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Gómez W, Organista KC, Sacks TK, Holmes SM, Carrico AW. Narratives of Disconnection: A Life Course Perspective of Methamphetamine Use Among Sexual Minority Men Living with HIV. Int J Behav Med 2024:10.1007/s12529-024-10299-x. [PMID: 38816641 DOI: 10.1007/s12529-024-10299-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND Sexual minority men (SMM) are exposed to societal and structural stressors that translate into poor health outcomes. One such outcome is substance use, which research has long documented as a prominent disparity among SMM. Methamphetamine is a particularly deleterious substance for SMM because its use is often framed as a coping response to social and structural stressors. METHOD Guided by stress and coping theory and a life course perspective, the purpose of this qualitative study is to assess the development of coping strategies in the context of prominent social and structural determinants among SMM living with HIV who use methamphetamine. RESULTS Data were collected from 2016 to 2018 via in-depth interviews with 24 SMM living with HIV who use methamphetamine in San Francisco, CA. Mean age of participants was 47 and over half self-identified as ethnoracial minorities. Narrative analysis surfaced a sequential pattern of disconnection at foundational, relational, and recovery levels. This analysis revealed that multi-level stressors were present across the life course that amplified engagement in methamphetamine use. CONCLUSION Findings highlight the benefits of holistic, integrated, and trauma-informed approaches to address the function of methamphetamine use as a response to societal, cultural, and institutional processes of stigmatization and discrimination. Peer-based approaches may also be beneficial to reframe the ways in which SMM living with HIV who use methamphetamine form and sustain relationships.
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Affiliation(s)
- Walter Gómez
- Jane Addams College of Social Work, University of Illinois Chicago, 1040 West Harrison Street (MC309), Chicago, IL, 60607-7134, USA.
| | - Kurt C Organista
- School of Social Welfare, University of California Berkeley, Berkeley, CA, USA
| | - Tina K Sacks
- School of Social Welfare, University of California Berkeley, Berkeley, CA, USA
| | - Seth M Holmes
- Division of Society and Environment, University of California Berkeley, Berkeley, CA, USA
- Department of Anthropology, University of Barcelona, Barcelona, Spain
- Catalan Institute for Research and Advanced Study, Barcelona, Spain
| | - Adam W Carrico
- Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, USA
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Pharr JR, Chien LC, Gakh M, Flatt JD, Kittle K, Terry E. Moderated Mediation Analysis of Structural Stigma and Suicidal Ideation and Behaviors Among Sexual and Gender Minority Adults. LGBT Health 2024; 11:239-248. [PMID: 38285526 DOI: 10.1089/lgbt.2022.0349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2024] Open
Abstract
Purpose: This study aimed to conduct a moderated mediation analysis to understand further the complex pathways through which structural stigma in the form of transgender sports bans was associated with suicidal ideation and behaviors among sexual and gender minority (SGM) adults. Methods: A cross-sectional survey of 1033 adults who identified as SGM from across the 50 U.S. states and Washington, DC was conducted between January 28 and February 7, 2022. Distal discrimination distress was the mediation variable; individual resilience and social resources were the moderation variables. Familiarity with transgender sports bans represented structural stigma. The conditional process analysis was applied to build a moderated mediation model. Both conditional direct and indirect effects were computed by estimated coefficients. All models were based on linear regression. Results: Our final model explained nearly half (46%) of the variation in suicidal ideation and behaviors between those SGM adults familiar and those not familiar with transgender sports bans. Social resources significantly moderated the conditional indirect effect of distal discrimination distress (adjusted estimate = -0.23; 95% confidence interval = -0.37 to -0.08). Conclusion: Both discrimination distress and social resources influenced the association between structural stigma as measured by familiarity with transgender sports bans and suicidal ideation and behaviors among SGM adults. Findings support the need for future research examining the pathway between structural stigma and suicidal ideation and behaviors among SGM adults and how minority stress, social safety, and other constructs shape this pathway.
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Affiliation(s)
- Jennifer R Pharr
- Department of Environmental and Occupational Health, School of Public Health, University of Nevada, Las Vegas, Las Vegas, Nevada, USA
| | - Lung-Chang Chien
- Department of Epidemiology and Biostatistics, School of Public Health, University of Nevada, Las Vegas, Las Vegas, Nevada, USA
| | - Maxim Gakh
- Department of Environmental and Occupational Health, School of Public Health, University of Nevada, Las Vegas, Las Vegas, Nevada, USA
| | - Jason D Flatt
- Department of Social and Behavioral Health, School of Public Health, University of Nevada, Las Vegas, Las Vegas, Nevada, USA
| | - Krystal Kittle
- Department of Social and Behavioral Health, School of Public Health, University of Nevada, Las Vegas, Las Vegas, Nevada, USA
| | - Emylia Terry
- Department of Environmental and Occupational Health, School of Public Health, University of Nevada, Las Vegas, Las Vegas, Nevada, USA
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Marconi E, Monti L, Marfoli A, Kotzalidis GD, Janiri D, Cianfriglia C, Moriconi F, Costa S, Veredice C, Sani G, Chieffo DPR. A systematic review on gender dysphoria in adolescents and young adults: focus on suicidal and self-harming ideation and behaviours. Child Adolesc Psychiatry Ment Health 2023; 17:110. [PMID: 37735422 PMCID: PMC10515052 DOI: 10.1186/s13034-023-00654-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 08/30/2023] [Indexed: 09/23/2023] Open
Abstract
INTRODUCTION Gender dysphoria (GD) is characterized by the incongruence between one's experienced and expressed gender and assigned-sex-at-birth; it is associated with clinically significant distress. In recent years, the number of young patients diagnosed with GD has increased considerably. Recent studies reported that GD adolescents present behavioural and emotional problems and internalizing problems. Furthermore, this population shows a prevalence of psychiatric symptoms, like depression and anxiety. Several studies showed high rates of suicidal and non-suicidal self-injurious thoughts and behaviour in GD adolescents. To increase understanding of overall mental health status and potential risks of young people with GD, this systematic review focused on risk of suicide and self-harm gestures. METHODS We followed the PRISMA 2020 statement, collecting empirical studies from four electronic databases, i.e., PubMed, Scopus, PsycINFO, and Web of Science. RESULTS Twenty-one studies on GD and gender nonconforming identity, suicidality, and self-harm in adolescents and young adults met inclusion criteria. Results showed that GD adolescents have more suicidal ideation, life-threatening behaviour, self-injurious thoughts or self-harm than their cisgender peers. Assessment methods were heterogeneous. CONCLUSION A standardised assessment is needed. Understanding the mental health status of transgender young people could help develop and provide effective clinical pathways and interventions.
