More LGBTQ-inclusive sex ed reduces odds of bullying, depression, suicidal thoughts, and victimization (J Adolesc Health)

Title: Associations of LGBTQ-inclusive sex education with mental health outcomes and school-based victimization in U.S. high school students

Journal: Journal of Adolescent Health

Public access URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6478545/pdf/nihms-1516132.pdf

Summary: Students with a greater proportion of LGBTQ-inclusive sex education have lower odds of experiencing school-based victimization and adverse mental health [such as depressive symptoms, suicidal thoughts, or making a plan to commit suicide

Heteronormative safety policies, violence, & harassment at schools cause decrease in perceived safety for gender-nonconforming students in 28 high schools. (J. Adolesc)

Heteronormativity, school climates, and perceived safety for gender nonconforming peers.

Abstract

Students' perceptions of their school climates are associated with psychosocial and academic adjustment. The present study examined the role of school strategies to promote safety in predicting students' perceptions of safety for gender nonconforming peers among 1415 students in 28 high schools. Using multilevel modeling techniques, we examined student- and school-level effects on students' perceptions of safety for gender nonconforming peers. We found that older students, bisexual youth, Latino youth, and youth who experienced school violence perceived their gender nonconforming male peers to be less safe. Similarly, we found that older students and students who experienced school violence and harassment due to gender nonconformity perceived their gender nonconforming female peers to be less safe. At the school-level, we found that when schools included lesbian, gay, bisexual, transgender, and queer (LGBTQ) issues in the curriculum and had a Gay-Straight Alliance, students perceived their schools as safer for gender nonconforming male peers.

Citation

Toomey et al. (2012) Heteronormativity, school climates, and perceived safety for gender nonconforming peers. Journal of Adolescence. 2012 Feb;35(1):187-96. doi: 10.1016/j.adolescence.2011.03.001. Epub 2011 Apr 8.

W. Canada schools w/ GSAs of 3+yrs consistently reduces suicidal ideation for ALL students regardless of orientation (Int'l Journal of Child Youth Family Studies)

School-Based Strategies to Reduce Suicidal Ideation, Suicide Attempts, and Discrimination among Sexual Minority and Heterosexual Adolescents in Western Canada.

Excerpt from abstract:

Analyses of the province-wide random cluster-stratified 2008 B.C. Adolescent Health Survey (n =21,70 8) compared students in schools with GSAs or policies implemented at least 3 years, and less than 3 years, with those in schools without GSAs or anti-homophobia policies, using multinomial logistic regression, separately by gender. LGB students had lower odds of past year discrimination, suicidal thoughts and attempts, mostly when policies and GSAs had been in place for 3+ years; policies had a less consistent effect than GSAs. Heterosexual boys, but not girls, also had lower odds of suicidal ideation and attempts in schools with longer-established anti-homophobic bullying policies and GSAs. 

Citation

Saewcy EM, Konishi C, Rose HA, Homma Y. School-based strategies to reduce suicidal ideation, suicide attempts, and discrimination among sexual minority and heterosexual adolescents in Western Canada. External  International Journal of Child, Youth and Family Studies 2014;1:89‒112.

"The presence of a GSA correlates with fewer depressive symptoms & mental health referrals for suicidal thoughts." (Journal of Youth & Adolescence)

School Climate & Sexual and Gender Minority Adolescent Mental Health.

Excerpt from abstract:

This study uses a survey that measures all four measures of school environment with a national sample of 240 sexual/gender minority high school students ages 14-18 (mean age 15.77) where 53% of participants had a Gay-Straight Alliance in their school. The sample is 53% cisgender, 100% sexual minority and 62% white. Adjusting for demographics and presence of a Gay-Straight Alliance, fewer depressive symptoms were associated with lower help-seeking intentions for suicidal thoughts. The presence of Gay-Straight Alliance was not statistically associated with past-month help-seeking intentions or behaviors. Additionally, a more supportive school climate was associated with lower anxiety and depressive symptoms. However, the presence of a Gay-Straight Alliance was not statistically associated with anxiety or depressive symptoms. These findings suggest that a supportive school climate and supportive school personnel may be important for supporting the mental health of sexual/gender minority students.

Citation

Colvin et al. (2019) School Climate & Sexual and Gender Minority Adolescent Mental Health. (2019) J. Youth Adolesc. 2019 Oct;48(10):1938-1951. doi: 10.1007/s10964-019-01108-w. Epub 2019 Aug 24.

