1
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Davison GC, Walden KR. History and Iatrogenic Effects of Conversion Therapy. Annu Rev Clin Psychol 2024; 20:333-354. [PMID: 38237038 DOI: 10.1146/annurev-clinpsy-080822-052144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2024]
Abstract
Research indicates that sexual orientation change efforts (SOCEs) are not effective and furthermore commonly lead to iatrogenic effects such as depression, anxiety, and even suicide. Negative attitudes toward homosexuality derive from most formal religions and are incarnated in medical and psychological theories that support and encourage SOCEs. Oppression of sexual minorities makes it unlikely that change requests by patients are voluntary. Recently there has been a dramatic change as the field moves from reparative to affirmative approaches. Here, we review the history of SOCEs, their consequences, current affirmative treatments, and future directions in the field as they pertain to the well-being of the queer community. From an institutional community psychology perspective, we argue that even if true conversion were possible, such efforts are unethical and should not be pursued even if requested. As is the case with all psychological/psychiatric interventions, the issue is not "can" but "ought."
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Affiliation(s)
- Gerald C Davison
- Department of Psychology, University of Southern California, Los Angeles, California, USA;
| | - Kyla-Rose Walden
- Department of Psychology, University of Southern California, Los Angeles, California, USA;
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2
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Wang XX, Cosquer M, Zhuang M, Ali A, Falissard B, Corruble E, Gressier F, Jousselme C. The role of parents' and friends' support in preventing suicide attempts among French sexual minority adolescents. Rev Epidemiol Sante Publique 2023; 71:101594. [PMID: 36966599 DOI: 10.1016/j.respe.2023.101594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 12/27/2022] [Accepted: 02/14/2023] [Indexed: 05/16/2023] Open
Abstract
OBJECTIVES French sexual minority adolescents are at higher risk for suicide attempts than their heterosexual peers. However, little is known about the role of parents' and friends' support among French lesbian, gay and bisexual (LGB) youth. This study aimed to research the role of their support in preventing suicide attempts among LGB adolescents in France. MATERIALS AND METHODS Data were drawn from a French cross-sectional study entitled "Portraits d'adolescents". Parental support was defined by satisfactory relations between participants and their parents. Friends' support was defined by satisfactory relations between participants and their friends. Chi-square and multiple logistic regression analyses were used to estimate and identify associated factors of suicide attempts in LGB as opposed to heterosexual youth. RESULTS Data from a sample of 14,265 French adolescents aged 13 to 20 were analyzed. Among them, 637 (4.47%) identified as LGB. Attempted suicide was independently associated with sexual orientation (30.7% vs 10.6%; OR = 2.59 [2.11-3.18]; p < 0.0001). Both parents' and friends' support appeared to be protective factors in suicide attempts among heterosexuals (adjusted ORs = 0.40 [0.35-0.46] and 0.61 [0.51-0.75], respectively), whereas in the LGB group, only parental support was significant (adjusted OR = 0.42 [0.27-0.65]), independently of other variables. DISCUSSION Prevention efforts might be carried out by identifying within-group differences among French adolescents with different sexual orientations. The supportive role of family members should be strengthened. Positive resources and salutary support systems may effectively prevent suicide attempts. CONCLUSIONS French LGB adolescents have a higher risk for suicide attempts than their heterosexual peers. Parental support was reconfirmed as a major protective factor against suicide attempts in sexual minority adolescents.
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Affiliation(s)
- Xavier Xu Wang
- CESP, U1018, Moods Team, Paris-Saclay University, Bicêtre University Hospital, Le Kremlin Bicêtre, France; Centre Hospitalier Fondation Vallée, Gentilly, France.
| | - Mireille Cosquer
- CESP, U1018, Moods Team, Paris-Saclay University, Bicêtre University Hospital, Le Kremlin Bicêtre, France; Centre Hospitalier Fondation Vallée, Gentilly, France
| | - Min Zhuang
- Saint Louis University, 1 N. Grand Blvd. St. Louis, MO 63103, USA
| | - Aminata Ali
- CESP, U1018, Moods Team, Paris-Saclay University, Bicêtre University Hospital, Le Kremlin Bicêtre, France; Fondation Santé des Etudiants de France (FSEF), 75014, Paris, France
| | - Bruno Falissard
- CESP, U1018, Moods Team, Paris-Saclay University, Bicêtre University Hospital, Le Kremlin Bicêtre, France
| | - Emmanuelle Corruble
- CESP, U1018, Moods Team, Paris-Saclay University, Bicêtre University Hospital, Le Kremlin Bicêtre, France; Department of Psychiatry, Bicêtre University Hospital, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Saclay, Le Kremlin-Bicêtre, France
| | - Florence Gressier
- CESP, U1018, Moods Team, Paris-Saclay University, Bicêtre University Hospital, Le Kremlin Bicêtre, France; Department of Psychiatry, Bicêtre University Hospital, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Saclay, Le Kremlin-Bicêtre, France
| | - Catherine Jousselme
- CESP, U1018, Moods Team, Paris-Saclay University, Bicêtre University Hospital, Le Kremlin Bicêtre, France; Centre Hospitalier Fondation Vallée, Gentilly, France
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3
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Broadway-Horner M, Kar A. "Our feelings are valid" - reviewing the lesbian, gay, and bisexual affirmative approaches in a mental health setting. Int Rev Psychiatry 2022; 34:376-382. [PMID: 36151835 DOI: 10.1080/09540261.2022.2033180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
In recent years, although research into support mechanisms for managing distress experienced by Lesbian Gay and Bisexual (LGB) communities has increased. Stigma-related discrimination related to sexual minority status remains. This is further compounded by stigma against mental illnesses thus creating double jeopardy. This review will outline recent discoveries by exploring existing theories highlighting factors that explain health disparities for cisgender LGB people. It appears that the experience of the LGB population and the use of psychological therapies is varied across the spectrum. Some focus upon symptom reduction as part of the experience, but others talk about not being validated. Some mention minority stress constructs, alongside the psychological mediation framework, which offers a potential theoretical understanding of the experiences of the LGB population who receive psychological therapies.
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Affiliation(s)
| | - Anindya Kar
- Advanced Neuropsychiatry Institute, Kolkata, India
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4
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O'Reilly LM, Pettersson E, Donahue K, Quinn PD, Klonsky ED, Lundström S, Larsson H, Lichtenstein P, D'Onofrio BM. Sexual orientation and adolescent suicide attempt and self-harm: a co-twin control study. J Child Psychol Psychiatry 2021; 62:834-841. [PMID: 32924137 DOI: 10.1111/jcpp.13325] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 06/25/2020] [Accepted: 08/06/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Research has demonstrated that individuals who identify as a sexual minority (e.g., gay/lesbian, bisexual) are at increased risk for suicidality-related outcomes. However, previous research is primarily limited by the lack of adjustment for unmeasured (i.e., genetic and environmental) confounding factors and previous psychopathology. METHODS Using the Child and Adolescent Twin Study in Sweden, we employed a co-twin control design to examine the extent to which the association between sexual orientation and adolescent suicide attempt and self-harm (SA/SH) was independent of genetic and environmental factors shared by twins, as well as measured symptoms of childhood psychopathology. RESULTS Adolescents who identified as a sexual minority (i.e., gay/lesbian, bisexual, or other sexual orientation) were at two-fold increased odds for SA/SH (OR, 2.01 [95% confidence interval, 1.63-2.49) compared to heterosexual adolescents. When adjusting for all genetic and shared environmental factors that make twins similar and for measured childhood psychopathology, the association remained positive but attenuated to OR, 1.55 (1.11-2.16). CONCLUSIONS Identifying as a sexual minority was associated with approximately 50% increased odds of SA/SH in adolescence after adjusting for unmeasured genetic and environmental factors shared by twins and for childhood psychopathology. The results support that environmental factors specifically associated with identifying as a sexual minority likely increase risk for SA/SH. Our findings highlight the need to monitor suicidality risk among this group.
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Affiliation(s)
- Lauren M O'Reilly
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA
| | - Erik Pettersson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Kelly Donahue
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Patrick D Quinn
- Department of Applied Health Science, School of Public Health, Indiana University, Bloomington, IN, USA
| | - E David Klonsky
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Sebastian Lundström
- Department of Psychiatry and Neurochemistry, University of Gothenburg, Gothenburg, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Brian M D'Onofrio
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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5
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Lynch KE, Gatsby E, Viernes B, Schliep KC, Whitcomb BW, Alba PR, DuVall SL, Blosnich JR. Evaluation of Suicide Mortality Among Sexual Minority US Veterans From 2000 to 2017. JAMA Netw Open 2020; 3:e2031357. [PMID: 33369662 PMCID: PMC7770555 DOI: 10.1001/jamanetworkopen.2020.31357] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
IMPORTANCE Identification of subgroups at greatest risk for suicide mortality is essential for prevention efforts and targeting interventions. Sexual minority individuals may have an increased risk for suicide compared with heterosexual individuals, but a lack of sufficiently powered studies with rigorous methods for determining sexual orientation has limited the knowledge on this potential health disparity. OBJECTIVE To investigate suicide mortality among sexual minority veterans using Veterans Health Administration (VHA) electronic health record data. DESIGN, SETTING, AND PARTICIPANTS This retrospective population-based cohort study used data on 8.1 million US veterans enrolled in the VHA after fiscal year 1999 that were obtained from VHA electronic health records from October 1, 1999 to September 30, 2017. Data analysis was carried out from March 1, 2020 to October 31, 2020. EXPOSURE Veterans with documentation of a minority sexual orientation. Documentation of sexual minority status was obtained through natural language processing of clinical notes and extraction of structured administrative data for sexual orientation in VHA electronic health records. MAIN OUTCOMES AND MEASURES Suicide mortality rate using data on the underlying cause of death obtained from the National Death Index. Crude and age-adjusted mortality rates were calculated for all-cause death and death from suicide among sexual minority veterans compared with the general US population and the general population of veterans. RESULTS Among the 96 893 veterans with at least 1 sexual minority documentation in the electronic health record, the mean (SD) age was 46 (16) years, 68% were male, and 70% were White. Of the 12 591 total deaths, 3.5% were from suicide. Veterans had a significantly higher rate of mortality from suicide (standardized mortality ratio, 4.50; 95% CI, 4.13-4.99) compared with the general US population. Suicide was the fifth leading cause of death in 2017 among sexual minority veterans (3.8% of deaths) and the tenth leading cause of death in the general US population (1.7% of deaths). The crude suicide rate among sexual minority veterans (82.5 per 100 000 person-years) was higher than the rate in the general veteran population (37.7 per 100 000 person-years). CONCLUSIONS AND RELEVANCE The results of this population-based cohort study suggest that sexual minority veterans have a greater risk for suicide than the general US population and the general veteran population. Further research is needed to determine whether and how suicide prevention efforts reach sexual minority veterans.