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Affiliation(s)
- Elisa Marconi
- Clinical Psychology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 1, 00168, Rome, Italy.
| | - Laura Monti
- Clinical Psychology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 1, 00168, Rome, Italy
| | - Angelica Marfoli
- Catholic University of the Sacred Heart-Rome, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Georgios D Kotzalidis
- NESMOS Department (Neurosciences, Mental Health, and Sensory Organs), University of Rome "La Sapienza", Via Di Grottarossa1035-1039, 00198, Rome, Italy
- Department of Psychiatry, Department of Neuroscience, Head, Neck and Thorax, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 1, 00168, Rome, Italy
- Institute of Psychiatry, Department of Neuroscience, Catholic University of the Sacred Heart-Rome, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Delfina Janiri
- Department of Psychiatry, Department of Neuroscience, Head, Neck and Thorax, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 1, 00168, Rome, Italy
- Institute of Psychiatry, Department of Neuroscience, Catholic University of the Sacred Heart-Rome, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Cecilia Cianfriglia
- Catholic University of the Sacred Heart-Rome, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Federica Moriconi
- Clinical Psychology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 1, 00168, Rome, Italy
| | - Stefano Costa
- UOSD Operative Unit Psychiatry and Psychotherapy for Adolescents, Azienda USL Di Bologna, Ospedale MaggioreLargo Bartolo Nigrisoli, 2, 40133, Bologna, Italy
| | - Chiara Veredice
- Pediatric Neuropsychiatry Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168, Rome, Italy
| | - Gabriele Sani
- Department of Psychiatry, Department of Neuroscience, Head, Neck and Thorax, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 1, 00168, Rome, Italy
- Institute of Psychiatry, Department of Neuroscience, Catholic University of the Sacred Heart-Rome, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Daniela Pia Rosaria Chieffo
- Clinical Psychology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 1, 00168, Rome, Italy
- Departement of Life Sciences and Public Health Department, Catholic University of Sacred Heart, 00168, Rome, Italy
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Bränström R, Narusyte J, Svedberg P. Sexual-orientation differences in risk of health-related impaired ability to work and to remain in the paid workforce: a prospective population-based twin study. BMC Public Health 2023; 23:454. [PMID: 36890524 PMCID: PMC9996859 DOI: 10.1186/s12889-023-15384-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 03/06/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Studies consistently show an increased risk of poor health among sexual minorities (i.e., those identifying as lesbian, gay, bisexual [LGB] or other non-heterosexuals individuals), as compared to those identifying as heterosexual. It is largely unknown whether the increased risk of mental and physical health problems among sexual minorities is also reflected in an increased risk of health-related impaired ability to work, in terms of sickness absence (SA) and disability pension (DP), or successfully remain in the paid workforce. This study made use of a large sample of Swedish twins with self-reported information about sexual behavior in young adulthood to examine sexual orientation difference in SA and DP during a 12-year follow-up period. METHOD Data from the Swedish Twin project of Disability pension and Sickness absence (STODS), including Swedish twins born 1959-1985 was used (N = 17,539; n = 1,238 sexual minority). Self-report survey data on sexual behavior was linked to information about SA and DP benefits from the MicroData for Analysis of the Social Insurance database (MiDAS), the National Social Insurance Agency. Sexual orientation differences in SA and DP between 2006 and 2018 was analyzed, as well as, the influence of sociodemographic, social stress exposure (i.e., victimization, discrimination), mental health treatment, and family confounding on these differences. RESULTS Compared to heterosexuals, sexual minorities were more likely to having experienced SA and having been granted DP. The odds were highest for DP, where sexual minorities were 58% more likely to having been granted DP compared to heterosexuals. The higher odds for SA due to any diagnosis could largely be explained by sociodemographic factors. The higher odds of SA due to mental diagnosis could partially be explained by increased risk of being exposed to discrimination and victimization, and partially by having received treatment with antidepressant medication. The higher odds of being granted DP could also partially be explain by increased risk of being exposed to social stress and treatment with antidepressant medication. CONCLUSION To our knowledge, this is the first study to report on sexual orientation differences in risk of SA and DP in a population-based sample. We found higher period prevalence of both SA and DP among sexual minorities as compared to heterosexuals. The higher odds of SA and DP could partially or fully be explained by sexual orientation differences in sociodemographic factors, exposure to social stress, and antidepressant treatment for depression. Future studies can extend these findings by continuing to investigate risk factors for SA and DP among sexual minorities and how such factors can be reduced.
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Affiliation(s)
- Richard Bränström
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Nobels väg 9, 171 77, Stockholm, Sweden.
| | - Jurgita Narusyte
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Pia Svedberg
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Hainsworth S, Toomey RB, Anhalt K. Comparing sexual orientation identity development in plurisexual versus monosexual latinx sexual minority youth. J Adolesc 2023. [PMID: 36737251 DOI: 10.1002/jad.12146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 01/19/2023] [Accepted: 01/20/2023] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Plurisexual individuals represent 50% of sexual minority adolescent communities. However, most studies of sexual minority adolescents analyze this population as a homogeneous group rather than attending to plausible differences between plurisexual and monosexual sexual minority youth. This study examined whether plurisexual Latinx youth differed from monosexual youth on three facets of sexual orientation identity (SOI) development (exploration, resolution, and affirmation). Further, we examined whether plurisexual (vs. monosexual) identity moderated the relationship between SOI development and depressive symptoms and self-esteem. METHODS The sample included 365 Latinx sexual minority youth (14-24 years) living in the United States or US Territory. The majority of participants identified as monosexual (84.1%); 15.9% were plurisexual. The sample was 75.6% male, 19.5% female, and 2.0% transgender. Participants were asked to complete an online, cross-sectional survey that asked questions pertaining to ethnicity and sexual orientation. This data was collected in the fall of 2014. RESULTS Latinx plurisexual youth had higher levels of SOI affirmation, exploration, and resolution than monosexual youth. SOI affirmation and exploration and were positively associated with self-esteem for all youth. SOI affirmation was significantly negatively associated with depressive symptoms for monosexual youth but not for plurisexual youth. SOI exploration and resolution were not significantly associated with depressive symptoms. CONCLUSIONS This study demonstrates that there are significant differences between plurisexual and monosexual Latinx adolescent populations in reference to identity affirmation, exploration, and resolution, and that these sexual orientations should be treated distinctly in future research. In addition, all three aspects of identity development were significantly related to higher self-esteem for all youth regardless of identity, providing evidence for the importance of developing these three factors.
