Elliot Kale Edmiston

Background: Transgender and nonbinary (trans) people face elevated risk for suicidal ideation (SI); yet, many do not experience SI, necessitating study of mechanisms contributing to, or buffering against, trans suicide risk. Gender minority stress and resilience theories have been tested cross-sectionally; however, no work has tested these models in the daily lives of suicidal trans adults. Methods: Trans adults with past-month suicidal thoughts or behaviors ( N = 47) were enrolled for a virtual research study involving a baseline set of interviews and questionnaires, followed by a 4-week ecological momentary assessment protocol. Ecological momentary assessment surveys were administered six times daily and assessed various minority stressors and momentary SI; each day’s first survey assessed resilience factors. Dynamic structural equation modeling was used to disentangle within- and between-person effects of minority stress and resilience factors on changes in SI. Results: We observed that interpersonal and intrapersonal minority stressors predicted proximal within-person changes in SI over several hours; however, between-person estimates of resilience did not moderate the minority stress–SI relationship, as argued by extant theory. Conclusions: Although the sample demonstrated adequate geographic, age, and gender diversity, participants were primarily White, limiting generalizability to racial minority trans people, and those outside the United States. Results suggest that interventions targeting minority stress and resilience factors may be appropriate for suicidal trans people, alongside social and political efforts to address discrimination and other interpersonal harms faced by trans people.

Recent research in autism spectrum disorder (ASD) has suggested a higher prevalence of gender diversity in individuals diagnosed with ASD. Adolescence is a critical period for the consolidation of gender identity, yet the extent to which the experience of gender diversity is stable over adolescence and puberty in autistic youth is poorly understood. The aim of the study was to examine the consistency of gender diversity using the gender diversity screening questionnaire for self‐ and parent‐report of youth (GDSQ‐S, GDSQ‐P) over a four‐year longitudinal study of pubertal development in youth with ASD (N = 140, 36 assigned‐female‐at birth (AFAB)) and typical development (TD, N = 104, 58 assigned‐male‐at‐birth [AMAB]) and their parents. The extent to which diagnosis (ASD vs. TD), assigned sex (AFAB vs. AMAB) and developmental level (age, puberty) predict GDSQ trajectory over time was explored. There was a significant diagnosis by sex‐assigned‐at‐birth by age interaction for GDSQ‐S Gender Diversity, p = 0.002, showing higher scores in autistic AFAB youth over adolescence, and TD AFAB showing initially lower, then increasing levels over adolescence. For GDSQ‐P, Gender Incongruence was significantly different between the groups, p = 0.032, showing higher incongruence for autistic AFAB around age 10, decreasing between age 12–14 before increasing again, while TD AFAB evidence the inverse trend. AMAB trends were stable. The significant diagnostic, developmental and sex‐based differences indicate AFAB youth experience greater gender diversity that evolves over development. Findings suggest gender identity formation is nuanced and may be influenced by pubertal progression, hormonal patterns, and psychosocial factors. Results underscore the need for enhanced understanding of the unique, dynamic profiles of females‐assigned‐at‐birth.

Anxiety and depression co-occur; the neural substrates of shared and unique components of these symptoms are not understood. Given emotional alterations in internalizing disorders, we hypothesized that function of regions associated with emotion processing/regulation, including the anterior cingulate cortex (ACC), amygdala and fusiform gyrus (FG), would differentiate these symptoms. Forty-three adults with depression completed an emotional functional magnetic resonance imaging task and the Hamilton Depression and Anxiety Scales. We transformed these scales to examine two orthogonal components, one representing internalizing symptom severity and the other the type of internalizing symptoms (anxiety vs depression). We extracted blood oxygen level dependent signal from FG subregions, ACC, and amygdala and performed generalized psychophysiological interaction analyses to assess relationships between symptoms and brain function. Type of internalizing symptoms was associated with FG3-FG1 coupling (F = 8.14, P = 0.007). More coupling was associated with a higher concentration of depression, demonstrating that intra-fusiform coupling is differentially associated with internalizing symptom type (anxiety vs depression). We found an interaction between task condition and internalizing symptoms and dorsal (F = 4.51, P = 0.014) and rostral ACC activity (F = 4.27, P = 0.012). Post hoc comparisons revealed that less activity was associated with greater symptom severity during emotional regulation. Functional coupling differences during emotional processing are associated with depressive relative to anxiety symptoms and internalizing symptom severity. These findings could inform future treatments for depression.

The fundamental mechanism underlying emotional processing in major depressive disorder (MDD) remains unclear. To better understand the neural correlates of emotional processing in MDD, we investigated the role of multiple functional networks (FNs) during emotional stimuli processing. Thirty-two medication-naïve subjects with MDD and 36 healthy controls (HCs) underwent an emotional faces fMRI task that included neutral, happy and fearful expressions. Spatial independent component analysis (sICA) and general linear model (GLM) were conducted to examine the main effect of task condition and group, and two-way interactions of group and task conditions. In sICA analysis, MDD patients and HCs together showed significant differences in task-related modulations in five FNs across task conditions. One FN mainly involving the ventral medial prefrontal cortex showed lower activation during fearful relative to happy condition. Two FNs mainly involving the bilateral inferior frontal gyrus and temporal cortex, showed opposing modulation relative to the ventral medial prefrontal cortex FN, i.e., greater activation during fearful relative to happy condition. Two remaining FNs involving the fronto-parietal and occipital cortices, showed reduced activation during both fearful and happy conditions relative to the neutral condition. However, MDD and HCs did not show significant differences in expression-related modulations in any FNs in this sample. SICA revealed differing functional activation patterns than typical GLM-based analyses. The sICA findings demonstrated unique FNs involved in processing happy and fearful facial expressions. Potential differences between MDD and HCs in expression-related FN modulation should be investigated further.