Experiences of LGBTIQ+ Population within Healthcare Contexts

Although research on the health of lesbian, gay, bisexual, transgender, intersex (LGBTI+) populations is expanding rapidly, including a focus on social and health policies, research on the experiences of LGBTI+ people within healthcare contexts needs to be deepened and expanded. Indeed, social acceptance of LGBTI+ people has been improving in the last decades, but they continue to face stigma and discrimination (Gallup, 2016; Grant et al., 2011; Scandurra et al., 2017). Stigmatizing experiences, combined with a lack of access to a culturally-affirming health care, result in a disadvantaged social status and health disparities for LGBTI+ population (Fredriksen-Goldsen et al., 2014; Reisner et al., 2014). To this end, many LGBTI+ people still avoid healthcare contexts for fear of discrimination from healthcare providers or because they feel the lack of healthcare professional knowledge and negative views of LGBTI+ individuals (Krehely, 2009). For instance, approximately 30% of LGBTI+ adults do not have access healthcare services or lack a regular healthcare provider (Winter, 2012). Furthermore, LGBTI+ people are more likely to avoid healthcare contexts compared to heterosexual counterparts, delaying proper treatments and, thus, resulting in negative health outcomes (Shields et al., 2012). Despite subjective experiences of LGBTI+ people within healthcare contexts, structural barriers (e.g., binary male/female medical record identification system, financial barriers, lack of equality signs and gender-neutral language, etc.) significantly contribute to the delay or avoidance of seeking healthcare (Roberts & Fantz, 2014). Indeed, the structural/institutional stigma is embedded within some health organizations due to the existence of laws and regulations that not guarantee full equality for LGBTI+ populations. On the other hand, many healthcare providers still have little knowledge about the specific health needs of this population (Roberts & Fantz, 2014), resulting in non-affirmative and competent provision of care. Thus, a more accurate understanding of the quality of care received and perceived by LGBTI+ population represents a fundamental social issue and a central focus for reducing health inequalities. It means that it is an urgent to provide affirmative and inclusive healthcare services for LGBTI+ people. The current thematic issue of the puntOorg International Journal intended to answer this need focusing on the experiences of LGBTI+ people within healthcare contexts. To this end, we were able to collect scientific contributions from multidisciplinary viewpoints. Specifically, the contribution by Annalisa Anzani (University of Milano Bicocca) reviews recent literature on microaggressions toward transgender and gender nonconforming (TGNC) individuals. The critical review offered by Annalisa Anzani is particularly focused on the emotional, cognitive, and behavioral reactions to microaggressions, as well as on the detrimental effects that microaggressions towards TGNC people have on their health and wellbeing. The work ends with some reflections on the affirmative psychological practice with TGNC individuals. The contribution by Emanuele Maria Merlo, Fabio Frosinone, and Salvatore Settineri (University of Messina) addresses again TGNC experiences within healthcare contexts, but from a different point of view. Indeed, the authors address their psychological-clinical experiences with transgender people who have access to the gender identity clinic of the University Hospital G. Martino in Messina, paying specific attention to the “clinical contact” from a theoretical perspective which embraces both the phenomenology and the life-course framework. The paper by Andrea Pennasilico and Anna Lisa Amodeo (University of Naples Federico II), instead, reviews critically recent literature on bisexual health. In particular, authors presents a critical review on 3 main areas: (1) stigma towards bisexual population; (2) health of bisexual people and its interface with stigma; and (3) experiences of bisexual people within healthcare contexts. The article by Joshua Minh Quach (New York University) explores qualitatively the lived-experiences of 20 men who have sex with men (MSM), divided in two age-cohorts (18-49 and 50+ ages). Specifically, the author provides an interesting comparison between these cohorts concerning their patient-provider relationships and assessing differences and similarities in healthcare experiences with regard to social trauma, medical trauma, and their proximity to the 1980s AIDS crisis. Finally, the contribution by Davide Bizjak (University of Naples Federico II), from an organizational perspective, addresses inclusive organizational practices for TGNC people, proposing a model centered on the relationship between transition stages and work status. This model may be applied to healthcare contexts, if interpreted as complex organizations. The editors hope this collection of scientific papers will expand the topic on the healthcare experiences of LGBTI+ individuals, drawing the attention of both scholars and policymakers. Indeed, this thematic issue highlights the need of promoting a culturally-affirming health care for LGBTI+ people, removing both individual and structural barriers which produce health disparities and drastically increase the psycho-social risk of developing negative health outcomes