Psychologists recognize that TGNC people are more likely to experience positive life outcomes when they receive social support or trans-affirmative care. (APA)

Source: American Psychological Association. (2015). Guidelines for Psychological Practice with Transgender and Gender Nonconforming People. American Psychologist, 70 (9), 832-864. doi: 10.1037/a0039906

Guideline 11. Psychologists recognize that TGNC people are more likely to experience positive life outcomes when they receive social support or trans-affirmative care.

Research has primarily shown positive treatment outcomes when TGNC adults and adolescents receive TGNC-affirmative medical and psychological services (i.e., psychotherapy, hormones, surgery; Byne et al., 2012; R. Carroll, 1999; Cohen-Kettenis, Delemarre-van de Waal, & Gooren, 2008; Davis & Meier, 2014; De Cuypere et al., 2006; Gooren, Giltay, & Bunck, 2008; Kuhn et al., 2009), although sample sizes are frequently small with no population-based studies. In a meta-analysis of the hormone therapy treatment literature with TGNC adults and adolescents, researchers reported that 80% of participants receiving trans-affirmative care experienced an improved quality of life, decreased gender dysphoria, and a reduction in negative psychological symptoms (Murad et al., 2010).

In addition, TGNC people who receive social support about their gender identity and gender expression have improved outcomes and quality of life (Brill & Pepper, 2008; Pinto, Melendez, & Spector, 2008).

Several studies indicate that family acceptance of TGNC adolescents and adults is associated with decreased rates of negative outcomes, such as depression, suicide, and HIV risk behaviors and infection (Bockting et al., 2013; Dhejne et al., 2011; Grant et al., 2011; Liu & Mustanski, 2012; Ryan, 2009).

Family support is also a strong protective factor for TGNC adults and adolescents (Bockting et al., 2013; Moody & Smith, 2013; Ryan et al., 2010).

TGNC people, however, frequently experience blatant or subtle antitrans prejudice, discrimination, and even violence within their families (Bradford et al., 2007). Such family rejection is associated with higher rates of HIV infection, suicide, incarceration, and homelessness for TGNC adults and adolescents (Grant et al., 2011; Liu & Mustanski, 2012). Family rejection and lower levels of social support are significantly correlated with depression (Clements-Nolle et al., 2006; Ryan, 2009).

Many TGNC people seek support through peer relationships, chosen families, and communities in which they may be more likely to experience acceptance (Gonzalez & McNulty, 2010; Nuttbrock et al., 2009).

Peer support from other TGNC people has been found to be a moderator between antitrans discrimination and mental health, with higher levels of peer support associated with better mental health (Bockting et al., 2013).

Works cited:

  1. Bockting, W. O., Miner, M. H., Swinburne Romine, R. E., Hamilton, A., & Coleman, E. (2013). Stigma, mental health, and resilience in an online sample of the US transgender population. American Journal of Public Health, 103, 943–951. http://dx.doi.org/10.2105/AJPH.2013 .301241

  2. Brill, S., & Pepper, R. (2008). The transgender child: A handbook for families and professionals. San Francisco, CA: Cleis Press.

  3. Byne, W., Bradley, S. J., Coleman, E., Eyler, A. E., Green, R., Menvielle, E. J., . . . American Psychiatric Association Task Force on Treatment of Gender Identity Disorder. (2012). Report of the American Psychiatric Association Task Force on Treatment of Gender Identity Disorder. Archives of Sexual Behavior, 41, 759 –796. http://dx.doi.org/10.1007/ s10508-012-9975-x

  4. Carroll, R. (1999). Outcomes of treatment for gender dysphoria. Journal of Sex Education & Therapy, 24, 128 –136.

  5. Clements-Nolle, K., Marx, R., & Katz, M. (2006). Attempted suicide among transgender persons: The influence of gender-based discrimination and victimization. Journal of Homosexuality, 51, 53– 69. http://dx .doi.org/10.1300/J082v51n03_04

  6. Cohen-Kettenis, P. T., Delemarre-van de Waal, H. A., & Gooren, L. J. G. (2008). The treatment of adolescent transsexuals: Changing insights. Journal of Sexual Medicine, 5, 1892–1897. http://dx.doi.org/10.1111/j .1743-6109.2008.00870.x

  7. Davis, S. A., & Meier, S. C. (2014). Effects of testosterone treatment and chest reconstruction surgery on mental health and sexuality in femaleto-male transgender people. International Journal of Sexual Health, 26, 113–128. http://dx.doi.org/10.1080/19317611.2013.833152

