Transgender Adults Research Articles

Posttraumatic stress disorder mediating associations between child sexual abuse and substance use among transgender adults in the United States.

Transgender people experience an excess burden of child sexual abuse (CSA), mental health concerns, and substance use compared to cisgender populations. Posttraumatic stress disorder (PTSD) has been found to mediate the association between CSA and substance use behaviors in cisgender populations, but this dynamic has not been previously examined among transgender adults. The aim of this study is to test if PTSD may mediate a relationship between CSA and substance use among transgender adults. Data were analyzed from the U.S. Transgender Population Health Survey (2016-2018), a national probability sample of transgender adults (N = 274). CSA was measured using the Adverse Childhood Experiences subsection for sexual abuse. Past-month PTSD was measured using the Primary Care-PTSD Diagnostic and Statistical Manual of Mental Disorders, fourth edition screening tool. Substance use was determined by lifetime binge drinking, polydrug use, and the Drug Use Disorders Identification Test. Baron and Kenny's approach was used to assess PTSD as a mediator between CSA and substance use. Within our sample, nearly half (45%) of the transgender adults experienced CSA. Lifetime binge drinking (40%), polydrug use (20%), and indications of drug-use-related problems (Drug Use Disorders Identification Test x¯ = 4.52) were frequently reported. Transgender adults who have experienced CSA had increased risk of PTSD and substance use, and PTSD was a mediator in all models. Results suggest that adult transgender CSA survivors are at increased risk of drug and alcohol use, and that PTSD may be an important contextual factor for substance use. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Social Determinants of Health Inequities for Older LGBT Adults: A Scoping Review.

Despite the research on a health-disparate population, less is known about the social determinants of health (SDOH) inequities among older lesbian, gay, bisexual, and transgender (LGBT) adults. This scoping review aimed to explore and summarize what is known in the literature regarding the SDOH among older LGBT adults. The Joanna Briggs Institute's (JBI) approach guided this scoping review, which examined 31 articles that included quantitative, qualitative, and mixed-method studies. Data were analyzed by three independent reviewers through a predesigned process of data charting, descriptive summary, and thematic analysis. Older participants were primarily LGBT and LGB. The findings identified four intersecting dimensions of individuals, social, economic, and health care system, contributing to health inequities and poor health outcomes. Given the importance of SDOH for older LGBT adults, stakeholders including health care providers need to better understand the multiple intersecting influences, provide culturally congruent health care, and integrate sources of support into the care of these sexual- and gender-minority older adults.

Association between serum estradiol and cardiovascular health among transgender adults using gender-affirming estrogen therapy.

Gender-affirming estrogen therapy (GAET) is commonly used for feminization in transgender and nonbinary (TNB) individuals, yet the optimal rate of change (ROC) in estradiol levels for cardiovascular health is unclear. We examined the association between serum estradiol levels and cardiovascular-related mortality, adverse events, and risk factors in TNB adults using GAET. Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE, and Web of Science were systematically searched (inception-April 2023) for original articles reporting serum estradiol levels and cardiovascular-related mortality, adverse events, and risk factors in TNB adults using GAET. Data extraction was completed in duplicate following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Stratified random effect meta-analyses using serum estradiol ROC (serum estradiolbaseline - serum estradiolfollow-up/study duration) was used to assess longitudinal studies (low, 0 < ROC ≤ 1 pg/mL/mo; moderate, 1 < ROC ≤ 3 pg/mL/mo; high, ROC ≥ 3 pg/mL/mo). Thirty-five studies (13 cross-sectional, 19 cohort, and 3 trials) were included. Two studies collectively reported 50 cardiovascular-related deaths, and four collectively reported 23 adverse cardiovascular events. Nineteen studies reporting cardiovascular risk factors were meta-analyzed by ROC stratum (low = 5; moderate = 6; high = 8), demonstrating an association between moderate [0.40, 95% confidence interval (CI): 0.22, 0.59 kg/m2, I2 = 28.2%] and high (0.46, 95% CI: 0.15, 0.78 kg/m2; I2 = 0.0%) serum estradiol ROC and increased body mass index. High (-6.67, 95% CI: -10.65, -2.68 mg/dL; I2 = 0.0%) serum estradiol ROC was associated with decreased low-density lipoproteins. Low (-7.05, 95% CI: -10.40, -3.70 mmHg; I2 = 0.0%) and moderate (-3.69, 95% CI: -4.93, -2.45 mmHg; I2 = 0.0%) serum estradiol ROCs were associated with decreases in systolic blood pressure. In TNB adults using GAET, serum estradiol ROC may influence cardiovascular risk factors, which may have implications for clinical cardiovascular outcomes.NEW & NOTEWORTHY In this systematic review and meta-analysis of 35 studies involving 7,745 participants, high rates of serum estradiol change were associated with small increases in body mass index. Moderate to high rates of change were associated with decreases in low-density lipoprotein. Low rates of change were associated with small decreases in systolic blood pressure. Rate of serum estradiol change in adults using gender-affirming estrogen therapy may influence cardiovascular risk factors, though further research is warranted.

