The role of emotional intelligence in attitudes towards elderly patients - Comparative study of medical students from rural and urban areas

INTRODUCTION

Medical care in geriatrics has its own specificity, and in order to build a successful doctor-patient relationship it is important while studying medicine to learn some functioning aspects of this age group.

OBJECTIVE

The aim of this study is to explore and describe the role of emotional intelligence in the attitudes of medical students towards elderly patients, taking into account their the place of residence. The place of residence has an impact on social relations and socialization, which could effect with disparities in behaviour towards elderly patients.

MATERIAL AND METHODS

Medical University of Lublin students from rural (N=71; M=23.44 SD=1.80) and urban (N=87; M=23.34; SD=1.38) areas took part in the study. Emotional Intelligence Questionnaire (INTE) and Attitude Towards Elderly Patients Questionnaire (ATEP) were used.

RESULTS

There are statistically significant differences between medical students from rural and urban areas in their attitude towards elderly patients (p=0.001), but no differences were observed between rural and urban residents in terms of emotional intelligence (general result, action factor and cognitive factor). Positive correlations were observed between action factor (r=0.322), cognitive factor (r=0.311) and general INTE result (r=0.358) and attitude towards elderly patients in the group of medical students from rural area.

CONCLUSIONS

Medical students from rural areas are characterized by a more positive attitude towards elderly patients than medical students from urban areas. The predictors of attitudes towards elderly patients are the cognitive factor of emotional intelligence and the place of residence of medical students. The results give the opportunity to design a well-developed programme of a geriatric course which could be matched to the personal predispositions of students.

Common Types of Gender-Based Microaggressions in Medicine

PURPOSE

Microaggressions are subtle verbal or nonverbal everyday behaviors that arise from unconscious bias, covert prejudice, or hostility. They may contribute to the persistent disparities faced by women in medicine. In this study, the authors sought to identify common microaggressions experienced by women faculty in medicine and to determine if specific demographic characteristics affect the reported frequencies of these microaggressions.

METHOD

The authors used chain referral sampling to collect real-life anecdotes about microaggressions from women faculty across the nation. Thirty-four unique experiences from those reported were identified and scripted then reenacted using professional actors to create 34 videos of the real-life microaggressions and 34 corresponding fictional "control" versions of the same situations. The videos, presented in a random order, were evaluated by faculty from 4 academic medical centers from 2016 to 2018.

RESULTS

A total of 124 faculty (79 women, 45 men) participated. Women reported higher frequencies of microaggressions than men in 33 of the 34 videos depicting microaggressions (P value range: < .001 to .042, area under the curve range: 0.60-0.69). No such differences were seen with the control videos. Women identified 21 microaggressions as occurring frequently. No significant differences were found with respect to participants' age, race/ethnicity, academic rank, or years in medicine. Post hoc analyses showed that the microaggressions fell into 6 themes: encountering sexism, encountering pregnancy- and child care-related bias, having abilities underestimated, encountering sexually inappropriate comments, being relegated to mundane tasks, and feeling excluded/marginalized.

CONCLUSIONS

Privilege is often invisible to those who have it, whereas bias and discrimination are readily apparent to those who experience it. Knowledge of common microaggressions will allow for targeted individual, interpersonal, and institutional solutions to mitigate disparities in medicine.

Knowledge, attitudes and prejudices of nursing students about the provision of transcultural nursing care to refugees: A comparative descriptive study

OBJECTIVES

The aim of this study was to determine the knowledge, attitudes, and prejudices of nursing students regarding the provision of transcultural nursing care to refugees.

METHODS

The sample of this comparative descriptive study was composed of 317 volunteering nursing students living in Ankara, Turkey. Descriptive statistics were presented as number, percentage, and mean ± standard deviation. The relationships among dependent and independent variables were analyzed with Pearson chi-square test. p ≤ 0.05 was accepted as statistically significant.

RESULTS

The mean age of the students was 21.19 ± 1.66 years; 88.6% were female. Only 30.0% (n = 95) of students (predominantly seniors) were educated on transcultural nursing. Statistically significant differences were found among grades of nursing students on the answers to the items, "Refugees are under coverage of general medical insurance system," "The concept of 'Health' differs from culture to culture," "Cultural features of the patient are important for caring nurse," "In order to provide care to only refugees and foreign patients, nurses from other cultures should be employed in hospitals," "Interpreters should be employed in hospitals 24 hours for services for refugees," and "According to my observations, refugees and their relatives admitted to the hospital are not respecting the healthcare workers and hospital rules." In addition, there was a statistically significant difference in students' comfort level with nursing care activities between those students who were literate in a foreign language and those who were not literate in a foreign language.

