Intersex Mental Health and Social Support Options in Pediatric Endocrinology Training Programs

ABSTRACT

The birth of a child with an intersex condition is often an emotionally stressful event for parents. Preparation and ongoing support systems could be beneficial to both parents and children and would alleviate some of the shame and isolation associated with intersex conditions. To assess the extent to which psychological support is available, a short e-mail survey on this topic was sent to the directors of 50 pediatric endocrinology fellowship training programs (PEFTPs), who are most likely to evaluate and treat intersex children and their parents. Of the 29 PEFTPs that responded, 69% offer psychological support and 58% have a mental health specialist on staff. However, only 19% of patients or families receive emotional support during diagnosis and only 15% receive support after diagnosis. We found two barriers that prevent patients and families from receiving psychological help from their intersex care team. First, there is a lack of training for mental health professionals regarding the needs of intersex patients and families. Second, some families refuse help even though it is offered. This study reveals that further research is needed to overcome these two barriers regarding mental health treatment of intersex patients and families.     

Children and the Mental Health of Older Adults in China: What Matters?

China is witnessing several major demographic, socioeconomic, and cultural trends that likely intersect in unique and significant ways to influence the health and well-being of its older adult population. Concerns that such trends may be eroding traditional family structures and values raise questions about the continued importance and impact of children on the lives of their older parents. Do children matter and, if so, what is it about having children that makes a difference to the mental health of their parents? This study addressed these issues using baseline data drawn from the Chinese Longitudinal Aging Social Survey, conducted in 2014. Multivariate OLS regression analyses revealed the importance of having children for parental mental health. This relationship was found to be mediated by economic/utilitarian factors (co-residence, the receipt of financial, and instrumental support) as well as psychological/emotional factors (companionship, emotional support), and social/traditional factors (children’s socioeconomic status achievements). These findings support the view that children continue to be important to the mental health of their older parents in contemporary China. Further, what matters most when it comes to understanding the influence that children have on parents’ mental health are their perceived accomplishments in life and their meaningful presence in the day-to-day lives of their parents.

     

Costs and benefits of children: implications for population policy

Family size preferences are strongly affected by parents' perceptions of the value, economic contributions, and costs of children. Better understanding of these factors can help policy-makers to improve the effectiveness of population IEC campaigns, design strategies to persuade couples to have smaller families, assess the relationship between economic development and family size preferences, and devise national population policies and family planning programs that reflect individual choices. Parents in high-fertility countries are more likely to perceive children as productive investments than those in low-fertility countries. Parents in the former countries maintain children are an economic advantage or provide practical assistance in the household; they are less likely to emphasize the psychological advantages of children. As economic development occurs, and parents no longer value children for their economic contributions, psychological and social reasons become more important. Changing fertility preferences is more complex than providing couples with family planning services. Similarly, efforts to persuade families that large families are a burden are successful only when families are already interested in reducing their family size. Efforts to persuade couples to have smaller families are likely to be more successful if there are alternative sources of old-age support available, for example, from increased household savings, public or private pensions, or greater contributions from 1st and 2nd children. Investments in education and training, especially for women and children, would also support these goals.     

Health care issues among lesbian, gay, bisexual, transgender and intersex (LGBTI) populations in the United States: Introduction

This supplemental issue of the Journal of Homosexuality presents research that explores a variety of health care issues encountered by lesbian, gay, bisexual, transgender and intersex (LGBTI) population groups in the United States over the 10-year period from 1993 to 2002. Topics include access to health care, utilization of care, training of medical and mental health providers, and the appropriate preparation of clinical offices and waiting areas. Authors used a variety of community-based public health research methods, including participant and provider surveys and retrospective chart reviews of patients, to develop this body of research, providing a recent-historical perspective on the complex health care and health-related needs of sexual and gender minorities. Particularly for transgender and intersex populations, the state of research describing their health care needs is in its infancy, and much remains to be done to design effective medical and mental health programs and interventions.     

Health Care Issues Among Lesbian,Gay, Bisexual,Transgender and Intersex (LGBTI) Populations in the United States: Introduction

ABSTRACT

This supplemental issue of the Journal of Homosexuality presents research that explores a variety of health care issues encountered by lesbian, gay, bisexual, transgender and intersex (LGBTI) population groups in the United States over the 10-year period from 1993 to 2002.

