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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]

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]

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]

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.)