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Grady A, Stinchcombe A. The impact of COVID-19 on the mental health of older sexual minority Canadians in the CLSA. BMC Geriatr 2023; 23:816. [PMID: 38062412 PMCID: PMC10704833 DOI: 10.1186/s12877-023-04513-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 11/23/2023] [Indexed: 12/18/2023] Open
Abstract
PURPOSE Limited research has examined the mental health impacts of the COVID-19 pandemic on sexual minority (i.e., lesbian, gay, bisexual; LGB) older adults using a longitudinal approach. This study aimed to compare the mental health trajectories (i.e., reported symptoms of depression and loneliness) of LGB and heterosexual participants across four time points. METHODS Data were drawn from the Canadian Longitudinal Study on Aging (CLSA), an ongoing study on the experiences of adults between 45 to 85 at Baseline. Data included for analysis were collected at Baseline (2011-2015), Follow-up 1 (2015-2018), and two time points during the COVID-19 pandemic (April-December 2020). We used General Estimating Equations (GEE) to model changes in depression symptoms (CESD-10; n = 47,728) and loneliness (UCLA 3-item loneliness scale; n = 41,698), adjusting for covariates (i.e., age, sex, race/ethnicity, education, and income). RESULTS Results indicated that LGB participants reported more symptoms of depression (B = .595, p < .001) and loneliness (B = .313, p < .001) in comparison to heterosexual peers across the four time points. Mean depression and loneliness scores increased regardless of sexual orientation. CONCLUSION This study highlighted the detrimental effects of the pandemic on the mental health of older adults regardless of sexual orientation. It also showed that LGB older adults experienced more loneliness and depression symptoms than heterosexual older adults both before and during the pandemic. Understanding diverse identities, needs, and disparities in mental health is critical to promoting equitable aging experiences for everyone.
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Affiliation(s)
- Alexandra Grady
- School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Arne Stinchcombe
- School of Psychology, University of Ottawa, Ottawa, ON, Canada.
- Bruyère Research Institute (BRI), Ottawa, ON, Canada.
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Yang W, Craig SL, Ross LE, Anderson JAE, Muntaner C. Impact of Neighborhood Deprivation on Aging Sexual Minority People's Depression: Results from the CANUE and CLSA data. Arch Gerontol Geriatr 2023; 112:105013. [PMID: 37058815 DOI: 10.1016/j.archger.2023.105013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 03/28/2023] [Accepted: 03/30/2023] [Indexed: 04/03/2023]
Abstract
As the aging population grows across the world, exploring the impact of social environment on minority populations' aging and well-being would be an essential step towards building an inclusive society. Using the Canadian Longitudinal Study on Aging (CLSA) and Canadian Urban Environmental Health Research Consortium (CANUE) data, the study investigated the relationship between deprivation and depression level in aging sexual minority people to examine how neighborhood level social and material deprivation influence mental health. 48,792 survey respondents were included in our analyses and the average age was 62.9. The study had 47,792 heterosexual, 760 gay/lesbian, and 240 bisexual individuals (23,977 men and 24,815 women). Regression analyses were conducted while controlling for age in each model. Results revealed that neighborhood material deprivation has a significant impact on mental health outcomes of aging lesbian women and bisexual men. The study provides an opportunity for intervention considerations for materially deprived neighborhoods to serve the aging sexual minority people residing in such areas.
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Affiliation(s)
- Wook Yang
- Rongxiang Xu College of Health and Human Services, California State University, Los Angeles, 5151 State University Drive, Los Angeles, California, USA 90032.
| | - Shelley L Craig
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, Ontario, Canada M5S 1V4
| | - Lori E Ross
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario, Canada M5T 3M7
| | - John A E Anderson
- Department of Cognitive Science, Carleton University, 2202A Dunton Tower, 1125 Colonel By Drive, Ottawa, Ontario, Canada K1S 5B6
| | - Carles Muntaner
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario, Canada M5T 3M7; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Toronto, Ontario, Canada M5T 3M7
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3
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Primeau CA, Philpott HT, Vader K, Unger J, Le CY, Birmingham TB, MacDermid JC. Students' attitudes, beliefs and perceptions surrounding 2SLGBTQIA + health education and inclusiveness in Canadian physiotherapy programs. BMC Public Health 2023; 23:1661. [PMID: 37644532 PMCID: PMC10466852 DOI: 10.1186/s12889-023-16554-2] [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] [Received: 07/30/2022] [Accepted: 08/17/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Patients who identify as 2SLGBTQIA + report negative experiences with physiotherapy. The objectives were to evaluate student attitudes, beliefs and perceptions related to 2SLGBTQIA + health education and working with individuals who identify as 2SLGBTQIA + in entry-level physiotherapy programs in Canada and to evaluate physiotherapy program inclusiveness towards 2SLGBTQIA + persons. METHODS We completed a nationwide, cross-sectional survey of physiotherapy students from Canadian institutions. We recruited students via email and social media from August-December 2021. Frequency results are presented with percentages. Logistic regression models (odds ratios [OR], 95%CI) were used to evaluate associations between demographics and training hours with feelings of preparedness and perceived program 2SLGBTQIA + inclusiveness. RESULTS We obtained 150 survey responses (mean age = 25 years [range = 20 to 37]) from students where 35 (23%) self-identified as 2SLGBTQIA + . While most students (≥ 95%) showed positive attitudes towards working with 2SLGBTQIA + patients, only 20 students (13%) believed their physiotherapy program provided sufficient knowledge about 2SLGBTQIA + health and inclusiveness. Students believed more 2SLGBTQIA + training is needed (n = 137; 92%), believed training should be mandatory (n = 141; 94%) and were willing to engage in more training (n = 138; 92%). Around half believed their physiotherapy program (n = 80, 54%) and clinical placements (n = 75, 50%) were 2SLGBTQIA + -inclusive and their program instructors (n = 69, 46%) and clinical instructors (n = 47, 31%) used sex/gender-inclusive language. Discrimination towards 2SLGBTQIA + persons was witnessed 56 times by students and most (n = 136; 91%) reported at least one barrier to confronting these behaviours. Older students (OR = 0.89 [0.79 to 0.99]), individuals assigned female at birth (OR = 0.34 [0.15 to 0.77]), and students self-identifying as 2SLGBTQIA + (OR = 0.38 [0.15 to 0.94]) were less likely to believe their program was 2SLGBTQIA + inclusive. Older students (OR = 0.85 [0.76 to 0.94]) and 2SLGBTQIA + students (OR = 0.42 [0.23 to 0.76]) felt the same about their placements. Students who reported > 10 h of 2SLGBTQIA + training were more likely to believe their program was inclusive (OR = 3.18 [1.66 to 6.09]). CONCLUSIONS Entry-level physiotherapy students in Canada show positive attitudes towards working with 2SLGBTQIA + persons but believe exposure to 2SLGBTQIA + health and inclusiveness is insufficient in their physiotherapy programs. This suggests greater attention dedicated to 2SLGBTQIA + health would be valued.
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Affiliation(s)
- Codie A Primeau
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, ON, Canada.
- Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, Western University, London, ON, Canada.
