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Purpose: The sociopolitical context in which transgender and gender-diverse (TGD) people live has significant effects on mental health. We examined whether perceptions of context (TGD people's perceptions of how TGD people were viewed) differed across four United States (U.S.) states and associations with mental health and identity pride, the mediational effects of minority stressors, and potential buffering effects of resilience. Methods: TGD individuals in Oregon, Michigan, Nebraska, and Tennessee (n=158; ages 19–70, mean=33.06) completed questionnaires assessing their perceptions of how TGD people were viewed in their local area and in the U.S., as well as scales assessing minority stressors, pride, resilience, and mental health. Data were collected during Fall 2019 to Spring 2020. Results: Oregon participants viewed perceptions in their state the most positively, with no state-level differences in terms of broader U.S. perceptions. Tennessee participants experienced more expectations of rejection; however, there were no differences across the states in other minority stress variables, identity pride, resilience, or mental health. Participants who viewed their area as having more negative views of TGD people reported higher levels of discrimination, expectations of negative events, internalized stigma, and anxiety, as well as less pride. The effects of perceptions of local context on mental health were partially explained by enacted stigma and internalized stigma. Resilience did not buffer the effects of perceptions of the local context on mental health or pride. Conclusion: Context is important to shaping exposure to minority stressors and mental health, potentially through increasing enacted and internalized stigma. [ABSTRACT FROM AUTHOR]

Increasing numbers of youth are identifying as transgender or gender diverse (TGD), meaning their gender identity or expression do not conform to culturally defined expectations for their designated sex at birth. The mental health needs of TGD youth are diverse, and to effectively address these needs requires knowledgeable general pediatric providers, who often are families' first resource for education and support around gender diversity. To help general pediatric providers work more effectively with TGD youth, we describe the role of mental health providers working with TGD youth and how best to support TGD youth's access to gender-affirming mental health and medical interventions. [Pediatr Ann. 2023;52(12):e456–e461.] [ABSTRACT FROM AUTHOR]

Transgender and gender diverse (TGD) individuals often must undergo a psychosocial assessment and receive a letter of support from a mental health care provider to access gender-affirming medical care (GAMC). This study describes TGD individuals' perceptions of barriers and benefits of the assessment process and uses thematic analysis to explore TGD individuals' opinions on how mental health care should or should not be related to gender-affirming medical care. Two hundred and eighteen TGD participants completed an online survey. Participants endorsed benefits and negative impacts associated with the psychosocial assessment and provided qualitative responses to explain their support or opposition to involvement of mental health care and assessment in accessing GAMC. Nearly all participants identified both benefits (e.g. "experienced validation") and barriers (e.g. "experienced an increase in psychological distress") to the psychosocial assessment. Results are considered in the context of the historical marginalization and gatekeeping of TGD people by the medical system. [ABSTRACT FROM AUTHOR]

In institutions of higher education, mandatory reporting policies require certain employees to report students' sexual assault disclosures to university officials, even if the student does not want to report. It is commonly assumed that these policies will benefit survivors, but there is a paucity of research to substantiate this assumption. The current study examined college sexual assault survivors' perceptions of mandatory reporting policies, including three specific policy approaches (Universal, Selective, Student‐Directed). Interviews were conducted with 40 college sexual assault survivors and thematic analysis was used to analyze these data. Results found that the mandatory reporting policy approaches that survivors prefer, which limit the number of mandatory reporters and offer more autonomy and flexibility, do not align with the policy approaches most frequently implemented within institutions of higher education (i.e., Universal). Survivors anticipated more harms resulting from mandatory reporting than benefits (e.g., pushing survivors into disclosures before they are ready, increasing stress and anxiety, discouraging help‐seeking from trusted sources of support on campus). Survivors lacked substantive knowledge of their university's mandatory reporting policy. Findings suggest that policy makers at institutional, state, and federal levels should consider survivors' perspectives when crafting such policies and institutions should increase educational efforts about mandatory reporting. [ABSTRACT FROM AUTHOR]

Experiencing college sexual assault is detrimental for students' mental health. Counseling options exist in every type of college/university, but many survivors do not use these resources and lesbian, gay, bisexual, transgender, and queer (LGBTQ) survivors may have additional unmet mental healthcare needs. Using 40 qualitative interviews, we examined LGBTQ and (cis)straight survivors' actual and anticipated interactions with counseling in a counseling center and women's center. More survivors used the counseling center than the women's center. Students anticipated and experienced positive treatment from both centers, but believed the women's center would have more experience working with survivors. Ciswomen (straight and queer) and survivors with marginalized gender identities (e.g., trans, genderqueer) were most likely to anticipate and experience negative treatment. However, the women's center may be less accessible for cismen and gender minorities, as there were concerns that this resource may only be for cisgender women. [ABSTRACT FROM AUTHOR]

