Mental Health Needs of People Who Identify as Transgender: A Review of the Literature

Transgender people face many challenges in society including accessing and using healthcare systems. However, little is known about the specific mental health service needs and concerns of transgender people in this regard. The aim of the study was to establish the mental health service needs of transgender people through a review of relevant studies that address the experiences and views of this group. A comprehensive search of CINHAL, Cochrane, Google Scholar, PubMed, PsychInfo, PsychLit, Sociological Abstracts, Scopus, and Web of Science databases from inception to January 2014 was conducted. Studies were identified that met specific criteria that included: using qualitative methods, involving transgender people, and addressing issues related to mental health services. The search yielded 217 papers in total. Following the application of rigorous inclusion and exclusion criteria 33 papers were included for retrieval. Finally, 10 papers were considered suitable for the review. The data were analyzed and key themes identified. The review highlighted distinct challenges that exist in terms of mental health service provision. These included accessing appropriate services and treatments, responsiveness of practitioner's, the provision of family supports and potential mental health service developments. The review findings are discussed and key recommendations are made in terms of mental health nursing practice developments, education and research

The design and development of an online education program for families of trans young people

Education programs can help families of trans young people to accept and support a trans family member. However, little has been written about the design and development of such programs. This article seeks to fill this gap in the literature by detailing the design and development of an education program for families of trans young people. A seven-step learner-centered, outcomes-based approach was used as the basis for program design and development. The process also included participatory elements throughout, including input from professionals, families, and trans young people in a consultation and evaluation process. This culminated in the development of an eight-module online education program. The approach presented in this article may be of value to anyone interested in developing an education resource for families of trans young people, and it would be recommended to consider how such an approach could be applied in a specific context. The program also provided an opportunity for involvement from professionals, families, and trans young people in the community, and it would be important for anyone working in the area to consider how such participation could be both enhanced and enabled

A Mixed-Methods Evaluation of a Gender Affirmative Education Program for Families of Trans Young People

Research evidence suggests that education can play an important role in a family’s acceptance and support of a trans(gender) young person. However, there is a lack of robust evidence around the impact of education programs for these families. This article reports the findings of a mixed-methods evaluation of an online education program developed for families of trans young people. Surveys were administered before and after participation in the education program to assess the impact of the program on several measures, including trans-related knowledge, self-reflection and insight, family problem-solving, family communication, self-efficacy, and views of gender identity. Interviews were used to explore family members’ experiences of the program, its perceived impact, and recommendations for further development. The survey findings revealed a statistically significant increase in knowledge scores from the pre-education program to post-education program. Interview participants felt the education program was accessible and easy to use and the majority reported learning about trans-related issues from the program. Fewer participants reported developing skills around self-reflection, problem-solving, and communication following participation in the program. The findings from this evaluation add to the evidence base concerning the efficacy of education for families of trans young people, with further implications and recommendations highlighted

Education Needs of Families of Transgender Young People: A Narrative Review of International Literature.

Education plays a crucial role in the lives of families of transgender young people and mental healthcare practitioners are well-placed to support families in this regard. This paper reports findings from a narrative review of 31 papers that explored the education needs of families of transgender young people. The emergent themes were synthesised to develop a five-stage model that depicts the role of education in the lives of these families. Key themes included: (i) learning that a family member is trans; (ii) family responses; (iii) accessing education and information; (iv) impact on the individual; and (iv) moving beyond the individual. The key implications for mental health practitioners, families, and future research are discussed

Older LGBT people's experiences and concerns with healthcare professionals and services in Ireland

BACKGROUND: The specific healthcare needs and concerns for older lesbian, gay, bisexual and transgender (LGBT) persons have not been explored to any degree within Ireland. AIMS AND OBJECTIVES: The aim of this paper, which is part of a larger study, is to detail older LGBT persons' usage, experiences and concerns with accessing healthcare services, disclosing their LGBT identity to professionals, preferences for care and their suggestions for improvement in services, including nursing services. DESIGN: A mixed methods research design combining quantitative survey and qualitative interview approaches of equal significance was used. METHODS: 144 respondents completed an 84-item questionnaire concerning their use of healthcare services, experiences and needs. The qualitative phase involved in-depth interviews where 36 participants' experiences and concerns around health services were explored more in-depth. Quantitative data were analysed using descriptive statistics. Qualitative analysis employed the constant comparative process to generate the leading themes. RESULTS: Only one in three participants believed that healthcare professionals have sufficient knowledge of LGBT issues, and less than half (43%) felt respected as an LGBT person by healthcare professionals. Although 26% had chosen not to reveal their LGBT status for fear of a negative response, many positive encounters of coming out to healthcare professionals were relayed in the interviews. LGBT persons have specific concerns around residential care, particularly in relation to the perception that the Irish healthcare services emanate a heteronormative culture. CONCLUSIONS: Irish healthcare services need to reflect on how they currently engage with older LGBT persons at both an organisational and practitioner level. Consideration needs to be given to the specific concerns of ageing LGBT persons, particularly in relation to long-term residential care. IMPLICATIONS FOR PRACTICE: Healthcare practitioners need to be knowledgeable of, and sensitive to, LGBT issues

