Mental Health Service Delivery to Sexual Minority and Gender Non-Conforming Students in Schools: A Winnicottian Approach

Current research highlights the increased risk factors that sexual minority (lesbian, gay, bisexual) and gender minority (transgender/gender non-conforming) students face as compared to their heterosexual and cisgender peers. These risk factors include higher rates of depression, suicide, substance use, school dropout, sexually transmitted infections, experiences with bullying on school campuses and increased risk of homelessness. Although this research has aided our understanding of the needs and risks of this population of youth, few articles have emerged from these data which offer a comprehensive theoretical approach to work clinically with these adolescents in school-based settings. This article explores how school mental health staff can address the behavioural health needs of sexual and gender minority students through the adoption of a Winnicottian theoretical approach. With an intensive focus on academic achievement, schools have historically been limited in their usage of evidence-based data to create programs which adequately address the mental health needs of student populations on their campuses. Yet, sexual and gender minority students are likely to be present in almost every school in the country. Schools can serve as gateways to mental health access and can offer innovative and culturally responsive practices across racial, ethnic, class, and geographic lines. As the single largest holders of the student population in the United States, schools have the ability to play a significant role in mental health service provision for sexual and gender minority youth.     

Harassment Due to Gender Nonconformity Mediates the Association Between Sexual Minority Identity and Depressive Symptoms

The visibility of a stigmatized identity is central in determining how individuals experience that identity. Sexual minority status (e.g., identifying as gay, lesbian, or bisexual) has traditionally been identified as a concealable stigma, compared with race/ethnicity or physical disability status. This conceptualization fails to recognize, however, the strong link between sexual minority status and a visible stigma: gender nonconformity. Gender nonconformity, or the perception that an individual fails to conform to gendered norms of behavior and appearance, is strongly stigmatized, and is popularly associated with sexual minority status. The hypothesis that harassment due to gender nonconformity mediates the association between sexual minority status and depressive symptoms was tested. Heterosexual and sexual minority–identified college and university students (N = 251) completed questionnaires regarding their sexual minority identity, experiences of harassment due to gender nonconformity, harassment due to sexual minority status, and depressive symptoms. A mediational model was supported, in which the association between sexual minority identity and depressive symptoms occurred via harassment due to gender nonconformity. Findings highlight harassment due to gender nonconformity as a possible mechanism for exploring variability in depressive symptoms among sexual minorities.     

Associations of Bisexual-Specific Minority Stress and Health Among Cisgender and Transgender Adults with Bisexual Orientation

Among sexual minorities, bisexuals are at the greatest risk for poor health due in part to prejudice and stigma. This research examined associations of bisexual-specific minority stress and health among cisgender (non-transgender) and transgender adults with bisexual orientation. Participants were 488 adults (378 cisgender women, 49 cisgender men, 61 transgender individuals), age 18 to 66 years, with bisexual orientation based on identity and/or attractions to multiple genders. Participants completed an online survey. Hierarchical linear regression analyses were conducted with sexual minority stress and bisexual-specific minority stress as the predictors and physical health, measured by the 36-Item Short Form Survey (SF-36), as the outcome. Models controlled for demographic variables. Moderation analyses were conducted to test for gender differences. Greater bisexual-specific minority stress significantly predicted poorer overall physical health (β = ?0.16), greater pain (β = ?0.16), and poorer general health (β = ?0.25) above and beyond the effects of sexual minority stress. Gender moderated the association between bisexual-specific minority stress and health, such that bisexual-specific minority stress predicted overall physical health and role limitations for transgender individuals but not for cisgender women. Addressing bisexual-specific minority stress is necessary to improve the health and well-being of bisexual individuals.     

School and Community Service Providers' Perspectives on Gay,Lesbian and Questioning Bullying

ABSTRACT

Existing literature details many forms of harassment against sexual minority youth, including those behaviors that are present in schools. School and community service providers, such as counselors and psychologists, often witness first-hand the bullying that occurs in schools. Through their direct contact with sexual minority youth, they remain knowledgeable of current school environments facing these youth. Their perspectives on bullying of this population, however, are lacking. Sixteen school and community service providers participated in face-to-face, in-depth interviews regarding their perceptions and observations of general bullying and specific bullying of GLBTQI youth. The principles of grounded theory are used to analyze the data, which resulted in themes on bullying of GLQ youth. Results on these themes are presented in six main categories: Types and Locations of Bullying, Characteristics of Victims, Characteristics of Bullies, Effects of Bullying, Victim Response, and “Non-Targets.” The perspectives of the service providers give support for existing literature on the nature of bullying of sexual minority youth, and provide anecdotal information on victim approaches seen to be effective at combating or preventing sexual minority bullying.     

