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Bränström R, Hatzenbuehler ML, Lattanner MR, Hollinsaid NL, McDade TW, Pachankis JE. Threats to social safety and neuro-inflammatory mechanisms underlying sexual orientation disparities in depression symptom severity: A prospective cohort study of young adults. Brain Behav Immun 2024; 119:211-219. [PMID: 38548185 DOI: 10.1016/j.bbi.2024.03.036] [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: 09/26/2023] [Revised: 02/25/2024] [Accepted: 03/26/2024] [Indexed: 04/09/2024] Open
Abstract
Sexual minority individuals have a markedly elevated risk of depression compared to heterosexuals. We examined early threats to social safety and chronically elevated inflammation as mechanisms contributing to this disparity in depression symptoms, and compared the relative strength of the co-occurrence between chronic inflammation and depression symptoms for sexual minorities versus heterosexuals. To do so, we analyzed data from a prospective cohort of sexual minority and heterosexual young adults (n = 595), recruited from a nationally representative sample, that included assessments of early threats to social safety in the form of adverse childhood interpersonal events, three biomarkers of inflammation (i.e., CRP, IL-6, TNF-α) measured at two time points, and depression symptoms over four years. In pre-registered analyses, we found that sexual minorities experienced more adverse childhood interpersonal events, were more likely to display chronically elevated inflammation, and reported more severe depression symptoms than heterosexuals. Adverse childhood interpersonal events and chronically elevated inflammation explained approximately 23 % of the total effect of the association between sexual orientation and depression symptom severity. Further, there was an increased coupling of chronically elevated inflammation and depression symptoms among sexual minorities compared to heterosexuals. These results provide novel longitudinal, population-based evidence for the role of chronically elevated inflammation in linking threats to social safety during childhood with depression symptom severity in young adulthood, consistent with the primary tenets of the social signal transduction theory of depression. Our study extends this theory to the population level by finding that members of a stigmatized population (i.e., sexual minorities) experience a greater risk of depression because of their greater exposure to adverse childhood interpersonal events and the subsequent link to chronic inflammation, highlighting potential biopsychosocial intervention targets.
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Affiliation(s)
- Richard Bränström
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
| | | | - Micah R Lattanner
- Department of Public Health, Santa Clara University, Santa Clara, CA USA
| | | | - Thomas W McDade
- Department of Anthropology and Institute for Policy Research, Northwestern University, Evanston, IL, USA
| | - John E Pachankis
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
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Juster RP, Rutherford C, Keyes K, Hatzenbuehler ML. Associations Between Structural Stigma and Allostatic Load Among Sexual Minorities: Results From a Population-Based Study. Psychosom Med 2024; 86:157-168. [PMID: 38345315 DOI: 10.1097/psy.0000000000001289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
OBJECTIVE Structural forms of stigma and discrimination are associated with adverse health outcomes across numerous stigmatized groups, including lesbian, gay, and bisexual (LGB) individuals. However, the biological consequences of structural stigma among LGB populations are understudied. To begin to address this gap, we assessed associations between indicators of structural stigma (i.e., state-level policies) targeting LGB individuals and allostatic load (AL) indices representing physiological dysregulations. METHODS Pooled data from the continuous 2001-2014 National Health and Nutritional Examination Survey were analyzed (LGB: n = 864; heterosexual: n = 20,310). Ten state-level LGB-related policies (e.g., employment nondiscrimination protections, same-sex marriage) were used to operationalize structural stigma. A sex-specific AL index representing 11 immune, metabolic, and cardiovascular biomarkers was estimated. Multilevel models were used to examine associations between structural stigma and AL, net of nine individual-level characteristics (e.g., education, race/ethnicity, age, and health behaviors). RESULTS Sexual minority men living in states with low levels of structural stigma experienced significantly lower AL ( β = -0.45, p = .02) compared with sexual minority men living in states with high structural stigma (i.e., fewer protective policies). There was no significant association between structural stigma and AL among sexual minority women. CONCLUSIONS By demonstrating direct associations between structural stigma and indices of physiological dysregulation, our findings provide a mechanistic understanding of how the social environment can "get under the skin and skull" for sexual minority men in the United States. Future research should explore whether these mechanisms generalize to other marginalized groups exposed to structural stigma.
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Affiliation(s)
- Robert-Paul Juster
- From the Department of Psychiatry and Addiction (Juster), University of Montreal; Research Center of the Montreal Mental Health University Institute (Juster), Montreal, Quebec, Canada; Department of Epidemiology, Mailman School of Public Health, Columbia University (Rutherford, Keyes), New York, New York; and Department of Psychology, Harvard University (Hatzenbuehler), Cambridge, Massachusetts
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Barbee H, McKay T. Do supportive work environments matter for minority aging? Work stress and subjective cognitive impairment among middle-age and older lesbian, gay, bisexual, transgender, and queer adults. Acta Psychol (Amst) 2023; 237:103949. [PMID: 37267881 PMCID: PMC11089649 DOI: 10.1016/j.actpsy.2023.103949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 04/08/2023] [Accepted: 05/21/2023] [Indexed: 06/04/2023] Open
Abstract
Research has documented how people's experiences at work affect their cognitive health outcomes, but how these processes unfold for minority groups, particularly lesbian, gay, bisexual, transgender, and queer (LGBTQ+) populations, is unclear. This study builds on the nascent literature by employing generalized structural equation models to test how experiencing major problems at work and working with LGBTQ+ supportive coworkers affect subjective cognitive impairment among middle-age and older LGBTQ+ adults. We also test for mediated and indirect effects of support and problems at work operating via vascular disease, sleep problems, and depression symptoms. Experiencing major problems at work is associated with a higher likelihood of reporting cognitive symptoms consistent with mild cognitive impairment, but this relationship is mediated by depression symptoms and sleep problems. Having LGBTQ+ supportive coworkers does not have direct effects on mild cognitive impairment, but does operate indirectly by decreasing problems at work and, in turn, decreases the likelihood of reporting cognitive symptoms consistent with mild cognitive impairment. Overall, we find that workplace stressors contribute to cognitive health directly and through mediated and indirect pathways and that supportive contexts reduce exposure to problems at work. We conclude with suggested possibilities to reorganize workplaces to improve long-term cognitive health outcomes for older adults, especially those who are LGBTQ+-identified.
