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Mental and Social Health

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2019

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Articles 1 - 27 of 27

Full-Text Articles in Psychiatry and Psychology

Subanesthetic Iv Ketamine Reduces Acute Suicidal Ideation In Patients With Mood Disorders, Kimberly Jenko, Jack Anzilotti Dec 2019

Subanesthetic Iv Ketamine Reduces Acute Suicidal Ideation In Patients With Mood Disorders, Kimberly Jenko, Jack Anzilotti

Physician Assistant Capstones, 2016 to 2019

Background. Depression and suicide are common in the United States and present a significant problem in the healthcare landscape. Currently, there are few options that can rapidly reduce suicidal ideation in patients with depression. Ketamine, a glutamate N-methyl-D-aspartate (NMDA) receptor antagonist, has been shown to reduce acute suicidality in patients with depression. Previous studies have a reduction of suicidal ideation compared to saline placebo, but few studies have shown a significant effect compared to a similar psychoactive drug such as midazolam.

Method. A search of PubMed and PsychNET was performed in September 2018 using the terms “ketamine,” “suicide,” …


Results From The Su Health & Wellness Goal Survey, Shannon M. Monnat, Mary Kate Schutt, Ashley Van Slyke, Alexandra Punch Nov 2019

Results From The Su Health & Wellness Goal Survey, Shannon M. Monnat, Mary Kate Schutt, Ashley Van Slyke, Alexandra Punch

Population Health Research Brief Series

In Spring 2019, SU’s Lerner Center for Public Health Promotion surveyed over 600 SU faculty, staff, and undergraduate and graduate students to identify their goals related to health and wellness. This research brief summarizes the top ranked goals, including increasing physical activity, improving diet and nutrition, and better managing stress. There were interesting differences in goals across SU roles, sexes, and racial/ethnic groups.


Trans Collaborations Clinical Check-In (Tc3): Initial Validation Of A Clinical Measure For Transgender And Gender Diverse Adults Receiving Psychological Services, Natalie R. Holt, Terrence Z. Huit, Grant Shulman, Jane L. Meza, Jolene Smyth, Nathan Woodruff, Richard Mocarski, Jae Puckett, Debra A. Hope Nov 2019

Trans Collaborations Clinical Check-In (Tc3): Initial Validation Of A Clinical Measure For Transgender And Gender Diverse Adults Receiving Psychological Services, Natalie R. Holt, Terrence Z. Huit, Grant Shulman, Jane L. Meza, Jolene Smyth, Nathan Woodruff, Richard Mocarski, Jae Puckett, Debra A. Hope

Trans Collaborations Academic Papers

One key aspect of evidence-based psychological services is monitoring progress to inform treatment decision making, often using a brief self-report measure. However, no such measure exists to support measurement based care given the distinct needs of transgender and gender diverse people (TGD), a group facing large documented health disparities and marginalization in healthcare. The purpose of the present study was to develop and provide initial psychometric validation of a short, behavioral health progress monitoring self-report measure, the Trans Collaborations Clinical Check-in (TC3). TGD communities, providers identified as TGD-affirmative, and relevant academic experts contributed to item and scale development. The final …


The Complex Relationship Between Celebrity-Driven Magazines And Depictions Of Fertility At Advanced Reproductive Ages, Brennan Peterson Oct 2019

The Complex Relationship Between Celebrity-Driven Magazines And Depictions Of Fertility At Advanced Reproductive Ages, Brennan Peterson

Marriage and Family Therapy Faculty Articles and Research

"In this issue of the Journal of Women’s Health, Willson and colleagues explore how age and fertility are portrayed in celebrity-driven magazines.1 Specifically, they examine if popular media depictions of celebrity pregnancies present accurate information related to age and fertility, the use of assisted reproductive technology (ARTs), and pregnancy-related risks associated with advanced maternal age (AMA >35 years). Their study provides an important viewpoint related to the impact of media on reproductive perceptions, and its potential intersection with delayed childbearing, fertility awareness, and reproductive decision making."


