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Jennings TL, Gleason N, Pachankis JE, Bőthe B, Kraus SW. LGBQ-affirming clinical recommendations for compulsive sexual behavior disorder. J Behav Addict 2024; 13:413-428. [PMID: 38592797 PMCID: PMC11220820 DOI: 10.1556/2006.2024.00012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 01/28/2024] [Accepted: 03/14/2024] [Indexed: 04/11/2024] Open
Abstract
Background and aims Since the inclusion of Compulsive Sexual Behavior Disorder (CSBD) in the International Classification of Diseases (11th ed.), there has been little effort placed into developing clinical recommendations for lesbian, gay, bisexual, and queer (LGBQ) clients with this condition. Thus, we develop preliminary clinical recommendations for mental health professionals working with LGBQ clients who may be struggling with CSBD. Methods The present paper synthesizes the CSBD literature with advances in LGBQ-affirming care to develop assessment and treatment recommendations. These recommendations are discussed within the context of minority stress theory, which provides an empirically supported explanation for how anti-LGBQ stigma may contribute to the development of mental health conditions in LGBQ populations. Results Assessment recommendations are designed to assist mental health professionals in distinguishing aspects of an LGBQ client's sociocultural context from CSBD symptomology, given recent concerns that these constructs may be wrongly conflated and result in misdiagnosis. The treatment recommendations consist of broadly applicable, evidence-based principles that can be leveraged by mental health professionals of various theoretical orientations to provide LGBQ-affirming treatment for CSBD. Discussion and Conclusions The present article provides theoretically and empirically supported recommendations for mental health professionals who want to provide LGBQ-affirming care for CSBD. Given the preliminary nature of these recommendations, future research is needed to investigate their clinical applicability and efficacy.
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Affiliation(s)
- Todd L. Jennings
- Department of Psychology, University of Nevada, Las Vegas, Las Vegas, NV, USA
| | - Neil Gleason
- Department of Psychology, University of Washington, Seattle, WA, USA
| | | | - Beáta Bőthe
- Department of Psychology, University of Montréal, Montréal, QC, CAN
| | - Shane W. Kraus
- Department of Psychology, University of Nevada, Las Vegas, Las Vegas, NV, USA
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2
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Kieu TKT, Galper EF, Sorin CR, Bloom BE. Using an intersectional life course perspective to understand familial environment and its impact on sexuality development among Asian American sexual minority college students. CULTURE, HEALTH & SEXUALITY 2024:1-19. [PMID: 38639035 DOI: 10.1080/13691058.2024.2341832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 04/08/2024] [Indexed: 04/20/2024]
Abstract
There is a dearth of research understanding the sexual health of Asian American adolescents, and even more so for those who identify as sexual minorities (lesbian, gay, bisexual, queer, asexual, and other sexual orientations). This study is a secondary qualitative analysis focused on young adults' recollections of their formal and informal sex education experiences in childhood and adolescence using a sub-sample of in-depth interviews from students who self-identified as both Asian and sexual minorities living in the USA (n = 9). Results were organised into three sections: (1) latent cultural factors (e.g. stigma surrounding sex, self-sufficiency, filial piety); (2) the downstream effects of latent cultural factors (e.g. sex-related discussions, rules disallowing dating, role of lateral family members); and (3) the impact of deficient familial sex-related discussions (e.g. Internet, resentment). Study findings underscore the links between identity concealment and relationship concealment that are unique to Asian sexual minority individuals. We suggest that interventions involving Asian American US youth and their families should be culturally informed and promote cross-generational sex-related discussion. Future research should further explore the role of chosen family and non-parental family members as a point of intervention as they can be helpful sources of informal sex education.