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Affiliation(s)
- Sydney Hainsworth
- Family Studies and Human Development, The University of Arizona, Tucson, Arizona, USA
| | - Russell B Toomey
- Family Studies and Human Development, The University of Arizona, Tucson, Arizona, USA
| | - Karla Anhalt
- School of Lifespan Development and Educational Sciences, Kent State University, Kent, Ohio, USA
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Bränström R, Tognetti A. Comment l’évolution de l’opinion publique et des réformes législatives influence-t-elle la satisfaction de vie des minorités sexuelles ? SANTE PUBLIQUE (VANDOEUVRE-LES-NANCY, FRANCE) 2023; 34:169-178. [PMID: 37336731 DOI: 10.3917/spub.hs2.0169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
INTRODUCTION Structural stigma in the form of legal discrimination and population acceptance of same-sex relationships vary greatly across European countries. Previous cross-sectional research has linked such county variation in stigma with life-satisfaction among sexual minorities, but the consequences of the past decade's improvement in legal recognition and social acceptance of same-sex relationships are unknown. In the current study, we, therefore, examined the change in life-satisfaction among sexual minorities between 2012 and 2019 in France, Sweden, and Poland - three countries for which the legal situation and social acceptance of sexual minorities have changed in different directions during the past decade. METHOD Between April and July 2012, and again between May and July 2019, the European Union Agency for Fundamental Rights conducted web-based surveys to monitor the fundamental rights situation affecting lesbian, gay, and bisexual (LGB) individuals, living in 28 European countries. For the current study, we analyzed data from all LGB respondents in France, Sweden, and Poland, with no history of migration in 2012 (n = 12,357) and 2019 (n = 21,858). RESULTS Regression models adjusted for age, gender, education, and relationship status, showed a strong and significant improvement in life-satisfaction among sexual minorities in France between 2012 and 2019 (β = 0.397, 95 % CI: 0.337, 0.457, p < .001), a country that had experienced improvements in legal recognition (e.g., same-sex marriage legislation in 2013) and improved social acceptance during the same period. In Sweden, which had a high degree of legal recognition and social acceptance in place already in 2012, we found a small increase life-satisfaction among sexual minorities between 2012 and 2019 (β = 0.188, 95 % CI: 0.042, 0.333, p = .012). In Poland, who had experienced deteriorating social acceptance between 2012 and 2019, we found a declined in life-satisfaction among sexual minorities (β = - 0.289, 95 % CI: - 0.385, - 0.193, p < .001). CONCLUSIONS Although life satisfaction has increased during the past decade among sexual minorities living in Europe, there are significant variations across countries largely due to the structural stigma and degree of legal recognition of same-sex relationships of those countries. The findings highlight the importance of further efforts to reduce structural stigma by improving legal recognition and social acceptance of same-sex relationships to promote equitable life satisfaction.
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Salway T, Rich AJ, Ferlatte O, Gesink D, Ross LE, Bränström R, Sadr A, Khan S, Grennan T, Shokoohi M, Brennan DJ, Gilbert M. Preventable mortality among sexual minority Canadians. SSM Popul Health 2022; 20:101276. [PMID: 36337988 PMCID: PMC9634359 DOI: 10.1016/j.ssmph.2022.101276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 10/02/2022] [Accepted: 10/23/2022] [Indexed: 11/06/2022] Open
Abstract
Background Epidemiologic studies point to multiple health inequities among sexual minority people, but few studies have examined mortality. Some causes of death are more preventable than others, and access to prevention is theorized to follow patterns of access to social and material resources. The objective of this study is to compare estimates of preventable mortality between sexual minority (SM)-i.e., bisexual, lesbian, gay-and heterosexual adults in Canada. Methods A population-based retrospective cohort with 442,260 (unweighted N) Canadian adults, ages 18-59 years, was drawn from the Canadian Community Health Survey/Canadian Mortality Database linked database (2003-2017). The Rutstein preventability rating index was used to classify cause-specific mortality (low/high). Longitudinal analyses were conducted using Cox proportional hazards models. Results SM respondents had higher hazard of all-cause mortality (unadjusted hazard ratio [uHR] 1.28, 95% CI 1.06, 1.55). The uHR increased when the outcome was limited to highly-preventable causes of mortality (uHR 1.43, 95% CI 1.14, 1.80). The uHR further increased in sensitivity analyses using higher thresholds of the Rutstein index. SM respondents had higher hazard of cause-specific mortality for heart disease (uHR 1.53, 95% CI 1.03, 2.29), accidents (uHR 1.97, 95% CI 1.01, 3.86), HIV (uHR 75.69, 95% CI 18.77, 305.20), and suicide (uHR 2.22, 95% CI 0.93, 5.30) but not for cancer (uHR 0.86, 95% CI 0.60, 1.25). The adjusted HR (aHR) for highly-preventable mortality was not attenuated by adjustment for confounders (aHR 1.57, 95% CI 1.20, 2.05) but was reduced by adjustment for hypothesized mediators relating to access to social and material resources (marital status, children, income, education; aHR 1.11, 95% CI 0.78, 1.58). Conclusions Preventable mortality was elevated for SM Canadians compared to heterosexuals. Early and broad access to sexual minority-affirming primary and preventive healthcare should be expanded.
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Affiliation(s)
- Travis Salway
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
- British Columbia Centre for Disease Control, Vancouver, Canada
- Centre for Gender and Sexual Health Equity, Vancouver, Canada
- Corresponding author. Blusson Room 11300, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada.
| | - Ashleigh J. Rich
- Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Olivier Ferlatte
- École de santé publique, Université de Montréal, Montréal, Canada
- Centre de Recherche en Santé Publique, Université de Montréal et CIUSSS du Centre-Sud-de-l’Île-de-Montréal, Montreal, Canada
| | - Dionne Gesink
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Lori E. Ross
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Richard Bränström
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Aida Sadr
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Syma Khan
- Department of Emergency Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Troy Grennan
- British Columbia Centre for Disease Control, Vancouver, Canada
- Division of Infectious Diseases, University of British Columbia, Vancouver, Canada
| | - Mostafa Shokoohi
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - David J. Brennan
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Mark Gilbert
- British Columbia Centre for Disease Control, Vancouver, Canada
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada
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Pharr JR, Chien LC, Gakh M, Flatt J, Kittle K, Terry E. Serial Mediation Analysis of the Association of Familiarity with Transgender Sports Bans and Suicidality among Sexual and Gender Minority Adults in the United States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191710641. [PMID: 36078355 PMCID: PMC9518152 DOI: 10.3390/ijerph191710641] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/23/2022] [Accepted: 08/24/2022] [Indexed: 05/14/2023]
Abstract
BACKGROUND Discriminatory laws and policies are a form of structural stigma that is associated with increased suicidality among sexual and gender minority (SGM) people. Unfortunately, in the United States, there has been an increase in state-level discriminatory laws and policies targeting SGM people in 2021 and 2022, particularly, transgender sports bans. The purpose of this study was to (1) determine if familiarity with transgender sports bans was associated with suicidality among SGM adults; and (2) determine if interpersonal stigma and/or individual stigma mediated this association. METHODS This was a cross-sectional study of data collected from a national sample of 1033 SGM adults in the United States between 28 January and 7 February 2022. Univariate and serial mediator models were used in this analysis. RESULTS The increased suicidality was associated with familiarity with state-level transgender sports bans among SGM adults (p-value = 0.0150). Even after interpersonal and individual stigma mediated this relationship, the association between suicidality and familiarity with state-level transgender sports bans remained (p-value = 0.0106). CONCLUSION State-level transgender sports bans appear to exacerbate existing disparities in mental health, especially for individuals who are familiar with the bans. They directly discriminate against people who are transgender and indirectly stigmatize the broader SGM community.
