Skip to main content

Advertisement

SpringerLink
Log in

Syndemic relationship of depressive symptoms, substance use, and suicidality in transgender youth: a cross-sectional study using the U.S. youth risk behavior surveillance system

  • Original Paper
  • Published:
Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

Abstract

Purpose

Syndemics are co-occurring epidemics that cluster within populations due to shared socio-structural factors and are often in populations with intersecting forms of vulnerability. Suicide, depression, and substance use all disproportionately affect transgender and gender diverse (TGD) youth. In this study, we test a syndemic model of the relationship between these three mental health conditions in the context of economic deprivation and interpersonal discrimination.

Methods

We used data on substance use, depressive symptoms, suicidality, and social–structural factors from 2680 TGD youth captured in the 2017 and 2019 survey waves of the Youth Risk Behavior Surveillance System. We used a latent class analysis (LCA) to identify groups with distinct patterns of self-reported substance use and depressive symptoms, and regression models to characterize the relationship between substance-use, depressive symptoms, class membership, social–structural factors, and suicidality.

Results

A three-class LCA solution identified a subset of student respondents in a “high use” latent class characterized by high self-reported substance use frequency and depressive symptoms compared with other classes. Online bullying (aOR: 1.58; 95% CI: 1.28–1.95) and housing insecurity (aOR: 8.78; 95% CI: 4.35–17.71) were associated with increased odds of “high use” class membership relative to the “no use” class membership. “High use” class membership was associated with increased odds of suicidal ideation (aOR: 2.26; 95% CI: 1.75–2.94), plans (aOR: 2.59; 95% CI: 2.01–3.36), and attempts (aOR: 6.85; 95% CI: 3.17–15.68).

Conclusion

The co-occurrence of substance use and depressive symptoms is associated with socio-structural factors and may drive risk for suicidality among TGD youth. Meaningful suicide prevention efforts that address disproportionate risk in this population must be attentive to and mitigate the shared determinants of mood symptoms and substance use behavior.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Kronk CA, Everhart AR, Ashley F et al (2021) Transgender data collection in the electronic health record: current concepts and issues. J Am Med Inform Assoc. https://doi.org/10.1093/jamia/ocab136

    Article  PubMed Central  Google Scholar 

  2. Shields JP, Cohen R, Glassman JR, Whitaker K, Franks H, Bertolini I (2013) Estimating population size and demographic characteristics of lesbian, gay, bisexual, and transgender youth in middle school. J Adolesc Health 52(2):248–250. https://doi.org/10.1016/j.jadohealth.2012.06.016

    Article  PubMed  Google Scholar 

  3. Rider GN, McMorris BJ, Gower AL, Coleman E, Eisenberg ME (2018) Health and care utilization of transgender and gender nonconforming youth: a population-based study. Pediatrics 141(3):e20171683. https://doi.org/10.1542/peds.2017-1683

    Article  PubMed  Google Scholar 

  4. Zhang Q, Goodman M, Adams N et al (2020) Epidemiological considerations in transgender health: a systematic review with focus on higher quality data. Int J Transgender Health 21(2):125–137. https://doi.org/10.1080/26895269.2020.1753136

    Article  Google Scholar 

  5. White Hughto JM, Reisner SL, Pachankis JE (2015) Transgender stigma and health: a critical review of stigma determinants, mechanisms, and interventions. Soc Sci Med 147:222–231. https://doi.org/10.1016/j.socscimed.2015.11.010

    Article  PubMed  PubMed Central  Google Scholar 

  6. Reisner SL, Vetters R, Leclerc M et al (2015) Mental health of transgender youth in care at an adolescent urban community health center: a matched retrospective cohort study. J Adolesc Health 56(3):274–279. https://doi.org/10.1016/j.jadohealth.2014.10.264

    Article  PubMed  PubMed Central  Google Scholar 

  7. Perez-Brumer A, Day JK, Russell ST, Hatzenbuehler ML (2017) Prevalence and correlates of suicidal ideation among transgender youth in California: findings from a representative, population-based sample of high school students. J Am Acad Child Adolesc Psychiatry 56(9):739–746. https://doi.org/10.1016/j.jaac.2017.06.010