“Emotional Nose”: The Hedonic Character of Olfaction and its Epistemological and Clinical Implications

The olfactory system is the oldest device that most organisms have to perceive their physical and social environment. However, progressing in the evolutionary tree, the importance of the olfactory perception has decreased, and the sight has taken dominance. Notwithstanding, the olfaction still plays a fundamental role, as it is strictly associated with emotions, which are a medium between perception and behavior. The current work aims at addressing the hedonic character of the olfaction, showing its strong clinical implications for clinical psychology, neuropsychology, and CogInfoCom

Minority stress e transgenderismi. Effetti dello stigma vissuto ed interiorizzato e dei fattori protettivi sulla salute mentale di un campione di persone transgender italiane

Le persone transgender vivono violenze ed oppressioni continue e sistematiche a causa della propria non conformità di genere rappresentando una popolazione altamente stigmatizzata e a rischio di esperire problematiche di salute mentale. Un modello teorico di grande utilità per comprendere le cause di queste problematiche e gli effetti dello stigma sociale è quello del minority stress (Meyer, 1995; 2003; 2007). Nonostante ciò, fino a pochissimi anni fa, le persone transgender sono state inspiegabilmente lasciate fuori dalle ricerche che si sono occupate di studiare gli effetti di questo particolare stress sulla salute mentale. È solo di recente che si è cominciato ad applicare questo modello alle differenti identità transgender (Bockting et al., 2013; Hendricks & Testa, 2012). In Italia, contrariamente agli USA, studi applicativi di questo modello indirizzati alla popolazione transgender sono ancora molto scarsi. Il presente lavoro di ricerca, di natura quantitativa, si è proposto di applicare il modello del minority stress ad un campione di persone transgender italiane (N = 149), analizzando gli effetti dello stigma vissuto ed interiorizzato e dei fattori protettivi sulla salute mentale. I risultati sostengono la validità teorica e clinica dell'utilizzo di questa prospettiva per meglio comprendere gli effetti diretti ed indiretti della violenza sulla salute mentale delle persone transgender. Uno sguardo particolare è stato indirizzato al ruolo della transfobia interiorizzata, lo stressor più soggettivo ed insidioso la cui presenza aumenta di gran lunga la possibilità di sviluppare problematiche di salute mentale. I risultati ottenuti nel presente lavoro di ricerca sono stati, infine, analizzati nel loro risvolto psicologico-clinico, discutendone le implicazioni legate agli interventi di counselling e/o di psicoterapia rivolti alle persone transgender

Desire for Genital Surgery in Trans Masculine Individuals: The role of Internalized Transphobia, Transnormativity and Trans Positive Identity

Some trans people experience gender dysphoria, which refers to psychological distress that results from an incongruence between one’s gender assigned at birth and one’s gender identity. People who are trans masculine or nonbinary assigned-female-at-birth may pursue multiple domains of gender affirmation, including surgical affirmation (e.g., masculine chest reconstruction, penile reconstruction, etc.). The present study aimed to investigate the possible factors involved in trans people’s desire to undergo gender-affirming genital surgery. Trans masculine and nonbinary participants (N = 127; mean age = 26.90) were recruited through a web-based survey and completed self-report instruments (i.e., the Internalized Transphobia subscale of the Gender Minority Stress and Resilience Measure, the Trans Positive Identity Measure, the Gender Congruence and Life Satisfaction Scale, an ad hoc scale on transnormativity, and a single-item on desire to undergo genital affirmation surgery). A path analysis showed that higher levels of internalized transphobia led to more significant genital discomfort via a dual parallel mediation of transnormativity and positive identity. Moreover, this genital discomfort fueling pattern was the most significant predictor of the desire to undergo genital surgery as the effect of internalized transphobia was fully mediated by increased genital discomfort. Findings are discussed in the light of the recent strand of research on gender dysphoria as a multifaceted construct, with social components

Olfactory-related quality of life impacts psychological distress in people with COVID-19: The affective implications of olfactory dysfunctions

