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Singh K, Wendt FR. Effects of sex and gender on the etiologies and presentation of select internalizing psychopathologies. Transl Psychiatry 2024; 14:73. [PMID: 38307846 PMCID: PMC10837201 DOI: 10.1038/s41398-024-02730-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 12/19/2023] [Accepted: 01/02/2024] [Indexed: 02/04/2024] Open
Abstract
The internalizing spectrum encompasses a subset of psychopathologies characterized by emotional liability, anhedonia, anxiousness, distress, and fear, and includes, among others, diagnoses of major depressive disorder (MDD), generalized anxiety disorder (GAD), and posttraumatic stress disorder (PTSD). In this review, we describe the vast body of work highlighting a role for sex and gender in the environment, symptom onset, genetic liability, and disorder progression and comorbidities of MDD, GAD, and PTSD. We also point the reader to different language used in diverse fields to describe sexual and gender minorities that may complicate the interpretation of emerging literature from the social sciences, psychiatric and psychological sciences, and genetics. Finally, we identify several gaps in knowledge that we hope serve as launch-points for expanding the scope of psychiatric studies beyond binarized sex-stratification. Despite being under-represented in genomics studies, placing emphasis on inclusion of sexual and gender diverse participants in these works will hopefully improve our understanding of disorder etiology using genetics as one tool to inform how biology (e.g., hormone concentration) and environmental variables (e.g., exposure to traumatic events) contribute to differences in symptom onset, pattern, and long-term trajectory.
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Affiliation(s)
- Kritika Singh
- Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Frank R Wendt
- Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
- Department of Anthropology, University of Toronto, Mississauga, ON, Canada.
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Haarmann L, Folkerts AK, Lieker E, Eichert K, Neidlinger M, Monsef I, Skoetz N, Träuble B, Kalbe E. Comprehensive systematic review and meta-analysis on physical health conditions in lesbian- and bisexual-identified women compared with heterosexual-identified women. Womens Health (Lond) 2023; 19:17455057231219610. [PMID: 38146632 PMCID: PMC10752089 DOI: 10.1177/17455057231219610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 11/03/2023] [Accepted: 11/23/2023] [Indexed: 12/27/2023]
Abstract
BACKGROUND Sexual minority individuals experience discrimination, leading to mental health disparities. Physical health disparities have not been examined to the same extent in systematic reviews so far. OBJECTIVES To provide a systematic review and, where possible, meta-analyses on the prevalence of physical health conditions in sexual minority women (i.e. lesbian- and bisexual-identified women) compared to heterosexual-identified women. DESIGN The study design is a systematic review with meta-analyses. DATA SOURCES AND METHODS A systematic literature search in MEDLINE, EMBASE, CENTRAL, CINAHL, and Web of Science databases was conducted on epidemiologic studies on physical health conditions, classified in the Global Burden of Disease project, published between 2000 and 2021. Meta-analyses pooling odds ratios were calculated. RESULTS In total, 23,649 abstracts were screened and 44 studies were included in the systematic review. Meta-analyses were run for arthritis, asthma, back pain, cancer, chronic kidney diseases, diabetes, headache disorders, heart attacks, hepatitis, hypertension, and stroke. Most significant differences in prevalence by sexual identity were found for chronic respiratory conditions, especially asthma. Overall, sexual minority women were significantly 1.5-2 times more likely to have asthma than heterosexual women. Furthermore, evidence of higher prevalence in sexual minority compared to heterosexual women was found for back pain, headaches/migraines, hepatitis B/C, periodontitis, urinary tract infections, and acne. In contrast, bisexual women had lower cancer rates. Overall, sexual minority women had lower odds of heart attacks, diabetes, and hypertension than heterosexual women (in terms of diabetes and hypertension possibly due to non-consideration of pregnancy-related conditions). CONCLUSION We found evidence for physical health disparities by sexual identity. Since some of these findings rely on few comparisons only, this review emphasizes the need for routinely including sexual identity assessment in health research and clinical practice. Providing a more detailed picture of the prevalence of physical health conditions in sexual minority women may ultimately contribute to reducing health disparities.
