Sexual and Reproductive Justice and Health Equity for LGBTQ+ Women.

LGBTQ+ women have long been overlooked in sexual and reproductive health research. However, recent research has established that LGBTQ+ women have unique and specific needs that need to be addressed in order to improve effectiveness of sexual health education and practice with this historically and presently underserved population. Informed by a reproductive justice framework coupled with liberation psychology theory, this review discusses the current state of sexual and reproductive health and technologies among LGBTQ+ women. In particular, we focus on a range of HIV prevention and reproductive technologies and their use and promotion, including the internal condom, abortion, oral contraceptives, dapivirine ring, HIV pre-exposure prophylaxis, intrauterine device, and other less studied options, such as the contraceptive sponge. Grounded in an intersectional framing, this review acknowledges the intersecting systems of oppression that affect multiply marginalized women inequitably and disproportionately. A sociohistorical, critical lens is applied to acknowledge the well-documented racist origins of reproductive health technologies and ongoing coercive practices that have led to medical mistrust among marginalized and stigmatized communities, particularly racialized LGBTQ+ women, women with disabilities, and women who are poor or incarcerated. Moreover, we discuss the urgent need to center LGBTQ+ women in research and clinical care, community-engaged health promotion efforts, affirming non-heteronormative sexual health education, and health policies that prioritize autonomy and dismantle structural barriers for this population. We conclude with recommendations and future directions in this area to remedy entrenched disparities in health.

Exploring the Efficacy of an Online Intervention in Processing Experiences of Heterosexism Among Autistic-LGBQ + Individuals.

This experimental study explored the use of online expressive writing interventions to cope with distress from heterosexist events among a sample of autistic-LBGQ + individuals. This study included an open writing condition and an emotion focused therapy guided writing condition. Over 89% of the participants indicated that the writing exercises were helpful in processing the event, with significant decreases for measures of depressive and trauma/stressor symptoms. A thematic analysis identified specific aspects of each condition that were helpful for participants in coping with heterosexist distress, such as the development of insight through the emotion-focused exercises. This low-demand exercise is promising as a solo exercise or as a therapy homework assignment, especially given the accessibility of this online intervention for autistic-LGBQ + people.

Daily experiences of minority stress and mental health in transgender and gender-diverse individuals.

Transgender and gender-diverse people experience various minority stressors although minimal research has examined prospective effects on daily affect or mental health. We explored rates of marginalization for transgender and gender-diverse participants in a daily diary study and the concurrent and prospective associations with daily affect and weekly measures of depression and anxiety symptoms, as well as the mediating effects of internalized stigma, rumination, and isolation. There were 167 participants (82.2% white; M age = 25) retained in the daily surveys. Participants completed surveys for 56 days reflecting exposure to marginalization, gender nonaffirmation, internalized stigma, rumination, isolation, affect (negative, anxious, and positive affect), and mental health (anxiety and depression symptoms). Participants experienced marginalization on 25.1% of the days. Within-person analyses revealed concurrent associations between marginalization and gender nonaffirmation with increased negative and anxious affect and increased anxiety and depression symptoms, as well as associations for gender nonaffirmation and decreased positive affect. At the within-person level, there were prospective associations between marginalization and gender nonaffirmation with increased negative affect on the next day, as well as increased anxiety and depression symptoms the next week. Concurrent analyses revealed significant indirect effects with marginalization and gender nonaffirmation associated with all three affect variables and mental health via increases in internalized stigma, rumination, and isolation. However, only gender nonaffirmation was related to isolation and affect or mental health in the prospective analyses. Clinical considerations include strategies to address the immediate effects of minority stress as well as the long-term interpersonal effects. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

"There's no real roadmap that I know of": Experiences of transgender and nonbinary graduate students in counseling psychology programs.