Background Coronavirus disease 2019 (COVID-19) often causes chemosensory impairment, and olfactory dysfunctions may have negative consequences on psychological distress. This study aimed at assessing which dimension of perceived olfactory disfunctions (i.e., subjective olfactory capability, smell-related problems, or olfactory-related quality of life [QoL]) was most associated with psychological distress in people diagnosed with COVID-19. Methods 364 participants (65 men and 299 women) diagnosed with COVID-19 on average 7 months prior to the beginning of the study were recruited between June 5 and 21, 2021, to take part in an online cross-sectional survey. Participants answered questions on demographics, clinical factors, perceived olfactory functioning, and psychological distress. Hierarchical multiple linear regression analysis was conducted, assessing the role of demographics, clinical factors, and perceived olfactory functioning dimensions on psychological distress. Results More than half of the participants met the cut-off for all perceived olfactory dysfunctions scales and psychological distress. Being women, smoker, with comorbidities, and greater severity of COVID-19 symptoms were associated with higher scores on psychological distress. Among perceived olfactory functioning scales, only impairment in olfaction QoL was associated with psychological distress. Limitations Limitations concerned the cross-sectional nature of the study and the unbalanced sample in terms of gender. Conclusions The study confirmed the core intertwining between mood, perceived QoL, and olfactory functioning, showing how impairments in olfactory processing are strongly correlated with psychological distress through the impact they have on the perceived QoL

An Animal-Assisted Education Intervention with Dogs to Promote Emotion Comprehension in Primary School Children—The Federico II Model of Healthcare Zooanthropology

Emotion comprehension (EC) is a crucial competence for children, as it determines the quality of peer interactions. This study assessed the efficacy of an animal-assisted education (AAE) intervention with dogs based on the Federico II Model of Healthcare Zooanthropology (FMHZ) to promote EC in a group of primary school children. One hundred and four children (48 females) aged 6–7 years took part in the study, of whom 63 participated in the AAE intervention (i.e., experimental group) and 41 did not (i.e., control group). The intervention was deployed in a school setting through a group format and consisted of five bimonthly sessions. EC was assessed pre- and post-intervention, and at a 3-month follow-up. Student’s t-test and mixed-model ANOVA were performed to analyze the effect of the intervention on EC. EC significantly improved in children of the experimental group compared to the control group. Significant time effects from pre- to post-intervention, post-intervention to follow-up, and pre-intervention to follow-up assessment were found in the experimental group only. AAE based on FMHZ was effective in improving EC in children

Experiences of life and intersectionality of transgender refugees living in Italy: A qualitative approach

Transgender refugees are at risk of experiencing increased minority stress due to experiences of trauma in their country of origin, and the intersection of multiple marginalized identities in their host country. Adopting a transfeminist and decolonial approach, the present study aimed at exploring transgender refugees’ experiences of life and migration. A semi-structured interview protocol was developed, grounded in the perspectives of minority stress and intersectionality. Participants were five transgender refugees (four women and one non-binary) from different cultural/geographic contexts, professing different religions. Using thematic analysis, the researchers identified three themes: pre- and post-migration minority stress and transphobia; religion as a protective factor for gender affirmation; and individuation and the synthesis of social identities. Participants reported traumatic experiences and the inability to openly live out their gender identity in their country of origin as the main push factors to migration. They also reported feelings of isolation and experiences of victimization during interactions with the Italian asylum services, due to a lack of adequate training, racial prejudice, and transphobia. Participants demonstrated positive individuation, linked to gender affirmation treatments and religious protective factors. The interview protocol may be used by social operators to support the claims of transgender asylum seekers, and to clinically assess transgender people with an immigrant background

Right-Wing Authoritarianism and Antipathy Toward Immigrants and Sexual Minorities in the Early Days of the Coronavirus Pandemic in Italy

Theory and research in social, evolutionary, and political psychology indicates that subjective feelings of threat and exposure to objectively threatening circumstances—including pandemic diseases—may contribute to increased affinities for political conservatism, right-wing authoritarianism, and prejudice against out-group members. We investigated these possibilities in the context of Italy, which was the first Western country to be severely affected by the spread of COVID-19. Early on in the pandemic, from March 3–8, 2020, we surveyed 757 Italian adults ranging in age from 18 to 78 years. Results revealed that antipathy toward immigrants and sexual minorities was predicted by (male) sex, COVID-19 anxiety, RWA, and political distrust. Furthermore, COVID-19 anxiety magnified the effect of RWA on disliking of immigrants and sexual minorities (but not obese or disabled people). Contrary to prediction, political trust failed to attenuate the effects of COVID-19 anxiety or RWA on out-group antipathy. Implications for the theories of right-wing authoritarianism and political ideology as motivated social cognition, as well as the state of contemporary Italian politics are discussed