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Affiliation(s)
- Harry Barbee
- Johns Hopkins University, United States of America.
| | - Tara McKay
- Vanderbilt University, United States of America.
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Significant Others and Not Family or Friend Support Mediate Between Stigma and Discrimination Among People Living With HIV in Lagos State, Nigeria: A Cross-sectional Study. J Assoc Nurses AIDS Care 2023; 34:96-104. [PMID: 36198119 DOI: 10.1097/jnc.0000000000000366] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
ABSTRACT Approximately 70% of the 37.7 million people living with HIV (PLWH) globally reside in sub-Saharan Africa and 10% of the global HIV burden is in Nigeria. PLWH encounter stigma and discrimination. Limited support from family, friends, and significant others increases stigma and discrimination among PLWH. This study sought to understand how support from family, friends, and significant others mediates stigma and discrimination in the Nigerian context. This descriptive cross-sectional study enrolled 396 PLWH from six health facilities between June and July 2021 in Lagos State, Nigeria. Stigma, discrimination, and social support were assessed. On average, participants were 32 years of age and female. Increased social support was associated with reduced stigma and discrimination. Support from participants' significant others was found to mediate the relationship between stigma and discrimination.
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Transgender identity: Development, management and affirmation. Curr Opin Psychol 2022; 48:101467. [PMID: 36219930 DOI: 10.1016/j.copsyc.2022.101467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 09/04/2022] [Accepted: 09/08/2022] [Indexed: 01/28/2023]
Abstract
In this review, I discuss recent research on transgender identity development, management and affirmation, situating key topics within a social feedback model of transgender identity. This model foregrounds the dynamic interplay between internal and external influences on transgender identity. Furthermore, issues of intersectionality are highlighted throughout and located within broader socio-political contexts. Collectively, research on topics such as gender euphoria, passing, identity affirmation and social transitions, among others, points to the pivotal role of supportive social relationships and social environments in the healthy development and expression of transgender identities. Future work should prioritize longitudinal studies with careful and rigorous assessment of identity-related constructs in order to further examine these and other topics.
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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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DuBois LZ, Juster RP. Lived experience and allostatic load among transmasculine people living in the United States. Psychoneuroendocrinology 2022; 143:105849. [PMID: 35797839 DOI: 10.1016/j.psyneuen.2022.105849] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 06/20/2022] [Accepted: 06/20/2022] [Indexed: 12/17/2022]
Abstract
BACKGROUND Transgender and gender diverse people face significant stigma that can adversely affect their physical and mental health. However, the psychobiological link between lived experience and health has been underexplored in this population. We thus examine perceived distress, mental health, and physiological 'wear and tear' by indexing allostatic load (AL) and assess associations with a range of contextual and experiential factors from transmasculine people living in the United States. METHODS Sixty-five people who identified as transgender men or along a transmasculine spectrum, living in Massachusetts, Vermont, and Rhode Island participated in The Transition Experience Study (age: M=31.8, range 18-55), which examines lived experience of social and medical transition and embodied gender minority/marginalization stress among a sample of transmasculine people. Based on in-depth in-person interview and survey data and inspired by an ecological systems model, we created indices representing (1) perceived progressive geopolitical climate; (2) socio-demographic advantage; (3) social support and resources; (4) gender minority and marginalization stressors; and (5) health behaviors. The Perceived Stress Scale and psychological symptoms (depression, anxiety, insomnia) were also assessed. AL indexed 10 neuroendocrine, immune, cardiovascular, and metabolic biomarkers. RESULTS Regressions revealed that perceived stress and psychological symptoms were negatively correlated with progressive geopolitical climate (respectively B=-1.47, p = 0.19; B=-.77, p < .001) and positively correlated with gender minority and marginalization stressors (respectively B=1.51, p < .001; B =.38, p = .005). AL was negatively associated with perceived progressive geopolitical climate (B=-.55, p = .007) and socio-demographic advantage (B=-3.2, p = .001). DISCUSSIONS These findings underline the importance of assessing geopolitical context and indexing lived experiences and life domains along with biomarker sampling. Together, these enable the identification of psychobiological pathways to better nuance multi-level contributors to health and well-being and understand embodied inequalities. These analyses of embodied stigma inclusive of AL biomarkers thus provide a model to further research centering transgender people's health from youth through old age.
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Affiliation(s)
- L Zachary DuBois
- Department. of Anthropology, University of Oregon, 355 Condon Hall, Eugene, OR 97403, United States.
| | - Robert-Paul Juster
- Center on Sex⁎Gender, Allostasis, and Resilience, 7331 Hochelaga, Pavillon Fernand-Seguin, FS-145-12, Montreal, Quebec H1N 3V2, Canada; Department of Psychiatry and Addiction, University of Montreal, Researcher, Research Center of the Montreal Mental Health University Institute, 7331 Hochelaga, Pavillon Fernand-Seguin, FS-145-12, Montreal, Quebec H1N 3V2, Canada.
