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Nowaskie DZ, Werner-Sleva SB, Jacobs AK. It's a Start: An Online, On-Demand LGBTQ+ Mental Health Training Session for Providers Nationwide. Psychiatr Serv 2024; 75:481-484. [PMID: 38124553 DOI: 10.1176/appi.ps.20220473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
OBJECTIVE The purpose of this study was to determine whether an online, on-demand, and publicly accessible mental health training session on care for lesbian, gay, bisexual, transgender, queer, and all sexual-diverse and gender-diverse (LGBTQ+) individuals could improve providers' preparedness, attitudes, and knowledge regarding care for LGBTQ+ patients. METHODS Between January and June 2022, participating mental health providers completed the Lesbian, Gay, Bisexual, and Transgender Development of Clinical Skills Scale (LGBT-DOCSS) before and after training. RESULTS Participants (N=322) represented various mental health specialties and all U.S. regions. LGBT-DOCSS scores significantly increased after training: for overall LGBT-DOCSS, Cohen's d=0.77 (p<0.001); for clinical preparedness, Cohen's d=0.68 (p<0.001); for attitudinal awareness, Cohen's d=0.14 (p=0.014); and for basic knowledge, Cohen's d=0.62 (p<0.001). CONCLUSIONS Although participating mental health providers had improvements in the parameters assessed, small but notable gaps in their LGBTQ+ health awareness and practice remained, suggesting that LGBTQ+ education requires motivated, longitudinal, ongoing, and lifelong learning approaches.
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Affiliation(s)
- Dustin Z Nowaskie
- Department of Psychiatry and the Behavioral Sciences, Keck School of Medicine of University of Southern California, Los Angeles (Nowaskie); Department of Psychiatry, Indiana University School of Medicine, Indianapolis (Werner-Sleva); Department of Social Work, Michigan Medicine, Ann Arbor (Jacobs)
| | - Stephen B Werner-Sleva
- Department of Psychiatry and the Behavioral Sciences, Keck School of Medicine of University of Southern California, Los Angeles (Nowaskie); Department of Psychiatry, Indiana University School of Medicine, Indianapolis (Werner-Sleva); Department of Social Work, Michigan Medicine, Ann Arbor (Jacobs)
| | - Amy K Jacobs
- Department of Psychiatry and the Behavioral Sciences, Keck School of Medicine of University of Southern California, Los Angeles (Nowaskie); Department of Psychiatry, Indiana University School of Medicine, Indianapolis (Werner-Sleva); Department of Social Work, Michigan Medicine, Ann Arbor (Jacobs)
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Alibudbud R. Incorporating LGBT+ mental health into psychiatric residency and training: perspectives from the Philippines. BJPsych Int 2024; 21:29-31. [PMID: 38693951 PMCID: PMC11035962 DOI: 10.1192/bji.2023.39] [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: 06/26/2023] [Revised: 11/02/2023] [Accepted: 11/12/2023] [Indexed: 05/03/2024] Open
Abstract
The Philippine Mental Health Act upholds the rights and inclusivity of all people, regardless of gender and sexual orientation, within mental health services and programmes. Nevertheless, a noteworthy challenge lies in the inadequate attention given to the needs of LGBT+ individuals within the medical and health professions education in the country. Therefore, it is imperative to integrate LGBT+ mental health into psychiatric residency training. To address this gap, this paper proposes the inclusion of concepts relevant to LGBT+ mental health, including minority stress, intersectionality, identity concealment and LGBT+-affirming practices, to enhance the understanding and response to the needs of LGBT+ Filipinos.
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Affiliation(s)
- Rowalt Alibudbud
- Faculty member, Department of Sociology and Behavioral Sciences, College of Liberal Arts, De La Salle University, Manila, Philippines.