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Affiliation(s)
- Kristine E. Lynch
- Veterans Affairs (VA) Informatics and Computing Infrastructure, VA Salt Lake City Health Care System, Salt Lake City, Utah
- Division of Epidemiology, Department of Internal Medicine, The University of Utah, Salt Lake City
| | - Elise Gatsby
- Veterans Affairs (VA) Informatics and Computing Infrastructure, VA Salt Lake City Health Care System, Salt Lake City, Utah
| | - Benjamin Viernes
- Veterans Affairs (VA) Informatics and Computing Infrastructure, VA Salt Lake City Health Care System, Salt Lake City, Utah
- Division of Epidemiology, Department of Internal Medicine, The University of Utah, Salt Lake City
| | - Karen C. Schliep
- Veterans Affairs (VA) Informatics and Computing Infrastructure, VA Salt Lake City Health Care System, Salt Lake City, Utah
- Department of Family and Preventive Medicine, The University of Utah, Salt Lake City
| | - Brian W. Whitcomb
- Department of Public Health and Health Sciences, University of Massachusetts, Amherst
| | - Patrick R. Alba
- Veterans Affairs (VA) Informatics and Computing Infrastructure, VA Salt Lake City Health Care System, Salt Lake City, Utah
- Division of Epidemiology, Department of Internal Medicine, The University of Utah, Salt Lake City
| | - Scott L. DuVall
- Veterans Affairs (VA) Informatics and Computing Infrastructure, VA Salt Lake City Health Care System, Salt Lake City, Utah
- Division of Epidemiology, Department of Internal Medicine, The University of Utah, Salt Lake City
| | - John R. Blosnich
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
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6
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Malta M, Gomes de Jesus J, LeGrand S, Seixas M, Benevides B, Silva MDD, Lana JS, Huynh HV, Belden CM, Whetten K. 'Our life is pointless … ': Exploring discrimination, violence and mental health challenges among sexual and gender minorities from Brazil. Glob Public Health 2020; 15:1463-1478. [PMID: 32436430 DOI: 10.1080/17441692.2020.1767676] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Worldwide, Brazil has the highest prevalence of violence and hate crimes against sexual and gender minorities (SGMs) among countries with available data. To explore the impact of this scenario, we conducted a qualitative study with 50 SGMs from Rio de Janeiro, Brazil. Among the participants, 66% screened positive for generalised anxiety disorder, 46% for major depressive disorder and 39% for PTSD. A third reported low self-esteem (32%) and one quarter low social support (26%). Experiences of interpersonal discrimination were highly prevalent (>60%), while institutional discrimination related to employment or healthcare was reported by 46% of participants. Verbal abuse is very common (80%), followed by physical assault (40%). Sexual violence is highly frequent among women. Focus groups analysis highlighted three major domains: (1) stigma and discrimination (family, friends and partners, in schools and health services, influencing social isolation); (2) violence (bullying, harassment, physical and sexual violence); and (3) mental suffering (alcohol and drug abuse, depression, suicidality, anxiety). Our findings suggest a close synergy between experiences of discrimination and violence with selected mental disorders. This complex synergy might be better addressed by longer-term individual and group-level interventions that could foster social solidarity among the different groups that comprise SGMs.
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Affiliation(s)
- Monica Malta
- Faculty of Medicine, Department of Psychiatry, University of Toronto, Toronto, Canada.,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada.,Department of Social Science, National School of Public Health, Oswaldo Cruz Foundation (ENSP/FIOCRUZ), Rio de Janeiro, Brazil
| | - Jaqueline Gomes de Jesus
- Rio de Janeiro Federal Institute of Education, Science and Technology, Rio de Janeiro, Brazil.,Center for Health Policies and Inequalities Research, Duke Global Health Institute, Duke University, Durham, NC, USA.,Leader-Researcher of ODARA - Group of Interdisciplinary Research on Culture, Diversity and Identity, National Council for Scientific and Technological Development (CNPq), Brasilia, Brazil
| | - Sara LeGrand
- Center for Health Policies and Inequalities Research, Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Michele Seixas
- UN Women Brazil, Civil Society Advisory Group, Brasilia, Brazil.,Felipa de Sousa Women's Group, Rio de Janeiro, Brazil
| | - Bruna Benevides
- National Association of Travestis and Transsexuals (ANTRA), Salvador, Brazil
| | - Maria das Dores Silva
- Department of Social Science, National School of Public Health, Oswaldo Cruz Foundation (ENSP/FIOCRUZ), Rio de Janeiro, Brazil
| | - Jonas Soares Lana
- Rio de Janeiro Federal Institute of Education, Science and Technology, Rio de Janeiro, Brazil
| | - Hy V Huynh
- Center for Health Policies and Inequalities Research, Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Charles M Belden
- Center for Health Policies and Inequalities Research, Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Kathryn Whetten
- Center for Health Policies and Inequalities Research, Duke Global Health Institute, Duke University, Durham, NC, USA
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7
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Halkitis PN, Maiolatesi AJ, Krause KD. The Health Challenges of Emerging Adult Gay Men: Effecting Change in Health Care. Pediatr Clin North Am 2020; 67:293-308. [PMID: 32122561 PMCID: PMC8690571 DOI: 10.1016/j.pcl.2019.12.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
This article focuses on the health and health care challenges experienced by young and emerging adult gay men. Evidence is provided on the extent to which young and emerging adult gay men are disproportionally burdened by multidimensional health disparities, barriers to health care access, and inadequate provider-patient interactions. Recommendations are provided for health care providers and public health officials working with populations of emerging adult gay men that might have the greatest overall impact on improving this population's well-being and access to competent health care by increasing providers' awareness of the unique needs of young and emerging adult gay men.
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Affiliation(s)
- Perry N. Halkitis
- Center for Health, Identity, Behavior & Prevention Studies, Rutgers School of Public Health, One Riverfront Plaza, Newark, NJ 07102, USA,Department of Biostatistics, Rutgers School of Public Health, 683 Hoes Lane West, Piscataway, NJ 08854, USA,Department of Urban-Global Health, Rutgers School of Public Health, 683 Hoes Lane West, Piscataway, NJ 08854, USA,Corresponding author. Departments of Biostatistics, Epidemiology and Urban-Global Health, School of Public Health, Rutgers University, 683 Hoes Lane West, Piscataway, NJ 08854.
| | - Anthony J. Maiolatesi
- Center for Health, Identity, Behavior & Prevention Studies, Rutgers School of Public Health, One Riverfront Plaza, Newark, NJ 07102, USA,Department of Social and Behavioral Sciences, Yale School of Public Health, 60 College Street, New Haven, CT 06510, USA,Center for Interdisciplinary Research on AIDS, Yale University, 135 College Street, New Haven, CT 06510, USA
| | - Kristen D. Krause
- Center for Health, Identity, Behavior & Prevention Studies, Rutgers School of Public Health, One Riverfront Plaza, Newark, NJ 07102, USA,Department of Health Behavior, Society, and Policy, Rutgers School of Public Health, 683 Hoes Lane West, Piscataway, NJ 08854, USA
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8
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Hopwood M, Cama E, de Wit J, Treloar C. Stigma, Anxiety, and Depression Among Gay and Bisexual Men in Mixed-Orientation Marriages. QUALITATIVE HEALTH RESEARCH 2020; 30:622-633. [PMID: 31315511 DOI: 10.1177/1049732319862536] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The mental health of gay and bisexual men in mixed-orientation marriages is poorly understood. In this article, the authors explore the development of anxiety and depression among gay and bisexual men in heterosexual marriages. Sixteen men, living in the Australian states of New South Wales, Queensland, Victoria, and Tasmania were interviewed throughout 2016 and 2017. An analysis of interviews identified four main themes, namely, compulsory heterosexuality, existential distress, compartmentalization, and integration and resolution. Participants reported experiencing anxiety and depression, which were exacerbated by the stigmatization of same-sex attraction and by an overwhelming distress from feelings of shame and guilt regarding their marital infidelity. Findings indicate that gay and bisexual men in mixed-orientation marriages develop anxiety and depression in response to the exigencies of compulsory heterosexuality and the compartmentalizing of same-sex attraction and identity during heterosexual marriage. Coming-out as same-sex attracted resolved men's distress by facilitating an integrative self-structure.
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Affiliation(s)
- Max Hopwood
- UNSW Sydney, Sydney, New South Wales, Australia
| | - Elena Cama
- UNSW Sydney, Sydney, New South Wales, Australia
| | - John de Wit
- UNSW Sydney, Sydney, New South Wales, Australia
- Utrecht University, Utrecht, The Netherlands
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9
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Frimpong EY, Rowan GA, Williams D, Li M, Solano L, Chaudhry S, Radigan M. Health Disparities, Inpatient Stays, and Emergency Room Visits Among Lesbian, Gay, and Bisexual People: Evidence From a Mental Health System. Psychiatr Serv 2020; 71:128-135. [PMID: 31590623 DOI: 10.1176/appi.ps.201900188] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE This study examined differences in health outcomes and acute service use between lesbian, gay, and bisexual (LGB) individuals and a matched heterosexual control group. METHODS Individuals ages 18 to 85 whose electronic health records indicated a sexual orientation as LGB and who were included in the 2015 New York State Office of Mental Health Patient Characteristics Survey (N=5,775) were matched with heterosexuals (N=5,775) by sex assigned at birth, age, race, Hispanic ethnicity, and county of residence and compared on health status indicators, conditions and behaviors, and acute service use. Generalized estimating equation models were used to estimate the odds and rates of acute service use. RESULTS LGB individuals appeared to have more chronic general medical conditions and physical disabilities and tended to use fewer acute services compared with heterosexuals. Gay men and lesbians were significantly less likely than heterosexuals to have used a mental health-related inpatient service (adjusted odds ratio [AOR]=0.69, 95% confidence interval [CI]=0.57-0.85; and AOR=0.73, 95% CI=0.59-0.89 [respectively]) or emergency room (ER) service in the past 12 months (AOR=0.63, 95% CI=0.53-0.76; and AOR=0.79, 95% CI=0.66-0.94 [respectively]). Bisexual men and women were more likely than heterosexuals to have shorter substance use-related inpatient stays (rate ratio [RR]=0.65, 95% CI=0.47-0.90; and RR=0.66, 95% CI=0.51-0.86 [respectively]) and to have fewer substance use-related ER visits (RR=0.69, 95% CI=0.48-0.99; and RR=0.55, 95% CI=0.43-0.69 [respectively]). CONCLUSIONS The health care system needs strategies in LGB-centered care, research, medical education, health policy, and evidence-based practices to engage sexual minority groups in mental health and general medical care.