Lesbian, gay, bisexual and transgender older people in Ireland: Mental health issues

International policy initiatives have highlighted the need to include older lesbian, gay, bisexual and transgender (LGBT) issues in the provision of appropriate health and social care. However, empirical studies in the area remain sparse. The aim of this study was to investigate the experiences and needs of LGBT people over the age of 55 years living in Ireland and this article reports on specific mental health issues. Mixed methods were used involving 144 surveys and 36 semi-structured in-depth interviews. The findings revealed that a significant number of the survey respondents had experienced a mental health problem at some point in their lives with interview participants providing further details of their concerns. It is recommended that policy makers address the mental health needs of older LGBT people in future strategic directives and develop standards of care that support the principles of equality, inclusion and respect for diversity

Capacity Building Impact of the Foundation Programme in Sexual Health Promotion: A Multiple Stakeholder Perspective.

Today, there is widespread agreement that investment in comprehensive sexuality education is critical if as a society we wish to promote sexual health amongst citizens. To this end, in addition to investing in sexual health education, there is an international, national and regional recognition that part of that investment must be in the area of capacity building, which is a key feature of sustainable and effective health promotion. Building capacity increases the range of people, organisations and communities who are able to address health problems, and increases critical problem solving and collaboration within and across organisations, thus multiplying health gains. Similar to international trends, within Ireland the importance of sexual health promotion has been identified as a priority in a number of policy documents and research reports. In addition, there is a move from an issues-driven focus on unintended pregnancy, crisis pregnancy and sexually transmitted infections to a broader multi-sectoral and multidisciplinary concentration on the determinants of sexual health, other forms of sexual health promotion, and sexual health capacity building. However, despite this, there is a limited knowledge base evaluating the outcomes of education and training for those involved in sexual health promotion for capacity building, within both the national and international literature. The focus of this report is the evaluation of the Foundation Programme in Sexual Health Promotion (FPSHP). The FPSHP was developed by staff within the southern region of the Irish Health Service Executive (HSE) in response to an identified need for a more comprehensive programme to develop the sexual health promotion capacity of health, education and community workers in this region. The overall aim of the FPSHP is to enhance participants’ capacity to incorporate sexual health promotion into their work through the development of their comfort levels, confidence, knowledge and skills in relation to sexual health. The programme is comprised of ten days education, with five, two-day sessions spread over four to five months. Between 2009 and the summer of 2012, when the evaluation process began, 12 programmes had been delivered in three HSE South regions. In total, 200 participants completed the programme, drawn from a variety of health, education and social care backgrounds. The evaluation study aimed to: - evaluate the effectiveness of the FPSHP (and its support activities) in building capacity amongst health, education and community professionals with regard to the promotion of sexual health within HSE South; and - establish whether the FPSHP demonstrated sufficient promise in relation to its contribution to sexual health promotion capacity building to warrant a further feasibility study regarding its extension beyond HSE South

Visible Lives: Identifying the Experiences and Needs of Older LGBT People in Ireland

Huge progress has been made in recognising and supporting lesbian, gay, bisexual and transgender (LGBT) people in Ireland. In the space of twenty years we have seen the decriminalisation of homosexuality and the introduction of a sophisticated equality infrastructure, with the Employment Equality Act 1998 and the Equal Status Act 2000 having been at the forefront internationally in naming sexual orientation as a specific equality ground and in extending its scope outside the field of employment. More recently, in 2010 comprehensive Civil Partnership legislation was introduced and the Government is determined to bring forward legislation later this year to provide for the recognition of the acquired gender of transgender people, on the basis of the recommendations of the Gender Recognition Advisory Group published in June. This report is the first comprehensive study of the lives of older LGBT people in Ireland. It offers unique insights into the lives of those people who have lived through and been most personally affected by these changes in Irish society. It shows the negative consequences for LGBT people of living through a period where a fundamental aspect of their identity - to be themselves and to live openly and securely with the person they love - was stigmatised, criminalised or even viewed as an illness

Isolated nuclei adapt to force and reveal a mechanotransduction pathway in the nucleus

Mechanical forces influence many aspects of cell behavior. Forces are detected and transduced into biochemical signals by force bearing molecular elements located at the cell surface, in adhesion complexes or in cytoskeletal structures1. The nucleus is physically connected to the cell surface through the cytoskeleton and the linker of nucleoskeleton and cytoskeleton (LINC) complex, allowing rapid mechanical stress transmission from adhesions to the nucleus2. Whereas it has been demonstrated that nuclei experience force3, the direct effect of force on the nucleus is not known. Here we show that isolated nuclei are able to respond to force by adjusting their stiffness to resist the applied tension. Using magnetic tweezers, we found that applying force on nesprin-1 triggers nuclear stiffening that does not involve chromatin or nuclear actin, but requires an intact nuclear lamina and emerin, a protein of the inner nuclear membrane. Emerin becomes tyrosine phosphorylated in response to force and mediates the nuclear mechanical response to tension. Our results demonstrate that mechanotransduction is not restricted to cell surface receptors and adhesions but can occur within the nucleus