Adolescents in China face intensifying mental health challenges as extraordinary academic pressures rooted in cultural expectations for high achievement. While government-led initiatives provide multilevel formal support structures, critical gaps remain in understanding adolescents' perceptions of both formal and informal social support adequacy across different phases of mental health problems. This study applied qualitative thematic analysis to semi-structured interview data collected in Anhui Province. Participants included 17 adolescents aged 10-19 years and one 25-year-old whose mental health concerns originated in adolescence (age 15), with 15 family members jointly interviewed alongside them. Four themes characterized participants' narratives: the early manifestation phase, marked by multilevel barriers to timely mental health intervention, including insufficient parental response, a lack of systematic school-based prevention and stigma among adolescents; the problem escalation phase, characterized by insufficient policy implementation and a demand-execution gap, reflected in barriers to formal support access, insurance issues and disruptions in peer support; the treatment-recovery phase, multi-dimensional support gaps involving medicalization path dependence, limited inter-institutional coordination and inadequate follow-up support for families; and participants' visions for ideal collaborative support systems. The findings underscore the critical need to strengthen formal support systems for adolescents, which not only shape the identification of mental health needs and resource access but also play a crucial role in fostering adolescents' psychological development through informal networks such as families and peers.

Many individuals with psychiatric disabilities employed by work integration social enterprises (WISEs) rely on disability financial supports to supplement their income. However, little research has investigated the interconnections between WISE, disability support, and psychiatric disability. We draw on data from a qualitative study of employees, supervisors and administrators from seven WISEs in Ontario, Canada, to determine: (a) how does receipt of disability support impact the work experiences and choices of WISE workers? and (b) how does workers' receipt of disability support impact the business practices of WISEs? We find that the cap on employment income earned without triggering a reduction in benefits limits worker engagement and places WISEs in the difficult position of jeopardizing continuity of benefits while pursuing their mandate of encouraging participation in work. These findings illustrate how the structure and function of WISE are interconnected with the structure and function of disability support in ways that bring to light the tensions between their respective understandings of psychiatric disability.

Queer, transgender and nonbinary (QTNB) people access midwifery services, yet little is known about their experiences of midwifery care. Our qualitative study used critical narrative inquiry to examine how QTNB midwifery service-users in Ontario, Canada, experience cisheteronormativity in healthcare. Drawing on in-depth interviews with 14 participants, our analysis examines the effects of biomedicalisation on QTNB people who navigate these systems. Our findings show that QTNB people access and participate in technologies of pregnancy surveillance, which deploy information-seeking practices that collect information about the genetic makeup of the baby, conception and paternity. These 'lines of inquiry' present in mundane but insidious ways, embedded within cisheteronormative assumptions about paternity and conception. Stemming from broader biomedical discourse that views sex and gender as one and the same, genetically determined and binary, the discursive effects of lines of inquiry render invisible QTNB identities, family building processes and kinship structures. We explore this tension, showing how lines of inquiry have unequal effects of surveillance across queer family building, kinship and identity, and how QTNB resist dominant discourse around sex, gender and sexuality. Findings can be used by perinatal health professionals to better care for QTNB perinatal service-users as they navigate technologies of surveillance during pregnancy.

Reproductive violence and coerced sterilizations, both in the past and present, continue to shape fertility and reproductive health systems, which reproduce inequities rooted in heteronormativity, white supremacy, colonialism, and racialization. For 2SLGBTQ + Black, Indigenous, and people of colour (BIPOC), these systems pose particular barriers, requiring individuals to negotiate their identities and family-expansion desires using assisted reproductive technologies (ART). This study draws on queer of colour critique and theories of disidentification to examine reproductive justice in the context of ART. Interviews were conducted with 32 BIPOC and 2SLGBTQ + people who had undergone or were seeking ART in Ontario, Canada. A situational analysis approach was used to examine how participants experienced, and strategically navigated fertility systems shaped by racial and heteronormative power structures. Findings highlight three central dynamics: (1) ongoing violations of reproductive autonomy, (2) pressures of being positioned as the "wrong kind of queer" in clinical spaces, and (3) disidentificatory practices employed to navigate white heteronormative systems. These strategies, which ranged from conformist to resistant and survivalist, illuminate both the possibilities and limits of reproductive access for 2SLGBTQ + BIPOC. The findings point to the structural limitations of fertility systems for 2SLGBTQ + BIPOC, where access is negotiated within heteronormative and white supremacist norms. These dynamics highlight the urgency of transforming reproductive health systems so that equitable, trauma-informed, and affirming care becomes the norm rather than the exception, irrespective of sexual orientation, gender identity/expression, and race.

