Network Survey (69% LGBQ, 68% cisgen-der female, 68% White, Mage = 16.07). Multilevel modeling results indicated that members who perceived more support/socializing from their GSA, had more LGB friends, were longer serving members, and were in GSAs with more open and respectful climates reported greater engagement. Further, there was a curvilinear association between organizational structure in the GSA and engagement: Perceptions of more structure were associated with greater engagement to a point, after which greater structure was related to less engagement.

16.
J Youth Adolesc ; 45(7): 1438-51, 2016 Jul.
Article in English | MEDLINE | ID: mdl-26781740

ABSTRACT

Gay-Straight Alliances (GSAs) may promote wellbeing for sexual minority youth (e.g., lesbian, gay, bisexual, or questioning youth) and heterosexual youth. We considered this potential benefit of GSAs in the current study by examining whether three GSA functions-support/socializing, information/resource provision, and advocacy-contributed to sense of agency among GSA members while controlling for two major covariates, family support and the broader school LGBT climate. The sample included 295 youth in 33 Massachusetts GSAs (69 % LGBQ, 68 % cisgender female, 68 % white; M age = 16.06 years). Based on multilevel models, as hypothesized, youth who received more support/socializing, information/resources, and did more advocacy in their GSA reported greater agency. Support/socializing and advocacy distinctly contributed to agency even while accounting for the contribution of family support and positive LGBT school climate. Further, advocacy was associated with agency for sexual minority youth but not heterosexual youth. Greater organizational structure enhanced the association between support/socializing and agency; it also enhanced the association between advocacy and agency for sexual minority youth. These findings begin to provide empirical support for specific functions of GSAs that could promote wellbeing and suggest conditions under which their effects may be enhanced.


Subject(s)
Heterosexuality/psychology , Interpersonal Relations , Sexual and Gender Minorities/psychology , Social Support , Adolescent , Female , Humans , Internal-External Control , Male , Massachusetts , Models, Psychological , Prejudice/psychology , Quality of Life/psychology , Social Adjustment , Social Perception , Socialization
17.
Am J Public Health ; 105(9): 1842-8, 2015 Sep.
Article in English | MEDLINE | ID: mdl-26180946

ABSTRACT

OBJECTIVES: We examined sexual orientation disparities in physical activity, sports involvement, and obesity among a population-based adolescent sample. METHODS: We analyzed data from the 2012 Dane County Youth Assessment for 13,933 students in grades 9 through 12 in 22 Wisconsin high schools. We conducted logistic regressions to examine sexual orientation disparities in physical activity, sports involvement, and body mass index among male and female adolescents. RESULTS: When we accounted for several covariates, compared with heterosexual females, sexual minority females were less likely to participate in team sports (adjusted odds ratio [AOR] = 0.44; 95% confidence interval [CI] = 0.37, 0.53) and more likely to be overweight (AOR = 1.28; 95% CI = 1.02, 1.62) or obese (AOR = 1.88; 95% CI = 1.43, 2.48). Sexual minority males were less likely than heterosexual males to be physically active (AOR = 0.62; 95% CI = 0.46, 0.83) or to participate in team sports (AOR = 0.26; 95% CI = 0.20, 0.32), but the 2 groups did not differ in their risk of obesity. CONCLUSIONS: Sexual orientation health disparities in physical activity and obesity are evident during adolescence. Culturally affirming research, interventions, and policies are needed for sexual minority youths.


Subject(s)
Heterosexuality/psychology , Homosexuality/psychology , Motor Activity , Obesity/epidemiology , Sexual Behavior/psychology , Sports/psychology , Adolescent , Female , Gender Identity , Humans , Male , Sexual Behavior/statistics & numerical data , Sports/statistics & numerical data , Wisconsin/epidemiology
19.
Child Dev ; 86(1): 176-93, 2015.
Article in English | MEDLINE | ID: mdl-25176579

ABSTRACT

Gay-straight alliances (GSAs) may promote resilience. Yet, what GSA components predict well-being? Among 146 youth and advisors in 13 GSAs (58% lesbian, gay, bisexual, or questioning; 64% White; 38% received free/reduced-cost lunch), student (demographics, victimization, attendance frequency, leadership, support, control), advisor (years served, training, control), and contextual factors (overall support or advocacy, outside support for the GSA) that predicted purpose, mastery, and self-esteem were tested. In multilevel models, GSA support predicted all outcomes. Racial/ethnic minority youth reported greater well-being, yet lower support. Youth in GSAs whose advisors served longer and perceived more control and were in more supportive school contexts reported healthier outcomes. GSA advocacy also predicted purpose. Ethnographic notes elucidated complex associations and variability as to how GSAs operated.


Subject(s)
Adolescent Development/physiology , Counseling , Heterosexuality/psychology , Homosexuality/psychology , Interpersonal Relations , Self Concept , Social Support , Adolescent , Adult , Bisexuality/psychology , Female , Humans , Male , Middle Aged , Schools , Students , Young Adult
20.
J Couns Psychol ; 62(3): 425-437, 2015 Jul.
Article in English | MEDLINE | ID: mdl-26010289

ABSTRACT

Sexual minorities (e.g., lesbians, gay men, bisexual individuals) are at an increased risk for poorer mental and physical health outcomes than heterosexuals, and some of these health disparities relate to minority stressors such as discrimination. Yet, there is little research elucidating pathways that predict health or that promote resiliency among sexual minorities. Building on the minority stress model, the present study utilized relational cultural theory to situate sexual minority health within a relational framework. Specifically, the study tested mediators of the relationships between distal (i.e., discrimination, rejection, victimization) and proximal stressors (i.e., internalized homophobia, sexual orientation concealment) and psychological and physical distress for sexual minorities. Among 719 sexual minority adults, structural equation modeling analyses were used to test 4 models reflecting the mediating effects of shame, poorer relationships with a close peer and the lesbian/gay/bisexual/transgender (LGBT) community, and loneliness on the associations between minority stressors and psychological distress (i.e., depression and anxiety) and physical distress (i.e., distressing physical symptoms). As hypothesized, the associations between distal and proximal minority stressors and distress were mediated by shame, poorer relationships with a close peer and the LGBT community, and loneliness. Findings underscore the possible relational and interpersonal mechanisms by which sexual minority stressors lead to psychological and physical distress.


Subject(s)
Health Status , Loneliness/psychology , Mental Health , Minority Groups/psychology , Sexual Behavior/psychology , Shame , Adolescent , Adult , Aged , Bisexuality/psychology , Cross-Sectional Studies , Female , Homophobia/psychology , Homosexuality, Female/psychology , Humans , Interpersonal Relations , Male , Middle Aged , Stress, Psychological/psychology , Transgender Persons/psychology , Young Adult
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