Topics include access to health care, utilization of care, training of medical and mental health providers, and the appropriate preparation of clinical offices and waiting areas. Authors used a variety of community-based public health research methods, including participant and provider surveys and retrospective chart reviews of patients, to develop this body of research, providing a recent-historical perspective on the complex health care and health-related needs of sexual and gender minorities. Particularly for transgender and intersex populations, the state of research describing their health care needs is in its infancy, and much remains to be done to design effective medical and mental health programs and interventions.     

流动儿童精神健康状况分析

与以往主要关注家庭因素、基本人口特征的流动儿童精神健康研究不同,本研究将分析视野扩展到社会经济地位、社会支持和个体抗逆力。数据表明,流动儿童的精神健康差于非流动儿童,社会经济地位、家庭支持和个体抗逆力均对其产生影响,其他社会支持的影响不显著。流动儿童由于面临着社会经济地位和家庭流动方面的"双重劣势",单纯提升个体抗逆力不足以改变其精神健康不良的事实。因此,一方面努力提升流动儿童的个体抗逆力,充分发挥其面对逆境的主体性;另一方面,在宏观层面上不断地瓦解产生"双重劣势"的制度基础。通过两方面的共同作用能改善流动儿童的精神健康状况。     

A problem worthy to be noted by society and parents]

The problems in China faced by families and teachers dealing with the "only child" are discussed in this report. Out of 1144 students studied for this report, 26.2% came from 1-child families. Based on interviews with parents and teachers, the report determines that the only child shows a rapid development in intelligence, has a better standard of living than children from households of 2 or more children, and enjoys better health. However, the only child is found to be less equipped to deal with the pressures of daily life in spite of the above advantages, due mostly to the fact that his parents shelter him and do not allow him to deal with his own problems (some to the point of spoon-feeding their children who are old enough to attend school). The new governmental policy of 1 child per family, says the report, is in fact reversing population growth, yet seems to be creating a new generation of "little kings and queens" that are beginning to receive a sizable amount of attention from social workers. The main concern of social workers is that these children are being spoiled by their families and are creating difficulties in the classroom; namely, they 1) lack common courtesy and act superior to other children; 2) are willful, causing disturbances in the classroom; 3) lack discipline; and 4) seem to be lazier than other children. These characteristics are generally fostered in the home and parents are guilty of not enforcing discipline.     

Returns on Lifetime Investments in Children in Egypt

Parental expectations about the companionship and assistance they will receive in later life from their children are key considerations in family formation decisions. We explore patterns of parents’ investment and the support and contact they receive from adult children in Egypt, where fertility is falling and sources of support at all life stages are in flux. Using data from a survey of older adults in Ismailia governorate, we consider parents’ past investments in childbearing, child survival, and children’s education and marriage, as well as recent assistance to adult children via housing, care for grandchildren, gifts, and money. The returns from children considered include economic assistance, instrumental support, and visits. Most parental investments are associated with frequent visits from children. The assistance children provide to parents is gendered: sons tend to provide economic transfers, whereas daughters tend to provide instrumental help. A greater number of surviving children is most strongly associated with parents’ receipt of multiple types of later-life returns. Investments in children’s education and marriage are not associated with assistance, but recent assistance to children—especially economic transfers and provision of housing—is associated with receiving instrumental assistance from adult children.     

Psychotherapy with gay/lesbian couples and their children in "stepfamilies": a challenge for marriage and family therapists

As increasing numbers of gay/lesbian parents and their children enter into "stepfamily-like" relationships with a gay partner, they are beginning to seek therapy for difficulties peculiar to stepfamily living involving two same-sex partners. This paper focuses on the difficulties experienced by gay parents and children in a step-relationship, and seeks to sensitize mental health professionals to issues specific to intervention with such families. Effective therapy with these families requires that therapists be sensitive to their personal biases and prejudices with regard to gay men and women in general and as parents, and be aware that such attitudes can intrude and negatively affect the therapeutic process and its outcomes. Guidelines for therapy are offered.     