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Affiliation(s)
- Talia Kim-Thanh Kieu
- Department of Health Behavior, Gillings School of Global Public Health, University of NC, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina, Chapel Hill, NC, USA
| | - Emily F Galper
- Hussman School of Journalism and Media, University of North Carolina, Chapel Hill, NC, USA
| | - Cierra Raine Sorin
- Department of Sociology, University of CA Santa Barbara, Santa Barbara, CA, USA
| | - Brittnie E Bloom
- University of California Global Health Institute Women's Health, Gender, and Empowerment Center of Expertise, Los Angeles, CA, USA
- Graduate School of Public Health, San Diego State University, San Diego, CA, USA
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3
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Ueno K, Dominguez R, Bastow S, D'Amours JV. LGBTQ Young Adults' Identity Disclosure in the Workplace: A Longitudinal Qualitative Analysis of Disclosure Intentions and Outcomes. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:1327-1341. [PMID: 38308106 DOI: 10.1007/s10508-024-02807-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 12/29/2023] [Accepted: 01/01/2024] [Indexed: 02/04/2024]
Abstract
Research shows that LGBTQ workers make strategic decisions about whether to disclose their sexual and gender identities to their colleagues as they assess potential costs and benefits. The present study sought to extend this literature by examining how they plan their identity disclosure in future workplace interactions and why they may diverge from their initial intentions. The analysis used longitudinal data from in-depth interviews, in which young LGBTQ workers reported disclosure intentions and their outcomes two years later. Participants often expressed intentions to disclose their LGBTQ identities while emphasizing the importance of identity disclosure for self-authenticity and the LGBTQ community's visibility. Sometime over the course of the study, however, a substantial number of participants did not carry out their intentions because of unanticipated workplace constraints such as a lack of opportunities for personal conversations, an expectation for professionalism, and an absence of LGBTQ colleagues. However, participants who diverged from their initial disclosure intentions maintained an identity as an open LGBTQ person by emphasizing their willingness for disclosure.
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Affiliation(s)
- Koji Ueno
- Department of Sociology, Florida State University, 526 Bellamy Building, Tallahassee, FL, 32306-2270, USA.
| | - Rachael Dominguez
- Department of Sociology, Florida State University, 526 Bellamy Building, Tallahassee, FL, 32306-2270, USA
| | - Skyler Bastow
- Department of Sociology, Florida State University, 526 Bellamy Building, Tallahassee, FL, 32306-2270, USA
| | - Jason V D'Amours
- Department of Sociology, Florida State University, 526 Bellamy Building, Tallahassee, FL, 32306-2270, USA
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4
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Dillon FR, Ertl MM, Eklund AC, Westbrook J, Balek G, Algarin A, Martin J, Sánchez FJ, Ebersole R. Sexual Identity Development and Social Ecological Facilitators and Barriers of PrEP Uptake and Adherence Among Latinx Men Who Have Sex with Men. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:1197-1211. [PMID: 38212437 DOI: 10.1007/s10508-023-02776-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 10/20/2023] [Accepted: 11/30/2023] [Indexed: 01/13/2024]
Abstract
Latinx gay, bisexual, and other men who have sex with men (LMSM) report lower pre-exposure prophylaxis (PrEP) use than their white, non-Latinx counterparts. We hypothesize that this disparity is partially attributable to social ecological factors that can be addressed via prevention interventions. In this retrospective study, we first examined data from 253 LMSM to determine whether theorized associations existed between acquisition of a PrEP prescription (uptake) in relation to several social ecological factors based on a conceptual framework of determinants of access to and uptake of PrEP for LMSM. We also explored relations between frequency of PrEP use (adherence) and social ecological factors with a subsample of 33 LMSM who had initiated PrEP 12 months prior to assessment. In this study, individual-level factors from this framework included age and socioeconomic status. Perceived access to medical care represented both individual- and community-level determinants of PrEP uptake and adherence. Interpersonal-level factors were social support and relationship status. Structural/cultural-level factors were sexual identity development status, the masculinity norm of heterosexual self-presentation, traditional Latinx masculine gender role beliefs of machismo and caballerismo, racial identity, and immigration status. Results indicated that older men and those who endorsed the synthesis/integration status of sexual identity development were more likely to acquire a PrEP prescription during their lifetime in comparison to peers. PrEP adherence was linked with being older, reporting higher socioeconomic status, reporting more appraisal social support, self-identifying as white-Latinx, being U.S.-born, and endorsing less sexual identity uncertainty and more heterosexual self-presentation. Results specify modifiable factors that may inform tailored, community-based prevention efforts to increase PrEP use and decrease existing HIV/AIDS disparities among LMSM.