  8. De Cuypere, G., Elaut, E., Heylens, G., Van Maele, G., Selvaggi, G., T’Sjoen, G.,... Monstrey, S. (2006). Long-term follow-up: Psychosocial outcomes of Belgian transsexuals after sex reassignment surgery. Sexologies, 15, 126 –133. http://dx.doi.org/10.1016/j.sexol.2006.04.002

  9. Dhejne, C., Lichtenstein, P., Boman, M., Johansson, A. L. V., Långström, N., & Landén, M. (2011). Long-term follow-up of transsexual persons undergoing sex reassignment surgery: Cohort study in Sweden. PLoS ONE, 6(2), e16885. http://dx.doi.org/10.1371/journal.pone.0016885

  10. Gooren, L. J., Giltay, E. J., Bunck, M. C. (2008). Long-term treatment of transsexuals with cross-sex hormones: Extensive personal experience. Journal of Clinical Endocrinology & Metabolism: Clinical and Experimental, 93, 19 –25. http://dx.doi.org/10.1210/jc.2007-1809

  11. Grant, J. M., Mottet, L. A., Tanis, J., Harrison, J., Herman, J. L., & Kiesling, M. (2011). Injustice at every turn: A report of the national transgender discrimination survey. Washington, DC: National Center for Transgender Equality & National Gay and Lesbian Task Force. Retrieved from http://endtransdiscrimination.org/PDFs/NTDS_Report .pdf

  12. Kuhn, A., Brodmer, C., Stadlmayer, W., Kuhn, P., Mueller, M. D., & Birkhauser, M. (2009). Quality of life 15 years after sex reassignment surgery for transsexualism. Fertility and Sterility, 92, 1685–1689. http:// dx.doi.org/10.1016/j.fertnstert.2008.08.126

  13. Liu, R. T., & Mustanski, B. (2012). Suicidal ideation and self-harm in lesbian, gay, bisexual, and transgender youth. American Journal of Preventive Medicine, 42, 221–228. http://dx.doi.org/10.1016/j.amepre .2011.10.023

  14. Moody, C. L., & Smith, N. G. (2013). Suicide protective factors among trans adults. Archives of Sexual Behavior, 42, 739 –752. http://dx.doi .org/10.1007/s10508-013-0099-8

  15. Murad, M. H., Elamin, M. B., Garcia, M. Z., Mullan, R. J., Murad, A., Erwin, P. J., & Montori, V. M. (2010). Hormonal therapy and sex reassignment: A systemic review and meta-analysis of quality of life and psychosocial outcomes.Clinical Endocrinology, 72, 214 –231. http:// dx.doi.org/10.1111/j.1365-2265.2009.03625.x

  16. Pinto, R. M., Melendez, R. M., & Spector, A. Y. (2008). Male-to-female transgender individuals building social support and capital from within a gender-focused network. Journal of Gay and Lesbian Social Services, 20, 203–220. http://dx.doi.org/10.1080/10538720802235179

  17. Ryan, C. (2009). Supportive families, healthy children: Helping families with lesbian, gay, bisexual & transgender children. San Francisco, CA: Family Acceptance Project, Marian Wright Edelman Institute, SanFrancisco State University. Retrieved from http://familyproject.sfsu.edu/files/FAP_English%20Booklet_pst.pdf

  18. Ryan, C., Russell, S. T., Huebner, D., Diaz, R., & Sanchez, J. (2010). Family acceptance in adolescence and the health of LGBT young adults. Journal of Child and Adolescence and the Health of LGBT Young Adults, 23, 205–213.

Doctor's Rec: 64,000+ pediatricians recommend gender-affirming treatment for children based on best available evidence

A September 2015 presentation from the American Academy of Pediatrics notes that treatment recommendations are based on the best available evidence. Their guidance defined three approaches to gender dysphoria in children: “corrective,” “supporting,” and “affirming,” with the AAP advising the “affirming” approach to gender dysphoria in children.



Sources:

  1. Kim Lacapria. (2016) American Pediatricians Issue Statement That Transgenderism Is ‘Child Abuse’? It was an official-sounding but fringe group of politically motivated pediatricians who issued a statement on gender, not the respected American Academy of Pediatrics. Snopes (6 May 2016) (pdf).

  2. Robert Garofalo. (2015) Understanding Gender Nonconformity in Childhood and Adolescence. American Academy of Pediatrics (September 2015). (pdf).

