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Reciprocal associations between sexual orientation concealment and mental health among LGBQ college students

Introduction Lesbian, gay, bisexual, and queer (LGBQ) individuals confront ongoing decisions about whether to reveal their sexual orientation to others. In some situations, LGBQ individuals opt for a strategy of concealment (i.e., an active effort to hide one’s sexual minority identity). A robust body of research has linked concealment to mental health challenges. However, most previous studies have been cross-sectional, limiting their ability to draw conclusions about the directionality of these associations. Method The present study used data collected at two times points four months apart to examine the reciprocal association of concealment with depressive symptoms and life satisfaction in a sample of 91 LGBQ college students. Data were analyzed using cross-lagged panel models. Results Results revealed that depressive symptoms and life satisfaction predicted concealment four months later. Concealment predicted lower levels of later life satisfaction—but not depressive symptoms—four months later. Experiences of heterosexist discrimination did not confound the associations between concealment and mental health. Conclusion Findings highlight the value of longitudinal study designs for research on LGBQ identity and have implications for the theory of identity management. In particular, general mental health variables may have a greater impact on the LGBQ identity management process than previously thought.

“The hardest and most difficult days of my life”: Mental health of khwaja sira in Swat, Pakistan during the COVID-19 pandemic

Introduction Khwaja sira (third gender people) in Pakistan experience several forms of social marginalization, which were likely exacerbated during the COVID-19 pandemic. Methods We completed 45 interviews with khwaja sira in Mingora, Khyber Pakhtunkhwa, Pakistan to understand the impact of the COVID-19 pandemic on their daily lives. Interviews were conducted in Pashto, digitally audio-recorded, and analyzed using Minority Stress Theory, which posits that sexual and gender minorities are at increased risk for mental health disorders due to the psychosocial stress resulting from experiences of stigmatization and discrimination. Results We identified three overarching themes: (1) financial insecurity; (2) social vulnerability; and (3) resilience. Under the theme of financial insecurity, we identified three subthemes: (1) loss of income and financial stress; (2) dependence of khwaja sira’s family members on their income; and (3) risk from engagement in sex work. Under the theme of social vulnerability, we identified three subthemes: (1) heightened social isolation; (2) psychological distress; and (3) the inability to access medical care. There were no additional subthemes under the code of resilience. Conclusion Findings demonstrate that although khwaja sira experienced heightened vulnerabilities throughout the pandemic, they identified resilient coping strategies to handle these challenges.

Empathy as a resilience factor in lesbian, gay, and bisexual individuals: A scoping review

Introduction: Much research has developed around higher prevalence rates of mental illness in the LGBTQ+ community with little work done on resilience factors, further stigmatizing this population. The present study facilitated a scoping review that charts scientific articles that looked at empathy as a potential resilience factor. The scoping review highlighted areas of concordance and discordance within the literature, reviewed strengths and weaknesses, and provided areas for further investigation. Method: Online databases were used to identify papers published between 2010 and 2022, from which we selected three publications from the United States that conceptualized empathy as a resilience factor in lesbian, gay, and bisexual (LGB) individuals that were 18 or older. PRISMA’s guidelines for systematic reviews were used to create the protocol for this paper. Results: All publications were cross sectional, used qualitative methods, and suggested that empathy was developed through identity integration that was facilitated by a supportive social environment. The articles in this review differed in conceptualizing resilience at various ecological levels. Conclusion: Much work remains in examining empathy as a resilience factor in LGB individuals. Future research must better define empathy and resilience as concepts in addition to potentially operationalizing empathy as an adaptive resilience factor.

Feasibility and acceptability of a peer influencer delivered social media based intervention to promote mental health awareness for young Black and Latinx gay and bisexual men and transgender women

Background Young Black and Latinx Gay and Bisexual Men and Transgender Women (YBLGBMTW) face high levels of mental health related concerns. While online interventions show promise for addressing mental health conditions, few models focus on this population. Methods We used a pre-post design to assess the feasibility and acceptability of a peer delivered mental health awareness intervention for YBLGBMTW. This study was nested as the control arm from a larger study investigating if Peer Influencers (PIs) can improve HIV prevention. PIs helped develop an online outreach campaign to raise awareness of pertinent mental health topics as chosen by the PIs. PIs recruited YBLGBMTW participants from online social networks, posted contents over a six-week period, and participants completed baseline and post-intervention surveys. Results PIs successfully recruited 71 participants of whom 92% completed the six-week post-intervention survey. Participants had on average 6.7 engagements with posted contents and 82% of participants indicated being very satisfied with the intervention. Conclusion Using an intervention informed and delivered by PIs, participants were presented with information to address relevant mental health concerns. We found that such novel means of engaging this sample to raise mental health awareness is feasible, acceptable, and merits further development.

“Coming home to my body”: A qualitative exploration of gender-affirming care-seeking and mental health

Introduction: Among transgender, non-binary, and/or gender expansive (TNG) persons, interest in medical and/or surgical forms of gender affirmation is heterogenous, as is access to those forms of medically necessary health care. Yet, the literature characterizing TNG persons’ interest in medical and/or surgical gender-affirming care, barriers to accessing that care, and how societal narratives and expectations impact TNG individuals’ self-image and mental health, as well as their personal choices regarding gender-affirming care remains sparse. Here we present qualitative research exploring TNG participants’ interest in gender-affirming care and how such interventions impact identity formation. Method: We conducted semi-structured qualitative interviews with a convenience sample of 54 TNG persons in the U.S. and Canada from Facebook pages used to recruit TNG research participants. One-hour interviews were conducted by an openly TNG researcher; participants were compensated. Results: The most frequently sought gender-affirming care was hormone therapy, followed by chest (“top”) surgery, genital (“bottom”) surgery, electrolysis, breast augmentation, hysterectomy, and voice training. Less commonly desired interventions included fertility preservation, facial feminization/masculinization, and vocal surgery. Participants described four main categories of access barriers: financial (e.g., cost of medical/surgical care, inadequate insurance), logistical (e.g., no local providers, gatekeeping policies around body size and mental health, pandemic-related delays), personal fears about sub-optimal outcomes (e.g., complications, loss of sensation, undesired esthetic and/or functional results), and societal discrimination (e.g., familial rejection, job loss, safety concerns). Participants reported primarily seeking this healthcare for social legibility, alleviating dysphoria/pursuing euphoria, and/ or gender exploration. All who sought gender-affirming care reported improved mental health—including depression, anxiety, dissociation, and eating disorders—and social relationships, though many struggled to find TNG-competent mental health providers. Conclusion: This work provides key insights into how gender-affirming care can contribute to improving mental health for TNG communities, which will assist health providers in optimally treating TNG patients.