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Lippard ETC, Nemeroff CB. Going beyond risk factor: Childhood maltreatment and associated modifiable targets to improve life-long outcomes in mood disorders. Pharmacol Biochem Behav 2022; 215:173361. [PMID: 35219755 DOI: 10.1016/j.pbb.2022.173361] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 02/17/2022] [Accepted: 02/20/2022] [Indexed: 01/26/2023]
Abstract
Childhood maltreatment increases risk for mood disorders and is associated with earlier onset-and more pernicious disease course following onset-of mood disorders. While the majority of studies to date have been cross-sectional, longitudinal studies are emerging and support the devastating role(s) childhood maltreatment has on development of, and illness course in, mood disorders. This manuscript extends prior reviews to emphasize more recent work, highlighting longitudinal data, and discusses treatment studies that provide clues to mechanisms that mediate disease risk, course, relapse, and treatment response. Evidence suggesting systemic inflammation, alterations in hypothalamic-pituitary-adrenal (HPA) axis function and corticotropin-releasing factor (CRF) neural systems, genetic and other familial factors as mechanisms that mediate risk and onset of, and illness course in, mood disorders following childhood maltreatment is discussed. Risky behaviors following maltreatment, e.g., substance use and unhealthy lifestyles, may further exacerbate alterations in the HPA axis, CRF neural systems, and systematic inflammation to contribute to a more pernicious disease course. More research on sex differences and the impact of maltreatment in vulnerable populations is needed. Future research needs to be aimed at leveraging knowledge on modifiable targets, going beyond childhood maltreatment as a risk factor, to inform prevention and treatment strategies and foster trauma-informed care.
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Affiliation(s)
- Elizabeth T C Lippard
- Department of Psychiatry and Behavioral Sciences, Dell Medical School, University of Texas, Austin, TX, USA; Institute of Early Life Adversity Research, Dell Medical School, University of Texas, Austin, TX, USA; Waggoner Center for Alcohol and Addiction Research, University of Texas, Austin, TX, USA; Department of Psychology, University of Texas, Austin, TX, USA; Mulva Clinic for Neuroscience, Dell Medical School, University of Texas, Austin, TX, USA.
| | - Charles B Nemeroff
- Department of Psychiatry and Behavioral Sciences, Dell Medical School, University of Texas, Austin, TX, USA; Institute of Early Life Adversity Research, Dell Medical School, University of Texas, Austin, TX, USA; Waggoner Center for Alcohol and Addiction Research, University of Texas, Austin, TX, USA; Mulva Clinic for Neuroscience, Dell Medical School, University of Texas, Austin, TX, USA
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2
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Madireddy S, Madireddy S. Supportive model for the improvement of mental health and prevention of suicide among LGBTQ+ youth. INTERNATIONAL JOURNAL OF ADOLESCENCE AND YOUTH 2022. [DOI: 10.1080/02673843.2022.2025872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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3
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Horvath SA, Kolp HM, Andersen CV, Johnson EE, Racine SE, Borsari B, Stuart GL, Gidycz CA, Shorey RC. Emotion dysregulation moderates the relationship between alcohol use and eating pathology among heavy-drinking college men. J Clin Psychol 2021; 77:1763-1775. [PMID: 33971020 DOI: 10.1002/jclp.23157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 04/02/2021] [Accepted: 04/12/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVES There is limited research examining the relationship between alcohol use and eating pathology in men or factors that may moderate this association. The current study investigated the relationship between alcohol use and eating pathology, and examined emotion dysregulation as a moderator of this association, among heavy-drinking college men. METHOD Men mandated to receive an alcohol intervention (N = 88; average age = 19 years) completed questionnaires related to alcohol use, emotion dysregulation, and eating pathology. RESULTS Results demonstrated positive relationships between alcohol use and some eating pathology, and a significant interaction between alcohol use and emotion dysregulation. However, results were contrary to hypotheses, such that there was a positive relationship between alcohol use and eating pathology at low levels of emotion dysregulation. CONCLUSION Future studies should continue to examine the overall presentation of eating pathology in men and investigate factors that may impact the relationship between alcohol use and eating pathology.
