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      Relationships between internalized stigma and depression and suicide risk among queer youth in the United States: a systematic review and meta-analysis

      systematic-review

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          Abstract

          Background

          Queer youth experience high rates of depression and suicidality. These disparities stem from stigma-based stressors, including internalized stigma (i.e., negative social views that minoritized individuals internalize about their own identity). Given the importance of this factor in understanding mental health disparities among queer youth, we completed a systematic review and meta-analysis examining the relationships between internalized stigma and outcomes of depression and suicide risk (i.e., suicidal ideation, non-suicidal self-injury, and suicidal behavior).

          Methods

          We followed the PRISMA standards. Six bibliographic databases were searched for studies in the United States from September 2008 to March 2022. Dual independent screening of search results was performed based on a priori inclusion criteria.

          Results

          A total of 22 studies were included for data extraction and review. Most studies examined general internalized homophobia, with few examining internalized biphobia or transphobia. Many studies examined depression as an outcome, few studies examined suicidal ideation or behavior, and no studies examined non-suicidal self-injury. Meta-analyses model results show the association between general internalized queer stigma and depressive symptoms ranged r = 0.19, 95% CI [0.14, 0.25] to r = 0.24, 95% CI [0.19, 0.29], the latter reflecting more uniform measures of depression. The association between internalized transphobia and depressive outcomes was small and positive ( r = 0.21, 95% CI [−0.24, 0.67]). General internalized queer stigma and suicidal ideation had a very weak positive association ( r = 0.07, 95% CI [−0.27, 0.41]) and an even smaller, weaker positive association with suicide attempt ( r = 0.02, 95% CI [0.01, 0.03]).

          Conclusion

          Implications for clinical practice, policy, and future research are discussed.

          Related collections

          Most cited references86

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          The PRISMA 2020 statement: An updated guideline for reporting systematic reviews

          The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement, published in 2009, was designed to help systematic reviewers transparently report why the review was done, what the authors did, and what they found. Over the past decade, advances in systematic review methodology and terminology have necessitated an update to the guideline. The PRISMA 2020 statement replaces the 2009 statement and includes new reporting guidance that reflects advances in methods to identify, select, appraise, and synthesise studies. The structure and presentation of the items have been modified to facilitate implementation. In this article, we present the PRISMA 2020 27-item checklist, an expanded checklist that details reporting recommendations for each item, the PRISMA 2020 abstract checklist, and the revised flow diagrams for original and updated reviews.
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            Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence.

            Ilan Meyer (2003)
            In this article the author reviews research evidence on the prevalence of mental disorders in lesbians, gay men, and bisexuals (LGBs) and shows, using meta-analyses, that LGBs have a higher prevalence of mental disorders than heterosexuals. The author offers a conceptual framework for understanding this excess in prevalence of disorder in terms of minority stress--explaining that stigma, prejudice, and discrimination create a hostile and stressful social environment that causes mental health problems. The model describes stress processes, including the experience of prejudice events, expectations of rejection, hiding and concealing, internalized homophobia, and ameliorative coping processes. This conceptual framework is the basis for the review of research evidence, suggestions for future research directions, and exploration of public policy implications.
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              Introduction to Meta-Analysis

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                Author and article information

                Contributors
                Journal
                Front Psychiatry
                Front Psychiatry
                Front. Psychiatry
                Frontiers in Psychiatry
                Frontiers Media S.A.
                1664-0640
                20 July 2023
                2023
                : 14
                : 1205581
                Affiliations
                [1] 1School of Social Work, University of North Carolina , Chapel Hill, NC, United States
                [2] 2Brown School of Social Work at Washington University , St. Louis, MO, United States
                Author notes

                Edited by: Yan Wang, University of Florida, United States

                Reviewed by: Kavita Batra, University of Nevada, Las Vegas, United States; Victor J. Avila-Quintero, Yale University, United States

                *Correspondence: Denise Yookong Williams dyookong@ 123456ad.unc.edu
                Article
                10.3389/fpsyt.2023.1205581
                10399219
                7f73dfeb-0b67-43e8-b622-53c9f83521b6
                Copyright © 2023 Williams, Hall, Dawes, Srivastava, Radtke, Ramon, Bouchard, Chen and Goldbach.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 14 April 2023
                : 30 June 2023
                Page count
                Figures: 0, Tables: 2, Equations: 0, References: 103, Pages: 13, Words: 11738
                Funding
                The authors of this article were supported by an award (R01MD015109) from the National Institute of Minority Health and Health Disparities of the National Institutes of Health in the creation of this scholarship.
                Categories
                Psychiatry
                Systematic Review
                Custom metadata
                Public Mental Health

                Clinical Psychology & Psychiatry
                lgb,queer,transgender,sexual minority,internalized stigma,internalized homophobia,youth,adolescents

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