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Affiliation(s)
- Eric Y Frimpong
- New York State Office of Mental Health, Albany (Frimpong, Rowan, Li, Solano, Chaudhry, Radigan); New York State Department of Health, Albany (Williams)
| | - Grace A Rowan
- New York State Office of Mental Health, Albany (Frimpong, Rowan, Li, Solano, Chaudhry, Radigan); New York State Department of Health, Albany (Williams)
| | - David Williams
- New York State Office of Mental Health, Albany (Frimpong, Rowan, Li, Solano, Chaudhry, Radigan); New York State Department of Health, Albany (Williams)
| | - Mengxuan Li
- New York State Office of Mental Health, Albany (Frimpong, Rowan, Li, Solano, Chaudhry, Radigan); New York State Department of Health, Albany (Williams)
| | - Louis Solano
- New York State Office of Mental Health, Albany (Frimpong, Rowan, Li, Solano, Chaudhry, Radigan); New York State Department of Health, Albany (Williams)
| | - Sahil Chaudhry
- New York State Office of Mental Health, Albany (Frimpong, Rowan, Li, Solano, Chaudhry, Radigan); New York State Department of Health, Albany (Williams)
| | - Marleen Radigan
- New York State Office of Mental Health, Albany (Frimpong, Rowan, Li, Solano, Chaudhry, Radigan); New York State Department of Health, Albany (Williams)
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10
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Liu RT, Bettis AH, Burke TA. Characterizing the phenomenology of passive suicidal ideation: a systematic review and meta-analysis of its prevalence, psychiatric comorbidity, correlates, and comparisons with active suicidal ideation. Psychol Med 2020; 50:367-383. [PMID: 31907085 PMCID: PMC7024002 DOI: 10.1017/s003329171900391x] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Compared to active ideation, passive ideation remains relatively understudied and its clinical importance poorly defined. The weight that should be accorded passive ideation in clinical risk assessment is therefore unclear. METHODS We conducted a systematic review and meta-analysis of the prevalence of passive ideation, its psychiatric comorbidity, associated sociodemographic characteristics, as well as psychological and environmental correlates. For reference, pooled effects were also calculated for direct comparisons of passive and active ideation with respect to potential correlates. Relevant articles published since inception to 9 September 2019 were identified through a systematic search of MEDLINE and PsycINFO. RESULTS A total of 86 studies were included in this review. The prevalence of passive ideation was high across sample types, ranging from 5.8% for 1-year prevalence to 10.6% for lifetime prevalence in the general population. Passive ideation was strongly associated with sexual minority status, psychiatric comorbidity, psychological characteristics implicated in risk, and suicide attempts. Preliminary evidence exists for a large association with suicide deaths. The effect sizes for individual correlates of passive and active ideation were largely equivalent and mostly non-significant in head-to-head comparisons. CONCLUSIONS Passive ideation is a prevalent clinical phenomenon associated with significant psychiatric comorbidity. Current evidence also suggests notable similarities exist between passive and active ideation in terms of psychiatric comorbidity and psychological and other characteristics traditionally associated with risk.
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Affiliation(s)
- Richard T Liu
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Bradley Hospital, 1011 Veterans Memorial Parkway, East Providence, RI02915, USA
| | - Alexandra H Bettis
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Bradley Hospital, 1011 Veterans Memorial Parkway, East Providence, RI02915, USA
| | - Taylor A Burke
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Bradley Hospital, 1011 Veterans Memorial Parkway, East Providence, RI02915, USA
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11
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Bränström R, van der Star A, Pachankis JE. Untethered lives: barriers to societal integration as predictors of the sexual orientation disparity in suicidality. Soc Psychiatry Psychiatr Epidemiol 2020; 55:89-99. [PMID: 31300892 DOI: 10.1007/s00127-019-01742-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 06/24/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Despite increasing legal protections and supportive attitudes toward sexual minorities (e.g., those who identify as lesbian, gay, and bisexual [LGB]) in recent decades, suicidality remains more common among this population than among heterosexuals. While barriers to societal integration-or a lack of meaning, purpose, and belonging as derived from societal norms, goals, and attachment-have been widely theorized as determinants of suicidality for the general population, they have not been comprehensively explored to explain the sexual orientation disparity in suicidality. The aim of this study was to examine differences in suicidal ideation and attempts between LGB and heterosexual individuals in a nationally representative sample, and to examine barriers to societal integration as a potential explanation for any observed disparities over-and-above the influence of established contributors to sexual orientation disparity in suicidality. METHODS Data come from the cross-sectional Swedish National Public Health Survey, which collected data from unrestricted random samples of individuals (16-84 years of age) living in Sweden, annually from 2010 to 2015 (n = 57,840 individuals [response rates: 48.1-51.3%]; 1281 (2.2%) self-identified as LGB). Analyses examined sexual orientation differences in suicidality (i.e., past-12-month ideation and attempts), and explored the role of barriers to societal integration (i.e., not living with a partner or children, unemployment, and lack of societal trust) in explaining this disparity over-and-above more commonly explored psychological (e.g., depression, substance use) and interpersonal (e.g., discrimination, victimization, lack of social support) suicidality risk factors. RESULTS Compared to heterosexuals, suicidal ideation and attempts were more common among both gay men/lesbians (adjusted odds ratio [AOR] for suicide ideation: 2.69; 95% confidence intervals [CI]: 2.09, 3.47; AOR for suicide attempts: 5.50; 95% CI: 3.42, 8.83), and bisexuals (AOR for suicide ideation: 3.83; 95% CI: 3.26, 4.51; AOR suicide attempts: 6.78; 95% CI: 4.97, 9.24). Barriers to societal integration mediated the association between sexual orientation and suicidality even in models adjusting for established risk factors for suicidality. CONCLUSION Our results suggest that previously under-examined factors, namely the disproportionate barriers to societal integration that LGB individuals experience, are important contributors to the substantially elevated risk of suicidality among sexual minorities. Preventive interventions should consider innovative ways to foster societal integration within sexual minority populations and to adjust hetero-centric social institutions to better include sexual minority individuals.
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Affiliation(s)
- Richard Bränström
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA. .,Department of Clinical Neuroscience, Karolinska Institutet, Nobels väg 9, 171 77, Stockholm, Sweden.
| | - Arjan van der Star
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA.,Department of Clinical Neuroscience, Karolinska Institutet, Nobels väg 9, 171 77, Stockholm, Sweden
| | - John E Pachankis
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
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Barbonetti A, D’Andrea S, Cavallo F, Martorella A, Francavilla S, Francavilla F. Erectile Dysfunction and Premature Ejaculation in Homosexual and Heterosexual Men: A Systematic Review and Meta-Analysis of Comparative Studies. J Sex Med 2019; 16:624-632. [DOI: 10.1016/j.jsxm.2019.02.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 01/29/2019] [Accepted: 02/22/2019] [Indexed: 01/23/2023]
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13
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Sexual orientation and mental health among adults in four U.S. cities. Psychiatry Res 2019; 273:134-140. [PMID: 30641343 DOI: 10.1016/j.psychres.2018.12.092] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 12/17/2018] [Accepted: 12/17/2018] [Indexed: 11/24/2022]
Abstract
Sexual minorities have higher risk for psychological distress than heterosexual populations. However, this disparity remains under-studied in urban settings, and there likewise has been minimal prior research of potential interactions with gender and race/ethnicity. The present study aimed to examine mental health correlates of sexual minority identification in conjunction with gender and race/ethnicity. A community sample of 1,615 adults from four eastern cities in the United States was used. A series of regression analyses were conducted to examine differences in psychological distress and suicidal ideation across different sexual orientation populations. The results showed that only bisexual individuals had significantly higher psychological distress and risk for suicidal ideation than heterosexual individuals even after adjusting for age and income. The associations were consistent across gender and race/ethnicity. No significant differences between homosexual and heterosexual individuals were found. Health professionals working with people of bisexual orientation in urban settings should attend to potential psychological distress and recent suicidal ideation.
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Salway T, Plöderl M, Liu J, Gustafson P. Effects of Multiple Forms of Information Bias on Estimated Prevalence of Suicide Attempts According to Sexual Orientation: An Application of a Bayesian Misclassification Correction Method to Data From a Systematic Review. Am J Epidemiol 2019; 188:239-249. [PMID: 30188991 DOI: 10.1093/aje/kwy200] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 08/27/2018] [Indexed: 11/13/2022] Open
Abstract
Multiple epidemiologic studies demonstrate a disparity in suicide risk between sexual minority (lesbian, gay, bisexual) and heterosexual populations; however, both "exposure" (sexual minority status) and outcome (suicide attempts) may be affected by information bias related to errors in self-reporting. We therefore applied a Bayesian misclassification correction method to account for possible information biases. A systematic literature search identified studies of lifetime suicide attempts in sexual minority and heterosexual adults, and frequentist meta-analysis was used to generate unadjusted estimates of relative risk. A Bayesian model accounting for prior information about sensitivity and specificity of exposure and outcome measures was used to adjust for misclassification biases. In unadjusted frequentist analysis, the relative risk of lifetime suicide attempt comparing sexual minority with heterosexual groups was 3.38 (95% confidence interval: 2.65, 4.32). In Bayesian reanalysis, the estimated prevalence was slightly reduced in heterosexual adults and increased in sexual minority adults, yielding a relative risk of 4.67 (95% credible interval: 3.94, 5.73). The disparity in lifetime suicide attempts between sexual minority and heterosexual adults is greater than previously estimated, when accounting for multiple forms of information bias. Additional research on the impact of information bias in studies of sexual minority health should be pursued.
