Santé mentale des adolescents selon leur attirance sexuelle : enquête en milieu scolaire

IntroductionAlthough homosexuality is a subject often addressed by the media, little is said about homosexuality in adolescents who are particularly affected by the question of sexual orientation. This work aims to study the mental health of adolescents who report being exclusively attracted to members of the same sex. We explore the evidence for an association between homosexuality and depression, suicide attempts, and consulting a psychiatrist or a psychologist.MethodsWe used data from the cross-sectional study “Adolescent Portraits – A Multicenter Epidemiological Survey in Schools in 2013” (CHU Fondation Vallée, Inserm CESP U1018). Data were gathered through the use of an anonymous, self-administered questionnaire (348 questions) given to students between the “4^e” and “terminale school” years (comparable to the 8th and 12th grade in the U.S. education system) in three contrasting French geographical areas. The risk of depression was measured using the Adolescent Depression Rating Scale (ADRS).ResultsThe results reflect the survey responses provided by 15,235 young people. Of these, 1.5 % reported only being attracted to members of the same sex (homosexual group). This group contained twice as many girls as boys. Students who did not report sexual attraction, who reported bisexual attraction, or who did not answer the question were excluded from the results (830 students). In the homosexual group, 24 % presented with depression versus 11.5 % of those attracted exclusively to members of the opposite sex (heterosexual group). There is also a significant difference between sexes: 13.2 % of boys in the homosexual group were depressed compared to 29.3 % of girls in the same group; 6.7 % of boys in the heterosexual group reported being depressed versus 16.1 % of girls in the same group. In the heterosexual group, 10.7 % of respondents reported having already made at least one suicide attempt versus 20.7 % of those in the homosexual group. There was a difference according to sex, since 6.3 % of boys in the heterosexual group had a history of attempted suicide versus 14.9 % of girls in the same group. This gap disappeared completely within the homosexual group, as 21.4 % of boys and 20.4 % of girls had already made at least one suicide attempt at the time of the survey. Depressed adolescents in the homosexual group also reported a higher number of previous suicide attempts than those in the heterosexual group (46.9 % versus 31.6 %). In terms of sex, 25.3 % of depressed boys in the heterosexual group made at least one suicide attempt versus 34.1 % of girls. In the homosexual group, 44.4 % of depressed boys reported having made at least one suicide attempt versus 47.5 % of depressed girls. Adolescents in the homosexual group were significantly more likely to report having consulted a psychiatrist or psychologist than those in the heterosexual group (14.6 % versus 6.5 %), regardless of sex (16.7 % versus 4.7 % for boys; 13.5 % versus 8.2 % for girls). This difference was also found among depressed subjects (26.0 % in the homosexual group versus 15.4 % in the heterosexual group). Sexual activity (having already had sex) was higher in the homosexual group than in the heterosexual group (53.7 % versus 37.5 %), and this difference remained significant after adjusting for age. Fifty percent of the sexually active homosexual respondents reported having engaged in sexual activity of a homosexual nature versus 0.7 % of sexually active heterosexual respondents. In the homosexual group, mental suffering appeared to be more severe among sexually active subjects, in terms of dark thoughts (64 % versus 46 %) and a prior history of attempted suicide (29.3 % versus 10 %), but not in terms of depression (27.9 % versus 18.9 %; NS).ConclusionYoung people who reported being exclusively attracted to members of the same sex presented a higher level of mental distress compared to those who reported being attracted to members of the opposite sex. This was especially the case for boys. These findings led to the identification of risk and protective factors that can inform the development of appropriate preventive measures.     

Sexting Among Young Men Who Have Sex With Men: Results From a National Survey

PurposeWe know little about the prevalence of sexting behavior among young men who have sex with men (YMSM) or its association with their sexual behaviors.MethodsTo address these gaps, we used data from an online study examining the partner-seeking behaviors of single YMSM (N = 1,502; ages 18–24 years) in the United States. Most participants (87.5%) reported sexting, with 75.7% of the sample reporting having sent and received a sext.ResultsSexting was more frequent among sexually active YMSM, with YMSM who had sent and received a sext being more likely to report insertive anal intercourse, with and without condoms, than those who had not sexted. We found no association between sexting and receptive anal intercourse.ConclusionsOur findings suggest that sexting may vary by YMSM's sexual roles. We discuss our findings with attention to their implications for sexual health promotion.     

Gender dysphoria and homosexuality: A patient series

PurposeTo present the clinical course of adolescents who presented to the child and adolescent psychiatry outpatient clinic due to gender dysphoria and homosexuality through a patient series.MethodsThe clinical features, comorbidities, and the treatment process of 10 patients who presented to the outpatient clinic and were followed up over a period were presented.ResultsThe average age of the 10 patients, 5 girls and 5 boys, was 14.3 years for the girls and 16 years for the boys. Nine patients were admitted by their families primarily with the desire for the elimination of gender dysphoria or homosexual orientation. Only one female patient was brought by her family because of her intense depressive symptoms and suicidal thoughts. All of the patients had comorbid psychiatric diseases, nine had depression, and one had bipolar affective disorder comorbidity. The anxiety levels of all patients were high. Psychiatric management in each patient focused on the emotional, cognitive and social difficulties of the case. The treatment of two girls was interrupted suddenly by the family because they saw that the homosexual orientation of the patients was continuing. Two male patients were not brought back for treatment after the evaluation process.ConclusionsGender dysphoria and homosexual orientation are situations that families still find it difficult to accept and that they think it can be eliminated by pressure, coercion or psychiatric treatment. Patients show a high rate of psychiatric comorbidity due to family pressure and social exclusion. Although psychiatric support can cure comorbid disorders in a relatively short time, strains of family and social relationships continue to affect patients.     