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Affiliation(s)
- Lena Haarmann
- Department of Medical Psychology ǀ Neuropsychology and Gender Studies and Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Ann-Kristin Folkerts
- Department of Medical Psychology ǀ Neuropsychology and Gender Studies and Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Emma Lieker
- Department of Medical Psychology ǀ Neuropsychology and Gender Studies and Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Kai Eichert
- Department of Medical Psychology ǀ Neuropsychology and Gender Studies and Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Marlene Neidlinger
- Department of Medical Psychology ǀ Neuropsychology and Gender Studies and Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Ina Monsef
- Evidence-Based Medicine, Department of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Nicole Skoetz
- Evidence-Based Medicine, Department of Internal Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Birgit Träuble
- Department of Psychology ǀ Research Unit for Developmental Psychology, Faculty of Human Sciences Cologne, University of Cologne, Cologne, Germany
| | - Elke Kalbe
- Department of Medical Psychology ǀ Neuropsychology and Gender Studies and Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Macdowall WG, Clifton S, Palmer MJ, Tanton C, Copas AJ, Lee DM, Mitchell KR, Mercer CH, Sonnenberg P, Johnson AM, Wellings K. Salivary Testosterone and Sexual Function and Behavior in Men and Women: Findings from the Third British National Survey of Sexual Attitudes and Lifestyles (Natsal-3). J Sex Res 2022; 59:135-149. [PMID: 34634954 PMCID: PMC7613951 DOI: 10.1080/00224499.2021.1968327] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Using data from the third British National Survey of Sexual Attitudes and Lifestyles (Natsal-3) we examined associations between salivary testosterone (Sal-T) and sexual function and behavior. Single morning saliva samples were self-collected from a subsample of participants aged 18-74 years and analyzed using mass spectrometry. 1,599 men and 2,123 women were included in the analysis (40.6% of those invited to provide a sample). We adjusted for confounders in a stepwise manner: in model 1 we adjusted for age only; model 2 for age, season and relationship status, and model 3 we added BMI and self-reported health. In the fully adjusted models, among men, Sal-T was positively associated with both partnered sex (vaginal sex and concurrent partners) and masturbation. Among women, Sal-T was positively associated with masturbation, the only association with partnered sex was with ever experience of same-sex sex. We found no clear association between Sal-T and sexual function. Our study contributes toward addressing the sparsity of data outside the laboratory on the differences between men and women in the relationship between T and sexual function and behavior. To our knowledge, this is the first population study, among men and women, using a mass spectrometry Sal-T assay to do so.
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Affiliation(s)
- W G Macdowall
- Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine
| | - S Clifton
- Institute for Global Health, University College London, Mortimer Market Centre
- NatCen Social Research
| | - M J Palmer
- Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine
| | - C Tanton
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine
| | - A J Copas
- Institute for Global Health, University College London, Mortimer Market Centre
| | - D M Lee
- Faculty of Health, Psychology and Social Care, Manchester Metropolitan University
| | - K R Mitchell
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow
| | - C H Mercer
- Institute for Global Health, University College London, Mortimer Market Centre
| | - P Sonnenberg
- Institute for Global Health, University College London, Mortimer Market Centre
| | - A M Johnson
- Institute for Global Health, University College London, Mortimer Market Centre
| | - K Wellings
- Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine
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Luoto S. Did Prosociality Drive the Evolution of Homosexuality? Response to Barron (2020). Arch Sex Behav 2021; 50:2777-2779. [PMID: 33638066 DOI: 10.1007/s10508-021-01944-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 02/02/2021] [Accepted: 02/06/2021] [Indexed: 06/12/2023]
Affiliation(s)
- Severi Luoto
- English, Drama and Writing Studies, University of Auckland, Auckland, 1010, New Zealand.
- School of Psychology, University of Auckland, Auckland, New Zealand.
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Barron AB. Did Prosociality Drive the Evolution of Homosexuality? Response to Luoto (2021). Arch Sex Behav 2021; 50:2781-2783. [PMID: 34327589 DOI: 10.1007/s10508-021-02110-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 07/16/2021] [Accepted: 07/19/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Andrew B Barron
- Department of Biological Sciences, Macquarie University, Sydney, NSW, 2109, Australia.