CONCLUSIONS

Our findings show that attending lectures on transcultural nursing in a curriculum of seniors and being literate in a foreign language had a positive impact on the attitudes of students in terms of the provision of medical care to refugees. It is recommended that nursing programs integrate lectures on transcultural nursing into the curricula of all four grades of nursing education and encourage students in language learning to better serve our disadvantageous guests.

Parallel Changes in Ethnic/Racial Discrimination and Identity in High School

Research has yet to understand how ethnic/racial discrimination and ethnic/racial identity change simultaneously in adolescence. In a multiethnic sample of 211 adolescents (58% female; 41% Asian American, 10% Black, 24% Latinx, 22% White, 4% other), this study used latent change modeling to examine parallel changes in adolescents' discrimination experiences (frequency and distress) and ethnic/racial identity (private regard, centrality) from 9th to 11th grade. The year immediately following the transition into high school, from 9th to 10th grade, emerged as a challenging period with higher levels of discrimination and accompanying declines in adolescents' private regard. In contrast, from 10th to 11th grade, discrimination distress declined, and adolescents' private regard remained relatively stable. Across both time periods, parallel changes were observed for discrimination (frequency, distress) and adolescents' private regard. Implications for considering the importance of school transition, as well as individual differences by adolescent characteristics and school contexts, are discussed.

Is the exclusion of psychiatric patients from access to physician-assisted suicide discriminatory?

Advocates of physician-assisted suicide (PAS) often argue that, although the provision of PAS is morally permissible for persons with terminal, somatic illnesses, it is impermissible for patients suffering from psychiatric conditions. This claim is justified on the basis that psychiatric illnesses have certain morally relevant characteristics and/or implications that distinguish them from their somatic counterparts. In this paper, I address three arguments of this sort. First, that psychiatric conditions compromise a person's decision-making capacity. Second, that we cannot have sufficient certainty that a person's psychiatric condition is untreatable. Third, that the institutionalisation of PAS for mental illnesses presents morally unacceptable risks. I argue that, if we accept that PAS is permissible for patients with somatic conditions, then none of these three arguments are strong enough to demonstrate that the exclusion of psychiatric patients from access to PAS is justifiable.

Sources of Resilience as Mediators of the Effect of Minority Stress on Stimulant Use and Sexual Risk Behavior Among Young Black Men who have Sex with Men

The greatest proportion of new HIV infections among men who have sex with men (MSM) is occurring among young Black MSM (YBMSM) ages 13-24. Consequently, research is needed to understand the psychosocial pathways that influence HIV risk and resilience in YBMSM. Minority Stress Theory proposes that the stigma, prejudice, and discrimination facing sexual and racial minorities are chronic stressors that lead to increased engagement in risk behaviors. The present study examined whether minority stress is associated with stimulant use and sexual risk behaviors by depleting psychosocial resilience. We recruited 1817 YBMSM, ages 18-29, from multiple venues in two major cities in Texas for participation in a brief survey. Results from structural equation modeling indicated that decreased resilience partially mediated the association of minority stress with sexual risk behavior. Resilience was also negatively associated with stimulant use. Interventions focused on cultivating psychosocial resilience could mitigate the deleterious consequences of minority stress and reduce stimulant use in YBMSM.

Uncovering Unconscious Bias and Health Disparities in the Practice of Dermatology

The concept of unconscious bias has recently emerged as a possible contributor to current health disparities. A pilot study was performed to evaluate the presence of unconscious bias in dermatology, which has not yet been thoroughly examined. Our results show that some degree of unconscious bias may be present during clinical decision-making for patients of different skin tones and sex. Additional studies are needed to further characterize the role of unconscious bias in health disparities in dermatology.

Perceived Discrimination, Depression, and the Role of Perceived Social Support as an Effect Modifier in Korean Young Adults

OBJECTIVES

The relationships among discrimination, social support, and mental health have mostly been studied in minorities, and relevant studies in the general population are lacking. We aimed to investigate associations between discrimination and depressive symptoms in Korean non-minority young adults, considering the role of social support.

