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Worrell S, Waling A, Anderson J, Lyons A, Pepping CA, Bourne A. 'It feels meaningful': How informal mental health caregivers in an LGBTQ community interpret their work and their role. Cult Health Sex 2023:1-16. [PMID: 37705445 DOI: 10.1080/13691058.2023.2256833] [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] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
Many members of lesbian, gay, bisexual, trans and gender diverse, and queer (LGBTQ) communities provide informal mental health support to peers. This type of support is valuable for people who receive it - even helping to prevent suicide. It is also meaningful to those who provide it. In this article, we focus on how LGBTQ people derive meaning from their experiences of supporting peers. In-depth interviews with 25 LGBTQ people in Melbourne, Australia, indicate that those providing informal mental health support to fellow community members recognise their roles as meaningful in three main ways: in terms of self, relationships and communities. Recognising the meanings that LGBTQ caregivers derive from helping fellow community members provides useful information service providers and policymakers seeking to better address mental distress in LGBTQ communities and support caregivers. It is useful to understand this meaningful work in an LGBTQ context as caregiving that challenges gendered and heteronormative assumptions about what care is, and who provides it.
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Affiliation(s)
- Shane Worrell
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
| | - Andrea Waling
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
| | - Joel Anderson
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
| | - Anthony Lyons
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
| | | | - Adam Bourne
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
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Worrell S, Waling A, Anderson J, Lyons A, Fairchild J, Bourne A. Coping with the stress of providing mental health-related informal support to peers in an LGBTQ context. Cult Health Sex 2022:1-16. [PMID: 36074892 DOI: 10.1080/13691058.2022.2115140] [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] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 08/16/2022] [Indexed: 06/15/2023]
Abstract
Many lesbian, gay, bisexual, trans or gender diverse, or queer-identifying (LGBTQ) people provide informal support to peers experiencing mental ill health. This reflects both the high prevalence of mental ill health in their communities - often a product of discrimination - and barriers to accessing formal services. In this article, we explore how LGBTQ people who help peers with their mental health seek to cope with the stress of providing such support. Drawing on interviews with 25 LGBTQ people in Melbourne, Australia, we consider how community members being 'leant on' engage in self-care practices and seek help from their communities to cope with the stress of their support roles. We demonstrate that participants' ways of coping, even when similar, can vary in effectiveness and often come with limitations. Thus, we conclude that LGBTQ people providing informal support to peers should be better assisted to do so, in ways that acknowledge the diversity of support provided in LGBTQ communities.
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Affiliation(s)
- Shane Worrell
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
| | - Andrea Waling
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
| | - Joel Anderson
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
| | - Anthony Lyons
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
| | - Jackson Fairchild
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
| | - Adam Bourne
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
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Worrell S, Waling A, Anderson J, Lyons A, Pepping CA, Bourne A. The Nature and Impact of Informal Mental Health Support in an LGBTQ Context: Exploring Peer Roles and Their Challenges. Sex Res Social Policy 2022; 19:1586-1597. [PMID: 35003381 PMCID: PMC8724749 DOI: 10.1007/s13178-021-00681-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/20/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Research shows that LGBTQ communities experience high levels of suicidality and mental ill health. They also face significant barriers to accessing adequate mental health treatment in service settings. In response to these factors, it is likely that LGBTQ community members turn to their peers for informal mental health-related support. Such support, however, is largely undefined, the extent of it poorly understood and its impacts on those who perform it underexplored. METHODS We explored the nature and impact of informal mental health-related support provided by peers in LGBTQ communities in Melbourne, Australia. Drawing on semi-structured in-depth interviews with 25 LGBTQ adults in 2020, we explored how and why peers provided mental health support to friends, partners, housemates and even strangers and the impact this had on them. RESULTS We found that participants performed support roles as extensions of their existing relationships. We demonstrate that the support roles of the safe friend, housemate and partner, among others, represent everyday relationships stretched-even to breaking point-to incorporate informal mental health support. Each of these support roles is distinct, but they can all potentially result in similar impacts on those performing them. One of the more significant of these is burnout. CONCLUSIONS LGBTQ community members face a diverse range of challenges when they support peers with their mental health. Informal peer-support roles are a significant responsibility for those performing them. LGBTQ community members stepping up to support others should be better supported to help manage their roles and the impacts of performing them. POLICY IMPLICATIONS Findings can contribute to policy that not only addresses high levels of mental ill health in LGBTQ communities, but also seeks to help peers in support roles to prevent them from being negatively impacted.