- School of Health and Rehabilitation Sciences, Faculty of Health Sciences, Western University, London, ON, Canada.
- Bone and Joint Institute, Western University, London, ON, Canada.
| | - Holly T Philpott
- School of Health and Rehabilitation Sciences, Faculty of Health Sciences, Western University, London, ON, Canada
- Bone and Joint Institute, Western University, London, ON, Canada
| | - Kyle Vader
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
| | - Janelle Unger
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, ON, Canada
- School of Health and Rehabilitation Sciences, Faculty of Health Sciences, Western University, London, ON, Canada
| | - Christina Y Le
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Trevor B Birmingham
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, ON, Canada
- School of Health and Rehabilitation Sciences, Faculty of Health Sciences, Western University, London, ON, Canada
- Bone and Joint Institute, Western University, London, ON, Canada
| | - Joy C MacDermid
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, ON, Canada
- School of Health and Rehabilitation Sciences, Faculty of Health Sciences, Western University, London, ON, Canada
- Bone and Joint Institute, Western University, London, ON, Canada
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4
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Wu D, Zhong X, Deng R, Pan H, Gao Y, Lin B, Tang X, Dai J, Liang H, Huang A. Study on anxiety and depression of men who have sex with men: An application of group-based trajectory model. Front Psychol 2023; 13:857203. [PMID: 36660287 PMCID: PMC9842664 DOI: 10.3389/fpsyg.2022.857203] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 06/30/2022] [Indexed: 01/04/2023] Open
Abstract
The prevalence of anxiety and depression is high among men who have sex with men (MSM), but limited studies focus on their development trends. This study examined the prevalence and influencing factors of anxiety and depression in HIV-negative MSM. In this study, 711 subjects were followed up every 24 weeks for 96 weeks. A group-based trajectory model was used to identify different development trends and a logistic regression model was used to explore the influencing factors of different trajectories. Low, moderate, and high anxiety groups accounted for 32.56, 56.12, and 11.32%; and low and high depression groups accounted for 73.90 and 26.10%. High anxiety was associated with a lower education degree, little HIV-related knowledge, and other characteristics (more agreed that "HIV is a threat to me/my family," had high frequency of seeking sexual partners via the Internet, had a history of sexually transmitted disease (STD), and a sense of discrimination by doctors). High depression was associated with a lower education degree, little HIV-related knowledge, being bisexual and the following characteristics: they felt that HIV infection rate of MSM around them was high, and more agreed that "HIV is a threat to me/my family," had a high frequency of seeking sexual partners through the Internet and alcohol drinking, had a history of STD, and felt being discriminated against by doctors and others. There is heterogeneity in the development trends of anxiety and depression. We need to improve intervention in the mental health of MSM, especially those with high anxiety and depression development trends. Clinical Trial Registration [http://www.chictr.org.cn/showproj.aspx?proj=5716], identifier [ChiCTR-TRC-13003849].
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Affiliation(s)
- Dan Wu
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China,Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, China,Changzhou Center for Disease Control and Prevention, Changzhou, China
| | - Xiaoni Zhong
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China,Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, China,*Correspondence: Xiaoni Zhong,
| | - Ruibin Deng
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China,Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, China
| | - Hong Pan
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China,Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, China
| | - Yuwen Gao
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China,Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, China
| | - Bing Lin
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China,Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, China
| | - Xian Tang
- Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China,Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, China
| | - Jianghong Dai
- Department of Epidemiology and Health Statistics, School of Public Health, Xinjiang Medical University, Xinjiang, China
| | - Hao Liang
- Department of Epidemiology and Health Statistics, School of Public Health, Guangxi Medical University, Nanning, China
| | - Ailong Huang
- Key Laboratory of Molecular Biology, Ministry of Molecular Biology, Chongqing, China
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A Profile of Social Participation in a Nationally Representative Sample of Canadian Older Adults: Findings from the Canadian Longitudinal Study on Aging. Can J Aging 2022; 41:505-513. [PMID: 35899988 DOI: 10.1017/s0714980822000150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Social participation has tremendous implications for the physical and mental health of older adults. A growing body of Canadian literature has examined social participation among older adults, including frequency of participation; gender, age, and regional differences in participation; and associations with self-perceived health, loneliness, and life dissatisfaction. The current study adds to this important body of research, using a large, nationally representative sample of adults 45-85 years of age (Canadian Longitudinal Study on Aging [CLSA] baseline data [n = 51,338]), to examine nuanced characteristics associated with social participation (socio-demographics, social support, cognitive ability, mental health, physical conditions), frequency of participation, and the relationship between the aforementioned characteristics and frequency of participation. Findings indicated that compared with those who reported infrequent/no participation, more frequent participation was associated with greater social support, higher cognitive abilities, increased satisfaction with life, fewer depressive symptoms, reduced odds of self-reported mood and anxiety disorders, and fewer self-reported physical conditions. Findings highlight the importance of active social participation, and have important implications for the development and implementation of accessible community programs across Canada.
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6
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Feinstein BA, Katz BW, Benjamin I, Macaulay T, Dyar C, Morgan E. The Roles of Discrimination and Aging Concerns in the Mental Health of Sexual Minority Older Adults. LGBT Health 2022; 10:324-330. [DOI: 10.1089/lgbt.2022.0113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Brian A. Feinstein
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | - Benjamin W. Katz
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Isabel Benjamin
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | - Taylor Macaulay
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | - Christina Dyar
- College of Nursing, The Ohio State University, Columbus, Ohio, USA
| | - Ethan Morgan
- College of Nursing, The Ohio State University, Columbus, Ohio, USA
- Infectious Diseases Institute, and The Ohio State University, Columbus, Ohio, USA
- College of Public Health, The Ohio State University, Columbus, Ohio, USA
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7
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Kothari A, Peter N, Donelle L. Use of equity-informed social media COVID-19 risk communication tools: a scoping review protocol. BMJ Open 2022; 12:e061851. [PMID: 36307165 PMCID: PMC9620523 DOI: 10.1136/bmjopen-2022-061851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Health agencies and community organisations play a crucial role in disseminating information to the public about COVID-19 risks and events, providing instructions on how to change behaviour to mitigate those risks, motivating compliance with health directives and addressing false information. Social media platforms are a critical tool in risk communication, providing a medium for rapid transmission of messages as well as providing the opportunity for engagement and immediate feedback. Access to health information, services and support are especially important for marginalised and underserved ('equity-deserving') populations who are disproportionately affected by COVID-19. This scoping review aims to review the breadth and depth of the academic and grey literature on equity-informed social media risk communication tools to provide guidance on promising practices and principles for reaching equity-deserving populations through social media. METHODS AND ANALYSIS Arksey and O'Malley's (2005) framework guided the identification of the research question; identification and selection of relevant studies from electronic databases and hand-searches of discipline-specific journals; extraction and charting of the data; and collating and reporting of findings. The results of the screening process will be reported using the Preferred Reporting Items for Systematic Review and Meta-Analysis-Scoping Review guidelines. FINDINGS We will identify reported facilitators and barriers to the development of risk communications that target equity-deserving communities. We will also identify recommendations for equity-informed risk communication for COVID-19. ETHICS AND DISSEMINATION This study does not require ethics approval. We intend to disseminate the results through publication in an open-access peer-reviewed journal, conference presentations, lay summaries (eg, checklists) for health organisations and messages to be shared through social media.
