“Find a Local Queer Community and Jump In”: Perspectives of Lesbian, Gay, Bisexual, Transgender, and Queer Youth on Mental Health Difficulties and Sources of Support in Aotearoa/New Zealand

LGBTQ youth mental health during COVID-19: unmet needs in public health and policy

BackgroundYouth in Canada's Northwest Territories (NWT) experience sexual and mental health disparities. Higher rates of sexual and mental health concerns among lesbian, gay, bisexual, transgender and queer (LGBTQ) youth in comparison with heterosexual and cisgender peers have been associated with stigma and discrimination. Although LGBTQ youth in the NWT are situated at the nexus of Northern and LGBTQ health disparities, there is little known about their health, well-being and experiences of stigma. This short communication discusses the process of developing a LGBTQ youth community-based research programme in the NWT.MethodsWe developed an interdisciplinary research team of LGBTQ and allied young adults, including indigenous and non-indigenous researchers, community organisers and service providers in the NWT. We conducted meetings in Yellowknife with LGBTQ youth (n=12) and key stakeholders (n=15), including faculty, students, community groups and health and social service providers. Both meetings included LGBTQ and allied participants who were LGBTQ, indigenous, youth and persons at the intersection of these identities.ResultsLGBTQ youth participants discussed community norms that devalued same sex identities and stigma surrounding LGBTQ-specific services and agencies. Stigma among LGBT youth was exacerbated for youth in secondary schools, gender non-conforming and transgender youth and young gay men. In the stakeholder meeting, service providers discussed the importance of integrating LGBTQ issues in youth programmes, and LGBTQ community groups expressed the need for flexibility in service delivery to LGBTQ youth. Stakeholders identified the need to better understand the needs of indigenous LGBTQ youth in the NWT.ConclusionsCommunity-based LGBTQ groups, researchers and health and social service providers are interested in addressing LGBTQ youth issues in the NWT. The emergence of LGBTQ community building, support groups and activism in Northern Canada suggests that this is an opportune time to explore LGBTQ youth health.

Children and adolescents with a history of adverse childhood experiences (ACEs) are more likely than their peers to develop mental health difficulties, but not enough is known about their help-seeking behaviours and preferences. We aimed to determine whether ACEs are associated with access to and perceived unmet need for mental health services and support amongst secondary school students. We used multi-level logistic regression with data from the 2020 OxWell Student Survey to assess whether ACEs were associated with (1) prior access to mental health support and (2) perceived unmet need for mental health services in a community sample of English secondary school students. We assessed ACEs as a cumulative score from the Center for Youth Wellness Adverse Childhood Experiences Questionnaire: Teen Self-Report version and accounted for current mental health difficulties as measured by the 25-item Revised Children's Anxiety and Depression Scale (RCADS). Our analysis included 2018 students across 64 schools, of whom 29.9% (598/2002) reported prior access to mental health support. Of those not reporting prior access, 34.1% (469/1377) reported a perceived unmet need for services. In the unadjusted models, cumulative ACE scores were significantly positively associated with both prior access to mental health support (odds ratio (OR)=1.36; 95% confidence interval (CI): 1.29-1.43) and perceived unmet need for mental health services (OR=1.47; 95% CI: 1.37-1.59), meaning that students who had experienced adversity had a greater chance of having previously accessed support as well as perceiving an unmet need for services. After adjusting for mental health difficulties and other sociodemographic variables, cumulative ACE scores were positively associated with prior access (adjusted OR (aOR)=1.25; 95% CI: 1.17-1.34 with a significant interaction between RCADS and ACE scores, aOR=0.88; 95% CI: 0.84-0.93) as well as perceived unmet need (aOR=1.32; 95% CI: 1.21-1.43 with a significant interaction between RCADS and ACE scores, aOR=0.85; 95% CI: 0.78-0.91). Although it is encouraging that adolescents with experience of adversity are more likely than their peers with similar levels of depression and anxiety symptoms to have accessed mental health support, there remains a concern that those who have not accessed support are more likely to perceive an as-yet unmet need for it. Mental health support must be available, accessible and acceptable to all who need it, especially for those groups that traditionally have not accessed services, including the more marginalised and vulnerable populations.