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Affiliation(s)
- Jennifer R. Pharr
- Department of Environmental and Occupational Health, School of Public Health, University of Nevada, Las Vegas, NV 89119, USA
- Correspondence: ; Tel.: +1-(702)-895-2006
| | - Lung-Chang Chien
- Department of Epidemiology and Biostatistics, School of Public Health, University of Nevada, Las Vegas, NV 89119, USA
| | - Maxim Gakh
- Department of Environmental and Occupational Health, School of Public Health, University of Nevada, Las Vegas, NV 89119, USA
| | - Jason Flatt
- Department of Social and Behavioral Health, School of Public Health, University of Nevada, Las Vegas, NV 89119, USA
| | - Krystal Kittle
- Department of Social and Behavioral Health, School of Public Health, University of Nevada, Las Vegas, NV 89119, USA
| | - Emylia Terry
- Department of Environmental and Occupational Health, School of Public Health, University of Nevada, Las Vegas, NV 89119, USA
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Diamond LM, Alley J. Rethinking minority stress: A social safety perspective on the health effects of stigma in sexually-diverse and gender-diverse populations. Neurosci Biobehav Rev 2022; 138:104720. [PMID: 35662651 DOI: 10.1016/j.neubiorev.2022.104720] [Citation(s) in RCA: 61] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/25/2022] [Accepted: 05/30/2022] [Indexed: 12/13/2022]
Abstract
For over two decades, the minority stress model has guided research on the health of sexually-diverse individuals (those who are not exclusively heterosexual) and gender-diverse individuals (those whose gender identity/expression differs from their birth-assigned sex/gender). According to this model, the cumulative stress caused by stigma and social marginalization fosters stress-related health problems. Yet studies linking minority stress to physical health outcomes have yielded mixed results, suggesting that something is missing from our understanding of stigma and health. Social safety may be the missing piece. Social safety refers to reliable social connection, inclusion, and protection, which are core human needs that are imperiled by stigma. The absence of social safety is just as health-consequential for stigmatized individuals as the presence of minority stress, because the chronic threat-vigilance fostered by insufficient safety has negative long-term effects on cognitive, emotional, and immunological functioning, even when exposure to minority stress is low. We argue that insufficient social safety is a primary cause of stigma-related health disparities and a key target for intervention.
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Affiliation(s)
- Lisa M Diamond
- Department of Psychology, University of Utah, Salt Lake City, UT, USA.
| | - Jenna Alley
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
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Bränström R, Stormbom I, Bergendal M, Pachankis JE. Transgender-based disparities in suicidality: A population-based study of key predictions from four theoretical models. Suicide Life Threat Behav 2022; 52:401-412. [PMID: 35067978 PMCID: PMC10138751 DOI: 10.1111/sltb.12830] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 09/30/2021] [Accepted: 10/14/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Numerous studies have reported a high prevalence of suicidality among transgender individuals. Yet few studies have reported results from population-based samples, leaving open questions about the generalizability of existing findings. Factors proposed to explain transgender individuals' elevated risk of suicidality derive from several theoretical models (i.e., clinical model, interpersonal model, minority stress model, and societal integration model). These models identify both general risk factors (e.g., mental health risks and interpersonal risks) assumed to be elevated among transgender individuals because of transgender individuals' exposure to stigma-related disadvantage and the stigma-specific risks themselves (e.g., minority stressors such as discrimination). This is one of the first population-based studies to examine differences in suicidality between transgender and cisgender individuals and theoretically derived factors potentially explaining such differences. METHODS A sample of 533 transgender and 104,757 cisgender individuals (age 16-84) was analyzed. RESULTS Compared to cisgender individuals, transgender individuals were at a substantially higher risk of reporting both lifetime and past 12-month suicidality. Several factors partially mediated the increased risk of suicidality among transgender compared to cisgender individuals, including depressive symptoms, lack of social support, and exposure to discrimination. CONCLUSIONS This study suggests that transgender people experience multiple psychosocial health threats and calls for interventions to reduce these threats.
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Affiliation(s)
- Richard Bränström
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Isabella Stormbom
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Morgan Bergendal
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - John E Pachankis
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA
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Marchi M, Arcolin E, Fiore G, Travascio A, Uberti D, Amaddeo F, Converti M, Fiorillo A, Mirandola M, Pinna F, Ventriglio A, Galeazzi GM. Self-harm and suicidality among LGBTIQ people: a systematic review and meta-analysis. Int Rev Psychiatry 2022; 34:240-256. [PMID: 36151841 DOI: 10.1080/09540261.2022.2053070] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Research evidence has consistently documented a higher risk of suicidality in the Lesbian, Gay, Bisexual, Transgender, Intersex, and Queer (LGBTIQ) population. This systematic review and meta-analysis aimed to report a detailed description of research data regarding the risk of Attempted Suicide (SA), Suicide Ideation (SI), and Non-Suicidal Self-Injury (NSSI) behaviours for LGBTIQ people and their subgroups. Medline, Scopus, PsycINFO, and EMBASE were searched for studies reporting a comparative estimation of SA, SI, and NSSI rates among LGBTIQ population and the general population (i.e. heterosexual/cisgender), without restrictions on participants' age and setting for the enrolment. Pooled analyses were based on odds ratios (ORs, with 95% CIs), estimated through inverse variance models with random effects. Fifty studies were selected for the quantitative synthesis and included fifty samples involving 3.735.601 controls and 87.252 LGBTIQ people. LGBTIQ people reported an increased risk of SA (OR:4.36[95%CI:3.32;5.71]), SI (OR:3.76[95%CI:3.02;4.69]), and NSSI (OR:4.24[95%CI:3.23;5.55]). Among LGBTIQ subgroups, the Bisexual group has shown the highest risk of suicidality (SA, OR:6.71; SI, OR:5.04; NSSI, OR: 5.03), followed by the Lesbian-Gay for attempted suicide (SA, OR:6.03), and the Transgender-Intersex-Queer for suicide ideation and non-suicidal self-injury (SI and NSSI, OR:3.42). The quality of the evidence ranged from low to moderate. Our findings have shown that LGBTIQ people report a higher risk of suicidality compared with their cisgender/heterosexual peers. This evidence may contribute to the public awareness on LGBTQI mental health needs and suggest supportive strategies as well as preventive interventions (e.g. supportive programs, counselling, and destigmatizing efforts) as parts of a tailored health-care planning aimed to reduce psychiatric morbidity and mortality in this at-risk population.