The Importance Of Shared Language In Rural Behavioral Health Interventions: An Exploratory Linguistic Analysis, Michele Staton, Jennifer Cramer, Robert Walker, Claire Snell-Rood, Athena Kheibari Oct 2019

The Importance Of Shared Language In Rural Behavioral Health Interventions: An Exploratory Linguistic Analysis, Michele Staton, Jennifer Cramer, Robert Walker, Claire Snell-Rood, Athena Kheibari

Behavioral Science Faculty Publications

A focus on the use of shared language to enhance congruence in interventionist-client dialogue is missing from traditional research on evidence-based practices and rural behavioral health. This study incorporates qualitative interactional sociolinguistics, which includes discourse analysis (typically written or audio recordings of face-to-face encounters with 11 clients and a study interventionist), to describe those speech patterns in a broad sense (dialect), as well as more specific use of communicative strategies to increase parity in the interaction between a rural interventionist delivering an evidence-based practice in the context of a research study with rural women opioid users in a non-therapeutic context. …


Long-Term Mental Health Support For Refugees After Resettlement: Assessment Of Mental Health And Psychosocial Support Services For Refugees In Switzerland, Courtney W. Chan Oct 2019

Long-Term Mental Health Support For Refugees After Resettlement: Assessment Of Mental Health And Psychosocial Support Services For Refugees In Switzerland, Courtney W. Chan

Independent Study Project (ISP) Collection

By definition, refugees are people forced to escape their home countries, often as a result of persecution, war, or disaster. While abundant literature exists on the psychological effects of trauma and corresponding psychological treatment during or immediately following crises, we know little about how post-migration factors affect refugees’ psychological well-being after resettlement. Few such longitudinal studies have been reported; moreover, evaluations of current long-term mental health and psychosocial services (MHPSS) and refugee access to MHPSS in host countries remain sparse. This study presents an evaluation of MHPSS services for refugees currently implemented around the world, with a focus on services …


Pensaba Que Te Había Olvidado: El Daño Duradero De La Trauma Que Viene De Tortura En La Dictadura Chilena, Antonia Mcdonnell Capossela Oct 2019

Pensaba Que Te Había Olvidado: El Daño Duradero De La Trauma Que Viene De Tortura En La Dictadura Chilena, Antonia Mcdonnell Capossela

Independent Study Project (ISP) Collection

Research question: Is there a more useful model to characterize the torture that was implemented in Chile using the context of theory and history to establish an in-depth understanding of the symptomology and effects of the experience of torture survivors?

Objective: The general objective of this study is to establish the origin of the methods of torture used during the Pinochet dictatorship and use these results to suggest a model of reparations that is more wholistic. The specific objectives are to understand the intervention and instruction by the CIA in Chile, to study the testimonies of torture during the dictatorship …


Integrative Pharmacotherapeutic Approaches To Treating Depression, Charlotte Tse Oct 2019

Integrative Pharmacotherapeutic Approaches To Treating Depression, Charlotte Tse

Independent Study Project (ISP) Collection

Traditional Chinese Medicine (TCM), based in the philosophy-religions of Buddhism, Confucianism, and Daoism, is more than a purely prescriptive medical system; it is a way of life focused primarily on the principles of prevention rather than the more reactionary direction that pharmacotherapy in the US has taken. Mental illness is expected to account for a quarter of China’s overall health burden by 2020, with depression affecting around 100 million people and nearly 30 percent of young Chinese adults. Conventional antidepressants have a delayed onset and unpredictable therapeutic efficacy in this condition, especially in mild to moderate cases of depression. In …


Logistic And Structural Considerations For The Use Of Psychological First Aid In Humanitarian Emergencies, Taylor Johnson Oct 2019

Logistic And Structural Considerations For The Use Of Psychological First Aid In Humanitarian Emergencies, Taylor Johnson

Independent Study Project (ISP) Collection

Following the IASC recommendations for implementation of psychological first aid (PFA) in 2007, providing PFA in humanitarian emergencies as a method of psychosocial support has become one of the standard interventions in the wake of crises. However, the impact of PFA on future mental health outcomes remains largely unstudied and many structural and logistic factors (e.g. training of PFA providers, reviewing evidence to inform practice, and policy considerations) must be managed in order to ensure appropriate, high-quality PFA in humanitarian emergencies. This research aims to synthesize both primary interview data and the existing literature surrounding PFA in humanitarian emergencies to …


Frontal Alpha Asymmetry And Inhibitory Control Among Individuals With Cannabis Use Disorders, Alina Shevorykin, Lesia M. Ruglass, Robert D. Melara Aug 2019