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3
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Clark KA, Schwartzman JM, Bettis AH. Sexual and gender minority stress and clinical symptom severity in psychiatrically hospitalized adolescents. Psychiatry Res 2024; 334:115838. [PMID: 38452497 DOI: 10.1016/j.psychres.2024.115838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 01/10/2024] [Accepted: 03/03/2024] [Indexed: 03/09/2024]
Abstract
This study examined the role of lifetime and past 30-day experiences of sexual and gender minority (SGM) stress on clinical symptom severity in 286 psychiatrically hospitalized adolescents. Participants completed measures of clinical symptoms, and SGM adolescents (n = 176, 61.5 %) reported on minority stress experiences across three domains (i.e., negative expectancies, internalized homonegativity, homonegative climate). SGM adolescents reported greater clinical symptom severity than non-SGM adolescents. Most SGM adolescents (77.3%) reported lifetime minority stress exposure, endorsing an average of 3.3 stressors (SD = 2.9). Among those endorsing lifetime minority stress history, 76.1% reported past 30-day minority stress exposure. Lifetime and recent minority stress exposure were positively associated with clinical symptom severity. Findings support the importance of assessing SGM identities and minority stress experiences in psychiatric settings and supporting youth in coping with these experiences.
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Affiliation(s)
- Kirsty A Clark
- Department of Medicine, Health, & Society, Vanderbilt University, United States
| | - Jessica M Schwartzman
- Department of Pediatrics, Keck School of Medicine of USC, United States; Division of Developmental-Behavioral Pediatrics, Children's Hospital Los Angeles, United States
| | - Alexandra H Bettis
- Department of Psychiatry & Behavioral Sciences, Vanderbilt University Medical Center, 1500 21st Avenue South, Suite 2200, Nashville 37212, United States.
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Clark KA, Argiros AP, Dougherty LR, Pachankis JE. Stigma and anxiety and depressive symptoms in parents of sexual and gender minority youth. JOURNAL OF FAMILY PSYCHOLOGY : JFP : JOURNAL OF THE DIVISION OF FAMILY PSYCHOLOGY OF THE AMERICAN PSYCHOLOGICAL ASSOCIATION (DIVISION 43) 2024; 38:201-211. [PMID: 38227468 PMCID: PMC10922310 DOI: 10.1037/fam0001183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2024]
Abstract
Parents of sexual and gender minority (SGM) youth play an important role in supporting their SGM child's mental health in the face of stigma. Yet, parents of SGM youth may themselves experience stigma, including discrimination/rejection, and its emotional consequences, including vicarious stigma and shame. The present cross-sectional study leveraged a national sample of parents of SGM youth to investigate associations between parents' stigma experiences and self-reported anxiety and depression symptoms. Further, we additionally explored sociodemographic and contextual correlates of parents' stigma experiences. Participants included 264 parents (Mage = 46) who reported having at least one SGM child under age 30 (Mage = 18). The Lesbian, Gay, Bisexual-Affiliate Stigma Measure (LGB-ASM) assessed parents' experiences of discrimination/rejection (e.g., actual and anticipated rejection experiences due to having an SGM child), vicarious stigma (e.g., worry and concern for one's SGM child), and shame (e.g., feeling embarrassed for having an SGM child). Parents indicated their anxiety and depressive symptoms using respective Patient-Reported Outcomes Measurement Information System-short forms. Results showed that vicarious stigma and shame, but not discrimination/rejection, were uniquely associated with parents' increased symptoms of anxiety (vicarious stigma: β = 1.59, p < .001; shame: β = 2.15, p < .001) and depression (vicarious stigma: β = 0.90, p < .01; shame: β = 2.77, p < .001). Further, parents with more accepting religious, racial, ethnic, and/or cultural communities reported lower stigma experiences. This study advances understanding of how the psychological consequences of stigma extend beyond SGM people themselves and contribute to mental health difficulties in parents of SGM youth. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Kirsty A Clark
- Department of Medicine, Health, and Society, Vanderbilt University
| | | | - Lea R Dougherty
- Department of Psychology, University of Maryland, College Park
| | - John E Pachankis
- Department of Social and Behavioral Sciences, Yale School of Public Health
