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Jeon ME, Robison M, Robertson L, Udupa NS, Potter MR, Joiner TE. From identity-based distress to thinking "I am better off being dead:" Minority stress, posttraumatic cognitions, and suicidal ideation. J Affect Disord 2024; 354:143-151. [PMID: 38490586 DOI: 10.1016/j.jad.2024.03.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 02/18/2024] [Accepted: 03/09/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Suicidal ideation (SI) disproportionately impacts individuals with minoritized race/ethnicity, gender, and sexual orientation. Minority stress - i.e., traumatic, insidious distress that results from acts of discrimination - may lead to the formation of posttraumatic cognitions that may generalize to suicidal ideation, elevating SI risk in minoritized populations. The current study aimed to test this potential relationship by examining whether minority stress and posttraumatic cognitions accounted for the association between discrimination and SI. METHODS Series of structural equation models, including multigroup confirmatory factor analyses conducted to test invariance of latent constructs, were estimated on cross-sectional data collected from minoritized young adults (n = 337). RESULTS Results supported the hypothesized model: experience of discrimination indirectly associated with SI via correlations shared between minority stress and posttraumatic cognitions. Experiences of discrimination lacked a significant correlation with SI while accounting for minority stress and posttraumatic cognition variance. Invariance testing conducted to account for applicability of the model across race, ethnicity, sexual orientation, and plurality of minoritized identities all demonstrated that the model was applicable across these identity dimensions. LIMITATIONS Granular inspection of identity dimensions was infeasible due to sample size and causal inferences cannot be drawn given cross-sectional nature of the data used. CONCLUSIONS Posttraumatic cognitions within the context of discrimination may be effective treatment targets for minoritized individuals who present with minority stress and SI. Future studies should aim to replicate such findings longitudinally to infer temporality.
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Affiliation(s)
- Min Eun Jeon
- Department of Psychology, Florida State University, United States of America.
| | - Morgan Robison
- Department of Psychology, Florida State University, United States of America
| | - Lee Robertson
- Department of Psychology, Florida State University, United States of America
| | - Nikhila S Udupa
- Department of Psychology, Florida State University, United States of America
| | - Miracle R Potter
- Department of Psychology, Florida State University, United States of America
| | - Thomas E Joiner
- Department of Psychology, Florida State University, United States of America
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Fergerson AK, Caulfield NM, Dworkin ER, Capron DW. Sexual Assault History May Moderate Posttraumatic Cognition and Posttraumatic Stress Among Trauma-Exposed Sexual Minority Women. Behav Ther 2024; 55:431-442. [PMID: 38670659 DOI: 10.1016/j.beth.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 06/21/2023] [Accepted: 07/03/2023] [Indexed: 04/28/2024]
Abstract
Sexual minority women (SMW) are highly vulnerable to trauma exposure and posttraumatic stress disorder (PTSD) symptoms following trauma exposure. Negative posttraumatic cognitions (i.e., negative cognitions about self, world, and self-blame following trauma exposure) are hypothesized to exacerbate and maintain the relationship between trauma exposure and PTSD symptoms. Posttraumatic cognitions are particularly important to examine in relation to PTSD symptoms among trauma-exposed SMW given their elevated risk for trauma exposure and PTSD. It is also important to understand whether the strength of this relationship differs as a function of trauma type to elucidate potentially differential pathways for risk by trauma type in this population. The current study explored whether trauma type (sexual assault vs. nonsexual trauma) moderated the relationship between negative posttraumatic cognitions and PTSD symptom severity among a sample of trauma-exposed SMW. Participants were SMW (n = 516) users of an online survey platform, Prolific. Data were collected via 20-minute online survey. Results indicated that trauma type moderated the relationship between negative posttraumatic cognitions and PTSD symptom severity, such that the relationship was stronger among those who had experienced at least one sexual assault in their lifetime. Results suggest that negative posttraumatic cognitions may be more strongly related to PTSD symptom severity among SMW who have experienced at least one sexual assault. Notably, this difference was in magnitude only, as the posttraumatic cognition-PTSD symptom relationship remained significant among nonsexual trauma survivors. Negative posttraumatic cognitions may be an especially relevant treatment target among SMW survivors of sexual assault.
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Fergerson AK, Karnick A, Caulfield NM, Tennity CL, Capron DW. The Indirect Effects of Proximal Stressors Associated with Posttraumatic Stress Symptoms Severity among Sexually Victimized Sexual Minority Women: A Cross-Sectional Path Analysis. Violence Against Women 2024; 30:1517-1537. [PMID: 36744378 DOI: 10.1177/10778012231153362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Sexual minority women (SMW) are at risk for sexual victimization and stressors specifically related to their minority identity (e.g., discrimination). However, SMW experience posttraumatic stress disorder (PTSD) at rates beyond what may be explained by elevated risk for sexual victimization alone. This study aimed to examine the impact of stigma on PTSD symptoms among SMW survivors of sexual victimization. Results indicate that in relation to minority-specific distal stressors (i.e., heterosexist experiences), both minority-specific and general proximal stressors (i.e., internalized heterosexism, negative posttraumatic cognitions) indirectly affected PTSD symptom severity among this cross-sectional sample of sexually victimized SMW.
