Family Rejection Research Articles

Working With Suicidal and Homeless LGBTQ+ Youth in the Context of Family Rejection.

LGBTQ+ individuals are at increased risk of suicide. Homelessness further increases the risk, as does family-of-origin rejection. A model that combines suicidal risk factors and minority stress theory is useful in clinical practice. An openness to “hearing” the lived experiences of LGBTQ+ individuals is essential to treatment. An LGBTQ+ affirming therapeutic approach is recommended. It is also frequently helpful to rebuild family relationships and support for the LGBTQ+ individual, particularly with younger youth. Principles of practice are described and illustrated.

“That Name Is Dead to Me”: Reforming Name Change Laws to Protect Transgender and Nonbinary Youth

Content warning: this Article discusses suicidality. For transgender and some nonbinary youth, living under a chosen name is a first step toward becoming their authentic selves. For these youth, a name change is powerful; it allows them to choose a name that matches their gender identity. They consider their birth name to be a distressing “dead” name—one that they cannot relate to and need to bury. Using one’s chosen name decreases suicidality among transgender youth who face many challenges, including family rejection and other severe mental health stressors. Transgender and nonbinary youth can only require others to use their chosen names after obtaining a legal name change. But only two states in the nation currently allow minors to change their name legally without their parents’ consent and active assistance. Parental consent requirements are problematic because youth whose parents do not support their gender identity must wait, exposed to harm and distress. Thus, we deny them this first step towards correcting their gender and the accompanying mental health relief—delaying youth who have otherwise transitioned years before adulthood. In the meantime, with identification cards that do not match their gender identity, transgender and nonbinary youth are at risk of discrimination and other harm. They may drop out of school and avoid seeking employment for fear of bias and rejection. Our laws must change to protect our transgender and nonbinary youth by allowing them to change their legal name independently. Their mental health and well-being depend on these crucial reforms.

Socio-Health Context and Practice of Pelvic Muscle Rehabilitation in Morocco

The high rate of maternal mortality (112 per 100000 new births)[29], as well as the maternal health problems observed at the level of health facilities, place maternal health at the center of the concerns of ministerial decision-makers in Morocco.. At the same time, the issue of maternal morbidity remains less addressed and documented in comparison to mortality, despite its frequency and its significant consequences of social and family rejection of women. These observations have led us to wonder about the management of morbidity during childbirth and postpartum, in particular the practice of pelvic muscle rehabilitation PMR, which is still absent in public health establishments in Morocco. What are the reasons for this deficit in the prescription of perineal rehabilitation? This question of understanding guided us to study the socio-cultural context, representations around the epistemology of the body within Moroccan Arab-Muslim society, to link them to this re-educational gap. The semi-structured interview tool with diversified populations highlights an organizational and strategic dysfunction despite the efforts made by the Ministry of Health, linked to the lack of awareness and training of health professionals, as well as to the inadequacy of pre, per and especially postnatal care. At the same time, the responses of patients with pelvic floor dysfunction PFD refer to the socio-marital repercussions as well as impairments of the body schema, representations of self and self-esteem, altering their quality of life.

Psychiatrists Discuss Impact of Racism Across Generations

Psychiatrists Discuss Impact of Racism Across Generations

Transgender women of color in the U.S. South: A qualitative study of social determinants of health and healthcare perspectives

