Depression, Self-Esteem, and Resilience and its Relationship with Psychological Features of Sexuality among Transgender Men and Women from Brazil.

This cross-sectional study investigated whether depression, self-esteem, and resilience (mental health indicators) are associated with some psychological features of sexuality (sexual fear, sexual anxiety, sexual dissatisfaction, and sexual body image worries) in a sample of 462 transgender men and women from Brazil. Pearson's correlations were performed between all continuous variables in the study. Those that were significantly associated with the psychological features of sexuality in previous analyses were tested as independent variables in multiple linear regression models. Sexual fear, sexual anxiety, sexual dissatisfaction, and sexual body image worries were negatively related to self-esteem and resilience, while positively related to depression. Higher levels of depression were associated with sexual fear, while higher levels of depression and lower self-esteem were associated with sexual anxiety. In addition, higher levels of depression and lower levels of resilience were associated with sexual dissatisfaction. Depression and resilience were associated with the composite score of sexual dissatisfaction and sexual anxiety. Our results suggest that negative mental health indicators may impair the sexual life of transgender individuals. Clinical interventions should be developed and tested to address the psychological features of sexuality.

Relato de experiência de um grupo lúdico terapêutico de crianças com incongruência de gênero / An experience report of a ludic therapeutic group of children with gender incongruence

Relato sobre proposta inovadora, que se sustenta como ato terapêutico, lúdico e sequencial, objetivando encontros específicos para trabalhar de maneira psicoterápica questões ligadas às vidas e identidades, inclusive de gênero, dessas crianças. Em 2019, os pacientes de até 12 anos do Ambulatório Transdisciplinar de Identidade de Gênero e Orientação Sexual (AMTIGOS) do IPq/HC/FM/USP foram convidados a participar do Grupo de brincar. O grupo foi acompanhado por uma equipe transdisciplinar e mediado por psicólogos que apresentaram atividades estruturadas de forma a favorecer a explosão por parte das crianças e compartilhamento de suas experiências de forma lúdica.

COMVC-19: A Program to protect healthcare workers' mental health during the COVID-19 Pandemic. What we have learned.

OBJECTIVE: In 2020, the COVID-19 pandemic brought a work and stress overload to healthcare workers, increasing their vulnerability to mental health impairments. In response, the authors created the COMVC-19 program. The program offered preventive actions and mental health treatment for the 22,000 workers of The Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP). This paper aims to describe its implementation and share what we have learned from this experience. METHODS: Workers were able to easily access the program through a 24/7 hotline. Additionally, a mobile phone app that screened for signs and symptoms of emotional distress and offered psychoeducation and/or referral to treatment was made available. Data from both these sources as well as any subsequent psychiatric evaluations were collected. RESULTS: The first 20 weeks of our project revealed that most participants were female, and part of the nursing staff working directly with COVID-19 patients. The most frequently reported symptoms were: anxiety, depression and sleep disturbances. The most common diagnoses were Adjustment, Anxiety, and Mood disorders. CONCLUSIONS: Implementing a mental health program in a multimodal intervention was feasible in a major quaternary public hospital. Our data also suggests that preventive actions should primarily be aimed at anxiety and depression symptoms, with a particular focus on the nursing staff.

Condom-Protected Sex and Minority Stress: Associations with Condom Negotiation Self-Efficacy, "Passing" Concerns, and Experiences with Misgendering among Transgender Men and Women in Brazil.

This cross-sectional exploratory study aims to verify associations between condom-protected sex, condom negotiation self-efficacy, self-esteem, and four minority stressors (experiences with misgendering, "passing" concerns, anticipated prejudice, and perceived prejudice) among transgender men (TM) and transgender women (TW). 260 individuals (192 TW and 68 TM) residing in two Brazilian states participated in the study. Data was collected online and in two hospital programs for transgender people and included sociodemographic data, condom-protected sex, the Trans-Specific Condom/Barrier Negotiation Self-Efficacy (T-Barrier) Scale, the Rosenberg Self-Esteem Scale, and four minority stressors. Measures that were significantly associated with condom-protected sex were tested as independent variables in a linear regression model. The main results suggest that lower condom negotiation self-efficacy, higher "passing" concerns, and higher experiences with misgendering were predictors of lower frequency of condom-protected sex. These negative outcomes were found among both TM and TW, which justifies their inclusion in public health policies. Structural strategies and clinical interventions are suggested to address condom negotiation self-efficacy and "passing" concerns in transgender populations.