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Affiliation(s)
- Ava K Fergerson
- Department of Psychology, University of Southern Mississippi, Hattiesburg, MS 39406, USA
| | - Aleksandrs Karnick
- Department of Psychology, University of Southern Mississippi, Hattiesburg, MS 39406, USA
| | - Nicole M Caulfield
- Department of Psychology, University of Southern Mississippi, Hattiesburg, MS 39406, USA
| | - Cassidy L Tennity
- Department of Psychology, University of Southern Mississippi, Hattiesburg, MS 39406, USA
| | - Daniel W Capron
- Department of Psychology, University of Southern Mississippi, Hattiesburg, MS 39406, USA
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4
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Nguyen J, Anderson J, Pepping CA. A systematic review and research agenda of internalized sexual stigma in sexual minority individuals: Evidence from longitudinal and intervention studies. Clin Psychol Rev 2024; 108:102376. [PMID: 38218122 DOI: 10.1016/j.cpr.2023.102376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 10/07/2023] [Accepted: 12/21/2023] [Indexed: 01/15/2024]
Abstract
Internalized sexual stigma is a well-established risk factor for poor mental health among sexual minority individuals. However, there has been no synthesis of the literature pertaining to risk and protective factors that influence the development of internalized sexual stigma over time. This systematic review presents findings from 31 studies addressing this question (n = 9192); 23 studies examined psychosocial and sociodemographic predictors of internalized sexual stigma among sexual minority individuals, and eight studies tested the effects of psychological interventions on internalized sexual stigma. Longitudinal studies highlight the stability of internalized sexual stigma over time, and the role of stigma and discrimination, proximal minority stressors (e.g., outness, concealment), and psychological factors (e.g., depressive and anxious symptoms, coping styles, and demoralization) in predicting subsequent internalized sexual stigma. Demographic factors appear to play only a limited role in predicting subsequent internalized sexual stigma. Finally, most intervention studies found no significant effects in reducing internalized sexual stigma, with three exceptions finding significant intervention effects among young sexual minority individuals. We conclude by outlining a theory-driven model of internalized stigma and a research agenda to test more nuanced models of internalized stigma that include multifactorial risk indices.
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Affiliation(s)
- Josh Nguyen
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Joel Anderson
- Australian Research Centre in Sex, Health, and Society, La Trobe University, Melbourne, Australia; Institute for Positive Psychology and Education, Australian Catholic University, Melbourne, Australia
| | - Christopher A Pepping
- School of Applied Psychology, Griffith University, Brisbane, Australia; Department of Psychology, Counselling and Therapy, La Trobe University, Melbourne, Australia.
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Kilimnik CD, García-Ramírez G, Salamanca NK, Mazzone GM, Mullican KN, Davis KC, Orchowski LM, Leone RM, Kaysen D, Gilmore AK. Associations among sexual assault, posttraumatic stress, drinking to cope with anxiety, and alcohol use based on gender identity and sexual orientation. Alcohol Clin Exp Res (Hoboken) 2023; 47:2169-2183. [PMID: 38226754 DOI: 10.1111/acer.15194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 09/11/2023] [Accepted: 09/13/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND Sexual assault (SA) is experienced by a substantial proportion of emerging adult college students and is associated with elevated rates of posttraumatic stress disorder (PTSD) and alcohol use. This study examines the mediating role of posttraumatic stress symptoms (PTSS) in the associations among SA severity, drinking to cope with anxiety, and average weekly drinks while considering the moderating roles of gender identity and sexual orientation. METHODS A total of 2160 college students who were diverse in gender (cisgender women, 64.4%; cisgender men, 30.6%, and transgender and gender diverse [TGD] individuals = 4.9%) and sexual orientation (heterosexual = 68.0%, LGBQ+ = 32.0%) completed measures of SA severity, PTSS, drinking to cope with anxiety motives, and average weekly drinks. RESULTS The mediation model for the full sample indicated significant indirect effects of SA severity on drinking to cope with anxiety through PTSS, but not on average weekly drinks. Moderation analyses revealed differential relationships between the variables based on both gender identity and sexual orientation. For instance, the association between SA severity and PTSS was stronger for cisgender women and TGD individuals than cisgender men, and for LGBQ+ individuals than heterosexual individuals. While the association between PTSS and average weekly drinks was only significant for cisgender men, the association between PTSS and drinking to cope with anxiety was significant for both cisgender men and women but not TGD individuals. Furthermore, the association between SA severity and drinking to cope with anxiety was stronger for cisgender women than cisgender men. CONCLUSIONS Findings from this study demonstrate sexual orientation and gender identity differences and similarities in the associations of SA severity, PTSS, drinking to cope with anxiety, and alcohol use. Results are discussed in relation to the self-medication hypothesis and tailoring interventions for diverse groups.