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Affiliation(s)
- Travis Salway
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Martin Plöderl
- Department of Crisis Intervention and Suicide Prevention, Paracelsus Medical University, Salzburg, Austria
- Department of Clinical Psychology, University Clinic of Psychiatry, Psychotherapy, and Psychosomatics, Paracelsus Medical University, Salzburg, Austria
| | - Juxin Liu
- Department of Mathematics and Statistics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Paul Gustafson
- Department of Statistics, University of British Columbia, Vancouver, British Columbia, Canada
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Timmins L, Rimes KA, Rahman Q. Minority stressors, rumination, and psychological distress in monozygotic twins discordant for sexual minority status. Psychol Med 2018; 48:1705-1712. [PMID: 29108521 DOI: 10.1017/s003329171700321x] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Lesbian, gay, and bisexual (LGB) individuals report higher levels of depression and anxiety than heterosexual people. Genetic factors may be a 'common cause' of sexual minority status and psychological distress. Alternatively, these may be correlated because of non-genetic environmental factors (e.g. minority stressors). This study investigated minority stressors and distress in monozygotic twins discordant for sexual minority status. This design provides a test of the role of non-shared environmental factors while minimizing differences due to genetics. METHODS Thirty-eight twin pairs in which one was heterosexual and the other was LGB completed a survey. Differences between twin pairs in minority stressors, rumination, psychological distress, and gender non-conformity were examined. Associations between these variables were also tested. RESULTS Although there were no significant group differences for distress, LGB twins had higher rumination, a vulnerability factor for distress, than heterosexual co-twins. LGB twins also had higher scores than heterosexual co-twins on expectations of rejection, active concealment, self-stigma, prejudice events, childhood gender non-conformity, and lower scores on sexual orientation disclosure. Differences between twin pairs in rumination were positively associated with differences in acceptance concerns and self-stigma. Finally, self-stigma was positively associated with rumination in the full sample of heterosexual co-twins and microaggressions were positively associated with rumination when looking at exclusively heterosexual co-twins. CONCLUSIONS These results support environmental factors as a causal explanation for disparities in rumination between LGB and heterosexual individuals. These factors likely include minority stressors. Rumination may also be associated with minority stressors in heterosexual MZ co-twins of LGB individuals.
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Affiliation(s)
- Liam Timmins
- Department of Psychology,Institute of Psychiatry, Psychology and Neuroscience, King's College London,5th Floor, Bermondsey Wing,Guy's Hospital Campus,London SE1 9RT,UK
| | - Katharine A Rimes
- Department of Psychology,Institute of Psychiatry, Psychology and Neuroscience, King's College London,5th Floor, Bermondsey Wing,Guy's Hospital Campus,London SE1 9RT,UK
| | - Qazi Rahman
- Department of Psychology,Institute of Psychiatry, Psychology and Neuroscience, King's College London,5th Floor, Bermondsey Wing,Guy's Hospital Campus,London SE1 9RT,UK
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Flores D, McKinney R, Arscott J, Barroso J. Obtaining waivers of parental consent: A strategy endorsed by gay, bisexual, and queer adolescent males for health prevention research. Nurs Outlook 2018; 66:138-148. [PMID: 28993074 PMCID: PMC5857413 DOI: 10.1016/j.outlook.2017.09.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 09/05/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Requiring parental consent in studies with sexual minority youth (SMY) can sometimes be problematic as participants may have yet to disclose their sexual orientation, may not feel comfortable asking parents' permission, and may promote a self-selection bias. PURPOSE We discuss rationale for waiving parental consent, strategies to secure waivers from review boards, and present participants' feedback on research without parents' permission. METHODS We share our institutional review board proposal in which we made a case that excluding SMY from research violates ethical research principles, does not recognize their autonomy, and limits collection of sexuality data. DISCUSSION Standard consent policies may inadvertently exclude youth who are at high risk for negative health outcomes or may potentially put them at risk because of forced disclosure of sexual orientation. Securing a waiver addresses these concerns and allows for rich data, which is critical for providers to have a deeper understanding of their unique sexual health needs. CONCLUSION To properly safeguard and encourage research informed by SMY, parental consent waivers may be necessary.
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Affiliation(s)
| | - Ross McKinney
- Association of American Medical Colleges, Washington, DC
| | | | - Julie Barroso
- Medical University of South Carolina School of Nursing, Charleston, SC
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Sutter M, Perrin PB, Trujillo MA. Understanding the association between discrimination and depression among sexual minority people of color: Evidence for diminishing returns of socioeconomic advantage. J Clin Psychol 2017; 74:940-952. [PMID: 29139126 DOI: 10.1002/jclp.22558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 09/02/2017] [Accepted: 09/05/2017] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To examine the differential association of heterosexism and racism on depression as moderated by socioeconomic status (SES) among sexual minority people of color. METHOD A cross-sectional sample of sexual minority people of color (n = 170) was surveyed on their experiences of heterosexism, racism, depression, and SES in a national online study based in the United States. RESULTS Bivariately, SES was inversely associated with depression, racism, and heterosexism. Moderation analyses found that for individuals with less socioeconomic advantage, the associations between heterosexism and depression were not as strong. However, at higher socioeconomic advantage, heterosexism was more strongly positively associated with depression. CONCLUSION These results suggest that the effects of discrimination on depression in sexual minority individuals of color may be accentuated at higher socioeconomic levels. Implications suggest helping sexual minority clients of color from higher SES backgrounds explore the effects of discrimination on their mental health.
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Yüksel Ş, Aslantaş Ertekin B, Öztürk M, Bikmaz PS, Oğlağu Z. A Clinically Neglected Topic: Risk of Suicide in Transgender Individuals. Noro Psikiyatr Ars 2017; 54:28-32. [PMID: 28566955 DOI: 10.5152/npa.2016.10075] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 11/13/2015] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The aim of this study was to determine whether adolescence of transgender individuals is characterized by a high risk of suicide. METHODS In total, 141 participants with transgenderism were questioned using a semi-structured interview to determine whether participants had current suicidal thoughts, had a lifetime history of such thoughts, or had attempted suicide. These findings were cross-referenced to the participants' sociodemographic characteristics, and information about their families' general attitudes toward sexuality, gender identity, and commitment to religious views. In total, 101 participants attended group psychotherapy sessions for at least a year. In these sessions, family and partner relationships, occupational problems, financial problems, medical issues, and religious concerns were discussed. RESULTS The incidence of suicide attempts, current suicidal thoughts, and lifetime suicidal thoughts were 29.8%, 9.2%, and 55.3%, respectively. In total, 76.7% of the suicide attempts occurred before the age of 21. CONCLUSION Transsexual individuals present a high risk of suicide, particularly during adolescence. This finding may be considered a sign for taking action to prevent suicide when working with transgender individuals, particularly during adolescence.
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Affiliation(s)
- Şahika Yüksel
- Department of Psychiatry, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | | | - Mine Öztürk
- Clinic of Psychiatry, Balıklı Rum Hospital, İstanbul, Turkey
| | - Pervin Sevda Bikmaz
- Department of Psychology, Haliç University School of Arts and Sciences, İstanbul, Turkey
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Mental health in non-heterosexuals: Minority stress theory and related explanation frameworks review. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.mhp.2016.10.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Abstract
Many studies, reviews, and meta-analyses have reported elevated mental health problems for sexual minority (SM) individuals. This systematic review provides an update by including numerous recent studies, and explores whether SM individuals are at increased risk across selected mental health problems as per dimensions of sexual orientation (SO), genders, life-stages, geographic regions, and in higher quality studies. A systematic search in PubMed produced 199 studies appropriate for review. A clear majority of studies reported elevated risks for depression, anxiety, suicide attempts or suicides, and substance-related problems for SM men and women, as adolescents or adults from many geographic regions, and with varied SO dimensions (behaviour, attraction, identity), especially in more recent and higher quality studies. One notable exception is alcohol-related problems, where many studies reported zero or reversed effects, especially for SM men. All SM subgroups were at increased risk, but bisexual individuals were at highest risk in the majority of studies. Other subgroup and gender differences are more complex and are discussed. The review supports the long-standing mental health risk proposition for SM individuals, overall and as subgroups.
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Affiliation(s)
- Martin Plöderl
- a Department of Suicide Prevention , University Clinic of Psychiatry and Psychotherapy, University Institute of Clinical Psychology, Christian Doppler Clinic, Paracelsus Medical University , Salzburg , Austria
| | - Pierre Tremblay
- b Faculty of Social Work, University of Calgary , Calgary, Alberta , Canada
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21
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Cameron P, Landess T, Cameron K. Homosexual Sex as Harmful as Drug Abuse, Prostitution, or Smoking. Psychol Rep 2016; 96:915-61. [PMID: 16173359 DOI: 10.2466/pr0.96.3c.915-961] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In 2003, the U.S. Supreme Court said same-sex sexual activity could not be prohibited by law. Analyzing data from the 1996 National Household Survey of Drug Abuse ( N = 12,381) and comparing those who engaged in four recreational activities—homosexual sex, illegal drug use, participation in prostitution, and smoking—against those who abstained, participants (1) were more frequently disruptive (e.g., more frequently criminal, drove under the influence of drugs or alcohol, used illegal drugs, took sexual risks), (2) were less frequently productive (e.g., less frequently had children in marriage, more frequently missed work), and (3) generated excessive costs (e.g., more promiscuous, higher consumers of medical services). Major sexuality surveys have reported similar findings for homosexuals. Societal discrimination inadequately accounts for these differences since parallel comparisons of black and white subsamples produced a pattern unlike the differences found between homosexuals and nonhomosexuals.