Cortisol secretory activity in older people in relation to positive and negative well-being

Posthuman research methodologies center nonhuman actors and spaces. In this paper, we argue that technological mediation is a key component in a move toward the exploration of posthuman subjectivity in research and the restructuring of dominant understandings of gender and sexualized difference. Drawing on a cellphilm (cellphone + film production) based project with queer, trans, and non-binary youth in New Brunswick, Canada, we seek to center queer stories and experiences to speak back to their erasures in school spaces and landscapes. We argue that in researching with queer, trans, and non-binary youth in the Anthropocene, cellphilm method offers us the opportunity to think critically and creatively about environments, inclusions, and queering environmental futures (Lebel, 2019) within schooling structures.

ABSTRACTThis essay explores the relationship of two homeless youth—one queer and one trans—as they move together through and pass time in public space between the opening hours of their shelters and groups homes. Pulling from a critical ethnography of the experiences of trans and queer youth in New York City, this essay examines how these two youth come to know how to navigate and be in relation with the affects, structures, bodies, and discourses that comprise the city. The essay centers their relationship as an act of resistance, or queerruption as per this symposium, against normative assumptions about race, gender, and sexuality that dictate how the city is “supposed” to be used. The essay is written in a narrative form that asks readers to consider how they are coming to know these two youth through the ways they are animated in the text, with the purpose being to unpack the assumptions of presupposing who, what, and where trans and queer youth are thought to be.

As increasing numbers of transgender, gender diverse, and queer youths come out to their friends, families and communities, their rights to express their identities in public life have become the subject of intense media scrutiny and political debate. But for all the attention transgender, gender diverse, and queer youth have received from politicians, journalists, and public intellectuals, basic science research on how these youth actually experience their identities over time remains scarce. In this monograph, we contribute to the emerging knowledge base on this topic by presenting a detailed quantitative description of gender identity and sexual orientation in a sample of over 900 North American transgender, gender diverse, and cisgender youths in the Trans Youth Project (Mage = 8.1 years at first visit; Mage = 14.3 at latest visit; 99% living in the United States, 1% in Canada; 69% non-Hispanic white; 73% household income >$75,000). Youths are in one of three groups: (1) a group of early identifying transgender youths, who were supported by their parents in a social gender transition (changing their name, pronouns, hairstyle, and clothing) by age 12 (Mage at transition = 6.5; N = 317); (2) a group of their siblings, who were cisgender at the beginning of their participation in the study (N = 218); and (3) a group of cisgender youths who were age- and gender-matched to, but not family members of, the early identifying transgender youths (N = 377). Data on the youths' identities have been collected from the youths themselves and their parents between 2013 and 2024. We had two primary research goals. First, we described stability or change in youths' gender identity (Chapter 4) and sexual orientation (Chapter 6). We asked whether transgender youths' rates of change were or were not different from those of cisgender youths. Second, we examined whether measures of gender development earlier in development were related to youths' later gender identity (Chapter 5) or sexual orientation (Chapter 6) trajectories into adolescence. Stability in gender identity was by far the most common pathway for youths in all three groups, with over 80% of youths showing stability throughout their participation in the study. We saw similarity between the three groups of youths, such that the early identifying transgender youths were no more or less likely to show gender change than their siblings or youths in the unrelated comparison sample. Nevertheless, 11.9% of youths who started as cisgender were not so at their most recent report-a much higher proportion than would be predicted based on assumptions held in classic developmental psychology research about gender since the 1950s. When gender change did occur in all three groups, it overwhelmingly involved change to (and, to a lesser extent, from) a nonbinary gender identity. Results were similar regardless of whether youth- or parent-report data were considered, and we found no evidence that youths were more or less likely to change at particular ages. We observed some evidence that more gender nonconformity in childhood (e.g., more femininity in childhood among children living as boys) was related to later gender change, but results were somewhat inconsistent across measures and gender identities. Youths showed diverse sexual orientations, with 60% of binary transgender and 33% of cisgender adolescents expressing queer (i.e., not straight) romantic or sexual interest. A high percentage of youths overall (37%) indicated interest in both boys and girls-a pattern particularly common among nonbinary youths. Finally, more than a third of youths have shown change in their sexual orientation, and childhood gender nonconformity was associated with whether currently binary transgender or cisgender teenagers most recently reported a queer identity. Our results accord with recent evidence indicating that today's youth are defying assumptions about gender and sexual orientationfrom decades of developmental research, considering gender and sexual orientation to be relatively flexible social identitiesrather than ones that are fixed, and view gender as having more than two categories. Early identifying transgender children's sense of their own gender was no more or less stable than cisgender children's, suggesting that children who are supported in their transgender identities tend to show developmental patterns that mirror their cisgender peers. Finally, in Chapter 7, we discuss how our findings exemplify and respond to this unique historical moment, the ways in which our findings do and do not align with past work about gender- nonconforming children, and how future research can continue to make strides toward better understanding a wider swath of gender development trajectories.