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Affiliation(s)
- Anita Kothari
- School of Health Studies, Western University, London, Ontario, Canada
| | - Nedra Peter
- School of Health Studies, Western University, London, Ontario, Canada
| | - Lorie Donelle
- Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada
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Cosco TD, Randa C, Hopper S, Wagner KR, Pickering J, Best JR. Ageing and Mental Health in Canada: Perspectives from Law, Policy, and Longitudinal Research. JOURNAL OF POPULATION AGEING 2022; 15:863-878. [PMID: 35999953 PMCID: PMC9388363 DOI: 10.1007/s12062-022-09389-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 08/12/2022] [Indexed: 11/24/2022]
Abstract
Abstract
Canada is a relatively young, geographically-diverse country, with a larger proportion of the population aged over 65 than under 15. Increasing alongside the number of ageing Canadians is the number of older adults that live with mental health challenges. Across the life course, one in five Canadians will experience a mental health disorder with many more living with subclinical symptoms. For these individuals, their lived experience may be directly impacted by the contemporary laws and policies governing mental illness. Examining and reviewing the historical context of mental health and older adults, we provide insights into the evolving landscape of Canadian mental health law and policy, paternalistic roots in the infancy of the country, into modern foci on equity and diversity. Progressing in parallel to changes in mental health policy has been the advancement of mental health research, particularly through longitudinal studies of ageing. Although acting through different mechanisms, the evolution of Canadian mental health law, policy, and research has had, and continues to have, considerable impacts on the substantial proportion of Canadians living with mental health challenges.
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Affiliation(s)
- T. D. Cosco
- Gerontology Research Centre, Simon Fraser University, Vancouver, BC Canada
- Department of Gerontology, Simon Fraser University, Vancouver, BC Canada
- Oxford Institute of Population Ageing, University of Oxford, Oxford, UK
| | - C. Randa
- Department of Gerontology, Simon Fraser University, Vancouver, BC Canada
| | - S. Hopper
- Department of Gerontology, Simon Fraser University, Vancouver, BC Canada
| | - K. R. Wagner
- Department of Government and International Relations, University of Sydney, Sydney, NSW Australia
| | - J. Pickering
- Gerontology Research Centre, Simon Fraser University, Vancouver, BC Canada
- Department of Gerontology, Simon Fraser University, Vancouver, BC Canada
| | - J. R. Best
- Gerontology Research Centre, Simon Fraser University, Vancouver, BC Canada
- Department of Gerontology, Simon Fraser University, Vancouver, BC Canada
- Department of Psychiatry, University of British Columbia, Vancouver, BC Canada
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Abstract
OBJECTIVES The purpose of this study was to explore the impacts of sexual stigma experiences on the mental health of older gay and bisexual men in Portugal. METHODS Self-identified older gay and bisexual men (n = 210) between 50 and 80 years old (mean age = 60.03; SD = 6.33) participated in this study. Measurement instruments included a sociodemographic questionnaire, the Brief Symptom Inventory-18, measures of suicidal ideation and intention, and the Sexual Stigma Scale. RESULTS Older gay and bisexual men with higher levels of sexual stigma presented significantly higher anxiety, depression, somatization, and suicidal ideation scores. Correlational analyses showed significant correlations among mental health variables and sexual stigma variables. Regression analyses showed that sexual stigma explained 11% of anxiety symptoms, 10% of depression symptoms, and 9% of somatization symptoms. DISCUSSION Sexual stigma has a negative impact on older gay and bisexual men's mental health. Mental health professionals should be aware of how sexual stigma affects sexual minority men's quality of life and work toward the reduction/elimination of sexual stigma in society.
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Affiliation(s)
- Henrique Pereira
- Department of Psychology and Education, Faculty of Social Sciences, University of Beira Interior, Covilhã, Portugal.,The Research Center in Sports Sciences, Health Sciences and Human Development (CIDESD), Vila Real, Portugal
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10
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Primeau CA, Vader K, Philpott HT, Xiong Y. A Need for Greater Emphasis on 2SLGBTQIA+ Health Among Physiotherapists in Canada. Physiother Can 2022; 74:117-120. [PMID: 37323717 PMCID: PMC10262744 DOI: 10.3138/ptc-2021-0107-gee] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 10/21/2021] [Indexed: 07/21/2023]
Affiliation(s)
- Codie A. Primeau
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
- School of Health and Rehabilitation Sciences, Faculty of Health Sciences, Western University, London, Ontario, Canada
- Bone and Joint Institute, Western University, London, Ontario, Canada
| | - Kyle Vader
- School of Rehabilitation Therapy, Queen’s University, Kingston, Ontario, Canada
| | - Holly T. Philpott
- School of Health and Rehabilitation Sciences, Faculty of Health Sciences, Western University, London, Ontario, Canada
- Bone and Joint Institute, Western University, London, Ontario, Canada
| | - Yijun Xiong
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
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11
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Primeau CA, Vader K, Philpott HT, Xiong Y. La nécessité d’insister davantage sur la santé LGBTQI2SA+ chez les physiothérapeutes au Canada. Physiother Can 2022. [DOI: 10.3138/ptc-2021-0107-gef] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Codie A. Primeau
- École de physiothérapie, faculté des sciences de la santé, Université Western, London, Ontario, Canada
- École des sciences de la santé et de la réadaptation, faculté des sciences de la santé, Université Western, London, Ontario, Canada
- Bone and Joint Institute, Université Western, London, Ontario, Canada
| | - Kyle Vader
- École de réadaptation, Université Queen’s, Kingston, Ontario, Canada
| | - Holly T. Philpott
- École des sciences de la santé et de la réadaptation, faculté des sciences de la santé, Université Western, London, Ontario, Canada
- Bone and Joint Institute, Université Western, London, Ontario, Canada
| | - Yijun Xiong
- École de physiothérapie, faculté des sciences de la santé, Université Western, London, Ontario, Canada
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12
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Flatt JD, Cicero EC, Kittle KR, Brennan-Ing M, Anderson JG, Wharton W, Hughes TL. Advancing Gerontological Health Research With Sexual and Gender Minorities Across the Globe. J Gerontol Nurs 2022; 48:13-20. [PMID: 35343840 PMCID: PMC9949509 DOI: 10.3928/00989134-20220304-03] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The current article presents results of a scoping review of international research on the health and health care needs of sexual and gender minority (SGM) older adults. Electronic databases and related resources were used to identify empirical and review studies published during the past 10 years. We reviewed 33 peer-reviewed articles from 19 countries. Findings were organized using the SGM Health Disparities Research Framework, which highlights factors at individual, interpersonal, community, and societal levels that impact health. Overall, historic and current environmental factors, including stigma, discrimination, and social exclusion, played an important role in SGM older adults' health, health care access, and use of related aging and social services. There is a critical need for training and future research, and health professionals are needed to advance gerontological health and health care research and improve the health and care of SGM older adults globally. [Journal of Gerontological Nursing, 48(4), 13-20.].