大众健康的社会心理问题

运动不足、精神紧张、营养不平衡、环境污染构成了现代生活中妨害大众健康的四大因素，相比生理健康，现代人的心理健康问题更为严重，越来越多的现代人受到心理问题的困扰。这已经成为了突出的社会问题。目前影响我国农村大众健康状况的社会心理问题包括环境污染、农村社会变迁、以及“留守儿童”和“空巢老人”等问题：影响我国城市居民健康状况的社会心理问题包括生活方式现代化导致的“文明病”、环境污染、拥挤、精神负荷超重等问题；影响我国学生健康状况的社会心理问题包括学生个体内在的生理和心理特点、家庭方面的原因、学校方面的原因、同辈群体方面的原因以及社会方面的原因。     

农村50岁以上独生子女父母与子女经济互动及养老预期——基于对全国5县调查

根据对全国5县(区)抽样调查,农村50岁以上独生子女老年父母家庭有近6成空巢。尽管这些父母的大多数觉得2个及以上孩子对于养老来说更好,但依靠子女养老和多代同堂观念已大为削弱。这些家庭代际间财富流动以子女对父母反哺为主。6成独生子女父母赞成与子女分开住,即使子女今后搬到城镇住,也有近一半人明确表示不会到子女家住,但他们同时并未显示出对社会养老保障的信任,这种窘境使这些曾为人口控制做出突出贡献的老人面临严峻的养老挑战。     

Creating coherent perinatal care journeys: An ethnographic study of the role of continuity of care for Danish parents in a vulnerable position

BackgroundWhile continuity of care is a core element of high-quality maternity care, it is potentially even more important for pregnant women and their partners who are at risk of adverse health outcomes because of psychosocial vulnerability. However, little is known about how a coherent care journey can be ensured for women and families who may require interdisciplinary and inter-sectoral services during pregnancy and the postnatal period.AimTo explore the role of continuity of care in creating a coherent care journey for vulnerable parents during pregnancy and the postnatal period.MethodsAn ethnographic study conducted in Denmark based on interviews with, and field observations, of 26 mothers and 13 fathers receiving services due to mental health problems, young age, past substance abuse and/or adverse childhood experiences.FindingsThree key findings emerged: 1). Developing relationships allowed parents to know and feel known by care providers, which helped them feel secure and reach out for support. 2). Handover of information allowed parents to feel secure as their need for support was recognised by care providers; some parents, however, felt exposed when information was shared 3). Receiving relevant services allowed parents to have their needs for support addressed, which requires easy referral pathways and coordination of services.ConclusionAll forms of continuity of care should be prioritised in the organisation of maternity care services for women and families in vulnerable positions. While relational continuity is important, continuity of care must also reach across providers, sectors and services to ensure coherent care journeys.     

利还是弊:“啃老”对老年生活满意度的影响

本文利用中国健康与养老追踪调查数据(CHARLS)2011年数据,实证分析子女"啃老"对老年人生活满意度的影响。在考虑了数据聚类特征的情况下,发现老年人向子女提供经济支持有利于老年人生活满意度的提高,而照看孙子女则降低了老年人的生活满意度。而且,上述影响在不同老年人群体间缺乏一致性,也就是存在性别、城乡、年龄、不同经济状况间的差异。此外,老年人的健康状况、年龄、受教育程度、个人经济状况及所在社区情况都会对老年人生活满意度产生影响。     

家庭结构对老年人代际支持的影响研究

本文利用中国老年健康影响因素跟踪调查（CLHLS）项目2008年的数据,分析了家庭结构的变迁（表现为居住安排与子女数量两方面）对老年人所获得的来自子女的代际支持的影响。研究结论显示,是否与子女同住会影响老年人获得的经济支持、情感支持与照料支持,而子女数量对代际支持的获得有正向作用。     

Intergenerational relations in urban China: Proximity, contact, and help to parents

Although most older Chinese parents live with an adult son or daughter, most adult offspring do not live with parents. We examine the relations of these noncoresident offspring with parents in terms of proximity, frequency of contact, and exchange of help. Based on a 1993 random sample survey conducted in two major Chinese cities, we find that although rates of coresidence are high, noncoresident sons and daughters live close to parents, have frequent contact with their parents, and provide regular help to parents. Relationships with noncoresident sons and daughters are unaffected by whether parents coreside with another child. There is some evidence of closer relationships with sons than with daughters, but parents without a son receive as much help from all children as do parents with sons. The effects of these and other predictors are estimated in multivariate analyses, and results are interpreted in terms of the persistence or change of traditional family norms.     