Objective: Sexual assault is pervasive on college campuses, but survivors rarely use formal supports. A frequent reason that survivors do not use supports is the belief that the assault was not "serious enough." Our convergent parallel mixed method study examined the causes and consequences of minimization as a service barrier. We used qualitative interviews to examine the manifestation and impact of minimization in survivors' lives. We used quantitative surveys to examine whether minimization differed across four formal supports (Campus Police, Title IX Office, Counseling Center, Victim Advocate) and survivor characteristics (assault type, assault acknowledgment, race/ethnicity, sexuality), and the associations between minimization and mental health outcomes. Method: We collected survey data from 93 survivors and 40 semi-structured interviews. Results: Our qualitative thematic analysis suggested that minimization does not occur in a vacuum (e.g., minimization of sexual assault by society, peer groups, and resources fosters survivors' own minimization). There were few significant differences in minimization across survivor characteristics or type of formal support, but there was a trend that minimization was somewhat lower among survivors who experienced completed rape (vs. other forms) and labeled the assault (vs. unacknowledged survivors). Minimization occurred even when survivors experienced adverse mental health outcomes. Conclusions: Findings illustrated connections between social and institutional discourse around sexual assault (e.g., what is seen as "severe") and minimization. Survivors' endorsement of minimization as a reason they did not use formal supports does not reflect the consequences of the assault on survivors' wellbeing. Interventions to reduce service barriers should address minimization. [ABSTRACT FROM AUTHOR]

In many universities/colleges, employees are required to report students' sexual assault disclosures to university officials, even if the student does not want to make a report. These "mandatory reporting" policies have been shaped by federal mandates and guidelines, including Title IX. There is a notable lack of research on the implementation and effectiveness of these policies. The current study examined formal service providers' beliefs about university mandatory reporting policies and perceptions of three specific policy approaches (universal mandatory reporting, selective mandatory reporting, and student‐directed mandatory reporting). Focus groups were conducted with 12 service providers and these qualitative data were analyzed using thematic analysis. Participants had strong reservations about mandatory reporting policies, particularly universal approaches that designate all employees as reporters. Although they believed mandatory reporting may have been implemented with good intentions, they discussed how such policies may harm both survivors and employees. Lack of transparency and training in the implementation of mandatory reporting policies can create a climate of fear on campus, where neither survivors nor employees feel comfortable discussing sexual assault. Findings suggest the need for more empirically informed approaches to mandatory reporting of sexual assault in higher education and more comprehensive training for employees and students. [ABSTRACT FROM AUTHOR]

Treatment utilization following child sexual abuse (CSA) is essential in combatting the various negative consequences of CSA. Youth may present to treatment for CSA with symptoms that cut across multiple diagnostic presentations that impact their ability to successfully engage in treatment. In particular, children who have difficulties with attention may have unique treatment needs following CSA. The purpose of this study was to examine how attention problems interplay with comorbid symptoms and how these clinical presentations impact treatment outcomes for youth who have been sexually abused. Participants included 323 families presenting to treatment for CSA. Youth were 7 to 19 years old, 78.5% female, and 76.6% identified as Caucasian/White. Results indicated that 22.9% of the youth presented with clinically elevated attention problems as collected through parent-report of the Child Behavior Checklist (CBCL). Results demonstrated that child survivors of CSA who presented with attention problems self-reported more psychological concerns (e.g., symptoms of depression, anxiety, and post-traumatic stress). At post-treatment, attention problems, interpersonal problems, and thought problems were significantly reduced for youth initially presenting with attention problems. Further implications for treatment following CSA and unique needs for youth with attention problems are discussed. [ABSTRACT FROM AUTHOR]

In recent years, the transgender and gender diverse (TGD) population has gained a stronger voice in the media. Although these voices are being heard, there are limits on the types of TGD representation displayed in media. The current study interviewed 27 TGD individuals. These interviews exposed how participants view the rise of TGD media representation. The main themes that emerged were TGD awareness and TGD identity discovery and role modeling. Clearly, there is a disconnect between transnormativity in the media and transnormativity in reality. [ABSTRACT FROM AUTHOR]

Abstract Psychosocial assessment by a qualified mental health provider, colloquially referred to as “getting a letter,” is recommended for transgender and gender diverse (TGD) individuals seeking gender-affirming medical care (GAMC). This study used an online survey to examine the logistics and overall affective responses of TGD adults (n = 134) to this process. Findings revealed that, to varying degrees, participants were involved in several steps to obtaining the letter, including seeing the letter before it was sent to medical providers. Overall, participants reported generally positive experiences with the process of “getting a letter” based on the affective measures of empowerment, stigma, helpfulness, and harm, with transgender women feeling more empowered than transgender men in the process. Documenting the lived experiences of TGD adults seeking GAMC is a critical step on the path to realizing health equity. [ABSTRACT FROM AUTHOR]

