A Preliminary Survey on Clinical Practice for Children and Adolescents with Gender Dysphoria in Japan: Current Situation and Challenges

Little is known about the treatment of gender dysphoria among children and adolescents in Japan. This preliminary survey aims to improve understanding of current clinical practice for treatment of children with gender dysphoria. Subjects were 315 certified child and adolescent psychiatrists in Japan. The questionnaire asked about clinical experiences concerning gender dysphoria and gender identity-related concerns. A total of 128 psychiatrists responded to the questionnaire. Mean length of clinical experience was 24.2±10.0 years in total and 16.9±11.5 years as child and adolescent psychiatry specialists. Among the respondents, 74 (57.8%) had seen children and adolescents with DSM-5 gender dysphoria, and 87 (67.7%) had examined cases with gender identity-related concerns. The mean number of experienced cases with gender dysphoria was 1.80±2.3 per respondent. We found that even among certified child and adolescent psychiatrists in Japan, experience with treatment of children with gender dysphoria was limited.

Persistent and multisite homophobic harassment during childhood and adolescence and its association with school difficulties in gay and bisexual men in Taiwan

Abstract Background: Homophobic harassment can compromise mental health of sexual minority youths. Objectives: This study examined the rates of persistent and multisite homophobic harassment and their associations with school difficulties during childhood and adolescence among gay and bisexual men in Taiwan. Methods: Participants were recruited through advertisements on the Facebook, Bulletin Board Systems, and the home pages of health promotion and counseling centers for the gay, lesbian, and bisexual community. The experiences of traditional and cyber harassment based on gender role nonconformity and sexual orientation of 500 gay or bisexual men were examined. The associations of multisite and persistent harassment victimization with school difficulties were evaluated. Results: A total of 239 (47.8%) and 131 (26.2%) participants experienced persistent and multisite harassment victimization, respectively. Harassment victimization was significantly associated with low satisfaction with academic performance in any stage of study. Moreover, the participants who were harassed in senior high schools were more likely to miss classes or be truant than those who were not harassed. The victims of multisite harassment at senior high schools were more likely to miss classes or be truant than those of school-only harassment. Discussion: Prevention and intervention programs are warranted to reduce homophobic harassment in sexual minority youths.

Manejo médico de personas transgénero en la niñez y la adolescencia / Medical management of transgender children and adolescents

Resumen Las personas transgénero o con inconformidad de género (IG) se identifican a sí mismas con un género distinto al que les correspondería por su sexo al nacimiento. La demanda de servicios de salud de familias con niños, niñas o adolescentes transgénero va en aumento. La prevalencia de IG en niños no se conoce, pero se ha estimado que es mayor del 1% en adolescentes. Existe un elevado riesgo de depresión, suicidio, abuso de drogas ilícitas, infección por virus de la inmunodeficiencia humana y lesiones no accidentales en estos sujetos. El modelo más aceptado para la atención de personas con IG asume que estos desenlaces adversos son producto de la marginación social y no de la condición de IG en sí. La transición de género de tipo social, así como la física, parecen ser efectivas para aumentar el bienestar de las personas con IG y reducir los riesgos en salud. Durante el proceso de transición social, los profesionales de la salud mental pueden apoyar al menor. Los endocrinólogos pediatras pueden ofrecer el bloqueo de la pubertad y la inducción contrasexual de la misma. Las intervenciones quirúrgicas de reasignación de sexo se reservan para mayores de edad. La identidad de género, la expresión de género y la orientación sexual son tres categorías relativamente independientes que pueden tomar cualquier valor no necesariamente binario (masculino/femenino) ni fijo. Los profesionales de la salud deben estar familiarizados con estos conceptos para ofrecer los mejores recursos disponibles y optimizar el bienestar de cada niño, niña o adolescente transgénero de forma individualizada.