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Affiliation(s)
- Sarah A Horvath
- Department of Psychology, Ohio University, Athens, Ohio, USA
| | - Haley M Kolp
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | | | - Ellen E Johnson
- Department of Psychology, Ohio University, Athens, Ohio, USA
| | - Sarah E Racine
- Department of Psychology, McGill University, Montreal, Qubec, Canada
| | - Brian Borsari
- Department of Psychiatry, University of California, San Francisco, California, USA
| | - Gregory L Stuart
- Department of Psychology, University of Tennessee, Knoxville, Tennessee, USA
| | | | - Ryan C Shorey
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
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Call DC, Challa M, Telingator CJ. Providing Affirmative Care to Transgender and Gender Diverse Youth: Disparities, Interventions, and Outcomes. Curr Psychiatry Rep 2021; 23:33. [PMID: 33851310 DOI: 10.1007/s11920-021-01245-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/24/2021] [Indexed: 12/28/2022]
Abstract
PURPOSE OF REVIEW This paper reviews the evolving body of research on the mental health of transgender and gender diverse (TGD) youth. Minority stress experiences in families, schools, and the community impact the health and well-being of this population due to experiences of stigma, discrimination, and rejection. Poor healthcare access and outcomes may be compounded in youth with intersectional identities. RECENT FINDINGS There is increasing evidence that gender-affirming interventions improve mental health outcomes for TGD youth. TGD youth report worse mental health outcomes in invalidating school and family environments and improved outcomes in affirming climates. TGD youth experience significant healthcare disparities, and intersectional clinical approaches are needed to increase access to affirmative care. Providers can best support TGD youth by considering ways they can affirm these youth in their healthcare settings, and helping them access support in schools, family systems, and communities. Understanding the intersection of multiple minority identities can help providers address potential barriers to care to mitigate the health disparities seen in this population.
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Affiliation(s)
- David C Call
- Department of Psychiatry and Behavioral Sciences, Children's National Hospital, Washington, DC, USA
| | - Mamatha Challa
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Cynthia J Telingator
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA, USA. .,Harvard Medical School, Boston, MA, USA.
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Higgins A, Downes C, Murphy R, Sharek D, Begley T, McCann E, Sheerin F, Smyth S, De Vries J, Doyle L. LGBT + young people's perceptions of barriers to accessing mental health services in Ireland. J Nurs Manag 2020; 29:58-67. [PMID: 33068465 DOI: 10.1111/jonm.13186] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 10/06/2020] [Accepted: 10/12/2020] [Indexed: 01/15/2023]
Abstract
AIM To explore the barriers to accessing mental health services in the Republic of Ireland from the perspectives of young LGBT + people aged 14-25. BACKGROUND Significant mental health disparities exist between LGBT + young people and their cisgender and heterosexual peers, yet they do not have equitable access to mental health services. Limited research has explored barriers, which exist for LGBTI + young people in accessing services, particularly from their perspectives. METHOD An anonymous online survey design, consisting of closed and open questions, was used. The study was advertised through local and national organisations and media. 1,064 LGBT + participants aged 14-25 opted to complete the survey. RESULTS Most participants reported several barriers to them accessing mental health services that were interlinked across three levels: individual; sociocultural; and mental health system. CONCLUSION Cultural competency training for practitioners, which address issues and concerns pertinent to LGBT + young people, is key to addressing many of the barriers identified. IMPLICATIONS FOR NURSING MANAGEMENT Nurse managers can use the findings to advocate for practice and organisational change within their services to ensure that care and support is responsive and sensitive to the particular needs of LGBT + young people.