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Affiliation(s)
- Chelsea D Kilimnik
- Department of Psychology & Neuroscience and the Renée Crown Wellness Institute, University of Colorado Boulder, Colorado, Boulder, USA
| | - Grisel García-Ramírez
- Department of Health Policy & Behavioral Sciences, School of Public Health, Georgia State University, Georgia, Atlanta, USA
- The National Center for Sexual Violence Prevention, Mark Chaffin Center for Healthy Development, Georgia State University, Georgia, Atlanta, USA
| | - Nashalys K Salamanca
- The National Center for Sexual Violence Prevention, Mark Chaffin Center for Healthy Development, Georgia State University, Georgia, Atlanta, USA
- Department of Psychology, Georgia State University, Georgia, Atlanta, USA
| | | | - K Nicole Mullican
- Department of Health Policy & Behavioral Sciences, School of Public Health, Georgia State University, Georgia, Atlanta, USA
- The National Center for Sexual Violence Prevention, Mark Chaffin Center for Healthy Development, Georgia State University, Georgia, Atlanta, USA
| | - Kelly Cue Davis
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Lindsay M Orchowski
- Department of Psychiatry and Human Behavior, Brown University, Rhode Island, Providence, USA
| | - Ruschelle M Leone
- Department of Health Policy & Behavioral Sciences, School of Public Health, Georgia State University, Georgia, Atlanta, USA
- The National Center for Sexual Violence Prevention, Mark Chaffin Center for Healthy Development, Georgia State University, Georgia, Atlanta, USA
| | - Debra Kaysen
- Division of Public Mental Health and Population Sciences, Department of Psychiatry, Stanford University School of Medicine, California, Stanford, USA
| | - Amanda K Gilmore
- Department of Health Policy & Behavioral Sciences, School of Public Health, Georgia State University, Georgia, Atlanta, USA
- The National Center for Sexual Violence Prevention, Mark Chaffin Center for Healthy Development, Georgia State University, Georgia, Atlanta, USA
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Holmes SC, Zalewa D, Wetterneck CT, Haeny AM, Williams MT. Development of the oppression-based traumatic stress inventory: a novel and intersectional approach to measuring traumatic stress. Front Psychol 2023; 14:1232561. [PMID: 37941761 PMCID: PMC10629001 DOI: 10.3389/fpsyg.2023.1232561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 09/25/2023] [Indexed: 11/10/2023] Open
Abstract
There is a growing body of literature demonstrating that experiences of oppression (e.g., racism, sexism, heterosexism, poverty) are associated with posttraumatic stress disorder symptoms. Traditional trauma assessments do not assess experiences of oppression and it is therefore imperative to develop instruments that do. To assess oppression-based traumatic stress broadly, and in an intersectional manner, we have developed the oppression-based traumatic stress inventory (OBTSI). The OBTSI includes two parts. Part A comprises open-ended questions asking participants to describe experiences of oppression as well as a set of questions to determine whether Criterion A for PTSD is met. Part B assesses specific posttraumatic stress symptoms anchored to the previously described experiences of oppression and also asks participants to identify the various types of discrimination they have experienced (e.g., based on racial group, sex/gender, sexual orientation, etc.). Clients from a mental health clinic and an undergraduate sample responded to the OBTSI and other self-report measures of depression, anxiety, and traditional posttraumatic stress (N = 90). Preliminary analyses demonstrate strong internal consistency reliability for the overall symptom inventory (α = 0.97) as well as for the four symptom clusters of posttraumatic stress symptoms in the DSM-5 (α ranging from 0.86 to 0.94). In addition to providing descriptive information, we also assess the convergent validity between the OBTSI and measures of anxiety, depression, and traditional posttraumatic stress and examine the factor structure. This study provides preliminary evidence that the OBTSI is a reliable and valid method of assessing oppression-based traumatic stress symptoms.
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Affiliation(s)
- Samantha C. Holmes
- College of Staten Island, City University of New York, Staten Island, NY, United States
| | - Daniel Zalewa
- Behavioral Wellness Clinic, Tolland, CT, United States
| | | | - Angela M. Haeny
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, United States
| | - Monnica T. Williams
- Behavioral Wellness Clinic, Tolland, CT, United States
- School of Psychology, University of Ottawa, Ottawa, ON, Canada
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Salim SR, Bhuptani PH, Eshelman LR, LaPlena NM, Messman TL. Trauma-Related Shame Mediates the Associations Between Self-Blame, Bisexual Minority Stress, and Rape-Related PTSD Symptoms. J Interpers Violence 2023; 38:10259-10281. [PMID: 37232183 DOI: 10.1177/08862605231172487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Bisexual women experience higher rates of rape and post-traumatic stress disorder (PTSD) prevalence compared to heterosexual and lesbian women. In addition, bisexual women experience unique antibisexual stigma and minority stress, which are associated with post-trauma outcomes. The aim of the current study was to test trauma-related shame as a mechanism in the relations of self-blame and bisexual minority stress (i.e., antibisexual stigma and internalized binegativity) with rape-related PTSD symptom. The sample consisted of 192 cisgender bisexual women (ages 18-35 years) who reported an experience of rape since the age of 18. Results from path analysis conducted in Mplus indicated that trauma-related shame mediated the link between self-blame and rape-related PTSD severity, as well as the links from antibisexual stigma and internalized binegativity to rape-related PTSD severity. There was also an indirect serial effect from antibisexual stigma to internalized binegativity to shame to PTSD severity. Thus, findings highlight the mechanistic role of trauma-related shame in rape-related PTSD symptoms. We identified two risk pathways: (a) general/universal risk from self-blame about rape and shame to PTSD severity and (b) group-specific risk from bisexual minority stress and shame to PTSD severity. Results indicate that reducing trauma-related shame may be an important target to improve post-rape outcomes. Finally, stigma associated with rape and sexual violence as well as antibisexual stigma must be eradicated to improve post-trauma outcomes among bisexual survivors.
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8
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Scheer JR, Clark KA, McConocha E, Wang K, Pachankis JE. Toward Cognitive-Behavioral Therapy for Sexual Minority Women: Voices From Stakeholders and Community Members. Cogn Behav Pract 2023; 30:471-494. [PMID: 37547128 PMCID: PMC10403251 DOI: 10.1016/j.cbpra.2022.02.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Sexual minority women (SMW) experience an elevated risk of mental health problems compared to heterosexual women. However, knowledge gaps remain regarding whether cognitive-behavioral therapy (CBT) interventions meet SMW's mental health needs. Further, virtually no studies have integrated stakeholder (i.e., researchers with content expertise in SMW's health and clinical providers who work with SMW) and community member (i.e., SMW) perspectives to identify CBT approaches that address SMW-specific issues. This study used qualitative data gathered from 39 SMW who reported depression, anxiety, suicidality, and heavy drinking in the past 3 months and 16 content experts and clinical providers to obtain information relevant to enhancing CBT for SMW. In addition, we used thematic analysis to identify themes related to the adaptation and delivery of CBT for SMW. Building on prior literature, this study's findings revealed seven considerations for delivering mental health services to SMW: (1) attending to SMW's diverse gender identities and expressions; (2) focusing on SMW's nonbinary stressors; (3) formulating SMW's gender-based stressors within a feminist framework; (4) applying intersectionality frameworks; (5) incorporating issues of diversity, multiculturalism, and social justice; (6) addressing the role of trauma exposure; and (7) addressing the role of alcohol use in SMW's lives. These considerations are reviewed in terms of their implications for clinical practice, with a focus on enhancing applications of existing CBT interventions, to best respond to the unique needs of this population.