Abstract Transgender or gender nonconforming (GN) persons identify themselves with a gender which is different from that correspondent to their birth sex. The demand for health services by families with transgender children or adolescents tends to increase. The prevalence of GN in children is unknown; however, it has been estimated to be > 1% in adolescents. Transgender persons are at increased risk of depression, suicide, illicit drug abuse, human immunodeficiency virus infection, and non-accidental injury. The most accepted model for the care of transgender persons assumes that these adverse outcomes are the consequence of social margination rather than the GI condition itself. Social and physical gender transition seem to be effective in increasing the well-being of people with GI and reducing associated health risks. Mental health professionals can support the child in the process of social transition. The pediatric endocrinologist may offer puberty blockade and cross-sex induction of puberty. Surgical sex reassignment interventions are reserved for adults. Gender identity, gender expression and sexual orientation are three relatively independent categories that can take any value, which is not necessarily binary (male/female) or fixed. Health professionals should be familiar with these concepts in order to offer the best resources available to optimize the well-being of each transgender child or adolescent with an individualized approach.

Anxiety and depression symptoms in Brazilian sexual minority ecstasy and LSD users / Sintomas de ansiedade e depressão em brasileiros não heterossexuais usuários de ecstasy e LSD

Abstract Background This study examined drug use patterns and psychiatric symptoms of anxiety and depression among young Brazilian sexual minority ecstasy and LSD users and compared findings with those reported for their heterosexual peers. Method This cross-sectional study employed targeted sampling and ethnographic mapping approaches via face-to-face interviews conducted at bars and electronic music festivals using an adapted, semi-structured version of the Global Appraisal of Individual Needs questionnaire. The sample comprised 240 male and female young adults who had used ecstasy and/or LSD in the 90 days prior to the interview and who were not on treatment for alcohol and drug abuse. Results Of the 240 subjects enrolled (mean age: 22.9±4.5 years), 28.7% were gay or bisexuals. Multivariate regression analysis showed that the prevalence of depression symptoms in the past 12 months in the sexual minority group was 37% higher than among heterosexuals (prevalence ratio [PR]=1.79; 95% confidence interval [95%CI] 1.03-3.11; p=0.037). Conclusion Strategies should be developed to assess and address individual needs and treatment approaches should be tailored to address depressive symptoms in young, sexual minority club drug users.

Resumo Introdução Este estudo examinou os padrões de uso de drogas e os sintomas psiquiátricos de ansiedade e depressão entre brasileiros não heterossexuais usuários de ecstasy e/ou LSD e comparou os achados com aqueles relatados por seus pares heterossexuais. Método Este estudo transversal empregou amostragens direcionadas e abordagens de mapeamento etnográfico através de entrevistas presenciais realizadas em bares e festivais de música eletrônica usando uma versão adaptada e semiestruturada do questionário de Avaliação Global de Necessidades Individuais. A amostra incluiu 240 adultos jovens do sexo masculino e feminino que haviam usado ecstasy e/ou LSD nos 90 dias anteriores à entrevista e que não estavam em tratamento para abuso de álcool e drogas. Resultados Dos 240 sujeitos incluídos (idade média: 22,9±4,5 anos), 28,7% eram homossexuais ou bissexuais. A análise de regressão multivariada mostrou que a prevalência de sintomas de depressão nos últimos 12 meses no grupo não heterossexual foi 37% superior à dos heterossexuais [razão de prevalência (RP) = 1,79; intervalo de confiança de 95% (IC95%) 1.03-3.11; p=0,037]. Conclusão Estratégias devem ser desenvolvidas para avaliar e abordar as necessidades individuais, e as abordagens de tratamento devem ser adaptadas para sintomas depressivos em usuários de drogas jovens e não heterossexuais.