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Affiliation(s)
- Mattia Marchi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Department of Mental Health and Drug Abuse, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Elisa Arcolin
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Gianluca Fiore
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Antonio Travascio
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Daniele Uberti
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesco Amaddeo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | | | - Andrea Fiorillo
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Massimo Mirandola
- Department of Diagnostics and Public Health, Infectious Diseases Section, University of Verona, Verona, Italy.,School of Health Sciences, University of Brighton, Brighton, UK
| | - Federica Pinna
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Antonio Ventriglio
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Gian Maria Galeazzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Department of Mental Health and Drug Abuse, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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12
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Broman N, Prever F, di Giacomo E, Jiménez-Murcia S, Szczegielniak A, Hansson H, Håkansson A. Gambling, Gaming, and Internet Behavior in a Sexual Minority Perspective. A Cross-Sectional Study in Seven European Countries. Front Psychol 2022; 12:707645. [PMID: 35498152 PMCID: PMC9045133 DOI: 10.3389/fpsyg.2021.707645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 11/23/2021] [Indexed: 12/02/2022] Open
Abstract
Background Addictive behavior of gambling, gaming and internet activity is partly a new research domain and has not been well investigated with regard to sexual minority populations. Although health disparities between sexual minorities and the general population are well documented, there is a lack of inclusion of sexual minorities in both research and clinic. Among lesbian, gay and bisexual populations certain features could be present that play a role for the development of addictive behaviors, such as social isolation and increased risk of other psychiatric problems. The aim of this study was to investigate problem gambling, problem gaming and problematic internet behavior in a European context and if it is affected by sexual orientation status. Methods An online web-survey was distributed among web-panels in England, Poland, Switzerland, Italy, Spain, Denmark, and Sweden in 2017-2018. Result 10 983 complete answers were collected. 7.1% of the participants had a sexual minority status (n = 774). Regression models found that there was no difference in gambling, gaming and internet behavior among heterosexual and sexual minority men. Sexual minority women were associated with problematic gambling and gaming behavior, when also controlling for age and nationality. When also controlling for psychological distress, women defining as having another sexual minority status than lesbian and bisexual remained significant for having a problematic gaming behavior (AOR = 2.3). Conclusion An awareness of female sexual minority perspectives is relevant in facilities treating behavioral addiction as well as in future research in behavioral addiction. More research is needed in problematic gambling and gaming behavior in different sexual minority populations with regard to psychiatric comorbidity and living conditions. An inclusion of sexual minority groups defining as other than gay and bisexual is needed in future research. No significant differences were found between heterosexual and sexual minority men in adjusted analysis in this study.
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Affiliation(s)
- Niroshani Broman
- Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden
- Gambling Disorder Unit, Malmö Addiction Center, Region Skåne, Malmö, Sweden
| | - Fulvia Prever
- National Health System (NHS), Addiction Department, Milan, Italy
- SUN(N)COOP Scientific Director “Women and Gambling Project,” Milan, Italy
| | - Ester di Giacomo
- Section of Forensic Psychiatry, King’s College London, Institute of Psychiatry, London, United Kingdom
- School of Medicine and Surgery, University of Milan Bicocca, Milan, Italy
- Psychiatric Department -Azienda Socio-Sanitaria Territoriale (ASST), Monza, Italy
| | - Susana Jiménez-Murcia
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain
- Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain
- Department of Clinical Sciences, Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Anna Szczegielniak
- Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Helena Hansson
- Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden
| | - Anders Håkansson
- Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden
- Gambling Disorder Unit, Malmö Addiction Center, Region Skåne, Malmö, Sweden
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13
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Puccinelli M, Seay J, Otto A, Garcia S, Crane TE, Benzo RM, Solle N, Mustanski B, Merchant N, Safren SA, Penedo FJ. An adapted cognitive behavioral stress and self-management (CBSM) intervention for sexual minority men living with HIV and cancer using the SmartManage eHealth platform: Study design and protocol. (Preprint). JMIR Res Protoc 2022; 11:e37822. [PMID: 35849435 PMCID: PMC9345025 DOI: 10.2196/37822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 05/11/2022] [Accepted: 05/17/2022] [Indexed: 11/13/2022] Open
Abstract
Background Objective Methods Results Conclusions International Registered Report Identifier (IRRID)
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Affiliation(s)
- Marc Puccinelli
- Department of Psychology, University of Miami, Miami, FL, United States
| | - Julia Seay
- Naval Health Research Center, San Diego, CA, United States
| | - Amy Otto
- Department of Public Health Sciences, University of Miami, Miami, FL, United States
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, United States
| | - Sofia Garcia
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Tracy E Crane
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, United States
- Department of Medicine, University of Miami, Miami, FL, United States
| | - Roberto M Benzo
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, United States
| | - Natasha Solle
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, United States
- Department of Medicine, University of Miami, Miami, FL, United States
| | - Brian Mustanski
- Feinberg School of Medicine, Northwestern University, chicago, IL, United States
| | - Nipun Merchant
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, United States
| | - Steven A Safren
- Department of Psychology, University of Miami, Miami, FL, United States
| | - Frank J Penedo
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, United States
- Department of Medicine, University of Miami, Miami, FL, United States
- Department of Psychology, University of Miami, Coral Gables, FL, United States
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14
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Ramchand R, Schuler MS, Schoenbaum M, Colpe L, Ayer L. Suicidality Among Sexual Minority Adults: Gender, Age, and Race/Ethnicity Differences. Am J Prev Med 2022; 62:193-202. [PMID: 35000689 DOI: 10.1016/j.amepre.2021.07.012] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 07/14/2021] [Accepted: 07/20/2021] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Lesbian, gay, and bisexual individuals have elevated suicide risk, but there is little information available about how this risk may vary by gender, age, and race/ethnicity. METHODS This study examined past-year suicide thoughts, plans, and attempts among adult respondents to the 2015-2019 National Surveys on Drug Use and Health (pooled N=191,954). Logistic regression was used to examine the differences between lesbian, gay, and bisexual and heterosexual adults for each outcome, once by gender and age category and once by gender and race/ethnicity category, while controlling for core sociodemographic characteristics. Race/ethnicity and age differences were also estimated within sexual identity groups. RESULTS Suicide thoughts, plans, and attempts were more common among lesbian, gay, and bisexual adults in almost every age and race/ethnicity category relative to that among corresponding heterosexual adults. In some age and race/ethnicity categories, bisexual women were more likely to report suicidal thoughts than lesbian/gay women. Each outcome decreased significantly across age groups among women of all sexual identity groups and heterosexual men; yet, this age effect was less pronounced among gay and bisexual men. Black women had significantly lower rates of suicidal thoughts and plans than White women in all sexual identity groups. CONCLUSIONS In light of consistently elevated rates of suicide thoughts and behaviors, lesbian, gay, and bisexual adults may expressly benefit from enhanced prevention, identification, and treatment of suicide risk. Additional research is needed to assess the associations between sexual identity and suicide mortality as well as to understand the heterogeneity in suicide risk among lesbian, gay, and bisexual youth, particularly by race/ethnicity.
