psychology

Suicide risk and prevention research published in LGBT journal

Few studies to date have examined how certain stressors can cause high suicide rates among minority individuals including transgender individuals. More than 47,000 people die by suicide every year in the United States, and studies show that at least 10% of members in the lesbian, gay, bisexual and transgender (LGBT) community have attempted suicide at least once in their lives. These startling statistics have enacted new waves of detection, prevention and intervention for those at risk of suicide, but more research and action are needed.

Gender minority theory

Why do minority individuals experience more adverse mental and physical outcomes? One proposed explanation is the gender minority theory involving distal and proximal stressors along with several resilience factors. Distal stressors include gender-based victimization, discrimination, rejection, and non-affirmation of gender identity. Proximal stressors are experienced within the psyche of an individual such as transphobia, negative expectations related to gender identity and concealment of one’s gender identity.

The gender minority stress theory suggests potential reasons why these stressors may increase the risk of suicide, but community resiliency has never been factored into the equation. A group of TU psychology students decided to take on the task of exploring the moderating role of resiliency in the relationship between stressors, trauma exposure and suicide risk. Their findings were published in the Journal of LGBT Issues in Counseling this spring.

The original study began in 2017 as the dissertation of PhD student Jim Scholl (BA ’13, MA ’16, PhD ’19) who focused on gender minority stress and trauma within a trans sample. “I talked him into including a four-item self-report measure on suicide risk,” said doctoral student Chelsea Cogan (MA ’18). “He was gracious enough to let me run with different ideas I had on what to look at within his sample.”

Cogan took on the primary role of conducting analyses, writing the results and writing the bulk of the paper’s introduction. Scholl contributed the data and methods, and then-undergraduate student Hannah Cole (BS ’18) assisted with formatting and discussion. Professor of Psychology Joanne Davis served as the project’s faculty adviser.

“The goal was to try and find protective factors within the trans population primarily through the gender minority theory framework,” Cogan explained. “The idea is that this relationship can be moderated by community resiliency, such that the higher levels of community resiliency an individual possesses, the less impact the distal and proximal stressors have on their mental and physical well-being.”

Assessing the role of resilience

A total of 155 self-identified transgender individuals participated in the study and completed a basic demographics measure. Data was collected in the fall of 2017. The TU students used the gender minority stress and resilience measure to assess nine constructs: gender-related discrimination, gender-related rejection, gender-related victimization, non-affirmation of gender identity, internalized transphobia, negative expectations for future events, concealment, community connectedness and pride. Other methods included a life events checklist to determine the total number of traumatic experiences reported by the individuals and a suicide behaviors questionnaire that looks at suicidal ideation, behaviors, communication and likelihood of future suicide attempts.

Analyses revealed the community resilience factors specified in the gender minority stress theory were not sufficient to mitigate the risk of suicide. Community resilience did not significantly moderate the relationships between minority stressors, trauma exposure and suicide risk.

“Unfortunately, there is no definitive answer as to why community resilience was not a significant moderator,” Cole said. “One theory that we touch on briefly in the paper is that in order to access the community and draw resilience from it, individuals would likely need to be out and visible in a way that could potentially expose them to greater stigma and even violence, which could wash out the benefits gained from community resilience. Another thing to consider is that we only looked at community resilience, rather than individual level factors like hardiness, and therefore may have limited the complete picture.”

Sharing the findings in a national journal

According to Cogan, the TU team was surprised to learn that community resilience was not a factor. She said this is the first study to include all three components of the gender minority stress theory as they relate to suicide risk. As a result, they felt it was crucial to submit their findings to the Journal of LGBT Issues in Counseling to reach a broad range of clinical providers who regularly interact and work with trans individuals.

“This study is important because it demonstrates the need for much more research into protective factors to help decrease suicide risk within trans individuals,” Cogan said. “It also further demonstrates how integral assessing for the presence of distal and proximal stressors (in addition to trauma exposure) is when assessing suicide risk with trans clients.”

Although Cole has since graduated from TU, she says her involvement in the project and other TU research has sparked her passion for research and advocacy in sexual and gender minority communities. She plans to begin a clinical psychology program in the fall under the mentorship of a professor who studies violence prevention and intervention in the LGBT population. “I hope to continue this work throughout my career with the ultimate aim of increasing access to competent, sensitive care for historically underserved communities,” she stated.

Cogan explained next steps in this research would involve further examining the gender minority stress theory variables and replicating the findings in another sample to explore other potential protective factors, such as social connection, etc. Now that the research is published, more work remains to be accomplished, but Cogan and Cole agree the study is beneficial in reducing trauma exposure, violence and negative mental and physical health outcomes in the transgender and gender diverse communities.

See the published paper The Moderating Role of Community Resiliency on Suicide Risk in the Transgender Population.