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A systematic review and meta-analysis of the Everyday Discrimination Scale and biomarker outcomes. Psychoneuroendocrinology 2022; 142:105772. [PMID: 35490482 PMCID: PMC9997446 DOI: 10.1016/j.psyneuen.2022.105772] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 03/01/2022] [Accepted: 04/17/2022] [Indexed: 02/08/2023]
Abstract
Discrimination has consistently been associated with multiple adverse health outcomes. Like other psychosocial stressors, discrimination is thought to impact health through stress-related physiologic pathways including hypothalamic-pituitary-adrenal (HPA) axis activation, dysregulation of inflammation responses, and accelerated cellular aging. Given growing attention to research examining the biological pathways through which discrimination becomes embodied, this systematic review and meta-analysis synthesizes empirical evidence examining relationships between self-reported discrimination and four biomarker outcomes (i.e., cortisol, C-reactive protein (CRP), interleukin-6 (IL-6), and telomere length) among studies that have used the Everyday Discrimination Scale. We conducted a systematic review of studies discussing self-reported, everyday, or chronic discrimination in the context of health by searching Medline / PubMed (National Library of Medicine, NCBI), PsycInfo (APA, Ebsco) and Web of Science Core Collection (Clarivate). Twenty-five articles met the criteria for meta-analysis, with several reporting on multiple outcomes. Discrimination was associated with elevated CRP levels (r = 0.11; 95% CI: 0.01, 0.20, k = 10), though not cortisol (r = 0.05; 95% CI: -0.06, 0.16, k = 9), IL-6 (r = 0.05; 95% CI: -0.32, 0.42, k = 5), or telomere length (r = 0.03; 95% CI: -0.01, 0.07, k = 6). We identify several points of consideration for future research including addressing heterogeneity in assessment of biomarker outcomes and the need for longitudinal assessments of relationships between discrimination and biomarker outcomes.
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Diamond LM, Alley J. Rethinking minority stress: A social safety perspective on the health effects of stigma in sexually-diverse and gender-diverse populations. Neurosci Biobehav Rev 2022; 138:104720. [PMID: 35662651 DOI: 10.1016/j.neubiorev.2022.104720] [Citation(s) in RCA: 66] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/25/2022] [Accepted: 05/30/2022] [Indexed: 12/13/2022]
Abstract
For over two decades, the minority stress model has guided research on the health of sexually-diverse individuals (those who are not exclusively heterosexual) and gender-diverse individuals (those whose gender identity/expression differs from their birth-assigned sex/gender). According to this model, the cumulative stress caused by stigma and social marginalization fosters stress-related health problems. Yet studies linking minority stress to physical health outcomes have yielded mixed results, suggesting that something is missing from our understanding of stigma and health. Social safety may be the missing piece. Social safety refers to reliable social connection, inclusion, and protection, which are core human needs that are imperiled by stigma. The absence of social safety is just as health-consequential for stigmatized individuals as the presence of minority stress, because the chronic threat-vigilance fostered by insufficient safety has negative long-term effects on cognitive, emotional, and immunological functioning, even when exposure to minority stress is low. We argue that insufficient social safety is a primary cause of stigma-related health disparities and a key target for intervention.
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Affiliation(s)
- Lisa M Diamond
- Department of Psychology, University of Utah, Salt Lake City, UT, USA.
| | - Jenna Alley
- Department of Psychology, University of Utah, Salt Lake City, UT, USA
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10
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Discrimination is associated with C-reactive protein among young sexual minority men. J Behav Med 2022; 45:649-657. [PMID: 35394239 DOI: 10.1007/s10865-022-00307-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 03/07/2022] [Indexed: 12/25/2022]
Abstract
This report examines associations between everyday discrimination, microaggressions, and CRP to gain insight on potential mechanisms that may underlie increased CVD risk among sexual minority male young adults. The sample consisted of 60 participants taken from the P18 cohort between the ages of 24 and 28 years. Multinomial logistic regression models were used to examine the association between perceived everyday discrimination and LGBQ microaggressions with C-reactive protein cardiovascular risk categories of low-, average-, and high-risk, as defined by the American Heart Association and Centers for Disease Control. Adjustments were made for BMI. Individuals who experienced more everyday discrimination had a higher risk of being classified in the high-risk CRP group compared to the low-risk CRP group (RRR = 3.35, p = 0.02). Interpersonal LGBQ microaggressions were not associated with CRP risk category. Everyday discrimination, but not specific microaggressions based on sexual orientation, were associated with elevated levels of CRP among young sexual minority men (YSMM). Thus, to implement culturally and age-appropriate interventions, further researcher is needed to critically examine the specific types of discrimination and the resultant impact on YSMM's health.
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11
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Comparison of depressive symptoms and inflammation between sexual minorities and heterosexuals using NHANES study of 8538 participants. Sci Rep 2022; 12:3792. [PMID: 35260636 PMCID: PMC8904501 DOI: 10.1038/s41598-022-07702-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 02/22/2022] [Indexed: 11/08/2022] Open
Abstract
The present study aims to compare the rate of depressive symptoms and inflammation levels between sexual minorities and heterosexuals. Data were obtained from the National Health and Nutrition Examination Survey from 2005 to 2010. Depressive-related symptoms were measured using the Patient Health Questionnaire-9 scoring system. C-reactive protein was analyzed with the Behring Nephelometer. Of 8538 participants, 95.8% self-reported as heterosexual and 4.2% as sexual minority. Depressive symptoms were reported in 7.1% of heterosexuals compared to 15.8% in sexual minorities (P = 0.001). In heterosexuals, C-reactive protein was higher in those with depressive symptoms compared to those without (P < 0.001). In sexual minorities, similar results were found, however, it was statistically insignificant. The intersection group of black sexual minority females reported the highest rate of depressive symptoms at 33.4%. We found that depressive symptoms were higher in sexual minorities compared to heterosexuals. Furthermore, systemic inflammation was highest in the intersection group of black sexual minority females.
