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BMC Public Health Dec 2023Evidence from many parts of the world shows that sexual and gender minority (SGM) people have poorer health than their cisgender heterosexual counterparts. Minority... (Review)
Review
Health disparities in one of the world's most progressive countries: a scoping review of mental health and substance use among sexual and gender minority people in the Netherlands.
BACKGROUND
Evidence from many parts of the world shows that sexual and gender minority (SGM) people have poorer health than their cisgender heterosexual counterparts. Minority stressors, particularly stigma and discrimination, have been identified as major contributors to sexual orientation- and gender identity-related health disparities, particularly negative mental health and behavioral health outcomes. To better understand factors that contribute to these disparities, we conducted a scoping review of SGM mental health and substance use research in the Netherlands-a country with a long-standing reputation as a pioneer in SGM equality.
METHODS
Using Joanna Briggs Institute guidelines and the PRISMA-ScR protocol, we searched seven databases to identify studies published between 2010 and 2022 that focused on substance use and/or mental health of SGM youth and adults in the Netherlands.
RESULTS
Although there was some evidence that SGM people in the Netherlands report fewer substance use and mental health concerns than those in less progressive countries, with very few exceptions studies found poorer outcomes among SGM participants than cisgender, heterosexual participants. However, this observation must be considered cautiously given major gaps in the literature. For example, only one study focused exclusively on adult sexual minority women, two focused on older SGM adults, and very little attention was given to nonbinary individuals. Most studies used non-probability samples that were quite homogenous. Many studies, especially those with youth, assessed sexual orientation based on sexual attraction; some studies of adults operationalized SGM status as having a same-sex partner. Importantly, we found no studies that directly assessed associations between structural-level stigma and health outcomes. Studies were mostly focused at the individual level and on health problems; very little attention was given to strengths or resilience.
CONCLUSIONS
Findings of persistent health disparities-despite the relatively long history of SGM supportive policies in the Netherlands-highlight the need for more research and greater attention to population groups that have been underrepresented. Such research would not only provide guidance on strategies to improve the health of SGM people in the Netherlands, but also in other countries that are seeking to reduce health inequities. Addressing SGM health disparities in the Netherlands and elsewhere is complex and requires a multifaceted approach that addresses individual, interpersonal and structural factors.
Topics: Adult; Adolescent; Humans; Female; Male; Gender Identity; Mental Health; Netherlands; Sexual Behavior; Sexual and Gender Minorities; Substance-Related Disorders
PubMed: 38110908
DOI: 10.1186/s12889-023-17466-x -
BMC Women's Health Dec 2023Although there are calls for women's empowerment and gender equity globally, there are still large disparities regarding women's autonomy in healthcare decision making....
OBJECTIVES
Although there are calls for women's empowerment and gender equity globally, there are still large disparities regarding women's autonomy in healthcare decision making. The autonomy of women is believed to be crucial in improving their health-related outcomes. This review discusses factors that influence autonomy among women in healthcare decision making.
DESIGN
Systematic review.
DATA SOURCES
PubMed, Web of Science and Scopus were searched from 2017-2022.
ELIGIBILITY CRITERIA
The inclusion criteria include original articles, case studies and reports that has been written in the English Language, while manuscripts with no full article, reviews, newspaper reports, grey literatures, and articles that did not answer the review objectives were excluded.
DATA EXTRACTION AND SYNTHESIS
We carried out data extraction using a standardized data extraction form, that has been organized using Microsoft Excel. A narrative synthesis was carried out to combine the findings of all included articles.
RESULTS
A total of 70 records were identified and 18 were reviewed, yielding eight articles to be included in the accepted list of studies. All studies were conducted in developing countries and most of the studies were cross sectional. Factors that were associated with women's autonomy in healthcare decision making were age, women's education and occupation, husbands'/partners' education and occupation, residential location or region of residence, household wealth index as well as culture and religion.
CONCLUSIONS
Identification of these factors may help stakeholders in improving women's autonomy in healthcare decision making. Policymakers play a crucial role in healthcare decision making by enacting laws and policies that protect women's rights, promoting gender-sensitive healthcare services, ensuring access to comprehensive information, promoting health education, and supporting vulnerable populations. These efforts ensure women's autonomy including able to access to unbiased and effective healthcare services.