TU psychology faculty and students helping kids and teens with nightmares

When traumatizing nightmares plague a child’s sleep routine, parents often search for answers. University of Tulsa faculty and student researchers in the Department of Psychology have investigated this psychological condition since the early 2000s. Today, Associate Professor of Psychology and clinical psychologist Lisa Cromer leads a team of graduate and undergraduate students in nightmare treatment for children and adolescents.

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Professor Lisa Cromer and psychology students

The University of Tulsa’s specialization in sleep among children began with graduate student research that was mentored by Professor of Psychology Joanne Davis. She focuses on nightmare and sleep problems in trauma-exposed individuals and when Cromer joined the psychology faculty, Davis invited her to expand upon the original project. With her expertise in children and adolescents, Cromer developed manuals and workbooks to adapt the research more broadly. Since then, graduate and undergraduate students have helped her establish a children’s sleep lab. Cromer and her students currently are conducting their second clinical trial that provides a five-session therapy series for youth, ages 5 to 17, who experience nightmares.

Combining sports and child psychology

Second-year grad student Jack Stimson earned a bachelor’s degree in psychology and worked with traumatized, abused and neglected children in Seattle, Washington, before beginning the psychology Ph.D. program at TU. A former rugby athlete, he is interested in both sports and child psychology. “That’s the reason I chose TU and Dr. Cromer in particular,” he said. “She is an expert in a lot of areas, and I have an immense passion for working with kids.”

Stimson contributes to the clinical trial by asking questions and assessing participants once they have received therapy for nightmares. So far, 14 kids and teenagers have entered the treatment with encouraging results. Stimson said the youth and teens are “almost glowing” when he meets with them following the successful therapy sessions. They sleep sounder, feel better and experience fewer nightmares. “In supervision, we’ll sometimes watch tapes from earlier assessments before they went through treatment, and it’s amazing to see the shift in body language,” he said. “Instead of having nightmares every single night, they now maybe have one once or twice a month.”

As an undergraduate, psychology senior Andrew Helt also serves an important purpose in Cromer’s lab. He discovered his career interests in trauma psychology while working with children with communicative disorders at Happy Hands Education Center his freshman year. Helt’s research is the focus of a Tulsa Undergraduate Research Challenge (TURC) project and his final class project. After learning about the enriching environment of Cromer’s lab, basic literature reviews and data entry led him to explore a sub-study within her clinical trial. “We started to notice that while there’s a lot of kids with nightmares, some of them were reluctant to get into research,” Cromer said. “We wanted to understand the hesitation for either seeking treatment or seeking treatment for a research study when the therapy is free.”

During the summer, Helt learned how to use software systems and review literature to understand the psychological constructs associated with children who suffer from frequent nightmares. Overcoming barriers to treatment can help make it more accessible for children who desperately need relief. “I’m looking at what factors play into whether a parent decides to express interest in joining the trial (before) and what impact the nightmare treatment has in reducing symptoms (after) related to cognitive, behavioral functions,” Helt said.

Additional benefits of nightmare treatment

Published findings show parents who pursue therapy typically are of a higher socioeconomic status, and Cromer’s lab wants to learn how to make therapy and research more accessible to diverse groups. Helt’s sub-study also looks at how treatment can improve executive functions such as impulse control, working memory, task switching and goal-directed behavior. “For most of the medical studies I’ve read about, it’s not about convenience but rather factors like a person’s evaluation of the risks vs. benefits of participating,” Helt explained. “Underprivileged populations, for various reasons, have lower executive function, which plays into poor academic and social outcomes. It’s important to find any way possible to improve those executive functions in kids. We want nightmares to go away, but we also want to see if nightmare treatment can help in other areas too.”

The main objective of the second clinical trial is to determine if nightmares decrease in severity and frequency after the five-session therapy series. To accomplish this, Cromer is teaming up with Dr. Tara Buck, assistant professor of psychiatry and Oxley Chair in Child and Adolescent Psychiatric Research at the University of Oklahoma School of Community Medicine. The university collaboration allows OU to recruit participants for the study while TU graduate students conduct the therapy and post-therapy assessments.

Resilience amid adversity

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Psychology students assist Cromer with the clinical trial

Cromer and TU have built a credible reputation nationwide for sleep research, but her lab also encompasses other important areas of study, including psychological resilience amid adversity. “Dissertations that have come out of my lab have focused on special populations such as athletes and military families,” she said. “Through the ongoing SHAPE (Student Health, Academic Performance and Education) program, we work directly with TU teams and coaches on goal setting, mental toughness and preventing anxiety.”

Cromer’s research in child and sports psychology is extensive, and her special interest in how sleep affects other aspects of physical and emotional health inspires students like Stimson and Helt to continue working in the field. “The cool part of being in Dr. Cromer’s lab is that we view sleep as this underlying thing that we’re finding pops up in so many disorders and problems,” Stimson said. “We’re on the leading edge of this kind of research.”