BackgroundSchools in the United Kingdom and elsewhere are expected to protect and promote pupil mental health. However, many school staff members do not feel confident in identifying and responding to pupil mental health difficulties and report wanting additional training in this area.ObjectiveWe aimed to explore the feasibility of Kognito’s At-Risk for Elementary School Educators, a brief, interactive web-based training program that uses a simulation-based approach to improve school staff’s knowledge and skills in supporting pupil mental health.MethodsWe conducted a mixed methods, nonrandomized feasibility study of At-Risk for Elementary School Educators in 6 UK primary schools. Our outcomes were (1) school staff’s self-efficacy and preparedness to identify and respond to pupil mental health difficulties, (2) school staff’s identification of mental health difficulties and increased risk of mental health difficulties, (3) mental health support for identified pupils (including conversations about concerns, documentation of concerns, in-class and in-school support, and referral and access to specialist mental health services), and (4) the acceptability and practicality of the training. We assessed these outcomes using a series of questionnaires completed at baseline (T1), 1 week after the training (T2), and 3 months after the training (T3), as well as semistructured qualitative interviews. Following guidance for feasibility studies, we assessed quantitative outcomes across time points by comparing medians and IQRs and analyzed qualitative data using reflexive thematic analysis.ResultsA total of 108 teachers and teaching assistants (TAs) completed T1 questionnaires, 89 (82.4%) completed T2 questionnaires, and 70 (64.8%) completed T3 questionnaires; 54 (50%) completed all 3. Eight school staff members, including teachers, TAs, mental health leads, and senior leaders, participated in the interviews. School staff reported greater confidence and preparedness in identifying and responding to mental health difficulties after completing the training. The proportion of pupils whom they identified as having mental health difficulties or increased risk declined slightly over time (medianT1=10%; medianT2=10%; medianT3=7.4%), but findings suggested a slight increase in accuracy compared with a validated screening measure (the Strengths and Difficulties Questionnaire). In-school mental health support outcomes for identified pupils improved after the training, with increases in formal documentation and communication of concerns as well as provision of in-class and in-school support. Referrals and access to external mental health services remained constant. The qualitative findings indicated that school staff perceived the training as useful, practical, and acceptable.ConclusionsThe findings suggest that brief, interactive web-based training programs such as At-Risk for Elementary School Educators are a feasible means to improve the identification of and response to mental health difficulties in UK primary schools. Such training may help address the high prevalence of mental health difficulties in this age group by helping facilitate access to care and support.

