Research indicates that marriage equality legislation is associated with improved mental health outcomes for lesbian, gay, bisexual, transgender, and queer (LGBTQ) people. However, the public debate that often precedes such legislation may exacerbate psychological distress and minority stress. In 2017, the Australian Federal Government conducted a national survey to gauge support for marriage equality. The present study investigated the mental health of a sample of LGBTQ people during and after this survey period. A sample of 2,220 LGBTQ participants completed measures of psychological distress and minority stress during the survey period. Participants were invited for follow-up 1 week, 3 months, and 12 months after the postal survey results were announced. Data were analyzed using linear mixed models to evaluate change in psychological distress and minority stress across time points, and the influence of exposure to the marriage equality debate, sexual identity, and gender identity on psychological distress and minority stress. Reported symptoms of psychological distress and minority stress significantly decreased following the postal survey period. Greater exposure to the marriage equality campaign was associated with greater psychological distress and perceived stigma but not internalized stigma. Sexual and gender identity subgroups significantly differed on outcome variable means. This study documents the longitudinal effects on a minority group of a public vote and the enactment of legislation regarding their human rights. The results suggest the postal survey served as a significant stressor to Australia's LGBTQ community. Implications for policy and clinical practice are discussed. Public Policy Relevance StatementExposure to campaigns to deny marriage rights to lesbian, gay, bisexual, transgender, and queer people has been associated with greater psychological distress for this community. This longitudinal study considers the case of Australia, in which marriage equality legislation was recently passed following a public debate and vote on the topic. The findings suggest that this debate and vote represented a period of heightened stress for lesbian, gay, bisexual, transgender, and queer people, and that direct democracy approaches to determining the rights of minority groups have serious implications for the well-being of members of those groups. R elative to the general population, lesbian, gay, bisexual, transgender, and queer (LGBTQ) people are more vulnerable to developing psychological disorders (Bostwick, Boyd, Hughes, West, & McCabe, 2014). For example, lesbian, gay, and bisexual (LGB) people have 1.5 times the risk of developing a mood or anxiety disorder compared with the general population (King et al., 2008). These poorer mental health outcomes are generally held to be due to minority stress, or the experience of living in a stigmatizing social environment (Meyer, 1995(Meyer, , 2003. Researchers have proposed that marriage equality, being the extension of civil marriage rights to all couples, ...

Marriage equality legislation was introduced in Australia in 2017 following a national survey of enrolled voters conducted via the postal system ("the postal survey"). Consistent with other major anti-LGBTQ rights campaigns, research has demonstrated that this event posed a unique source of social stress for LGBTQ people. This study seeks to expand the clinical utility of previous research by employing a cognitive-behavioral lens to explore the life stressors reported by LGBTQ Australians during the postal survey. During the postal survey period, a sample of 2,200 LGBTQ Australians answered the open-ended question, "Do you think the public discussion about marriage equality and the marriage equality postal survey has affected you and/or your family? If so, how?" Seven-hundred of these responses were randomly selected and analyzed using reflexive thematic analysis. Cognitive themes were hyperawareness of stigma, social and political exclusion, changes in self-perception, and fear of harm. Affective themes were anger, anxiety, and sadness. Behavioral themes were avoidance, changing social relationships, hiding identity, and preoccupation. The physiological theme was exhaustion. The results have implications for the assessment and treatment of LGBTQ people experiencing distress in the face of future anti-LGBTQ rights campaigns. Public Significance StatementPublic votes on the rights of LGBTQ people can pose unique challenges for LGBTQ individuals and communities. This study articulates the psychological impacts of one such vote on the topic of marriage equality in Australia. It extends previous research by applying a cognitive-behavioral lens to the results in the interests of increasing the utility of findings for clinical practice.

Over the last decade, the manner in which gender dysphoria is defined has changed significantly, as have the presentations of transgender clients to specialist gender services. Although the use of patientreported outcome measures (PROMs) to assess gender dysphoria is widespread, there is a lack of literature that assesses the methodological quality of these measures. To address the limits of the existing literature, the aim of the current study was to conduct a systematic review of PROMs that assess gender dysphoria. The systematic review was performed in accordance with the PRISMA and COSMIN methodologies. Five measurement studies met inclusion criteria. Results suggested that none of the measures could be recommended for use without further development. Poor content validity was evident across all measures and internal validity and construct validity were mixed, ranging from inadequate to very good. Measures that show promise for the future include the Gender Congruence and Life Satisfaction Scale, Gender Identity Reflection and Rumination Scale, Gender Preoccupation and Stability Questionnaire, and Transgender Adaptation and Integration Measure. A need to develop reliable and valid measures that are appropriate for use with adolescent samples experiencing gender dysphoria was also identified. Public Significance StatementFor clinicians, the study highlights the strengths and weaknesses of existing measures of gender dysphoria. For researchers, the study identifies additional research necessary to improve the methodological quality and measurement properties of the identified measures.

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