    Article  PubMed  PubMed Central  Google Scholar 

  8. 2021 National Survey on LGBTQ Youth Mental Health. The trevor project; 2021. https://www.thetrevorproject.org/survey-2021/. Accessed 6 Oct 2021

  9. Spack NP, Edwards-Leeper L, Feldman HA et al (2012) Children and adolescents with gender identity disorder referred to a pediatric medical center. Pediatrics 129(3):418–425. https://doi.org/10.1542/peds.2011-0907

    Article  PubMed  Google Scholar 

  10. Olson J, Schrager SM, Belzer M, Simons LK, Clark LF (2015) Baseline physiologic and psychosocial characteristics of transgender youth seeking care for gender dysphoria. J Adolesc Health Off Publ Soc Adolesc Med 57(4):374–380. https://doi.org/10.1016/j.jadohealth.2015.04.027

    Article  Google Scholar 

  11. Testa RJ, Michaels MS, Bliss W, Rogers ML, Balsam KF, Joiner T (2017) Suicidal ideation in transgender people: gender minority stress and interpersonal theory factors. J Abnorm Psychol 126(1):125–136. https://doi.org/10.1037/abn0000234

    Article  PubMed  Google Scholar 

  12. Valentine SE, Shipherd JC (2018) A systematic review of social stress and mental health among transgender and gender non-conforming people in the United States. Clin Psychol Rev 66:24–38. https://doi.org/10.1016/j.cpr.2018.03.003

    Article  PubMed  PubMed Central  Google Scholar 

  13. Kuper LE, Adams N, Mustanski BS (2018) Exploring cross-sectional predictors of suicide ideation, attempt, and risk in a large online sample of transgender and gender nonconforming youth and young adults. LGBT Health 5(7):391–400. https://doi.org/10.1089/lgbt.2017.0259

    Article  PubMed  PubMed Central  Google Scholar 

  14. Pellicane MJ, Ciesla JA (2022) Associations between minority stress, depression, and suicidal ideation and attempts in transgender and gender diverse (TGD) individuals: systematic review and meta-analysis. Clin Psychol Rev 91:102113

    Article  PubMed  Google Scholar 

  15. Singer M (1996) A dose of drugs, a touch of violence, a case of AIDS: conceptualizing the SAVA syndemic. Free Inq Creat Sociol 24(2):99–110

    Google Scholar 

  16. Singer M, Bulled N, Ostrach B, Mendenhall E (2017) Syndemics and the biosocial conception of health. The Lancet 389(10072):941–950. https://doi.org/10.1016/S0140-6736(17)30003-X

    Article  Google Scholar 

  17. Arrington-Sanders R, Alvarenga A, Galai N et al (2021) Social determinants of transactional sex in a sample of young black and latinx sexual minority cisgender men and transgender women. J Adolesc Health Off Publ Soc Adolesc Med. https://doi.org/10.1016/j.jadohealth.2021.08.002

    Article  Google Scholar 

  18. Mimiaga MJ, Hughto JMW, Biello KB et al (2019) Longitudinal analysis of syndemic psychosocial problems predicting HIV risk behavior among a multicity prospective cohort of sexually active young transgender women in the United States. JAIDS J Acquir Immune Defic Syndr 81(2):184–192. https://doi.org/10.1097/QAI.0000000000002009

    Article  PubMed  Google Scholar 

  19. Reisner SL, White Hughto JM, Pardee D, Sevelius J (2016) Syndemics and gender affirmation: HIV sexual risk in female-to-male trans masculine adults reporting sexual contact with cisgender males. Int J STD AIDS 27(11):955–966. https://doi.org/10.1177/0956462415602418

    Article  PubMed  Google Scholar 

  20. Ferlatte O, Dulai J, Hottes TS, Trussler T, Marchand R (2015) Suicide related ideation and behavior among Canadian gay and bisexual men: a syndemic analysis. BMC Public Health 15(1):597. https://doi.org/10.1186/s12889-015-1961-5