METHODS

In total, 372 participants who completed the psychological examinations conducted in the third wave of the Jangseong High School Cohort study were included. We used the Everyday Discrimination Scale to evaluate perceived discrimination and the Beck Depression Inventory-II to measure depressive symptoms. Social support was measured by the Multidimensional Scale of Perceived Social Support. Multivariate linear regression was conducted to investigate associations between discrimination and depression, along with the effect modification of social support. We stratified the population by gender to investigate gender differences.

RESULTS

Perceived discrimination was significantly associated with depressive symptoms (β=0.736, p<0.001), and social support was negatively associated with depression (β=-0.245, p<0.001). In men, support from friends was the most influential factor (β=-0.631, p=0.011), but no significant effect modification was found. In women, support from family was the most influential factor (β=-0.440, p=0.010), and women with higher familial support showed a significantly diminished association between discrimination and depression, unlike those with lower family support.

CONCLUSIONS

Discrimination perceived by individuals can lead to depressive symptoms in Korean young adults, and this relationship can may differ by gender and social support status.

How in-group bias influences the level of detail of speaker-specific information encoded in novel lexical representations

An important issue in theories of word learning is how abstract or context-specific representations of novel words are. One aspect of this broad issue is how well learners maintain information about the source of novel words. We investigated whether listeners' source memory was better for words learned from members of their in-group (students of their own university) than it is for words learned from members of an out-group (students from another institution). In the first session, participants saw 6 faces and learned which of the depicted students attended either their own or a different university. In the second session, they learned competing labels (e.g., citrus-peller and citrus-schiller; in English, lemon peeler and lemon stripper) for novel gadgets, produced by the in-group and out-group speakers. Participants were then tested for source memory of these labels and for the strength of their in-group bias, that is, for how much they preferentially process in-group over out-group information. Analyses of source memory accuracy demonstrated an interaction between speaker group membership status and participants' in-group bias: Stronger in-group bias was associated with less accurate source memory for out-group labels than in-group labels. These results add to the growing body of evidence on the importance of social variables for adult word learning. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Primary Care Clinician and Clinic Director Experiences of Professional Bias, Harassment, and Discrimination in an Underserved Agricultural Region of California

IMPORTANCE

Many rural and agricultural communities experience hardship from a shortage of clinicians. The aging of the clinician population threatens future supply in these areas. Developing policies to build a sustainable workforce requires the understanding of experiences from those currently in medical practice. Previous research about rural clinicians has primarily sampled non-Latinx white men, and to a lesser extent, non-Latinx white women; to date, no study has examined differences by race/ethnicity, sexual orientation, or gender identity.

OBJECTIVE

To describe the professional experiences of a diverse group of primary care clinicians and clinic directors in an underserved rural and agricultural region of California.

DESIGN, SETTING, AND PARTICIPANTS

In this qualitative study, semistructured in-depth qualitative interviews were performed with clinicians and clinic directors from December 1, 2017, to December 31, 2018, with a present or recent medical practice in the central San Joaquin Valley region of California. Participants (N = 26) consisted of physicians, nurse practitioners, and clinic directors practicing in primary care settings. Settings included solo and group private practice, academic training programs, community health centers, and rural health clinics.

MAIN OUTCOMES AND MEASURES

Personal experiences as primary care clinicians and clinic directors, and perceived associations with gender, race/ethnicity, sexual orientation, and gender identity.

RESULTS

Of 26 primary care clinicians and clinic directors interviewed, 16 (62%) identified as female, 12 (46%) identified as non-Latinx white, and 3 (12%) identified as a member of a sexual and gender minority group. Participants who self-identified as female, nonwhite, and of certain sexual orientation and gender identity minority groups described burnout from bias, harassment, and hostility in their professional relationships with colleagues and health care staff. These experiences intensified their feelings of community isolation and professional isolation. Harassment and institutional discrimination were factors in the decision of participants to change practices or exit the region entirely. Discriminatory acts against members of sexual and gender minority groups were the most severe, including threats to licensure and denial of hospital admitting privileges. In contrast to the minority group participants, the remaining participants expressed little to no awareness of these negative experiences, or the association between these experiences and retention.

CONCLUSIONS AND RELEVANCE

Professional harassment and discrimination may hamper efforts to improve clinician and clinic director recruitment and retention in underserved rural and agricultural areas and may pose barriers to addressing health disparities within those communities. Additional investigation appears to be needed to assess the extent to which professional harassment and discrimination affect clinicians and clinic directors in similar communities across the United States.