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Affiliation(s)
- Jason D. Flatt
- Department of Social and Behavioral Health, School of Public Health, University of Nevada Las Vegas, Las Vegas, Nevada
| | - Ethan C. Cicero
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | - Krystal R. Kittle
- Department of Social and Behavioral Health, School of Public Health, University of Nevada Las Vegas, Las Vegas, Nevada
| | - Mark Brennan-Ing
- Brookdale Center for Healthy Aging, Hunter College, The City University of New York, New York, New York
| | - Joel G. Anderson
- College of Nursing, University of Tennessee, Knoxville, Tennessee
| | - Whitney Wharton
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | - Tonda L. Hughes
- School of Nursing and Department of Psychiatry, Columbia University, New York, New York
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13
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LGBTQ+ Psychosocial Concerns in Nursing and Midwifery Education Programmes: Qualitative Findings from a Mixed-Methods Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111366. [PMID: 34769885 PMCID: PMC8582806 DOI: 10.3390/ijerph182111366] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 10/22/2021] [Accepted: 10/25/2021] [Indexed: 12/30/2022]
Abstract
LGBTQ+ people experience significant physical and psychosocial health issues and concerns, and encounter barriers when accessing healthcare services. We conducted a mixed-methods research study across all Schools of Nursing and Midwifery in the United Kingdom and Ireland using a survey and qualitative interviews. This was to identify the current content within nursing and midwifery pre-registration programmes in relation to LGBTQ+ health and to identity best practice and education innovation within these programmes. The survey was completed by 29 academics, with 12 selected to participate in a follow-up in-depth qualitative interview. Analysis of the data from the survey and interviews identified five themes: there is variable programme content; academics are developing their own programmes with no clear consistency; LGBTQ+ health is being linked to equality and diversity; there are barriers to education provision; and these is some evidence of best practice examples. The findings of the study support the need to develop and implement a curriculum for LGBTQ+ health in nursing and midwifery pre-registration programmes with learning aims and outcomes. Academics need support and tools to prepare and deliver LGBTQ+ health content to nurses and midwives as they ultimately have the potential to improve the experiences of LGBTQ+ people when accessing healthcare.
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How Do Non-Catastrophic Natural Disasters Impact Middle-Aged-to-Older Persons? Using Baseline Canadian Longitudinal Study on Aging Data to Explore Psychological Outcomes Associated with the 2013 Calgary Flood. Can J Aging 2021; 41:184-192. [PMID: 34431471 DOI: 10.1017/s0714980821000271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The objective of this study was to identify group-level health outcomes associated with the 2013 Calgary flood on Calgary participants (45-85 years of age) in the Canadian Longitudinal Study on Aging (CLSA). We compared baseline CLSA data collected on Calgary participants during the 6 months prior to and following the flood. Logistic regression models were created to explore whether select psychological outcomes were associated with the flood for participants categorized by evacuation status. Participants living in evacuated communities pre-flood had significantly lower levels of a diagnosed anxiety disorder than non-evacuated communities, which disappeared post-flood. Participants with higher household income were less likely to have post-traumatic stress disorder symptoms, worse self-rated mental health, and lower life satisfaction post-flood. Living alone reduced and female gender increased levels of perceived functional social support post-flood. Although natural disasters can shape research findings, the scope of the data being collected and the representativeness of impacted groups may challenge the ability to detect subtle impacts.
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Wilson K, Stinchcombe A, Regalado SM. LGBTQ+ Aging Research in Canada: A 30-Year Scoping Review of the Literature. Geriatrics (Basel) 2021; 6:geriatrics6020060. [PMID: 34204715 PMCID: PMC8293146 DOI: 10.3390/geriatrics6020060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/03/2021] [Accepted: 06/04/2021] [Indexed: 11/16/2022] Open
Abstract
Canada has a unique socio-political history concerning the inclusion of lesbian, gay, bisexual, transgender, and queer (LGBTQ+) people. With aging populations, understanding diverse groups of older adults is paramount. We completed a systematic search and scoping review of research in Canada to quantify and articulate the scale and scope of research on LGBTQ+ aging. Our search identified over 4000 results and, after screening for relevance, our review focused on 70 articles. Five major themes in the literature on LGBTQ+ aging in Canada were identified: (1) risk, (2) HIV, (3) stigma, and discrimination as barriers to care, (4) navigating care and identity, (5) documenting the history and changing policy landscapes. Most of the articles were not focused on the aging, yet the findings are relevant when considering the lived experiences of current older adults within LGBTQ+ communities. Advancing the evidence on LGBTQ+ aging involves improving the quality of life and aging experiences for LGBTQ+ older adults through research.
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Affiliation(s)
- Kimberley Wilson
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, ON N1G 2W1, Canada
- Correspondence: ; Tel.: +1-519-824-4120 (ext. 53003)
| | - Arne Stinchcombe
- Department of Recreation and Leisure Studies, Brock University, St. Catharines, ON L2S 3A1, Canada;
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16
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Davison KM, Hyland CE, West ML, Lin SL, Tong H, Kobayashi KM, Fuller-Thomson E. Post-traumatic stress disorder (PTSD) in mid-age and older adults differs by immigrant status and ethnicity, nutrition, and other determinants of health in the Canadian Longitudinal Study on Aging (CLSA). Soc Psychiatry Psychiatr Epidemiol 2021; 56:963-980. [PMID: 33533972 DOI: 10.1007/s00127-020-02003-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 11/25/2020] [Indexed: 01/09/2023]
Abstract
PURPOSE This study aimed to address knowledge gaps about post-traumatic stress disorder (PTSD) in mid-age and older adults, with particular attention to the relationship of PTSD with nutrition and with ethnicity and immigrant status. METHODS Binary logistic regression analysis of weighted comprehensive cohort data from the baseline Canadian Longitudinal Study on Aging (CLSA; n = 27,211) was conducted using the four-item Primary Care-PTSD tool (outcome) and immigrant status by ethnicity (Canadian-born white, Canadian-born minority, immigrant white, immigrant minority). Covariates included various social, economic, nutrition and health-related variables. RESULTS After controlling for socioeconomic and health variables, immigrants from minority groups had significantly higher odds of PTSD compared to their Canadian-born counterparts, whereas white immigrants had lower odds of PTSD. These relationships were significantly robust across seven cluster-based regression models. After adjusting for ethnicity/immigrant status, the odds of PTSD were higher among those earning lower household incomes, widowed, divorced, or separated respondents, ever smokers, and those who had multi-morbidities, chronic pain, high nutritional risk, or who reported daily consumptions of pastries, pulses and nuts, or chocolate. Conversely, those 55 years and over, who had high waist-to-height ratio, or who consumed 2-3 fiber sources daily had significantly lower odds of PTSD. CONCLUSION Interventions aimed at managing PTSD in mid-age and older adults should consider ethnicity, immigrant status, as well as socioeconomic, health, and nutrition status.