COMVC-19: A Program to protect healthcare workers' mental health during the COVID-19 Pandemic. What we have learned

OBJECTIVE: In 2020, the COVID-19 pandemic brought a work and stress overload to healthcare workers, increasing their vulnerability to mental health impairments. In response, the authors created the COMVC-19 program. The program offered preventive actions and mental health treatment for the 22,000 workers of The Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP). This paper aims to describe its implementation and share what we have learned from this experience. METHODS: Workers were able to easily access the program through a 24/7 hotline. Additionally, a mobile phone app that screened for signs and symptoms of emotional distress and offered psychoeducation and/or referral to treatment was made available. Data from both these sources as well as any subsequent psychiatric evaluations were collected. RESULTS: The first 20 weeks of our project revealed that most participants were female, and part of the nursing staff working directly with COVID-19 patients. The most frequently reported symptoms were: anxiety, depression and sleep disturbances. The most common diagnoses were Adjustment, Anxiety, and Mood disorders. CONCLUSIONS: Implementing a mental health program in a multimodal intervention was feasible in a major quaternary public hospital. Our data also suggests that preventive actions should primarily be aimed at anxiety and depression symptoms, with a particular focus on the nursing staff.

HIV-Related Healthcare Needs and Access Barriers for Brazilian Transgender and Gender Diverse People.

The aim of this study is to investigate HIV-related healthcare needs and access barriers for Brazilian transgender and gender diverse people. Data were collected from gender identity clinics and the questionnaire was also made available on the Internet. Out of the 543 participants-62.1% (n = 337) transgender women, 28.7 (n = 156) transgender men and 9.2% (n = 50) gender diverse people, 63.7% had been tested at least once in their lives. The prevalence of self-reported HIV-positive status among transgender women was 16.5%, of which 92.0% reported having a physician with whom they regularly consulted about HIV, whereas none of the transgender men or gender diverse people reported HIV-positive status. In addition, 8.2% of transgender men and 12.5% of gender diverse people did not know their serological status. Finally, 71.0% of the participants were unfamiliar with post-exposure prophylaxis. The study discusses the need for adequate behavior-oriented HIV health policies and training of healthcare professionals regarding the needs of Brazilian transgender and gender diverse people.

Healthcare Needs of and Access Barriers for Brazilian Transgender and Gender Diverse People.

Transgender and gender diverse people (TGD) have specific healthcare needs and struggles with access barriers that should be addressed by public health systems. Our study aimed to address this topic in the Brazilian context. A hospital and web-based cross-sectional survey built with input from the medical and transgender communities was developed to assess TGD healthcare needs of and access barriers in two Brazilian states. Although services that assist this population have existed in Brazil since the 1990s, TGD have difficulty accessing these services due to discrimination, lack of information and a policy design that does not meet the needs of TGD. A history of discrimination was associated with a 6.72-fold increase in the frequency of health service avoidance [95% CI (4.5, 10.1)]. This article discusses the urgent necessity for adequate health policies and for the training of professionals regarding the needs of Brazilian TGD.