The Implicit Association Test in health professions education: A meta-narrative review

INTRODUCTION

Implicit bias is a growing area of interest among educators. Educational strategies used to elicit awareness of implicit biases commonly include the Implicit Association Test (IAT). Although the topic of implicit bias is gaining increased attention, emerging critique of the IAT suggests the need to subject its use to greater theoretical and empirical scrutiny.

METHODS

The authors employed a meta-narrative synthesis to review existing research on the use of the IAT in health professions education. Four databases were searched using key terms yielding 1151 titles. After title, abstract and full-text screening, 38 articles were chosen for inclusion. Coding and analysis of articles sought a meaningful synthesis of educational approaches relating to the IAT, and the assumptions and theoretical positions that informed these approaches.

RESULTS

Distinct, yet complementary, meta-narratives were found in the literature. The dominant perspective utilizes the IAT as a metric of implicit bias to evaluate the success of an educational activity. A contrasting narrative describes the IAT as a tool to promote awareness while triggering discussion and reflection.

DISCUSSION

Whether used as a tool to measure bias, raise awareness or trigger reflection, the use of the IAT provokes tension between distinct meta-narratives, posing a challenge to educators. Curriculum designers should consider the premise behind the IAT before using it, and be prepared to address potential reactions from learners such as defensiveness or criticism. Overall, findings suggest that educational approaches regarding implicit bias require critical reflexivity regarding assumptions, values and theoretical positioning related to the IAT.

Perceived discrimination, categorization threat, and Dominican Americans' attitudes toward African Americans

OBJECTIVES

This study examined whether members of one racial or ethnic minority group (i.e., Dominican Americans) express fewer positive attitudes toward members of a different racial or ethnic minority group (i.e., African Americans)-with which they do not identify-when they perceive that their group faces discrimination on a basis that categorizes them together with that other group (i.e., race).

METHOD

Ninety-nine Dominican-American undergraduate students (Mage = 20.23, SD = 1.64; 53% women, 18% first generation) were randomly assigned to read a brief article stating that discrimination against Dominicans was based either on language or immigrant status (n = 48) or race (n = 51). Afterward they reported their attitudes toward and similarity to African Americans.

RESULTS

Dominican-American undergraduates who perceived that they were dissimilar to African Americans expressed fewer positive attitudes toward the group when told that Dominicans face discrimination because of race as opposed to because of their language and immigrant status.

CONCLUSIONS

The study suggests that perceived discrimination from White Americans can induce categorization threat and influence intraminority relations. Members of 1 racial or ethnic minority group can express fewer positive attitudes toward members of another group with which they do not feel similar when they perceive that members of both groups face discrimination based on a shared category. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Twelve tips for responding to microaggressions and overt discrimination: When the patient offends the learner

Microaggressions and expressions of overt discrimination negatively affect the experience of medical trainees at all levels. Mistreatment of trainees, including abusive and discriminatory behavior by patients and families, occurs commonly and is receiving increased attention in both the medical literature and popular press. Heightened awareness of the problem has sparked a call to engage in substantive conversations about bias in health professions education. The emphasis on direct observation in medical education makes the bedside a common setting for educators to witness these behaviors firsthand. Many educators are committed to developing a positive climate for learners but lack the training and skills to facilitate discussions about discrimination. As a result, these difficult but important conversations may not occur. The authors present a three-phase approach to responding to microaggressions and discrimination toward trainees from patients, and offer a communication toolkit that frontline medical educators can use in their daily practice.

School Climate & Sexual and Gender Minority Adolescent Mental Health

Sexual/gender minority (Sexual/gender minority people are also referred to as Lesbian, Gay, Bisexual, Transgender, Queer) youth are more likely than cisgender heterosexual youth to exhibit depressive symptoms and be victimized. School climate research indicates that the presence of a Gay-Straight Alliance (a Gay-Straight Alliance or Gender-Sexuality Alliance is also referred to as a GSA and is a youth group to support sexual/gender minority youth), a supportive school climate, and seeking help from teachers are associated with more positive mental health outcomes; however, they are not typically measured together. This study uses a survey that measures all four measures of school environment with a national sample of 240 sexual/gender minority high school students ages 14-18 (mean age 15.77) where 53% of participants had a Gay-Straight Alliance in their school. The sample is 53% cisgender, 100% sexual minority and 62% white. Adjusting for demographics and presence of a Gay-Straight Alliance, fewer depressive symptoms were associated with lower help-seeking intentions for suicidal thoughts. The presence of Gay-Straight Alliance was not statistically associated with past-month help-seeking intentions or behaviors. Additionally, a more supportive school climate was associated with lower anxiety and depressive symptoms. However, the presence of a Gay-Straight Alliance was not statistically associated with anxiety or depressive symptoms. These findings suggest that a supportive school climate and supportive school personnel may be important for supporting the mental health of sexual/gender minority students.