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Affiliation(s)
- Karen M Davison
- Faculty of Social Science, University of Hawaii, Honolulu, HI, USA.,Faculty of Science and Horticulture (Health Science), Kwantlen Polytechnic University, Surrey, BC, Canada
| | - Christina E Hyland
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Toronto, ON, M5S 1V4, Canada
| | - Meghan L West
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Toronto, ON, M5S 1V4, Canada
| | - Shen Lamson Lin
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Toronto, ON, M5S 1V4, Canada.,Institute for Life Course & Aging, University of Toronto, Toronto, ON, Canada
| | - Hongmei Tong
- Faculty of Health and Community Studies, MacEwan University, Edmonton, AB, Canada
| | - Karen M Kobayashi
- Faculty of Social Science, University of Victoria, Victoria, BC, Canada
| | - Esme Fuller-Thomson
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Toronto, ON, M5S 1V4, Canada. .,Institute for Life Course & Aging, University of Toronto, Toronto, ON, Canada.
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17
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Stinchcombe A, Hammond NG. Correlates of memory and executive function in mid-aged and older adults in the CLSA: A minority stress approach. J Gerontol B Psychol Sci Soc Sci 2021; 77:1105-1117. [PMID: 33964152 DOI: 10.1093/geronb/gbab084] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Maintaining cognitive function is an important component of healthy aging. There is increasing recognition that extraneous factors expedite the typical cognitive aging process. Risk factors for cognitive decline cluster around inequalities and disproportionally affect minority and vulnerable groups. Taking a minority stress approach, we examined the relationship between proxy measures of minority stress and cognitive health in a large sample of Canadians aged 45-85 years. METHODS Data were drawn from the baseline of the Canadian Longitudinal Study on Aging (CLSA), a prospective cohort study. Memory (n = 36,849) and executive function (n = 36,266) were assessed using standardized assessment tools. We ran multiple linear regression models with memory and executive function as the outcomes. Explanatory variables included known correlates of cognitive health (i.e., demographic, health, and cognitive reserve) and proxy measures of minority stress (i.e., sexual orientation, race, and perceived social standing). RESULTS Results were consistent with existing evidence showing that demographic and health variables were associated with cognitive performance. Modifiable health variables, walking and fruit/ vegetable consumption were associated with better cognitive performance, as were cognitive reserve and social support measures. Within the models, racial minority status was consistently associated with lower cognitive performance. As one's perceived social standing within their own community increased, so too did cognitive function. DISCUSSION These findings identify factors that may put people at risk for cognitive decline. There is a need to support the cognitive health of racialized Canadians and members of other disadvantaged groups, while promoting health equity.
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Affiliation(s)
- Arne Stinchcombe
- Department of Recreation and Leisure, Brock University, St. Catharines, Ontario, Canada
| | - Nicole G Hammond
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
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18
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Sivakumaran G, Margolis R. Self-Rated Health by Sexual Orientation Among Middle-Aged and Older Adults in Canada. J Gerontol B Psychol Sci Soc Sci 2021; 75:1747-1757. [PMID: 31120125 DOI: 10.1093/geronb/gbz067] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES This article examines patterns of self-rated physical and mental health by sexual orientation among middle-aged and older adults in Canada, a rapidly growing subpopulation shown to be at risk of poor health. METHOD We use the Canadian Community Health Survey (CCHS 2015-2016) to estimate logit models predicting fair/poor self-rated physical and mental health by sexual orientation among middle-aged and older adults, stratifying by sex and age group. RESULTS We find no differences in physical health for gay men and lesbian women compared with their heterosexual counterparts. However, middle-aged gay men are disadvantaged in terms of mental health, but not women. Bisexual women are disadvantaged in terms of physical health, and for mental health in some model specifications. Respondents who did not know their sexual orientation have poorer health across some measures of health and age groups. DISCUSSION Our findings add to the paucity of research on older sexual minorities in Canada. They highlight the importance of separating out sexual minority groups because bisexual women have distinct health profiles. In addition, this is the first study to examine the health of respondents who "do not know" their sexual orientation, and future research should distinguish between different explanations for their poor health.
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Affiliation(s)
- Gajan Sivakumaran
- Department of Sociology, University of Western Ontario, Social Science Center, London, Canada
| | - Rachel Margolis
- Department of Sociology, University of Western Ontario, Social Science Center, London, Canada
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19
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Lee M, Jenkins WD, Adjei Boakye E. Cancer screening utilization by residence and sexual orientation. Cancer Causes Control 2020; 31:951-964. [PMID: 32833199 DOI: 10.1007/s10552-020-01339-4] [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: 11/22/2019] [Accepted: 08/13/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE Although few studies have examined screening uptake among sexual minorities (lesbian, gay, bisexual, queer), almost none have examined it in the specific context of rural populations. Therefore, our objective was to assess how cancer screening utilization varies by residence and sexual orientation. METHODS Publicly available population-level data from the 2014 and 2016 Behavioral Risk Factor Surveillance System were utilized. Study outcomes included recommended recent receipt of breast, cervical, and colorectal cancer screening. Independent variables of interest were residence (rural/urban) and sexual orientation (heterosexual/gay or lesbian/bisexual). Weighted proportions and multivariable logistic regressions were used to assess the association between the independent variables and the outcomes, adjusting for demographic, socioeconomic, and healthcare utilization factors. RESULTS Rates for all three cancer screenings were lowest in rural areas and among sexual minority populations (cervical: rural lesbians at 64.8% vs. urban heterosexual at 84.6%; breast: rural lesbians at 66.8% vs. urban heterosexual at 80.0%; colorectal for males: rural bisexuals at 52.4% vs. urban bisexuals at 81.3%; and colorectal for females: rural heterosexuals at 67.2% vs. rural lesbians at 74.4%). In the multivariate analyses for colorectal screening, compared to urban heterosexual males, both rural gay and rural heterosexual males were less likely to receive screening (aOR = 0.45; 95% = 0.24-0.73 and aOR = 0.79; 95% = 0.72-0.87, respectively) as were rural heterosexual females (aOR = 0.87; 95% = 0.80-0.94) compared to urban heterosexual females. For cervical screening, lesbians were less likely to receive screening (aOR = 0.62; 95% = 0.41-0.94) than heterosexuals, and there were no differences for breast screening. CONCLUSION We found that rural sexual minorities may experience disparities in cancer screening utilization associated with the compounding barriers of rural residence and sexual minority status, after adjusting for demographic, socioeconomic, and healthcare utilization factors. Further work is needed to identify factors influencing these disparities and how they might be addressed.
