Various studies have shown that the mental health of sexual minorities, known as LGBTQ+, is easily compromised. The author has interviewed over 1000 transgender people at the Okayama University Gender Clinic and has come to believe that the nature of the distress seen in transgender people is also shared by LGBTQ+ people. The distress of LGBTQ+ people does not stem from their own sexuality being different from that of the majority, but from a social system that favors the heterosexual and cisgender majority.

For example, various gender norms in schools affect transgender people. Enforced gender-specific uniforms, teaching materials, rosters, etc., often cause strong feelings of discomfort and avoidance for transgender students. While Japanese students are repeatedly exposed to negative information about homosexuality or gender questioning, they have very limited access to positive information about the diversity of sexuality during their school education. The percentage of the LGBTQ+ population is reported to be between 5 and 3 percent, which translates to one person in every elementary school class. Hence, even if no student comes out as LGBTQ+, the school environment should be planned in such a way that LBGTQ+ students do not feel distressed. Positive education regarding sexual diversity should also be provided in schools.

Even after finishing school, LGBTQ+ people repeatedly see people like them being teased, called derogatory names, given stigmatized characterizations, etc. on television and other media. They are frequently hurt by daily conversations that implicitly assume that men and women are couples, such as “Aren’t you getting married?”, “Do you have a boyfriend or girlfriend?”, “Do you want children?” The experience of being hurt by various forms of stigma and discrimination continues.

The percentage of LGBTQ+ people is estimated to be 1 in 20-30. The majority of LGBTQ+ people do not come out, but they do show up in everyday medical situations. Many healthcare professionals would consider themselves to be unbiased towards LGBTQ+. However, many irrational systems remain in the medical system, for example, the gender column on documents that can only be marked as Male or Female. There is also an unconscious bias in the conversations about them, such as the use of words that inadvertently identify gender, such as “son,” “daughter,” “boyfriend,” and “girlfriend. To protect the mental health of LGBTQ+ persons, medical professionals should not assume that they are free from biases, but should actively identify and correct them.

Obstetricians/gynecologists provide a diagnosis and hormonal treatment to people with gender identity disorders/gender dysphoria/gender incongruence together with psychiatrists, urologists, and plastic surgeons in the gender clinic. The obstetricians/gynecologists make a diagnosis of the biological (physical) sex by medical examination and blood tests. They also perform estrogen therapy on transwomen (MTF persons) and the resection of the uterus and ovary (sex reassignment surgery) on transmen (FTM persons). They then officialize the sex change in the family register by writing the medical certificate.

Obstetricians/gynecologists specializing in reproductive medicine often consult and give advice about cryopreservation of sperm and ovum before loss of fertility by hormonal therapy and/or sex reassignment surgery and about reproductive medicine using a donor semen or ovum. Furthermore, they often work as lecturers in sex education and life plan education in schools. They also play an important role in treatment with GnRH agonists to delay the secondary sex characteristics of pubertal transgender children in collaboration with school teachers.

The definition of “socially unacceptable” or “abnormal” is determined by the people in society, and it changes with time and country. In modern society, in the division of labor and in power structures, strong gender-based social structures have been created, so a person’s gender is treated as an important indicator. LGBT people who stray from this structure are marginalized and rejected. Recent sociological research has focused on the fact that the “there are only two genders” view of gender itself is socially constructed, and typical prejudice structures have been revealed. Therefore, LGBTs have become an identity, forming a social group and creating significant changes as a result of social movements. SOGI is considered a human rights issue, and same-sex marriage is being legalized in many countries. These changes will not only affect the treatment of LGBT people, but will also gradually change the entire social structure of gender and sexuality.

It has been reported that young people belonging to sexual minorities experience many mood disorders such as depression, anxiety disorders, post-traumatic stress disorders, alcohol use and abuse, suicidal ideation, and suicide attempts. In addition, risk factors for worsening mental health and suicide include family conflict, stigma, and discrimination. Recently, university students have been expected to enhance their support for LGBT students. We have introduced examples of LGBT students who visited the health care center and considered issues in university life and the direction of support.

This study clarified the life problems and mental health of evacuees of the Fukushima prefecture nuclear accident. A total of 4,905 households evacuated to the Tokyo metropolitan area due to the nuclear accident were surveyed from October 2017 to January 2018. The collected 362 copies (recovery rate, 7.4%) were included in the analysis.

The results of the survey indicated that the percentage of K6 scores of 13 points or higher was 20.2% and the ratio of 17 points or higher was 10.8%. As a result of logistic regression analysis, the adjusted odds ratio for psychological distress in the “yes” group was 3.906, which had a significant positive association with the adjusted odd ratio for financial difficulties in the “no” group. Free-form analysis revealed issues such as financial anxiety/anxiety, work anxiety/anxiety, and aging anxiety/anxiety.

These results indicate the need to strengthen individual and concrete support activities, establish a one-stop counseling organization to solve complicated and intertwined living problems, and foster a new community through exchanges with private support groups.

Objective : This case report showed that psychosocial support focusing on a patient’s emotional and cognitive traits was effective in restoring a recurrent cancer patient’s subjectivity.

Case : We initiated a counseling with a woman patient in her 60s, as she was emotionally unstable due to her third recurrence of ovarian cancer, pain associated with not being adapted to surgery, and anxiety about chemotherapy.

Case report : During initial counseling, the patient’s subjectivity receded and she was unable to comply with the treatment policy, but with supportive interventions led by her husband, her emotions were stabilized and she agreed to a treatment policy. She spoke about their couple conflicts and chemotherapy and those distress were alleviated by joint couple interviews and the patient’s paced chemotherapy. Moreover, by understanding her cognitive traits, she dealt with and gained self-affirmation. After completion of chemotherapy, although she had a conflict regarding the maintenance chemotherapy, subjectively, she considered and decided to discontinue the maintenance chemotherapy.

Discussion : Psychosocial support focusing on the patient’s emotional and cognitive traits can be an effective intervention in restoring a patient’s subjectivity.