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Affiliation(s)
- Paul Cameron
- Family Research Institute, P.O. Box 62640, Colorado Springs, CO 80962, USA
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Hottes TS, Bogaert L, Rhodes AE, Brennan DJ, Gesink D. Lifetime Prevalence of Suicide Attempts Among Sexual Minority Adults by Study Sampling Strategies: A Systematic Review and Meta-Analysis. Am J Public Health 2016; 106:e1-12. [PMID: 27049424 DOI: 10.2105/ajph.2016.303088] [Citation(s) in RCA: 227] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Previous reviews have demonstrated a higher risk of suicide attempts for lesbian, gay, and bisexual (LGB) persons (sexual minorities), compared with heterosexual groups, but these were restricted to general population studies, thereby excluding individuals sampled through LGB community venues. Each sampling strategy, however, has particular methodological strengths and limitations. For instance, general population probability studies have defined sampling frames but are prone to information bias associated with underreporting of LGB identities. By contrast, LGB community surveys may support disclosure of sexuality but overrepresent individuals with strong LGB community attachment. OBJECTIVES To reassess the burden of suicide-related behavior among LGB adults, directly comparing estimates derived from population- versus LGB community-based samples. SEARCH METHODS In 2014, we searched MEDLINE, EMBASE, PsycInfo, CINAHL, and Scopus databases for articles addressing suicide-related behavior (ideation, attempts) among sexual minorities. SELECTION CRITERIA We selected quantitative studies of sexual minority adults conducted in nonclinical settings in the United States, Canada, Europe, Australia, and New Zealand. DATA COLLECTION AND ANALYSIS Random effects meta-analysis and meta-regression assessed for a difference in prevalence of suicide-related behavior by sample type, adjusted for study or sample-level variables, including context (year, country), methods (medium, response rate), and subgroup characteristics (age, gender, sexual minority construct). We examined residual heterogeneity by using τ(2). MAIN RESULTS We pooled 30 cross-sectional studies, including 21,201 sexual minority adults, generating the following lifetime prevalence estimates of suicide attempts: 4% (95% confidence interval [CI] = 3%, 5%) for heterosexual respondents to population surveys, 11% (95% CI = 8%, 15%) for LGB respondents to population surveys, and 20% (95% CI = 18%, 22%) for LGB respondents to community surveys (Figure 1). The difference in LGB estimates by sample type persisted after we accounted for covariates with meta-regression. Sample type explained 33% of the between-study variability. AUTHOR'S CONCLUSIONS Regardless of sample type examined, sexual minorities had a higher lifetime prevalence of suicide attempts than heterosexual persons; however, the magnitude of this disparity was contingent upon sample type. Community-based surveys of LGB people suggest that 20% of sexual minority adults have attempted suicide. PUBLIC HEALTH IMPLICATIONS Accurate estimates of sexual minority health disparities are necessary for public health monitoring and research. Most data describing these disparities are derived from 2 sample types, which yield different estimates of the lifetime prevalence of suicide attempts. Additional studies should explore the differential effects of selection and information biases on the 2 predominant sampling approaches used to understand sexual minority health.
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Affiliation(s)
- Travis Salway Hottes
- Travis Salway Hottes, Laura Bogaert, and Dionne Gesink are with the Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. Anne E. Rhodes is with the Division of Epidemiology, Dalla Lana School of Public Health, and Department of Psychiatry, University of Toronto; and the Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario. David J. Brennan is with the Factor-Inwentash Faculty of Social Work, University of Toronto
| | - Laura Bogaert
- Travis Salway Hottes, Laura Bogaert, and Dionne Gesink are with the Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. Anne E. Rhodes is with the Division of Epidemiology, Dalla Lana School of Public Health, and Department of Psychiatry, University of Toronto; and the Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario. David J. Brennan is with the Factor-Inwentash Faculty of Social Work, University of Toronto
| | - Anne E Rhodes
- Travis Salway Hottes, Laura Bogaert, and Dionne Gesink are with the Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. Anne E. Rhodes is with the Division of Epidemiology, Dalla Lana School of Public Health, and Department of Psychiatry, University of Toronto; and the Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario. David J. Brennan is with the Factor-Inwentash Faculty of Social Work, University of Toronto
| | - David J Brennan
- Travis Salway Hottes, Laura Bogaert, and Dionne Gesink are with the Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. Anne E. Rhodes is with the Division of Epidemiology, Dalla Lana School of Public Health, and Department of Psychiatry, University of Toronto; and the Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario. David J. Brennan is with the Factor-Inwentash Faculty of Social Work, University of Toronto
| | - Dionne Gesink
- Travis Salway Hottes, Laura Bogaert, and Dionne Gesink are with the Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada. Anne E. Rhodes is with the Division of Epidemiology, Dalla Lana School of Public Health, and Department of Psychiatry, University of Toronto; and the Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario. David J. Brennan is with the Factor-Inwentash Faculty of Social Work, University of Toronto
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Jahangir JB, Abdul-Latif H. Investigating the Islamic Perspective on Homosexuality. JOURNAL OF HOMOSEXUALITY 2016; 63:925-954. [PMID: 26549277 DOI: 10.1080/00918369.2015.1116344] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
In his 2006 article in the Journal of the Islamic Medical Association of North America (JIMA), Dr. Ahmed qualified the predominant psychiatric view on homosexuality by recourse to opinions prevalent within reparative therapy circles. Conservative Muslim thinkers, online counselors, and other professionals continue to hold opinions similar to those delineated by Dr. Ahmed in his journal article. We use his article as a focal point to critique the general opinions upheld by conservative Muslim thinkers by alluding to the harms associated with reparative therapy and by rejecting the unreasonable prescription of permanent celibacy. We critique Dr. Ahmed's association of homosexuality with mental health issues, fatal diseases, alcoholism, and illicit sexual intercourse. Investigating the Muslim tradition, we encourage conservative Muslim leaders to facilitate Muslim gays and lesbians in their legitimate human need for intimacy, affection, and companionship.
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Affiliation(s)
- Junaid B Jahangir
- a Department of Anthropology, Economics and Political Science , MacEwan University , Edmonton , Alberta , Canada
| | - Hussein Abdul-Latif
- b Pediatric Endocrinology , University of Alabama at Birmingham , Birmingham , Alabama , USA
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24
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Kinney RL. Homosexuality and Scientific Evidence: On Suspect Anecdotes, Antiquated Data, and Broad Generalizations. Linacre Q 2016. [DOI: 10.1179/2050854915y.0000000002a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Swannell S, Martin G, Page A. Suicidal ideation, suicide attempts and non-suicidal self-injury among lesbian, gay, bisexual and heterosexual adults: Findings from an Australian national study. Aust N Z J Psychiatry 2016; 50:145-53. [PMID: 26631718 DOI: 10.1177/0004867415615949] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES This study investigated associations between sexual orientation and measures of suicidality and non-suicidal self-injury in Australian adults. Previous studies of sexual orientation and suicidality have been limited by unclear conceptualisations of suicidal intent, failure to differentiate between homosexuality and bisexuality, inattention to gender differences and use of convenience-based samples. METHODS A large (N = 10,531) representative national sample of Australian adults was used to investigate associations between sexual orientation (heterosexual, homosexual, bisexual) and (1) suicidal ideation, (2) attempted suicide and (3) non-suicidal self-injury, for males and females separately, in a series of sequentially adjusted logistic regression models. RESULTS Sexual minority participants were at greater risk of suicidality and self-injury than heterosexuals, after adjusting for age and other covariates, with patterns of risk differing by sexual orientation and gender. Compared with their heterosexual counterparts, gay men, but not bisexual men, were more likely to report suicidal ideation (odds ratio = 3.05, 95% confidence interval = [1.65, 5.60]) and suicide attempts (odds ratio = 4.16, confidence interval = [2.18, 7.93]). Bisexual women, but not lesbian women, were more likely to report suicidal ideation (odds ratio = 4.40, confidence interval = [3.00, 6.37]) and suicide attempts (odds ratio = 4.46, confidence interval = [2.41, 8.24]). Neither bisexual nor gay men were more likely than heterosexual men to report self-injury. However, bisexual women, but not lesbian women, were more likely than heterosexual women to report self-injury (odds ratio = 19.59, confidence interval = [9.05, 42.40]). Overall, bisexual females were at greatest risk of suicidality and self-injury. CONCLUSION Clinicians working with sexual minority populations are encouraged to openly discuss suicidal and self-injurious thoughts and behaviours with their clients and may consider using therapeutic strategies to reduce internalised stigma and enhance personal and social resources.
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Affiliation(s)
- Sarah Swannell
- Discipline of Psychiatry, School of Medicine, The University of Queensland, Herston, QLD, Australia
| | - Graham Martin
- Discipline of Psychiatry, School of Medicine, The University of Queensland, Herston, QLD, Australia
| | - Andrew Page
- Centre for Health Research, School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
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Michaels MS, Parent MC, Torrey CL. A Minority Stress Model for Suicidal Ideation in Gay Men. Suicide Life Threat Behav 2016; 46:23-34. [PMID: 25981684 DOI: 10.1111/sltb.12169] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 03/16/2015] [Indexed: 11/30/2022]
Abstract
There is a dearth of research on mechanisms underlying higher rates of suicidal ideation among gay men compared to heterosexual men. The purpose of this study was to establish the link between social/psychological predictor variables and suicidal ideation by testing a hypothesized minority stress model. Structural equation modeling was used to assess the relationships posited in the model using data from a community sample of 167 gay men. Model fit was adequate and hypothesized relationships were partially supported. Also, depressive symptoms partially mediated the relationship between (less) outness predicting suicidal ideation. These findings imply that therapeutic approaches targeting the coming out process may be more effective than approaches targeting internalized homophobia when suicidal ideation is indicated in the clinical presentation of gay and bisexual men.
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Affiliation(s)
- Matthew S Michaels
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Mike C Parent
- Department of Psychology, Texas Tech University, Lubbock, TX, USA
| | - Carrie L Torrey
- Department of Psychology, University of Florida, Gainesville, FL, USA
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Simonsen RK, Giraldi A, Kristensen E, Hald GM. Long-term follow-up of individuals undergoing sex reassignment surgery: Psychiatric morbidity and mortality. Nord J Psychiatry 2016; 70:241-7. [PMID: 26479779 DOI: 10.3109/08039488.2015.1081405] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND There is a lack of long-term register-based follow-up studies of sex-reassigned individuals concerning mortality and psychiatric morbidity. Accordingly, the present study investigated both mortality and psychiatric morbidity using a sample of individuals with transsexualism which comprised 98% (n = 104) of all individuals in Denmark. AIMS (1) To investigate psychiatric morbidity before and after sex reassignment surgery (SRS) among Danish individuals who underwent SRS during the period of 1978-2010. (2) To investigate mortality among Danish individuals who underwent SRS during the period of 1978-2010. METHOD Psychiatric morbidity and mortality were identified by data from the Danish Psychiatric Central Research Register and the Cause of Death Register through a retrospective register study of 104 sex-reassigned individuals. RESULTS Overall, 27.9% of the sample were registered with psychiatric morbidity before SRS and 22.1% after SRS (p = not significant). A total of 6.7% of the sample were registered with psychiatric morbidity both before and after SRS. Significantly more psychiatric diagnoses were found before SRS for those assigned as female at birth. Ten individuals were registered as deceased post-SRS with an average age of death of 53.5 years. CONCLUSIONS No significant difference in psychiatric morbidity or mortality was found between male to female and female to male (FtM) save for the total number of psychiatric diagnoses where FtM held a significantly higher number of psychiatric diagnoses overall. Despite the over-representation of psychiatric diagnoses both pre- and post-SRS the study found that only a relatively limited number of individuals had received diagnoses both prior to and after SRS. This suggests that generally SRS may reduce psychological morbidity for some individuals while increasing it for others.