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Affiliation(s)
- Shane Worrell
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
| | - Andrea Waling
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
| | - Joel Anderson
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
| | - Anthony Lyons
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
| | | | - Adam Bourne
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
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Goodman J, Worrell S, Cheng A, Yuan C, Seethamraju K. P396Tranexamic acid effectively inhibits fibrinolysis in the presence of anticoagulant and antiplatelet medications. Europace 2018. [DOI: 10.1093/europace/euy015.207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- J Goodman
- Medtronic, Inc, Minneapolis, United States of America
| | - S Worrell
- Medtronic, Inc, Minneapolis, United States of America
| | - A Cheng
- Medtronic, Inc, Minneapolis, United States of America
| | - C Yuan
- Medtronic, Inc, Minneapolis, United States of America
| | - K Seethamraju
- Medtronic, Inc, Minneapolis, United States of America
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O’Donovan J, Proctor A, Gutierrez J, Worrell S, Nally J, Marques P, Brady C, McElroy M, Sammin D, Buxton D, Maley S, Bassett H, Markey B. Distribution of Lesions in Fetal Brains Following Experimental Infection of Pregnant Sheep With Toxoplasma gondii. Vet Pathol 2011; 49:462-9. [DOI: 10.1177/0300985811424732] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Six ovine fetal brains were harvested 33 to 35 days postchallenge from 5 ewes, each of which was given 3000 Toxoplasma gondii oocysts on day 90 of pregnancy. Histopathologic examination of transverse sections taken at 13 levels in the fetal brains revealed the presence of toxoplasmosis-related lesions in all 6 brains. However, lesions were not randomly distributed ( P = .007); they were most numerous at the level of the optic tract, the rostral margin of the pons, and 4 mm caudal to the ansate sulcus and were absent in all sections at the level of the caudal cerebellum. Lesion distribution may be due to hemodynamic factors, differences in the expression of endothelial surface receptor molecules at the level of the blood-brain barrier, or the presence of localized permissive/inhibitory factors within the brain. The results have implications for the selection of areas of brain from aborted ovine fetuses to be examined histopathologically for laboratory diagnosis.
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Affiliation(s)
- J. O’Donovan
- Regional Veterinary Laboratory, Department of Agriculture, Fisheries, and Food, Athlone, Ireland
| | - A. Proctor
- School of Agriculture, Food Science and Veterinary Medicine, University College Dublin, Dublin, Ireland
| | - J. Gutierrez
- School of Agriculture, Food Science and Veterinary Medicine, University College Dublin, Dublin, Ireland
| | - S. Worrell
- School of Agriculture, Food Science and Veterinary Medicine, University College Dublin, Dublin, Ireland
| | - J. Nally
- School of Agriculture, Food Science and Veterinary Medicine, University College Dublin, Dublin, Ireland
| | - P. Marques
- School of Agriculture, Food Science and Veterinary Medicine, University College Dublin, Dublin, Ireland
| | - C. Brady
- Central Veterinary Research Laboratory, Department of Agriculture, Fisheries, and Food, Celbridge, Ireland
| | - M. McElroy
- Central Veterinary Research Laboratory, Department of Agriculture, Fisheries, and Food, Celbridge, Ireland
| | - D. Sammin
- Central Veterinary Research Laboratory, Department of Agriculture, Fisheries, and Food, Celbridge, Ireland
| | - D. Buxton
- Moredun Research Institute, Pentland Science Park, Edinburgh, Scotland
| | - S. Maley
- Moredun Research Institute, Pentland Science Park, Edinburgh, Scotland
| | - H. Bassett
- School of Agriculture, Food Science and Veterinary Medicine, University College Dublin, Dublin, Ireland
| | - B. Markey
- School of Agriculture, Food Science and Veterinary Medicine, University College Dublin, Dublin, Ireland
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Nagurney J, Moselewski F, Nichols J, Brown D, Marill K, Peak D, Harris N, Swap C, Worrell S, Halpern E, Hoffmann U. Impact of Multi-detector Computerized Axial Tomography Scan of the Coronary Arteries on the Decision to Admit Emergency Department Patients with Chest Pain and Inconclusive Emergency Department Evaluations for Acute Coronary Syndrome. Acad Emerg Med 2007. [DOI: 10.1197/j.aem.2007.03.1046] [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: 11/10/2022]