Bullied and Punished: Exploring the Links between Bullying and Discipline for Sexual and Gender Minority Youth

This study investigated connections between sexual and gender minority youths’ (SGMY) experiences with bullying victimization and their experiences with punishment. We interviewed 20 diverse adolescents (X = 18.45) about their experiences with bullying and school discipline. Using a qualitative mapping technique, we analyzed the pathways between victimization and punishment that emerged from our participants’ narratives. Our analyses revealed that among the adolescents who had experienced victimization related to their sexual orientation and/or gender identity (or expression) (n = 17), most of them (n = 15) had also experienced punishment connected to their victimization. We identified five pathways linking victimization and bullying. Further, we found that the majority of participants were navigating school contexts rife with pervasive and ongoing harassment and that adults ineffectively intervened and often compounded the harm experienced.     

Missing from the Conversation: Sexual Risk Factors Across Young People by Gender Identity and Sexual Orientation

Abstract

Objectives: Lesbian, gay, bisexual, and queer/questioning (LGBQ), and transgender/nonbinary (trans/NB) youth experience health disparities. Much research combines gender identity with sexual orientation or siloes them, ignoring intersections. Methods: Logistic regressions with representative data from 2015 Healthy Kids Colorado Survey (n?=?15,970) explores sexual risk. Results: Findings indicate LGBQ and trans/NB youth have differential levels of sexual risk (drugs during sexual interactions, not using condoms) compared to cisgender heterosexual peers. Other identities, mental health, and bullying are also related. Conclusions: There is a need for culturally responsive bullying prevention, mental health support, education, and sexual health services for marginalized populations.     

Avenues for Future Minority Stress and Substance Use Research among Sexual and Gender Minority Populations

Sexual and gender minority individuals (lesbian, gay, bisexual, transgender, queer [LGBTQ]) experience elevated rates of minority stress and associated substance use relative to their heterosexual and cisgender counterparts. Although the minority stress–substance use relationship is well documented, less is currently known regarding day-to-day minority stress and substance use risk processes. Rather than criticize existing literature, this review highlights future directions and advocates for the use of experience sampling methodology as a valuable research tool regarding real-time data capture. Greater utilization of this methodology is encouraged and expected to improve understanding of daily minority stress processes, and provide insight into real-time risk monitoring and intervention strategies.     

A Social Ecology of Bias-Based Bullying of Sexual and Gender Minority Youth: Toward a Conceptualization of Conversion Bullying

Homophobic bullying is pervasive and deleterious, and a source of extensive health and mental health disparities affecting sexual and gender minority youth (SGMY). Investigations conducted over the past two decades across the social ecology of SGMY indicate individual (e.g., gender), microsystem (e.g., schools), and exosystem level (e.g., community norms) factors associated with homophobic bullying. Emerging evidence at the macrosystem level demonstrates the powerful influence of laws, policies, and ideologies on the population health of sexual minority adults. Based on social ecological theory and emerging evidence at the macrosystem level, we advance a conceptualization of the religious social ecology of homophobic bullying and articulate the construct of conversion bullying, a form of bias-based bullying that may be unique to SGMY. Conversion bullying is manifested in the invocation of religious rhetoric and rationalizations in repeated acts of peer aggression against SGMY that cause harm, based on the premise that same-sex attractions and behaviors are immoral or unnatural and with implicit or explicit communication that one should change one's sexuality to conform to heteronormative ideals. We describe implications of conversion bullying for social work practice, education, social policy, and research.     

Self-Reported Gender Identity and Sexuality in an Online Sample of Cisgender,Transgender, and Gender-Diverse Individuals: An Exploratory Study

The relations between self-reported aspects of gender identity and sexuality were studied in an online sample of cisgender (n = 4,954), transgender (n = 406), and gender-diverse (n = 744) groups. Aspects of gender identity and sexual fantasies, attraction, behavior, and romantic relations were assessed using the Multi-gender Identity Questionnaire (Multi-GIQ) and a sexuality questionnaire. Results show a wide spectrum of gender experiences and sexual attractions within each group, an overlap among the groups, and very weak relations between atypical gender identity and atypical sexuality. At the group level, aspects of gender identity and sexuality were mainly predicted by gender and sex-gender configuration, with little contribution of sex assigned at birth. A principal component analysis (PCA) revealed that measures of gender identity and of sexuality were independent, the structure of sexuality was mostly related to gender, whereas the structure of gender identity was mostly related to sex-gender configuration. The results of both approaches suggest that measures of gender identity could roughly be divided into three classes: one including feeling as a man and feeling as a woman; a second including measures of nonbinary and “trans” feelings; and a third including feeling as a “real” woman and feeling as a “real” man. Our study adds to current scientific data that challenge dichotomous conventions within gender identity and sexuality research. Possible social and clinical implications are discussed.     