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Lindert J, Paul KC, Lachman Margie E, Ritz B, Seeman T. Social stress and risk of declining cognition: a longitudinal study of men and women in the United States. Soc Psychiatry Psychiatr Epidemiol 2022; 57:1875-1884. [PMID: 33864472 PMCID: PMC8522181 DOI: 10.1007/s00127-021-02089-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 04/07/2021] [Indexed: 12/16/2022]
Abstract
Limited research is available on the relationship between social stress and risk of declining cognition. We sought to examine whether social stress has adverse effects on risk of declining episodic memory and executive functioning in aging individuals. We used data from the MIDUS study, a national probability sample of non-institutionalized, English speaking respondents aged 25-74 living in the 48 contiguous states of the United States. The initial wave (1995) included 4963 non-institutionalized adults aged 32-84 (M = 55, SD = 12.4). We used an analytic sample from MIDUS-II (1996/1997) and MIDUS-III (2013) (n = 1821). The dependent variables are episodic memory and executive functioning, which were assessed with the Brief Test for Cognition (BTACT). The independent variables were social stress variables (subjective social status, family and marital stress, work stress and discrimination). To evaluate episodic memory and executive functioning changes over a time period of 10 years, we estimated adjusted linear regression models. Women report significantly lower subjective social status and more discrimination stress than men across all age groups. Controlling for education and income, age, and baseline episodic memory and executive functioning, lower subjective social status had additional adverse effects on declines in episodic memory in men and women. Marital risk had adverse effects on episodic memory in men but not in women. Daily discrimination had adverse effects on executive functioning on all individuals. Public health strategies should focus on reducing social stress in a socio-ecological perspective. Especially, subjective social status and discrimination stress might be a target for prevention efforts.
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Affiliation(s)
- Jutta Lindert
- Department of Health and Social Work, University of Applied Sciences Emden/Leer, Constantiaplatz 4, 22687, Emden, Germany. .,Women's Research Center at Brandeis University, 415 South St., Waltham, MA, 02453, USA.
| | - Kimberley C. Paul
- Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California At Los Angeles, 650 Charles E. Young Dr. S, Los Angeles, CA 90095 USA
| | - E. Lachman Margie
- The Heller School for Social Policy and Management, Brandeis University, 415 South St., Waltham, MA 02453 USA
| | - Beate Ritz
- Department of Epidemiology, Jonathan and Karin Fielding School of Public Health, University of California At Los Angeles, 650 Charles E. Young Dr. S, Los Angeles, CA 90095 USA
| | - Teresa Seeman
- Division of Geriatrics, David Geffen School of Medicine, 10833 Le Conte Ave, Los Angeles, CA 90095 USA
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13
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Poteat TC, Divsalar S, Streed CG, Feldman JL, Bockting WO, Meyer IH. Cardiovascular Disease in a Population-Based Sample of Transgender and Cisgender Adults. Am J Prev Med 2021; 61:804-811. [PMID: 34364725 PMCID: PMC8608688 DOI: 10.1016/j.amepre.2021.05.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 04/25/2021] [Accepted: 05/09/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Existing data on cardiovascular disease among transgender people are inconsistent and are derived from nonrepresentative samples or population-based data sets that do not include transgender-specific risk factors such as gender-affirming hormone use and gender minority stressors. A nationally representative sample of cisgender and transgender adults aged ≥40 years was used to assess the prevalence and correlates of smoking, select cardiovascular disease conditions, and venous thromboembolism. METHODS Participants were recruited from 2016 to 2018, with analysis conducted in December 2020 with 114 transgender and 964 cisgender individuals. Sample weights and multiple imputations were used for all estimates except for descriptive statistics. Logistic regression models estimated the ORs and 95% CIs expressing the relationship between each outcome variable and a set of independent variables. Each model controlled for race and age. RESULTS No meaningful differences between cisgender and transgender participants were found in smoking or cardiovascular disease conditions. However, there was an increased odds of venous thromboembolism among transgender women compared with those among cisgender women. Transgender people had greater odds of discrimination, psychological distress, and adverse childhood experiences. These stressors were associated with increased odds of a cardiovascular condition, and everyday discrimination and adverse childhood experiences were associated with increased odds of smoking. Discrimination and psychological distress were associated with venous thromboembolism. CONCLUSIONS Transgender people face disparities in cardiovascular disease risk. This study provides support for the gender minority stress model as a framework for understanding cardiovascular disease disparities. Future research with larger samples and adjudicated outcomes is needed to advance the field.
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Affiliation(s)
- Tonia C Poteat
- Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
| | - Shahrzad Divsalar
- Institute for Digital Research & Education, University of California, Los Angeles, Los Angeles, California
| | - Carl G Streed
- Section of General Internal Medicine, Boston University School of Medicine, Boston, Massachusetts; Center for Transgender Medicine and Surgery, Boston Medical Center, Boston, Massachusetts
| | - Jamie L Feldman
- Program in Human Sexuality, Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota
| | - Walter O Bockting
- Division of Gender, Sexuality, and Health, New York State Psychiatric Institute/Columbia Psychiatry, New York, New York
| | - Ilan H Meyer
- Williams Institute, School of Law, University of California, Los Angeles, Los Angeles, California
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Christian LM, Cole SW, McDade T, Pachankis JE, Morgan E, Strahm AM, Kamp Dush CM. A biopsychosocial framework for understanding sexual and gender minority health: A call for action. Neurosci Biobehav Rev 2021; 129:107-116. [PMID: 34097981 PMCID: PMC8429206 DOI: 10.1016/j.neubiorev.2021.06.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 05/26/2021] [Accepted: 06/01/2021] [Indexed: 12/29/2022]
Abstract
The number of US adults identifying as lesbian, gay, bisexual, transgender, or a different sexual identity has doubled since 2008, and about 40 % of the sexual and gender minority population identify as people of color. Minority stress theory posits that sexual and gender minorities are at particular risk for stress via stigma and discrimination at the structural, interpersonal, and individual levels. This stress, in turn, elevates the risk of adverse health outcomes across several domains. However, there remains a conspicuously limited amount of research on the psychoneuroimmunology of stress among sexual and gender minorities. We developed the Biopsychosocial Minority Stress Framework which posits that sexual minority status leads to unique experiences of minority stress which results in adverse health behavioral factors, elevated psychological distress and sleep disturbance, and immune dysregulation. Moderators in the model include both individual differences and intersectional identities. There is a crucial need to understand the biological-psychological axis of stress among the increasingly visible sexual and gender minority population to increase their health, longevity, and quality of life.