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Affiliation(s)
- Agnes Higgins
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Carmel Downes
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Rebecca Murphy
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland.,Department of Psychology, National University of Ireland, Maynooth, Ireland
| | - Danika Sharek
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Thelma Begley
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Edward McCann
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Fintan Sheerin
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Siobhán Smyth
- School of Nursing and Midwifery, National University of Ireland, Galway, Ireland
| | - Jan De Vries
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Louise Doyle
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
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6
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Saenz SR. Sexuality and Gender in Psychiatry: Ethical and Clinical Issues. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2020; 18:304-306. [PMID: 33162869 PMCID: PMC7587911 DOI: 10.1176/appi.focus.20200019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Samuel Ricardo Saenz
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
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Moore KL, Lopez L, Camacho D, Munson MR. A Qualitative Investigation of Engagement in Mental Health Services Among Black and Hispanic LGB Young Adults. Psychiatr Serv 2020; 71:555-561. [PMID: 31960774 PMCID: PMC7364786 DOI: 10.1176/appi.ps.201900399] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Little attention has been paid to engagement in mental health services among racially and ethnically diverse youths who identify as a sexual minority, despite research indicating that they face significant mental health disparities. In this study, the authors assessed the service use experiences of black and Hispanic lesbian, gay, and bisexual (LGB) young adults to identify factors that promoted or hindered their engagement. METHODS Semistructured interviews with 38 young adults regarding past and present experiences with mental health services were analyzed thematically for perceived challenges to and support for engagement. Participants' service use histories were reviewed for significant interruptions in services reported over the past year. RESULTS Seventeen participants (45%) reported disengagement despite continuing to need services. Factors that influenced engagement were identified across four domains: personal, social environment, accessibility, and provider characteristics. Stigma related to sexual orientation and cultural attitudes presented engagement barriers, whereas providers who were knowledgeable about sexual-minority issues were important engagement promoters. Additional barriers to engagement were ambivalence about treatment efficacy, lack of family support, and difficulty finding suitable and affordable care. Peers who identified as a sexual minority helped participants locate LGB-affirming services. Rapport with providers and health care autonomy assisted participants to manage barriers to engagement. CONCLUSIONS These findings offer insights about factors that can influence engagement with treatment among black and Hispanic LGB young adults. The findings reveal important provider competencies and can inform interventions to improve engagement and reduce mental health inequities among these youths.
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Affiliation(s)
- Kiara L Moore
- Silver School of Social Work, New York University, New York (Moore, Munson); School of Medicine, City University of New York, New York (Lopez); Columbia University School of Social Work, New York (Camacho)
| | - Lucy Lopez
- Silver School of Social Work, New York University, New York (Moore, Munson); School of Medicine, City University of New York, New York (Lopez); Columbia University School of Social Work, New York (Camacho)
| | - David Camacho
- Silver School of Social Work, New York University, New York (Moore, Munson); School of Medicine, City University of New York, New York (Lopez); Columbia University School of Social Work, New York (Camacho)
| | - Michelle R Munson
- Silver School of Social Work, New York University, New York (Moore, Munson); School of Medicine, City University of New York, New York (Lopez); Columbia University School of Social Work, New York (Camacho)
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8
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Muntinga M, Beuken J, Gijs L, Verdonk P. Are all LGBTQI+ patients white and male? Good practices and curriculum gaps in sexual and gender minority health issues in a Dutch medical curriculum. GMS JOURNAL FOR MEDICAL EDUCATION 2020; 37:Doc22. [PMID: 32328524 PMCID: PMC7171358 DOI: 10.3205/zma001315] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 05/13/2019] [Accepted: 09/26/2019] [Indexed: 05/13/2023]
Abstract
Objectives: People marginalized based on their sexual and gender identity face specific health risks and experience barriers to culturally competent care. Insight into how Dutch medical schools address LGBTQI+ health-related learning objectives is scarce. We therefore examined how LGBTQI+ health issues are integrated in the Amsterdam UMC-VUmc medical curriculum by evaluating the year-two course 'Sex, Sexuality and Relationships' for LGBTQI+ content. Methods/Design: We examined written course content (course syllabus, lecture notes, and course literature) of the 2016-2017 course. We used a framework for essential LGBTQI+ content in medical education and an intersectional approach to examine which LGBTQI+ themes and subthemes were addressed. Results: Several essential LGBTQI+ health issues were adequately addressed and integrated into the Amsterdam UMC-VUmc curriculum, but we also identified curriculum gaps. The needs of patients with lesbian, bisexual, or gender non-conforming identities were marginally addressed, and issues related to intersections of minoritized sexual and gender identities with other aspects of diversity such as ethnicity, age and class remained unexplored. The course discussed gender and sexuality as fixed and mainly binary constructs, and only addressed biomedical explanatory models of sex, gender and sexuality. Discussion and conclusion: The absence of complex patient identities in relation to sex, gender and sexuality does not adequately prepare students to provide LGBTQI+ responsive care. If not designed and taught competently, LGBTQI+-related curriculum content may reproduce bias and stereotypes, and contribute to a medical climate where both LGBTQI+ patients, students, and doctors conceal their identities. Further implementation of LGBTQI+ health issues is required in (continuing) medical education to secure culturally competent clinical environments. Educational research is needed to understand how medical education contributes to marginalization of LGBTQI+ identities and thus, to health disparities.