Minimal research has examined the experiences of transgender and nonbinary (TNB) people in graduate school with no studies to date examining the experiences of TNB students in psychology graduate programs. The purpose of this study was to utilize a critical-ideological paradigm to identify recruitment, retention, and attrition factors for TNB people in counseling psychology (CP) programs with the aim of providing specific recommendations to CP programs. Individual interviews (between 35 and 70 min) were conducted with a sample of 16 TNB graduate students, aged 23-37-years old (M = 26.9, SD = 3.84), in masters (n = 6) and doctoral (n = 10) CP programs. Participants were nonbinary (n = 13) and trans men (n = 3), the majority were White (n = 10), and all were sexual minorities. Participants were recruited online through email listservs and on social media posts on Facebook and Twitter. Reflexive thematic analysis revealed themes related to challenges experienced in CP programs (systemic/structural challenges, interpersonal challenges, individual/internal challenges) and strengths of or recommendations for CP programs (transaffirming resources/policies, supporting TNB competence and expertise, being a TNB accomplice). Several unique subthemes emerged across the seven themes. Findings may be applied by CP programs to more effectively recruit and retain TNB people, and collectively contribute to an increasing number of TNB people within this field. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

"Tuned into a different channel": Autistic transgender adults' experiences of intersectional stigma.

In this critical-constructivist grounded theory study, we interviewed 13 autistic-transgender, nonbinary, and/or gender diverse (TNG) individuals on the intersection of their autistic-TNG identities and how they resisted marginalization related to these experiences. Analysis revealed the experiences of living in a world that "doesn't seem quite set up the right way" and situated autistic-TNG experiences in complex set of intersectional processes that require navigating relationships, health care systems, and safety challenges living in a heterosexist, cissexist, and ableist society. Participants had to constantly assess the safety and disclosure of their identities in the face of oppressive systems while claiming space and creating community that affirmed them. We conclude by highlighting the importance of taking an intersectional lens to highlight the many positive aspects of being autistic and TNG, which have been largely absent in research and clinical dialogues. We provide some suggestions for providing culturally responsive mental health and ways neurotypical and cisgender people can begin to challenge ableist and cissexist narratives in their clinical practice and research, alongside autistic-TNG people. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The meaning of scientific objectivity and subjectivity: From the perspective of methodologists.

Given the challenges to the notion of objectivity posed by social psychological research on investigator effects, constructivist and critical epistemological perspectives, and the introduction of qualitative research methods in psychology, the investigators examined how leading methodologists understand the function of objectivity and subjectivity in psychological science. The aim of the study was to learn how contemporary methodologists view these issues so as to communicate converging perspectives to the field and inform methods education. A brief historical review of the concept of objectivity in psychology is presented to contexualize this examination. Eleven accomplished methodologists with expertise in a range of methods and epistemological perspectives were interviewed. Findings from a grounded theory analysis demonstrated that all the participants expressed concern about the belief that science is unaffected by scientists' perspectives, believing researchers and educators should problematize this perspective. Recommendations from participants included that science be viewed as a value-laden endeavor in which scientists systematically conduct research from multiple epistemological perspectives, and/or utilize diverse methods tailored to address their questions. Scientific procedures were detailed that could curtail dangers of either unchecked subjectivity or a false sense of objectivity. A functional analysis of these constructs, objectivity and subjectivity, suggested they both serve a similar scientific and an ethical purpose-to prevent the premature foreclosure of possible understanding because of the expectations of researchers. The mainstreaming of disclosures about the perspectives and positions of investigators, as well as their management, and the implementation of epistemological and methodological pluralism are encouraged to support this ethic. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The stench of bathroom bills and anti-transgender legislation: Anxiety and depression among transgender, nonbinary, and cisgender LGBQ people during a state referendum.