Racial/ethnic differences in the association between transgender-related U.S. state policies and self-rated health of transgender women

BackgroundPolicy protections for transgender adults in the United States are consistently associated with positive health outcomes. However, studies over-represent non-Latinx White transgender people and obscure variation in policies’ intended goals. This study examined racial differences in the relationship between transgender-related policies and transgender women’s self-rated health. Guided by Critical Race Theory, we hypothesized that policies conferring access to resources (e.g., healthcare) would be associated with better self-rated health among all participants while policies signifying equality (e.g., nondiscrimination laws) would be associated with better self-rated health only for White participants.MethodsUsing cross-sectional data collected between March 2018-December 2020 from 1566 transgender women, we analyzed 7 state-level ‘access policies,’ 5 ‘equality policies,’ and sum indices of each. Participants represented 29 states, and 54.7% were categorized as people of color. We fit a series of multilevel ordinal regression models predicting self-rated health by each policy. Multivariate models were adjusted for relevant covariates at the individual- and state-level. We then tested moderation by race/ethnicity using interaction terms and generated stratified predicted probability plots.ResultsIn bivariate models, 4 access policies, 2 equality policies, and both indices were associated with better self-rated health, but associations did not persist in adjusted models. Results from the multivariable models including interaction terms indicated that policies concerning private insurance coverage of gender-affirming care, private insurance nondiscrimination, credit nondiscrimination, and both indices were statistically significantly associated with better self-rated health for White participants and worse self-rated health for participants of color.ConclusionsThe policies included in this analysis do not mitigate racism’s effects on access to resources, indicating they may be less impactful for transgender women of color than White transgender women. Future research and policy advocacy efforts promoting transgender women’s health must center racial equity as well as transgender people of color’s priorities.

Revisiting the Link: A qualitative analysis of the diverse experiences of gender dysphoria as a subset of pervasive social dysphoria co-occurring with autism in Japan.

Studies have suggested that autistic people are more likely to experience gender dysphoria, which refers to the gender-related distress emerging from personal factors and gender norms that some transgender people experience. Transgender people are diverse; some experience gender incongruence (i.e. an incompatibility between a person's gender identity and that expected of them based on their birth-assigned gender), whereas others do not. Therefore, the association of autistic transgender people's gender dysphoria with gender incongruence varies, and the literature has overlooked such diversity. Interviews with 15 Japanese autistic transgender adults revealed diverse gender dysphoria experiences independent of gender incongruence, such as resistance to the societal gender norms themselves, physical dysphoria caused by the imposition of gender, sensory disgust related to autistic sensory sensitivities, uncertainty about the gender norms of the social majority, and the autistic burden of living in a gendered society. Moreover, we found that most participants had not only accumulated distress over gender norms (i.e. gender dysphoria) but also over pervasive social norms, termed Pervasive Social Dysphoria. Our findings suggests that future co-occurrence research and practice must affirm these internal perspectives more, such as by providing support for both gender dysphoria and Pervasive Social Dysphoria, as autistic transgender people may experience gender dysphoria as a subset of Pervasive Social Dysphoria.