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Affiliation(s)
- Lisa M Christian
- Department of Psychiatry & Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH, USA; The Institute for Behavioral Medicine Research, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
| | - Steve W Cole
- Department of Psychiatry & Biobehavioral Sciences and Medicine, UCLA School of Medicine, Los Angeles, CA, USA
| | - Thomas McDade
- Department of Anthropology, Northwestern University, Evanston, IL, USA; Institute for Policy Research, Northwestern University, Evanston, IL, USA; Child and Brain Development Program, Canadian Institute for Advanced Research, Toronto, ON, Canada
| | - John E Pachankis
- Yale School of Public Health, New Haven, CT, USA; Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, USA
| | - Ethan Morgan
- College of Nursing, The Ohio State University, Columbus, OH, USA
| | - Anna M Strahm
- Department of Psychiatry & Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH, USA; The Institute for Behavioral Medicine Research, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Claire M Kamp Dush
- Minnesota Population Center, University of Minnesota, Minneapolis, MN, USA; Department of Sociology, University of Minnesota, Minneapolis, MN, USA
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Diamond LM, Dehlin AJ, Alley J. Systemic inflammation as a driver of health disparities among sexually-diverse and gender-diverse individuals. Psychoneuroendocrinology 2021; 129:105215. [PMID: 34090051 DOI: 10.1016/j.psyneuen.2021.105215] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/25/2021] [Accepted: 03/25/2021] [Indexed: 01/28/2023]
Abstract
Sexually-diverse individuals (those who seek sexual or romantic relationships with the same and/or multiple genders) and gender-diverse individuals (those whose gender identity and/or expression differs from their birth-assigned sex/gender) have disproportionately high physical health problems, but the underlying biological causes for these health disparities remain unclear. Building on the minority stress model linking social stigmatization to health outcomes, we argue that systemic inflammation (the body's primary response to both physical and psychological threats, indicated by inflammatory markers such as C-reactive protein and proinflammatory cytokines) is a primary biobehavioral pathway linking sexual and gender stigma to physical health outcomes. Expectations and experiences of social threat (i.e., rejection, shame, and isolation) are widespread and chronic among sexually-diverse and gender-diverse individuals, and social threats are particularly potent drivers of inflammation. We review research suggesting that framing "minority stress" in terms of social safety versus threat, and attending specifically to the inflammatory consequences of these experiences, can advance our understanding of the biobehavioral consequences of sexual and gender stigma and can promote the development of health promoting interventions for this population.
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Doyle DM, Molix L. Reconciling Associations Between Minority Stress and Sexual Minority Romantic Relationship Functioning. Front Psychol 2021; 12:707058. [PMID: 34248806 PMCID: PMC8267149 DOI: 10.3389/fpsyg.2021.707058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 05/31/2021] [Indexed: 11/28/2022] Open
Affiliation(s)
- David Matthew Doyle
- Washington Singer Laboratories, Department of Psychology, University of Exeter, Exeter, United Kingdom
| | - Lisa Molix
- Department of Psychology, Tulane University, New Orleans, LA, United States
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Flentje A, Clark KD, Cicero E, Capriotti MR, Lubensky ME, Sauceda J, Neilands TB, Lunn MR, Obedin-Maliver J. Minority Stress, Structural Stigma, and Physical Health Among Sexual and Gender Minority Individuals: Examining the Relative Strength of the Relationships. Ann Behav Med 2021; 56:573-591. [PMID: 34228052 PMCID: PMC9242547 DOI: 10.1093/abm/kaab051] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background Sexual and gender minority (SGM; i.e., non-heterosexual and transgender or gender-expansive, respectively) people experience physical health disparities attributed to greater exposure to minority stress (experiences of discrimination or victimization, anticipation of discrimination or victimization, concealment of SGM status, and internalization of stigma) and structural stigma. Purpose To examine which components of minority stress and structural stigma have the strongest relationships with physical health among SGM people. Methods Participants (5,299 SGM people, 1,902 gender minority individuals) were from The Population Research in Identity and Disparities for Equality (PRIDE) Study. Dominance analyses estimated effect sizes showing how important each component of minority stress and structural stigma was to physical health outcomes. Results Among cisgender sexual minority women, transmasculine individuals, American Indian or Alaskan Native SGM individuals, Asian SGM individuals, and White SGM individuals a safe current environment for SGM people had the strongest relationship with physical health. For gender-expansive individuals and Black, African American, or African SGM individuals, the safety of the environment for SGM people in which they were raised had the strongest relationship with physical health. Among transfeminine individuals, victimization experiences had the strongest relationship with physical health. Among Hispanic, Latino, or Spanish individuals, accepting current environments had the strongest relationship with physical health. Among cisgender sexual minority men prejudice/discrimination experiences had the strongest relationship with physical health. Conclusion Safe community environments had the strongest relationships with physical health among most groups of SGM people. Increasing safety and buffering the effects of unsafe communities are important for SGM health.