    Article  PubMed  PubMed Central  Google Scholar 

  21. Mustanski B, Andrews R, Herrick A, Stall R, Schnarrs PW (2014) A syndemic of psychosocial health disparities and associations with risk for attempting suicide among young sexual minority men. Am J Public Health 104(2):287–294. https://doi.org/10.2105/AJPH.2013.301744

    Article  PubMed  PubMed Central  Google Scholar 

  22. Reisner SL, Biello KB, White Hughto JM et al (2016) Psychiatric diagnoses and comorbidities in a diverse, multicity cohort of young transgender women: baseline findings from project lifeskills. JAMA Pediatr 170(5):481. https://doi.org/10.1001/jamapediatrics.2016.0067

    Article  PubMed  PubMed Central  Google Scholar 

  23. Newcomb ME, Hill R, Buehler K, Ryan DT, Whitton SW, Mustanski B (2020) High burden of mental health problems, substance use, violence, and related psychosocial factors in transgender, non-binary, and gender diverse youth and young adults. Arch Sex Behav 49(2):645–659. https://doi.org/10.1007/s10508-019-01533-9

    Article  PubMed  Google Scholar 

  24. VanBronkhorst SB, Edwards EM, Roberts DE et al (2021) Suicidality among psychiatrically hospitalized lesbian, gay, bisexual, transgender, queer, and/or questioning youth: risk and protective factors. LGBT Health 8(6):395–403. https://doi.org/10.1089/lgbt.2020.0278

    Article  PubMed  Google Scholar 

  25. Vance SR, Boyer CB, Glidden DV, Sevelius J (2021) Mental health and psychosocial risk and protective factors among black and latinx transgender youth compared with peers. JAMA Netw Open 4(3):e213256. https://doi.org/10.1001/jamanetworkopen.2021.3256

    Article  PubMed  PubMed Central  Google Scholar 

  26. Hughto JMW, Reisner SL, Kershaw TS et al (2019) A multisite, longitudinal study of risk factors for incarceration and impact on mental health and substance use among young transgender women in the USA. J Public Health Oxf Engl 41(1):100–109. https://doi.org/10.1093/pubmed/fdy031

    Article  Google Scholar 

  27. Mereish EH, O’Cleirigh C, Bradford JB (2014) Interrelationships between LGBT-based victimization, suicide, and substance use problems in a diverse sample of sexual and gender minorities. Psychol Health Med 19(1):1–13. https://doi.org/10.1080/13548506.2013.780129

    Article  PubMed  Google Scholar 

  28. Nuttbrock L, Bockting W, Rosenblum A et al (2014) Gender abuse, depressive symptoms, and substance use among transgender women: a 3-year prospective study. Am J Public Health 104(11):2199–2206. https://doi.org/10.2105/AJPH.2014.302106

    Article  PubMed  PubMed Central  Google Scholar 

  29. Keuroghlian AS, Reisner SL, White JM, Weiss RD (2015) Substance use and treatment of substance use disorders in a community sample of transgender adults. Drug Alcohol Depend 152:139–146. https://doi.org/10.1016/j.drugalcdep.2015.04.008

    Article  PubMed  PubMed Central  Google Scholar 

  30. Puckett JA, Maroney MR, Wadsworth LP, Mustanski B, Newcomb ME (2020) Coping with discrimination: the insidious effects of gender minority stigma on depression and anxiety in transgender individuals. J Clin Psychol 76(1):176–194. https://doi.org/10.1002/jclp.22865

    Article  PubMed  Google Scholar 

  31. Staples JM, Neilson EC, Bryan AEB, George WH (2018) The role of distal minority stress and internalized transnegativity in suicidal ideation and nonsuicidal self-injury among transgender adults. J Sex Res 55(4–5):591–603. https://doi.org/10.1080/00224499.2017.1393651

    Article  PubMed  Google Scholar 

  32. Jackman KB, Caceres BA, Kreuze EJ, Bockting WO (2021) Suicidality among gender minority youth: analysis of 2017 youth risk behavior survey data. Arch Suicide Res 25(2):208–223. https://doi.org/10.1080/13811118.2019.1678539