Topics: Female; Humans; Women's Rights; Socioeconomic Factors; Gender Identity; Decision Making; Delivery of Health Care; Personal Autonomy
PubMed: 38042837
DOI: 10.1186/s12905-023-02792-4 -
Clinical Psychology Review Feb 2024The current study aimed at systematically reviewing evidence on the relationships between gender minority stress and mental health outcomes among European transgender... (Review)
Review
The current study aimed at systematically reviewing evidence on the relationships between gender minority stress and mental health outcomes among European transgender and gender diverse (TGD) individuals. A systematic search was conducted in PsycINFO, PubMED, Scopus, and Google Scholar. It was based on Boolean operators to combine terms related to minority stress, TGD identities, and mental health. Thirty studies were identified as eligible. The results confirmed that gender minority stress factors are significantly related with mental health problems among European TGD individuals. Distal stressors were identified as strongly associated with poorer mental health, with gender-related discrimination emerging as the most documented risk factor. The significant role of proximal stressors was also highlighted, with some mediation analyses detecting an indirect effect on mental health. However, identity concealment appeared unrelated to mental health outcomes. Resilience-promoting factors buffering the impact of stressors were also identified, including self-esteem, pride, transitioning, and social support. Conversely, data on community connectedness as a source of resilience were inconclusive. The studies reviewed have several limitations, including lack of longitudinal designs, sampling bias, variability in measurement methods, and unaccounted ethnic variables. Research and clinical recommendations in this field are reported.
Topics: Humans; Transgender Persons; Mental Health; Gender Identity; Sexual and Gender Minorities; Resilience, Psychological
PubMed: 37995435
DOI: 10.1016/j.cpr.2023.102358 -
Journal of Advanced Nursing Apr 2024To inform efforts to integrate gender and race into moral distress research, the review investigates if and how gender and racial analyses have been incorporated in such... (Meta-Analysis)
Meta-Analysis Review
AIM
To inform efforts to integrate gender and race into moral distress research, the review investigates if and how gender and racial analyses have been incorporated in such research.
DESIGN
Scoping review.
METHODS
The PRISMA (Preferred Reporting Items for Systematic and Meta-Analysis) Extension for Scoping Reviews was adopted.
DATA SOURCES
Systematic literature search was conducted through PubMed, CINAHL and Web of Science databases. Boolean operators were used to identify moral distress literature which included gender and/or race data and published between 2012 and 2022.
RESULTS
After screening and full-text review, 73 articles reporting on original moral distress research were included. Analysis was conducted on how gender and race were incorporated in research and interpretation of moral distress experiences among healthcare professionals.
IMPACT
This study found that while there is an upward trend in including gender and race-disaggregated data in moral distress research, over half of such research did not conduct in-depth analysis of such data. Others only highlighted differential experiences such as moral distress levels of women vis-à-vis men. Only about 20% of publications interrogated how experiences of moral distress differed and/or explored factors behind their findings.
CONCLUSION
There is a need to not only collect disaggregated data in moral distress research but also engage this data through gender and race-based analysis. Particularly, we highlight the need for intersectional analysis, which can elucidate how social identities and categories (such as gender and race) and structural inequalities (such as those sustained by sexism and racism) interact to influence moral experiences.
IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE
Moral distress as experienced by healthcare professionals is increasingly recognized as an important area of research with significant policy implications in the healthcare sector. This study offers insights for nuanced and targeted policy approaches.
PATIENT OR PUBLIC CONTRIBUTION
No patient or public contribution.
Topics: Male; Humans; Female; Gender Identity; Health Personnel; Morals; Stress, Psychological
PubMed: 37849045
DOI: 10.1111/jan.15901 -
Journal of Plastic, Reconstructive &... Dec 2023Among plastic surgeons, there are several conventional techniques for performing chest surgery. Research on surgical approaches has focused cis-gender patients with... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Among plastic surgeons, there are several conventional techniques for performing chest surgery. Research on surgical approaches has focused cis-gender patients with medical conditions, such as breast cancer or gynecomastia, but has never studied transgender populations. The aim of this study is to perform the first systematic review of gender-affirming surgery (GAS) in transgender populations and determine postoperative outcomes differences in relation to surgical technique.
METHODS
Two reviewers independently searched Medline, Embase, CINAHL, Web of Science, and Cochrane databases for studies published prior to 2021. Studies selected for inclusion were retrospective or prospective studies of adult transgender men undergoing GAS that utilized appropriate operative techniques and reported complications and/or patient-reported outcomes.
RESULTS
A total of 26 randomized controlled trials, including 40 distinct populations and 3055 patients, were identified. Surgical techniques compared double incision free nipple graft (DIFNG) (2053 patients [67.20%]), pedicled nipple techniques (PNT) (297 [9.72%]), and periareolar techniques (PAT) (705 [23.08%]). Pairwise analysis found the lowest complication rates associated with procedures utilizing DIFNG, followed by PNT, then PAT. Patients with PAT had significantly higher satisfaction scores than DIFNG.