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Scheer JR, Helminen EC, Cascalheira CJ, Jaipuriyar V, Shaw TJ, Zabelski S, Behari K, Pirog S, Batchelder AW, Possemato K, Hughes TL, Sullivan TP. Probable PTSD, PTSD symptom severity, and comorbid PTSD and hazardous drinking among sexual minority women compared to heterosexual women: A meta-analysis. Clin Psychol Rev 2023; 102:102283. [PMID: 37150043 PMCID: PMC10205673 DOI: 10.1016/j.cpr.2023.102283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 01/24/2023] [Accepted: 04/20/2023] [Indexed: 05/09/2023]
Abstract
Posttraumatic stress disorder (PTSD) is more prevalent among sexual minority women (SMW) than among heterosexual women. PTSD risk varies among SMW, but no meta-analysis has clarified sexual identity-related disparities in probable PTSD among women or SMW's heterogeneity in PTSD risk. SMW are also at pronounced risk of comorbid PTSD and hazardous drinking (HD). However, the difference in comorbid PTSD/HD between SMW and heterosexual women is understudied. This meta-analysis aimed to provide a comprehensive understanding of differences between SMW and heterosexual women and among SMW across demographic characteristics. Peer-reviewed publications that were written in English and reported quantitative data on PTSD specific to SMW were included. Eligible publications (n = 45) were identified through a systematic search of 11 electronic databases, supplemented by a search of reference lists of relevant papers. We found that probable PTSD, PTSD symptom severity, and probable comorbid PTSD/HD are highly prevalent among SMW, with SMW of color, transgender and gender diverse people, and bi+ women (e.g., bisexual, pansexual, queer) being at greatest risk. These results emphasize the need to improve accurate assessment of trauma-related sequelae among SMW and to develop, disseminate, and implement culturally sensitive treatments to reduce PTSD and comorbid PTSD/HD among at-risk SMW.
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Affiliation(s)
- Jillian R Scheer
- Department of Psychology, Syracuse University, 414 Huntington Hall, Syracuse, NY 13244, USA.
| | - Emily C Helminen
- Department of Psychology, Syracuse University, 414 Huntington Hall, Syracuse, NY 13244, USA; College of Health Science and Technology, Rochester Institute of Technology, USA
| | - Cory J Cascalheira
- Department of Psychology, Syracuse University, 414 Huntington Hall, Syracuse, NY 13244, USA; Department of Counseling & Educational Psychology, New Mexico State University, Las Cruces, NM, USA
| | - Virinca Jaipuriyar
- Department of Psychology, Syracuse University, 414 Huntington Hall, Syracuse, NY 13244, USA
| | - Thomas J Shaw
- Department of Psychology, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
| | - Sasha Zabelski
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Kriti Behari
- Department of Psychology, Syracuse University, 414 Huntington Hall, Syracuse, NY 13244, USA
| | - Sophia Pirog
- Department of Psychology, Syracuse University, 414 Huntington Hall, Syracuse, NY 13244, USA
| | - Abigail W Batchelder
- Harvard Medical School, Harvard University, Boston, MA, USA; Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Kyle Possemato
- VA Center for Integrated Healthcare, Syracuse Veterans Affairs Medical Center, Syracuse, NY, USA
| | - Tonda L Hughes
- School of Nursing and Department of Psychiatry, Columbia University, New York, NY, USA; Columbia University School of Nursing Center for Sexual and Gender Minority Research, New York, NY, USA
| | - Tami P Sullivan
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
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Landes SJ, Jaffe AE, McBain SA, Feinstein BA, Rhew IC, Kaysen DL. Prospective Predictors of Work Limitations in Young Adult Lesbian and Bisexual Women: An Examination of Minority Stress, Trauma Exposure, and Mental Health. Stigma Health 2023; 8:232-242. [PMID: 38516361 PMCID: PMC10956643 DOI: 10.1037/sah0000292] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
Trauma exposure and mental health problems adversely affect work functioning. Sexual minority women are at increased risk for trauma exposure, depression, and PTSD. Sexual minority women also experience unique stressors related to their sexual orientation, which can directly impact work functioning. However, little research to date has examined the impact of trauma exposure and mental health problems among sexual minority women on their occupational outcomes. The goal of the current study was to examine whether trauma exposure, mental health problems, and minority stressors were associated with occupational functioning one year later in a large sample of young adult lesbian and bisexual women. The study utilized a subset of data (N = 304) from a larger longitudinal study on health risk behaviors among young adult lesbian and bisexual women. Results indicated that trauma exposure, posttraumatic stress, depression, and perceived heterosexism were each associated with subsequent work limitations, but after accounting for shared variance between predictors, only perceived heterosexism and depression were uniquely associated with subsequent work functioning. These findings highlight the roles of mental health and sexual orientation-related stress in the challenges that lesbian and bisexual women experience at work and point to a need for additional research to better understand risk and protective factors related to negative employment outcomes among lesbian and bisexual women.