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Affiliation(s)
- Rikke Kildevæld Simonsen
- a Psychiatric Centre Sexological Clinic , GIUUC, Copenhagen, Denmark.,b Department of Clinical Medicine , University of Copenhagen , Denmark
| | - Annamaria Giraldi
- a Psychiatric Centre Sexological Clinic , GIUUC, Copenhagen, Denmark.,b Department of Clinical Medicine , University of Copenhagen , Denmark
| | - Ellids Kristensen
- a Psychiatric Centre Sexological Clinic , GIUUC, Copenhagen, Denmark.,b Department of Clinical Medicine , University of Copenhagen , Denmark
| | - Gert Martin Hald
- c Department of Public Health , University of Copenhagen , Denmark
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Rabinovitch AE, Perrin PB, Tabaac AR, Brewster ME. Coping Styles and Suicide in Racially and Ethnically Diverse Lesbian, Bisexual, and Queer Women. PSYCHOLOGY OF SEXUAL ORIENTATION AND GENDER DIVERSITY 2015; 2:497-504. [PMID: 34322571 PMCID: PMC8315006 DOI: 10.1037/sgd0000137] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The purpose of the current study was to examine whether coping strategies are associated with past suicidal ideation and history of suicide attempts among sexual minority women (SMW). Participants were 150 racially and ethnically diverse lesbian, bisexual, queer, or "other" nonheterosexual-identified cisgender women who were recruited as part of a national online survey on the experiences of SMW. Simultaneous multiple regressions suggested that coping styles significantly explained 20.3% of the variance in past suicidal ideation and 30.4% of the variance in lifetime history of suicide attempts. Within these regressions, self-blame coping positively predicted past suicidal ideation, and religious coping and venting coping were associated with a higher lifetime history of suicide attempts. Based on these findings, directions for future research and interventions to reduce suicide risk among SMW are discussed.
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Kinney RL. Homosexuality and scientific evidence: On suspect anecdotes, antiquated data, and broad generalizations. LINACRE QUARTERLY 2015; 82:364-90. [PMID: 26997677 PMCID: PMC4771012 DOI: 10.1179/2050854915y.0000000002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
The American Psychiatric Association and the American Psychological Association have suggested for many years now that there is significant empirical evidence supporting the claim that homosexuality is a normal variant of human sexual orientation as opposed to a mental disorder. This paper summarizes and analyzes that purported scientific evidence and explains that much (if not all) of the evidence is irrelevant and does not support the homosexuality-is-not-a-mental-disorder claim. As a result of their deficiencies and arbitrariness, the credibility those two groups that are typically deemed authoritative and trustworthy is called into question. Lay summary: At one time, homosexuality was considered to be mentally disordered. Since the 1970s, however, major medical associations in the U.S. have labeled homosexuality as a normal counterpart of heterosexuality. Those medical associations have proposed that their homosexuality-is-normal claim is based on "scientific evidence." This article critically reviews that "scientific evidence" and finds that much of their literature does not support the claim that homosexuality is normal. This article suggests that instead of supporting their claim with scientific evidence, those major medical associations arbitrarily label homosexuality as normal.
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Aldén L, Edlund L, Hammarstedt M, Mueller-Smith M. Effect of Registered Partnership on Labor Earnings and Fertility for Same-Sex Couples: Evidence From Swedish Register Data. Demography 2015; 52:1243-68. [DOI: 10.1007/s13524-015-0403-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Abstract
The expansion of legal rights to same-sex couples is afoot in a number of Western countries. The effects of this rollout are not only important in their own right but can also provide a window on the institution of marriage and the rights bundled therein. In this article, using Swedish longitudinal register data covering 1994–2007, we study the impact of the extension of rights to same-sex couples on labor earnings and fertility. In 1994, registered partnership for same-sex couples was introduced, which conferred almost all rights and obligations of marriage—a notable exception being joint legal parenting, by default or election. The latter was added in the 2002 adoption act. We find registered partnership to be important to both gays and lesbians but for different reasons. For gays, resource pooling emerges as the main function of registered partnerships. For lesbians, registered partnership appears to be an important vehicle for family formation, especially after the 2002 adoption act. In contrast to heterosexual couples (included for comparison), we find no evidence of household specialization among lesbians. The lack of specialization is noteworthy given similar fertility effects of registered partnership (after 2002) and the fact that lesbian couples were less assortatively matched (on education) than heterosexual couples—children and unequal earnings power being two factors commonly believed to promote specialization.
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Affiliation(s)
- Lina Aldén
- Centre for Labour Market and Discrimination Studies, Linnaeus University, Växjö, Sweden
| | - Lena Edlund
- Department of Economics, Columbia University, New York, NY, USA
| | - Mats Hammarstedt
- Centre for Labour Market and Discrimination Studies, Linnaeus University, Växjö, Sweden
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Associations of sexual and gender minority status with health indicators, health risk factors, and social stressors in a national sample of young adults with military experience. Ann Epidemiol 2015; 25:661-7. [PMID: 26184439 DOI: 10.1016/j.annepidem.2015.06.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 05/29/2015] [Accepted: 06/03/2015] [Indexed: 11/22/2022]
Abstract
PURPOSE To assess the associations of self-identified lesbian, gay, bisexual, and questioning sexual orientation or transgender status (LGBTQ) and military experience with health indicators. METHODS We used data from the Fall 2012 National College Health Assessment. The survey included self-identified sociodemographic characteristics, mental (e.g., depression) and physical (e.g., human immunodeficiency virus) conditions, health risk behaviors (e.g., smoking), and social stressors (e.g., victimization). We used modified Poisson regression models, stratified by self-reported military service, to examine LGBTQ-related differences in health indicators, whereas adjusting for sociodemographic characteristics. RESULTS Of 27,176 in the sample, among the military-experienced group, LGBTQ individuals had increased adjusted risks of reporting a past-year suicide attempt (adjusted risk ratio [aRR] = 4.37; 95% confidence interval [CI] = 1.39-13.67), human immunodeficiency virus (aRR = 9.90; 95% CI = 1.04-79.67), and discrimination (aRR = 4.67; 95% CI = 2.05-10.66) than their non-LGBTQ peers. Among LGBTQ individuals, military experience was associated with a nearly four-fold increased risk of reporting a past-year suicide attempt (aRR = 3.61; 95% CI = 1.46-8.91) adjusting for age, sex, race and ethnicity, marital status, depression, and other psychiatric diagnoses. CONCLUSIONS Military experience may moderate health indicators among LGBTQ populations, and likewise, LGBTQ status likely modifies health conditions among military-experienced populations. Results suggest that agencies serving military populations should assess how and if the health needs of LGBTQ individuals are met.
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Cochran SD, Mays VM. Mortality risks among persons reporting same-sex sexual partners: evidence from the 2008 General Social Survey-National Death Index data set. Am J Public Health 2015; 105:358-64. [PMID: 25033136 PMCID: PMC4289448 DOI: 10.2105/ajph.2014.301974] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2014] [Indexed: 12/18/2022]
Abstract
OBJECTIVES We investigated the possibility that men who have sex with men (MSM) and women who have sex with women (WSW) may be at higher risk for early mortality associated with suicide and other sexual orientation-associated health risks. METHODS We used data from the 1988-2002 General Social Surveys, with respondents followed up for mortality status as of December 31, 2008. The surveys included 17 886 persons aged 18 years or older, who reported at least 1 lifetime sexual partner. Of these, 853 reported any same-sex partners; 17 033 reported only different-sex partners. Using gender-stratified analyses, we compared these 2 groups for all-cause mortality and HIV-, suicide-, and breast cancer-related mortality. RESULTS The WSW evidenced greater risk for suicide mortality than presumptively heterosexual women, but there was no evidence of similar sexual orientation-associated risk among men. All-cause mortality did not appear to differ by sexual orientation among either women or men. HIV-related deaths were not elevated among MSM or breast cancer deaths among WSW. CONCLUSIONS The elevated suicide mortality risk observed among WSW partially confirms public health concerns that sexual minorities experience greater burden from suicide-related mortality.
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Affiliation(s)
- Susan D Cochran
- Susan D. Cochran is with the departments of Epidemiology and Statistics, University of California, Los Angeles (UCLA) Fielding School of Public Health, Los Angeles. Vickie M. Mays is with the departments of Psychology and Health Policy and Management, UCLA. Both authors are also with the UCLA Center for Bridging Research Innovation, Training and Education for Minority Health Disparities Solutions, Los Angeles
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Sandfort TGM, de Graaf R, Ten Have M, Ransome Y, Schnabel P. Same-sex sexuality and psychiatric disorders in the second Netherlands Mental Health Survey and Incidence Study (NEMESIS-2). LGBT Health 2014; 1:292-301. [PMID: 26609539 DOI: 10.1089/lgbt.2014.0031] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Sexual orientation has been shown to be a risk factor for psychiatric disorders. This study compared whether sexual orientation-related disparities in the prevalence of psychiatric disorders are similar based on homosexual behavior versus attraction and tested whether, with increased acceptance of homosexuality, these disparities have diminished over time. METHODS The Composite International Diagnostic Interview 3.0 was administered with a total of 6,646 Dutch persons, aged 18 to 64 years. RESULTS Between 2.0% and 2.5% of the participants reported same-sex sexual behavior in the preceding year or same-sex attraction. Homosexually active persons and persons with same-sex attraction reported a higher prevalence of disorders than heterosexual persons. There were more disparities in the prevalence of disorders based on sexual attraction than based on sexual behavior. Comparing these results with a previous study, showed that no significant changes over time have occurred in the pattern of health disparities. CONCLUSIONS Sexual orientation continues to be a risk factor for psychiatric disorders, stressing the need for understanding the origins of these disparities.