The role of internalized transphobia, loneliness, and social supportin thepsychological well-being of a group of Italian transgender and gender non-conforming youths: A moderated-mediation model

The contribution investigates the quality of life of transgender and gender non-conforming (TGNC)people in according to the support received from social and family context. Although TGNC youth represent a highly resilient community capable of successfully overcoming adverse life circumstances, they still experience social stigma that negatively impacts their health (Molnar, 2018), especially if approached to the possibility of being rejectedby the family and peer group.An additional risk is represented by the common idea that the sex assigned at birth must be aligned with gender identity (Nadal et al., 2012) on which the support (Lev, 2013) can play a role as a moderator. Objectives of thisresearch are:1) evaluating how internalized transphobia (IT) and loneliness are correlated withthe quality of life; 2) clarifying whether social support would act as a protective factor in the quality of life of research participants. The research used a multimethod approach through a questionnaire divided into 5 sections including 4 different scales (Warwick–Edinburgh Mental Well-being Scale; Gender Minority Stress and Resilience Scale; Multidimensional Scale of Perceived Social Support; Scala Revised University of California at Los Angeles Loneliness Scale). Thus, within the framework of the minority stress, this paper aims to investigate the role of loneliness as a mediator of the relationship between IT and psychological well-being (PW), as well as the moderating role of social support. A total of 79 Italian TGNC youths (45 binary and 34 non binary) aged 18 to 30 years (M = 23.73, SD = 3.59) participated in an online survey. A moderated mediation model was tested using the PROCESS Macro for SPSS with gender identity and age as control variables. Results showed that: (1)IT was negatively associated with PW(b = -0.03, p = 0.001); (2) IT was positively associated with loneliness (b = 0.03, p< 0.001); (3) loneliness was negatively associated with PW(b = -0.49, p = 0.001); and (4) loneliness partially mediated the relationship between IT and PW(b = -0.19, p = 0.006). In addition, social support proved to be a significant moderator, as the effect of IT on PW decreased with moderate (b = -0.03, 95% C.I. [-0.04, -0.01], p = 0.001) and high social support (b = -0.04, 95% C.I. [-0.06, -0.01], p < 0.001), but not with low (p< 0.05). Other clinical and social implications of our findings are discussed in terms of individual, interpersonal, and structural stigma.Based on our findings, it is advisable both to expand the social network, promoting intimate and community relationships, and to take charge, on a clinical level, of the experiences of loneliness that can become radicalized over time also through the early experiences of one's personal and family history

Negative Affectivity, Authoritarianism, and Anxiety of Infection Explain Early Maladjusted Behavior During the COVID-19 Outbreak

During the first phase of the COVID-19 outbreak, Italy experienced problems of public order and maladjusted behavior. This study assessed the role of negative affectivity, right-wing authoritarianism, and anxiety of COVID-19 infection in explaining a variety of the maladjusted behaviors (i.e., “China-phobic” discrimination, panic buying) observed with an Italian sample. Specifically, we examined the effect of Negative Affectivity and Right-Wing Authoritarianism on maladjusted behaviors, and the moderating role of anxiety of infection. Seven hundred and fifty-seven Italian participants completed an online survey between March 3rd to the 7th 2020, which was immediately before the lockdown. A moderated-mediation model was tested using a structural equation modeling approach. Results indicated that both Negative Affectivity and Right-Wing Authoritarianism were positively associated with COVID-19-related maladjusted behavior, and that Right-Wing Authoritarianism mediated the relationship between Negative Affectivity and maladjusted behavior. Furthermore, the effect of Right-Wing Authoritarianism on maladjusted behavior was greater for those with high anxiety of infection, and the indirect effect of Negative Affectivity on maladjusted behavior through Right-Wing Authoritarianism was moderated by infection anxiety. Findings highlight potential psychological paths that may inform communication strategies and public health initiatives aimed at promoting healthy behavior during an outbreak