Discussions surrounding the rights, desires, and subjectivities of queer youth in education have a history marked by both controversy and optimism. Many researchers, practitioners, and teachers who critically examine the role of education in the lives of queer youth insist that the youth themselves should be involved in setting the terms of debate surrounding if and how they should be included in sites of education. This is important because the ways in which their needs and subjectivities are conceptualized have a direct impact on the futures that queer youth imagine for themselves and for others. For example, the furious and impassioned debates about sex education in schooling are also to do with the amount of empathy we have for queer youth. Thus, sex education is a frequent point of analysis in literature on queer youth in education. Literature on queer youth and education also helpfully demonstrates how racialization, gender, neoliberalism, and settler-colonialism permeate discourses of queer inclusion and constitute the conditions of both acceptance and oppression for queer youth. While queer studies has at times sharpened perceptions of queer youth’s subjective and systemic experiences in education, it cannot be collapsed into a unified theory of sexuality because it too is ripe with debate, variation, and contradiction. As many scholars and intellectual traditions make clear, the global and transnational dimensions of gender and sexuality cannot be subsumed into a unified taxonomy of desire or subject formation. More ethical interactions between teachers, peers, and queer youth are needed because our theories of queer desire and the discourses we attach to them evince material realities for queer youth. Despite the often prevailing insistence that queer youth belong in educational institutions, homophobia and heteronormativity continue to make inclusion a complicated landscape. In recognition of these dynamics, literature in the field of educational studies also insists that some queer youth find hope in education. Withdrawing advocacy and representation for queer, trans, and nonbinary youth in educational settings becomes dangerous when it creates a terrain for isolation and shame. Importantly, queer theory and LGBTQ studies have conceptualized the needs of queer youth in ways that emphasize education as a space wrought with emotion, power, and desire. Early theorizing of non-normative sexual desire continues to set the stage for contemporary discussions of schools as spaces of power and repression. That is, histories of activism, knowledge, and policy construction have made the present conditions of both inclusion and exclusion for queer youth. Contemporary debates about belonging and marginalization in schools are made from the residues and endurance of earlier formations of gender and race.

Background Health and Safety Executive data show that teachers are at heightened risk of mental health difficulties, yet few studies have attempted to address this. Poor teacher mental health may impact on the quality of support provided to young people, who also report increased mental health difficulties themselves. Objective To test the effectiveness of an intervention aiming to improve secondary school teachers’ well-being through mental health support and training. Design A cluster randomised controlled trial with embedded process and economic evaluations. Setting Twenty-five mainstream, non-fee-paying secondary schools in the south-west of England and South Wales, stratified by geographical area and free school meal entitlement, randomly allocated to intervention or control groups following collection of baseline measures (n = 12, intervention; n = 13, control) between May and July 2016. Participants All teachers in the study schools at any data collection. All students in year 8 (baseline) and year 10 (final follow-up). Intervention Each intervention school received three elements: (1) a 1-day mental health first aid for schools and colleges training session delivered to 8% of all teachers; (2) a 1-hour mental health session delivered to all teachers; and (3) 8% of staff trained in the 2-day standard mental health first aid training course set up a confidential peer support service for colleagues. Control schools continued with usual practice. Main outcome measures The primary outcome was teacher well-being (using the Warwick–Edinburgh Mental Wellbeing Scale). Secondary outcomes were teacher depression, absence and presenteeism, and student well-being, mental health difficulties, attendance and attainment. Follow-up was at 12 and 24 months. Data were analysed using intention-to-treat mixed-effects repeated-measures models. Economic evaluation A cost–consequence analysis to compare the incremental cost of the intervention against the outcomes measured in the main analysis. Process evaluation A mixed-methods study (i.e. qualitative focus groups and interviews, quantitative surveys, checklists and logs) to examine intervention implementation, activation of the mechanisms of change outlined in the logic model, intervention acceptability and the wider context. Results All 25 schools remained in the study. A total of 1722 teachers were included in the primary analysis. We found no difference in mean teacher well-being between study arms over the course of follow-up (adjusted mean difference –0.90, 95% confidence interval –2.07 to 0.27). There was also no difference in any of the secondary outcomes (p-values 0.203–0.964 in the fully adjusted models). The average cost of the intervention was £9103 (range £5378.97–12,026.73) per intervention school, with the average cost to Welsh schools being higher because of a different delivery model. The training components were delivered with high fidelity, although target dosage was sometimes missed. The peer support service was delivered with variable fidelity, and reported usage by teachers was low (5.9–6.1%). The intervention had high acceptability, but participants reported low support from senior leadership, and minimal impact on school culture. Limitations Participants and the study team were unblinded, self-report for the main outcome measures and inaccurate measurement of peer support service usage. Conclusions The Wellbeing in Secondary Education (WISE) intervention was not effective at improving teacher or student well-being, or reducing mental health difficulties, possibly because of contextual barriers preventing it becoming embedded in school life. Future work Identification of ways in which to achieve system-level change and sustained support from senior leaders is important for future school-based mental health interventions. Trial registration Current Controlled Trials ISRCTN95909211. Funding This project was funded by the National Institute for Health Research Public Health Research programme and will be published in full in Public Health Research; Vol. 9, No. 12. See the NIHR Journals Library website for further project information. Intervention costs were met by Public Health Wales, Public Health England and Bristol City Council.