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Affiliation(s)
- Annesa Flentje
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, CA, USA.,Alliance Health Project, Department of Psychiatry, School of Medicine, University of California, San Francisco, CA, USA.,The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Kristen D Clark
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, CA, USA
| | - Ethan Cicero
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | | | - Micah E Lubensky
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, CA, USA.,The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Palo Alto, CA, USA
| | - John Sauceda
- Division of Prevention Science, University of California, San Francisco, Center for AIDS Prevention Studies (CAPS), UCSF Prevention Research Center, San Francisco, CA, USA
| | - Torsten B Neilands
- Division of Prevention Science, University of California, San Francisco, Center for AIDS Prevention Studies (CAPS), UCSF Prevention Research Center, San Francisco, CA, USA
| | - Mitchell R Lunn
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Palo Alto, CA, USA.,Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.,Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Juno Obedin-Maliver
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Palo Alto, CA, USA.,Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, CA, USA.,Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA, USA
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Vincent W, Carrico AW, Dilworth SE, Fuchs D, Neilands TB, Moskowitz JT, Flentje A. Intersecting minority statuses and tryptophan degradation among stimulant-using, sexual minority men living with HIV. J Consult Clin Psychol 2021; 89:156-165. [PMID: 33829804 PMCID: PMC8547766 DOI: 10.1037/ccp0000586] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Disclosure of one's sexual orientation as a sexual-minority (SM) person (i.e., being "out") may affect HIV-related health outcomes. This longitudinal study examined whether race/ethnicity moderated effects of outness on the plasma kynurenine/tryptophan (KT) ratio, a marker of dysregulated serotonin metabolism due to immune activation that predicts clinical HIV progression. METHODS Participants were African American, Hispanic/Latino, and non-Hispanic White, methamphetamine-using SM men living with HIV (N = 97) who completed self-report scales of outness and SM stress at baseline for a randomized controlled trial of a positive affect intervention. Linear mixed modeling was used to test whether race/ethnicity and experimental condition moderated the association of baseline outness with the KT ratio at baseline, 6, 12, and 15 months controlling for SM stress, sociodemographics, HIV disease markers, and recent stimulant use. RESULTS The interactions of outness by race/ethnicity and outness by experimental condition on the KT ratio were significant. Greater outness predicted a lower KT ratio over time in non-Hispanic White SM men, but not among SM men of color (MOC). Greater outness predicted a lower KT ratio over time for SM men in the control, but not among those in the intervention arm. CONCLUSION Being more out may be protective for non-Hispanic White SM men, but not for their SM MOC peers. Outness mattered for participants who did not receive the positive affect intervention. Findings underscore the potentially different contexts and consequences of outness depending on SM men's race/ethnicity and whether they received a positive affect intervention. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Wardecker BM, Graham-Engeland JE, Almeida DM. Perceived discrimination predicts elevated biological markers of inflammation among sexual minority adults. J Behav Med 2021; 44:53-65. [PMID: 32930919 PMCID: PMC7855007 DOI: 10.1007/s10865-020-00180-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 09/05/2020] [Indexed: 01/24/2023]
Abstract
Sexual minority (SM) adults (those who are lesbian, gay, or bisexual) consistently report more health problems compared to heterosexuals, and they tend to experience excess social stress. Although numerous studies have established links between social stress and clinical outcomes in SM adults, few studies have examined biological factors that may help explain how social stress leads to health disparities among SM adults. We used data from the Midlife in the United States Study (MIDUS) to examine whether two inflammatory markers that have been commonly associated with social stress-C-reactive protein (CRP) and interleukin-6 (IL-6)-differed by sexual orientation and whether any differences were explained by perceptions of discrimination. Participants self-identified as heterosexual (n = 1956) or lesbian, gay, or bisexual (n = 81). After controlling for age, gender, race, and education, SM individuals had higher CRP and IL-6 than heterosexuals on average and these differences were partially explained by perceptions of discrimination. Implications for inflammatory pathways as mechanisms related to SM health disparities and discrimination are discussed.
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Affiliation(s)
- Britney M Wardecker
- College of Nursing, The Pennsylvania State University, University Park, PA, USA.
- Center for Healthy Aging, The Pennsylvania State University, University Park, PA, USA.
| | - Jennifer E Graham-Engeland
- Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA, USA
- Center for Healthy Aging, The Pennsylvania State University, University Park, PA, USA
| | - David M Almeida
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, USA
- Center for Healthy Aging, The Pennsylvania State University, University Park, PA, USA
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Cuevas AG, Ong AD, Carvalho K, Ho T, Chan SW(C, Allen JD, Chen R, Rodgers J, Biba U, Williams DR. Discrimination and systemic inflammation: A critical review and synthesis. Brain Behav Immun 2020; 89:465-479. [PMID: 32688027 PMCID: PMC8362502 DOI: 10.1016/j.bbi.2020.07.017] [Citation(s) in RCA: 91] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 07/01/2020] [Accepted: 07/13/2020] [Indexed: 12/21/2022] Open
Abstract
Exposure to discrimination or unfair treatment has emerged as an important risk factor for illness and disease that disproportionately affects racial and ethnic minorities. Discriminatory experiences may operate like other stressors in that they activate physiological responses that adversely affect the maintenance of homeostasis. Research suggests that inflammation plays a critical role in the pathophysiology of stress-related diseases. Recent findings on discrimination and inflammation are discussed. We highlight limitations in the current evidence and provide recommendations for future studies that seek to examine the association between discrimination and inflammation.
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Affiliation(s)
- Adolfo G. Cuevas
- Department of Community Health, Tufts University, United States,Corresponding author at: Tufts University, Department of Community Health, 574 Boston Ave, Suite 208, Medford, MA 02155, United States. (A.G. Cuevas)
| | - Anthony D. Ong
- Department of Human Development, Cornell University, United States,Department of Medicine, Weill Cornell Medical College, United States
| | - Keri Carvalho
- Department of Community Health, Tufts University, United States
| | - Thao Ho
- Department of Community Health, Tufts University, United States
| | | | | | - Ruijia Chen
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, United States
| | - Justin Rodgers
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, United States
| | - Ursula Biba
- Department of Community Health, Tufts University, United States
| | - David R. Williams
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, United States,Department of African and African American Studies, Harvard University, United States
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Ciftci EE, Barreto M, Doyle DM, Breen J, Darden S. Distancing or drawing together: Sexism and organisational tolerance of sexism impact women's social relationships at work. EUROPEAN JOURNAL OF SOCIAL PSYCHOLOGY 2020. [DOI: 10.1002/ejsp.2695] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Manuela Barreto
- University of Exeter Exeter UK
- Lisbon University Institute (CIS/ISCTE‐IUL) Lisbon Portugal
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The relationship between minority stress and biological outcomes: A systematic review. J Behav Med 2019; 43:673-694. [PMID: 31863268 DOI: 10.1007/s10865-019-00120-6] [Citation(s) in RCA: 113] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 11/27/2019] [Indexed: 02/06/2023]
Abstract
Sexual minority (non-heterosexual) individuals experience higher rates of physical health problems. Minority stress has been the primary explanatory model to account for this disparity. The purpose of this study was to identify in published research empirically established relationships between minority stress processes and biological outcomes and identify avenues for future research. The PubMed database was queried with search terms relevant to minority stress and a comprehensive list of physical and biological outcomes. To be included in the analysis, studies had to examine the relationship between minority stress and a biological outcome among sexual minority individuals. Those meeting inclusion criteria were coded for key variables including methodology used, positive and null results, participant characteristics, and specific minority stress processes and biological outcomes considered. In total, 26 studies met inclusion criteria. Studies tested relationships between specific minority stress processes including prejudice, expectations of prejudice, concealment of sexual orientation, and internalized stigma and multiple biological outcomes, such as overall physical health, immune response, HIV specific outcomes, cardiovascular outcomes, metabolic outcomes, cancer related outcomes, and hormonal outcomes. Studies included both analyses that detected this relationship (42% of analyses) and analyses that did not detect this relationship (58%). There is substantial evidence to support the relationship between minority stress and biological outcomes, yet additional research is needed to identify the measurements and outcomes that have the most rigorous and replicable results.