Navigating infant feeding supports after migration: Perspectives of Arabic and Chinese mothers and health professionals in Australia

Optimal feeding practices can establish lifelong, transgenerational and global health benefits. Migration and cultural factors impact infant feeding practices and the support mothers receive for optimal infant feeding. This qualitative study explored support for infant feeding among Arabic and Chinese speaking migrant mothers in Australia.Semi-structured focus groups were conducted in language with 24 Arabic and 22 Chinese-Mandarin speaking migrant mothers with children under five years of age. Individual interviews were conducted in English with 20 health professionals working with Arabic or Chinese speaking migrant families. Data were thematically analysed using the framework method.Traditional family networks and trusted bi-cultural doctors were influential infant feeding supports for mothers. Health professionals perceived maternal and child health services to be poorly understood, and some mothers who accessed services felt they were not always culturally sensitive. Mothers sought additional information and support through online sources and peers. Both mothers and health professionals recognised the challenges of managing conflicting infant feeding advice and seeking best-practice support.The findings of this study highlight opportunities for health professionals to better support migrant mothers’ infant feeding practices, for example through engaging families and working with doctors. There is a need for greater cultural sensitivity within maternal and child health services and culturally relevant programs to support healthy infant feeding practices among migrant communities.     

Parents’ Religious Involvement,Family Socialization and Development of Their Children in a Chinese Sample of Hong Kong

The present study investigates the effects of parents’ religious involvement on their psychological health, family functioning and development of their children from a Chinese sample of parent–child pairs in Hong Kong. Results support the beneficial effects of religious involvement on effective parenting and favorable outcomes of their children, which have been well reported in western studies. Besides, this investigation finds that (1) parental psychological health is a mediator between their religious involvement and positive family processes; (2) family processes is an important family socialization factor with spill-over effects into the function of parenting; (3) different family socialization factors have different effects on child outcomes; (4) parental positive religious coping is a function of their intrinsic religiosity; and (5) both parental religious coping and their intrinsic religiosity have a protective effect on parental psychological difficulties, with the former having robust direct effects on positive family processes and effective parenting, and (6) both intrinsic religiosity and positive religious coping in parents show significant total indirect effects on respective child outcomes through parental psychological and family socialization factors. Implications and directions for further study are also discussed.     

子女教育影响老年父母健康的机制及其异质性

基于2018年中国健康与养老追踪调查(CHARLS)数据,运用Logit计量方法考察子女教育对老年父母健康的影响。结果发现子女教育提高1年,老年父母健康状况改善的可能性显著提高4.28%,异质性检验发现这种影响不存在城乡和性别差异。基于人力资本代际传递理论和社会资本理论,将子女教育影响老年父母健康的渠道归纳为资源转移、健康行为和社会性支持,结果发现:子女教育主要通过向父母转移资源和帮助老年父母优化健康行为习惯来改善父母健康,未能通过社会支持渠道产生健康促进效应。其中通过资源转移渠道和以适度饮酒、运动及休闲为代表的健康行为渠道分别解释了子女教育对老年父母健康促进效应的27.78%和9.78%,提高资源转移能力是子女教育影响老年父母健康的主要渠道。在我国老龄化背景下,需要重视子女教育对父母健康的促进作用。同时,采取积极措施拓展社会支持渠道,降低父母对子女的资源依赖,并加强健康教育,优化健康行为。     

独生子女家庭空巢风险分析

在中国的人口转变过程中,由于独生子女的大量增加,已经出现了一种全新的空巢现象,即越来越多的独生子女家庭提前进入空巢期,并使空巢期延长,增加了独生子女父母养老和心理健康风险。本文对独生子女空巢家庭产生的原因、发展趋势、特征及其风险进行了深入分析,最后提出了化解独生子女家庭空巢风险及其危害的对策。