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Pachankis JE, Soulliard ZA, Seager van Dyk I, Layland EK, Clark KA, Levine DS, Jackson SD. Training in LGBTQ-affirmative cognitive behavioral therapy: A randomized controlled trial across LGBTQ community centers. J Consult Clin Psychol 2022; 90:582-599. [PMID: 35901370 DOI: 10.1037/ccp0000745] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES This randomized controlled trial examined whether an 11-week synchronous (i.e., real-time) online training in lesbian, gay, bisexual, transgender, queer, and other sexual or gender diverse (LGBTQ)-affirmative cognitive behavioral therapy (CBT) could lead to increased uptake of this practice at LGBTQ community centers across 20 U.S. states and internationally. METHOD A total of 121 mental health providers (Mage = 37.74; 78.5% LGBTQ; 60.3% non-Hispanic/Latinx White) were randomized to receive the 11-week training either immediately (n = 61) or after a 4-month wait (n = 60). At baseline and 4 and 8 months after baseline, participants self-reported their LGBTQ-affirmative competency, cultural humility, and knowledge of the minority stress theory and practice skills underlying LGBTQ-affirmative CBT. To objectively assess uptake of LGBTQ-affirmative CBT, participants demonstrated, through simulated practice, how they would respond to two video-based clinical vignettes. RESULTS Compared to wait-list, participants in the immediate training condition reported greater improvements in self-reported cultural competence (d = 1.24), minority stress knowledge (d = 0.78), LGBTQ-affirmative CBT knowledge (d = 0.78), and LGBTQ-affirmative CBT skills familiarity (d = 0.91) and use (d = 0.96); effects persisted 8 months postbaseline. Cultural humility showed no significant difference by condition (d = 0.07). In objectively coded assessments of simulated practice, participants in the training condition demonstrated greater uptake of LGBTQ-affirmative practice skills (d = 0.82). CONCLUSIONS Findings preliminarily suggest that mental health providers can be trained to deliver LGBTQ-affirmative CBT using the low-cost, efficient reach of online training. This training can help disseminate evidence-based mental health care to LGBTQ individuals and support its implementation across practice settings. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Harkness A, Rogers BG, Mayo D, Smith-Alvarez R, Pachankis JE, Safren SA. A Relational Framework for Engaging Latino Sexual Minority Men in Sexual and Behavioral Health Research. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:2399-2412. [PMID: 35763160 PMCID: PMC9549688 DOI: 10.1007/s10508-021-02237-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 11/12/2021] [Accepted: 11/15/2021] [Indexed: 06/15/2023]
Abstract
Latino sexual minority men (LSMM) experience sexual and behavioral health disparities. Yet, LSMM are underrepresented in sexual and behavioral health research, creating scientific inequity. There is, therefore, a need to identify the barriers and facilitators to LSMM's participation in sexual and behavioral health research, which is the gap that the current study sought to fill. We interviewed LSMM (n = 28; age 18-40, 57% US born) and key informants (n = 10) regarding LSMM's barriers and facilitators to participating in sexual and behavioral health research and suggestions for increasing participation. The research team coded the data via thematic analysis. We found that relational factors are central to understanding LSMM's participation in sexual and behavioral health research. Some relational experiences (e.g., interpersonal stigma) interfered with participation, whereas others (e.g., altruistic desires to contribute to community well-being) facilitated participation. The findings are consolidated within a new relational framework for understanding LSMM's participation in sexual and behavioral health research. Study findings highlight the centrality of relational factors in influencing LSMM's participation in sexual and behavioral health research. Relational factors can be used to inform the development of culturally relevant recruitment strategies to improve representation of LSMM in sexual and behavioral health research. Implementing these recommendations may address scientific inequity, whereby LSMM are disproportionately impacted by sexual and behavioral health concerns yet underrepresented in related research.