Background: Research has shown that transgender and nonbinary people experience health disparities. However, few studies have explored, in-depth, the health-related experiences, perceptions, needs, and priorities of transgender women of color living in the U.S. South, a region that poses unique challenges to achieving health for transgender people. Aims: This study explored the social determinants of health, healthcare experiences, and health-related priorities of transgender women of color living in the U.S. South. Methods: Using a community-based participatory research approach, we conducted iterative in-depth interviews with 15 African American/Black and Latinx transgender women in North Carolina in May-July 2019 for a total of 30 interviews. We analyzed interview data using constant comparison, an approach to grounded theory. Results: Participants’ mean age was 34 (range 19–56) years. Twenty themes emerged that were categorized into three domains: (1) social determinants of health (family rejection; bullying, discrimination, and violence; isolation; policy barriers; mistrust in systems; employment obstacles; sex work; high cost of care; transportation barriers; church antagonism; and substance misuse), (2) healthcare experiences (emotional burden of healthcare interactions; name and gender misidentification; staff discomfort and insensitivity; sexual risk assumptions; and use of nonmedical or predatory providers), and (3) health-related priorities (understanding healthcare; respect at all levels of healthcare; inclusive gender-affirming care; and comprehensive resources). Discussion: Transgender women of color living in the U.S. South face profound health barriers compounded throughout the life course and have unmet healthcare needs. Participants faced multilayered minority stressors: racial discrimination from society at large and within the LGTBQ community; gender identity discrimination within their regional context and racial/ethnic communities; and exclusion from existing health equity movements for transgender women of color, which often are found in and focus on larger urban communities. Health interventions mindful of this intersection are needed, including antidiscrimination policies and increasing gender-affirming healthcare access.

A influência dos aspectos biopsicossociais nas elevadas taxas de suicídio da população transgênero

Esse artigo buscou analisar como os aspectos biopsicossociais específicos da população transgênero, travesti e não-binária influenciam nas elevadas taxas de suicídio desse grupo. Foram analisados como fatores de risco para o comportamento suicida nessa população o desrespeito ao nome social, dificuldade de acesso à terapia hormonal e cirurgias de adequação de gênero, rejeição familiar, disforia de gênero, trans/travestifobia, além do racismo dentro da mesma população. Ademais, observa-se a marginalização social dessa comunidade no acesso à atenção à saúde, diante de situações de discriminação, hostilidade e diagnóstico patologizante no processo transexualizador. Os resultados apontam aspectos biopsicossociais específicos da população transgênero, travesti e não-binária como fatores de risco consolidados para o suicídio, promovendo uma reflexão quanto à necessidade da elaboração de medidas de proteção a esses grupos, assim como a introdução desse tema nos diversos níveis da educação, além do fomento de pesquisas sobre o assunto, capacitação das equipes de saúde quanto à humanização e respeito às diferentes identidades de gênero.

Emerging Ideas. Familial Influences, Shame, Guilt, and Depression Among Sexual Minority Adolescents

ObjectiveThis study examined the mediating effects of self‐conscious emotions (i.e., shame and guilt) on the relationships between familial influences and depressive symptoms among sexual minority adolescents (SMAs).BackgroundFamilial influences, such as family rejection or parental affirmation, are associated with depression. However, little research has been conducted to identify specific mechanisms that can explain the associations between familial influences and depressive symptoms among SMAs.MethodParticipants were 94 adolescents, aged 12 to 18 years, who were recruited through the community and completed self‐report measures.ResultsFamily rejection was associated with more feelings of shame and guilt, whereas parent affirmation was associated with less shame and guilt. Shame and guilt were associated with more depressive symptoms. Indirect effects of family rejection on depression were significant through shame but not guilt. Indirect effects of parental affirmation on depression were significant through shame and guilt.ConclusionThe results help identify mechanisms through which familial influences may be associated with depressive symptoms. Shame and guilt are important modifiable psychological factors that can be targets of intervention for SMAs.ImplicationsFuture research and interventions must incorporate familial influences as well as self‐conscious emotions to improve the mental health of SMAs.

Experiences of minority stress among gay, bisexual, and other men who have sex with men (GBMSM) in Nigeria, Africa: The intersection of mental health, substance use, and HIV sexual risk behavior

ABSTRACT Nigerian gay, bisexual, and other men who have sex with men (GBMSM) experience social marginalisation, discrimination and violence due to their sexual orientation and same-sex attraction, which may affect mental health, substance use, and HIV sexual risk behavior. The goal of the current study was to conduct formative qualitative research to gain better understanding of these issues among GBMSM in Lagos, Nigeria. Face-to-face, semi-structured, in-depth interviews were conducted with 30 GBMSM in Lagos, Nigeria. Data were analysed using a deductive content analysis approach. We found that Nigerian GBMSM experienced both general life stressors as well as proximal and distal sexual minority identity stressors, including rejection by family members, harassment, and physical violence perpetrated by the general public and police officers. Participants described dealing with mental health problems within the context of family rejection, experienced stigma due to sexual orientation, and feelings of social isolation. Substance use was described as occurring within the context of social settings. Lastly, some participants mentioned that they engaged in risky sexual behaviour while under the influence of alcohol and drugs. These findings call for comprehensive and innovative, GBMSM-affirming behavioural healthcare, substance cessation services, and innovative HIV prevention interventions specifically designed and tailored for Nigerian GBMSM.

