Transgender and gender nonconforming (TGNC) people experience disparities in mental health when compared with non-TGNC sexual minorities and the general population. One line of inquiry with respect to these disparities is the examination of stigma and its connection to emotional and psychological well-being. Recent conceptualizations of stigma draw attention to multiple levels-individual, interpersonal, and structural-that are thought to impact well-being for TGNC people. However, little is known about how multilevel stigma is experienced by TGNC older adults, who navigate stigmatizing environments over a lifetime and who may be especially vulnerable to its cumulative effects. We conducted an interpretive content analysis of biographical interviews with 88 TGNC adults aged 50 and older, from across the United States, obtained from the photography and interview project To Survive on This Shore. Our analyses suggest that TGNC older adults' mental health is indeed impacted by multiple levels of stigma. Individual level stigma is experienced as ongoing vigilance about aspects of oneself that break gender norms, often manifesting in internal conflicts. At the interpersonal level, TGNC older adults navigate unpredictable relationships marked by conflicting expressions of love, acceptance, strain, and exclusion. Structural stigma manifests in constraints brought about by transphobic policies and social norms but also sparks intentional action on the part of TGNC older adults to resist and change these social forces. Clinical interventions to combat stigmatization can use life narratives and a focus on consciousness-raising to promote empowerment and well-being for this group of older adults. Public Policy Relevance StatementTransgender and gender nonconforming (TGNC) older adults experience multiple levels of stigma over the course of their lives, which often negatively impact their well-being. However, these older adults also find ways of resisting stigmatization and engage in action to improve both their own lives and those of TGNC youth. Autobiographical life narratives hold the potential to inform interventions to reduce stigma and promote therapeutic gains for this group of older adults.

ObjectivesResearch about the mental health of children in Francophone West Africa is scarce. This paper examines the relationships between adverse childhood experiences, including exposure to violence and exploitation, and mental health outcomes among children living in ultra-poverty in rural Burkina Faso.MethodsThis paper utilizes baseline data collected from 360 children ages 10–15 and 360 of their mothers recruited from twelve impoverished villages in the Nord Region of Burkina, located near the Sahel Desert and affected by extreme food insecurity. We used a Latent Class Analysis to identify underlying patterns of maltreatment. Further, the relationships between latent classes and mental health outcomes were tested using mixed effected regression models adjusted for clustering within villages.ResultsAbout 15% of the children in the study scored above the clinical cut-off for depression, 17.8% for posttraumatic stress disorder (PTSD), and 6.4% for low self-esteem. The study identified five distinct sub-groups (or classes) of children based on their exposure to adverse childhood experiences. Children with the highest exposure to violence at home, at work and in the community (Abused and Exploited class) and children not attending school and working for other households, often away from their families (External Laborer class), demonstrated highest symptoms of depression and trauma. Despite living in adverse conditions and working to assist families, the study also identified a class of children who were not exposed to any violence at home or at work (Healthy and Non-abused class). Children in this class demonstrated significantly higher self-esteem (b = 0.92, SE = 0.45, p<0.05) and lower symptoms of trauma (b = -3.90, SE = 1.52, p<0.05).ConclusionsThis study offers insight into the psychological well-being of children in the context of ultra-poverty in Burkina Faso and associated context-specific adverse childhood experiences. Identifying specific sub-groups of children with increased exposure to life stressors has implications for program developers. Study findings indicate a further need to explore the mental health consequences of traumatic experiences within the context of ultra-poverty and to develop integrated economic and psychosocial interventions that prevent or mitigate childhood adversities linked with the family-level poverty and violence in the family.

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Objective: This is the first experimental study testing the effects of an economic intervention alone and in combination with a family focused component, on women's empowerment status and family violence in Burkina Faso. Method: The 3-arm cluster randomized controlled trial with baseline and 1-year follow-up included 360 ultrapoor married women from 12 villages. Villages were randomized to the 3 study arms: economic intervention for women (Trickle Up/TU), a combination of economic intervention and family coaching (Trickle Up Plus), and waitlist (control arm). Analysis utilized repeated-measures mixed effects regressions. Results: Compared with the control group, there was a significant improvement in both the TU arm and the TU Plus arm in women's financial autonomy and in quality of marital relationships. In addition, women in both intervention arms reported a significant reduction in emotional spousal violence in the past year, with the effect size greater for the combined intervention (TU Group OR ϭ 0.28, 95% CI [0.10, 0.82], p ϭ .02 and TU ϩ Group OR ϭ 0.19, 95% CI [0.06, 0.64], p ϭ .007). Conclusions: Economic intervention shows benefits that go beyond changes in financial wellbeing and may increase women's status and improve family relationships. Integrating psychosocial components with economic strategies may be more effective for improving women's empowerment status in West Africa.

ObjectiveTo explore experiences of social support needs among South Asian Muslim patients with life-limiting illness, living in Scotland, who are parents of young children.DesignSecondary analysis of data from a multiperspective, longitudinal Scottish study involving in-depth semistructured interviews with patients, their nominated carers and healthcare professionals. Data were analysed using interpretive phenomenological analysis.SettingEdinburgh, Scotland.ParticipantsSouth-Asian Muslim patients with life-limiting illness with children under the age of 18 (n=8), their carer (n=6) and their healthcare professional.Main outcome measuresAccess and provision of social support in palliative care.ResultsOpen-ended qualitative interviews identified four main themes: (1) parental sadness over being unable to provide tangible support; (2) parental desire to continue to provide emotional support; (3) limited availability of informal social support networks; and (4) differing perspectives between healthcare professionals and patients on patient access to social support sources, with a subtheme being the capacity of male carers to provide social support.South-Asian parents at the end of life had limited access to extended-network support. Gender roles appeared as challenging for healthcare providers who at times overestimated the amount of support a female carer could provide and underestimated the amount of support male carers provided. Implications for practice include the need for greater awareness by healthcare providers of the social support needs of ethnic minority and migrant parents with life-limiting illnesses and especially an awareness of the importance of the role of male and female carers. Further research is needed to explore how the timing of migration impacts the need for and availability of tangible and emotional informal social support among ethnic minority parents with life-limiting illness.