    Article  PubMed  Google Scholar 

  33. Lian Q, Li R, Liu Z, Li X, Su Q, Zheng D (2022) Associations of nonconforming gender expression and gender identity with bullying victimization: an analysis of the 2017 youth risk behavior survey. BMC Public Health 22(1):650. https://doi.org/10.1186/s12889-022-13071-6

    Article  PubMed  PubMed Central  Google Scholar 

  34. Centers for Disease Control and Prevention (CDC), Brener ND, Kann L, et al. Methodology of the Youth Risk Behavior Surveillance System--2013. MMWR Recomm Rep Morb Mortal Wkly Rep Recomm Rep. 2013;62(RR-1):1–20

  35. Johns MM, Lowry R, Andrzejewski J et al (2019) Transgender identity and experiences of violence victimization, substance use, suicide risk, and sexual risk behaviors among high school students—19 states and large urban school districts, 2017. MMWR Morb Mortal Wkly Rep 68(3):67–71. https://doi.org/10.15585/mmwr.mm6803a3

    Article  PubMed  PubMed Central  Google Scholar 

  36. McBride RS (2021) A literature review of the secondary school experiences of trans youth. J LGBT Youth 18(2):103–134. https://doi.org/10.1080/19361653.2020.1727815

    Article  Google Scholar 

  37. Linzer DA, Lewis JB (2011) poLCA: An R package for polytomous variable latent class analysis. J Stat Softw 42(1):1–29

    Google Scholar 

  38. Masyn KE. Latent class analysis and finite mixture modeling. In: The Oxford handbook of quantitative methods in psychology, vol. 2

  39. R Core Team (2020) R: A language and environment for statistical computing. R Foundation for Statistical Computing

  40. Eisenberg ME, Gower AL, McMorris BJ, Rider GN, Coleman E (2019) Emotional distress, bullying victimization, and protective factors among transgender and gender diverse adolescents in city, suburban, town, and rural locations. J Rural Health 35(2):270–281. https://doi.org/10.1111/jrh.12311

    Article  PubMed  Google Scholar 

  41. McCann E, Brown M (2019) Homelessness among youth who identify as LGBTQ+: a systematic review. J Clin Nurs 28(11–12):2061–2072. https://doi.org/10.1111/jocn.14818

    Article  PubMed  Google Scholar 

  42. Morton MH, Dworsky A, Matjasko JL et al (2018) Prevalence and correlates of Youth Homelessness in the United States. J Adolesc Health 62(1):14–21. https://doi.org/10.1016/j.jadohealth.2017.10.006

    Article  PubMed  Google Scholar 

  43. Duncan DT, Hatzenbuehler ML (2014) Lesbian, gay, bisexual, and transgender hate crimes and suicidality among a population-based sample of sexual-minority adolescents in Boston. Am J Public Health 104(2):272–278. https://doi.org/10.2105/ajph.2013.301424

    Article  PubMed  PubMed Central  Google Scholar 

  44. Duncan DT, Hatzenbuehler ML, Johnson RM (2014) Neighborhood-level LGBT hate crimes and current illicit drug use among sexual minority youth. Drug Alcohol Depend 135:65–70. https://doi.org/10.1016/j.drugalcdep.2013.11.001

    Article  PubMed  Google Scholar 

  45. Hatzenbuehler ML (2017) Advancing research on structural stigma and sexual orientation disparities in mental health among youth. J Clin Child Adolesc Psychol 46(3):463–475. https://doi.org/10.1080/15374416.2016.1247360

    Article  PubMed  Google Scholar 

  46. Han B, Compton WM, Einstein EB, Volkow ND (2021) Associations of suicidality trends with cannabis use as a function of sex and depression status. JAMA Netw Open 4(6):e2113025–e2113025. https://doi.org/10.1001/jamanetworkopen.2021.13025

    Article  PubMed  PubMed Central  Google Scholar 

  47. James S, Herman J, Rankin S, Keisling M, Mottet L, Anafi M (2016) The report of the 2015 US transgender survey

  48. Tsai AC (1982) Syndemics: a theory in search of data or data in search of a theory? Soc Sci Med 2018(206):117–122. https://doi.org/10.1016/j.socscimed.2018.03.040