Informed by structural stigma theory, this article presents the results of two studies that explored mental health experiences of transgender, nonbinary, and gender-diverse (TNG) individuals and cisgender lesbian, gay, bisexual, and queer (LGBQ) individuals (N = 523) prior to and following a state referendum to remove gender-based protections. In the Preelection Study, a path model explored relationships among individual factors (i.e., TNG identity, history of gender-based victimization), interpersonal variables (i.e., Referendum familiarity, exposure to Referendum-related messages, sexual orientation, and gender identity-specific social support), and mental health factors (i.e., Referendum-related anxiety and depressive symptomatology). Referendum-related anxiety mediated the relationships between TNG identity, gender-based victimization, sexual orientation and gender identity social support, and depressive symptomatology, explaining 40% of the variance in depressive symptomatology. Postelection, a subsample of participants (N = 117) was used to test a model of differences from pre- to postelection. Neither TNG identity nor victimization predicted Postelection mental health, however, Referendum-related anxiety and depressive symptomatology were significantly lower following the ballot vote that retained gender-based rights. Clinical implications suggest sexual and gender minorities may report increased anxiety in the face of anti-lesbian, gay, bisexual, transgender, and queer (LGBTQ) legislation, which may be associated with heightened symptoms of depression. TNG people and LGBTQ people with histories of gender-based victimization may be more at risk for mental health concerns related to anti-TNG legislation. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Peeling Back the Layers: How Expressive Writing about Heterosexist Events Benefits Sexual Minority Adults.

Expressive writing exercises, in which participants self-reflect upon a difficult experience, are widely researched interventions. These exercises have been adapted to address a host of concerns, including trauma, mental distress, physical health, and minority stress. Although several theories exist about the mechanisms through which expressive writing yields psychological benefits, the direct perspectives of those who have completed expressive writing exercise has remained unexplored. This study used grounded theory methods to analyze sexual minority adults' interviews about their experience of engaging in various formats of expressive writing exercises about personal heterosexist events. Participants described both what they found helpful and frustrating about the writing process and reflected on how their perspectives shifted throughout the process. These findings contribute to the literature on how change occurs in expressive writing and provide guidance on how to assist sexual minority adults in healing from heterosexism in their lives.

Coping with discrimination: The insidious effects of gender minority stigma on depression and anxiety in transgender individuals.

OBJECTIVES: We examined types of discrimination encountered by transgender and gender diverse (TGD) individuals and the associations with symptoms of depression and anxiety, as well as the mediating and moderating effects of coping responses. METHOD: This online study included 695 TGD individuals ages 16 years and over (M = 25.52; standard deviation = 9.68). RESULTS: Most participants (76.1%) reported discrimination over the past year. Greater exposure to discrimination was associated with more symptoms of depression and anxiety. These associations were mediated by coping via detachment and via internalization, although a direct effect remained. CONCLUSIONS: Many TGD people will encounter discrimination and this is associated with greater psychological distress. Engagement in the internalization of blame or detachment partially explains the association between discrimination and mental health issues. These findings elucidate possible avenues for interventions to bolster adaptive coping responses for TGD people and highlight that actions to decrease discrimination are urgently needed.

Emergence of a transnational LGBTI psychology: Commonalities and challenges in advocacy and activism.

This contribution explores the historical developments of transnational lesbian, gay, bisexual, transgender, and intersex (LGBTI) psychology in Colombia, the Philippines, Russia, and South Africa in relationship to U.S. LGBT psychology. LGBTI psychology in these diverse contexts share commonalities but also have important variations in their development and focus within LGBTI concerns. The International Psychology Network for Lesbian, Gay, Bisexual, Transgender and Intersex Issues (IPsyNet) provides a model for international professional psychology collaboration and linkage on behalf of advocacy for LGBTI rights and sexual orientation and gender identity and/or expression concerns. Although there is the risk of transnational LGBTI psychology(ies) reproducing European-North American (Euro-N.A.) "homonationalism" and contributing to neo-colonization, these case examples illustrate the dynamic potential of transnational LGBTI psychology, including the possibilities of psychology to develop LGBTI psychologies drawing from indigenous as well as international structures and platforms, influencing Euro-N.A. models in the process. Finally, this article describes the promise and the limitations of transnational LGBTI psychology, including the role of human rights frameworks, as well as advocacy within professional psychology. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The Perspective of Older Men With Depression on Suicide and Its Prevention in Primary Care.