PurposeThe purpose of this paper is to examine the experiences of transgender and non-binary (TNB) people in peer researcher roles in order to contribute to an understanding of the extent to which peer research is effective in mitigating or reducing the potential harms of research for TNB people.MethodsSemi-structured qualitative interviews were conducted with 13 TNB peer researchers who had been employed in the 10 years prior in a paid research position that required TNB lived experience. Data were analyzed using approaches drawn from thematic analysis.ResultsFour major themes were generated that captured the experiences of TNB people in their work as peer researchers: (a) imposition of cis-centric language and frameworks, (b) devaluing of community-based TNB knowledge, (c) experiencing discrimination and oppression on the job, and (d) the importance of anti-oppression and conflict resolution.ConclusionCareful interrogation of peer research practices is needed to mitigate potential harms and create meaningful engagement of TNB people. TNB people should be in positions of leadership from inception to completion of the research to ensure that research projects and teams are not built upon ciscentric and cisnormative frameworks that by definition devalue TNB lives and experiences.

OBJECTIVE:Given that two-spirit, lesbian, gay, bisexual, transgender, and queer (2SLGBTQ+) people are more likely experience trauma and gender-based violence in their lifetimes compared with heterosexual and/or cisgender peers, it is important that service providers addressing violence and/or trauma be 2SLGBTQ+ culturally competent to support 2SLGBTQ+ communities and avoid retraumatization. To address this need, we developed and implemented a novel 2SLGBTQ+ competent trauma-informed care (TIC) intervention across Ontario, Canada. This article evaluates the intervention based on learning outcomes, professional relevance, changes in knowledge and comfort, and impacts on individual and organizational practices. METHOD:We used mixed methods to assess the acceptability and impact of the intervention on multidisciplinary service providers. The intervention was evaluated with principles of the Kirkpatrick model. Pre- to postsurveys were used to quantitatively assess the intervention's acceptability, as well as comfort and knowledge regarding 2SLGBTQ+ competent TIC. Qualitative interviews were conducted to understand acceptability and impact on personal, professional practice, and organizational levels. RESULTS:A total of 240 participants completed pretraining surveys, and 222 completed posttraining surveys. Participants were service providers who worked in mental health organizations (n = 71), antiviolence organizations (n = 31), community health centers (n = 20), private practice (n = 10), hospital-based services (n = 8), and other community-based organizations (n = 62). Interviews were conducted with 20 participants. Quantitative surveys indicated an increase in knowledge and comfort in providing TIC for 2SLGBTQ+ people. Qualitative interviews indicated a multilevel impact on service providers' capacity and delivery of 2SLGBTQ+ competent TIC. CONCLUSION:We found that novel interventions to engage service providers in providing 2SLGBTQ+ competent TIC are impactful and merit further development. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

The use of assisted reproductive technologies (ART) has risen steadily over the past two decades. In Canada, up to 25 % of assisted reproductive technologies (ART) users identify as Two-Spirit, lesbian, gay, bisexual, trans, and/or queer (2SLGBTQ+). Despite evidence of inequitable ART access for 2SLGBTQ+ communities, scant research has explored the intersectional experiences of 2SLGBTQ+ Black, Indigenous, and People of Colour (BIPOC). Theoretically grounded in reproductive justice and critical political economy, this study examines ART access and clinical experiences for 2SLGBTQ+ BIPOC communities. Interviews were conducted with BIPOC and 2SLGBTQ+ people who had undergone or were seeking ART in Ontario, Canada. Data analysis, guided by constructivist grounded theory and situational analysis, was coded using MAXQDA. The findings reveal structural powers and systemic inequalities shaping the ART process and parenthood. Participants identified four key barriers faced by 2SLGBTQ+ BIPOC families: (1) normative practices (re)produced through ART; (2) mandatory counselling as gatekeeping and disciplining; (3) regulation of known donor sperm augmenting legal, financial, and timeliness barriers; and (4) limited availability of Black, Indigenous, and People of Colour donor sperm. These intersectional barriers highlight the urgent need for ART providers to offer competent and inclusive care. Additionally, the study underscores the necessity for clinical policy reforms to challenge heteronormative and racist practices, ensuring equitable access and improving availability of BIPOC donor sperm for diverse family structures.

While the need for research, policy and practice addressing the health equity issues of Two-Spirit, lesbian, gay, bisexual, transgender, queer and other sexual and gender minority (2S/LGBTQ+) populations is increasingly recognized, we acknowledge that significant gaps remain in this area. As authors in this themed issue have consistently pointed out, interventions that grapple with the intersectionally varied structural drivers of 2S/LGBTQ+ health remain lacking and, in particular, warrant urgent consideration. This is especially the case during a time when structural threats to the well-being of 2S/LGBTQ+ populations are on the rise, both in Canada and in other geopolitical contexts.