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McGowan VJ, Lowther HJ, Meads C. Life under COVID-19 for LGBT+ people in the UK: systematic review of UK research on the impact of COVID-19 on sexual and gender minority populations. BMJ Open 2021; 11:e050092. [PMID: 34330861 PMCID: PMC8327638 DOI: 10.1136/bmjopen-2021-050092] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE To systematically review all published and unpublished evidence on the impact of the COVID-19 pandemic on the health and well-being of UK sexual and gender minority (LGBT+; lesbian, gay, bisexual, transgender, non-binary, intersex and queer) people. METHODS Any relevant studies with or without comparator were included, with outcomes of: COVID-19 incidence, hospitalisation rates, illness severity, death rates, other health and well-being. Six databases (platforms) were searched-CINAHL Plus (Ovid), Cochrane Central (Cochrane Library), Medline (Ovid), Embase (Ovid), Science Citation Index (Web of Science) and Scopus between 2019 and 2020 in December 2020, using synonyms for sexual and gender minorities and COVID-19 search terms. Data extraction and quality assessment (using the relevant Joanna Briggs checklist) were in duplicate with differences resolved through discussion. Results were tabulated and synthesis was through narrative description. RESULTS No published research was found on any outcomes. Eleven grey literature reports found to be of low quality were included, mostly conducted by small LGBT+ charities. Only four had heterosexual/cisgender comparators. Mental health and well-being, health behaviours, safety, social connectedness and access to routine healthcare all showed poorer or worse outcomes than comparators. CONCLUSIONS Lack of research gives significant concern, given pre-existing health inequities. Social and structural factors may have contributed to poorer outcomes (mental health, well-being and access to healthcare). Paucity of evidence is driven by lack of routinely collected sexual orientation and gender identity data, possibly resulting from institutional homophobia/transphobia which needs to be addressed. Men are more at risk of serious illness from COVID-19 than women, so using data from trans women and men might have started to answer questions around whether higher rates were due to sex hormone or chromosomal effects. Routine data collection on sexual orientation and gender identity is required to examine the extent to which COVID-19 is widening pre-existing health inequalities. PROSPERO REGISTRATION NUMBER CRD42020224304.
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Affiliation(s)
- Victoria J McGowan
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Hayley J Lowther
- Lancashire Applied Health Research Collaboration Hub (LARCH), University of Central Lancashire, Preston, UK
| | - Catherine Meads
- Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin University-Cambridge Campus, Cambridge, UK
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Booker CL, Meads C. Sexual Orientation and the Incidence of COVID-19: Evidence from Understanding Society in the UK Longitudinal Household Study. Healthcare (Basel) 2021; 9:healthcare9080937. [PMID: 34442074 PMCID: PMC8394317 DOI: 10.3390/healthcare9080937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 07/15/2021] [Accepted: 07/16/2021] [Indexed: 11/16/2022] Open
Abstract
COVID-19 infection rates and severity are worse in marginalised groups, although, for sexual and gender minorities, there are no data on infections, hospitalisations or deaths, but there may be worse rates. This study uses information from Understanding Society: The UK Household Longitudinal Study (UKHLS) to derive COVID-19 symptoms and positive tests by sexual orientation. Data came from all seven UKHLS COVID-19 survey waves in 2020 and 2021, and sexual orientation in main UKHLS waves 3 and 9. Numbers ranged from 17,800 to 12,000. Covariates in the regression models were gender, age, highest educational qualification, ethnicity, diagnosed medical condition, and key worker status. Compared to heterosexual individuals, more sexual minorities experienced symptoms, and bisexual individuals reported a greater number of symptoms. Gays and lesbians were no more or less likely to have been tested, but a larger proportion of bisexual individuals were tested. Regression models showed that differences mostly disappeared when other characteristics were considered. A small sample size means that principal questions remain, so health inequalities have been largely unnoticed and therefore not addressed. Suitable action should be taken to minimise their future risks. Why sexual and gender minorities have been omitted needs to be explored, and action needs to be taken to ensure this does not happen again.
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Affiliation(s)
- Cara L. Booker
- Institute for Social and Economic Research, University of Essex, Essex CO4 3SQ, UK
- Correspondence:
| | - Catherine Meads
- Faculty of Health, Education. Medicine and Social Care, Cambridge Campus, Anglia Ruskin University, Cambridge CB1 1PT, UK;
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Barron AB. Response to Luoto's (2020) "Did Prosociality Drive the Evolution of Homosexuality?". Arch Sex Behav 2020; 49:2245-2246. [PMID: 32770281 DOI: 10.1007/s10508-020-01812-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 07/24/2020] [Accepted: 07/27/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Andrew B Barron
- Department of Biological Sciences, Macquarie University, Sydney, NSW, 2109, Australia.
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Luoto S. Did Prosociality Drive the Evolution of Homosexuality? Arch Sex Behav 2020; 49:2239-2244. [PMID: 32474666 DOI: 10.1007/s10508-020-01749-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 05/14/2020] [Accepted: 05/18/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Severi Luoto
- English, Drama and Writing Studies, University of Auckland, 1010, Auckland, New Zealand.
- School of Psychology, University of Auckland, Auckland, New Zealand.
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