White American transgender adults' retrospective reports on the social and contextual aspects of their gender identity development.

A growing body of research has attended to the experiences of transgender and gender non-conforming (TGN) youth's gender identity development. However, practical and ethical concerns have impeded our ability to understand the experiences of TGN youth. Thus, the aim of this study was to utilize one-on-one semi-structured interviews to explore White American TGN adults' (N = 15) retrospective accounts of their gender identity development in childhood and adolescence. Findings demonstrate considerable heterogeneity in TGN adults' retrospective accounts of their gender identity development. However, TGN adults consistently highlighted the role of social (e.g. friends, family and teachers) and contextual (e.g. online, offline, educational and geographical) factors in their gender identity journeys. This study provides new insight into the role of social and contextual factors in TGN adults' retrospective accounts of their gender identity development, demonstrating the importance of continuing to examine these factors in gender diversity research.

Analyzing body dissatisfaction and gender dysphoria in the context of minority stress among transgender adolescents

BackgroundGender dysphoria among transgender adolescents has predominantly been examined in relation to body dissatisfaction. While in adult transgender samples, body dissatisfaction is higher than in cisgender controls, this has so far rarely been investigated for adolescents. In the context of a cisnormative society, the impact of influences from the social environment on body dissatisfaction and gender dysphoria has been neglected in research. Therefore, this study aimed to (1) provide a detailed analysis of body dissatisfaction among young transgender people and (2) investigate whether body dissatisfaction and gender dysphoria are associated with experiences of minority stress such as trans hostility and poor peer relations (PPR).MethodsThe paper presents a cross-sectional study among a sample of transgender adolescents, presenting at a specialized outpatient counseling clinic (N = 99; age M = 15.36, SD = 1.85). First, body dissatisfaction (assessed by the Body-Image-Scale; BIS), was explored and compared to data from a population-based control group of cisgender peers (N = 527; age M = 14.43, SD = 0.97). Second, within a clinic-referred transgender subsample (n = 74), associations between body dissatisfaction and gender dysphoria (measured by Utrecht Gender Dysphoria Scale; UGDS), PPR (measured by the Youth-Self-Report; YSR-R), and trans hostile experiences (assessed in clinical interview) were examined by correlations, t-tests and multivariate regression.ResultsTransgender adolescents reported more body dissatisfaction than cisgender peers. The dissatisfaction with sex characteristics, non-hormonal reactive body regions and the total score for body dissatisfaction were positively related with gender dysphoria. The majority had experienced trans hostility in the present and/or past (54.1%) and PPR (63.5%). More body dissatisfaction was correlated with more PPR regarding visible body parts i.e., hair, overall appearance and muscles, whilst PPR and gender dysphoria were not associated. Transgender adolescents who experienced trans hostility showed higher gender dysphoria and PPR, but not more body dissatisfaction. In multiple regression, trans hostility predicted gender dysphoria, whilst age and PPR predicted body dissatisfaction.DiscussionExperiences of minority-stress differentially interact with body dissatisfaction and gender dysphoria among transgender adolescents. Social correlates of body dissatisfaction and gender dysphoria must be considered when working with young transgender people.

Temporal Trends in Mental Health in the United States by Gender Identity, 2014-2021.

Objectives. To examine the temporal trends in the transgender-cisgender mental health disparity in the United States. Methods. We used 2014-2021 US Behavioral Risk Factor Surveillance System Survey data with logistic and ordinary least squares regression to document temporal trends in the transgender-cisgender disparity in self-reports of the number of poor mental health days in the past month and frequent mental distress. Results. In 2014, cisgender individuals reported a mean average of 3.68 (95% confidence interval [CI] = 3.65, 3.70) poor mental health days compared with a mean average of 5.42 (95% CI = 4.68, 6.16) poor mental health days among transgender respondents. The size of this disparity adjusted by differences in observable characteristics increased by 2.75 days (95% CI = 0.58, 4.91) over the sample period. In 2014, 11.4% (95% CI = 11.3%, 11.5%) of cisgender adults reported frequent mental distress compared with 18.9% (95% CI = 15.9%, 22%) of transgender adults. By 2021, 14.6% (95% CI = 15.9%, 22%) of cisgender adults and 32.9% (95% CI = 30.7%, 35.1%) of transgender adults reported frequent mental distress. Conclusions. Policies are needed to address the worsening mental health of transgender and gender-nonconforming people in the United States. (Am J Public Health. 2024;114(5):523-526. https://doi.org/10.2105/AJPH.2024.307603).