Greater Minority Stress is Associated with Lower Intentions to Disclose Suicidal Thoughts among LGBTQ + Youth

Objective The current study examined suicide-related disclosure intentions in LGBTQ + youth, and the associations between reporting of lifetime experiences of minority stress and intentions to disclose suicidal thoughts. Method A sample of 592 LGBTQ + youth ages 12–24 (22.3% cisgender men, 33.1% cisgender women, 44.6% gender diverse, 75.3% white) who contacted an LGBTQ-specific crisis service, completed a survey. Results Youth reported highest intentions to disclose future suicidal ideation to LGBTQ-specific crisis services, a mental health professional, and someone they know who also identifies as LGBTQ. They reported lowest suicide-related disclosure intentions to family, spiritual counselors, and emergency room personnel. Greater lifetime minority stress was significantly associated with lower suicide-related disclosure intentions. When specific domains of minority stress were examined separately, five domains were significantly associated with lower suicide-related disclosure intentions: identity management, family rejection, homonegative communication, negative expectancies, and internalized homonegativity. However, only internalized homonegativity remained significant when they were examined simultaneously. In addition, greater lifetime minority stress was significantly associated with lower suicide-related disclosure intentions to some groups (e.g., family, friends), but not others (e.g., others who have thought about or attempted suicide, others who identify as LGBT). Conclusions Minority stress may play an important role in LGBTQ + youth’s suicide-related disclosure intentions. As such, reducing minority stress and its effects may be an important target to promote disclosure of suicidal thoughts and access to treatment among LGBTQ + youth. HIGHLIGHTS Minority stress was associated with lower suicide-related disclosure intentions. Internalized homonegativity was uniquely associated with disclosure intentions. Reducing minority stress may promote disclosure of suicidal thoughts.

Comparing the Partnering, Minority Stress, and Depression for Bisexual, Lesbian, and Gay Adults from Religious Upbringings

ABSTRACT Minority stress impacts the mental health of bi+ individuals (e.g., bisexual, pansexual, queer), similar to gay and lesbian individuals. Bi+ individuals may have difficulty accessing social supports for mitigating minority stress. A religious upbringing may complicate this process. This study sought to compare a survey sample of bi+ individuals (n = 153) and their gay/lesbian (n = 231) peers from religious families on minority stress factors, depression, and partnering. Results highlighted differences between gay/lesbian and bi+ individuals in partnering and LGB community connection with bi+ group reporting more minority stressors. Bi+ individuals in same-gender partnerships reported lower parent rejection and being more out than those who were single or in different-gender partnerships. Family religiosity was associated with family rejection; however, it did not directly predict minority stress factors or depression for bi+ individuals. Implications for future research are discussed in light of the distinctions emerging between gay/lesbian and bi+ adults.

Suicidal behavior risks during adolescent pregnancy in a low-resource setting: A qualitative study.