ObjectivesThe COVID-19 pandemic has caused unforeseen impacts on sexual and reproductive healthcare (SRH) services worldwide, and the nature and prevalence of these changes have not been extensively synthesized. We sought to synthesise reported outcomes on the impact of COVID-19 on SRH access and delivery in comparable countries with universal healthcare systems.MethodsFollowing PRISMA guidelines, we searched MEDLINE, Embase, PsycInfo, and CINAHL from January 1st, 2020 to June 6th, 2023. Original research was eligible for inclusion if the study reported on COVID-19 and SRH access and/or delivery. Twenty-eight OECD countries with comparable economies and universal healthcare systems were included. We extracted study characteristics, participant characteristics, study design, and outcome variables. The methodological quality of each article was assessed using the Quality Assessment with Diverse Studies (QuADS) tool. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed for reporting the results. This study was registered on PROSPERO (#CRD42021245596).SynthesisEighty-two studies met inclusion criteria. Findings were qualitatively synthesised into the domains of: antepartum care, intrapartum care, postpartum care, assisted reproductive technologies, abortion access, gynaecological care, sexual health services, and HIV care. Research was concentrated in relatively few countries. Access and delivery were negatively impacted by a variety of factors, including service disruptions, unclear communication regarding policy decisions, decreased timeliness of care, and fear of COVID-19 exposure. Across outpatient services, providers favoured models of care that avoided in-person appointments. Hospitals prioritized models of care that reduced time and number of people in hospital and aerosol-generating environments.ConclusionsOverall, studies demonstrated reduced access and delivery across most domains of SRH services during COVID-19. Variations in service restrictions and accommodations were heterogeneous within countries and between institutions. Future work should examine long-term impacts of COVID-19, underserved populations, and underrepresented countries.

Introduction Labor force outcomes in LGBT (lesbian, gay, bisexual, transgender) populations often compare unfavorably with those of cisgender, heterosexual peers across OECD (Organization for Economic Co-operation and Development) countries. Persistent discrimination often emerges as a likely predictor of these disparities, and multiple OECD countries have implemented measures to address differences in labor force outcomes (i.e., income, unemployment). However, there has been no prior review of the literature that systematically and comprehensively identifies measures that address these labor force outcome disparities. Method The current study used a scoping review protocol to identify publications included in journals from January 1, 2000, to June 5, 2022, across seven databases that identified interventions used to address differences in labor force outcomes for LGBT individuals in OECD countries. An updated search identified journals from January 1, 2000, to August 1, 2023. Results From 7841 identified publications, 54 met criteria for data extraction. Underlying themes across these 54 articles were identified via thematic analysis and included state policy ( n = 17), workplace policy ( n = 28), mentorship ( n = 4), and interventions for unemployed LGBT individuals ( n = 5). Policy Implications The current review summarizes that legal and policy interventions meaningfully improve labor force outcomes for LGBT individuals. We suggest an intersectional approach that construes program-based interventions as complementary to legislation and policy. The current study also holds implications for global policy, though future studies should consider policy in non-OECD countries, as well. Conclusion Ultimately, interventions to address societal homophobia, biphobia, and transphobia, alongside intersecting forms of discrimination, are necessary before disparities in labor market outcomes for LGBT people will be dismantled.

Introduction Precarious employment disproportionately affects systemically marginalized populations. Despite ample literature identifying employment disparities among some marginalized groups, LGBTQ + populations are often overlooked by research in this area. Methods A scoping review of peer-reviewed literature was conducted to identify the prevalence of precarious employment characteristics (e.g., part-time work), how LGBTQ + people arrive at precarious employment, and what precarious employment among this population looks like. In February 2022, the study team searched ten bibliographic databases for studies in OECD countries published from 2000. Results The search yielded 2738 unique articles, of which 30 met inclusion criteria. The ability to fully characterize the prevalence or nature of precarious employment among LGBTQ + people was limited. However, it was clear that precariously employed LGBTQ + workers have limited power to address the hostility and discrimination they experience when pursuing employment and in the workplace. Conclusions Increased workplace protections for LGBTQ + people are needed in addition to addressing their devaluation within and exclusion from stable employment through effective social policy. Policy Implications Existing social policies are insufficient to address the unique conditions that structure LGBTQ + people’s experiences in the labor market. This analysis brings together disparate literature that might better inform and strengthen social policies targeted toward equity and inclusion of LGBTQ + populations.

Two-Spirit, lesbian, gay, bisexual, transgender, queer and other sexual and gender minority (2S/LGBTQ+) populations continue to experience profound health disparities. In this article, we prioritize five issues in 2S/LGBTQ+ health equity and discuss policy interventions to address disparities in each area: (1) poverty in 2S/LGBTQ+ communities; (2) Two-Spirit mental health; (3) health equity issues in migrant and racialized LGBTQ+ populations; (4) challenges in implementing bans on conversion therapy; and (5) the evolving context of gender-affirming care. Multi-level policy interventions, including those in healthcare-adjacent contexts such as housing and immigration, will be critical to address the structural undercurrents driving health inequities for 2S/LGBTQ+ populations. Recognizing growing complexity and political volatility in the lives of 2S/LGBTQ+ people across Canada, we challenge healthcare policy actors to recognize the breadth of structural barriers to 2S/LGBTQ+ health equity issues and act with urgency in this area.