Doctor's Rec: Statement from American Academy of Pediatrics

The official American Academy of Pediatrics published (link to summary article) 9 clear recommendations for caring for youth and adolescents who identify as transgender or gender-diverse.

I highlight the portions that specify providing health care according to what the youth wants, especially to match the youth’s gender expression. Not parent, guardian, teacher, staff member, administrator, guidance counselor, etc.

[Aside: You may have heard a FoxNews Glenn Beck headline about an anti-gay-marriage hate group calling itself “American Pediatricians” creating a hoax claiming supporting a transgender youth is abuse. Read more about how Snopes debunked this, as well as the American Academy of Pediatrics’ internal presentation recommending affirming a child’s gender expression (pdf). —RXS]

1. that youth who identify as TGD have access to comprehensive, gender-affirming, and developmentally appropriate health care that is provided in a safe and inclusive clinical space;

2. that family-based therapy and support be available to recognize and respond to the emotional and mental health needs of parents, caregivers, and siblings of youth who identify as TGD;

3. that electronic health records, billing systems, patient-centered notification systems, and clinical research be designed to respect the asserted gender identity of each patient while maintaining confidentiality and avoiding duplicate charts;

4. that insurance plans offer coverage for health care that is specific to the needs of youth who identify as TGD, including coverage for medical, psychological, and, when indicated, surgical gender-affirming interventions;

5. that provider education, including medical school, residency, and continuing education, integrate core competencies on the emotional and physical health needs and best practices for the care of youth who identify as TGD and their families;

6. that pediatricians have a role in advocating for, educating, and developing liaison relationships with school districts and other community organizations to promote acceptance and inclusion of all children without fear of harassment, exclusion, or bullying because of gender expression;

7. that pediatricians have a role in advocating for policies and laws that protect youth who identify as TGD from discrimination and violence;

8. that the health care workforce protects diversity by offering equal employment opportunities and workplace protections, regardless of gender identity or expression; and

9. that the medical field and federal government prioritize research that is dedicated to improving the quality of evidence-based care for youth who identify as TGD.

Citation:

Jason Rafferty (2018) Ensuring Comprehensive Care and Support for Transgender and Gender-Diverse Children and Adolescents. Pediatrics Sep 2018, e20182162; DOI: 10.1542/peds.2018-2162 (direct pdf)

Using a Transgender Person's Name Can Decrease Their Risk of Depression and Suicide (Teen Vogue)

A new study from The University of Texas at Austin has shed light on the importance of name usage for transgender youth. The study, which was published in the Journal of Adolescent Health in preparation for the annual Transgender Day of Visibility, concluded that when young transgender people are able to use their names in areas of everyday life, their risk of suicide and depression decreases.

They found that young people who could use their names in all four scenarios experienced 71% fewer symptoms of depression, 34% fewer symptoms of suicidal ideation, and a 65% decrease in attempted suicide than those who were not able to use their names.

Read the article here: https://www.teenvogue.com/story/using-transgender-persons-name-decrease-risk-of-depression-suicide

Using Chosen Names Reduces Odds of Depression and Suicide in Transgender Youths (Journal of Adolescent Health)

““It’s practical to support young people in using the name that they choose It’s respectful and developmentally appropriate.””
— Stephen T. Russell (University of Texas at Austin)

After interviewing 129 youths in 3 US cities, the researchers found that having even one context in which a chosen name could be used was associated with a 29 percent decrease in suicidal thoughts.

The research was funded by a grant from the National Institute of Mental Health and supported by the UT Population Research Center and a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development.

Citation: Stephen T. Russell, Amanda M. Pollitt, Gu Li, & Arnold H. Grossman. (2018) Chosen Name Use Is Linked to Reduced Depressive Symptoms, Suicidal Ideation, and Suicidal Behavior Among Transgender Youth. Journal of Adolescent Health, Volume 63, Issue 4, 503 - 505. DOI: https://doi.org/10.1016/j.jadohealth.2018.02.003

Victimization of Transgender Youths Linked to Suicidal Thoughts, Substance Abuse (Journal of Adolescent Health)

In two peer-reviewed papers, researchers at The University of Texas at Austin have found that transgender adolescents are twice as likely to have suicidal thoughts as the general population, and they are up to four times as likely to engage in substance use. Depression and school-based victimization factored heavily into the disparities in both cases.

Read more: https://cns.utexas.edu/news/victimization-of-transgender-youths-linked-to-suicidal-thoughts-substance-abuse