From euphoria to wellbeing: Correlates of gender euphoria and its association with mental wellbeing among transgender adults

Purpose There is a growing body of literature focusing on the importance of gender euphoria for transgender (hereafter ‘trans’) people. This article aims to explore factors that are associated with experiencing gender euphoria among trans adults in Australia, as well as identifying any correlation between gender euphoria and mental health within this population. Methods Data from 1359 trans adults was drawn from Private Lives 3, the largest survey of LGBTQ+ people aged 18 and over in Australia. Multivariable logistic regression analyses were conducted to identify the individual factors (sociodemographic characteristics, community connection and access to gender affirming care) associated with having ever experienced gender euphoria and to explore associations between gender euphoria and mental health outcomes, including psychological distress, suicidal ideation and suicide attempt within the past 12 months. Results Most (69.1%) of the sample had experienced gender euphoria in their lifetime. However, the likelihood of ever experiencing gender euphoria differed across several factors, including sexual orientation, gender, age, level of education, and residential location. Most notably, non-binary participants were least likely to have experienced gender euphoria. Importantly, participants who felt that they were a part of the LGBTQ+ community in Australia and those who indicated that they were easily able to access gender affirming care were more likely to have experienced gender euphoria. Participants who were currently experiencing gender euphoria were less likely to report high/very high psychological distress and less likely to have experienced suicidal ideation in the past year. Conclusion Experiencing gender euphoria may have important implications for the mental wellbeing of trans people, however, some are less likely than others to report these experiences. These findings have important implications for shaping trans affirming practices that enable experiences of gender euphoria.

Caring for the Older Transgender Adults: Social, Nursing, and Medical Challenges.

Aging is a challenging process for people with gender nonconformity. Indeed, the older transgender population faces several disparities in accessing and using health care and social support services. Furthermore, the clinical management of gender transition in later life is empirical since clear research evidence is lacking. This paper aimed to present the problems encountered by older transgender adults in their access to social support and health care and to propose insightful solutions to address them both from a social and medical/nursing perspective. Trans elders face profound disparities in health and social care due to factors associated with limited accessibility to health services, social restrictions, administrative failures, and physical vulnerabilities. The medical treatment of older transgender adults also needs a careful approach to achieve satisfying gender affirmation without clinically significant risks. The potential induction of hormone-sensitive malignancies and the provocation of major adverse vascular events are the main concerns. Gender transition in older adults without a prior history of following gender-affirming therapy is challenging due to biological factors related to advanced age. Caring for elderly trans people unfolds at multiple levels. International organizations and governmental bodies should address the underprivileged status of elderly transgender people by creating and implementing inclusive policies. Safe and respectful clinical and residential environments and the formation of clearer medical guidelines could meet the unique needs of older trans adults. Care providers must advocate for their patients and be equipped to provide safe and effective services.

Gender-Affirming Mastectomy: Psychosocial and Surgical Outcomes in Transgender Adults.