Frontal Alpha Asymmetry And Inhibitory Control Among Individuals With Cannabis Use Disorders, Alina Shevorykin, Lesia M. Ruglass, Robert D. Melara

Publications and Research

To better understand the biopsychosocial mechanisms associated with development and maintenance of cannabis use disorder (CUD), we examined frontal alpha asymmetry (FAA) as a measure of approach bias and inhibitory control in cannabis users versus healthy nonusers. We investigated: (1) whether FAA could distinguish cannabis users from healthy controls; (2) whether there are cue-specific FAA effects in cannabis users versus controls; and (3) the time course of cue-specific approach motivation and inhibitory control processes. EEG data were analyzed from forty participants (CUD (n = 20) and controls (n = 20)) who completed a modified visual attention task. Results showed controls …


Staying Out: Reentry Protective Factors Among Rural Women Offenders, Michele Staton, Megan F. Dickson, Martha Tillson, J. Matthew Webster, Carl G. Leukefeld Aug 2019

Staying Out: Reentry Protective Factors Among Rural Women Offenders, Michele Staton, Megan F. Dickson, Martha Tillson, J. Matthew Webster, Carl G. Leukefeld

Behavioral Science Faculty Publications

The current study examines protective factors for women who transition from county jails to rural Appalachian communities, areas with limited health and behavioral health services. The study included drug-using women recruited from three jails in rural Appalachia and followed-up at 12-months post-release. Analyses focused on differences between women who remained in the community and those who returned to custody, as well as a multivariate model to determine protective factors for reentry success. At the bivariate level, staying out of jail was associated with being older, having a job, not using drugs, stable housing, receiving health treatment, and having prosocial peers. …


Recent Trends, Current Research In Cyberpsychology: A Literature Review, Amarjit Kumar Singh, Pawan Kumar Singh Aug 2019

Recent Trends, Current Research In Cyberpsychology: A Literature Review, Amarjit Kumar Singh, Pawan Kumar Singh

Library Philosophy and Practice (e-journal)

Cyberpsychology refers to the study of the mind and behavior in the context of interactions with technology. It is an emerging branch, which has focused on the psychological aspects connected to the increasing presence and usages of technology in modern lives. This paper traces recent advancement and trends of Cyberpsychology is an emerging domain of knowledge and goes on the give a literature review of the same. An analysis of the recent research and literature covering 300 most relevant research papers from the period of 2012 to 15, August 2019 was conducted to determine and shape the research pattern based …


Identifying Depression In The National Health And Nutrition Examination Survey Data Using A Deep Learning Algorithm, Jihoon Oh, Kyongsik Yun, Uri Maoz, Tae-Suk Kim, Jeong-Ho Chae Jul 2019

Identifying Depression In The National Health And Nutrition Examination Survey Data Using A Deep Learning Algorithm, Jihoon Oh, Kyongsik Yun, Uri Maoz, Tae-Suk Kim, Jeong-Ho Chae

Psychology Faculty Articles and Research

Background

As depression is the leading cause of disability worldwide, large-scale surveys have been conducted to establish the occurrence and risk factors of depression. However, accurately estimating epidemiological factors leading up to depression has remained challenging. Deep-learning algorithms can be applied to assess the factors leading up to prevalence and clinical manifestations of depression.

Methods

Customized deep-neural-network and machine-learning classifiers were assessed using survey data from 19,725 participants from the NHANES database (from 1999 through 2014) and 4949 from the South Korea NHANES (K-NHANES) database in 2014.

Results

A deep-learning algorithm showed area under the receiver operating characteristic curve (AUCs) …


Brief Of Amicus Curiae 290 Criminal Law And Mental Health Law Professors In Support Of Petitioner's Request For Reversal And Remand, Kahler V. Kansas, 18-6135 (U.S. June 6, 2019), Paul F. Rothstein Jun 2019

Brief Of Amicus Curiae 290 Criminal Law And Mental Health Law Professors In Support Of Petitioner's Request For Reversal And Remand, Kahler V. Kansas, 18-6135 (U.S. June 6, 2019), Paul F. Rothstein

Georgetown Law Faculty Publications and Other Works

Amici curiae are a group of philosophically and politically diverse law school professors and scholars in the fields of criminal law and mental health from a variety of disciplines who have been teaching and writing about the insanity defense and related issues throughout their careers. They include the authors of leading criminal law and mental health law treatises and casebooks and numerous important scholarly books and articles.