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Affiliation(s)
- Sara J. Landes
- Department of Psychiatry, University of Arkansas for Medical Sciences
- Behavioral Health QUERI, Central Arkansas Veterans Healthcare System
- South Central Mental Illness Research Education and Clinical Center (MIRECC), Central Arkansas Veterans Healthcare System
| | - Anna E. Jaffe
- Department of Psychiatry and Behavioral Sciences, University of Washington
- Department of Psychology, University of Nebrask-Lincoln
| | - Sacha A. McBain
- Department of Psychiatry, University of Arkansas for Medical Sciences
- South Central Mental Illness Research Education and Clinical Center (MIRECC), Central Arkansas Veterans Healthcare System
| | - Brian A. Feinstein
- Department of Psychology, Rosalind Franklin University of Medicine and Science
| | - Isaac C. Rhew
- Department of Psychiatry and Behavioral Sciences, University of Washington
| | - Debra L. Kaysen
- Department of Psychiatry and Behavioral Sciences, University of Washington
- Department of Psychiatry and Behavioral Sciences, Stanford University
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11
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Berke DS, Tuten MD, Smith AM, Hotchkiss M. A qualitative analysis of the context and characteristics of trauma exposure among sexual minority survivors: Implications for posttraumatic stress disorder assessment and clinical practice. Psychol Trauma 2023; 15:648-655. [PMID: 35254848 PMCID: PMC11075702 DOI: 10.1037/tra0001226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
OBJECTIVE Sexual minority individuals are exposed to traumatic harms unique to the shared cultural experience of living under conditions of identity-based stigma, discrimination, and marginalization. However, the context and characteristics by which this culture shapes traumatic experiences among sexual minority people are poorly specified in the research literature, leaving even well-intentioned mental health professionals inadequately prepared to treat sexual minority trauma survivors in a culturally affirming, tailored, and evidence-based manner. METHOD To begin to address this gap, we conducted a thematic analysis of descriptions of 52 Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) Criterion A (traumatic) events described by sexual minority participants during administration of the Clinician-Administered PTSD Scale for DSM-5. RESULTS Probing for identity relatedness of Criterion A trauma produced a rich and reliable (κ = .83-.86) coding scheme reflecting the cultural context and characteristics of these experiences. CONCLUSIONS Clinicians working with sexual minority and other marginalized trauma survivors should specifically assess for the role of culture in traumatic experiences to inform case conceptualization and treatment plans supporting recovery of the whole survivor. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Danielle S. Berke
- Department of Psychology, Hunter College, City University of New York
| | | | | | - Maiya Hotchkiss
- Department of Psychology, Hunter College, City University of New York
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Veldhuis CB, Juster RP, Corbeil T, Wall M, Poteat T, Hughes TL. Testing whether the combination of victimization and minority stressors exacerbate PTSD risks in a diverse community sample of sexual minority women. Psychol Sex 2022; 14:252-278. [PMID: 38549608 PMCID: PMC10978045 DOI: 10.1080/19419899.2022.2106147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 07/19/2022] [Indexed: 10/16/2022]
Abstract
Informed by minority stress and intersectionality frameworks, we examined: 1) associations of sexual identity and race/ethnicity with probable diagnosis of post-traumatic stress disorder (PTSD-PD) among sexual minority women (SMW; e.g., lesbian, bisexual); and 2) potential additive and interactive associations of minority stressors (discrimination, stigma consciousness, and internalized homonegativity) and potentially traumatic childhood and adulthood events (PTEs) with PTSD-PD. Data come from a large and diverse community sample of SMW (N = 662; age range: 18-82; M = 40.0, SD = 14.0). The sample included 35.8% Black, 23.4% Latinx, and 37.2% White participants. Logistic regressions tested associations of sexual identity and race/ethnicity, minority stressors, and PTEs with PTSD-PD. More than one-third of SMW (37.2%) had PTSD-PD with significantly higher prevalence among bisexual, particularly White bisexual women, than lesbian women. Discrimination, stigma consciousness, and internalized homonegativity were each associated with higher odds of PTSD-PD, but only internalized homonegativity was additively associated with PTSD-PD in mutually adjusted models above and beyond effects of PTEs. No evidence for interactive effects between PTEs and minority stressors was found. In a diverse community sample of sexual minority women, PTSD is strongly associated with potentially traumatic childhood events and with minority stressors above and beyond the associations with other potentially traumatic events and stressors in adulthood. Our findings suggest a strong need for therapists to address the effects of stigma and homophobia in treatment for PTSD, as these minority stressors likely maintain and exacerbate the effects of past traumas.
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Affiliation(s)
| | | | - Thomas Corbeil
- Mental Health Data Science, New York State Psychiatric Institute
| | - Melanie Wall
- Mental Health Data Science, New York State Psychiatric Institute
| | - Tonia Poteat
- Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill
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Estrada F, Jones IJ, Rivera D, Ramirez A, Cerezo A. Trauma and Latinx Sexual- and Gender-Minority Immigrants in the U.S. Curr Opin Psychol 2022; 47:101439. [DOI: 10.1016/j.copsyc.2022.101439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/14/2022] [Accepted: 07/19/2022] [Indexed: 11/16/2022]
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Abstract
Among sexual minorities, bisexual individuals experience higher rates of victimization and symptoms of PTSD than their lesbian and gay peers as well as heterosexual individuals. Despite these disparities, little work has examined factors contributing to PTSD symptoms among bisexual adults. The current study examined the associations between bisexual-specific minority stress and PTSD symptoms in a sample of adults with bisexual orientation and tested social support as a potential mediator of this association. Participants were 488 adults (378 cisgender women, 49 cisgender men, 61 transgender individuals), ages 18 to 66 years, with bisexual orientation based on identity and/or attraction to multiple genders. Greater anti-bisexual prejudice was associated with greater PTSD symptoms (β = 0.16) and lower social support (β = -.16), while accounting for sociodemographics and sexual identity-based victimization. Social support was associated with lower PTSD symptoms (β = -.25), while accounting for sociodemographics, sexual identity-based victimization, and anti-bisexual prejudice. Mediation analyses indicated that anti-bisexual prejudice was indirectly associated with greater PTSD symptoms through lower social support. Addressing bisexual-specific minority stress and its role in diminishing social support for bisexual individuals represents a critical component of trauma-informed research and intervention development in the bisexual community.