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Bränström R, Fellman D, Pachankis JE. Age-varying sexual orientation disparities in mental health, treatment utilization, and social stress: A population-based study. PSYCHOLOGY OF SEXUAL ORIENTATION AND GENDER DIVERSITY 2022. [DOI: 10.1037/sgd0000572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Bränström R, Stormbom I, Bergendal M, Pachankis JE. Transgender-based disparities in suicidality: A population-based study of key predictions from four theoretical models. Suicide Life Threat Behav 2022; 52:401-412. [PMID: 35067978 PMCID: PMC10138751 DOI: 10.1111/sltb.12830] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 09/30/2021] [Accepted: 10/14/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Numerous studies have reported a high prevalence of suicidality among transgender individuals. Yet few studies have reported results from population-based samples, leaving open questions about the generalizability of existing findings. Factors proposed to explain transgender individuals' elevated risk of suicidality derive from several theoretical models (i.e., clinical model, interpersonal model, minority stress model, and societal integration model). These models identify both general risk factors (e.g., mental health risks and interpersonal risks) assumed to be elevated among transgender individuals because of transgender individuals' exposure to stigma-related disadvantage and the stigma-specific risks themselves (e.g., minority stressors such as discrimination). This is one of the first population-based studies to examine differences in suicidality between transgender and cisgender individuals and theoretically derived factors potentially explaining such differences. METHODS A sample of 533 transgender and 104,757 cisgender individuals (age 16-84) was analyzed. RESULTS Compared to cisgender individuals, transgender individuals were at a substantially higher risk of reporting both lifetime and past 12-month suicidality. Several factors partially mediated the increased risk of suicidality among transgender compared to cisgender individuals, including depressive symptoms, lack of social support, and exposure to discrimination. CONCLUSIONS This study suggests that transgender people experience multiple psychosocial health threats and calls for interventions to reduce these threats.
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Scheer JR, Pachankis JE, Bränström R. Gender-based Structural Stigma and Intimate Partner Violence Across 28 Countries: A Population-based Study of Women Across Sexual Orientation, Immigration Status, and Socioeconomic Status. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP8941-NP8964. [PMID: 33302766 PMCID: PMC8190183 DOI: 10.1177/0886260520976212] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Reducing structural drivers of intimate partner violence (IPV), including gender inequity in education, employment, and health, surrounding women worldwide represents a clear public health priority. Within countries, some women are at disproportionate risk of IPV compared to other women, including sexual minority women, immigrant women, and women in poverty. However, limited research has assessed women's IPV risk and related circumstances, including police involvement following IPV experiences and IPV-related worry, across sexual orientation, immigration status, and socioeconomic status in a population-based survey of women across countries. Further, few studies have examined IPV against minority women as a function of gender-based structural stigma. This study aimed to determine whether gender-based structural stigma is associated with IPV and related circumstances among European women; examine minority-majority IPV disparities; and assess whether structural stigma is associated with IPV disparities. We used the population-based 2012 Violence Against Women Survey (n = 42,000) administered across 28 European Union countries: 724 (1.7%) identified as sexual minority, 841 (2.0%) as immigrant, and 2,272 (5.4%) as living in poverty. Women in high gender-based structural stigma countries had a greater risk of past-12-month IPV (AOR: 1.18, 95% CI = 1.04, 1.34) and IPV-related worry (AOR: 1.09, 95% CI = 1.04, 1.15) than women in low structural stigma countries. All minority women were at disproportionate risk of IPV and IPV-related worry compared to majority women. Associations between gender-based structural stigma and IPV and related circumstances differed across minority status. Country-level structural stigma can possibly perpetuate women's risk of IPV and related circumstances. Associations between structural stigma and IPV and related circumstances for sexual minority women, immigrant women, and women in poverty call for research into the IPV experiences of minority populations across structural contexts.
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Sievwright KM, Stangl AL, Nyblade L, Lippman SA, Logie CH, Veras MADSM, Zamudio-Haas S, Poteat T, Rao D, Pachankis JE, Kumi Smith M, Weiser SD, Brooks RA, Sevelius JM. An Expanded Definition of Intersectional Stigma for Public Health Research and Praxis. Am J Public Health 2022; 112:S356-S361. [PMID: 35763723 PMCID: PMC9241457 DOI: 10.2105/ajph.2022.306718] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2022] [Indexed: 11/04/2022]
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Wang K, Maiolatesi AJ, Burton CL, Scheer JR, Pachankis JE. Emotion Regulation in Context: Expressive Flexibility as a Stigma Coping Resource for Sexual Minority Men. PSYCHOLOGY OF SEXUAL ORIENTATION AND GENDER DIVERSITY 2022; 9:214-221. [PMID: 35757788 PMCID: PMC9231373 DOI: 10.1037/sgd0000503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Although expressive flexibility (i.e., the ability to engage in expressive enhancement and suppression in accordance with situational demands) has been increasingly recognized as an important source of resilience, its role in the context of stigma coping remains under-investigated. The present research examined the role of expressive flexibility as a potential buffer in the association between perceptions of sexual orientation-related discrimination and psychological distress among sexual minority men, a population facing significant mental health problems driven by stigma-related stress. A U.S. sample of sexual minority men (N = 377) completed self-report measures of perceived sexual orientation-related discrimination, expressive flexibility, and psychological distress. Cross-sectional analyses revealed that perceived sexual orientation-related discrimination was positively associated with psychological distress, but the relationship was attenuated for participants with high levels of expressive flexibility. Longitudinal analyses further showed that the association between discrimination and psychological distress measured one year later was significant for sexual minority men with very low levels of expressive flexibility. These findings highlight the role of expressive flexibility as an important resource for coping with sexual orientation-related discrimination and underscore the potential utility of enhancing expressive flexibility in stigma coping interventions that seek to improve sexual minority men's mental health.