Cognitive, Regulatory, and Interpersonal Mechanisms of HIV Stigma on the Mental and Social Health of Men Who Have Sex With Men Living With HIV

Public stigma surrounding HIV is related to heightened emotional distress, poor psychological functioning, and reduced subjective well-being in people living with HIV. For men who have sex with men (MSM) living with HIV, they may also face stigmatizing attitudes within the gay community, which create an additional burden to their health. Grounded in the psychological mediation framework, the present study examined the underlying psychological processes through which HIV stigma from the public and within the gay community influences the mental and social health of MSM living with HIV. Findings from 206 Chinese MSM living with HIV in Hong Kong indicated that negative self-concept, maladaptive coping, and peer isolation mediated the effect of HIV stigma on mental and social health. The study revealed the cognitive, regulatory, and interpersonal processes underlying HIV stigma and health. Feeling intense HIV stigma from the public and within the gay community may render MSM living with HIV more vulnerable to negative self-concept, maladaptive coping, and peer isolation, which contribute to poor mental and social health. To combat prejudice and discrimination against people living HIV, stigma reduction initiatives should be implemented not only in the public, but also in the gay community. Cognitive-behavioral interventions can also be used to restructure negative self-beliefs and build adaptive emotion regulation skills, which can improve stigma-related health outcomes among MSM living with HIV.

Black people are convicted more for being black than for being poor: The role of social norms and cultural prejudice on biased racial judgments

Black and poor people are more frequently convicted of committing crimes. However, the specific role played by skin color and social class in convicting a person has yet to be clarified. This article aims to elucidate this issue by proposing that belonging to a lower social class facilitates the conviction of black targets and that this phenomenon is because information about social class dissimulates racial bias. Study 1 (N = 160) demonstrated that information about belonging to the lower classes increases agreement with a criminal suspect being sentenced to prison only when described as being black. Furthermore, Studies 2 (N = 170) and 3 (N = 174) show that the anti-prejudice norm inhibits discrimination against the black target when participants were asked to express individual racial prejudice, but not when they expressed cultural racial prejudice. Finally, Study 4 (N = 134) demonstrated that lower-class black targets were discriminated against to a greater degree when participants expressed either individual or cultural prejudice and showed that this occurs when racial and class anti-prejudice norms are salient. The results suggest that social class negatively affects judgments of black targets because judgment based on lower class mitigates the racist motivation of discrimination.

The two sides of Islamophobia and the perception of threat from Islamic terrorists

There is a heightened interest concerning the understanding of prejudice toward Muslims in Europe, steadily increasing since 2001. This study aimed at investigating whether the phenomenon of Islamophobia could have two different manifestations (i.e., Islamoprejudice and Secular Critique of Islam). In particular, we assessed whether two social attitudes, Right-Wing Authoritarianism (RWA, i.e., authoritarian aggression, and conservatism) and Social Dominance Orientation (SDO), could predict differently the two dimensions. Moreover, we wanted to investigate the different influence of the two dimensions in relation to the perceived threat from terrorism. A sample of 366 Italian adults participated in the study completing a self-report questionnaire. Data were analyzed by means of a structural equation model. Results showed that RWA and SDO were differently related to Islamoprejudice and Secular Critique of Islam, suggesting that certain forms of critique of Islam should not be associated with individual prejudice, because motivated only by secular, democratic, and universalistic convictions, denoting the traces of cultural biases. However, the nonprejudicial and apparently less problematic dimension of Islamophobia, that is, Secular Critique, does not preserve people from perceiving the threat from terrorism, in the same way as Islamoprejudice. Implications are discussed.