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Affiliation(s)
- Julie M Woulfe
- Syracuse University Barnes Center at the Arch, Syracuse, New York, USA
| | - Ethan H Mereish
- Department of Health studies, American University, Washington, DC, USA
| | - Sabra L Katz-Wise
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachussets, USA
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Kaysen D, Rhew IC, Bittinger J, Bedard-Gilligan M, Garberson LA, Hodge KA, Nguyen AJ, Logan DE, Dworkin ER, Lindgren K. Prevalence and Factor Structure of PTSD in DSM-5 Versus DSM-IV in a National Sample of Sexual Minority Women. J Interpers Violence 2021; 36:NP12388-NP12410. [PMID: 31833796 PMCID: PMC7292760 DOI: 10.1177/0886260519892960] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The impact of changes to posttraumatic stress disorder (PTSD) diagnostic criteria from Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) to Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) within diverse communities is unclear. Young adult sexual minority women are at high risk for interpersonal violence and other forms of trauma exposure compared with heterosexual populations and sexual minority men. They are also at heightened risk of PTSD. As a result, young adult sexual minority women are a key population of interest when examining the impact of diagnostic criteria changes. The goal of the current study was to evaluate the impact of changes to PTSD diagnostic criteria in sexual minority women. Using an online survey, we administered both the original PTSD Symptom Checklist-S (based on DSM-IV criteria) and a version adapted to assess DSM-5 criteria to a national, nonclinical sample of young adult sexual minority women (N = 767). The DSM-5 symptom criteria fit the data well in confirmatory factor analysis. Current PTSD prevalence was higher under the DSM-5 diagnostic algorithm compared with DSM-IV (18.6% vs. 22.9%; d = 0.15). Compared with DSM-IV, associations between PTSD and depression were stronger using DSM-5 criteria, whereas associations between PTSD and high-risk drinking were reduced. Findings suggest that changes to PTSD diagnostic criteria do not have a major impact on prevalence of PTSD among sexual minority women but may have some impact on observed comorbidities.
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Estrada F, Cerezo A, Ramirez A. An Examination of Posttraumatic Stress Disorder-Related Symptoms Among a Sample of Latinx Sexual- and Gender-Minority Immigrants. J Trauma Stress 2021; 34:967-976. [PMID: 34216504 DOI: 10.1002/jts.22714] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 04/03/2021] [Accepted: 05/11/2021] [Indexed: 11/06/2022]
Abstract
Latinx sexual- and gender- minority (SGM) immigrants experience stress across multiple axes of identity, which can lead to negative health consequences. Using an intersectional-cultural theory of stress, the current study sampled 194 Latinx SGM immigrants to examine the association between intersectional discrimination (i.e., race- and sexual orientation-based), acculturative stress, symptoms related to posttraumatic stress disorder (PTSD), and somatic distress. We used moderated hierarchical linear regression analysis to determine whether social support moderated the associations among intersectional discrimination, acculturative stress, and PTSD symptoms. The results showed that after controlling for time in the United States, PTSD symptoms were associated with intersectional discrimination, β = .57, SE = 3.14, p < .001, and acculturative stress, β = .42, SE = 2.47, p < .001, at higher levels of social support. The variability in outcome explained by the variables of interest was approximately 47%. These findings offer important and timely data that can inform future research and clinical applications in this underserved and understudied community.
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Affiliation(s)
- Fernando Estrada
- Department of Specialized Programs in Professional Psychology, Loyola Marymount University, Los Angeles, California, USA
| | - Alison Cerezo
- Department of Counseling, Clinical, and School Psychology, University of California Santa Barbara, Santa Barbara, California, USA
| | - Amaranta Ramirez
- Department of Counseling, Clinical, and School Psychology, University of California Santa Barbara, Santa Barbara, California, USA
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17
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Dworkin ER, Weaver TL. The impact of sociocultural contexts on mental health following sexual violence: A conceptual model. Psychol Violence 2021; 11:476-487. [PMID: 34631201 PMCID: PMC8494265 DOI: 10.1037/vio0000350] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Sexual violence has substantial mental health effects on survivors around the globe. Although there has been increasing attention to the ways that sociocultural environments can affect survivors' recovery, there has been no review to our knowledge of the specific factors within sociocultural environments that offer risk or protection, or the mechanisms by which these factors affect recovery. METHOD To address this gap, we present a conceptual model supported by a theoretical and empirical review that prioritizes research conducted with ethnic minority and global samples. RESULTS We identify three components of global sociocultural settings-norms, structures, and environmental stressors-that may affect mental health following sexual violence. We propose that these components may affect survivors' mental health by (1) influencing how survivors themselves, survivors' social contexts, and the systems with which survivors come into contact think about and respond to sexual violence, and (2) creating additional sources of stress, burden, or protection for survivors. CONCLUSIONS We argue that future research, practice, and policy could have a greater effect on survivors by attending to sociocultural factors in recovery.
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Abstract
ABSTRACT US women who report having experienced significant trauma at some point in their lives range from 50% to 90%. Yet posttraumatic stress disorder (PTSD) goes largely unrecognized in women. This article discusses ways to monitor, screen, and intervene for PTSD in women.