Introduction: 2SLGBTQ+ people are more likely than their heterosexual and/or cisgender peers to experience violence and/or trauma in their lifetime. Many 2SLGBTQ+ people may need support related to experiences of violence and/or trauma. Yet, research has shown that a lack of 2SLGBTQ+ competence and capacity from service providers has resulted in barriers for 2SLGBTQ+ people accessing health and social services. This intervention seeks to fill an important gap by integrating the approaches and principles of trauma-informed care and 2SLGBTQ+ competence.Method: The intervention was developed by a team of researchers in consultation with an Indigenous Elder and an advisory committee of service providers. The 2SLGBTQ+ competent trauma-informed care intervention was developed and implemented based on the following principles: centering intersectional perspectives; foregrounding Indigenous perspectives; modeling trauma-informed care; and anti-ableism and accessibility as the rule, rather than exception.Result: The training reached a total of 295 participants, and 116 institutions and services across Ontario, Canada.Conclusion: A 2SLGBTQ+ competent trauma-informed care intervention has the potential to increase capacity for service providers in healthcare, mental health, and social services to avoid re-traumatization and meet the needs of 2SLGBTQ+ people who have experienced violence and/or trauma.

People with serious and persistent mental illnesses and/or substance use disorders are among the most economically and socially disenfranchised populations in Canada, and often present with long histories of labour market detachment and underemployment. Work engagement has the potential to improve social determinants of health while also harnessing productive capacity. This article reports on a five-year study examining the social, economic, and health impacts of Work Integration Social Enterprises (WISEs) in the mental health sector in Ontario, Canada. The findings shed light on the population that works in WISEs, its levels of social and labour market integration, and organizational features that influence worker outcomes. Results highlight both the importance of WISEs as a means of supporting employment, and challenges to organizational sustainability.

[Voir la version anglaise de l'article ici : www.cmaj.ca/lookup/doi/10.1503/cmaj.231003][1] L'asexualité est un terme générique qui englobe la demisexualité (fait d'éprouver une attirance sexuelle uniquement en présence d'un lien émotionnel fort) et la grisexualité (fait de n'é

This study addresses a gap in the labour market and occupational health literatures among sexual and gender minority workers by exploring the relationship between precarious employment and mental health through a political economy framework. Narratives from 20 cisgender and transgender sexual minority men were analysed to uncover the production of employment and mental health inequities. Results are presented temporally, including employment readiness, looking for work, and on the job, illuminating the social and structural processes that underly participants' stories of precarious employment and mental health. A cyclical pattern was identified whereby participants' mental ill-health resulted in separation from the labour market and increased employment precarity that subsequently further impacted their mental health. Interventions and programmes must consider multipronged approaches that address all aspects of this syndemic, including social stigma and discrimination towards sexual and gender minority people and improved access to stable employment, mental healthcare, and adequate social welfare systems.

IntroductionAsexuals present at health services with unique needs, yet providers typically lack training to care for this population. This narrative review aims to inform providers on best methods of asexual care.MethodsSearch terms included "asexuality" and "health." Abstracts were screened against inclusion criteria, yielding 987 articles. After full-text screening, 44 papers were included.ResultsPathologization, microaggressions, lack of awareness, and institutional neglect pose challenges to asexuals seeking care. Providers can improve asexual care by affirming identity, taking asexual-specific approaches, educating themselves, challenging biases, and fighting for institutional-level changes.ConclusionThese findings may guide practitioners in developing asexual-competent practices.

BackgroundThis study brings lesbian, gay, bisexual, transgender (trans), and queer (LGBTQ+) populations into scholarly discourse related to precarious employment through a political economy of queer struggle.MethodsDrawing on narrative inquiry, 20 gay, bisexual, and queer men shared stories of precarious employment that were analyzed using Polkinghorne's narrative analysis.ResultsResults tell an overarching narrative in three parts that follow the trajectory of participants' early life experiences, entering the labor market and being precariously employed. Part 1: Devaluation of LGBTQ+ identities and adverse life experiences impacted participants' abilities to plan their careers and complete postsecondary education. Part 2: Participants experienced restricted opportunities due to safety concerns and learned to navigate white, cis, straight, Canadian ideals that are valued in the labor market. Part 3: Participants were without protections to respond to hostile treatment for fear of losing their employment.ConclusionsThese stories of precarious employment illustrate unique ways that LGBTQ+ people might be particularly susceptible to exploitative labor markets.