Discrimination in healthcare settings among adults with recent HIV diagnoses

The prevalence of discrimination in healthcare settings among HIV patients in the United States is unknown. The Medical Monitoring Project (MMP) is a complex sample survey of adults receiving HIV medical care in the United States. We analyzed nationally representative MMP data collected 2011-2015. We assessed the prevalence of self-reported healthcare discrimination, perceived reasons for discrimination, and factors associated with discrimination among persons with HIV diagnoses ≤5 years before interview (n = 3,770). Overall, 14.1% of patients living with HIV (PLWH) experienced discrimination, of whom 82.2% attributed the discrimination to HIV. PLWH reporting poverty, homelessness, or attending a non-Ryan White HIV/AIDS Program (RWHAP) facility were more likely to report discrimination compared with other groups. Of patients attending non-RWHAP facilities, discrimination was higher among those in poverty (27.5%) vs. not in poverty (15.1%). Discrimination was associated with homelessness regardless of facility type, and was highest among homeless persons attending non-RWHAP facilities. Healthcare discrimination was commonly reported among PLWH, and was most often attributed to HIV status. Discrimination was higher among those reporting poverty or homelessness, particularly those attending non-RWHAP facilities. Incorporating practices, such as anti-discrimination training, in facilities may reduce healthcare discrimination.

Longitudinal associations between self-reported experiences of discrimination and depressive symptoms in young women and men post- myocardial infarction

Objectives

Research suggests that following a myocardial infarction (MI), women under the age of 60 have more elevated depressive symptoms and adverse outcomes than similarly aged men. Identifying risk factors that contribute to gender differences in depressive symptoms among this group may be critical to the development of psychosocial interventions. Experiences of discrimination may be an important correlate of depressive symptoms in this group; however, studies of this relationship have largely been cross-sectional and focused on healthy populations. This study examines longitudinal associations among gender, discrimination, and depressive symptoms in a young post-MI cohort.

Methods

Participants were 313 adults from the Myocardial Infarction and Mental Stress Ischemia Study 2 of young (≤60 yrs) post-MI patients. At baseline and 6 month follow-up, depressive symptoms were measured with the Beck Depression Inventory-II and discrimination was assessed with the 10-item version Everyday Discrimination scale. Linear regression models were used to assess the longitudinal association between reports of discrimination and depressive symptoms adjusted for sociodemographic characteristics, psychosocial factors and health status indicators and tested for gender differences.

Results

The mean age was 51.2, 49.6% were women, and 69.5% were African-American. Although the discrimination-by-gender interaction was marginally significant (p=.09) in the fully adjusted model, findings suggest that the association between changes in reports of discrimination and depressive symptoms over time may be more pronounced for women (β=.61, standard error=.15, p<.001) than men (β=.27, standard error=.13, p=.033).

Conclusion

Our findings suggest that discrimination is a risk factor for depressive symptoms in young post-MI populations over time.

"Automatic assumption of your gender, sexuality and sexual practices is also discrimination": Exploring sexual healthcare experiences and recommendations among sexually and gender diverse persons in Arctic Canada

Sexual and mental health disparities are reported in Arctic Canada as in other Arctic regions that experience shared challenges of insufficient healthcare resources, limited transportation, and a scarcity of healthcare research. Lesbian, gay, bisexual, transgender, and queer persons (LGBTQ+) report sexual and mental health disparities in comparison with their heterosexual and cisgender counterparts, and these disparities may be exacerbated in rural versus urban settings. Yet limited research has explored sexual healthcare experiences among LGBTQ+ persons in the Arctic who are at the juncture of Arctic and LGBTQ+ health disparities. We conducted a qualitative study from May 2015 to October 2015 with LGBTQ+ persons in the Northwest Territories, Canada that involved in-depth individual interviews with LGBTQ+ youth (n = 16), LGBTQ+ adults (n = 21), and key informants (e.g. coaches, teachers, nurses, social workers, and healthcare providers) (n = 14). We conducted thematic analysis, a theoretically flexible approach that integrates deductive and inductive approaches, to identify and map themes in the data. Findings reveal geographical, social, and healthcare factors converge to shape healthcare access. Specifically, the interplay between heterosexism and cisnormativity, intersectional forms of stigma, and place limited LGBTQ+ persons' sexual healthcare access and produced negative experiences in sexual healthcare. Limited healthcare facilities in small communities resulted in confidentiality concerns. Heteronormativity and cisnormativity constrained the ability to access appropriate sexual healthcare. LGBTQ+ persons experienced LGBTQ+, HIV, and sexually transmitted infections stigma in healthcare. Participants also discussed healthcare provider recommendations to better serve LGBTQ+ persons: non-judgment, knowledge of LGBTQ+ health issues, and gender inclusivity. Findings can inform multi-level strategies to reduce intersecting stigma in communities and healthcare, transform healthcare education, and build LGBTQ+ persons' healthcare navigation skills.