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Affiliation(s)
- Frank R Dillon
- School of Counseling and Counseling Psychology, Arizona State University, 446 Payne Hall, MC-0811, Tempe, AZ, 85287-0811, USA.
| | - Melissa M Ertl
- HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Austin C Eklund
- Department of Educational & Counseling Psychology, University at Albany, State University of New York, Albany, NY, USA
| | - Jaelen Westbrook
- School of Counseling and Counseling Psychology, Arizona State University, 446 Payne Hall, MC-0811, Tempe, AZ, 85287-0811, USA
| | - Gabrielle Balek
- Department of Counseling and Educational Psychology, New Mexico State University, Las Cruces, NM, USA
| | - Angel Algarin
- School of Counseling and Counseling Psychology, Arizona State University, 446 Payne Hall, MC-0811, Tempe, AZ, 85287-0811, USA
| | - Jessica Martin
- Department of Educational & Counseling Psychology, University at Albany, State University of New York, Albany, NY, USA
| | - Francisco J Sánchez
- School of Counseling and Counseling Psychology, Arizona State University, 446 Payne Hall, MC-0811, Tempe, AZ, 85287-0811, USA
| | - Ryan Ebersole
- Department of Educational & Counseling Psychology, University at Albany, State University of New York, Albany, NY, USA
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5
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Taweh O, Moreira JD. Proposed mechanisms of hypertension and risk of adverse cardiovascular outcomes in LGBT communities. Am J Physiol Heart Circ Physiol 2023; 325:H522-H528. [PMID: 37477686 DOI: 10.1152/ajpheart.00346.2023] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/13/2023] [Accepted: 07/18/2023] [Indexed: 07/22/2023]
Abstract
Hypertension (HTN), a highly prevalent public issue affecting one in two adults in the United States, has recently been shown to differentially burden individuals belonging to marginalized communities, such as the lesbian, gay, bisexual, and transgender (LGBT) communities. The minority stress theory posits that a unique combination of marginalization-related psychosocial stressors and coping behaviors may underlie the increased burden of diseases like HTN in LGBT populations. Uncontrolled or poorly managed HTN often leads to the development of adverse cardiovascular outcomes, such as heart failure (HF). Despite our understanding of minority stress theory and demonstrated associations between LGBT identities and HTN, the mechanisms whereby psychosocial stress drives HTN in LGBT populations remain unclear. This mini-review discusses the physiological systems governing blood pressure and the epidemiology of HTN across different subgroups of LGBT people. In addition, we propose mechanisms demonstrated in the general population whereby psychological stress has been implicated in elevating blood pressure that may be occurring in LGBT populations. Finally, we discuss the limitations of current studies and methodological frameworks to make suggestions for study designs to better delineate the mechanisms of psychosocial stress-related HTN in LGBT communities.
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Affiliation(s)
- Omar Taweh
- T. H. Chan School of Medicine, University of Massachusetts Worcester, Worcester, Massachusetts, United States
| | - Jesse D Moreira
- Q.U.E.E.R. Laboratory, Programs in Human Physiology, Department of Health Sciences, Boston University Sargent College, Boston, Massachusetts, United States
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6
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Wootton AR, Soled KRS, Puckett JA, Garrett-Walker JJ, Hill AP, Delucio K, Veldhuis CB. Community (dis)connectedness and identity among LGBTQIA+ people during the COVID-19 pandemic: A qualitative cross-sectional and longitudinal trajectory study. PSYCHOLOGY & SEXUALITY 2023; 15:170-192. [PMID: 38800743 PMCID: PMC11114605 DOI: 10.1080/19419899.2023.2241868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 06/27/2023] [Indexed: 05/29/2024]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic and associated shelter-in-place ordinances passed in the first year of the pandemic rapidly limited access to in-person social interactions, raising concerns of diminishing social support and community cohesion while psychological stressors increased. For LGBTQIA+ people, connectedness to the LGBTQIA+ community is known to buffer against the harmful effects of stressors and decrease risks for poor psychological and behavioral health outcomes. The current study uses qualitative cross-sectional and trajectory analysis methods to characterize how LGBTQIA+ people's perceptions of community connectedness shifted during the first year of the pandemic. A convenience sample of LGBTQIA+-identified people in the U.S. completed an initial online survey in September 2020 (n = 298 and a follow-up survey in September 2021 (n = 129). The survey included changes in connectedness to the LGBTQIA+ community since the pandemic's beginning. Thus, we used both cross-sectional (between-person analyses) and longitudinal trajectory (within-person analyses) qualitative approaches to understanding changes in LGBTQIA+ people's sense of connection to the LGBTQIA+ community across the first two years of the COVID-19 pandemic. Eight cross-cutting themes (related to identity shifts/exploration, disconnection, online connections, and increased awareness of social justice issues) were identified and then organized within each level of the Social-Ecological Model of LGBTQIA+ wellbeing (i.e., the individual-, couple-, interpersonal-, organizational-, community-, and chronosystem- level). Given the importance of social support for LGBTQIA+ wellbeing, more longitudinal research is needed to determine whether these changes persist after the resolution of the acute phase of the pandemic.
