Association between Parental Attachment, Sexual and Substance Use Problems among Patients with Gender Dysphoria
Objective: To study the prevalence and association among parental attachment, other factors, substance use and sex-related behavioral problems in patients with gender dysphoria.
Methods: A cross-sectional descriptive study was conducted at gender variation (Gen-V) clinic, Ramathibodi Hospital. Participants were assessed with online questionnaire including demographic data, Thai version of the inventory of parent and peer attachment (IPPA) and Thai version of youth risk behavior survey (TYRBS).
Results: There are 103 participants in this study with the mean age of 29.47 years. Eighty-one of them (78.6%) were female. Fifty-four of the participants (52.4%) had smoked, ninety of them (87.4%) had drunk alcohol and ten of them (9.7%) had used other substances. The good parental attachment was found to be associated with decrease risk of irregularly condom usage, condom usage in last sexual intercourse, and blood test for HIV infection.
Conclusion: The prevalence of substance use and sex-related behavioral problems among patients with gender dysphoria is higher than general population. The individual factors and good parental attachment can protect risky behaviors in people with gender dysphoria. Promoting secure attachment might help prevent various behavioral problems in this group of people.
2. Johns MM, Lowry R, Andrzejewski J, Barrios LC, Demissie Z, McManus T, et al. Transgender Identity and Experiences of Violence Victimization, Substance Use, Suicide Risk, and Sexual Risk Behaviors Among High School Students - 19 States and Large Urban School Districts, 2017. MMWR Morb Mortal Wkly Rep 2019; 68(3): 67-71.
3. Becasen JS, Denard CL, Mullins MM, Higa DH, Sipe TA. Estimating the Prevalence of HIV and Sexual Behaviors Among the US Transgender Population: A Systematic Review and Meta-Analysis, 2006-2017. Am J Public Health 2018: e1-e8.
4. Giovanardi G, Vitelli R, Maggiora Vergano C, Fortunato A, Chianura L, Lingiardi V, et al. Attachment Patterns and Complex Trauma in a Sample of Adults Diagnosed with Gender Dysphoria. Front Psychol. 2018; 9: 60.
5. Jones JD, Ehrlich KB, Lejuez CW, Cassidy J. Parental knowledge of adolescent activities: links with parental attachment style and adolescent substance use. J Fam Psychol 2015; 29(2): 191-200.
6. Donenberg GR, Emerson E, Mackesy-Amiti ME. Sexual risk among African American girls: psychopathology and mother-daughter relationships. J Consult Clin Psychol 2011; 79(2):153-8.
7. Gullone E, Robinson K. The Inventory of Parent and Peer Attachment—Revised (IPPA-R) for children: a psychometric investigation. Clinical Psychology & Psychotherapy 2005;12(1): 67-79.
8. Lucktong A, Salisbury T, Chamratrithirong A. The impact of parental, peer and school attachment on the psychological well-being of early adolescents in Thailand. International Journal of Adolescence and Youth. 2018; 23(2): 235-249.
9. Ruangkanchanasetr S, Plitponkarnpim A, Hetrakul P, Kongsakon R. Youth risk behavior survey: Bangkok, Thailand. J Adolesc Health 2005; 36(3): 227-235.
10. Tobacco Control Research and Management Center. TRC Annual Report 2018. In: Pitayarungsarit S, editor.: Bangkok; 2018: 1-34.
11. Studies CfA. CAS Annual Report 2017. In: S. A, editor. Sahamitpattana (1992). 2017: 1-129.
12. Nuttbrock L, Bockting W, Rosenblum A, Hwahng S, Mason M, Macri M, et al. Gender abuse, depressive symptoms, and substance use among transgender women: a 3-year prospective study. Am J Public Health. 2014; 104(11): 2199-2206.