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Affiliation(s)
- Minjee Lee
- Department of Population Science and Policy, Southern Illinois University School of Medicine, Springfield, IL, USA. .,Simons Cancer Institute, Southern Illinois University School of Medicine, Springfield, IL, USA.
| | - Wiley D Jenkins
- Department of Population Science and Policy, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Eric Adjei Boakye
- Department of Population Science and Policy, Southern Illinois University School of Medicine, Springfield, IL, USA.,Simons Cancer Institute, Southern Illinois University School of Medicine, Springfield, IL, USA
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20
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Stinchcombe A, Hammond NG, Wilson K. Differential Effects of Social Support by Sexual Orientation: A Study of Depression Symptoms Among Older Canadians in the CLSA. Res Aging 2020; 42:251-261. [DOI: 10.1177/0164027520923111] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
This study examined differences in symptoms of mental illness, specifically depression, by sexual orientation and examined the protective role of social support among lesbian, gay, and bisexual (LGB) older Canadians. Data were drawn from the Canadian Longitudinal Study on Aging, a national study of adults aged 45–85 years at baseline ( n = 46,157). We examined whether the effect of sexual orientation on depression symptoms was moderated by four types of social support: emotional/informational support, affectionate support, tangible support, and positive social interaction. LGB identification was associated with increased depression symptoms relative to heterosexual participants. After adjustment for covariates, bisexual identity remained a significant predictor of depression symptoms. Low emotional/informational social support was associated with increased depression symptoms, an effect that was most pronounced for lesbian and gay participants. The findings contribute to the growing body of research on the mental health of older LGB people.
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Affiliation(s)
- Arne Stinchcombe
- Department of Recreation and Leisure Studies, Brock University, St. Catharines, Ontario, Canada
| | - Nicole G. Hammond
- School of Epidemiology and Public Health, University of Ottawa, Ontario, Canada
| | - Kimberley Wilson
- Department of Family Relations and Applied Nutrition, University of Guelph, Ontario, Canada
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21
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Chubby, Hairy and Fearless. Subcultural Identities and Predictors of Self-Esteem in a Sample of Polish Members of Bear Community. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17124439. [PMID: 32575744 PMCID: PMC7344702 DOI: 10.3390/ijerph17124439] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 06/17/2020] [Accepted: 06/17/2020] [Indexed: 11/17/2022]
Abstract
Bear subculture exists within a larger gay community, which has been recognized by public health experts as disproportionately burdened with stigma and related health adversities. Bears are distinguished by a particular body look—body hirsuteness and heavy-set physique. Previous research documented the various health risks, and the exposure to both sexual minority and weight stigma, of this population. In this study we focused on the determinants of self-esteem in Bears. We explored the significance of such predictors as: perceived sexual minority and weight stigma, age, resilience, and physique as reflected by the BMI. Our sample consisted of 60 men from the Polish Bear community (i.e., Bears, Cubs, Otters, Wolves). Linear regression models were performed for the entire sample (N = 60) and for Bear-identified men (N = 31). Perceived sexual minority stigma negatively, and resilience positively, predicted self-esteem. In the case of Bear-identified men, age, perceived exposure to weight discrimination, and BMI were also significant predictors of self-esteem. Higher BMI in the case of Bear-identified men predicted higher self-esteem. Our results suggest that although Bear-identified men are characterized by their similarities to other gay men, subcultural identities create unique social contexts that are important for health and health interventions in this population.
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22
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Davison KM, Lung Y, Lin SL, Tong H, Kobayashi KM, Fuller-Thomson E. Psychological distress in older adults linked to immigrant status, dietary intake, and physical health conditions in the Canadian Longitudinal Study on Aging (CLSA). J Affect Disord 2020; 265:526-537. [PMID: 32090781 DOI: 10.1016/j.jad.2020.01.024] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 12/03/2019] [Accepted: 01/05/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Psychological distress increases mortality risk; there is little knowledge about its prevelance and contributory factors in older populations. METHODS Canadian Longitudinal Study on Aging baseline data (2010-2015) were analyzed to examine the relationship between Kessler's Psychological Distress Scale-K10 and immigrant status (recent/mid-term,<20 years; long-term, ≥20 years; Canadian-born). Covariates included socioeconomic and health-related variables. Stratified by sex, two series of multinomial logistic regression were used to calculate the likelihood of having mild distress (20 < K10 score ≤24) and moderate/severe distress (K10 score >24). RESULTS Respondents (n = 25,700) were mainly Canadian-born (82.8%), 45-65 years (59.3%), earning <C$100,000/year (58.2%), and had a post-secondary education (78.4%). For women, psychological distress was associated with being a recent/mid-term immigrant(OR=1.76, 99% CI 1.09-2.83), marital status (widowed/divorced/separated, OR=1.62, 99% CI 1.19-2.20), lower education level (<secondary school; OR = 1.95, 99% CI 1.32-2.88), lower intake of fruit and vegetable (≤ 2/day; OR=1.50, 99% CI 1.05-2.14), higher waist-to-height ratio (>cut-off; OR=1.32, 99% CI 1.02-1.70), and higher nutritional risk (ORs = 2.16-3.31, p's <0.001). For men, psychological distress was associated with under-nutrition (grip strength<cut-off, OR=1.57, 99% CI 1.14-2.16). For men and women, psychological distress was associated with age (>56 years, ORs=0.19-0.79, p's<0.01), lower income (≤C$149,000, ORs = 1.68-7.79, p's<0.01), multi-morbidities (ORs = 1.67-4.70, p's<0.01), chronic pain (ORs = 1.67-3.09, p's<0.001) and higher intake of chocolate (≥ 0.6 bar/week, ORs=1.61-2.23, p's<0.001). LIMITATIONS Cross-sectional design prohibits causal inferences. CONCLUSIONS Nutritional factors, immigration status, social, and health-related problems are strongly associated with psychological distress among midlife and older adults.
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Affiliation(s)
- Karen M Davison
- Kwantlen Polytechnic University, Canada; University of Hawai'i, USA.
| | - Yu Lung
- Factor-Inwentash Faculty of Social Work & Institute for Life Course and Aging, University of Toronto, 246 Bloor Street W, Toronto, Ontario M5S 1V4, Canada.
| | - Shen Lamson Lin
- Factor-Inwentash Faculty of Social Work & Institute for Life Course and Aging, University of Toronto, 246 Bloor Street W, Toronto, Ontario M5S 1V4, Canada.
| | | | | | - Esme Fuller-Thomson
- Factor-Inwentash Faculty of Social Work & Institute for Life Course and Aging, University of Toronto, 246 Bloor Street W, Toronto, Ontario M5S 1V4, Canada; Department of Family & Community Medicine and Faculty of Nursing, University of Toronto, Canada.
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23
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Gupta N, Sheng Z. Disparities in the hospital cost of cardiometabolic diseases among lesbian, gay, and bisexual Canadians: a population-based cohort study using linked data. Canadian Journal of Public Health 2020; 111:417-425. [PMID: 32112310 DOI: 10.17269/s41997-020-00296-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 02/03/2020] [Indexed: 01/29/2023]
Abstract
OBJECTIVES Sexual identity has been recognized as a social determinant of health; however, evidence is limited on sexual minority status as a possible contributor to inequalities in cardiometabolic outcomes and the related hospital burden. This study aimed to investigate the association between sexual identity and hospital costs for cardiometabolic diseases among a cohort of Canadians using linked survey and administrative data. METHODS Data from the 2007-2011 Canadian Community Health Survey were linked to acute-care inpatient records from the 2005/2006-2012/2013 Discharge Abstract Database. Multiple linear regression was used to assess the association between self-reported sexual identity and inpatient resource use for cardiometabolic diseases. RESULTS Among the population ages 18-59, 2.1% (95% CI 1.9-2.2) identified as lesbian, gay, or bisexual (LGB). LGB individuals more often reported having diabetes or heart disease compared with heterosexuals. The mean inflation-adjusted cost for cardiometabolic-related hospitalizations was found to be significantly higher among LGB patients (CAD$26,702; 95% CI 26,166-60,365) than among their heterosexual counterparts ($10,137; 95% CI 8,639-11,635), in part a reflection of longer hospital stays (13.6 days versus 5.1 days). Inpatient costs remained 54% (95% CI 8-119) higher among LGB patients after controlling for socio-demographics, health status, and health behaviours. CONCLUSION This study revealed a disproportionate cost for potentially avoidable hospitalizations for cardiometabolic conditions among LGB patients, suggesting important unmet healthcare needs even in the Canadian context of universal coverage.
