Disproportionate exposure to early-life adversity and sexual orientation disparities in psychiatric morbidity

Sexuality Minority Status, Victimization, Mental Health, and Substance Use

Background: Prior research suggests that sexual minority status is related to victimization, mental health issues, and substance use. However, few studies have sought to connect these relationships in a way supported by theory, and fewer have utilized probability and/or nationally representative samples. Objective: The current study seeks to test the relationships among these variables, guided by general strain theory (GST). Methods: One wave of the National Longitudinal Study of Adolescent to Adult Health dataset (Add Health) (N = 14,121) and path modeling in Mplus are utilized. Results: Models run separately by race/ethnicity suggest that the relationship among these variables largely support expectations from GST, but with some notable differences by race/ethnicity. Conclusion: Results suggest a relationship among these variables that concurs with criminological theorizing. Implications and limitations are discussed.

Threats to social safety and neuro-inflammatory mechanisms underlying sexual orientation disparities in depression symptom severity: A prospective cohort study of young adults

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.

Characterizing Intimate Partner Violence-Caused Brain Injury in a Sample of Survivors in the Two Spirit, Lesbian, Gay, Bisexual, Transgender, Queer or Questioning Community

Research in the field of intimate partner violence-caused brain injury (IPV-BI) has predominantly focused on heterosexual women, ignoring the unique needs of the Two Spirit, Lesbian, Gay, Bisexual, Transgender, Queer or Questioning (2S/LGBTQ) community. The purpose of this exploratory research was to better understand the prevalence of IPV and IPV-BI in 2S/LGBTQ relationships where IPV was defined as physical, psychological, financial, sexual, and/or identity-based abuse from a current of former intimate partner. This study used a cross sectional internet-based survey that ran from September to December of 2022. In addition to descriptive statistics, prevalence rates and their corresponding Wilson Score confidence intervals are reported to estimate the proportion of individuals who experienced IPV and IPV-BI. Finally, for both gender identity and sexual orientation, we tested whether participants with each identity had differing levels of brain injury severity compared to participants who did not hold that identity using Mann-Whitney U tests. In total, 170 2S/LGBTQ+ adults responded to the survey. Among the respondents, 54% identified as Two-Spirit, 24% identified as gay, 17% identified as queer, 14% identified as bisexual, and 8% identified as lesbian or pansexual, respectively. Respondents were predominantly multiracial, post-secondary educated, full-time employed, cisgender women (35%) or cisgender men (19%). The overwhelming majority reported lifetime prevalence of IPV at 98% (n = 166, 95% CI [94.11, 99.08]). Additionally, 68% (n = 115, 95% CI [60.29, 74.22]) of participants reported symptoms consistent with an IPV-BI. These results are consistent with the findings that the 2S/LGBTQ community are at heightened risk of experiencing physical IPV. These findings are the first to our knowledge to report a high rate of symptoms consistent with an IPV-BI in the 2S/LGBTQ population.

Suicidal ideation risk among LGB Spanish university students: The role of childhood and adolescence adversities and mental disorders

BACKGROUND

Childhood/adolescence adversities and mental disorders are higher among LGB youths.

AIMS

To evaluate the role of childhood maltreatment, bullying, and mental disorders on the association between sexual orientation and suicidal ideation (SI); and the role of mental disorders on the association between sexual orientation discrimination and SI.

METHODS

Baseline and 12-month follow-up online surveys of Spanish first-year university students (18-24-year-olds). Multivariable logistic regression models assessed the effects of childhood/adolescence adversities and mental disorders in the relationship between sexual orientation, discrimination and SI.

RESULTS

A total of 1224 students were included (16.4 % LGBs). Risk factors of lifetime SI were sexual orientation (OR 2.4), any bullying (OR 2.4), any childhood maltreatment (OR 4.0), and any mental disorders (OR 3.8). Final model Area Under the Curve (AUC) 0.78. Among homosexual and bisexual students, discrimination showed increased risk of 12-month SI (OR 2.2), but this effect was no longer statistically significant when any 12-month mental disorder was added (OR 7.8). Final model AUC 0.72.