Bullying victimization,negative emotions,and substance use: utilizing general strain theory to examine the undesirable outcomes of childhood bullying victimization in adolescence and young adulthood

Bullying victimization has been directly associated with a variety of negative outcomes, but there are still many unknowns as to how deleterious emotional states resulting from victimization influence other undesirable events. The current study draws on Agnew’s general strain theory to examine multiple outcomes of youth victimized by repeated bullying prior to adolescence. Data from the National Longitudinal Survey of Youth 1997 were used to examine indicators of diminished moods and negative emotions on substance use for bullying victims in adolescence and again during young adulthood. Findings from various LISERL models indicate that bullying victimization directly increases diminished moods for males and females in adolescence. Additionally, childhood bullying victimization directly increases substance use in adolescence and young adulthood for males but not females. Finally, diminished moods in adolescence and negative emotions in young adulthood increase substance use for females but not for males. Policy implications and limitations for this analysis are discussed.     

Sexual Minority Women's Gender Identity and Expression: Challenges and Supports

Sexual minority women were divided into four groups to study their gender identities (butch and femme), and gender expression (traditionally gendered and non-traditionally gendered women who do not identify as butch or femme). Experiences of heterosexist events (discrimination, harassment, threats of violence, victimization, negative emotions associated with these events), mental health (self esteem, stress, depression), and supports for a sexual minority identity (social support, outness, internalized homophobia) were examined across these groups. Findings suggested that butch-identified women experienced more heterosexist events than femme women or women with non-traditional gender expressions. There were no differences in mental health variables.     

Gender Category and Gender Status: A Critical Distinction

Gender has been of explicit analytical interest in sociology for decades. Despite its centrality to the field, “gender” eludes conceptual specificity in significant ways, such as lacking distinction between gender category (identification as a man, woman, nonbinary, etc.) and gender status (the state of being cisgender or not). I contend that the cisgender status is a rich site of interpersonal and institutional power that has been understudied. This work forwards the concepts of gender category and status as analytical tools to help explore key elements of gender interaction and structure, such as cisness. I argue cisness must be teased out via the express distinction between gender category and status, and I provide empirical evidence from 75 interviews with various gendered actors (i.e., cisgender men, cisgender women, transgender men, transgender women, nonbinary individuals) to demonstrate the applied purchase of my findings.     

Bullying and Victimization: The Role of Conduct Problems and Psychopathic Traits

Bullying and victimization occurring in adolescence can have a long‐lasting negative impact into adulthood. This study investigates whether conduct problems (CP) and dimensions of psychopathy predict the developmental course of bullying and victimization from ages 12 to 14 among 1,416 Greek‐Cypriot adolescents. Results indicate that initial levels of bullying were highest among adolescents scoring high on narcissism, impulsivity, or CP—particularly for those also showing high callous‐unemotional (CU) traits. Bullying behaviors were also more stable among youth scoring high on narcissism. Further, youth high on impulsivity showed more stable victimization by peers across development. Importantly, adolescents high on CP+CU were at greater risk for engaging in bullying across development compared with those scoring lower on CU traits or CP.     

Taking Over the School: Student Gangs as a Strategy for Dealing with Homophobic Bullying in an Urban Public School District

SUMMARY

This article discusses the African American lesbian gang, DTO (Dykes Taking Over), as an example of a student-initiated strategy for dealing with homophobic bullying in an urban American school district. A series of alleged incidents of same-sex sexual harassment by gang members on heterosexual students illustrate how lesbian/bisexual threat was used by these women to re-establish a power differential after they experienced bullying based on their sexuality and gender expression. A series of alleged incidents of same-sex sexual harassment by gang members on female heterosexual students illustrate how gay/bisexual threat was used by these women to re-establish a power differential after they experienced bullying based on their sexuality and gender expression. This article considers how these students were reacting, perhaps preemptively and in retaliation, to homophobia in their schools, particularly from their peers, forming gangs and using same sex sexual harassment of other students as a weapon against homophobia and a means by which they could assert themselves in their masculinities, not unlike their male peers who experience same sex bullying and/or harassment and use anti-female sexual harassment to assert their masculinity. Intersections of gender, race, ethnicity, class, and sexuality frame several major questions that arise from these considerations, including: Might their masculinities be uniquely related to their performances of bullying? (How) could homophobic bullying be framed with sexual harassment in both policy and practice? Would this framing benefit or harm students who are bullied? How would/does that change the way we can handle it in schools (i.e., school policies), if at all? Implications for school-based practitioners are discussed with regard to how these students' behavior might be the result of a lack of programs and services available for LGBTQ and same gender loving youth both in and after school.     