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Affiliation(s)
- Rajeev Ramchand
- National Institute of Mental Health, Bethesda, Maryland; RAND Corporation, Arlington, Virginia.
| | | | | | - Lisa Colpe
- National Institute of Mental Health, Bethesda, Maryland
| | - Lynsay Ayer
- National Institute of Mental Health, Bethesda, Maryland; RAND Corporation, Arlington, Virginia
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15
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Motillon-Toudic C, Walter M, Séguin M, Carrier JD, Berrouiguet S, Lemey C. Social isolation and suicide risk: Literature review and perspectives. Eur Psychiatry 2022; 65:e65. [PMID: 36216777 PMCID: PMC9641655 DOI: 10.1192/j.eurpsy.2022.2320] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background Suicide is a major public health problem and a cause of premature mortality. With a view to prevention, a great deal of research has been devoted to the determinants of suicide, focusing mostly on individual risk factors, particularly depression. In addition to causes intrinsic to the individual, the social environment has also been widely studied, particularly social isolation. This paper examines the social dimension of suicide etiology through a review of the literature on the relationship between suicide and social isolation. Methods Medline searches via PubMed and PsycINFO were conducted. The keywords were “suicid*” AND “isolation.” Results Of the 2,684 articles initially retrieved, 46 were included in the review. Conclusions Supported by proven theoretical foundations, mainly those developed by E. Durkheim and T. Joiner, a large majority of the articles included endorse the idea of a causal relationship between social isolation and suicide, and conversely, a protective effect of social support against suicide. Moreover, the association between suicide and social isolation is subject to variations related to age, gender, psychopathology, and specific circumstances. The social etiology of suicide has implications for intervention and future research.
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16
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Pachankis JE, Soulliard ZA, Morris F, Seager van Dyk I. A Model for Adapting Evidence-Based Interventions to Be LGBQ-Affirmative: Putting Minority Stress Principles and Case Conceptualization into Clinical Research and Practice. COGNITIVE AND BEHAVIORAL PRACTICE 2022. [DOI: 10.1016/j.cbpra.2021.11.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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17
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Diamond LM, Dehlin AJ, Alley J. Systemic inflammation as a driver of health disparities among sexually-diverse and gender-diverse individuals. Psychoneuroendocrinology 2021; 129:105215. [PMID: 34090051 DOI: 10.1016/j.psyneuen.2021.105215] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/25/2021] [Accepted: 03/25/2021] [Indexed: 01/28/2023]
Abstract
Sexually-diverse individuals (those who seek sexual or romantic relationships with the same and/or multiple genders) and gender-diverse individuals (those whose gender identity and/or expression differs from their birth-assigned sex/gender) have disproportionately high physical health problems, but the underlying biological causes for these health disparities remain unclear. Building on the minority stress model linking social stigmatization to health outcomes, we argue that systemic inflammation (the body's primary response to both physical and psychological threats, indicated by inflammatory markers such as C-reactive protein and proinflammatory cytokines) is a primary biobehavioral pathway linking sexual and gender stigma to physical health outcomes. Expectations and experiences of social threat (i.e., rejection, shame, and isolation) are widespread and chronic among sexually-diverse and gender-diverse individuals, and social threats are particularly potent drivers of inflammation. We review research suggesting that framing "minority stress" in terms of social safety versus threat, and attending specifically to the inflammatory consequences of these experiences, can advance our understanding of the biobehavioral consequences of sexual and gender stigma and can promote the development of health promoting interventions for this population.
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18
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Pachankis JE, Clark KA, Jackson SD, Pereira K, Levine D. Current Capacity and Future Implementation of Mental Health Services in U.S. LGBTQ Community Centers. Psychiatr Serv 2021; 72:669-676. [PMID: 33882684 PMCID: PMC10374348 DOI: 10.1176/appi.ps.202000575] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Since the beginning of the lesbian, gay, bisexual, transgender, and queer (LGBTQ) rights movement, LGBTQ community centers have been on the front lines of mental health care for sexual and gender minorities (SGMs) across the United States. However, little is known about what types of mental health services LGBTQ community centers currently offer and their anticipated future needs, including training in and delivery of evidence-based practice. METHODS Sixty executive directors and chief executive officers of LGBTQ community centers across the United States completed a survey regarding their centers' current treatment capacity, format, and type as well as perceived future needs. Survey items were supplemented with qualitative questions about perceived barriers to and facilitators of strengthening the capacity of mental health services. RESULTS Center directors perceived a high need for mental health care in their communities and strove to meet that need despite constrained resources. About half of the centers (52%) reported having fewer than five mental health staff; still, most reported providing support groups (98%) and individual psychotherapy (85%). Most centers (88%) reported providing general evidence-based care, such as cognitive-behavioral therapy (62%), and all reported high support for their staff to receive training in more specific types of evidence-based, LGBTQ-affirmative care. CONCLUSIONS LGBTQ community centers continue to play an important role in supporting the mental health of SGMs. The centers also offer a significant opportunity to lead the way in addressing the substantial unmet mental health needs still facing this population by implementing evidence-based, LGBTQ-affirmative practice through efficient and cost-effective service delivery.
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Affiliation(s)
- John E Pachankis
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut (Pachankis, Clark, Jackson, Pereira); CenterLink, The Community of LGBT Centers, Ft. Lauderdale, Florida (Levine)
| | - Kirsty A Clark
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut (Pachankis, Clark, Jackson, Pereira); CenterLink, The Community of LGBT Centers, Ft. Lauderdale, Florida (Levine)
| | - Skyler D Jackson
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut (Pachankis, Clark, Jackson, Pereira); CenterLink, The Community of LGBT Centers, Ft. Lauderdale, Florida (Levine)
| | - Kobe Pereira
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut (Pachankis, Clark, Jackson, Pereira); CenterLink, The Community of LGBT Centers, Ft. Lauderdale, Florida (Levine)
| | - Deborah Levine
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut (Pachankis, Clark, Jackson, Pereira); CenterLink, The Community of LGBT Centers, Ft. Lauderdale, Florida (Levine)
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19
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Jeffery DD, Beymer MR, Mattiko MJ, Shell D. Health Behavior Differences Between Male and Female U.S. Military Personnel by Sexual Orientation: The Importance of Disaggregating Lesbian, Gay, and Bisexual Groups. Mil Med 2021; 186:556-564. [PMID: 33306807 DOI: 10.1093/milmed/usaa539] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/22/2020] [Accepted: 11/25/2020] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION The aims of the study are to identify health-related behaviors associated with sexual orientation among active duty military personnel and to compare those behaviors when lesbian, gay, and bisexual (LGB) groups are aggregated and disaggregated. MATERIALS AND METHODS We used public data from the 2015 Health-Related Behavior Survey of Active Duty Military Personnel. Binomial logistic regression analyses were used to examine differences between and within heterosexual, same-sex, and bisexual groups as predicted by the following correlates: demographic characteristics, physical activity, substance use, probable mood disorders, unwanted sexual contact, physical abuse, suicidal behaviors, and sexually transmitted infection (STI). RESULTS In univariate analyses, rates of lifetime unwanted sexual contact and lifetime suicidal ideation were significantly higher for bisexual females compared to other groups. The results of regression analyses differed depending on whether LGB groups were aggregated or disaggregated. Aggregated LGB versus heterosexual model found significant differences with respect to unwanted sexual contact, lifetime suicide attempt, STI, smoking, and marijuana use. Disaggregated models found different patterns of significant correlates, e.g., correlates comparing gays to heterosexual males were STI, sexual contact, lifetime suicide attempt, and age; correlates comparing lesbians to heterosexual females were heavy drinking, probable post-traumatic stress disorder, ever used marijuana, lifetime suicide attempt, lifetime physical abuse, and smoking. CONCLUSION The findings are consistent with those of previous research showing highest risk for suicidal behaviors and substance abuse among bisexual individuals. We recommend that future studies and clinical care consider LGB sexual identities as heterogeneous groups; otherwise, risks for adverse health behaviors may be overlooked.