Limited literature exists examining the effects of gender-affirming mastectomy on transmasculine and nonbinary patients that is prospective and uses validated survey instruments. The psychosocial functioning of transmasculine and nonbinary patients was compared between patients who underwent gender-affirming mastectomy and those who had not yet undergone surgery. Participants were enrolled in a single-site, combined study of surgical and psychosocial outcomes, including a cross-sectional cohort of preoperative and postoperative patients, as well as separate prospective cohort. Participants completed the BREAST-Q psychosocial and sexual well-being modules, the BODY-Q satisfaction with chest and nipples modules, the Body Image Quality of Life Inventory, the Transgender Congruence Scale, the Patient Health Questionnaire-9, and the Generalized Anxiety Disorder-7 scale before and after surgery. We also examined how patient demographic factors correlated with postoperative surgical and psychosocial outcomes. A total of 111 transmasculine and nonbinary patients 18 to 63 years of age (mean ± SD 26.5 ± 8) underwent mastectomy and were included in the study. All were included in the cross-sectional cohort, and 20 were enrolled in the prospective cohort. More than one-third (34.2%) of patients were nonbinary. After surgery, psychosocial and sexual well-being, satisfaction, body image-related quality of life, and gender congruence were increased (p < 0.001) in both cohorts, and depression (p < 0.009 cross-sectional), and anxiety (p < 0.001 cross-sectional) were decreased. The most common adverse event was hypertrophic scarring, which occurred in 41 (36.9%) participants. In this study of transmasculine and nonbinary adults, gender-affirming mastectomy was followed by substantial improvements in psychosocial functioning.

93. Attitudes Toward and Preferences For Different Routes of Delivery of HIV Pre-Exposure Prophylaxis (Prep) Among Adolescent and Young Adult Transgender Men

93. Attitudes Toward and Preferences For Different Routes of Delivery of HIV Pre-Exposure Prophylaxis (Prep) Among Adolescent and Young Adult Transgender Men

The Impact of Adverse Childhood Experiences for Older Transgender Adults on Chronic Disease and Health Behaviors

The Impact of Adverse Childhood Experiences for Older Transgender Adults on Chronic Disease and Health Behaviors

Protect Trans Kids: A Call to Action

The last several years have seen an increasing number of attacks on marginalized groups in the United States, including people of color, women, and members of the LGBTQ+ community. Most recently, some state legislatures have focused their efforts on preventing transgender youth from accessing gender-affirming medical care. Despite a virtually unanimous consensus on the importance and benefits of gender-affirming care, many conservative politicians have taken aim at vulnerable children, standing in the way of potentially life-saving treatment and accusing their families and doctors of child abuse. Laws preventing transgender youth from receiving gender-affirming care are just one battle in the larger war on individual liberty interests, bodily autonomy, and health care privacy. Already, anti-trans laws written under the pretext of protecting minors are being expanded to detransition transgender adults and criminalize the very existence of transgender people. At the same time, pregnant people around the country are losing their reproductive rights and access to safe and legal abortions. These are both part of a concerted effort to wedge the unjust influence of oppressive state governments into two of the most intimate social and legal relationships: the relationship between a child and their parent, and the relationship between a patient and their doctor. This Comment argues that these attacks must be met by political resistance. Litigation before the current Supreme Court and its conservative majority may do more harm than good, and patients in need of medical care deserve prospective protections to safeguard their right to privacy. Therefore, comprehensive federal legislation, such as the proposed Equality Act, is the best solution to protect transgender youth and the broader right to privacy in health care.

Food insecurity, nutritional status and socioeconomic factors in the transgender population: a cross-sectional study in the Metropolitan Region of Baixada Santista, Brazil, 2023.

To describe the distribution of nutritional status and food insecurity among the adult transgender population in the Baixada Santista region of the state of São Paulo and to identify associated factors. This was a cross-sectional study using data from the research project entitled Mapping the Transgender Population in Baixada Santista of the state of São Paulo, conducted through a structured questionnaire administered between August and December 2023. The outcomes were nutritional status and food and nutrition insecurity (FNI). The association analysis was performed using Fisher's exact test. A total of 237 people took part in the study. High prevalence of FNI was associated with an income of less than 2 minimum wages (p < 0.001), difficulty finding a job (p < 0.001) and lack of family support related to gender (p = 0.001). Difficulty reading/writing (p = 0.025) and proximity to an open-air market (p = 0.033) were negatively or positively associated with adequate nutritional status, respectively. The high prevalence of FNI among the most vulnerable population and the adequate nutritional status associated with proximity to open-air markets indicate the need for policies aimed at reducing inequities and expand access to adequate food.

Factors Associated with Sexual Victimization Among Transgender Emerging Adults.