13. Vichitkunakorn P. Provincial Alcohol Report 2017. Center for Alcohol Studies (CAS); 2017.
14. Reisner SL, Poteat T, Keatley J, Cabral M, Mothopeng T, Dunham E, et al. Global health burden and needs of transgender populations: a review. Lancet 2016; 388(10042): 412-436.
15. Cahill SR. Research and Policy Change to Improve Healthcare and Elder Services for LGBT Older Adults. LGBT Health 2017; 4(6): 381-383.
16. Parameshwaran V, Cockbain BC, Hillyard M, Price JR. Is the Lack of Specific Lesbian, Gay, Bisexual, Transgender and Queer/Questioning (LGBTQ) Health Care Education in Medical School a Cause for Concern? Evidence From a Survey of Knowledge and Practice Among UK Medical Students. J Homosex 2017; 64(3): 367-381.
17. Board on the Health of Select Populations. The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding. Warshington, D.C. 2011:1-347.
18. Kim HM, Miller LC. Are insecure attachment styles related to risky sexual behavior? A meta-analysis. Health Psychol 2020; 39(1): 46-57.
19. Griffin D, Bartholomew K. Models of the Self and Other: Fundamental Dimensions Underlying Measures of Adult Attachment. Journal of Personality and Social Psychology 1994; 67: 430-445.
20. Firestone L. Do You or Your Partner Have an Avoidant Attachment Pattern? Avoidant attachment forms and goes on to affect your relationships.: Psychology Today; 2019 [Available from: https://www.psychologytoday. com/us/blog/compassion-matters/201904/ do-you-or-your-partner-have-avoidant-attach¬ment-pattern.
21. Substance Abuse and Mental Health Services Administration Center for Behavioral Health Statistics and Quality. Results from the 2011 National Survey on Drug Use and Health: Summary of National Findings 2012 [Available from: https://www.samhsa.gov/data/sites/ default/files/Revised2k11NSDUHSummNat-Findings/Revised2k11NSDUHSummNatFind¬ings/NSDUHresults2011.htm.
22. Armsden GC, Greenberg MT. The inventory of parent and peer attachment: Individual differences and their relationship to psychological well-being in adolescence. J Youth Adolesc. 1987;16(5):427-54.
23. Pearson J, Wilkinson L. Family relationships and adolescent well-being: are families equally protective for same-sex attracted youth? J Youth Adolesc 2013; 42(3): 376-393.
24. Friedman MS, Marshal MP, Guadamuz TE, Wei C, Wong CF, Saewyc E, et al. A meta-analysis of disparities in childhood sexual abuse, parental physical abuse, and peer victimization among sexual minority and sexual nonminority individuals. American journal of public health 2011; 101(8): 1481-1494.
25. Sizemore KM, Carter JA, Millar BM, Cain D, Parsons JT, Rendina HJ. Attachment as a Predictor of Psychological and Sexual Wellbeing Among Transgender Women in New York City. J Sex Res 2019; 56(9): 1192-202.
26. Smalley KB, Warren JC, Barefoot KN. Differences in health risk behaviors across understudied LGBT subgroups. Health Psychol 2016; 35(2): 103-114.
27. Philbin MM, Mauro PM, Greene ER, Martins SS. State-level marijuana policies and marijuana use and marijuana use disorder among a nationally representative sample of adults in the United States, 2015-2017: Sexual identity and gender matter. Drug Alcohol Depend 2019; 204: 107506.
28. Feinstein BA, Dyar C. Bisexuality, minority stress, and health. Curr Sex Health Rep 2017; 9(1): 42-49.
29. de Vries AL, Steensma TD, Doreleijers TA, Cohen-Kettenis PT. Puberty suppression in adolescents with gender identity disorder: a prospective follow-up study. J Sex Med 2011; 8(8): 2276-2283.
30. Kulis S, Marsiglia FF, Lingard EC, Nieri T, Nagoshi J. Gender identity and substance use among students in two high schools in Monterrey, Mexico. Drug Alcohol Depend 2008; 95(3): 258-268.
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