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Affiliation(s)
- Diana D Jeffery
- Department of Defense, Defense Health Agency, Falls Church, VA 22042, USA
| | - Matthew R Beymer
- Behavioral and Social Health Outcomes Program, Defense Health Agency, US Army Satellite, Aberdeen Proving Ground, MD 21005, USA
| | - Mark J Mattiko
- Health, Safety, and Work-Life Directorate, United States Coast Guard, Washington, DC 20032, USA
| | - Donald Shell
- Department of Defense, Office of the Assistant Secretary of Defense (Health Affairs), Falls Church, VA 22042, USA
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20
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Peterson AL, Bender AM, Sullivan B, Karver MS. Ambient Discrimination, Victimization, and Suicidality in a Non-Probability U.S. Sample of LGBTQ Adults. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:1003-1014. [PMID: 33599884 DOI: 10.1007/s10508-020-01888-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 11/11/2020] [Accepted: 11/12/2020] [Indexed: 05/28/2023]
Abstract
Individuals who identify as lesbian, gay, bisexual, transgender, or queer (LGBTQ) are at a higher risk for suicidality compared to the general population. A growing body of research has investigated this risk, particularly with attention to systemic factors such as discrimination and harassment. Unfortunately, research has only examined the impact of direct discrimination on suicidality and has neglected to examine how ambient discrimination (i.e., witnessing or being made aware of discriminatory behaviors directed at someone other than yourself in your group) relates to suicidality. Additionally, although some links exist between discrimination and suicidality, the mechanisms by which these are related are understudied. This study aimed to address these gaps by exploring the effect of ambient discrimination on suicidal ideation and examining psychological pain as a mediator in this relationship. Data were collected from a sample of 200 LGBTQ-identified individuals (M age = 35 years; 53.5% female; 86% White). Results of independent t tests and a one-way multivariate ANOVA revealed greater vulnerability for ambient/direct discrimination and psychache among individuals identifying as transgender, queer, and other. Regression and mediation analyses revealed that while both ambient and direct discrimination predicted suicidal ideation, only direct discrimination accounted for unique variance in the outcome; however, both ambient and direct discrimination contributed unique variance to psychological pain, which fully mediated their relationships to suicidal ideation. Results of this study may begin to provide insight into the pathways of risk and points of intervention for suicidality in the LGBTQ community.
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Affiliation(s)
- Amanda L Peterson
- Department of Psychology, University of South Florida, 4202 E Fowler Ave., Tampa, FL, 33620, USA.
| | - Ansley M Bender
- Department of Psychology, University of South Florida, 4202 E Fowler Ave., Tampa, FL, 33620, USA
| | - Benjamin Sullivan
- Department of Psychology, University of South Florida, 4202 E Fowler Ave., Tampa, FL, 33620, USA
| | - Marc S Karver
- Department of Psychology, University of South Florida, 4202 E Fowler Ave., Tampa, FL, 33620, USA
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21
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Harvey TD, Keene DE, Pachankis JE. Minority stress, psychosocial health, and survival among gay and bisexual men before, during, and after incarceration. Soc Sci Med 2021; 272:113735. [DOI: 10.1016/j.socscimed.2021.113735] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 12/08/2020] [Accepted: 01/27/2021] [Indexed: 12/28/2022]
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22
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Rentería R, Benjet C, Gutierrez-Garcia RA, Ábrego Ramírez A, Albor Y, Borges G, Covarrubias Díaz Couder MA, Durán MDS, González González R, Guzmán Saldaña R, Hermosillo De la Torre AE, Martínez-Jerez AM, Martinez Martinez KI, Medina-Mora ME, Martínez Ruiz S, Paz Pérez MA, Pérez Tarango G, Zavala Berbena MA, Méndez E, Auerbach RP, Mortier P. Suicide thought and behaviors, non-suicidal self-injury, and perceived life stress among sexual minority Mexican college students. J Affect Disord 2021; 281:891-898. [PMID: 33243555 PMCID: PMC7856251 DOI: 10.1016/j.jad.2020.11.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 10/13/2020] [Accepted: 11/07/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Sexual minority college students are at a higher risk for suicidal thoughts and self-injurious behaviors compared to heterosexual students. Minority stress theory proposes sexual minority individuals experience higher stress due to stigma. Using a sample of Mexican college students, this study tested perceived life stress as a mediator of suicide and self-injury outcomes across various sexual orientation groups. METHODS The sample of college students (N=7882) was recruited from nine Mexican universities as part of the WHO World Mental Health International College Student (WMH-ICS) initiative. Participants completed an online survey including demographic questions, measure of perceived life stress, suicide outcomes, and non-suicidal self-injury (NSSI) in the past 12 months. RESULTS Logistic regression analyses revealed identifying as a sexual minority significantly predicted a higher likelihood of suicide ideation (ORs 2.05-3.00), suicide attempts (ORs 2.48-8.73), and NSSI (ORs 2.92-4.18) compared to heterosexual students reporting no same-gender attraction. Significant indirect effects from mediation path analyses showed perceived life stress mediated the relationship between a sexual minority identity and suicide ideation (range of proportion mediated 10.48-31.48%), attempts (10.48-31.48%), and NSSI (7.69-20.09%) across each group except among asexual students. LIMITATIONS The cross-sectional nature of the survey design precludes drawing causal inferences. CONCLUSION Findings from this study contribute to minority stress theory by elucidating the role of perceived life stress as a mediator of suicide ideation and attempts and NSSI among sexual minority college students. Clinical interventions may benefit in focusing on experiences of stress across various life areas when supporting sexual minority college students.
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Affiliation(s)
- Roberto Rentería
- Counseling & Counseling Psychology, Arizona State University, Tempe, Arizona, United States of America
| | - Corina Benjet
- Dirección de Investigaciones Epidemiológicas y Psicosociales, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, México.