This cross-sectional study documented between-group differences in risk factors associated with sexual victimization histories in an ethnically and racially diverse sample of transgender emerging adults (N = 248, ageM = 22.61 years). The sample was recruited using the Internet-based CloudResearch platform to answer questionnaires assessing predictors for recent experiences of intimate partner violence (IPV). Participants were categorized into four groups based on cross-classified self-reports of child sexual abuse (CSA) and recent sexual IPV, prior to the use of multivariate analysis of variance to evaluate mean score differences for past-year substance use, minority stressor, and relationship functioning variables. Participants reporting sexual IPV reported higher scores for all substance use variables, while transfeminine participants reported significantly higher scores for alcohol use problems and negative consequences related to substance use. Participants reporting both CSA and sexual IPV also reported the highest scores for everyday discrimination. Participants who experienced sexual IPV also reported the highest scores for internalized sexual stigma. Sexual revictimization among transgender adults occurs in the context of harmful patterns of substance use and several minority stressors. Our findings have implications for healthcare or counseling services for transgender emerging adults who have experienced multiple forms of victimization, substance use problems, and minority stressors, including the importance of trauma-informed and integrated intervention services, and specialized training for service providers.

The prevalence, phenotype and cardiometabolic risk of polycystic ovary syndrome in treatment-naïve transgender people assigned female at birth.

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder among women of reproductive age. We aimed to investigate the prevalence and phenotypic characteristics of PCOS in testosterone treatment-naïve transgender people assigned female at birth (AFAB), as well as to determine whether cardiometabolic risk factors vary based on the presence of PCOS and its components. Evaluation of 112 testosterone treatment-naïve transgender adults AFAB for PCOS and its individual components, including androgen excess, ovulatory dysfunction and polycystic ovarian morphology (PCOM). In our cohort, 79.5% of transgender individuals AFAB had at least one component of PCOS. The prevalence of PCOS was 38.4% (43/112). Phenotype C was the most common phenotype (17.8%), followed by phenotype B (10.7%). Transgender individuals AFAB with at least one component of PCOS had higher blood pressure (BP) measurements and higher fasting plasma glucose levels compared to those with none. Sixty-one subjects (54%) had hyperandrogenism (HA), with 20 (17.9%) having HA without other components of PCOS. When compared to those without HA, transgender individuals AFAB with HA had higher body mass index (BMI), BP, triglyceride and lower HDL-cholesterol levels. PCOS and androgen excess appear to be prevalent among transgender people AFAB. Transgender individuals AFAB with HA or PCOS may exhibit an unfavorable cardiometabolic risk profile compared to those without any PCOS component. Assessment of androgen excess and the specific components of PCOS at baseline could inform long-term management.

Effectiveness and Safety of Different Estradiol Regimens in Transgender Women (TREAT Study): Protocol for a Randomized Controlled Trial.

Current guidelines for gender-affirming hormone therapy (GAHT) for transgender women are mostly based on clinical experience from experts in the field and treatments used on postmenopausal women. While care is currently provided with the best available evidence, there is a critical gap in knowledge about the safest and most effective estradiol routes of administration for GAHT in transgender women; this statement is supported by the World Professional Association for Transgender Health on their Standards of Care for the Health of Transgender and Gender Diverse People, version 8. Furthermore, the reported rates of cardiometabolic adverse events in transgender women highlight the importance of investigating changes in lipoproteins, glucose, and insulin sensitivity, among other markers while receiving GAHT. This study aims to evaluate the degree of testosterone suppression achieved at 1, 6, and 12 months in treatment-naive transgender women when randomized to GAHT with estradiol and spironolactone as antiandrogens. As a secondary aim, this study will assess the treatment effect on metabolic and coagulation factors from baseline to 6 and 12 months after initiating GAHT. This is a prospective pilot, open-label, randomized clinical trial conducted at an adult transgender clinic in a tertiary medical center. The 3 treatment arms include once-daily sublingual 17-β estradiol, twice-daily sublingual 17-β estradiol, and transdermal 17-β estradiol. All participants received spironolactone as an antiandrogen. Transgender women aged 18 to 45 years who are being evaluated for the initiation of GAHT with 17-β estradiol and did not have a history of coagulopathy, cigarette smoking, liver disease, dyslipidemia requiring treatment, or use of gonadotropin-releasing hormone agonist were eligible to enroll. The main outcome is the total testosterone suppression at 1 and 6 months after the initiation of GAHT, and the secondary outcome is to assess treatment effect in a lipid panel; homeostatic model assessment for insulin resistance; coagulation factors II, IX, and XI; Von Willebrand factor; activated protein C resistance; protein C; and protein S at baseline, 6 months, and 12 months after therapy is initiated. This study was funded in March 2022, and enrollment concluded in August 2022. It was concluded in July 2023, and currently, the results are being analyzed for publication. The Transgender Estradiol Affirming Therapy (TREAT) study offers a rigorous and reproducible approach to answer important questions regarding GAHT in transgender women, specifically, the most effective 17-β estradiol regimen to suppress testosterone levels to 50 ng/dL, as currently recommended. ClinicalTrials.gov NCT05010707; https://clinicaltrials.gov/study/NCT05010707. DERR1-10.2196/53092.