Suicide is one of the most common causes of death among female adolescents. A greater risk is seen among adolescent mothers who become pregnant outside marriage and consider suicide as the solution to unresolved problems. We aimed to investigate the factors associated with suicidal behavior among adolescent pregnant mothers in Kenya. A total of 27 Focus Group Discussions (FGDs) and 8 Key Informant Interviews (KIIs) were conducted in a rural setting (Makueni County) in Kenya. The study participants consisted of formal health care workers and informal health care providers (traditional birth attendants and community health workers), adolescent and adult pregnant and post-natal (up to six weeks post-delivery) women including first-time adolescent mothers, and caregivers (husbands and/or mothers-in-law of pregnant women) and local key opinion leaders. The qualitative data was analyzed using Qualitative Solution for Research (QSR) NVivo version 10. Five themes associated with suicidal behavior risk among adolescent mothers emerged from this study. These included: (i) poverty, (ii) intimate partner violence (IPV), (iii) family rejection, (iv) social isolation and stigma from the community, and (v) chronic physical illnesses. Low economic status was associated with hopelessness and suicidal ideation. IPV was related to drug abuse (especially alcohol) by the male partner, predisposing the adolescent mothers to suicidal ideation. Rejection by parents and isolation by peers at school; and diagnosis of a chronic illness such as HIV/AIDS were other contributing factors to suicidal behavior in adolescent mothers. Improved social relations, economic and health circumstances of adolescent mothers can lead to reduction of suicidal behaviour. Therefore, concerted efforts by stakeholders including family members, community leaders, health care workers and policy makers should explore ways of addressing IPV, economic empowerment and access to youth friendly health care centers for chronic physical illnesses. Prevention strategies should include monitoring for suicidal behavior risks during pregnancy in both community and health care settings. Additionally, utilizing lay workers in conducting dialogue discussions and early screening could address some of the risk factors and reduce pregnancy- related suicide mortality in LMICs.

Freedom and struggling openly in psychotherapy: A qualitative inquiry with LGBQ young adults from religious families.

Lesbian, gay, bisexual, and queer (LGBQ) young people from religious families are at increased risk of family rejection, poor mental health outcomes, and are overrepresented in mental health services. This article describes a two-part qualitative study aimed at exploring the experiences of LGBQ young adults from religious families in psychotherapy, identifying positive and negative psychotherapy experiences, and understanding the influence of family and religion on the psychotherapy experience. Data were collected through a web-based survey (n=77) and interviews (n=7) with LGBQ young adults (ages 18-25) from religious families. The study followed an interpretative phenomenological approach. Integrated results found often invisible, relational therapy processes, and religious discourses as significant to LGBQ young people who seek psychotherapy. Implications for future research, effective systemic family therapy practices with LGBQ young people from religious families, and a critique on ethical and legal limits of confidentiality with policy implications are outlined.

Context, Types, and Consequences of Violence Across the Life Course: A Qualitative Study of the Lived Experiences of Transgender Women Living With HIV

Violence is a known driver of HIV vulnerability among transgender (trans) women, who are disproportionately impacted by HIV globally. Violence is also a barrier to accessing HIV prevention, treatment, and support. Yet, little is known about the everyday experiences of violence faced by trans women living with HIV, who live at the intersection of a marginalized gender identity and physical health condition. To address this gap, this study draws on semi-structured, individual interviews conducted 2017-2018 with a purposive sample (selected based on diverse identities) of trans women living with HIV (n = 11) participating in a large, community-based cohort study in three Canadian provinces. Framework analysis was used to identify key themes, patterns within themes between participants, and patterns across themes among participants. Findings showed that trans women living with HIV experience specific contexts of violence shaped at the intersection of stigma based on gender identity, gender expression, and HIV status, among other identities/experiences. Violence experienced in childhood (e.g., familial rejection, bullying) increased trans women's likelihood of being exposed to a violent social context in young adulthood (e.g., state violence perpetuated by the police, interpersonal violence perpetuated by sexual partners, and community violence perpetuated by society-at-large/the general public), which increased trans women's HIV vulnerability; once living with HIV trans women were subjected to discursive violence from healthcare providers. These multiple forms of violence have serious consequences for trans women living with HIV's ongoing social, mental, and physical well-being. The findings suggest that interventions are urgently needed to reduce violence against trans women in childhood and young adulthood, in addition to reducing violence against trans women living with HIV perpetuated by healthcare providers in adulthood, to both proactively and responsively promote their safety, health, and well-being.