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Pachankis JE, Harkness A, Maciejewski KR, Behari K, Clark KA, McConocha E, Winston R, Adeyinka O, Reynolds J, Bränström R, Esserman DA, Hatzenbuehler ML, Safren SA. LGBQ-affirmative cognitive-behavioral therapy for young gay and bisexual men's mental and sexual health: A three-arm randomized controlled trial. J Consult Clin Psychol 2022; 90:459-477. [PMID: 35482652 DOI: 10.1037/ccp0000724] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Effective Skills to Empower Effective Men (ESTEEM) represents the first intervention to address the psychological pathways through which minority stress undermines young sexual minority men's (SMM's) mental and sexual health using transdiagnostic cognitive-behavioral therapy. This study compared the efficacy of ESTEEM against two existing interventions. METHOD Participants were young human immunodeficiency virus (HIV)-negative SMM (N = 254; ages = 18-35; 67.2% racial/ethnic minority) experiencing a depression, anxiety, and/or stress-/trauma-related disorder and past-90-day HIV transmission risk behavior. After completing HIV testing and counseling, participants were randomized to receive 10-session ESTEEM (n = 100); 10-session community-based lesbian, gay, bisexual, and queer/questioning (LGBQ)-affirmative counseling (n = 102); or only HIV testing and counseling (n = 52). RESULTS For the primary outcome of any HIV transmission risk behavior at 8 months, ESTEEM was not significantly associated with greater reduction compared to HIV testing and counseling (risk ratio [RR] = 0.89, p = .52). Supportive analyses of the frequency of HIV transmission risk behavior at 8 months showed a nonsignificant difference between ESTEEM compared to HIV testing and counseling (RR = 0.69) and LGBQ-affirmative counseling (RR = 0.62). For secondary outcomes (e.g., depression, anxiety, substance use, suicidality, number of mental health diagnoses) at 8 months, ESTEEM had a larger effect size than the two comparison conditions, but these comparisons did not reach statistical significance when adjusting for the false discovery rate. Observed effect sizes for condition comparisons were smaller than the effect sizes used to power the study. In exploratory analyses, ESTEEM showed promise for reducing comorbidity. CONCLUSIONS Because the control conditions were associated with stronger effects than anticipated, and given the heterogeneous nature of transdiagnostic outcomes, the study possessed insufficient power to statistically detect the consistently small-to-moderate benefit of ESTEEM compared to the two control conditions. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Jackson SD, Wagner KR, Yepes M, Harvey TD, Higginbottom J, Pachankis JE. A pilot test of a treatment to address intersectional stigma, mental health, and HIV risk among gay and bisexual men of color. Psychotherapy (Chic) 2022; 59:96-112. [PMID: 35025569 PMCID: PMC9345305 DOI: 10.1037/pst0000417] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We tested the feasibility and acceptability of a group therapy treatment that addresses the intersecting stigma-related stressors theorized to drive elevated mental health risk, sexual health risk, and their co-occurrence among Black and Latino gay, bisexual, and other men who have sex with men (GBM). First, we modified an existing 10-week, one-on-one, cognitive-behavioral treatment addressing co-occurring health risks among GBM to develop a group-based, intersectionally informed treatment for GBM of color. Then, an open pilot was conducted (n = 21, across two cohorts) with young Black and Latino GBM. An evaluation of feasibility metrics (e.g., eligibility-enrollment ratio, session attendance, rate of retention) supported overall treatment feasibility. Qualitative data suggest high acceptability of the treatment length, format, and content-and revealed a powerful theme: The treatment and group composition led participants to feel less alone as GBM of color. To further evaluate acceptability, baseline and 3-month posttreatment assessments and exit interviews were used to examine the treatment's impact on stigma coping, mental health, and sexual health. Expected changes were found for: (a) stigma coping, as demonstrated by decreases in perceived sexual minority stress, racial minority stress, and intersectional stress; (b) mental health, including depression, anxiety, stress, and suicidality, but not alcohol use; and (c) sexual health, including condom use efficacy, sexual compulsivity, and preexposure prophylaxis uptake; with partial support for decreased in human immunodeficiency virus; HIV-transmission risk acts. This study lays the groundwork for a group treatment to address intersectional stigma, mental health, and HIV risk among young Black and Latino GBM in the U.S. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Maiolatesi AJ, Clark KA, Pachankis JE. Rejection sensitivity across sex, sexual orientation, and age: Measurement invariance and latent mean differences. Psychol Assess 2022; 34:431-442. [PMID: 35025579 DOI: 10.1037/pas0001109] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Intergroup differences in personality might be determined by systematic variation in social status and social experiences across groups. Because of its close association with social experiences, rejection sensitivity (RS)-a tendency toward anxious expectations of, and hypersensitivity to, interpersonal rejection-represents one such personality disposition that might differ across social groups, with implications for understanding mental health disparities. After first evaluating measurement invariance of the Adult Rejection Sensitivity Questionnaire (A-RSQ), the present research sought to assess whether latent mean differences in RS emerged across sex, sexual orientation, and age in a population-based sample of Swedish young adults (age 18-36; N = 1,679). Analyses revealed that the scale achieved full configural, metric, and scalar invariance across sex and sexual orientation and partial scalar invariance across age. As expected, tests of latent mean differences indicated that women, sexual minorities, and people 18-29 years old exhibited significantly higher RS levels than men, heterosexuals, and people 30-36 years old, respectively. Findings from the present research highlight the utility of attending to group differences in maladaptive personality dispositions and information processing styles and their potential role in contributing to persistent mental health hardships uniquely affecting women, sexual minorities, and younger people. Implications for scale administration and future research into the social causes and consequences of RS are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Pachankis JE, Soulliard ZA, Morris F, Seager van Dyk I. A Model for Adapting Evidence-Based Interventions to Be LGBQ-Affirmative: Putting Minority Stress Principles and Case Conceptualization into Clinical Research and Practice. COGNITIVE AND BEHAVIORAL PRACTICE 2022. [DOI: 10.1016/j.cbpra.2021.11.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Scheer JR, Clark KA, Talan A, Cabral C, Pachankis JE, Rendina HJ. Longitudinal associations between childhood sexual abuse-related PTSD symptoms and passive and active suicidal ideation among sexual minority men. CHILD ABUSE & NEGLECT 2021; 122:105353. [PMID: 34638046 PMCID: PMC8612966 DOI: 10.1016/j.chiabu.2021.105353] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 09/20/2021] [Accepted: 09/28/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Sexual minority men report high rates of childhood sexual abuse (CSA) and adulthood suicidality. However, mechanisms (e.g., PTSD symptoms) through which CSA might drive suicidality remain unknown. OBJECTIVE In a prospective cohort of sexual minority men, we examined: (1) associations between CSA and suicidal thoughts and behaviors; (2) prospective associations between CSA-related PTSD symptoms and suicidal ideation; and (3) interpersonal moderators of these associations. PARTICIPANTS AND SETTING Participants included 6305 sexual minority men (Mage = 33.2, SD = 11.5; 82.0% gay; 53.5% White) who completed baseline and one-year follow-up at-home online surveys. METHODS Bivariate analyses were used to assess baseline demographic and suicidality differences between CSA-exposed participants and non-CSA-exposed participants. Among CSA-exposed participants, multivariable logistic regression analyses were used to regress passive and active suicidal ideation at one-year follow-up on CSA-related PTSD symptoms at baseline. Interactions were examined between CSA-related PTSD symptoms and interpersonal difficulties. RESULTS CSA-exposed sexual minority men reported two-and-a-half times the odds of suicide attempt history compared to non-CSA-exposed men (95% CI = 2.15-2.88; p < 0.001). Among CSA-exposed sexual minority men, CSA-related PTSD symptoms were prospectively associated with passive suicidal ideation (adjusted odds ratio [aOR] = 1.38; 95% CI = 1.19; 1.61). Regardless of CSA-related PTSD symptom severity, those with lower social support and greater loneliness were at elevated risk of active suicidal ideation at one-year follow-up. CONCLUSIONS CSA-related PTSD symptom severity represents a psychological mechanism contributing to CSA-exposed sexual minority men's elevated suicide risk, particularly among those who lack social support and report loneliness.