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Boekeloo B, Fish J, Turpin R, Aparicio EM, Shin R, Vigorito MA, Lare SM, McGraw JS, King-Marshall E. LGBTQ+ cultural-competence training effectiveness: Mental health organization and therapist survey outcome results from a pilot randomized controlled trial. Clin Psychol Psychother 2023. [PMID: 37622344 DOI: 10.1002/cpp.2893] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 08/26/2023]
Abstract
Lesbian, gay, bisexual, transgender, queer/questioning and other sexual and gender diverse (LGBTQ+) persons frequently lack access to mental health service organizations (MHOs) and therapists who are competent with LGBTQ+ clients. Existing continuing education programmes to better equip therapists to work with LGBTQ+ clients are often not widely accessible or skills focused, evaluated for effectiveness and inclusive of MHO administrators who can address the organizational climate needed for therapist effectiveness. A virtual, face-to-face, multi-level (administrators and therapists) and multi-strategy (technical assistance, workshop and clinical consultations) LGBTQ+ cultural competence training-the Sexual and Gender Diversity Learning Community (SGDLC)-was tested in a pilot randomized controlled trial. Ten organizations were randomly assigned to the intervention (SGDLC plus free online videos) or control (free online videos only) group. Pretest/posttest Organization LGBTQ+ Climate Surveys (n = 10 MHOs) and pretest/posttest Therapist LGBTQ+ Competence Self-Assessments (n = 48 therapists) were administered. Results showed that at pretest, average ratings across organization LGBTQ+ climate survey items were low; twice as many items improved on average in the intervention (10/18 items) than control (5/18 items) group organizations. At pretest, therapist average scores (range 0-1) were highest for knowledge (0.88), followed by affirmative attitudes (0.81), practice self-efficacy (0.81), affirmative practices (0.75) and commitment to continued learning (0.69). Pretest/posttest change scores were higher for the intervention relative to the control group regarding therapist self-reported affirmative attitudes (cumulative ordinal ratio [OR] = 3.29; 95% confidence interval [CI] = 1.73, 6.26), practice self-efficacy (OR = 5.28, 95% CI = 2.00, 13.93) and affirmative practices (OR = 3.12, 95% CI = 1.18, 8.25). Average therapist and administrator satisfaction scores were high for the SGDLC. These findings suggest the SGDLC training can affect organizational- and therapist-level changes that may benefit LGBTQ+ clients.
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Affiliation(s)
- Bradley Boekeloo
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, Maryland, USA
| | - Jessica Fish
- Department of Family Science, School of Public Health, University of Maryland, College Park, Maryland, USA
| | - Rodman Turpin
- College of Public Health, Department of Global and Community Health, George Mason University, Fairfax, Virginia, USA
| | - Elizabeth M Aparicio
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, Maryland, USA
| | - Richard Shin
- Department of Counseling, Higher Education, and Special Education, University of Maryland, College Park, Maryland, USA
| | - Michael A Vigorito
- Vigorito Counseling and Consulting, LLC, Washington, District of Columbia, USA
| | - Sean M Lare
- Vigorito Counseling and Consulting, LLC, Washington, District of Columbia, USA
| | - James S McGraw
- Department of Psychology, Bowling Green State University, Bowling Green, Ohio, USA
| | - Evelyn King-Marshall
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, Maryland, USA
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Yu H, Flores DD, Bonett S, Bauermeister JA. LGBTQ + cultural competency training for health professionals: a systematic review. BMC MEDICAL EDUCATION 2023; 23:558. [PMID: 37559033 PMCID: PMC10410776 DOI: 10.1186/s12909-023-04373-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 05/17/2023] [Indexed: 08/11/2023]
Abstract
BACKGROUND Health disparities experienced by LGBTQ + individuals have been partially attributed to health professionals' lack of cultural competence to work with them. Cultural competence, the intricate integration of knowledge, skills, attitudes, and behaviors that improve cross-cultural communication and interpersonal relationships, has been used as a training framework to enhance interactions between LGBTQ + patients and health professionals. Despite multiple published LGBTQ + cultural competency trainings, there has been no quantitative appraisal and synthesis of them. This systematic review assessed articles evaluating the design and effectiveness of these trainings and examined the magnitude of their effect on cultural competence outcomes. METHODS Included studies quantitatively examined the effectiveness of LGBTQ + cultural competency trainings for health professionals across all disciplines in various healthcare settings. 