    Article  Google Scholar 

  49. Brennan J, Kuhns LM, Johnson AK, Belzer M, Wilson EC, Garofalo R (2012) Syndemic theory and HIV-related risk among young transgender women: the role of multiple, co-occurring health problems and social marginalization. Am J Public Health 102(9):1751–1757. https://doi.org/10.2105/AJPH.2011.300433

    Article  PubMed  PubMed Central  Google Scholar 

  50. Kuhns LM, Hotton AL, Garofalo R et al (2016) An index of multiple psychosocial, syndemic conditions is associated with antiretroviral medication adherence among HIV-positive youth. AIDS Patient Care STDs 30(4):185–192

    Article  PubMed  PubMed Central  Google Scholar 

  51. van der Feltz-Cornelis CM, Sarchiapone M, Postuvan V et al (2011) Best practice elements of multilevel suicide prevention strategies: a review of systematic reviews. Crisis 32(6):319–333. https://doi.org/10.1027/0227-5910/a000109

    Article  PubMed  PubMed Central  Google Scholar 

  52. Bliokas VV, Hains AR, Allan JA, Lago L, Sng R (2019) Community-based aftercare following an emergency department presentation for attempted suicide or high risk for suicide: study protocol for a non-randomised controlled trial. BMC Public Health 19(1):1380. https://doi.org/10.1186/s12889-019-7751-8

    Article  PubMed  PubMed Central  Google Scholar 

  53. Jones T, Hillier L (2013) Comparing trans-spectrum and same-sex-attracted youth in Australia: increased risks. Increased Activisms J LGBT Youth 10(4):287–307. https://doi.org/10.1080/19361653.2013.825197

    Article  Google Scholar 

  54. Perez-Brumer A, Hatzenbuehler ML, Oldenburg CE, Bockting W (2015) Individual- and structural-level risk factors for suicide attempts among transgender adults. Behav Med 41(3):164–171. https://doi.org/10.1080/08964289.2015.1028322

    Article  PubMed  Google Scholar 

  55. Batchelder AW, Choi K, Dale SK et al (2019) Effects of syndemic psychiatric diagnoses on health indicators in men who have sex with men. Health Psychol 38(6):509–517. https://doi.org/10.1037/hea0000724

    Article  PubMed  PubMed Central  Google Scholar 

  56. Trimble DG, Chandran A (2021) Associations between sad feelings and suicide behaviors in the 2019 youth risk behavior survey: a call for Action. Front Pediatr 9:694819. https://doi.org/10.3389/fped.2021.694819

    Article  PubMed  PubMed Central  Google Scholar 

  57. Goldenberg T, Reisner SL, Harper GW, Gamarel KE, Stephenson R (2020) State-level transgender-specific policies, race/ethnicity, and use of medical gender affirmation services among transgender and other gender-diverse people in the United States. Milbank Q 98(3):802–846. https://doi.org/10.1111/1468-0009.12467

    Article  PubMed  PubMed Central  Google Scholar 

  58. Kosciw JG, Clark CM, Truong NL, Zongrone AD (2020) The 2019 national school climate survey: the experiences of lesbian, gay, bisexual, transgender, and queer youth in our nation’s schools. A report from GLSEN. ERIC

  59. Gower AL, Rider GN, Brown C et al (2018) Supporting transgender and gender diverse youth: protection against emotional distress and substance use. Am J Prev Med 55(6):787–794. https://doi.org/10.1016/j.amepre.2018.06.030

    Article  PubMed  PubMed Central  Google Scholar 

  60. Johns MM, Beltran O, Armstrong HL, Jayne PE, Barrios LC (2018) Protective factors among transgender and gender variant youth: a systematic review by socioecological level. J Prim Prev 39(3):263–301. https://doi.org/10.1007/s10935-018-0508-9