LIMITATIONS

Sample of interest was relatively small. But it was similar to comparable studies and statistical adjustments have been performed. Assessment of mental disorders and SI was not based on clinical assessment. However, validated scales showing good diagnostic agreement with clinical judgement were used.

CONCLUSIONS

Childhood/adolescence adversities and mental disorders interact in the association between sexual orientation and SI. Mental disorders may mediate the association between sexual orientation discrimination and SI. Further research using larger samples and causal modelling approach assessing the mediators of SI risk among LGBs is needed.

Genetic and Environmental Influences on Sexual Orientation: Moderation by Childhood Gender Nonconformity and Early-Life Adversity

Existing evidence indicates genetic and non-genetic influences on sexual orientation; however, the possibility of gene-environment interplay has not been previously formally tested despite theories indicating this. Using a Finnish twin cohort, this study investigated whether childhood gender nonconformity and early-life adversities independently moderated individual differences in sexual orientation and childhood gender nonconformity, the relationship between them, and the etiological bases of the proposed moderation effects. Sexual orientation, childhood gender nonconformity, and early-life adversities were assessed using standard questionnaires. Structural equation twin model fitting was carried out using OpenMx. Childhood gender nonconformity was significantly associated with reduced phenotypic variance in sexual orientation (β =  - 0.14, 95% CI - 0.27, - 0.01). A breakdown of the underlying influences of this moderation effect showed that this was mostly due to moderation of individual-specific environmental influences which significantly decreased as childhood gender nonconformity increased (βE =  - 0.38; 95% CI - 0.52, - 0.001) while additive genetic influences were not significantly moderated (βA = 0.05; 95% CI - 0.30, 0.27). We also observed that the relationship between sexual orientation and childhood gender nonconformity was stronger at higher levels of childhood gender nonconformity (β = 0.10, 95% CI 0.05, 0.14); however, significance of the underlying genetic and environmental influences on this relationship could not be established in this sample. The findings indicate that beyond a correlation of their genetic and individual-specific environmental influences, childhood gender nonconformity is further significantly associated with reduced individual-specific influences on sexual orientation.

Substance Use Over Time Among Sexual and Gender Minority People: Differences at the Intersection of Sex and Gender

Purpose: Sexual and gender minority (SGM) people are at greater risk for substance use than heterosexual and cisgender people, but most prior work is limited by cross-sectional analyses or the examination of single substance use. This study examined substance use over time among SGM people to identify patterns of polysubstance use at the intersection of sex and gender. Methods: Data were collected annually over 4 years from SGM respondents (n = 11,822) in The Population Research in Identity and Disparities for Equality (PRIDE) Study. Differences in substance use patterns (any prior 30-day use of 15 substances) by gender subgroup were examined with latent class analysis, and multinomial regression models tested relationships between gender subgroup and substance use. Results: Eight classes of substance use were observed. The three most common patterns were low substance use (49%), heavy episodic alcohol use (≥5 alcoholic drinks on one occasion) with some cannabis and tobacco use (14%), and cannabis use with some tobacco and declining heavy episodic alcohol use (13%). Differences observed included lower odds of patterns defined by heavy episodic alcohol use with some cannabis and tobacco use in all gender subgroups relative to cisgender men and persons with low substance use (odds ratios [ORs] 0.26-0.60). Gender expansive people assigned female at birth, gender expansive people assigned male at birth, and transgender men had greater odds of reporting cannabis use with small percentages of heavy episodic alcohol and tobacco use (ORs: 1.41-1.60). Conclusion: This study suggests that there are unique patterns of polysubstance use over time among gender subgroups of SGM people.