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Affiliation(s)
- Theo G M Sandfort
- HIV Center for Clinical and Behavioral Studies, Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY 10032 ; New York State Psychiatric Institute, New York, NY 10032
| | - Ron de Graaf
- Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands
| | - Margreet Ten Have
- Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands
| | - Yusuf Ransome
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University
| | - Paul Schnabel
- The Netherlands Institute for Social Research, The Hague, the Netherlands
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Semp D, Read J. Queer conversations: improving access to, and quality of, mental health services for same-sex-attracted clients. PSYCHOLOGY & SEXUALITY 2014. [DOI: 10.1080/19419899.2014.890122] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Matarazzo BB, Barnes SM, Pease JL, Russell LM, Hanson JE, Soberay KA, Gutierrez PM. Suicide risk among lesbian, gay, bisexual, and transgender military personnel and veterans: what does the literature tell us? Suicide Life Threat Behav 2014; 44:200-17. [PMID: 24494604 DOI: 10.1111/sltb.12073] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Accepted: 08/27/2013] [Indexed: 11/28/2022]
Abstract
Research suggests that both the military and veteran and the lesbian, gay, bisexual, and transgender (LGBT) populations may be at increased risk for suicide. A literature review was conducted to identify research related to suicide risk in the LGBT military and veteran populations. Despite the paucity of research directly addressing this issue, themes are discussed evident in the literature on LGBT identity and suicide risk as well as LGBT military service members and veterans. Factors such as social support and victimization appear to be particularly relevant. Suggestions are made with respect to future research that is needed on this very important and timely topic.
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Affiliation(s)
- Bridget B Matarazzo
- Veterans Integrated Service Network (VISN) 19 Mental Illness, Research, Education and Clinical Center (MIRECC), Denver, CO, USA; Department of Psychiatry, School of Medicine, University of Colorado, Denver, CO, USA
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Fletcher JB, Shoptaw S, Peck JA, Reback CJ. Contingency Management Reduces Symptoms of Psychological and Emotional Distress among Homeless, Substance-dependent Men Who Have Sex with Men. ACTA ACUST UNITED AC 2014; 7:420-430. [PMID: 25364379 DOI: 10.1080/17523281.2014.892897] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND This prospective analysis evaluated the efficacy of a contingency management (CM) intervention to improve the psychological health of non-treatment seeking, homeless, substance-dependent, men who have sex with men in Los Angeles. It was hypothesized that administration of CM would be associated with reductions in participants' symptoms of psychological and emotional distress. METHODS One hundred and thirty-one participants were randomized into either a voucher-based contingency management (CM; n = 64) condition reinforcing substance abstinence and prosocial/health-promoting behaviors, or to a control condition (n = 67). Participants' symptoms of psychological and emotional distress were assessed at intake and at 12-months post-randomization. RESULTS Participants randomized into the CM intervention exhibited significantly lower levels of psychological distress in all measured symptom domains up to one year post randomization, reductions not evidenced in the control arm. Omnibus tests resultant from seemingly unrelated regression analysis confirmed that CM was significantly associated with reductions in symptoms of psychological and emotional distress, even when controlling for biomarker-confirmed substance use outcomes (χ2(9) = 17.26; p < 0.05). CONCLUSIONS Findings demonstrate that a CM intervention reduced symptoms of psychological and emotional distress among a sample of non-treatment seeking, homeless, substance-dependent men who have sex with men.
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Affiliation(s)
| | - Steven Shoptaw
- David Geffen School of Medicine at UCLA, Department of Family Medicine, 90024, USA
| | | | - Cathy J Reback
- Friends Research Institute, Inc., 90028, USA ; UCLA Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles, 90024, USA
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Abstract
The spread of HIV and other STDs among men who have sex with men (MSM) has been labeled a syndemic because in this population a number of different and interrelated health problems have come together and interact with one another. The various elements of the syndemic have an additive effect, each one intensifying the others. These factors include the number of infectious diseases endemic in this population, the high rate of substance abuse problems and psychological disorders, and the significant percentage of MSM who have experienced childhood sexual abuse and other adverse events. While MSM are disproportionately affected by HIV, syphilis, and other STDs, health activists from the gay community have systematically resisted the application of the full range of public health strategies traditionally used to prevent their spread. In the more than three decades since the beginning of the HIV/AIDS epidemic, there have been substantial advances in testing and treatment, yet the infection rate among MSM, and particularly young MSM, remains high, even as it has been dropping among other risk groups. This paper deals with the history of the syndemic, the failure of various risk reduction strategies, and treatment as prevention.
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Vrangalova Z, Savin-Williams RC. Psychological and physical health of mostly heterosexuals: a systematic review. JOURNAL OF SEX RESEARCH 2014; 51:410-45. [PMID: 24754361 DOI: 10.1080/00224499.2014.883589] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
We reviewed whether mostly heterosexuals, a sexual orientation group characterized by a small amount of same-sex sexuality, differ from heterosexuals and bisexuals on a variety of mental and physical health outcomes (e.g., internalizing problems, body dissatisfaction and disordered eating, obesity, sexual/reproductive health, physical health), health risk behaviors (e.g., substance use, sexual risk taking), and risk and protective factors (e.g., victimization, stressful/risky environment, socioeconomic status, personal and social relationships, gender nonconformity). A narrative and quantitative literature review was conducted of 60 papers covering 22 samples from five Western countries. Individual, mean, and median effect sizes (Cohen ds) were calculated whenever possible. Mostly heterosexuals reported higher levels of risk in most reviewed outcomes compared to heterosexuals (unweighted mean effect sizes ranged from 0.20 to 0.50) but typically somewhat lower than bisexuals (unweighted mean effect sizes ranged from -0.10 to -0.30). Various risk factors frequently reduced, but rarely eliminated, health disparities between mostly heterosexuals and heterosexuals. Findings are discussed through the lens of three potential explanations of elevated health risks among nonheterosexuals: minority stress, nonheterosexual lifestyles, and common causes. Because data on many outcomes were scarce or missing, particularly for men and in comparison with bisexuals, further research is needed.
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Abstract
Relative to the general population, lesbian and bisexual (LB) women are overrepresented in the military and are significantly more likely to have a history of military service compared to all adult women. Due to institutional policies and stigma associated with a gay or lesbian identity, very little empirical research has been done on this group of women veterans. Available data suggest that compared to heterosexual women veterans, LB women veterans are likely to experience heightened levels of prejudice and discrimination, victimization, including greater incidence of rape, as well as adverse health and substance use disorders. They are also likely to encounter a host of unique issues when accessing health care, including fears of insensitive care and difficulty disclosing sexual orientation to Veterans Health Administration (VHA) providers. Training of staff and providers, education efforts, outreach activities, and research on this subpopulation are critical to ensure equitable and high quality service delivery.
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Affiliation(s)
- Keren Lehavot
- VA Puget Sound Health Care System, 1660 S. Columbian Way (116-POC), Seattle, WA 98108, USA.
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Blosnich JR, Silenzio VMB. Physical health indicators among lesbian, gay, and bisexual U.S. veterans. Ann Epidemiol 2013; 23:448-51. [PMID: 23688720 DOI: 10.1016/j.annepidem.2013.04.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Revised: 04/04/2013] [Accepted: 04/16/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE To provide information about lesbian, gay, and bisexual (LGB) veterans' health status, diagnoses, and health screening behaviors compared with heterosexual veterans. METHODS Data are from 10 states' 2010 Behavioral Risk Factor Surveillance System surveys that contained sexual orientation data for veterans (n = 11,665). χ(2) tests and multiple logistic regression were used to examine outcomes among LGB and heterosexual veterans. RESULTS More LGB than heterosexual veterans reported current smoking, not seeking medical care owing to cost, and activity limitations. Compared with heterosexual veterans, LGB veterans had greater odds of ever having an human immunodeficiency virus test (odds ratio [OR], 5.42; 95% confidence interval [CI], 3.28-8.96) but lower odds of diabetes diagnosis (OR, 0.55; 95% CI, 0.34-0.89). CONCLUSIONS Findings from this sample suggest patterns of health behaviors and outcomes among LGB veterans that are both unique from and similar to results from general samples of LGB persons. With the formal end of the "Don't Ask, Don't Tell" policy that discriminated against LGB people in the military, institutions such as the Department of Veterans Affairs are likely to see an increase in its current population of LGB veterans. The Department of Veterans Affairs stands in a unique place to meet the health equity needs of this minority population.
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Affiliation(s)
- John R Blosnich
- Department of Veterans Affairs, VISN-2 Center of Excellence for Suicide Prevention, Canandaigua, NY, USA.
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A description of common mental disorders in men who have sex with men (MSM) referred for assessment and intervention at an MSM clinic in Cape Town, South Africa. AIDS Behav 2013; 17 Suppl 1:S77-81. [PMID: 23532397 DOI: 10.1007/s10461-013-0430-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Men who have sex with men (MSM) have a higher prevalence of common mental disorders (CMD), as compared with heterosexual men. HIV infection is independently associated with higher rates of CMD. Given this context, and the high background community prevalence of HIV in South Africa, MSM are at even greater risk of developing CMD. The aim of this research was to investigate neuropsychiatric symptoms and disorders in MSM who were referred for assessment and management of mental health problems, in an MSM Clinic in urban Cape Town, South Africa. Twenty-five men were screened using the MINI, AUDIT, DUDIT, and IPDE Screener. Depression, suicidality, as well as alcohol and drug use disorders were highly prevalent in this group (44, 56, 48, and 56 % respectively). The personality disorder screening was suggestive of a high prevalence of personality disorders. The high prevalence of neuropsychiatric disorders in this sample supports the idea that integrated mental health services are needed to address the complex needs of this population. Adequate input into the mental health needs of this population could reduce the potential for HIV acquisition and transmission, improve adherence to treatment and care, and ensure the provision a comprehensive health service for MSM.