Gender-Affirming Hormone Therapy Linked to Better MH in Trans Youth

Young people who identify as lesbian, gay, bisexual, and queer transgender have elevated rates of suicidality. Despite the increased risk, there is a paucity of research on lesbian, gay, bisexual, transgender and queer help-seeking and suicidality. We report on a UK sequential exploratory, two-stage, mixed-method study. Stage 1 involved 29 online and face-to-face semi-structured interviews with lesbian, gay, bisexual, transgender and queer youth aged 16–25 years old. Stage 2 utilised an online youth questionnaire employing a community-based sampling strategy (n = 789). Results indicated that participants only asked for help when they reached a crisis point because they were normalising their emotional distress. Those who self-harmed, had attempted or planned suicide or had experience of abuse related to their sexuality or gender were most likely to seek help. Results suggested that the reluctance to seek help was due to three interconnecting factors: negotiating sexuality, gender, mental health and age norms; being unable to talk about emotions; and coping and self-reliance. Policies aiming to prevent lesbian, gay, bisexual, transgender and queer youth suicide recognise that norms and normalising processes connected to sexual orientation and gender identity are additional difficulties that youth have accessing mental health support.

New Horizons for the Journal: Familiar Landscapes in Child Protection

Transgender youth are those whose genders do not align with their sex assigned at birth. Transgender youth are increasingly visible and frequently encounter discrimination and a lack of understanding from others, especially at school. As a result, they experience profound mental health challenges, with one in five transgender youth attempting suicide. However, such youth who are adequately supported do not experience serious mental health difficulties. Accordingly, promoting school support for transgender youth is critical. While school staff know how to help youth generally, many want more guidance on how to help transgender youth. However, few resources provide clear and actionable best practices for school staff to help transgender youth. Best practices for supporting transgender youth in schools include verbal, behavioral, and visual skills that all school staff can use. Research shows that when these practices are used, transgender youth experience fewer mental health challenges, feel more connected to their school community, and do better academically. There are at least 20 best practices for supporting transgender youth in schools supported by empirical and practice-based literature; they span four categories: (a) language to use and avoid, (b) coming out at school, (c) creating a supportive school environment, and (d) preventing and intervening in bullying. Examples include sharing pronouns, advocating for, and sharing the location of gender-inclusive facilities, and intervening in gender-based bullying. School staff—including school social workers—can and should use this set of easy-to-implement, research-informed best practices to improve transgender youths’ mental health.

The Silent Mental Health and Well‐Being Crisis of Early Career Researchers in Aquatic Sciences