THE UNIQUE CHARACTERISTICS OF “FAMILIES OF CHOICE” AND BIOLOGICAL FAMILIES OF LGBT ADULTS

Abstract This study joins a growing body of research on the unique families of aging individuals in sexual minorities. We explore the “families of choice” (who are close enough to be considered as family) and biological families of LGBT adults and their associations with mental health. Data for this study was collected via an online survey with self-identified lesbian, gay, bi-sexual and transgender (LGBT) adults aged 50+ in Israel (n=483). The participants were asked about characteristics of the relationship with their families of choice and biological families and about experiencing depressive symptoms. Descriptive results indicated that most participants had a family of choice, numbering five people on average. These families of choice were mostly composed of partners and friends, but also of the family members of one’s partner, and of ex-partners and colleagues. They reported having about four close biological family members, mostly children, parents, siblings, and nieces. Several differences emerged when comparing the two types of families: The relationships with biological families were more stable and their biological family members were contacted more often. On the other hand, families of choice were more likely to accept their sexual orientation and the relationship with them had fewer negative aspects. Regression analyses showed that individuals had more depressive symptoms if the relationship with their families of choice was less stable and if there were more negative relationships with both types of families. These findings shed light on the unique sources of support among LGBT adults and their associations with mental health.

PREMATURE MORTALITY IN LGBT VERSUS NON-LGBT VETERANS: THE ROLE OF HEALTH RISK FACTORS AND SOCIAL DETERMINANTS OF HEALTH

Abstract Lesbian, Gay, Bisexual, and Transgender (LGBT) adults experience substantially higher rates of mental health conditions and other health risk factors than non-LGBT adults, but there is limited reseach on how these conditions increase risk for premature mortality. The current study examined this issue among middle-aged and older Veterans ages 40-99 who used Veterans Administration healthcare services from 01OCT2009 to 30SEP2019 (N = 845,122). Earlier age of death by suicide, overdose, or all-causes was hypothesized for LGBT (n = 675,639 ) vs. non-LGBT (n = 675,639) Veterans, and health factors and social determinants of health were predicted as key risk factors of earlier age of mortality. As hypothesized, LGBT Veterans had significantly higher rates of death by suicide, overdose, and all-causes among younger age groups than non-LGBT Veterans. Adjusted risk ratios indicate a significant contribution of mental health conditions (e.g., anxiety/depression), medical comorbidity, pain, smoking history, and military sexual trauma accounting for differential mortality rates by age in LGBT and non-LGBT participants. Social determinants of health, such racial/ethnic minority status and housing instability, were also significant contributors. Findings suggest the need for Whole Health interventions for LGBT Veterans to manage multiple health risk factors contributing to increased mortality risk. Suicide prevention is critical for the many middle-aged and older adults who die from suicide each year, and for LGBT Veterans especially, beginning targeted suicide prevention efforts earlier in middle age may prevent suicide deaths in later life. Lastly, findings implicate subgroups of Veterans who may particularly benefit from outreach and services.