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Pachankis JE, Hatzenbuehler ML, Bränström R, Schmidt AJ, Berg RC, Jonas K, Pitoňák M, Baros S, Weatherburn P. Structural stigma and sexual minority men's depression and suicidality: A multilevel examination of mechanisms and mobility across 48 countries. JOURNAL OF ABNORMAL PSYCHOLOGY 2021; 130:713-726. [PMID: 34780228 DOI: 10.1037/abn0000693] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Sexual minority men are at greater risk of depression and suicidality than heterosexuals. Stigma, the most frequently hypothesized risk factor for this disparity, operates across socioecological levels-structural (e.g., laws), interpersonal (e.g., discrimination), and individual (e.g., self-stigma). Although the literature on stigma and mental health has focused on interpersonal and individual forms of stigma, emerging research has shown that structural stigma is also associated with adverse mental health outcomes. However, there is limited data on whether changes in structural stigma, such as when a stigmatized person moves to a lower stigma context, affect mental health, and on the mechanisms underlying this association. To address these questions, we use data from the 2017/18 European Men-who-have-sex-with-men Internet Survey (n = 123,428), which assessed mental health (i.e., Patient Health Questionnaire) and psychosocial mediators (i.e., sexual orientation concealment, internalized homonegativity, and social isolation). We linked these data to an objective indicator of structural stigma related to sexual orientation-including 15 laws and policies as well as aggregated social attitudes-in respondents' countries of origin (N = 178) and receiving countries (N = 48). Among respondents who still live in their country of birth (N = 106,883), structural stigma was related to depression and suicidality via internalized homonegativity and social isolation. Among respondents who moved from higher-to-lower structural stigma countries (n = 11,831), longer exposure to the lower structural stigma environments of their receiving countries was associated with a significantly: 1) lower risk of depression and suicidality; 2) lower odds of concealment, internalized homonegativity, and social isolation; and 3) smaller indirect effect of structural stigma on mental health through these mediators. This study provides additional evidence that stigma is a sociocultural determinant of mental health. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Hatzenbuehler ML, Pachankis JE. Does Stigma Moderate the Efficacy of Mental- and Behavioral-Health Interventions? Examining Individual and Contextual Sources of Treatment-Effect Heterogeneity. CURRENT DIRECTIONS IN PSYCHOLOGICAL SCIENCE 2021. [DOI: 10.1177/09637214211043884] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
In this article, we argue that stigma may be an important, but heretofore underrecognized, source of heterogeneity in treatment effects of mental- and behavioral-health interventions. To support this hypothesis, we review recent evidence from randomized controlled trials and spatial meta-analyses suggesting that stigma may predict not only who responds more favorably to these health interventions (i.e., individuals with more stigma experiences), but also the social contexts that are more likely to undermine intervention effects (i.e., communities with greater structural stigma). By highlighting the potential role of personal and contextual stigma in shaping response to interventions, our review paves the way for additional research.
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Pachankis JE, Clark KA, Klein DN, Dougherty LR. Early Timing and Determinants of the Sexual Orientation Disparity in Internalizing Psychopathology: A Prospective Cohort Study from Ages 3 to 15. J Youth Adolesc 2021; 51:458-470. [PMID: 34731394 DOI: 10.1007/s10964-021-01532-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/17/2021] [Indexed: 11/28/2022]
Abstract
Knowing the age at which the sexual orientation disparity in depression and anxiety symptoms first emerges and the early determinants of this disparity can suggest optimal timing and targets of supportive interventions. This prospective cohort study of children ages 3 to 15 (n = 417; 10.6% same-sex-attracted; 47.2% assigned female at birth) and their parents sought to determine the age at which the sexual orientation disparity in depression and anxiety symptoms first emerges and whether peer victimization and poor parental relationships mediate this disparity. Same-sex-attracted youth first demonstrated significantly higher depression symptoms at age 12 and anxiety symptoms at age 15 than exclusively other-sex-attracted youth. Age 12 peer victimization mediated the sexual orientation disparity in age 15 depression symptoms. Age 12 poor mother-child relationship mediated the sexual orientation disparity in age 15 anxiety symptoms. The findings are discussed in terms of implications for developmentally appropriate interventions against social stress during early development.
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Eaton NR, Rodriguez-Seijas C, Pachankis JE. Transdiagnostic Approaches to Sexual- and Gender-Minority Mental Health. CURRENT DIRECTIONS IN PSYCHOLOGICAL SCIENCE 2021. [DOI: 10.1177/09637214211043918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Sexual- and gender-minority individuals experience minority stress, which is hypothesized to underlie the mental-health disparities affecting these populations. Drawing on advances in the classification of mental disorders, we argue that transdiagnostic approaches hold great promise for understanding and reducing these disparities. In contrast to traditional diagnostic approaches, which have limited construct validity and have produced a piecemeal literature, transdiagnostic approaches (a) are evidence based, (b) account for diffuse patterns of disparities and comorbidity, (c) pinpoint psychological mechanisms linking minority stress to poor mental health, (d) reduce scientific stigma, and (e) identify efficacious and efficient points of intervention for treatment of negative outcomes of minority stress.