Drug Addiction and Alcoholism Among Sexually Abused Women in Pakistan

The study aims to identify factors which contribute to the prevalence of alcoholism and drug addiction among sexually abused women in an ultra-conservative society. A qualitative research design is used in conjunction with interviews from women and physicians, categories which included both psychiatrists and sexologists, across six districts of Khyber Pakhtunkhwa. The phenomena of drug addiction and alcoholism were more pronounced in victims working for the commercial sex sector. The findings suggest Post-Traumatic Stress Disorders (PTSD) as a driving factor of alcoholism and drug abuse, which in turn cascades into secondary and tertiary levels of trauma. Sexual victimization and re-victimization, familial rejection, stigmatisation and social degradation were contributing factors to relentless stress. Drugs in vogue among victims were Valium-two (Diazepam) and Lexotanil that contained Bromazepam. Hashish and alcohol were consumed sparingly by victims, while the use of cocaine and heroin was absent due to severe masculine perceptions and addiction. The study contributes to a better understanding of a socially-excluded, economically-disadvantaged and stigmatised group by taking a pro-feminist stance to advocate for the rights of victims.

EMOTIONAL DETACHMENT – RESILIENT SPACE: CHILD IN FAMILY DIFFICULTY

This article aims, first of all, to analyze emotional detachment for a child victim of domestic violence. Then, it presents this emotional detachment as a gateway to a that allows the development of internal resources known as mature resilience. The is to be considered in our approach under a systemic approach. This approach focuses our gaze on the resilient space system as well as all the elements that interact for the same purpose. Emotional detachment and the creation of a are two complementary and important steps in building a path. We postulate that in order to build resilience, a child who has suffered trauma in a family environment needs to first make an emotional detachment from insecure family attachments and then create a place of revival for his or her neo-development. In view of the strength and delicacy of the ties that unite family members, emotional detachment (which is not a family rejection) and the creation of a are therefore a chain that conditions the child who has suffered emotional clashes. They allow the child to move on while maintaining the family bond. Article visualizations:

We Are Family: Chosen and Created Families as a Protective Factor Against Racialized Trauma and Anti-LGBTQ Oppression Among African American Sexual and Gender Minority Youth

Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ) youth are at an increased risk for social isolation and family rejection. This is particularly true in African American communities where there is an increased lack of social support and acceptance for LGBTQ youth from their biological families, communities, churches, schools and healthcare systems. To counteract the social isolation and develop a sense of community, African American LGBTQ youth often form chosen or created families, with peers and older LGBTQ persons that mimic nuclear family structures, to cope with rejection at home and in their communities. These resilient social networks are created with varying sets of rules and relationship dynamics that may directly impact the social determinants of health among this community. The purpose of this manuscript is to systematically review the literature on African American LGBTQ youth and created families and identify patterns about the unique experiences of African LGBTQ youth who participate in these systems.

Family Rejection and Cigarette Smoking Among Sexual and Gender Minority Adolescents in the USA.

Sexual and gender minority (SGM) adolescents are more likely than their heterosexual and cisgender peers to smoke cigarettes. Family rejection has been associated with adverse health outcomes; however, few studies have examined whether SGM-specific family rejection is associated with cigarette smoking among SGM adolescents. A non-probability sample of 11,005 SGM adolescents (M = 15.58, SD = 1.27) completed an online cross-sectional survey. Bivariate and multivariable analyses were conducted to examine associations between SGM-specific family rejection, sociodemographic variables, and smoking. Approximately 7% of the sample currently smoked cigarettes. Pansexual, asexual, trans boys, and non-binary assigned female at birth adolescents had the highest SGM family rejection scores. In multivariable regression analyses, SGM-specific family rejection was independently associated with smoking after adjusting for covariates (AOR = 1.15, 95% CI 1.04, 1.28). Family support (AOR = 0.80, 95% CI 0.73, 0.88) and experiencing violence (AOR = 1.64, 95% CI 1.49, 1.82) were also associated with smoking in multivariable models. Adolescents who identified as bisexual versus gay/lesbian (AOR = 1.50, 95% CI 1.21, 1.85) and trans boys versus cisgender girls (AOR = 2.05, 95% CI 1.13, 3.71) had an increased odds of smoking. Those who disclosed their sexual orientation identity to most (AOR = 1.95, 95% CI 1.45, 2.63) and all (AOR = 1.60, 95% CI 1.21, 2.11) of their family/parents had increased odds of smoking. Our findings underscore the importance of attending to the role of SGM-specific family rejection and distinctions with SGM adolescents in tobacco prevention and smoking cessation efforts.