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Affiliation(s)
- Neeru Gupta
- University of New Brunswick, 9 Macaulay Lane, PO Box 4400, Fredericton, New Brunswick, E3B 5A3, Canada.
| | - Zihao Sheng
- University of New Brunswick, 9 Macaulay Lane, PO Box 4400, Fredericton, New Brunswick, E3B 5A3, Canada
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Davison KM, Lin S(L, Tong H, Kobayashi KM, Mora-Almanza JG, Fuller-Thomson E. Nutritional Factors, Physical Health and Immigrant Status Are Associated with Anxiety Disorders among Middle-Aged and Older Adults: Findings from Baseline Data of The Canadian Longitudinal Study on Aging (CLSA). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17051493. [PMID: 32110904 PMCID: PMC7084187 DOI: 10.3390/ijerph17051493] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 02/18/2020] [Accepted: 02/18/2020] [Indexed: 12/18/2022]
Abstract
The main purpose of this study was to compare the lifetime prevalence of anxiety disorders among foreign-born and Canadian-born adults in middle and later life. Using baseline data of the Canadian Longitudinal Study on Aging (2010–2015), multivariable binary logistic regression was conducted to investigate anxiety diagnosis and immigrant status, while controlling for socio-economic, health-related, and nutrition covariates. Of 26,991 participants (49.3% men, 82.5% Canadian born, 58.5% aged 45–65 years), the overall prevalence of self-reported physician diagnosis of anxiety disorders was 8.5%, with immigrants being lower than Canadian-born respondents (6.4% vs. 9.3%, p < 0.001). After accounting for all covariates, the adjusted odds ratio (aOR) for anxiety disorders was lower among immigrants (aOR = 0.77, 95% CI: 0.67–0.88) compared to those who were Canadian born. Identified risk factors included: younger age (aORs = 1.79–3.52), being a woman (aOR = 1.25, 95% CI: 1.07–1.46), single status (aOR = 1.27, 95% CI: 1.09–1.48), lower income (aORs = 1.28–2.68), multi-morbidities (aORs = 2.73–5.13), chronic pain (aOR = 1.31, 95% CI: 1.18–1.44), lifetime smoking ≥ 100 cigarettes (aOR = 1.35, 95% CI: 1.23–1.48), BMI < 18.5 (aOR = 1.87, 95% CI: 1.20–2.92), body fat ≥ 26% (aORs = 1.28–1.79), fruit and vegetable intake (<3/day; aORs = 1.24–1.26), and pastry consumption (>1/day; aOR = 1.55, 95% CI: 1.12–1.15) (p < 0.05). Targeting socio-economic and nutritional risk factors may reduce the burden of anxiety disorders in middle and late adulthood.
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Affiliation(s)
- Karen M. Davison
- Health Science, Kwantlen Polytechnic University, Surrey, BC V3W 2M8, Canada;
- Department of Psychology, University of Hawai’i at Mānoa, Honolulu, HI 96822, USA
- Correspondence: ; Tel.: +1-604-300-0331
| | - Shen (Lamson) Lin
- Factor-Inwentash Faculty of Social Work and Institute for Life Course & Aging, University of Toronto, Toronto, ON M5S 1V4, Canada (E.F.-T.)
| | - Hongmei Tong
- Faculty of Health and Community Studies, MacEwan University; Edmonton, AB T5J 4S2, Canada;
| | - Karen M. Kobayashi
- Department of Sociology, University of Victoria; Victoria, BC V8W 2Y2, Canada;
| | | | - Esme Fuller-Thomson
- Factor-Inwentash Faculty of Social Work and Institute for Life Course & Aging, University of Toronto, Toronto, ON M5S 1V4, Canada (E.F.-T.)
- Department of Family & Community Medicine and Faculty of Nursing, University of Toronto, Toronto, ON M5G 1V7 & M5T 1P8, Canada
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25
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Javanbakht M, Shoptaw S, Ragsdale A, Brookmeyer R, Bolan R, Gorbach PM. Depressive symptoms and substance use: Changes overtime among a cohort of HIV-positive and HIV-negative MSM. Drug Alcohol Depend 2020; 207:107770. [PMID: 31841750 PMCID: PMC6981056 DOI: 10.1016/j.drugalcdep.2019.107770] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 11/19/2019] [Accepted: 11/20/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND The objective of this study was to examine depressive symptoms overtime and quantify the variance in symptoms attributable to substance use among a cohort of HIV-positive and HIV-negative men. METHODS Participants were enrolled in an NIH/NIDA funded cohort, with 534 men resulting in 1,888 visits between August 2014 and June 2018. Participants were between 18 and 45 years, and half were HIV-positive. At baseline and semi-annual visits, information was collected on depressive symptoms, sexual behaviors, and substance use. Changes overtime in symptom scores were evaluated using individual growth curve modeling. RESULTS The average CES-D20 score was 19.5 (SD = 12.7). Depressive symptoms were highest among daily/weekly methamphetamine users (56% vs. 39% occasional users and 27% non-users; p value<.01). Factors independently associated with depressive symptoms included methamphetamine use (adjusted OR = 1.5; 95% CI 1.1-2.3) and transactional sex (adjusted OR = 1.8; 95% CI 1.4-2.5). Based on growth curve modeling, methamphetamine was the most influential predictor of depressive symptoms, accounting for 10% of individual variance (p value<.01). Declines in depressive symptoms were noted for heavy users of a number of drugs, except for methamphetamine. For instance, those reporting daily/weekly heroin had a 3.38 point decline in CESD20 scores overtime (p value = 0.01). However, heavy methamphetamine users had much higher CESD20 scores and their scores remained high overtime (p value for change = 0.91). CONCLUSIONS The prevalence of depressive symptoms among this cohort of HIV-negative and HIV-positive MSM was high, especially among frequent methamphetamine users. These findings suggest that reducing methamphetamine use may have the potential to reduce depressive symptoms.