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Christian LM, Cole SW, McDade T, Pachankis JE, Morgan E, Strahm AM, Kamp Dush CM. A biopsychosocial framework for understanding sexual and gender minority health: A call for action. Neurosci Biobehav Rev 2021; 129:107-116. [PMID: 34097981 PMCID: PMC8429206 DOI: 10.1016/j.neubiorev.2021.06.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 05/26/2021] [Accepted: 06/01/2021] [Indexed: 12/29/2022]
Abstract
The number of US adults identifying as lesbian, gay, bisexual, transgender, or a different sexual identity has doubled since 2008, and about 40 % of the sexual and gender minority population identify as people of color. Minority stress theory posits that sexual and gender minorities are at particular risk for stress via stigma and discrimination at the structural, interpersonal, and individual levels. This stress, in turn, elevates the risk of adverse health outcomes across several domains. However, there remains a conspicuously limited amount of research on the psychoneuroimmunology of stress among sexual and gender minorities. We developed the Biopsychosocial Minority Stress Framework which posits that sexual minority status leads to unique experiences of minority stress which results in adverse health behavioral factors, elevated psychological distress and sleep disturbance, and immune dysregulation. Moderators in the model include both individual differences and intersectional identities. There is a crucial need to understand the biological-psychological axis of stress among the increasingly visible sexual and gender minority population to increase their health, longevity, and quality of life.
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Scheer JR, Clark KA, Maiolatesi AJ, Pachankis JE. Syndemic Profiles and Sexual Minority Men's HIV-Risk Behavior: A Latent Class Analysis. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:2825-2841. [PMID: 33483851 PMCID: PMC8295412 DOI: 10.1007/s10508-020-01850-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 09/14/2020] [Accepted: 09/23/2020] [Indexed: 05/10/2023]
Abstract
Syndemic theory posits that "syndemic conditions" (e.g., alcohol misuse, polydrug use, suicidality) co-occur among sexual minority men and influence HIV-risk behavior, namely HIV acquisition and transmission risk. To examine how four syndemic conditions cluster among sexual minority men and contribute to HIV-risk behavior, we conducted latent class analysis (LCA) to: (1) classify sexual minority men (n = 937) into subgroups based on their probability of experiencing each syndemic condition; (2) examine the demographic (e.g., race/ethnicity) and social status (e.g., level of socioeconomic distress) characteristics of the most optimally fitting four syndemic classes; (3) examine between-group differences in HIV-risk behavior across classes; and (4) use syndemic class membership to predict HIV-risk behavior with sexual minority men reporting no syndemic conditions as the reference group. The four classes were: (1) no syndemic, (2) alcohol misuse and polydrug use syndemic, (3) polydrug use and HIV syndemic, and (4) alcohol misuse. HIV-risk behavior differed across these latent classes. Demographic and social status characteristics predicted class membership, suggesting that syndemic conditions disproportionately co-occur in vulnerable subpopulations of sexual minority men, such as those experiencing high socioeconomic distress. When predicting HIV-risk behavior, men in the polydrug use and HIV syndemic class were more likely (Adjusted Risk Ratio [ARR] = 2.93, 95% CI: 1.05, 8.21) and men in the alcohol misuse class were less likely (ARR = 0.17, 95% CI: 0.07, 0.44) to report HIV-risk behavior than were men in the no syndemic class. LCA represents a promising methodology to inform the development and delivery of tailored interventions targeting distinct combinations of syndemic conditions to reduce sexual minority men's HIV-risk behavior.