2,069 citations were retrieved from five electronic databases with 44 articles meeting inclusion criteria. The risk of bias in the included studies was assessed by two authors utilizing the Joanna Briggs Institute critical appraisal checklists. Data extracted included study design, country/region, sample characteristic, training setting, theoretical framework, training topic, modality, duration, trainer, training target, measurement instrument, effect size and key findings. This review followed the PRISMA statement and checklist to ensure proper reporting. RESULTS 75% of the studies were published between 2017 and 2023. Four study designs were used: randomized controlled trial (n = 1), quasi-experimental pretest-posttest without control (n = 39), posttest only with control (n = 1) and posttest only without control (n = 3). Training modalities were multiple modalities with (n = 9) and without simulation (n = 25); single modality with simulation (n = 1); and with didactic lectures (n = 9). Trainings averaged 3.2 h. Ten studies employed LGBTQ + trainers. The training sessions resulted in statistically significant improvements in the following cultural competence constructs: (1) knowledge of LGBTQ + culture and health (n = 28, effect size range = 0.28 - 1.49), (2) skills to work with LGBTQ + clients (n = 8, effect size range = 0.12 - 1.12), (3) attitudes toward LGBTQ + individuals (n = 14, effect size range = 0.19 - 1.03), and (4) behaviors toward LGBTQ + affirming practices (n = 7, effect size range = 0.51 - 1.11). CONCLUSIONS The findings of this review highlight the potential of LGBTQ + cultural competency training to enhance cultural competence constructs, including (1) knowledge of LGBTQ + culture and health, (2) skills to work with LGBTQ + clients, (3) attitudes toward LGBTQ + individuals, and (4) behaviors toward LGBTQ + affirming practices, through an interdisciplinary and multi-modal approach. Despite the promising results of LGBTQ + cultural competency training in improving health professionals' cultural competence, there are limitations in study designs, sample sizes, theoretical framing, and the absence of longitudinal assessments and patient-reported outcomes, which call for more rigorous research. Moreover, the increasing number of state and federal policies that restrict LGBTQ + health services highlight the urgency of equipping health professionals with culturally responsive training. Organizations and health systems must prioritize organizational-level changes that support LGBTQ + inclusive practices to provide access to safe and affirming healthcare services for LGBTQ + individuals.
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Affiliation(s)
- Hyunmin Yu
- School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, PA 19104 USA
| | - Dalmacio Dennis Flores
- School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, PA 19104 USA
| | - Stephen Bonett
- School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, PA 19104 USA
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Clark KA, Hatzenbuehler ML, Bränström R, Pachankis JE. Sexual orientation-related patterns of 12-month course and severity of suicidality in a longitudinal, population-based cohort of young adults in Sweden. Soc Psychiatry Psychiatr Epidemiol 2022; 57:1931-1934. [PMID: 35829726 PMCID: PMC9378663 DOI: 10.1007/s00127-022-02326-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 06/20/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE We assessed sexual orientation-related patterns in the 1-year longitudinal course (i.e., onset, remittance, persistence) and severity of suicidality. METHOD Data were obtained from a prospective, population-based cohort representing nearly 2.4 million Swedish young adults. RESULTS A higher proportion of sexual minorities remitted (14.6%) compared to heterosexuals (9.5%). However, over twice as many sexual minorities (35.1%) experienced persistent suicidality as heterosexuals (15.0%). Plurisexual (e.g., bisexual, pansexual) young adults and sexual minorities aged 17-25 were at greatest risk for persistent and more severe suicidality. CONCLUSION Findings call for the identification of sexual orientation-related predictors of chronic suicidality to inform responsive clinical interventions.
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Affiliation(s)
- Kirsty A Clark
- Department of Medicine, Health and Society, Vanderbilt University, 2201 West End Ave, Nashville, TN, 37235, USA.
| | | | - Richard Bränström
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - John E Pachankis
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
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