Amici believe this case raises important questions about principles of criminal responsibility, the integral role of the insanity defense in Anglo-American law, and the inadequacy of the “mens rea alternative” to the traditional …


Just Culture: It's More Than Policy, Linda Ann Paradiso, Nancy Sweeney Jun 2019

Just Culture: It's More Than Policy, Linda Ann Paradiso, Nancy Sweeney

Publications and Research

Any healthcare organization’s top priority is effective and safe care. Despite this, medical error is the third-leading cause of death in the US. Hospitals are imperfect systems where nurses have competing demands and are forced to improvise and develop workarounds. Errors rarely occur in a vacuum, rather they’re a sequence of events with multiple opportunities for correction. Clinical nurses can have a significant impact on reducing errors due to their proximity to patients. When errors are identified, the events and impact on safe care need to be shared. Just culture is a safe haven that supports reporting. In a just …


Human Learning, Memory, And Student Development, Alan R. Erickson May 2019

Human Learning, Memory, And Student Development, Alan R. Erickson

Contemporary Issues in Educational Leadership

My educational interests have largely been informed by my career in the sciences and medicine. My professional education has been both formative and transformative, opening doors to the joy of learning and a realization in the importance of memory. As an educator, clinician, and student, I have been greatly impacted by issues of curricular design, curricular development, learning and memory. My current responsibilities in student affairs also have exposed me to the delicate balance between student development, curricular design, learning and memory. Patton, Renn, Guido, and Quaye (2016) noted the importance of educators being able to use different literature sources …


Measuring Neural Time Series Data In A Sensory Deprivation Tank, Jackson Gregory, Tian Lan, Uri Maoz, Amir Raz May 2019

Measuring Neural Time Series Data In A Sensory Deprivation Tank, Jackson Gregory, Tian Lan, Uri Maoz, Amir Raz

Student Scholar Symposium Abstracts and Posters

We are interested in studying the neurological and physiological effects of the float pod, also known as REST therapy, or sensory deprivation tank. Float pods rely on the concept of depriving most senses (from sound and light to temperature and proprioception) in a pool filled with buoyant salt water at body temperature. While float pods are most commonly used in spa environments, we intend to look at the potential benefits of floating under the empirical lens. In this study, we aim to measure neural activity using electroencephalography (EEG). We intend to look at the different levels of relaxation and the …


Managing Madness: The Ethics Of Identifying And Treating Mental Illness, Mason Seely Apr 2019

Managing Madness: The Ethics Of Identifying And Treating Mental Illness, Mason Seely

Library Undergraduate Research Award

This essay analyzes different contemporary models for defining mental illness and offers a new framework that promotes the use of normative values during the clinical diagnostic process. Although ethic centric models for identifying mental illness do currently exist, these accounts are limited. Specifically, these accounts acknowledge the relationship between mental illness labels and implied responsibility in making their argument to support a normative framework, yet do not explain what capacities are necessary for an agent to have full responsibility. Recognizing this shortcoming, this paper provides an enriched model for identifying mental illness by marrying a normative conception of psychiatric dysfunction …


A Study Of Music: Music Psychology, Music Therapy, And Worship Music, Jessica Whittemore Apr 2019

A Study Of Music: Music Psychology, Music Therapy, And Worship Music, Jessica Whittemore

Senior Honors Theses

There are three specific fields related to music: the psychology of Music and how it affects human brain and functions, the methodology of Music Therapy and how it affects individuals undergoing treatment, and the psychological effects of Worship Music and how it can be used in music therapy. Music therapy is a growing field in which the therapeutic outcomes greatly benefit the patients. The overall purpose is to create a greater understanding of music and music therapy in order to a provide a system for introducing group worship services into music therapy to ultimately bring spiritual healing to individuals.