AMTIGOS - Ambulatório Transdisciplinar de Identidade de Gênero e Orientação Sexual, do IPq-HCFM/USP: proposta de trabalho com crianças, adolescentes e adultos / AMTIGOS- Transdisciplinary Ambulatory of Gender Identity and Sexual Orientation of the IPq-HCFM/USP: proposal of work with adolescents, children and adults

O artigo traz a experiência acumulada pelo Ambulatório Transdisciplinar de identidade de Gênero e Orientação Sexual do Instituto de Psiquiatria do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (AMTIGOS-IPq-HCFM/USP), que atualmente se volta para a atenção de crianças e adolescentes transexuais, com equipe multidisciplinar que inclui atenção familiar, psicológica e psiquiátrica, médica integral incluindo acompanhamento clínico e terapia hormonal , além orientação e realização da transexualização e a atenção ao longo período de espera da cirurgia. Apresenta como essa atenção em saúde vem contribuindo para o bem-estar e cidadania dessas pessoas e auxiliando seus familiares a integrá-los com suas necessidades específicas.

De adultos a crianças: análise retrospectiva e psicanalítica de serviço ambulatorial de população com disforia de gênero-transtorno de identidade de gênero-transexualismo / From adults to children: retrospective and psychoanalytic analysis of outpatient services of the population with gender dysphoria, gender identity disorder and transsexualism / De adultos a niños: análisis retrospectivo y psicoanalítico de servicio ambulatorio a población con disforia de género-trastorno de identidad de género-transexualismo

No Brasil, foi após 1997, com a publicação da padronização do Conselho Federal de Medicina, que o acompanhamento e o tratamento da população transexual se tornaram mais intensivos. O Ambulatório de Transtorno de Identidade de Gênero e Orientação Sexual - Amtigos, do Nufor-IPq-HCFMUSP foi criado em 2010; nele, pacientes com disforia de gênero são tratados seguindo as orientações da World Professional Association for Transgender Health (WPATH), adaptadas à realidade sociocultural brasileira. O Amtigos promove triagens multidisciplinares, atendimento médico psiquiátrico e psicoterapia para pacientes adultos e, mais recentemente, para adolescentes e crianças trazidos por familiares que buscam orientação e tratamento. Nossa proposta consiste em uma abordagem transdisciplinar com base em nossa experiência, para que seja provida adequada assistência psicológica, psiquiátrica e acompanhamento psicoterápico a esses pacientes. Não se trata de tutoria, mas sim de um desenvolvimento conjunto de responsabilidades por todo o processo.

In Brazil, it was after 1997, with the publication of the standardization of the Federal Council of Medicine, that the care and treatment of the transsexual population became more intensive. The Sexual Orientation and Gender Identity Disorder Outpatient Unit AMTIGOS-NUFOR-IPq-HCFMUSP was established in 2010; there, patients with gender dysphoria are treated following the orientations of the World Professional Association for Transgender Health WPATH, adapted to the Brazilian social and cultural reality. The amtigos promotes multidisciplinary selections, mental health care and psychotherapy for adults and, more recently, adolescents and children brought by family members seeking counseling and treatment. Our proposal consists of a transdisciplinary approach based on our experience in order to provide adequate psychological, psychiatric and psychotherapeutic assistance for these patients. It is not about tutoring, but a joint development of responsibilities for the entire process.

En Brasil, fue después del 1997, con la publicación de la estandarización del Consejo Federal de Medicina, que el seguimiento y el tratamiento de la población transexual se tornaron más intensivos. El Ambulatório de Transtorno de Identidade de Gênero e Orientação Sexual AMTIGOS-NUFOR-IPq-HCF-MUSP fue creado en el 2010; en él, pacientes con disforia de género son tratados siguiendo las orientaciones de la World Professional Association for Transgender Health WPATH, adaptadas a la realidad sociocultural brasileña. El amtigos promueve evaluaciones multidisciplinarias, atención médica psiquiátrica y psicoterapia a pacientes adultos y, más recientemente, a adolescentes y niños traídos por familiares que buscan orientación y tratamiento. Nuestra propuesta consiste en un abordaje transdisciplinario basado en nuestra experiencia para que se proporcione una adecuada asistencia psicológica, psiquiátrica y seguimiento psicoterápico a esos pacientes. No se trata de tutoría, sino de un desarrollo conjunto de responsabilidades por todo el proceso.