Report of Workshop “Toward better care for sexual minorities” / 日本プライマリ・ケア連合学会誌

The concept of sexual minority contains lesbian, gay, bisexual, transgender (LGBT) and disorders of sex development. Despite many recent advances in rights for sexual minorities in the world, bias against them still exit. We held a workshop ‘toward better care for sexual minorities' on the 6th Annual Conference of Japan Primary Care Association 2015. Four lecturers talked about health disparities among sexual minority patients. We want this paper help reducing the readers' prejudice towards the sexual minorities and thus impact their future clinical practice.

Internalized homophobia as a partial mediator between homophobic bullying and self-esteem among youths of sexual minorities in Quebec (Canada) / Homofobia internalizada como mediador parcial do bullying homofóbico e autoestima entre jovens de minorias sexuais em Quebec (Canadá)

Verbal/psychological homophobic bullying is widespread among youths of sexual minorities. Homophobic bullying has been associated with both high internalized homophobia and low self-esteem. The objectives were to document verbal/psychological homophobic bullying among youths of sexual minorities and model the relationships between homophobic bullying, internalized homophobia and self-esteem. A community sample of 300 youths of sexual minorities aged 14 to 22 years old was used. A structural equation model was tested using a nonlinear, robust estimator implemented in Mplus. The model postulated that homophobic bullying impacts self-esteem both directly and indirectly, via internalized homophobia. 60.7% of the sample reported at least one form of verbal/psychological homophobic bullying. The model explained 29% of the variance of self-esteem, 19.6% of the variance of internalized homophobia and 5.3% of the verbal/psychological homophobic bullying. The model suggests that the relationship between verbal/psychological homophobic bullying and self-esteem is partially mediated by internalized homophobia. The results underscore the importance of initiatives to prevent homophobic bullying in order to prevent its negative effects on the well-being of youths of sexual minorities.

A homofobia verbal/psicológica (bullying homofóbico) é comum entre jovens de minorias sexuais. Está associada com homofobia internalizada e baixa autoestima. Os objetivos foram documentar o bullying homofóbico verbal/psicológico entre jovens de minorias sexuais e modelar a relação entre o bullying homofóbico, homofobia internalizada e autoestima. Foi utilizada uma amostra da comunidade com 300 jovens de minorias sexuais, na faixa etária entre 14 a 22 anos. Foi testado um modelo de equação estrutural usando um estimador não linear, robusto, implementado no Mplus. O modelo postula que o bullying homofóbico tem impacto na autoestima, direta e indiretamente, via homofobia internalizada. Os resultados apontaram que 60,7 % da amostra relataram pelo menos uma forma de bullying homofóbico verbal/psicológico. O modelo explicou 29% da variância da autoestima, 19,6% da variância da homofobia internalizada e 5,3 % do bullying homofóbico verbal/psicológico. O modelo sugere que a relação entre bullying homofóbico verbal/psicológico, assédio moral e autoestima é parcialmente mediada por homofobia internalizada. Os resultados sublinham a importância de iniciativas para prevenir o bullying homofóbico, evitando os efeitos negativos sobre o bem-estar dos jovens de minorias sexuais.

Learning from a lecture about sexual minorities for first-year medical students / 医学教育

Objectives: The aim of this study was to explore the first-year medical students’ perception of their learning from a lecture about sexual minorities.<br>Methods: In September 2012, a physician and a gynecologist first lectured about sex differences, reproductive medicine, and sexually transmitted infections. Next, the representative of a support group for a sexual minority talked about the prejudice and discrimination toward sexual minorities. He showed a video about a high school student who had publicity revealed his sexual orientation. We analyzed the students’ reports by the qualitative data analysis method Step Coding and Theorization. The students’ descriptions were extracted, coded by contents, and then grouped into several categories.<br>Results: Many students were surprised at the percentage of persons belonging to a sexual minority. By watching the DVD they came to realize that homosexuals are just like other persons in most ways. They mentioned the need for correct knowledge about sexual minorities.<br>Conclusion: We believe that the educational session about sexual minorities is meaningful for and valued by medical students, and medical care for sexual minorities should be taught to medical students.