A new transgender divide

June 21, 2022

By Don Sapatkin

Hello, MindSite News readers! In today’s edition of the Daily: A battle rages among providers of transgender care over upcoming guidelines. Conservative states that reject Medicaid expansion are nevertheless extending popular postpartum Medicaid coverage. A researcher in Kenya seeks to reduce the stigma of mental health disorders through the music of call and response.

And then there’s this fun fact: Preliminary research aimed at improving the physical and mental health of zoo animals found that certain New World monkeys prefer audio over visual stimuli – think Spotify vs. Netflix – by a factor of two to one.

Doctors divided over gender therapy guidelines

A long story in the New York Times Sunday magazine looks at the rapid increase in the number of young people seeking gender transition – and a growing debate about how and when they should be helped. As the article reports, some red states have exploited discussions in the medical community by moving to restrict or ban gender-affirming medical care.

Teenagers who identify as transgender typically seek help from pediatric gender clinics around age 14 or 15. In the past, most were children who’d been assigned male at birth but identified as girls. Now, two-thirds identify as trans boys or as nonbinary. Compared to the general population their age, they have higher rates of autism, depression and eating or attention-deficit disorders – conditions that can complicate determining a clear course of treatment. And there are far more of them – partly, researchers believe, because trans celebrities have reduced stigma, allowing kids to express themselves in ways they previously would have buried.

Disagreements among experts in the world of gender health care came into sharp relief over two issues in updated international guidelines for adolescent treatment that will be released this summer. Both involve questions about when to provide puberty suppressants and hormones: 1) What kind of evidence, if any, should be provided to show how long a child has persistently identified as or behaved like another gender, in order to distinguish kids with long histories from those whose stated identity is recent? 2) What kind of assessment is needed to understand the psychological and social context of their gender identity and how it might intersect with other mental health conditions? Some providers and trans activists took the controversy public, arguing on Twitter and elsewhere that a shorter time period, or none at all, is sufficient, and that a comprehensive assessment is not needed.

But a newsletter item cannot do justice to a Sunday Times Magazine cover story that runs nearly 11,000 words and is based on more than 100 interviews. If you’re interested, you can access the full story here. You also may want to check out WebMD’s coverage of President Joe Biden’s Executive Order on Advancing Equality for Lesbian, Gay, Bisexual, Transgender, Queer, and Intersex Individuals, which promises to reduce youth exposure to conversion therapy and seek to protect LGBTQI+ individuals’ access to medically necessary care from harmful state and local laws. (And stay tuned to MindSite News, which will have two stories coming soon focused on the history and treatment of transgender people.)

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Conservative states are extending Medicaid for new mothers while still refusing Obamacare’s expansion

Medicaid pays for 42% of all births in the United States. Federal law also requires 60 days of postpartum Medicaid coverage for new mothers, although it often is not enough for women with related health problems to even get an appointment to see a specialist. The Affordable Care Act’s Medicaid expansion, by contrast, provides up to a year of coverage after women give birth in the 38 states, plus Washington, D.C., that have adopted it. 

Now, Kaiser Health News reports, nine of the states — 75% — that opted not to expand Medicaid are seeking or planning to seek federal approval for up to a year of postpartum coverage while continuing to reject the broader expansion. Last year’s American Rescue Plan made it easier for states to do that. (Currently, all states must continue Medicaid coverage until the Covid-related public health emergency ends.)

Some maternal health advocates believe that extending benefits for new mothers could eventually lead to full Medicaid expansion in some states. Others forcefully argue the opposite. “Postpartum moms are a group that politicians of any stripe are going to have an interest in supporting,” said Christian Soura, executive vice president of the South Carolina Hospital Association, adding that peeling away that small group for a coverage extension leaves what he called the “least politically sympathetic” groups uncovered.

In other Obamacare news, researchers found that suicides increased at significantly lower rates in states that expanded Medicaid compared to those that did not, averting an estimated 1,800 deaths between 2015 and 2018, The Hill reported. The study, published in JAMA Network Open, analyzed suicide rates for nonelderly adults but the  differences between expansion and non-expansion states were seen mainly among whites ages 20 to 29.

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In Kenya, tackling stigma through song

Researchers in Africa often have to address traditional beliefs and pervasive mistrust in science before studying medical issues, including mental health problems. Many people believe they are caused by evil spirits or curses from parents and grandparents, or that depression, for instance, is a sign of laziness.

In a podcast interview for the Nature group of publications, the Kilifi, Kenya-based mental health researcher Mary Bitta described how she uses a form of participatory action research — involving communities in song, dance, video and radio productions — to develop and test interventions to reduce stigma. It’s a challenge in a country where stigma is so high, she says, that the government doesn’t even conduct surveys to measure the prevalence of mental health conditions. 

Her community-wide campaigns often take the form of question-and-answer performances. “The artists will sing and ask, ‘What do you think causes depression’ as a song,” she says, “and then maybe a member of the community will say, ‘I don’t know, thinking too much, or maybe stress or something.’ And then the artists will reply in song and say, ‘Would you like to come and dance with me to, you know, to demonstrate how you can, like, stop depression or be happy.’”

The interview is the last episode in a transcribed series of podcasts on Science in Africa. And change, Bitta says, is coming.

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60% of males who died by suicides had no known mental health issues

Most males who die by suicide have no known mental health conditions, according to research from UCLA reported by Medical Dialogues. The study found that compared to males with a history of mental illness, males without mental health histories were more likely to use firearms to take their own lives and alcohol was more likely to be detected in their bodies. The findings suggest that, for many men with access to guns, suicide is an impulsive act.

The research, published in the American Journal of Preventive Medicine, analyzed  federal records of all suicide deaths among males ages 10 and above from 2016 to  2018 and discovered that 60% of them had no documented mental health condition. Yet relationship troubles, conflicts and crises were more common among adolescent, young adult and middle-age males in that group. They also were less likely to express suicidal thoughts compared to the group with mental illnesses.

The authors noted that males often experience anger or irritability rather than sadness when faced with emotional difficulties, and that life changes like unemployment and divorce are major stressors. In this study, arguments often preceded suicides by less than a day. The researchers concluded that, for males, emotional volatility, rather than just depression or other psychiatric conditions, might be worth considering when designing suicide prevention programs.

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In other news….

British Columbia will fight the overdose epidemic by decriminalizing adult possession of small amounts of opioids such as heroin, morphine and fentanyl as well as cocaine, MDMA and methamphetamine starting in January, according to Medscape. 

Severe grief can cause significant increases in inflammation, which in turn is linked to a range of health issues, including heart disease and premature death, according to HealthDay News, which cites the findings of a study published in Psychological Science.

A range of substance use behaviors such as alcohol, marijuana, tobacco and e-cigarette use decreased among young people ages 10 to 24 during the first two years of the pandemic, probably because they had to spend more time at home and less with their friends, according to a WebMD article about a Current Psychiatry Reports’ systematic review of 49 studies. 

The Sydney Morning Herald wondered whether mindfulness is overrated based on a research article in Science Advances. It combined data from two randomized controlled trials and found no structural changes to the brain following a popular, eight-week, mindfulness-based, stress-reduction course — directly contradicting the results of a handful of smaller studies that have been cited 3,200 times over the last decade.

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If you or someone you know is in crisis or experiencing suicidal thoughts, call the National Suicide Prevention Lifeline at 1-800-273-8255. Or contact the Crisis Text Line by texting HOME to 741741. En Español: 1-888-628-9454; Deaf and Hard of Hearing: 1-800-799-4889. Services are free and available 24/7.

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