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Sánchez FJ, Bocklandt S, Vilain E. The relationship between help-seeking attitudes and masculine norms among monozygotic male twins discordant for sexual orientation. Health Psychol 2013; 32:52-6. [PMID: 23025300 PMCID: PMC4031032 DOI: 10.1037/a0029529] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE In general, heterosexual men are less favorable to asking for help compared to women and gay men. This can be problematic if a man avoids professional help when he is experiencing significant psychological distress. Yet, it is unclear to what degree such attitudes among men are due to innate differences or social environments. Studying twins provides one avenue for teasing apart these relationships. METHOD We recruited 38 pairs of monozygotic male twins (Mage = 35.87 years, SD = 9.52) raised together and who were discordant for sexual orientation. They completed measures of psychological distress (Symptom Checklist-90-Revised), positive attitudes toward psychological help-seeking behavior, and emphasis with fulfilling traditional masculine norms. RESULTS Contrary to predictions, the heterosexual twins expressed more symptoms of specific distress-hostility (r = .30), paranoid ideation (r = .26), and psychoticism (r = .24)-than their gay cotwins. As predicted, heterosexual men were less favorable to seeking help (r = .25) and expressed greater emphasis on masculine norms (r = .26) than their cotwins. Within each group of men, unique aspects of masculine norms were significantly related to attitudes toward psychological help-seeking behavior. CONCLUSION The findings lend credence to the hypothesis that social environments influence attitudes and behaviors that are stereotypically masculine and potentially detrimental to men's health.
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Affiliation(s)
- Francisco J Sánchez
- Center for Gender-Based Biology, and Department of Human Genetics, UCLA School of Medicine, USA.
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Burkett J, Young L. Love and addiction: an uneasy marriage? A response to "The devil is in the differences". Psychopharmacology (Berl) 2012; 224:31-32. [PMID: 25110362 PMCID: PMC4123435 DOI: 10.1007/s00213-012-2881-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Langille DB, Asbridge M, Kisely S, Rasic D. Suicidal behaviours in adolescents in Nova Scotia, Canada: protective associations with measures of social capital. Soc Psychiatry Psychiatr Epidemiol 2012; 47:1549-55. [PMID: 22200838 DOI: 10.1007/s00127-011-0461-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Accepted: 12/01/2011] [Indexed: 11/29/2022]
Abstract
PURPOSE Few studies of adolescent suicidality have examined its associations with social capital. We explored associations of measures of individual level social capital with self-reported suicide ideation and suicide attempt in adolescents in Cape Breton, Nova Scotia, Canada, controlling for other factors known to be associated with adolescent suicidality. METHODS We surveyed 1,597 grade 10-12 students at three high schools in 2006 using self-completion questionnaires. Both sexes were combined for analysis. Outcome measures were suicidal ideation and attempt in the previous year. Measures of social capital included perceptions of trustworthiness and helpfulness of others at school, frequency of religious attendance and participation in extracurricular activities. Logistic regressions were carried out to determine associations of social capital with suicidality while controlling for other factors. RESULTS Perceived trustworthiness and helpfulness were protective for suicidal ideation and suicide attempt in the previous year. In adjusted analyses, there were interactions of gender and social capital-females reporting more social capital were more protected from suicide attempt relative to males with similar levels of social capital. CONCLUSIONS This study provides initial evidence of protective associations of individual level social capital with adolescent suicidality. Our findings suggest that among adolescents low social capital as measured by perceptions of trust and helpfulness of others at school may be a warning sign for suicidality, particularly for females. It may be helpful to inquire of young people how they perceive the trustworthiness and helpfulness of their school environment as a measure of how supportive that environment might be to them when they are facing challenges to their mental health.
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Affiliation(s)
- Donald B Langille
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, 5849 University Avenue, Halifax, NS, B3H 3H7, Canada.
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Teixeira-Filho FS, Rondini CA. Ideações e tentativas de suicídio em adolescentes com práticas sexuais hetero e homoeróticas. SAUDE E SOCIEDADE 2012. [DOI: 10.1590/s0104-12902012000300011] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Esta pesquisa, que teve como população-alvo adolescentes com idade entre 12 e 20 anos, residentes em três municípios do interior Paulista, buscou conhecer as associações entre orientação sexual e ideações e tentativas de suicídio. Corroborando com as pesquisas internacionais, evidenciou-se que os não heterossexuais têm mais chances de pensarem e tentarem suicídio, comparativamente aos heterossexuais. Todavia, encontrou-se que, dentre o grupo de adolescentes que se assumiram não heterossexuais, os que estão mais vulneráveis são aqueles que se autodefiniram bissexuais e "outros", os quais constituem o grupo de pessoas menos assumidas, dentre os não heterossexuais. Do mesmo modo, constatou-se que os respondentes apresentam diversas opiniões e valores homofóbicos, sexistas e heterocentrados, o que revela ser o espaço escolar, onde se encontram esses jovens não heterossexuais, bastante carregado de posicionamentos discursivos discriminatórios. Conclui-se que a questão do suicídio é uma problemática de saúde pública e que a população de jovens não heterossexuais necessita de abordagens específicas para a prevenção e de atenção relativas a essa conduta.
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Suicidality and sexual orientation among men in Switzerland: findings from 3 probability surveys. J Psychiatr Res 2012; 46:980-6. [PMID: 22591853 DOI: 10.1016/j.jpsychires.2012.04.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Revised: 04/06/2012] [Accepted: 04/13/2012] [Indexed: 11/24/2022]
Abstract
Few population-based surveys in Europe have examined the link between suicidality and sexual orientation. The objective of this study was to assess the prevalences of and risk for suicidality by sexual orientation, especially among adolescent and young adult men. Data came from three probability-based surveys in Switzerland from 2002: 1) Geneva Gay Men's Health Survey (GGMHS) with 571 gay/bisexual men, 2) Swiss Multicenter Adolescent Survey on Health (SMASH) with 7,428 16-20 year olds, and 3) Swiss Recruit Survey (ch-x) with 22,415 new recruits. In GGMHS, suicidal ideation (12 months/lifetime) was reported by 22%/55%, suicide plans 12%/38%, and suicide attempts 4%/19%. While lifetime prevalences and ratios are similar across age groups, men under 25 years reported the highest 12-month prevalences for suicidal ideation (35.4%) and suicide attempts (11.5%) and the lowest attempt ratios (1:1.5 for attempt to plan and 1:3.1 for attempt to ideation). The lifetime prevalence of suicide attempts among homo/bisexual men aged 16-20 years varies from 5.1% in ch-x to 14.1% in SMASH to 22.0% in GGMHS. Compared to their heterosexual counterparts, significantly more homo/bisexual men reported 12-month suicidal ideation, plans, and attempts (OR = 2.09-2.26) and lifetime suicidal ideation (OR = 2.15) and suicide attempts (OR = 4.68-5.36). Prevalences and ratios vary among gay men by age and among young men by both sexual orientation and study population. Lifetime prevalences and ratios of non-fatal suicidal behaviors appear constant across age groups as is the increased risk of suicidality among young homo/bisexual men.
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Hayes JA, Chun-Kennedy C, Edens A, Locke BD. Do Double Minority Students Face Double Jeopardy? Testing Minority Stress Theory. JOURNAL OF COLLEGE COUNSELING 2011. [DOI: 10.1002/j.2161-1882.2011.tb00267.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Sivasubramanian M, Mimiaga MJ, Mayer KH, Anand VR, Johnson CV, Prabhugate P, Safren SA. Suicidality, clinical depression, and anxiety disorders are highly prevalent in men who have sex with men in Mumbai, India: findings from a community-recruited sample. PSYCHOL HEALTH MED 2011; 16:450-62. [PMID: 21749242 DOI: 10.1080/13548506.2011.554645] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
In India men who have sex with men (MSM) are a stigmatized and hidden population, vulnerable to a variety of psychosocial and societal stressors. This population is also much more likely to be HIV-infected compared to the general population. However, little research exists about how psychosocial and societal stressors result in mental health problems. A confidential, quantitative mental-health interview was conducted among 150 MSM in Mumbai, India at The Humsafar Trust, the largest non-governmental organization serving MSM in India. The interview collected information on sociodemographics and assessed self-esteem, social support and DSM-IV psychiatric disorders using the Mini International Neuropsychiatric Interview (MINI). Participants' mean age was 25.1 years (SD = 5.1); 21% were married to women. Forty-five percent reported current suicidal ideation, with 66% low risk, 19% moderate risk, and 15% high risk for suicide per MINI guidelines. Twenty-nine percent screened in for current major depression and 24% for any anxiety disorder. None of the respondents reported current treatment for any psychiatric disorder. In multivariable models controlling for age, education, income, and sexual identity, participants reporting higher levels of self-esteem and greater levels of satisfaction with the social support they receive from family and friends were at lower risk of suicidality (self-esteem AOR = 0.85, 95% CI: 0.78-0.93; social support AOR = 0.76, 95% CI: 0.62-0.93) and major depression (self-esteem AOR = 0.79, 95% CI: 0.71-0.89; social support AOR = 0.68, 95% CI: 0.54-0.85). Those who reported greater social support satisfaction were also at lower risk of a clinical diagnosis of an anxiety disorder (AOR = 0.80; 95% CI: 0.65-0.99). MSM in Mumbai have high rates of suicidal ideation, depression, and anxiety. Programs to improve self-esteem and perceived social support may improve these mental health outcomes. Because they are also a high-risk group for HIV, MSM HIV prevention and treatment services may benefit from incorporating mental health services and referrals into their programs.
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Coleman D, Kaplan MS, Casey JT. The Social Nature of Male Suicide: A New Analytic Model. ACTA ACUST UNITED AC 2011. [DOI: 10.3149/jmh.1003.240] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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O'Donnell S, Meyer IH, Schwartz S. Increased risk of suicide attempts among Black and Latino lesbians, gay men, and bisexuals. Am J Public Health 2011; 101:1055-9. [PMID: 21493928 PMCID: PMC3093285 DOI: 10.2105/ajph.2010.300032] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2010] [Indexed: 11/04/2022]
Abstract
Members of racial/ethnic minority groups have a lower lifetime prevalence than have Whites of mental disorders, a risk factor for suicide attempts; paradoxically, however, lesbian, gay, and bisexual (LGB) ethnic minority youths may be at increased risk for suicide attempts relative to White LGB youths. We found that the increased risk of suicide attempts among racial/ethnic minority LGB respondents in our sample relative to White respondents was not explained by excess youth onset of depression and substance abuse or by a higher susceptibility to suicide in the racial/ethnic minority LGB group.
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