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Affiliation(s)
- Angie R Wootton
- School of Social Welfare, University of California, Berkeley, California, USA
| | - Kodiak R S Soled
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - Jae A Puckett
- Department of Psychology, Michigan State University, East Lansing, Michigan, USA
| | - J J Garrett-Walker
- Ontario Institute for Studies in Education, University of Toronto, Toronto, Canada
| | - Aaron Perry Hill
- School of Social Welfare, University of California, Berkeley, California, USA
| | - Kevin Delucio
- Fairhaven College of Interdisciplinary Studies, Western Washington University, Bellingham, WA, USA
| | - Cindy B Veldhuis
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
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7
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Layland EK, Bränström R, Murchison GR, Pachankis JE. Kept in the Closet: Structural Stigma and the Timing of Sexual Minority Developmental Milestones Across 28 European Countries. J Youth Adolesc 2023:10.1007/s10964-023-01818-2. [PMID: 37410349 DOI: 10.1007/s10964-023-01818-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 06/25/2023] [Indexed: 07/07/2023]
Abstract
Structural stigma's role in lesbian, gay, and bisexual (LGB) people's attainment of identity development milestones remains unknown. In a sample of 111,498 LGB people (ages 15 to 65+) living across 28 European countries, associations were investigated between structural stigma measured using an objective index of discriminatory country-level laws and policies affecting LGB people and the timing and pacing of LGB self-awareness, coming out, and closet duration, and subgroup differences in these associations. On average, self-awareness occurred at age 14.8 years old (SD = 5.1), coming out occurred at 18.5 years old (SD = 5.7), and the closet was 3.9 years long (SD = 4.9); thereby highlighting adolescence as a key period for sexual identity development and disclosure. Greater structural stigma was associated with higher odds of never coming out, later age of coming out, and longer closet duration. Gender identity, transgender identity, and sexual identity moderated associations between structural stigma and these developmental milestones. Reducing structural stigma can plausibly promote sexual identity development among LGB populations, especially during adolescence when identity related milestones are often attained.
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Affiliation(s)
- E K Layland
- Department of Human Development and Family Sciences, University of Delaware, 111 Alison Hall West, Newark, DE, 19716, USA.
- Yale School of Public Health, Yale University, 60 College St, New Haven, CT, 06510, USA.
| | - R Bränström
- Department of Clinical Neuroscience, Karolinska Institutet, Nobels väg 9, 171 77, Stockholm, Sweden
| | - G R Murchison
- Yale School of Public Health, Yale University, 60 College St, New Haven, CT, 06510, USA
| | - J E Pachankis
- Yale School of Public Health, Yale University, 60 College St, New Haven, CT, 06510, USA
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8
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Pachankis JE, Jackson SD. Future Research Directions on "The Closet" as Metaphor and Reality. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:1931-1935. [PMID: 37308602 PMCID: PMC10411687 DOI: 10.1007/s10508-023-02636-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 05/22/2023] [Accepted: 05/23/2023] [Indexed: 06/14/2023]
Affiliation(s)
- John E Pachankis
- Department of Social and Behavioral Sciences, Yale School of Public Health, 60 College Street, Suite 316, New Haven, CT, 06510, USA.