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Hardy G, Worrell S, Hayes P, Barnett CM, Glass D, Pido-Lopez J, Imami N, Aspinall R, Dutton J, Gazzard B, Peters AM, Gotch FM. Evidence of thymic reconstitution after highly active antiretroviral therapy in HIV-1 infection. HIV Med 2004; 5:67-73. [PMID: 15012644 DOI: 10.1111/j.1468-1293.2004.00187.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES We aimed to provide evidence of thymic reconstitution after highly active antiretroviral therapy (HAART) in HIV-1 infected patients and to correlate this with the restoration of peripheral naïve T cells. METHODS Positron emission tomography (PET) enables definitive evidence of thymic activity, indicating functional potential. In this case study, a single patient who initiated HAART demonstrated reconstitution of the naïve T-cell pool and underwent thymic PET scans at baseline and 2 and 6 months following initiation of therapy. Two patients who failed to demonstrate such reconstitution acted as controls. These patients (mean age 27 years) had chronic HIV infection with low CD4 T-cell counts (mean 82, range 9-160 cells/microL blood). Increased function of the thymus visualized by PET was correlated with phenotypic changes in CD4 and CD8 T cells in the periphery measured by flow cytometry, and with numbers of recent thymic emigrants measured by quantification of the numbers of T-cell receptor excision circles (TRECs) in peripheral cells. RESULTS In one patient, clear correlations could be drawn between visible activity within the thymus, as measured by increased [F18]fluorodeoxyglucose (FDG) uptake, and regeneration of naïve CD4 (CD45RA/CD62L) T cells, increased numbers of CD4 T cells, controlled viraemia and increased numbers of recent thymic emigrants. A second patient displayed no increase in peripheral CD4 count and no increase in thymic activity. The third patient elected to stop therapy following the 2-month time point. CONCLUSIONS The use of PET suggests that thymic activity may increase after HAART, indicating that the thymus has the potential to be functional even in HIV-1 infected persons with low CD4 T-cell counts.
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Affiliation(s)
- G Hardy
- Department of Immunology, Imperial College London, Chelsea and Westminster Hospital, London, UK.
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Worrell S, Deayton J, Hayes P, Emery VC, Gotch F, Gazzard B, Larsson-Sciard EL. Molecular correlates in AIDS patients following antiretroviral therapy: diversified T-cell receptor repertoires and in vivo control of cytomegalovirus replication. HIV Med 2001; 2:11-9. [PMID: 11737371 DOI: 10.1046/j.1468-1293.2001.00044.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To evaluate whether successful, long-term immune reconstitution in vivo can be achieved in end-stage AIDS patients following antiretroviral therapy (ART). METHODS A 1-year prospective study of changes of CD4+ and CD8+ T-cell surface phenotypes, T-cell receptor (TCR) repertoires and capacity to control in vivo replication of cytomegalovirus (CMV) was performed in five treatment-naive end-stage AIDS patients (median CD4+ T-cell counts of 19 cells/microL) following therapy. Proportions of CD45RA+, CD45RO+ and CD28+ cells within the CD4+ and CD8+ subsets, were determined by flow cytometry. Changes in TCR Vbeta repertoires within the CD4+ and CD8+ T-cell compartments were evaluated using CDR3 spectratyping. CMV replication was determined by a sensitive polymerase chain reaction (PCR) assay using whole blood. RESULTS Following ART, proportionate increases in 'naive' (CD45RA+) and 'memory' (CD45RO+) T cells were observed within both CD4+ and CD8+ T-cell subsets, while increased numbers of CD28+ T cells were mainly observed within the CD4+ subset. Diversification of CD4+ and CD8+ TCR repertoires was established concomitantly with renewed in vivo control of CMV replication. CONCLUSIONS An important degree of molecular and functional immune recovery is possible in end-stage AIDS patients introduced to therapy. Diversification of TCR repertoires and the in vivo restoration of immunocompetence to control opportunistic infections clearly show that an important degree of molecular immune reconstitution is established following the initiation of ART even in late-stage AIDS.