The Confluence of Housing Instability and Psychosocial, Mental, and Physical Health in Sexual Minority Young Adults: The P18 Cohort Study.

Sexual and gender minority (SGM) youth experience housing instability, including homelessness, at higher rates than heterosexuals. Few studies have examined differences within SGM populations and intersections of housing and health. Data were drawn from a study of SGM young adults who were assigned male at birth. Nearly one-quarter of the sample reported homelessness, unstable housing, or both in the six months prior to assessment. Housing instability was higher among those of lower income and educational attainment. Additionally, those who experienced any housing instability reported higher levels of depression, poorer self-rated health, and greater gay-related stigma; in multivariable models, only self-rated health was related to housing status. Stigma and discrimination may lead to poorer mental health; housing instability and homelessness may be a manifestation of stigma perpetuated by social conditions and mental health burdens directed by familial rejection. Findings indicate the importance of a biopsychosocial perspective in addressing housing instability in SGM youth.

Profile of Women with Mental Illness Admitted in Shelter Care Homes; A Co-relational Description of Changing Sociocultural Scenario in India.

Background:The prevalent explanations of gender and mental illness in the Indian social structure often highlighted in terms of traditions and gender-colored norms which is confirmed with the patriarchal framework. The combination of women and diagnosis of mental illness disturbs the prescribed gender expectations which accelerate the family abandonment, and many women lead their life in shelter care homes after psychiatric hospitalization. The aim of the study is to assess the sociodemographic characteristics of the residents admitted in shelter care homes and understand the co-relational aspects of changing sociocultural scenario.Subjects and Methods:Recruited 50 women residents living in 14 centers both the governmental and nongovernmental shelter care homes in Bengaluru, Karnataka. Utilized sociodemographic datasheet to assess the sociodemographic variables and retrospective file review to elicit commonalities among the sample.Results:The current study reveals that majority (74%) belongs to the nuclear family, lived in a rented house before institutionalization (46%). The reason for stay in shelter care home reported to be family abandonment and rejection (72%) and majority of the residents experiencing chronic homelessness (92%) are unmarried/separated (82%) and majority revealed none of the family members ever visited them in shelter care homes (66%).Conclusion:It is imperative to understand the connection between sociodemographic details of the women admitted in shelter care homes and the rapid changes occurring in the sociocultural structure for comprehensive understanding of mental illness-homelessness-institutionalization nexus.

Identity, stigma, and HIV risk among transgender women: a qualitative study in Jiangsu Province, China

BackgroundTransgender women have multiple disparities globally, including social rejection and stigma, HIV infection and untreated mental health problems. However, few data on transgender women are available in China. Therefore, this study aimed to explore transgender women’s experiences on gender identity, disclosure, discrimination, transgender-specific medical care, and perceptions of HIV and sexually transmitted infections (STI) risk in China.MethodsA qualitative study was conducted in Nanjing and Suzhou city, China in 2018. Key informant interviews (n = 14) and focus group discussions (n = 2) with diverse transgender women were implemented. Text was transcribed and translated, and Dedoose™ software was used for coding, analysis and interpretation by the research team.ResultsChinese transgender women share experiences with transgender women worldwide, including a long and challenging identity search, stigma and discrimination, poor access to trans-specific services and unmet needs for mental health care. Features unique to them include terms used for self-identification, culturally-shaped expectations for reproduction, and ideals of placing the familial and societal welfare over personal fulfillment. Social networks of this population appear sparse, scattered, and underground. Familial rejection was experienced by nearly all respondents. Perceptions of HIV and STI risk and history of HIV testing were notably low.ConclusionsTransgender women in China face high social rejection and discrimination along with unmet need for various types of healthcare. Scaling up transgender-specific services including gender-affirming medical care, mental health care and HIV/STI prevention are warranted to address the social, medical and mental health of transgender women in China.