CONCLUSIONS
This is the first systematic review to evaluate outcomes of chest surgery techniques among the transgender population. Results indicate significantly more complications for PAT compared to DIFNG or PNT. Analysis of patient-reported outcomes was limited due to heterogeneity in reporting.
Topics: Male; Adult; Humans; Retrospective Studies; Prospective Studies; Transsexualism; Transgender Persons; Outcome Assessment, Health Care; Thoracic Wall
PubMed: 37837944
DOI: 10.1016/j.bjps.2023.09.002 -
PloS One 2023Conversion practices (CPs) refer to organized attempts to deter people from adopting or expressing non-heterosexual identities or gender identities that differ from...
RATIONALE
Conversion practices (CPs) refer to organized attempts to deter people from adopting or expressing non-heterosexual identities or gender identities that differ from their gender/sex assigned at birth. Numerous jurisdictions have contemplated or enacted legislative CP bans in recent years. Syntheses of CP prevalence are needed to inform further public health policy and action.
OBJECTIVES
To conduct a systematic review describing CP prevalence estimates internationally and exploring heterogeneity across country and socially relevant subgroups.
METHODS
We performed literature searches in eight databases (Medline, Embase, PsycInfo, Social Work Abstracts, CINAHL, Web of Science, LGBTQ+ Source, and Proquest Dissertations) and included studies from all jurisdictions, globally, conducted after 2000 with a sampling frame of sexual and gender minority (SGM) people, as well as studies of practitioners seeing SGM patients. We used the Hoy et al. risk of bias tool for prevalence studies and summarized distribution of estimates using median and range.
RESULTS
We identified fourteen articles that reported prevalence estimates among SGM populations, and two articles that reported prevalence estimates from studies of mental health practitioners. Prevalence estimates among SGM samples ranged 2%-34% (median: 8.5). Prevalence estimates were greater in studies conducted in the US (median: 13%), compared to Canada (median: 7%), and greater among transgender (median: 12%), compared to cisgender (median: 4%) subsamples. Prevalence estimates were greatest among people assigned male at birth, whether transgender (median: 10%) or cisgender (median: 8%), as compared to people assigned female at birth (medians: 5% among transgender participants, 3% among cisgender participants). Further differences were observed by race (medians: 8% among Indigenous and other racial minorities, 5% among white groups) but not by sexual orientation.
CONCLUSIONS
CPs remain prevalent, despite denouncements from professional bodies. Social inequities in CP prevalence signal the need for targeted efforts to protect transgender, Indigenous and racial minority, and assigned-male-at-birth subgroups.
Topics: Infant, Newborn; Humans; Male; Female; Gender Identity; Prevalence; Sexual and Gender Minorities; Sexual Behavior; Transgender Persons
PubMed: 37792717
DOI: 10.1371/journal.pone.0291768 -
The Journal of Adolescent Health :... Jan 2024This systematic literature review explores the evidence base related to the diagnosis and clinical management of eating disorders among transgender and gender nonbinary... (Review)
Review
PURPOSE
This systematic literature review explores the evidence base related to the diagnosis and clinical management of eating disorders among transgender and gender nonbinary (TGNB) youth. Through an exploration of the literature, this review highlights key considerations for providers working with this population, including the complex relationship between body image and gender, the assessment of subthreshold eating disorder symptoms, the impact of gender-affirming care on eating disorder treatment outcomes, and available evidence-based metrics, with attention to factors impacting treatment, including family support, psychiatric comorbidities, and community safety.
METHODS
We conducted a search of the databases PubMed and Ovid MEDLINE for articles pertaining to eating disorders and TGNB youth, with forward citation chaining conducted via Google Scholar to provide a review of recent publications. Twenty-six articles published from 2017 to 2022 met the criteria for full-text review.
RESULTS
The selected articles primarily explored data from the United States and varied widely in methodology, including a systematic literature review (n = 1), narrative literature reviews (n = 3), case series (n = 4), case studies (n = 2), cross-sectional population surveys (n = 7), cross-sectional patient surveys (n = 3), other cross-sectional studies (n = 3), retrospective chart reviews (n = 2), and a retrospective longitudinal cohort study (n = 1). Most commonly, researchers sampled patients within the setting of gender clinics. Researchers used a range of validated measures in clinical settings, with the Eating Disorder Examination Questionnaire most frequently reported. The literature highlights several considerations unique to transgender populations, including the complex relationship between gender dysphoria, body dissatisfaction, disordered eating behavior, and gender-affirming care.