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Sun S, Hoyt WT, Tarantino N, Pachankis JE, Whiteley L, Operario D, Brown LK. Cultural context matters: Testing the minority stress model among Chinese sexual minority men. J Couns Psychol 2021; 68:526-537. [PMID: 33030914 DOI: 10.1037/cou000053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Minority stress theory (e.g., Meyer, 2003b), a model for understanding mental health disparities affecting sexual minorities, has primarily been tested in Western samples yet has not been carefully applied to the experiences of sexual minorities in a global context, including in East Asian countries. Combining minority stress theory with considerations of Chinese culture, the current study tested the associations among norm conformity, distal minority stressor (enacted stigma), proximal minority stressors (sexual identity concerns and concealment), lesbian, gay, and bisexual (LGB) family support, and psychological distress among Chinese sexual minority men (n = 748). Structural equation modeling showed that sexual identity concerns mediated the associations of norm conformity, enacted stigma, and lower family support with concealment. Psychological distress was associated with enacted stigma and lower family support, but not with proximal stressors (sexual identity concerns and concealment). Alternative model testing found sexual identity acceptance concerns predicted psychological distress and mediated the associations of norm conformity and LGB family support with distress. Findings provide partial support for the minority stress model in a Chinese context and suggest the importance of incorporating cultural considerations into minority stress conceptualizations. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Lattanner MR, Ford J, Bo N, Tu W, Pachankis JE, Dodge B, Hatzenbuehler ML. A Contextual Approach to the Psychological Study of Identity Concealment: Examining Direct, Interactive, and Indirect Effects of Structural Stigma on Concealment Motivation Across Proximal and Distal Geographic Levels. Psychol Sci 2021; 32:1684-1696. [PMID: 34543132 DOI: 10.1177/09567976211018624] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Psychological theories of identity concealment locate the ultimate source of concealment decisions within the social environment, yet most studies have not explicitly assessed stigmatizing environments beyond the immediate situation. We advanced the identity-concealment literature by objectively measuring structural forms of stigma related to sexual orientation (e.g., social policies) at proximal and distal geographic levels. We linked these measures to a new, population-based data set of 502 gay and bisexual men (residing in 44 states and Washington, DC; 269 counties; and 354 cities) who completed survey items about stigma, including identity-concealment motivation. Among gay men, the association between structural stigma and concealment motivation was (a) observed across three levels (city, county, and state), (b) conditional on one's exposure at another geographic level (participants reported the least motivations to conceal their identity if they resided in both cities and states that were lowest in structural stigma), and (c) mediated by subjective perceptions of greater structural stigma.
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Burton CL, Clark KA, Pachankis JE. Risk From Within: Intraminority Gay Community Stress and Sexual Risk-Taking Among Sexual Minority Men. Ann Behav Med 2021; 54:703-712. [PMID: 32206770 DOI: 10.1093/abm/kaaa014] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Sexual minority men remain highly impacted by the human immunodeficiency virus (HIV) with social stress being a clear predictor of their risk for infection. The past several decades of stress research regarding sexual minority men's HIV-risk behaviors has almost exclusively focused on the influence of stress emanating from outside the gay community (e.g., stigma-related stress, or minority stress, such as heterosexist discrimination). However, recent evidence suggests that sexual minority men also face stress from within their own communities. PURPOSE We sought to examine whether stress from within the gay community, or intraminority gay community stress, might influence sexual minority men's risk behaviors, including HIV-risk behaviors, over-and-above more commonly examined stressors affecting this risk. METHODS We tested whether intraminority gay community stress was associated with sexual minority men's HIV-risk behaviors in a large national survey of sexual minority men (Study 1), and experimentally tested intraminority gay community stress's impact on behavioral risk-taking and attitudes toward condom use (Study 2). RESULTS Self-reported exposure to intraminority gay community stress was positively associated with HIV-risk behaviors when accounting for the effects of several commonly examined minority stressors and general life stress (Study 1). Participants who were rejected from an online group of other sexual minority men evidenced greater risk-taking in a subsequent task and reported fewer benefits of condom use than participants who were accepted by the online group, when accounting for state affect (Study 2). CONCLUSIONS Sexual minority men's experiences of stress and rejection stemming from their own community may be an important and overlooked predictor of HIV infection and transmission.