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Affiliation(s)
- Elizabeth Heavey
- Elizabeth Heavey is a professor of nursing and Graduate Program Director at State University of New York Brockport and certified nurse-midwife at the Hazen Center for Integrated Care, Brockport, N.Y
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19
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Jaffe AE, Duckworth J, Blayney JA, Lewis MA, Kaysen D. A Prospective Study of Predictors and Consequences of Hooking Up for Sexual Minority Women. Arch Sex Behav 2021; 50:1599-1612. [PMID: 33977424 PMCID: PMC8493811 DOI: 10.1007/s10508-020-01896-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 11/07/2020] [Accepted: 11/28/2020] [Indexed: 06/12/2023]
Abstract
Hooking up, which refers to a sexual encounter (ranging from kissing to penetrative sex) between individuals who are not in a committed relationship, is an increasingly normative form of sexual exploration among emerging adults. Past research has focused on hookups within a heteronormative context, and some of this work has examined hookups as a way to cope with distress. Building on this work, we examined the role of hookups as a means for lesbian and bisexual women to cope with minority stress through increasing connection and engagement with the LGBTQ (lesbian/gay/bisexual/transgender/queer or questioning) community. A nationally recruited sample of 520 lesbian and bisexual women ages 18 to 25 years completed questionnaires regarding their hookup behaviors as part of a longitudinal study. Childhood sexual abuse, posttraumatic stress symptoms, alcohol use, minority stress, and involvement and connectedness with the LGBTQ community were also assessed. First, regression analyses were used to examine baseline predictors of hookup behaviors reported at a 12-month follow-up. Findings revealed that alcohol use was associated with a greater likelihood of any subsequent hookups, and individuals reporting more minority stress subsequently hooked up with more partners. Second, hookup behaviors at 12 months were examined as predictors of outcomes at a 24-month follow-up, after controlling for baseline variables. Findings revealed that hookup behaviors were associated with reduced minority stress as well as increased involvement with and connectedness to the LGBTQ community, suggesting hookups may serve a protective function. Overall, findings support the notion that, for sexual minority women, hookups may operate as a means of coping and connection.
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Affiliation(s)
- Anna E Jaffe
- Department of Psychology, University of Nebraska-Lincoln, 238 Burnett Hall, Lincoln, NE, 68588, USA.
| | - Jennifer Duckworth
- Department of Human Development, Washington State University, Pullman, WA, USA
| | - Jessica A Blayney
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Melissa A Lewis
- Department of Health Behavior and Health Systems, School of Public Health, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Debra Kaysen
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
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20
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Tai YM, Chang FS, Chou HY, Yang SN. Depression, posttraumatic stress, and suicidal ideation: A linkage study in Taiwanese army. Taiwan J Psychiatry 2021. [DOI: 10.4103/tpsy.tpsy_36_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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21
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Pachankis JE, McConocha EM, Clark KA, Wang K, Behari K, Fetzner BK, Brisbin CD, Scheer JR, Lehavot K. A transdiagnostic minority stress intervention for gender diverse sexual minority women's depression, anxiety, and unhealthy alcohol use: A randomized controlled trial. J Consult Clin Psychol 2020; 88:613-630. [PMID: 32437174 PMCID: PMC7597069 DOI: 10.1037/ccp0000508] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To remedy the notable gap in evidence-based treatments for sexual minority women, this study tested the efficacy of a minority-stress-focused cognitive-behavioral treatment intended to improve this population's mental and behavioral health. METHOD The intervention, EQuIP (Empowering Queer Identities in Psychotherapy), was adapted from a transdiagnostic cognitive-behavioral treatment as also recently adapted for sexual minority men. Sexual minority women at risk of mental and behavioral health problems (n = 19) and expert providers with this population (n = 12) shaped the treatment's development, including by supporting its primary focus on universal and minority-stress-focused processes underlying this population's disproportionately poor mental and behavioral health. The resulting treatment was then delivered to young adult sexual minority women (n = 60; M age = 25.58; 41.67% racial/ethnic minority; 43.33% transgender/nonbinary) experiencing depression/anxiety and past 90-day heavy alcohol use. RESULTS Compared to waitlist (n = 30), participants randomized to immediately receive EQuIP (n = 30) experienced significantly reduced depression and anxiety (d = 0.85, 0.86, respectively); effects for alcohol use problems were smaller (d = 0.29) and marginally significant. In pre- to post-intervention pooled analyses, effect sizes for minority stress processes (mean d = .25) and universal risk factors (mean d = .48), through which the treatment was expected to work, were small and moderate, respectively, and in the expected direction. CONCLUSIONS This study provides initial support for a minority-stress-focused transdiagnostic cognitive-behavioral treatment for sexual minority women. These first results can launch exploration of other mechanisms and modalities through which to equip this population with evidence-based support. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
| | | | | | - Katie Wang
- Department of Social and Behavioral Sciences
| | | | | | | | | | - Keren Lehavot
- Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care
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22
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Livingston NA, Berke D, Scholl J, Ruben M, Shipherd JC. Addressing Diversity in PTSD Treatment: Clinical Considerations and Guidance for the Treatment of PTSD in LGBTQ Populations. ACTA ACUST UNITED AC 2020; 7:53-69. [PMID: 32421099 PMCID: PMC7223966 DOI: 10.1007/s40501-020-00204-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Purpose of review Trauma exposure is widespread but is especially common among lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals. LGBTQ individuals also experience higher rates of discrimination, victimization, and minority stress which can complicate posttraumatic stress disorder (PTSD) treatment but also represent independent intervention targets. In this review, we highlight existing evidence-based practices, current limitations, and provide recommendations for care in the absence of established guidelines for treatment PTSD among LGBTQ patients. Recent findings Trauma-focused therapies (e.g., CPT, PE) and medications (e.g., SSRIs, SNRIs) have shown benefit for people with PTSD. However, evaluations of these interventions have failed to examine the role of LGBTQ identities in recovery from trauma, and existing PTSD treatments do not account for ongoing threat to safety or the pervasive minority stress experienced by LGBTQ patients. In addition, many LGBTQ patients report negative experiences with healthcare, necessitating increased education and cultural awareness on the part of clinicians to provide patient-centered care and, potentially, corrective mental health treatment experiences. Summary Providers should routinely assess trauma exposure, PTSD, and minority stress among LGBTQ patients. We provide assessment and screening recommendations, outline current evidence-based treatments, and suggest strategies for integrating existing treatments to treat PTSD among LGBTQ patients.