| | - Raúl A Gutierrez-Garcia
- Facultad de Ciencias Sociales y Humanidades, Universidad De La Salle Bajío, Campus Salamanca, Salamanca, Guanajuato, México
| | - Adrián Ábrego Ramírez
- Dirección de Investigación, Universidad Politécnica de Aguascalientes, Aguascalientes, Aguascalientes, México; Dirección de Educación a Distancia, Universidad Cuauhtémoc, Plantel Aguascalientes, Aguascalientes, Aguascalientes, México
| | - Yesica Albor
- Departamento de Salud Púbica, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - Guilherme Borges
- Dirección de Investigaciones Epidemiológicas y Psicosociales, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, México
| | | | - María Del Socorro Durán
- Dirección de Orientación y Desarrollo Educativo, Universidad De La Salle Bajío, Campus Campestre, León, Guanajuato, México
| | - Rogaciano González González
- Facultad de Ciencias Sociales y Humanidades, Universidad De La Salle Bajío, Campus Salamanca, Salamanca, Guanajuato, México
| | - Rebeca Guzmán Saldaña
- Instituto de Ciencias de la Salud, Universidad Autónoma del Estado de Hidalgo, Hidalgo, México
| | | | - Ana María Martínez-Jerez
- Facultad de Derecho y Ciencias Sociales, Universidad Autónoma de Tamaulipas. Tampico, Tamaulipas, México
| | - Kalina I Martinez Martinez
- Departamento de Psicología, Universidad Autónoma de Aguascalientes, Aguascalientes, Aguascalientes, México
| | - María Elena Medina-Mora
- Dirección de Investigaciones Epidemiológicas y Psicosociales, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, México
| | | | - María Abigail Paz Pérez
- Facultad de Ciencias Sociales y Humanidades, Universidad De La Salle Bajío, Campus Salamanca, Salamanca, Guanajuato, México
| | - Gustavo Pérez Tarango
- Dirección de Orientación y Desarrollo Educativo, Universidad De La Salle Bajío, Campus Campestre, León, Guanajuato, México
| | - María Alicia Zavala Berbena
- Dirección de Orientación y Desarrollo Educativo, Universidad De La Salle Bajío, Campus Campestre, León, Guanajuato, México
| | - Enrique Méndez
- Dirección de Investigaciones Epidemiológicas y Psicosociales, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, México
| | - Randy P Auerbach
- Department of Psychiatry, Columbia University, New York City, New York, USA
| | - Philippe Mortier
- Health Services Research Unit, IMIM (Hospital del Mar Medical Research Institute), CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
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23
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Pachankis JE, Williams SL, Behari K, Job S, McConocha EM, Chaudoir SR. Brief online interventions for LGBTQ young adult mental and behavioral health: A randomized controlled trial in a high-stigma, low-resource context. J Consult Clin Psychol 2020; 88:429-444. [PMID: 32271053 DOI: 10.1037/ccp0000497] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To identify scalable interventions for improving sexual minority mental health and health-risk behavior, this study tested the efficacy of two self-guided online writing interventions-expressive writing and self-affirmation. To reach sexual minority young adults living in high-stigma, low-resource settings, we developed and tested these interventions in Appalachian Tennessee. METHOD In consultation with sexual minority young adults (n = 10) and stakeholders (n = 10) living in Appalachian Tennessee, we adapted these two writing interventions that we then delivered to 108 local sexual minority young adults (Mage = 23.68, SD = 3.11). Participants, representing diverse sexual and gender identities and socioeconomic backgrounds, were randomly assigned to participate in a 3-session expressive writing intervention, self-affirmation intervention, or neutral control. Participants completed mental health and health-risk behavior measures at baseline, postintervention, and 3-month follow-up. RESULTS Compared to the neutral control, expressive writing exerted 3-month improvements in depressive symptoms (d = 0.48) and general psychological distress (d = 0.36) whereas self-affirmation exerted improvement in suicidal ideation (d = 0.62) and drug abuse (d = 0.59). Participants who were exposed to greater contextual minority stressors common in rural regions (i.e., discrimination and victimization) experienced significantly greater 3-month reductions in depression from expressive writing and self-affirmation compared to control. Those who experienced greater discrimination also experienced significantly greater 3-month reductions in suicidality from self-affirmation compared to control. CONCLUSION Brief writing interventions exert significant impact on the mental health of young adult sexual minorities, especially those exposed to minority stress. Future research can consider strategies for population-level implementation, especially in high-stigma, low-resource settings. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- John E Pachankis
- Department of Social and Behavioral Sciences, Yale School of Public Health
| | | | - Kriti Behari
- Department of Social and Behavioral Sciences, Yale School of Public Health
| | - Sarah Job
- Department of Psychology, East Tennessee State University
| | - Erin M McConocha
- Department of Social and Behavioral Sciences, Yale School of Public Health
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24
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Björkenstam C, Mannheimer L, Löfström M, Deogan C. Sexual Orientation-Related Differences in Sexual Satisfaction and Sexual Problems-A Population-Based Study in Sweden. J Sex Med 2020; 17:2362-2369. [PMID: 32873532 DOI: 10.1016/j.jsxm.2020.07.084] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 07/21/2020] [Accepted: 07/31/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Human sexuality is a natural and important part of peoples' life and well-being. The underlying interactions affecting sexual satisfaction are complex, and sexual orientation differences partly remain to be identified as well as explained. AIM Our aim was to investigate sexual orientation-related differences in sexual satisfaction and sexual dissatisfaction and differences in sexual function and sexual-related problems. METHODS We used Swedish data from SRHR2017 (sexual and reproductive health and rights), based on self-administered surveys, linked to nationwide registers. The national sample consisted of 14,537 women and men aged 16-84 years. With logistic regression, we examined sexual orientation-related differences in self-reported sexual satisfaction and sexual dissatisfaction, stratified by sex. MAIN OUTCOME MEASURES The main outcome measures of this study are odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS Bisexual women were more dissatisfied with their sex life, as compared with heterosexual women (OR: 1.8; 95% CI: 1.3-2.6), as were bisexual men compared with heterosexual men (OR: 2.7; 95% CI: 1.7-4.4). A bisexual or lesbian identity was a robust risk factor for premature orgasm (OR: 2.1; 95% CI: 1.1-3.9 and OR: 8.0; 95% CI: 3.2-20.0, respectively). Lesbian women seemed to have lower risk for many sexual-related problems (however not significant). Gay men lacked arousal (OR: 3.3; 95% CI: 1.6-6.9), had no orgasm (OR: 2.6; 95% CI: 1.4-4.7), and were at lower risk of experiencing premature ejaculation (OR: 0.4; 95% CI: 0.2-0.9), as compared with heterosexual men. CONCLUSION Our findings contribute to the sparse evidence of some sexual orientation differences in sexual satisfaction and sexual dysfunctions. Especially bisexual women and men appear to experience less sexual satisfaction in relation to heterosexual and homosexual women and men. Björkenstam C, Mannheimer L, Löfström M, et al. Sexual Orientation-Related Differences in Sexual Satisfaction and Sexual Problems-A Population-Based Study in Sweden. J Sex Med 2020;17:2362-2369.
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Affiliation(s)
- Charlotte Björkenstam
- Department of Communicable Disease Control and Health Protection, The Public Health Agency of Sweden, Stockholm, Sweden; Division Public Health Epidemiology, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
| | - Louise Mannheimer
- Department of Communicable Disease Control and Health Protection, The Public Health Agency of Sweden, Stockholm, Sweden; Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Matilda Löfström
- Department of Communicable Disease Control and Health Protection, The Public Health Agency of Sweden, Stockholm, Sweden
| | - Charlotte Deogan
- Department of Communicable Disease Control and Health Protection, The Public Health Agency of Sweden, Stockholm, Sweden; Division of Global Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
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