A Cross-Sectional Study to Investigate the Effects of Perceived Discrimination in the Health Care Setting on Pain and Depressive Symptoms in Wheelchair Users With Spinal Cord Injury

OBJECTIVES

In a sample of wheelchair users with spinal cord injury (SCI), the objectives were to investigate which participant characteristics are associated with greater perceived discrimination in the health care setting, and how such discrimination relates to health outcomes of pain and depressive symptoms.

DESIGN

Survey, cross-sectional.

SETTING

Spinal Cord Injury Model Systems (SCIMS) Center.

PARTICIPANTS

Full-time wheelchair users with SCI from 9 SCIMS centers (N=410), with data collected between 2011 and 2016.

INTERVENTIONS

N/A.

MAIN OUTCOMES

A 7-item questionnaire inquiring about perceived discrimination by hospital staff, self-reported pain severity over the past month using a 0-10 Numeric Rating Scale, and depressive symptoms using the 2-question Patient Health Questionnaire screener.

RESULTS

Participants who were black or from the lowest income group were more likely to report experiencing more discrimination than those who were white or from the highest income group, respectively (incidence rate ratio=2.2-2.6, P<.01). Those who reported more perceived discrimination had greater risk of severe pain compared to no pain (relative risk [RR]=1.11; 95% confidence interval [95% CI], 1.01-1.23; P<.05), mild depressive symptoms (RR=1.09; 95% CI, 1.02-1.17; P<.05), and severe depressive symptoms (RR=1.12; 95% CI, 1.04-1.21; P<.05) compared to no symptoms.

CONCLUSIONS

Wheelchair users with SCI who were from more disadvantaged groups (black, lower income levels) reported experiencing more discrimination in their health care setting. Furthermore, those who reported more discrimination were more likely to report worse mental and physical health outcomes. Attempts to reduce discrimination in health care settings may lead to better outcomes for people with SCI. These observations were correlational and not causal; a prospective analysis is necessary to prove causation. Future investigations should further explore the effect of discrimination on the many facets of living with an SCI.

Peer support specialists' experiences of microaggressions

Microaggressions and their consequences have been observed among people with mental illness. However, little is known about ways in which peer support specialists, those with lived experience who also provide mental health services, experience microaggressions or the impacts of these experiences. Using an online survey of open-ended questions, peer support specialists (N = 65) provided examples of microaggressions they have experienced on the job and described the frequency of these experiences, the content of messages they received, and their responses and coping strategies. Data were coded using directed content analysis. Participants across a wide range of facilities and geographic locations reported experiencing microaggressions in the workplace. The content of microaggressions fell into 2 domains: (1) negative messages about the nature of having a mental illness and disclosing this information to others and (2) negative messages about the role of peer support specialists. Peers' responses to microaggressions included feeling isolated, seeking social support, employing coping strategies, and demonstrating resiliency and increased motivation to do peer work. Some peers, however, also reported leaving positions due to these experiences. Findings indicate that microaggressions are a common experience for peer support specialists that can have a detrimental impact on their sense of self and role as mental health specialists. Despite this, peers sought out support, identified coping strategies, and exhibited resiliency. Findings have implications for ways to better support peers in their roles as support specialists. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Can immigrants counteract employer discrimination? A factorial field experiment reveals the immutability of ethnic hierarchies

How pervasive is labor market discrimination against immigrants and what options do policymakers and migrants have to reduce it? To answer these questions, we conducted a field experiment on employer discrimination in Sweden. Going beyond existing work, we test for a large range of applicant characteristics using a factorial design. We examine whether migrants can affect their employment chances—by adopting citizenship, acquiring work experience, or signaling religious practice—or whether fixed traits such as country of birth or gender are more consequential. We find little systematic evidence that immigrants can do much to reduce discrimination. Rather, ethnic hierarchies are critical: callback rates decline precipitously with the degree of ethno-cultural distance, leaving Iraqis and Somalis, especially if they are male, with much reduced employment chances. These findings highlight that immigrants have few tools at their disposal to escape ethnic penalties and that efforts to reduce discrimination must address employer prejudice.