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Robles G, Bosco SC, Dellucci TV, Starks TJ. Integrating intra-individual and dyadic factors in examining health among gay and bisexual men: A narrative review of recent literature. JOURNAL OF GLBT FAMILY STUDIES 2019; 16:488-513. [PMID: 33041710 PMCID: PMC7546157 DOI: 10.1080/1550428x.2019.1682740] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Gay and bisexual men (GBM) experience disproportionate rates of mental health and other negative health outcomes. For GBM in relationships, contextualizing the myriad of negative outcomes as a dyadic process may provide insight into the mechanisms through which these adverse outcomes develop. The objective of this review is to examine the current state of the relationship science literature using a health framework, Relationship Process and Health. We conducted a search for articles using PubMed, PsycInfo, and Web of Science for empirical articles in English published in the past 15 years on GBM in a relationship, assessing attachment, and relationship functioning as predictors of health outcomes. We found 649 articles. After screening, 23 articles were identified and reviewed. Findings overwhelming identified HIV risk as the primary health outcome. Attachment was associated with relationship functioning and sexual risk behaviors. Relationship-specific components were largely used as predictors of sexual HIV transmission risk behaviors. Together, these studies suggest that relationship functioning is a prospective link between attachment and health-related outcomes. The literature has yet to examine empirically dyadic-level mechanisms that may explain the association between individual attachment and health outcomes aside from HIV risk, and needs more examination of other health disparities affecting GBM.
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Affiliation(s)
- Gabriel Robles
- PRIDE Health Research Consortium of Hunter College of the City University of New York, 142 West 36 Street, 9 Floor, New York, NY 10018, USA
| | - Stephen C. Bosco
- PRIDE Health Research Consortium of Hunter College of the City University of New York, 142 West 36 Street, 9 Floor, New York, NY 10018, USA
- Doctoral Program in Health Psychology and Clinical Science, The Graduate Center of the City University of New York, 365 5th Ave, New York, NY 10034, USA
| | - Trey V. Dellucci
- PRIDE Health Research Consortium of Hunter College of the City University of New York, 142 West 36 Street, 9 Floor, New York, NY 10018, USA
- Doctoral Program in Health Psychology and Clinical Science, The Graduate Center of the City University of New York, 365 5th Ave, New York, NY 10034, USA
| | - Tyrel J. Starks
- PRIDE Health Research Consortium of Hunter College of the City University of New York, 142 West 36 Street, 9 Floor, New York, NY 10018, USA
- Doctoral Program in Health Psychology and Clinical Science, The Graduate Center of the City University of New York, 365 5th Ave, New York, NY 10034, USA
- Department of Psychology, Hunter College of the City University of New York, 695 Park Ave, New York, NY 10065, USA
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Mays VM, Juster RP, Williamson TJ, Seeman TE, Cochran SD. Chronic Physiologic Effects of Stress Among Lesbian, Gay, and Bisexual Adults: Results From the National Health and Nutrition Examination Survey. Psychosom Med 2019; 80:551-563. [PMID: 29952935 PMCID: PMC6214815 DOI: 10.1097/psy.0000000000000600] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Social disadvantage is associated with markers of physiological dysregulation, which is linked to disease trajectories. Chronic experiences with discrimination are thought to result in the accumulation of physiological "wear and tear" known as allostatic load (AL) among socially marginalized populations such as sexual minorities. Using a nationally representative US sample, we examined whether (1) people who self-identified as homosexual or bisexual display higher levels of AL than heterosexual individuals and (2) subgroups of sexual identity would further differ from each other as a consequence of distinct experiences of marginalization. METHODS We use data from the 2001-2010 National Health and Nutrition Examination Survey. Employing multivariate regression methods with sex-specific analyses, we examined AL score differences among lesbian/gay (n = 211), bisexual (n = 307), homosexually experienced (n = 424), and exclusively heterosexual (n = 12,969) individuals, adjusting for possible confounding due to demographics, health indicators, and, among men, HIV infection status. RESULTS Results indicate that elevated AL was more common in bisexual men compared with exclusively heterosexual men (adjusted β = 0.25, 95% confidence interval [CI] = 0.05 to 0.44), with significantly higher levels of glycosylated hemoglobin A1c (adjusted odd ratio = 3.51, 95% CI = 1.46-7.92) and systolic blood pressure (adjusted odd ratio = 2.07, 95% CI = 1.02 to 4.18). Gay-identified men evidenced significantly lower AL (adjusted β = -0.22, 95% CI = -0.41 to -0.04). No significant differences in AL were observed among women. CONCLUSIONS These findings indicate that physiological dysregulation is more common in bisexual males compared with all other men. The results are discussed with regard to differences in health outcomes between individuals with different sexual orientations.