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Mahon CP, Lombard-Vance R, Kiernan G, Pachankis JE, Gallagher P. Social Anxiety Among Sexual Minority Individuals: A Systematic Review. PSYCHOLOGY & SEXUALITY 2021. [DOI: 10.1080/19419899.2021.1936140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Scheer JR, Batchelder AW, Wang K, Pachankis JE. Mental health, alcohol use, and substance use correlates of sexism in a sample of gender-diverse sexual minority women. PSYCHOLOGY OF SEXUAL ORIENTATION AND GENDER DIVERSITY 2021; 9:222-235. [PMID: 35677582 PMCID: PMC9173652 DOI: 10.1037/sgd0000477] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Gender-based stressors (e.g., sexism) are rooted in hegemonic masculinity, a cultural practice that subordinates women and stems from patriarchal social structures and institutions. Sexism has been increasingly documented as a key driver of mental and behavioral health issues among women, yet prior research has largely focused on heterosexual women. The current study examined associations between sexism and mental health (i.e., psychological distress) and behavioral health (i.e., alcohol- and drug-related consequences) among sexual minority women (SMW). We also examined whether these associations might be more pronounced among SMW who identify as gender minorities (e.g., gender nonbinary, genderqueer) or are masculine-presenting compared to those who identify as cisgender women or are feminine-presenting. Participants included 60 SMW (ages 19-32; 55.0% queer, 43.3% gender minority, 41.7% racial and ethnic minority) who completed self-report measures of sexism, psychological distress, and alcohol- and drug-related consequences. Results indicated that sexism was positively associated with psychological distress, alcohol-related consequences, and drug-related consequences, respectively. In addition, sexism was associated with worse mental and behavioral health outcomes among SMW who identify as gender minorities or are masculine-presenting compared to SMW who identify as cisgender or are feminine-presenting. Findings provide evidence that the health impact of gender-based stressors among SMW may differ based on whether SMW identify as gender minorities and based on the extent to which SMW violate traditional gender norms.
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Harkness A, Rogers BG, Balise R, Mayo D, Weinstein ER, Safren SA, Pachankis JE. Who Aren't We Reaching? Young Sexual Minority Men's Non-participation in an HIV-Prevention and Mental Health Clinical Trial. AIDS Behav 2021; 25:2195-2209. [PMID: 33483898 PMCID: PMC8169533 DOI: 10.1007/s10461-020-03148-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2020] [Indexed: 11/29/2022]
Abstract
Despite many successful clinical trials to test HIV-prevention interventions for sexual minority men (SMM), not all SMM are reached by these trials. Identifying factors associated with non-participation in these trials could help to ensure the benefits of research extend to all SMM. Prospective participants in New York City and Miami were screened to determine eligibility for a baseline assessment for a mental health/HIV-prevention trial (N = 633 eligible on screen). Logistic regression and classification and regression tree (CART) analysis identified predictors of non-participation in the baseline, among those who were screened as eligible and invited to participate. Individuals who reported unknown HIV status were more likely to be non-participators than those who reported being HIV-negative (OR = 2.39; 95% CI 1.41, 4.04). In New York City, Latinx SMM were more likely to be non-participators than non-Latinx white SMM (OR = 1.81; 95% CI, 1.09, 2.98). A CART model pruned two predictors of non-participation: knowledge of HIV status and age, such that SMM with unknown HIV status and SMM ages 18-19 were less likely to participate. Young SMM who did not know their HIV status, and thus are more likely to acquire and transmit HIV, were less likely to participate. Additionally, younger SMM (18-19 years) and Latinx SMM in New York City were less likely to participate. The findings suggest the importance of tailored recruitment to ensure HIV-prevention/mental health trials reach all SMM.
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Pachankis JE, Clark KA, Jackson SD, Pereira K, Levine D. Current Capacity and Future Implementation of Mental Health Services in U.S. LGBTQ Community Centers. Psychiatr Serv 2021; 72:669-676. [PMID: 33882684 PMCID: PMC10374348 DOI: 10.1176/appi.ps.202000575] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Since the beginning of the lesbian, gay, bisexual, transgender, and queer (LGBTQ) rights movement, LGBTQ community centers have been on the front lines of mental health care for sexual and gender minorities (SGMs) across the United States. However, little is known about what types of mental health services LGBTQ community centers currently offer and their anticipated future needs, including training in and delivery of evidence-based practice. METHODS Sixty executive directors and chief executive officers of LGBTQ community centers across the United States completed a survey regarding their centers' current treatment capacity, format, and type as well as perceived future needs. Survey items were supplemented with qualitative questions about perceived barriers to and facilitators of strengthening the capacity of mental health services. RESULTS Center directors perceived a high need for mental health care in their communities and strove to meet that need despite constrained resources. About half of the centers (52%) reported having fewer than five mental health staff; still, most reported providing support groups (98%) and individual psychotherapy (85%). Most centers (88%) reported providing general evidence-based care, such as cognitive-behavioral therapy (62%), and all reported high support for their staff to receive training in more specific types of evidence-based, LGBTQ-affirmative care. CONCLUSIONS LGBTQ community centers continue to play an important role in supporting the mental health of SGMs. The centers also offer a significant opportunity to lead the way in addressing the substantial unmet mental health needs still facing this population by implementing evidence-based, LGBTQ-affirmative practice through efficient and cost-effective service delivery.
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