DISCUSSION
In clinical settings with TGNB youth, providers may consider implementing validated screening measures to assess for eating disorders. Future research should emphasize a nuanced understanding of the heterogeneity among TGNB patient populations and the impact of gender identity on treatment of eating disorders.
Topics: Humans; Male; Female; Adolescent; Gender Identity; Transgender Persons; Retrospective Studies; Cross-Sectional Studies; Longitudinal Studies; Feeding and Eating Disorders
PubMed: 37791928
DOI: 10.1016/j.jadohealth.2023.07.027 -
The Journal of Craniofacial SurgeryFor transwomen undergoing voice feminization interventions, fundamental frequency (F 0 ; vocal pitch) is a commonly reported functional outcome measure in the... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
For transwomen undergoing voice feminization interventions, fundamental frequency (F 0 ; vocal pitch) is a commonly reported functional outcome measure in the literature. However, F 0 may not correlate well with improvement in quality of life (QoL). Several validated voice-related QoL instruments have been used to assess QoL improvement in these patients, yet there is no consensus on the most appropriate instrument. This systematic review and meta-analysis aimed to assess the relationship between change in F 0 and QoL improvement following voice feminization, and to compare validated QoL instruments commonly used in this population.
DATA SOURCES
PubMed, Cochrane, and Embase.
REVIEW METHODS
A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Primary studies of transwomen undergoing voice feminization, reporting validated QoL outcomes were included. Meta-analyses for associations between mean change in QoL score and mean change in F 0 , as well as variations in mean change in QoL score by QoL instrument, were performed using a multilevel mixed effects model.
RESULTS
No statistically significant correlation was found between change in F 0 and QoL score improvement post-intervention. Different validated instruments showed statistically significant variation in QoL score change, with the Trans Women Voice Questionnaire (TWVQ) capturing a greater improvement in QoL score relative to other instruments.
CONCLUSIONS
Lack of correlation between changes in F 0 and QoL improvement further supports that F 0 alone is insufficient to assess the efficacy of voice feminizing interventions. Validated QoL measures are useful adjuncts. Of these, the TWVQ appears to be the most sensitive for measurement of QoL improvement following voice feminization.
Topics: Male; Humans; Female; Quality of Life; Feminization; Voice; Transsexualism; Surveys and Questionnaires
PubMed: 37702532
DOI: 10.1097/SCS.0000000000009742 -
Archives of Sexual Behavior Oct 2023
Correction: Sexual and Dating Violence Prevention Programs for Male Youth: A Systematic Review of Program Characteristics, Intended Psychosexual Outcomes, and Effectiveness.
PubMed: 37488272
DOI: 10.1007/s10508-023-02664-w -
Drug and Alcohol Dependence Sep 2023Transgender and gender diverse (TGD) adults are at elevated risk of problematic substance use. While understanding substance use disparities in TGD youth is crucial for... (Review)
Review
Transgender and gender diverse (TGD) adults are at elevated risk of problematic substance use. While understanding substance use disparities in TGD youth is crucial for informing early preventions, there is no known synthesis of prevalence and correlates of substance use in TGD youth. The objectives of this study were to: 1) describe the prevalence and patterns of substance use in TGD youth, 2) identify and evaluate potential correlates of substance use, and 3) report the strengths and limitations of the current literature in recommendation of future steps. A PRISMA-guided systematic search was conducted to identify 55 studies that reported prevalence, patterns, or correlates of substance use in TGD youth aged 10-24 years; were published in the English language; and followed a quantitative design. Fifty-four (98.18%) studies examined prevalence and patterns, 23 (41.82%) examined correlates, and 12 (21.82%) examined moderators and mediators of substance use in TGD youth. Findings suggest TGD youth exhibit a moderate-to-high prevalence of recent substance use, including alcohol (23-31%), binge drinking (11-59%), cigarettes (10-59%), e-cigarettes (17-27%), and marijuana (17-46%). Additionally, results supported that greater victimization experiences, including those related and unrelated to being a gender minority, were associated with increased substance use risk. Few studies examined polysubstance use, resilience, and protective factors, or considered TGD subgroup differences, which we recommend in future research. Further, we recommend improving population-based surveys to better capture gender identity and related experiences.
Topics: Female; Male; Adult; Adolescent; Humans; Gender Identity; Transgender Persons; Electronic Nicotine Delivery Systems; Prevalence; Sexual and Gender Minorities; Ethanol
PubMed: 37480799
DOI: 10.1016/j.drugalcdep.2023.110880