We examined transgender and gender-diverse (TGD) people's reports of their therapy experiences over the course of a year. We explored how participants' therapists integrated discussions about current events, as well as their more general perspectives on helpful and unhelpful experiences. A total of 107 participants provided data on these questions at least once over 12 months of surveys (M age = 33.79; 70.1% White), reflecting on their current therapy experiences. Through thematic analysis of qualitative data, the following themes were constructed regarding discussing sociopolitical events: (a) facilitating coping via bearing witness to clients' internal experiences and implementing other therapeutic interventions; (b) moving beyond the individual by integrating identity, systems, or contexts; (c) feeling disconnected and misunderstood. We grouped participants' helpful experiences into the following themes: (1) availability, connection, and therapeutic approaches facilitate positive experiences; (2) the necessity of knowledge, education, and affirmation of TGD identities; (3) helpful therapy means seeing the world in which clients live. We grouped participants' unhelpful experiences into the following themes: (1) logistical issues can interfere with therapy; (2) lack of depth and disconnection results in subpar therapy; (3) insufficient understandings of TGD identities results in potentially harmful practices. These findings deepen understandings of how to integrate discussions about current events into therapy and provide competent and affirming care to TGD clients. Public Significance Statement: General therapeutic skills are essential to the quality of care transgender clients receive, but so are identity-specific factors. Therapists can improve their work with transgender clients by attending to how sociopolitical contexts and identity shape lived experiences. [ABSTRACT FROM AUTHOR]

Background: Transgender and gender diverse (TGD) individuals face high rates of psychological distress, including depression, anxiety, and suicide risk. Further, TGD individuals living outside of urban areas experience additional disparities compared to their urban counterparts. Minority stress theory states that minority stressors (termed marginalization stressors for this paper), such as experiences of discrimination and internalized transphobia, lead to psychological distress. The current study compared marginalization stressors across rural (population less than 2,500), urban cluster (population between 2,500 and 50,000), and urban (population greater than 50,000) samples and tested the degree to which these stressors account for differences across areas of residence., Methods: Participants were 225 TGD individuals who completed an online survey that included measures of depression, anxiety, suicidal ideation marginalization stress, and protective factors., Results: In the first model, mental health outcomes, marginalization stressors, and protective factors differed between areas. Urban cluster participants reported experiencing higher levels of depression, anxiety, and suicidal ideation and rural participants reported experiencing higher levels of depression suicidal ideation than urban participants. Both rural and urban cluster participants reported more experiences of several marginalization stressors. In the subsequent path model, indirect effects between area and marginalization stress variables were significant, but urban cluster participants still reported higher depression, anxiety, and suicidal ideation symptoms ( p -values < .05)., Discussion: We demonstrate that marginalization stress processes appear to account for some of the differences between TGD individuals living in urban, rural, and urban cluster areas. The differences between areas largely persist, however, after controlling for marginalization stress, especially when comparing urban with urban cluster areas.

Research indicates that sleep problems are fairly common in childhood. However, the relationship between child sexual abuse (CSA) and sleep problems and how sleep issues influence psychological symptoms in children presenting for treatment remain unclear. The purpose of this study was to examine the presence of sleep problems and the association between sleep problems and psychological symptoms in youth presenting to treatment following CSA. Participants included 276 non-offending caregiver-child dyads at pre-treatment and 106 dyads at post-treatment. Youth were 6 to 19 years old and predominately female (82.9%). Caregivers were 23 to 72 years old and predominately female (87.4%). Youth and caregivers identified as predominately European American (76.6% and 86.0%, respectively). Results indicated that caregiver endorsement of a particular youth sleep problem (as measured by the Child Behavior Checklist sleep items) at pre-treatment ranged between 17.9 and 51.4%. Sleep problems were positively associated with psychological symptoms per caregiver- and youth self-report. Interestingly, a substantial proportion of youth reported decreased sleep problems at the end of treatment even though the treatment did not target sleep issues. This study highlights the commonality of sleep problems in children who experienced sexual abuse. Findings suggest that CSA interventions that do not directly address sleep may be missing a component that can contribute to successful recovery. The results provide preliminary evidence that sleep problems and mental health concerns among youth who experienced CSA are associated, indicating a need for further investigation into the association and potential implications for treatment. Other implications for future research and treatment following CSA are discussed., Competing Interests: Conflict of InterestOn behalf of all authors, the corresponding author states that there is no conflict of interest., (© The Author(s), under exclusive licence to Springer Nature Switzerland AG 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)