Mental Health Stigma In College Students By Academic Major, Kristen Miller Apr 2019

Mental Health Stigma In College Students By Academic Major, Kristen Miller

Mahurin Honors College Capstone Experience/Thesis Projects

Stigma is best defined as the disapproval and shame felt by people who display characteristics not widely accepted in society. Although mental illness has become more prevalent in society through advocacy and awareness campaigns, it fails to be accepted and often individuals may feel shame that prevents them from seeking help (Dyrbye, Eacker, Durning, Brazeau, Moutier, Massie, S., et al, 2015; Givens & Tjia, 2002). Physicians in particular have been shown to have decreased help-seeking behaviors for psychological issues due to fear of professional repercussions (Dyrbye et al., 2015). Physicians also show increased levels of stress, anxiety, depression, and elevated …


“Uno Logra Olvidar La Tortura”: Impactos De Las Dictaduras Militares Y Conversaciones Sobre Las Secuelas De La Tortura En El Instituto De Terapia E Investigación, Em Rosner Apr 2019

“Uno Logra Olvidar La Tortura”: Impactos De Las Dictaduras Militares Y Conversaciones Sobre Las Secuelas De La Tortura En El Instituto De Terapia E Investigación, Em Rosner

Independent Study Project (ISP) Collection

Investigué el impacto real de las dictaduras militares, y específicamente cómo las experiencias de tortura continuan marcando las vidas de los sobrevivientes y su habilidad de procesar los eventos de sus propias vidas, compartir sus experiencias con otras personas y hacer conexiones interpersonales. Mis preguntas primarias eran, ¿Cómo la tortura ha marcado la vida a largo plazo de las personas que la sufrieron? ¿Cómo impactan las experiencias de represión y tortura en las formas en que se construyen relaciones sociales y proyectos de vida? Para investigar este tema, entrevisté a personas que han tenido experiencias de tortura o que han …


Adgrl3 (Lphn3) Variants Predict Substance Use Disorder, Mauricio Arcos-Burgos, Jorge I. Vélez, Ariel F. Martinez, Marta Ribasés, Josep A. Ramos-Quiroga, Cristina Sánchez-Mora, Vanesa Richarte, Carlos Roncero, Bru Cormand, Noelia Fernández-Castillo, Miguel Casas, Francisco Lopera, David A. Pineda, Juan D. Palacio, Johan E. Acosta-López, Martha L. Cervantes-Henriquez, Manuel G. Sánchez-Rojas, Pedro J. Puentes-Rozo, Brooke S. G. Molina, Mta Cooperative Group, Margaret T. Boden, Deeann Wallis, Brett Lidbury, Saul Newman, Simon Easteal, James Swanson, Hardip Patel, Nora Volkow, Maria T. Acosta, Francisco X. Castellanos, Jose De Leon Jan 2019

Adgrl3 (Lphn3) Variants Predict Substance Use Disorder, Mauricio Arcos-Burgos, Jorge I. Vélez, Ariel F. Martinez, Marta Ribasés, Josep A. Ramos-Quiroga, Cristina Sánchez-Mora, Vanesa Richarte, Carlos Roncero, Bru Cormand, Noelia Fernández-Castillo, Miguel Casas, Francisco Lopera, David A. Pineda, Juan D. Palacio, Johan E. Acosta-López, Martha L. Cervantes-Henriquez, Manuel G. Sánchez-Rojas, Pedro J. Puentes-Rozo, Brooke S. G. Molina, Mta Cooperative Group, Margaret T. Boden, Deeann Wallis, Brett Lidbury, Saul Newman, Simon Easteal, James Swanson, Hardip Patel, Nora Volkow, Maria T. Acosta, Francisco X. Castellanos, Jose De Leon

Psychiatry Faculty Publications

Genetic factors are strongly implicated in the susceptibility to develop externalizing syndromes such as attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder, conduct disorder, and substance use disorder (SUD). Variants in the ADGRL3 (LPHN3) gene predispose to ADHD and predict ADHD severity, disruptive behaviors comorbidity, long-term outcome, and response to treatment. In this study, we investigated whether variants within ADGRL3 are associated with SUD, a disorder that is frequently co-morbid with ADHD. Using family-based, case-control, and longitudinal samples from disparate regions of the world (n = 2698), recruited either for clinical, genetic epidemiological or pharmacogenomic studies of ADHD, we …


An Exploratory Study Of Police Officers: Low Compassion Satisfaction And Compassion Fatigue, Heath Blair Grant, Cathryn F. Lavery, John Decarlo Jan 2019

An Exploratory Study Of Police Officers: Low Compassion Satisfaction And Compassion Fatigue, Heath Blair Grant, Cathryn F. Lavery, John Decarlo

Publications and Research

Background: Compassion fatigue, or the physical, mental, and emotional state experienced by professionals that assist others in distress, has been well documented in several caring professions such as nurses, firefighters, and emergency medical technicians. Until the current study, it has only rarely been examined in police samples despite their high rates of stress and suicide which is a likely result of a depletion of compassion satisfaction, or the pleasure an officer gets from relating to and helping others.