BACKGROUND: Suicide rates in older men are higher than in the general population, yet their utilization of mental health services is lower. AIMS: This study aimed to describe: (a) what primary care providers (PCPs) can do to prevent late-life suicide, and (b) older men's attitudes toward discussing suicide with a PCP. METHOD: Thematic analysis of interviews focused on depression and suicide with 77 depressed, low-socioeconomic status, older men of Mexican origin, or US-born non-Hispanic whites recruited from primary care. RESULTS: Several themes inhibiting suicide emerged: it is a problematic solution, due to religious prohibition, conflicts with self-image, the impact on others; and, lack of means/capacity. Three approaches to preventing suicide emerged: talking with them about depression, talking about the impact of their suicide on others, and encouraging them to be active. The vast majority, 98%, were open to such conversations. An unexpected theme spontaneously arose: "What prevents men from acting on suicidal thoughts?" CONCLUSION: Suicide is rarely discussed in primary care encounters in the context of depression treatment. Our study suggests that older men are likely to be open to discussing suicide with their PCP. We have identified several pragmatic approaches to assist clinicians in reducing older men's distress and preventing suicide.

Identity concealment in transgender adults: A qualitative assessment of minority stress and gender affirmation.

Minority individuals might conceal their identity in social contexts in an effort to avoid stigma and victimization. Unfortunately, identity concealment is thought to impact psychological distress in transgender and gender nonconforming (TGNC) individuals. Thus, through 30 in-depth interviews, we sought to understand if and how identity concealment was experienced by TGNC individuals. Findings indicated that (a) TGNC identity concealment is a source of stress, (b) individuals might conceal their TGNC identity based on social context, (c) concealment of assigned sex and gender history can function to affirm one's true gender identity, and (d) concealment of gender history is a rejection of one's assigned sex. In addition, (a) passing/blending is an important interpersonal and intrapersonal process, (b) the importance of passing/blending can change over time, and (c) not passing/blending may result in worrying about personal safety. The authors discuss how concealment can both inhibit and promote psychological health for TGNC individuals, and they offer clinical applications for health providers. (PsycINFO Database Record

Expecting Rejection: Understanding the Minority Stress Experiences of Transgender and Gender-Nonconforming Individuals.

Purpose: Transgender and gender-nonconforming (TGNC) individuals often are the target of enacted or external (i.e., distal) experiences of stigma, discrimination, and violence, which are linked to adverse health, particularly psychological distress. There is limited research, however, examining felt or internal (i.e., proximal) stressors faced by TGNC individuals. This study sought to examine one type of internal stressor, expecting rejection, and aimed to (1) identify how and to what extent rejection expectations operate day-to-day for TGNC individuals and (2) explore how TGNC individuals respond to expectations of rejection. Methods: In-depth interviews were conducted with 30 participants from 2014 to 2015 who identified as TGNC (mean age=30.4; 60% people of color); data were analyzed using a consensual qualitative research method. Results: Four thematic categories emerged about expecting rejection: (1) where to expect rejection; (2) thoughts and feelings associated with expectations of rejection; (3) coping strategies used to manage the expectation of rejection; and (4) the intersection of race and ethnicity with rejection expectations. Conclusion: Findings from this study suggest that expecting rejection is a frequent and salient internal stressor for TGNC individuals. We discuss the psychological and cumulative potential health impact of minority stress, and the applicability of Meyer's Minority Stress Model. Therapeutic interventions are needed to address the specific cognitive, emotional, and behavioral responses TGNC individuals experience as a result of the stress associated with expecting rejection, including fear, anxiety, and situational avoidance.