A Two-Question Method for Assessing Gender Categories in the Social and Medical Sciences

Three studies (N = 990) assessed the statistical reliability of two methods of determining gender identity that can capture transgender spectrum identities (i.e., current gender identities different from birth-assigned gender categories). Study 1 evaluated a single question with four response options (female, male, transgender, other) on university students. The missing data rate was higher than the valid response rates for transgender and other options using this method. Study 2 evaluated a method of asking two separate questions (i.e., one for current identity and another for birth-assigned category), with response options specific to each. Results showed no missing data and two times the transgender spectrum response rate compared to Study 1. Study 3 showed that the two-question method also worked in community samples, producing near-zero missing data. The two-question method also identified cisgender identities (same birth-assigned and current gender identity), making it a dynamic and desirable measurement tool for the social and medical sciences.     

Factors predicting student intervention when witnessing anti-LGBTQ harassment: The influence of peers,teachers, and climate

Bullying and harassment are systemic problems in schools, especially for sexual minority youth. Previous research suggests the importance of addressing student intervention in cases of bullying, but little is known about how to encourage this kind of intervention, particularly in response to anti-LGBTQ bullying. The present study used data collected through a participatory action research project to examine three factors' impact on students' intentions to intervene: hearing homophobic language, seeing teachers intervene, and seeing other students intervene. In the final model, seeing other students intervene (β = .19, p < .001) had a more significant positive effect on a students' own likelihood to intervene than seeing teachers intervene (β = .07, p < .05). In multivariate analysis, frequency of hearing homophobic language did not impact student's likelihood to intervene. Findings suggest the importance of youth leadership in multi-level anti-bullying programs.     

Bullying among urban Mexican-heritage youth: Exploring risk for substance use by status as a bully,victim, and bully-victim

Little is known about adolescent bullying behavior and its relationship to substance use in ethnic minority populations. In a sample of youth of Mexican heritage, the current study aimed to examine the prevalence of bullying behavior subtypes and its co-occurrence with recent alcohol, cigarette, and inhalant use. Data come from a school-based substance use prevention study in the Southwestern U.S. (n = 809). We explored the prevalence of bullying behavior by status among youth classified as bullies, victims, bully-victims, and rarely-involved bully-victims in an urban context. We also investigated risk of past 30-day use of alcohol, cigarettes, and inhalants by bullying behavior status. Compared to non-involved youth, rarely-involved bully-victims were more likely to use alcohol, bullies were more likely to engage in alcohol and cigarette use, and bully-victims were more likely to use alcohol, cigarettes, and inhalants. In contrast, victims were not significantly at risk of substance use compared to non-involved youth. Chronic bullies and bully-victims are particularly at risk for substance use, with chronic bully-victims reflecting the greatest risk of using multiple substances. Prevention and early intervention programs aimed to reduce bullying can also work to decrease other risky behaviors, such as substance use, and should attend to the growing ethnic diversity among youth.     

Parent-Adolescent Ethnic Identity Discrepancies and Adolescent Psychosocial Maladjustment: A Study of Gender Differences

The purpose of this study was to examine the influence of parent–adolescent ethnic identity disparities on the psychosocial adjustment of an ethnically diverse sample (n = 174, female = 96) of adolescents (M = 16.05, SD = 1.30). Findings from this investigation suggest gender differences in links between parent and adolescent acculturation disparities and psychosocial maladjustment. Whereas parent–child conflict regarding affiliating with the dominant group was associated with higher levels of depression and social stress for females, this was not the case for males. Implications for social workers providing services to youth and families struggling to acculturate are discussed.     

The Role of Distal Minority Stress and Internalized Transnegativity in Suicidal Ideation and Nonsuicidal Self-Injury Among Transgender Adults

Transgender people are at elevated risk for nonsuicidal self-injury (NSSI) and suicidal ideation compared to the general population. Transgender (trans) refers to a diverse group of people who experience incongruence between their gender identity and sex assigned at birth. The present study is guided by the minority stress model and the psychological mediation framework, which postulate that sexual minority groups experience elevated stress as a result of anti-minority prejudice, contributing to negative mental health outcomes. This study utilized these theories to investigate the role of internalized transnegativity—internalization of negative societal attitudes about one’s trans identity—in the relationships of distal trans stress to suicidal ideation and NSSI. A U.S. national sample of trans adults (N = 237) completed a battery of online measures. Structural equation modeling (SEM) was used to compare models with mediation and moderation effects. Results suggested that internalized transnegativity acts as both a mediator and a moderator in the relationship between distal trans stress and suicidal ideation. Log likelihood comparisons suggested moderation models had the superior fit for these data. Results suggest that clinical interventions should directly target individuals’ internalized transnegativity as well as societal-level transnegativity.