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Affiliation(s)
- Marjan Javanbakht
- UCLA Fielding School of Public Health, Department of Epidemiology, Los Angeles, CA, United States.
| | - Steven Shoptaw
- UCLA David Geffen School of Medicine, Department of Family Medicine, Los Angeles, CA
| | - Amy Ragsdale
- UCLA Fielding School of Public Health, Department of Epidemiology, Los Angeles, CA
| | - Ron Brookmeyer
- UCLA Fielding School of Public Health, Department of Biostatistics, Los Angeles, CA
| | | | - Pamina M. Gorbach
- UCLA Fielding School of Public Health, Department of Epidemiology, Los Angeles, CA
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26
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Davison KM, Lung Y, Lin SL, Tong H, Kobayashi KM, Fuller-Thomson E. Depression in middle and older adulthood: the role of immigration, nutrition, and other determinants of health in the Canadian longitudinal study on aging. BMC Psychiatry 2019; 19:329. [PMID: 31690283 PMCID: PMC6833158 DOI: 10.1186/s12888-019-2309-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 10/09/2019] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Little is known about depression in middle-aged and older Canadians and how it is affected by health determinants, particularly immigrant status. This study examined depression and socio-economic, health, immigration and nutrition-related factors in older adults. METHODS Using weighted comprehensive cohort data from the baseline Canadian Longitudinal Study on Aging (n = 27,162) of adults aged 45-85, gender-specific binary logistic regression was conducted with the cross-sectional data using the following variables: 1) Depression (outcome) measured using the Center for Epidemiologic Studies Short Depression (CESD-10) rating scale; 2) Immigration status: native-born, recent and mid-term (< 20 years), and long-term immigrants (≥20 years); and 3) covariates: socioeconomic status, physical health (e.g., multi-morbidity), health behavior (e.g., substance use), over-nutrition (e.g., anthropometrics), under-nutrition (e.g., nutrition risk), and dietary intake. RESULTS The sample respondents were mainly Canadian-born (82.6%), women (50.6%), 56-65 years (58.9%), earning between C$50,000-99,999 (33.2%), and in a relationship (69.4%). When compared to Canadian-born residents, recent, mid-term (< 20 years), and longer-term (≥ 20 years) immigrant women were more likely to report depression and this relationship was robust to adjustments for 32 covariates (adjusted ORs = 1.19, 2.54, respectively, p < 0.001). For women, not completing secondary school (OR = 1.23, p < 0.05), stage 1 hypertension (OR = 1.31, p < 0.001), chronic pain (OR = 1.79, p < 0.001), low fruit/vegetable intakes (OR = 1.33, p < 0.05), and fruit juice (OR = 1.80, p < 0.001), chocolate (ORs = 1.15-1.66, p's < 0.05), or salty snack (OR = 1.19, p < 0.05) consumption were associated with depression. For all participants, lower grip strength (OR = 1.25, p < 0.001) and high nutritional risk (OR = 2.24, p < 0.001) were associated with depression. For men, being in a relationship (OR = 0.62, p < 0.001), completing post-secondary education (OR = 0.82, p < 0.05), higher fat (ORs = 0.67-83, p's < 0.05) and omega-3 egg intake (OR = 0.86, p < 0.05) as well as moderate intakes of fruits/vegetables and calcium/high vitamin D sources (ORs = 0.71-0.743, p's < 0.05) predicted a lower likelihood of depression. For men, chronic conditions (ORs = 1.36-3.65, p's < 0.001), chronic pain (OR = 1.86, p < 0.001), smoking (OR = 1.17, p < 0.001), or chocolate consumption (ORs = 1.14-1.72, p's < 0.05) predicted a higher likelihood of depression. CONCLUSIONS The odds of developing depression were highest among immigrant women. Depression in middle-aged and older adults is also associated with socioeconomic, physical, and nutritional factors and the relationships differ by sex. These results provide insights for mental health interventions specific to adults aged 45-85.
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Affiliation(s)
- Karen M Davison
- Faculty of Social Science, University of Hawaii, Honolulu, Hawaii, USA
- Faculty of Science and Horticulture (Health Science), Kwantlen Polytechnic University, Surrey, British Columbia, Canada
| | - Yu Lung
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Shen Lamson Lin
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
- Institute for Life Course & Aging, University of Toronto, Toronto, Ontario, Canada
| | - Hongmei Tong
- Faculty of Health and Community Studies, MacEwan University, Edmonton, Alberta, Canada
| | - Karen M Kobayashi
- Faculty of Social Science, University of Victoria, Victoria, British Columbia, Canada
| | - Esme Fuller-Thomson
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada.
- Institute for Life Course & Aging, University of Toronto, Toronto, Ontario, Canada.
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Hammond NG, Stinchcombe A. Health Behaviors and Social Determinants of Migraine in a Canadian Population‐Based Sample of Adults Aged 45‐85 Years: Findings From the CLSA. Headache 2019; 59:1547-1564. [DOI: 10.1111/head.13610] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2019] [Indexed: 02/06/2023]
Affiliation(s)
| | - Arne Stinchcombe
- Department of Recreation and Leisure Brock University St. Catharines Canada
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28
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Ismail M, Hammond NG, Wilson K, Stinchcombe A. Canadians Who Care: Social Networks and Informal Caregiving Among Lesbian, Gay, and Bisexual Older Adults in the Canadian Longitudinal Study on Aging. Int J Aging Hum Dev 2019; 91:299-316. [PMID: 31353919 DOI: 10.1177/0091415019864603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Canada is experiencing population aging and evidence on the provision of care is based on data collected from majority populations. This analysis compared social networks and patterns of care provision between heterosexual and lesbian, gay, and bisexual (LGB) Canadians between the age of 45 and 85 years. Data were drawn from the Canadian Longitudinal Study on Aging (CLSA), a large national study of health and aging. The results from analysis of baseline data showed that LGB participants were less likely to have children and reported seeing their friends more recently than heterosexual participants. Gay and bisexual men were more likely to provide care support in comparison to heterosexual men. LGB participants were more likely to provide care to friends. The results highlight the importance of considering distinct social networks in the development of policy and practice approaches to support a diverse aging population.
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Affiliation(s)
- Mariam Ismail
- 636310064 Faculty of Human Sciences, Saint Paul University, Ottawa, Canada
| | | | - Kimberley Wilson
- 3653 Department of Family Relations and Applied Nutrition, University of Guelph, Canada
| | - Arne Stinchcombe
- 636310064 Faculty of Human Sciences, Saint Paul University, Ottawa, Canada.,School of Psychology, University of Ottawa, Canada.,Department of Recreation and Leisure Studies, Brock University, Canada
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29
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Goldhammer H, Krinsky L, Keuroghlian AS. Meeting the Behavioral Health Needs of LGBT Older Adults. J Am Geriatr Soc 2019; 67:1565-1570. [DOI: 10.1111/jgs.15974] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 04/08/2019] [Accepted: 04/11/2019] [Indexed: 01/08/2023]
Affiliation(s)
- Hilary Goldhammer
- National LGBT Health Education Center at The Fenway Institute, Fenway Health Boston Massachusetts
| | - Lisa Krinsky
- LGBT Aging Project at The Fenway Institute, Fenway Health Boston Massachusetts
| | - Alex S. Keuroghlian
- National LGBT Health Education Center at The Fenway Institute, Fenway Health Boston Massachusetts
- Department of Psychiatry Massachusetts General Hospital Boston Massachusetts
- Harvard Medical School Boston Massachusetts
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