Aim: This study documents findings from an ongoing study of compassion fatigue amongst a sample of US urban police officers which suggests …


Anxiety-Like Behavior In Adolescent Rats Following Maternal Separation And Chronic Cocaine Exposure, Jonathan Handy Jan 2019

Anxiety-Like Behavior In Adolescent Rats Following Maternal Separation And Chronic Cocaine Exposure, Jonathan Handy

Behavioral Neuroscience Honors Papers

Cocaine is one of the most widely used illicit substances in the world and has an addiction rate comparable to opioids. Early Life Stress (ELS) has been shown to have a profound influence on the development of an individual, showing strong correlations to the development of psychiatric disorders and psychostimulant abuse. Adolescents in particular are at a high risk for the abuse of psychostimulants such as cocaine. Previous studies have individually described the correlation between cocaine addiction and anxiety, and the correlation between ELS and cocaine addiction. Rats who have experienced some form of ELS have shown a higher levels …


An Assessment Of Attitudes And Perceptions Of College Students Toward A Suicide Program On A College Campus: A Descriptive Study, Rachel Tolliver Jan 2019

An Assessment Of Attitudes And Perceptions Of College Students Toward A Suicide Program On A College Campus: A Descriptive Study, Rachel Tolliver

DNP Research Projects

OBJECTIVE: A baseline assessment examines the status of attitudes and perceptions about the suicide prevention program of a small, private, southeastern, Christian university. Gaps in the literature include the lack of baseline evaluations at universities before evidenced-based practice (EBP) interventions.

PARTICIPANTS: A purposive sample of sixty-nine sophomores classified as first-year students for the 2016-2017 school year. The study sample lived on campus both semesters of the 2016-2017 school year.

METHODS: Participants completed the retired Suicide Prevention Exposure, Awareness and Knowledge Survey (SPEAKS) – SV (Student Version) by the Substance Abuse & Mental Health Services Administration (SAMHSA) for the Garrett …


First Impressions Online: The Inclusion Of Transgender And Gender Nonconforming Identities And Services In Mental Healthcare Providers’ Online Materials In The Usa, Natalie Holt, Debra A. Hope, Richard Mocarski, Nathan Woodruff Jan 2019

First Impressions Online: The Inclusion Of Transgender And Gender Nonconforming Identities And Services In Mental Healthcare Providers’ Online Materials In The Usa, Natalie Holt, Debra A. Hope, Richard Mocarski, Nathan Woodruff

Trans Collaborations Academic Papers

Background: When accessing mental healthcare services, transgender and gender nonconforming (TGNC) individuals face systemic barriers to gender-affirmative care. Initial points of contact, like intake forms, may show limited consideration for the heterogeneity of TGNC identities and can lead to negative consequences prior to face-to-face interaction with providers.

Aims: The first aim was to mimic a likely pathway a TGNC individual may follow to seek mental healthcare services in the USA and to describe the extent to which they may encounter enacted stigma or affirmative messages that may impede or facilitate access to care. The second aim was to determine if …


Unmet Expectations In Healthcare Settings: Experiences Of Transgender And Gender Diverse Adults In The Central Great Plains, Heather Meyer Jan 2019

Unmet Expectations In Healthcare Settings: Experiences Of Transgender And Gender Diverse Adults In The Central Great Plains, Heather Meyer

Trans Collaborations Academic Papers

Transgender and gender diverse (TGD) individuals face a long-term, multi-faceted process if they choose to begin a gender affirmation journey. Decisions to go on hormone therapy and/or have a surgical procedure necessitate the TGD individual to set up an appointment with a healthcare provider. However, when TGD patients interact with healthcare practitioners, problems can arise. This article documents and categorizes the types of unmet expectations that are common in the TGD patient-healthcare provider social dynamic in the Central Great Plains of the United States. Utilizing a community-based participatory research model, qualitative in-depth interviews were conducted with 27 TGD individuals about …