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Affiliation(s)
- S Worrell
- Department of Immunology and The Kobler Centre, Chelsea, UK
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Worrell S, Hardy G, Hayes P, Aspinal R, Barnett C, Dutton J, Gotch F, Gazzard B. 021 Assessment of thymic activity by positron emission tomography in HIV patients on HAART. HIV Med 2000. [DOI: 10.1046/j.1468-1293.2000.00024-41.x] [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: 11/20/2022]
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Mitchell SM, Membrey WL, Youle MS, Obi A, Worrell S, Gazzard BG. Cytomegalovirus retinitis after the initiation of highly active antiretroviral therapy: a 2 year prospective study. Br J Ophthalmol 1999; 83:652-5. [PMID: 10340970 PMCID: PMC1723070 DOI: 10.1136/bjo.83.6.652] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND/AIMS There have been several recent reports suggesting that the natural history of cytomegalovirus retinitis (CMVR) has been significantly modified with the development of highly active antiretroviral therapy (HAART). This 2 year prospective cohort study assesses the effect of HAART on the incidence and progression of CMV retinitis in patients with CD4 cell counts below 50 cells x10(6)/l. METHODS 63 patients, with CD4 cell counts below 50 cells x10(6)/l, who were recruited to a 2 year prospective cohort study at the commencement of combination antiretroviral therapy including the use of the proteinase inhibitor, indinavir, were reported. The response to HAART was assessed in terms of a rise in the CD4 cell count and fall in HIV viral load. An experienced ophthalmologist performed dilated funduscopy at the time of recruitment and thereafter at 2 weekly intervals and retinal photography was performed at monthly intervals in patients with CMVR. The activity and progression of CMV retinitis was assessed on the basis of the characteristic clinical and photographic findings. RESULTS 34 patients achieved at least 50 CD4 cells x10(6)/l at 3 months after initiation of therapy. New diagnoses of CMVR were seen only in the non-responder group (p=0. 085). Overall, the relative risk of a new retinitis event in this group was 3.52 (95% CI 1.16, 10.68) at 3 months compared with those patients who were responsive to HAART. 12 of the 63 patients had previous CMVR. Disease progression was associated with non-response to therapy (p=0.182 exact). In patients with CMVR the median time to first progression was 18 days (95% CI 8, 91) in non-responders and 121 days (95% CI 0.59, 3.65) in responders. By the end of the 2 year follow up period all surviving patients had >50 CD4 cells x10(6)/l. No CMV events were seen after 8 months of therapy in either group of patients. CONCLUSIONS These findings suggest that significant clinical immunorestoration to CMV occurs in response to HAART in patients with CMVR after a lag time of 3-8 months. Initially, a rise in CD4 count is predictive of CMVR response but after the lag period all survivors appear to have developed a clinical immunorestoration to CMV. If HAART is commenced in at risk patients before the development of CMVR the incidence of new disease falls significantly.
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Affiliation(s)
- S M Mitchell
- Department of Ophthalmology, St Stephen's Centre, Chelsea and Westminster Hospital, London
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