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Affiliation(s)
- Maaike Muntinga
- Amsterdam UMC-VUmc, School of Medical Sciences, Amsterdam Public Health research institute, Department of Medical Humanities, Amsterdam, The Netherlands
- *To whom correspondence should be addressed: Maaike Muntinga, Amsterdam UMC-VUmc, School of Medical Sciences, Amsterdam Public Health research institute, Department of Medical Humanities, Boelelaan 1089 a, 1081 HV Amsterdam, The Netherlands, E-mail:
| | - Juliëtte Beuken
- Amsterdam UMC-VUmc, School of Medical Sciences, Amsterdam Public Health research institute, Department of Medical Humanities, Amsterdam, The Netherlands
| | - Luk Gijs
- Amsterdam UMC-VUmc, Center of Expertise on Gender Dysphoria, Amsterdam, The Netherlands
| | - Petra Verdonk
- Amsterdam UMC-VUmc, School of Medical Sciences, Amsterdam Public Health research institute, Department of Medical Humanities, Amsterdam, The Netherlands
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Lippard ET, Nemeroff CB. The Devastating Clinical Consequences of Child Abuse and Neglect: Increased Disease Vulnerability and Poor Treatment Response in Mood Disorders. Am J Psychiatry 2020; 177:20-36. [PMID: 31537091 PMCID: PMC6939135 DOI: 10.1176/appi.ajp.2019.19010020] [Citation(s) in RCA: 205] [Impact Index Per Article: 51.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
A large body of evidence has demonstrated that exposure to childhood maltreatment at any stage of development can have long-lasting consequences. It is associated with a marked increase in risk for psychiatric and medical disorders. This review summarizes the literature investigating the effects of childhood maltreatment on disease vulnerability for mood disorders, specifically summarizing cross-sectional and more recent longitudinal studies demonstrating that childhood maltreatment is more prevalent and is associated with increased risk for first mood episode, episode recurrence, greater comorbidities, and increased risk for suicidal ideation and attempts in individuals with mood disorders. It summarizes the persistent alterations associated with childhood maltreatment, including alterations in the hypothalamic-pituitary-adrenal axis and inflammatory cytokines, which may contribute to disease vulnerability and a more pernicious disease course. The authors discuss several candidate genes and environmental factors (for example, substance use) that may alter disease vulnerability and illness course and neurobiological associations that may mediate these relationships following childhood maltreatment. Studies provide insight into modifiable mechanisms and provide direction to improve both treatment and prevention strategies.