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Affiliation(s)
- Nicholas A Livingston
- National Center for PTSD, Behavioral Science Division, Boston, MA USA.,2Department of Psychiatry, Boston University School of Medicine, Boston, MA USA.,3VA Boston Healthcare System, Boston, MA USA
| | - Danielle Berke
- 4Hunter College of the City University of New York, New York City, NY USA.,5The Graduate Center, City University of New York, New York City, NY USA
| | - James Scholl
- 2Department of Psychiatry, Boston University School of Medicine, Boston, MA USA.,3VA Boston Healthcare System, Boston, MA USA
| | - Mollie Ruben
- 6Department of Psychology, University of Maine, Orono, ME USA
| | - Jillian C Shipherd
- National Center for PTSD, Behavioral Science Division, Boston, MA USA.,National Center for PTSD, Women's Health Sciences Division, Boston, MA USA.,8Lesbian, Gay, Bisexual, and Transgender (LGBT) Health Program, Veterans Health Administration, Washington, DC USA
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23
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Scheer JR, Harney P, Esposito J, Woulfe JM. Self-Reported Mental and Physical Health Symptoms and Potentially Traumatic Events Among Lesbian, Gay, Bisexual, Transgender, and Queer Individuals: The Role of Shame. Psychol Violence 2020; 10:131-142. [PMID: 33062388 PMCID: PMC7556696 DOI: 10.1037/vio0000241] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals disproportionately face exposure to potentially traumatic events-adverse experiences that may have a traumatizing effect-and experience shame as a common consequence. Previous research demonstrates associations between shame and psychological and physical health issues among those with exposure to potentially traumatic events in general, with limited attention among LGBTQ individuals specifically. This study determined whether shame partially mediated the relationship between potentially traumatic events exposure and self-reported mental and physical health symptoms among LGBTQ individuals. METHOD Participants were 218 self-identified LGBTQ individuals who reported experiencing at least one potentially traumatic event (e.g., childhood sexual abuse). Online surveys assessed the type and frequency of potentially traumatic events exposure, shame, self-reported mental health (depression symptoms, posttraumatic stress disorder symptoms, and substance use), and physical health symptoms (sexual risk behavior, somatic symptoms, and chronic health conditions). RESULTS Greater potentially traumatic events exposure was associated with greater shame, and greater shame was associated with worse self-reported mental and physical health. Potentially traumatic events exposure had a direct effect on self-reported mental and physical health, and shame partially mediated this relationship. CONCLUSION Shame represents an important and modifiable factor that relates to poor health and may be amenable to change through psychosocial interventions. Given the prevalence of negative self-attribution stemming from potentially traumatic events exposure, in addition to the internalization of stigma among this population, practitioners need to uncover interventions specifically targeting shame when working with LGBTQ individuals.
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Affiliation(s)
| | | | - Jessica Esposito
- Brooklyn Campus of the Veterans Affairs New York Harbor Healthcare System, Brooklyn, New York
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24
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Newins AR, Wilson LC, Kanefsky R. Does sexual orientation moderate the relationship between posttraumatic cognitions and mental health outcomes following sexual assault? Psychology & Sexuality 2020. [DOI: 10.1080/19419899.2020.1729846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Amie R. Newins
- Department of Psychology, University of Central Florida, Orlando, FL, USA
| | - Laura C. Wilson
- Department of Psychological Science, University of Mary Washington, Fredericksburg, FL, USA
| | - Rebekah Kanefsky
- Department of Psychology, University of Central Florida, Orlando, FL, USA
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25
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Keating L, Muller RT. LGBTQ+ based discrimination is associated with ptsd symptoms, dissociation, emotion dysregulation, and attachment insecurity among LGBTQ+ adults who have experienced Trauma. J Trauma Dissociation 2020; 21:124-141. [PMID: 31581904 DOI: 10.1080/15299732.2019.1675222] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objectives: LGBTQ+ based discrimination is a form of insidious trauma and minority stress, and is associated with poor mental health. However, there is a dearth of research on the impact of discrimination on the psychological functioning of LGBTQ+ individuals who have experienced trauma. The current study seeks to remedy this gap. It was hypothesized that: (1) LGBTQ+ adults who perceived their experience of trauma as related to LGBTQ+ based discrimination would have greater attachment insecurity, emotion dysregulation, PTSD symptoms, and dissociative symptoms; (2) experiences of LGBTQ+ based discrimination would be associated with greater attachment insecurity, emotion dysregulation, PTSD symptoms, and dissociative symptoms; (3) transgender congruence (i.e., the extent to which one feels authentic and comfortable with their gender identity and appearance) would be negatively associated with attachment insecurity, emotion dysregulation, PTSD symptoms, and dissociative symptoms. Methods: Participants were 157 LGBTQ+ adults who had experienced trauma, and who completed questionnaires on discrimination and psychological functioning. Results: Compared to participants who did not experience their trauma as related to discrimination, those who did were higher in attachment anxiety, attachment avoidance, emotion dysregulation, PTSD, and dissociative symptoms. Biphobia was positively associated with attachment anxiety, emotion dysregulation, PTSD, and dissociative symptoms. Homophobia was positively associated with emotion dysregulation, PTSD, and dissociative symptoms. Transphobia was positively associated with PTSD and dissociative symptoms. Appearance congruence was negatively associated with emotion dysregulation, PTSD, and dissociative symptoms. Conclusions: When working with LGBTQ+ clients who have experienced trauma, clinicians should be mindful of the effects of discrimination on wellbeing.
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Affiliation(s)
- Leah Keating
- Department of Psychology, York University, Toronto, Ontario, Canada
| | - Robert T Muller
- Department of Psychology, York University, Toronto, Ontario, Canada
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