    Article  PubMed  PubMed Central  Google Scholar 

  61. Greytak EA, Kosciw JG, Boesen MJ (2013) Putting the “T” in “Resource”: the benefits of LGBT-related school resources for transgender youth. J LGBT Youth 10(1–2):45–63. https://doi.org/10.1080/19361653.2012.718522

    Article  Google Scholar 

  62. Lett E, Everhart A (2021) Considerations for transgender population health research based on US national surveys. Ann Epidemiol. https://doi.org/10.1016/j.annepidem.2021.10.009

    Article  PubMed  Google Scholar 

  63. Enders CK (2006) A primer on the use of modern missing-data methods in psychosomatic medicine research. Psychosom Med 68(3):427–436. https://doi.org/10.1097/01.psy.0000221275.75056.d8

    Article  PubMed  Google Scholar 

  64. Zhao J, Stockwell T, Macdonald S (2009) Non–response bias in alcohol and drug population surveys. Drug Alcohol Rev 28(6):648–657. https://doi.org/10.1111/j.1465-3362.2009.00077.x

    Article  PubMed  Google Scholar 

  65. Steyerberg EW (2019) Clinical prediction models. Springer, New York

    Book  Google Scholar 

  66. 2019 Combining YRBS data across years and sites. Published online 2020:7.

  67. Lett E, Abrams MP, Gold A, Fullerton FA, Everhart A (2022) Ethnoracial inequities in access to gender-affirming mental health care and psychological distress among transgender adults. Soc Psychiatry Psychiatr Epidemiol 57:1–9

    Article  Google Scholar 

  68. Turban JL, King D, Carswell JM, Keuroghlian AS (2020) Pubertal suppression for transgender youth and risk of suicidal ideation. Pediatrics 145(2):e20191725. https://doi.org/10.1542/peds.2019-1725

    Article  PubMed  Google Scholar 

  69. Green AE, DeChants JP, Price MN, Davis CK (2021) Association of gender-affirming hormone therapy with depression, thoughts of suicide, and attempted suicide among transgender and nonbinary youth. J Adolesc Health. https://doi.org/10.1016/j.jadohealth.2021.10.036

    Article  PubMed  PubMed Central  Google Scholar 

  70. 2021 Becomes record year for anti-trans legislation. Human Rights Campaign. Accessed 18 Feb 2022. https://www.hrc.org/press-releases/breaking-2021-becomes-record-year-for-anti-transgender-legislation

Download references

Acknowledgements

EL would like to thank the Black Health Scholars Network and the E2 Social Epidemiology Lab for their support of this work. The authors would like to thank Adam Mally with his assistance with figure preparation.

Funding

The authors did not receive support from any organization for the submitted work.

Author information

Authors and Affiliations

  1. Perelman School of Medicine, University of Pennsylvania, Blockley Hall, Philadelphia, PA, 19146, USA

    Elle Lett

  2. Center for Applied Transgender Studies, Chicago, IL, USA

    Elle Lett

  3. Center for Emergency Care Policy and Research, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Matthew P. Abrams

  4. Penn Medicine Center for Digital Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Matthew P. Abrams

  5. Unaffiliated Recent College Graduate, Los Angeles, CA, USA

    Emery Moberg

  6. Department of Psychology, North Carolina State University, Raleigh, NC, USA

    G. Perusi Benson

  7. Department of Psychiatry, Columbia University, New York, NY, USA

    Jacob E. Perlson

Authors
  1. Elle Lett
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Matthew P. Abrams
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Emery Moberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. G. Perusi Benson
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jacob E. Perlson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Elle Lett.

Ethics declarations

Conflict of interest

The authors have no relevant financial or non-financial interests to disclose. The authors report no conflicts of interests.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 119 KB)

Rights and permissions

Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lett, E., Abrams, M.P., Moberg, E. et al. Syndemic relationship of depressive symptoms, substance use, and suicidality in transgender youth: a cross-sectional study using the U.S. youth risk behavior surveillance system. Soc Psychiatry Psychiatr Epidemiol 57, 2293–2304 (2022). https://doi.org/10.1007/s00127-022-02348-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00127-022-02348-1

Keywords

Search

Navigation