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Affiliation(s)
- Elizabeth T.C. Lippard
- Department of Psychiatry, Dell Medical School, University of Texas, Austin, TX, USA,Institute of Early Life Adversity Research, Dell Medical School, University of Texas, Austin, TX USA,Waggoner Center for Alcohol and Addiction Research, University of Texas, Austin, TX USA,Department of Psychology, University of Texas, Austin, TX, USA,Mulva Clinic for Neuroscience, Dell Medical School, University of Texas, Austin, TX
| | - Charles B. Nemeroff
- Department of Psychiatry, Dell Medical School, University of Texas, Austin, TX, USA,Institute of Early Life Adversity Research, Dell Medical School, University of Texas, Austin, TX USA,Waggoner Center for Alcohol and Addiction Research, University of Texas, Austin, TX USA,Mulva Clinic for Neuroscience, Dell Medical School, University of Texas, Austin, TX
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10
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Bosse JD. Sexual and Gender Identity Development in Young Adults and Implications for Healthcare. CURRENT SEXUAL HEALTH REPORTS 2019. [DOI: 10.1007/s11930-019-00215-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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11
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Moore KL, Camacho D, Munson MR. Identity negotiation processes among Black and Latinx sexual minority young adult mental health service users. JOURNAL OF GAY & LESBIAN SOCIAL SERVICES 2019; 32:21-48. [PMID: 33223785 PMCID: PMC7678912 DOI: 10.1080/10538720.2019.1677542] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The transition to adulthood presents particular challenges for Black and Latinx sexual minorities in need of mental health services. Identity formation and marginalization during this developmental period can interfere with help-seeking and lead to health disparities. Identity-specific psychosocial supports are needed to assist young adults to successfully navigate these challenges, but research on identity processes, help-seeking, and service-utilization among sexual minority young people of color is very limited. To better understand how multiple minority young people navigate their identities in the context of using, or choosing not to use, mental health services, this study qualitatively explored the experiences of 31 emerging adults. Through in-depth interviews, analyses revealed that young adults negotiated social identity norms about mental health help-seeking by separating from unhelpful norms, managing stigmatized aspects of identity, integrating helpful identity alternatives, and forming individualized perspectives on help-seeking that allowed them to maintain important connections to their minority group identities. Findings are discussed in relation to previous research on ethnic and sexual minority identity development and service utilization. Practice and research recommendations for increasing knowledge, improving help-seeking, and promoting resilience around young adults' intersectional identities are offered.
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Affiliation(s)
- Kiara L. Moore
- Silver School of Social Work, New York University, New York, NY, USA
| | - David Camacho
- School of Social Work, Columbia University, New York, NY, USA
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12
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Butler ES, McGlinchey E, Juster R. Sexual and gender minority sleep: A narrative review and suggestions for future research. J Sleep Res 2019; 29:e12928. [DOI: 10.1111/jsr.12928] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 09/05/2019] [Accepted: 09/09/2019] [Indexed: 12/12/2022]
Affiliation(s)
- Eliana S. Butler
- School of Psychology Fairleigh Dickinson University Teaneck NJ USA
| | - Eleanor McGlinchey
- School of Psychology Fairleigh Dickinson University Teaneck NJ USA
- Division of Child and Adolescent Psychiatry Columbia University Medical Center/New York State Psychiatric Institute New York NY USA
| | - Robert‐Paul Juster
- Department of Psychiatry and Addiction University of Montreal Montreal QC Canada
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13
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Associations Between Sexual and Gender-Based Harassment by a Coach and Psychological Ill-Being Amongst Gender and Sexual Minority Sport Participants in Finland. JOURNAL OF CLINICAL SPORT PSYCHOLOGY 2019. [DOI: 10.1123/jcsp.2018-0035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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14
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Gillespie GL, Willis DG, Amar AF. Review and application of the National Academies of Sciences, Engineering, and Medicine bullying or cyberbullying recommendations for screening and lesbian, gay, bisexual, and transgender youth. Nurs Outlook 2018; 66:372-378. [PMID: 29699772 DOI: 10.1016/j.outlook.2018.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 03/05/2018] [Indexed: 11/24/2022]
Abstract
Bullying has been long seen as a natural part of childhood and adolescence. However, a growing body of evidence suggests bullying and now cyberbullying may inflict harm or distress on targeted youth including physical, psychological, social, or educational harm. The purpose of this paper is to endorse the National Academies of Sciences, Engineering, and Medicine statement, summarize the report, and apply the recommendations to screening lesbian, gay, bisexual and transgender youth related to bullying and cyberbullying; line 11 change exemplified to discussed. Screening for bullying against youth; lesbian, gay, bisexual, and transgender youth as a high-risk group for bullying victimization; and implications to address bullying against youth are exemplified. Nurses need to promote policies that foster inclusive, supportive, safe, and healthy schools and environments for youth.
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Affiliation(s)
| | - Danny G Willis
- School of Nursing, University of Wisconsin-Madison, Madison, WI
| | - Angela F Amar
- School of Nursing, University of Nevada Las Vegas, Las Vegas, NV
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