2010-2012年芜湖市男男性行为者人群艾滋病血清学及行为学调查分析

目的 了解男男性行为者艾滋病病毒(human immunodeficiency virus,HIV)感染率和行为学特征,为在该人群中开展更有效的艾滋病预防控制工作提供依据.方法 用分类滚雪球的抽样方法对男男性行为者(men who have sex with men,MSM)进行匿名问卷调查,同时采集外周血样进行HIV和梅毒血清学检测.结果 2010-2012年分别调查了422人,422人和434人,3次调查中调查对象的艾滋病知识知晓率无差异,调查对象HIV和梅毒确认检出率呈增高趋势,最近一次与同性发生性行为时安全套使用率差异有统计学意义(X2=128.39,P＜0.001),最近半年与同性性行为均用安全套的率差异无统计学意义(X2=0.83,P=0.660),最近半年与异性发生性行为比例呈下降趋势.接受艾滋病相关服务者所占比例呈增加趋势(X2=44.50,P＜0.001).结论 芜湖市MSM人群HIV感染率高,存在高危行为,应进一步加强干预工作.     

马鞍山市MSM人群艾滋病KABP调查分析

目的 了解马鞍山市男男性行为人群艾滋病性病流行现状以及艾滋病、安全套相关知识知晓情况,以确定健康教育的重点.方法 采用“滚雪球”的方式接触目标人群,进行一对一问卷调查,并对调查对象采集血标本进行艾滋病病毒与梅毒检测.结果 共收集男男同性恋者合格问卷274份,检测200人,调查结果显示男男性行为人群对艾滋病基本知识总知晓率为85.9％,男用安全套相关知识总知晓率为94.1％;最近1次与同性性交使用安全套的比例为55.5％,最近1次与同性发生商业性行为使用安全套的比例为9.9％,最近1次与异性性交使用安全套的比例14.2％;最近6个月与同性性交每次坚持使用安全套的比例40.1％,最近6个月与同性发生商业性行为每次坚持使用安全套的比例41.2％,最近6个月与异性性交每次坚持使用安全套的比例32.3％.接受过安全套宣传和发放/艾滋病咨询与检测服务比例83.9％,接受过同伴教育的占84.3％,最近1年接受过艾滋病检测的为198人(72.3％),其中知道检测结果的占接受过艾滋病检测的97.0％.此次检出HIV阳性者7人,感染率为3.5％;梅毒感染者22人,感染率为11.0％.结论 马鞍山市MSM人群对艾滋病和安全套知识认知水平较高,但安全套使用率仍然较低,需开展有针对性的宣传教育和干预工作.     

Utiliser les psychédéliques pour « guérir » des adolescents homosexuels ? Essai de thérapie de conversion,France, 1960

Between 1960 and 1962, a children's judge placed two French adolescents in a psychiatric hospital in Alsace. Described as “delinquent sexual perverts”, Michel, 15, and Bernard, 18, were in fact two young homosexuals. However, at the time, homosexuality was considered a psychiatric disorder that should be “cured”. With this in mind, psychiatrists set up shock or disgust therapies to push patients to become heterosexual. In this hospital, the chief doctor tested two new substances on them: mescaline and LSD. Injected in very high doses, the idea was to cause a powerful psychological shock in the hope of changing the adolescents’ sexual orientation. This type of placement as well as the treatment inflicted were then common (lobotomies or electroshocks were part of the “therapeutic” possibilities to “cure” homosexuality). Two aspects of these experiments are however particularly original: on the one hand, the use of substances such as mescaline and LSD, on the other hand, the very type of “therapy” implemented. It would thus seem, in the current state of knowledge on the use of LSD and mescaline in psychiatric therapy, that these experiences were isolated facts: the literature remains silent on the subject of the use of mescaline to “cure” homosexuality, and the few known therapies carried out using LSD were offered to adults and above all volunteers. Finally, these therapeutic methods were the opposite: psychotherapies in which particular attention was paid to patients and their well-being in the United States or in England and “psychic shocks” in Alsace. This hospital is the only French example of an attempt to “treat” homosexuality using psychedelics. The use of these substances by the French team therefore began in 1960; it involved administering mescaline or LSD in high doses (an exceptional characteristic in Europe where psychiatrists were in favor of therapy with low doses known as “psycholytic”) and in injections, ranging from 200 to 1200 mg for mescaline and for LSD from 100 to 800 micrograms. By way of comparison, a recreational dose is 300 to 500 mg for mescaline and 100 micrograms for LSD, administered orally. In order to create “psychic shock”, the effects of the substances were immediately stopped by the injection of chlorpromazine, a powerful neuroleptic. The authors noted that for all patients, “two modes of behavior are common: stupor and agitation”. They sometimes tore their sheets or pajamas or grabbed the examiner, asking for support. The sessions were linked: in 118 days, Bernard would undergo 16 of these sessions, one every 7 days on average. Michel, during one of the sessions, felt like he had been killed by his psychiatrists. Neither would subsequently become heterosexual. Elsewhere in the world, other forms of LSD conversion therapy have emerged. However, these were benevolent psychotherapies; the product was not injected but taken orally (therefore with more progressive effects), and the approach was not the same. Thus, acceptance of their homosexuality by patients was considered as desirable an option for therapists as was conversion to heterosexuality. For French practitioners, on the contrary, “healing” was the only objective. This article will highlight a double French specificity in the use of psychedelics: first, the refusal to introduce the new method of administering these substances, called “set and setting”, theorized from the late 1950s in Anglo-Saxon countries, and yet known and discussed by French experimenters. Then, it will show the use of these substances in shock therapy, particularly in the treatment of homosexuality.