| | - Skyler D Jackson
- Department of Social and Behavioral Sciences, Yale School of Public Health, 60 College Street, Suite 316, New Haven, CT, 06510, USA
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9
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Feinstein BA, Rentería R. Where Is the Line Between Being In versus Out of the Closet? ARCHIVES OF SEXUAL BEHAVIOR 2023:10.1007/s10508-023-02570-1. [PMID: 36856959 DOI: 10.1007/s10508-023-02570-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 02/15/2023] [Accepted: 02/16/2023] [Indexed: 06/18/2023]
Affiliation(s)
- Brian A Feinstein
- Department of Psychology, Rosalind Franklin University of Medicine and Science, 3333 Green Bay Road, North Chicago, IL, 60064, USA.
| | - Roberto Rentería
- Department of Psychology, Rosalind Franklin University of Medicine and Science, 3333 Green Bay Road, North Chicago, IL, 60064, USA
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10
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Alley J. Considering Evolutionary Developmental Theory in the Developmental Model of the Sexual Minority Closet. ARCHIVES OF SEXUAL BEHAVIOR 2023:10.1007/s10508-022-02512-3. [PMID: 36624328 DOI: 10.1007/s10508-022-02512-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/17/2022] [Accepted: 12/19/2022] [Indexed: 06/17/2023]
Affiliation(s)
- Jenna Alley
- Department of Psychiatry and Biobehavioral Sciences, University of California, UCLA, 10920 Wilshire Blvd., Suite 300 Room 313, Los Angeles, CA, USA.
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11
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Rosario M. Development of Lesbian/Gay, Bisexual, and Other Sexual Minority Individuals: The Closet and Disclosure as a Window into the Issue. ARCHIVES OF SEXUAL BEHAVIOR 2023:10.1007/s10508-022-02516-z. [PMID: 36604369 DOI: 10.1007/s10508-022-02516-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/19/2022] [Accepted: 12/20/2022] [Indexed: 06/17/2023]
Affiliation(s)
- Margaret Rosario
- Department of Psychology, The City University of New York-The City College and Graduate Center, 160 Convent Avenue, New York, NY, 10031, USA.
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12
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Abboud S, Flores DD. A Developmental Model of the Sexual Minority Closet: Implications for Arab Immigrant Sexual Minorities and Parent-LGBTQ Child Sex Communication. ARCHIVES OF SEXUAL BEHAVIOR 2023:10.1007/s10508-022-02522-1. [PMID: 36596907 DOI: 10.1007/s10508-022-02522-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 12/19/2022] [Accepted: 12/20/2022] [Indexed: 06/17/2023]
Affiliation(s)
- Sarah Abboud
- Department of Human Development Nursing Science, College of Nursing, University of Illinois Chicago, 845 S. Damen Avenue (Office # 854), Chicago, IL, 60612, USA.
| | - Dalmacio D Flores
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
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13
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Doyle DM, Barreto M. Toward a More Relational Model of Sexual Minority Identity Concealment. ARCHIVES OF SEXUAL BEHAVIOR 2022:10.1007/s10508-022-02491-5. [PMID: 36443612 DOI: 10.1007/s10508-022-02491-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 11/15/2022] [Accepted: 11/17/2022] [Indexed: 06/16/2023]
Affiliation(s)
- David Matthew Doyle
- Department of Psychology, Washington Singer Laboratories, University of Exeter, Exeter, EX4 4QG, UK.
| | - Manuela Barreto
- Department of Psychology, Washington Singer Laboratories, University of Exeter, Exeter, EX4 4QG, UK
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14
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Rawlings ZW, Soulliard ZA, Knafo D. When it doesn’t get better: A qualitative study of eating disorders, sexual identity, and coming out in sexual minority men. JOURNAL OF GAY & LESBIAN MENTAL HEALTH 2022. [DOI: 10.1080/19359705.2022.2118922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Zachary W. Rawlings
- aDepartment of Psychology, Long Island University, C.W. Post Campus, Brookville, NY, United States
| | | | - Danielle Knafo
- aDepartment of Psychology, Long Island University, C.W. Post Campus, Brookville, NY, United States
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