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Affiliation(s)
- Vickie M Mays
- From the Departments of Psychology and Health Policy and Management (Mays), Fielding School of Public Health University of California, Los Angeles; University of Montreal, Department of Psychiatry and Addiction (Juster), Montreal; University of California, Los Angeles (Williamson); UCLA School of Medicine and Fielding School of Public Health (Seeman), University of California, Los Angeles; and Department of Epidemiology, Fielding School of Public Health and Department of Statistics (Cochran), University of California, Los Angeles
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Panza GA, Puhl RM, Taylor BA, Zaleski AL, Livingston J, Pescatello LS. Links between discrimination and cardiovascular health among socially stigmatized groups: A systematic review. PLoS One 2019; 14:e0217623. [PMID: 31181102 PMCID: PMC6557496 DOI: 10.1371/journal.pone.0217623] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 05/15/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND There is a high prevalence of cardiovascular disease across diverse groups in the U.S. population, and increasing research has identified stigma as a potential barrier to cardiovascular disease prevention and treatment. This systematic review examines evidence linking discrimination and cardiovascular health among socially stigmatized groups. STUDY DESIGN Six databases were systematically reviewed from inception through February 2018 for studies with adult subjects, focusing on cardiovascular health indicators among social groups stigmatized because of their gender, race/ethnicity, age, body weight/obesity, or sexual orientation. The Newcastle-Ottawa Scale was used to evaluate the methodological quality and risk of bias for nonrandomized studies, and the Cochrane Collaboration 7-item domain for randomized controlled and experimental trials. RESULTS The search identified 84 eligible studies published between 1984 and 2017. Studies retrieved were categorized according to demonstrated links between stigma and cardiovascular disease risk factors including blood pressure (n = 45), heart rate variability (n = 6), blood/saliva cardiovascular biomarkers (n = 18), as well as other indicators of cardiovascular health (n = 15). Based on the findings from included studies, 86% concluded that there was a significant relationship among stigma or discrimination and cardiovascular health indicators among socially stigmatized groups. However, there were varying degrees of evidence supporting these relationships, depending on the type of discrimination and cardiovascular health indicator. The current evidence implies an association between perceived discrimination and cardiovascular health. However, a majority of these studies are cross-sectional (73%) and focus on racial discrimination (79%), while using a wide variety of measurements to assess social discrimination and cardiovascular health. CONCLUSIONS Future research should include longitudinal and randomized controlled trial designs, with larger and more diverse samples of individuals with stigmatized identities, using consistent measurement approaches to assess social discrimination and its relationship with cardiovascular health.
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Affiliation(s)
- Gregory A. Panza
- Department of Kinesiology, University of Connecticut, Storrs, CT, United States of America
- Department of Cardiology, Hartford Hospital, Hartford, CT, United States of America
- * E-mail:
| | - Rebecca M. Puhl
- Rudd Center for Food Policy & Obesity, University of Connecticut, Hartford, CT, United States of America
- Department of Human Development & Family Studies, University of Connecticut, Storrs, CT, United States of America
| | - Beth A. Taylor
- Department of Kinesiology, University of Connecticut, Storrs, CT, United States of America
- Department of Cardiology, Hartford Hospital, Hartford, CT, United States of America
| | - Amanda L. Zaleski
- Department of Kinesiology, University of Connecticut, Storrs, CT, United States of America
- Department of Cardiology, Hartford Hospital, Hartford, CT, United States of America
| | - Jill Livingston
- Department of Research Services, University of Connecticut, Storrs, CT, United States of America
| | - Linda S. Pescatello
- Department of Kinesiology, University of Connecticut, Storrs, CT, United States of America
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Juster RP, Doyle DM, Hatzenbuehler ML, Everett BG, DuBois LZ, McGrath JJ. Sexual orientation, disclosure, and cardiovascular stress reactivity. Stress 2019; 22:321-331. [PMID: 30835598 PMCID: PMC6760466 DOI: 10.1080/10253890.2019.1579793] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 01/31/2019] [Indexed: 12/15/2022] Open
Abstract
Stigma may strain the heart health of lesbian, gay, and bisexual (LGB) individuals. To date, however, LGB-related differences in cardiovascular diagnosis, risk factors, and basal biomarkers are inconsistently reported. Using a laboratory-based stress paradigm, the current study assessed whether cardiovascular stress reactivity differs as a function of sexual orientation and disclosure status ("coming out") in a sample of healthy young LGB and heterosexual adults. Eighty-seven participants aged 18-45 (M = 24.61 ± 0.61 SE) identifying as LGB and heterosexual (47%) were exposed to the Trier Social Stress Test, a well-validated laboratory stressor involving public speaking and mental arithmetic. Throughout a two-hour session, ambulatory recordings for heart rate and blood pressure were collected. Self-report questionnaires were also administered to assess psychosocial and demographic variables. Gay/bisexual men showed higher heart rate and lesbian/bisexual women showed marginally higher mean arterial blood pressure in response to a stressor, compared to sex- and age-matched heterosexuals. No significant differences emerged when comparing LGB individuals who had completely disclosed and those that had not completely disclosed their sexual orientation to family and friends. Compared to heterosexuals, heart rate is higher among gay/bisexual men and blood pressure is marginally higher among lesbian/bisexual women when exposed to a laboratory-based stressor. These preliminary findings contribute to small literature on sexual orientation differences in stress reactive biomarkers that requires further exploration. Lay abstract In response to stress exposure in a laboratory, gay/bisexual men showed higher heart rate than heterosexual men. By contrast, lesbian/bisexual showed a non-significant tendency towards higher blood pressure than heterosexual women. These preliminary findings suggest that the heart health of LGB individuals might be strained by stigma exposure.
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Affiliation(s)
- Robert-Paul Juster
- Department of Psychiatry and Addiction, University of Montreal, Montreal, Canada
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