Disclosure and Help-Seeking Experiences of Sexual and Gender Minority Victims of Intimate Partner Violence: A Mixed-Methods Study

Sexual and gender minorities assigned female at birth (SGM-AFAB) experience high rates of intimate partner violence (IPV), with negative effects on health and well-being. Disclosure of and help-seeking for IPV can support the well-being of IPV survivors, yet are understudied among SGM-AFAB people. To better understand the IPV disclosure and help-seeking experiences in this population, we conducted semi-structured interviews with 41 SGM-AFAB young adults who experienced physical, sexual, or severe psychological IPV. Qualitative analyses explored to whom SGM-AFAB disclosed IPV, barriers to disclosure/help-seeking, the types of responses received, and perceived helpfulness of responses. Exploratory mixed methods analyses assessed frequency of code endorsement, demographic differences, and associations among codes. Three-quarters of participants disclosed IPV, though rates were lower for sexual and physical than psychological IPV and very few sought help from formal sources. The most common barriers to disclosure were not viewing the IPV as abuse and anticipation of negative responses, often due to stigma; other participants described inability to access formal help and concerns about SGM incompetence in those services. Most actual responses received were considered helpful, including emotional support, labeling the IPV as unhealthy, nonjudgmental listening, actions to stop the IPV, and practical support. Minimizing IPV or criticizing the victim was common unhelpful response; advice to end the relationship was considered helpful and unhelpful. Whereas 92% of friend responses were described as helpful, around half of family (56%) and therapist (62%) responses were helpful. Findings suggest that efforts to increase access to culturally affirmative services and educate SGM youth to recognize IPV in their relationships may help promote help-seeking and well-being among SGM-AFAB IPV survivors.

Associations of past-year overall trauma, sexual assault and PTSD with social support for young adult sexual minority women

Background: Young adult sexual minority women (SMW) are at elevated risk for sexual assault (SA), posttraumatic stress disorder (PTSD), and inadequate social support. While SA and PTSD can lead to reductions in social support from close significant others, the impact of SA and PTSD on SMWs' social support has not previously been assessed.Objective: This study examined the associations of past year SA and PTSD with SMW's social support from intimate partners, family, and friends. It was hypothesized that SA and PTSD would be negatively associated with support from partners, family and friends, and that PTSD would moderate the effect of SA on support in early adulthood.Method: Young adult SMW in the United States (N = 235) who were M = 23.93 (SD = 2.15) years old, primarily lesbian or bisexual (n = 186, 79.1%) and White (n = 176, 74.9%) completed measures on past year exposure to SA and non-SA trauma, PTSD, and social support from intimate partners, family and friends.Results: PTSD was associated with less social support from partners, (b  = -0.06, SE = 0.02, p = .010, R2change = .02), family, (b  = -0.06, SE = 0.03, p = .025, R2change = .02), and friends, (b  = -0.07, SE = 0.02, p = .008, R2change = .02). There was a significant interaction between PTSD and SA on social support from partners (b  = -0.01, SE = 0.01, p = .047, R2change = .01). Neither non-SA nor SA trauma was associated with support from family or friends.Conclusions: Results underscore the potential impact of recent SA on intimate partnerships for young adult SMW with more severe PTSD. Future work should explore how addressing PTSD and improving social support quality may help SMW recover from traumatic experiences and ameliorate the effects of SA on intimate partnerships.

Intimate Partner Violence Perpetration Among Sexual Minority Young Adults: Associations With Alcohol Use, PTSD Symptoms, Internalized Homophobia, and Heterosexist Discrimination

Lesbian, gay, bisexual, queer, and other sexual minority (LGBQ+) young adults report similar or higher rates of intimate partner violence (IPV) perpetration than their heterosexual peers. Elevated IPV risk among LGBQ+ young adults may be attributable to experiencing heterosexist discrimination and internalized homophobia. In addition, LGBQ+ people report disproportionate posttraumatic stress disorder (PTSD) symptoms, alcohol use, and IPV perpetration in dating relationships. Thus, this study explored which combinations of IPV risk factors (i.e., experiencing heterosexist discrimination, internalized homophobia, PTSD symptoms, alcohol use) related to forms of IPV perpetration, inclusive of psychological, physical, and sexual forms, in a sample of 342 LGBQ+ young adults. Internalized homophobia was related to psychological IPV perpetration at high and medium levels of PTSD symptoms and only high levels of alcohol use. PTSD symptoms and alcohol use interacted to predict psychological IPV perpetration; and PTSD symptoms related to increased psychological IPV perpetration at high and medium, but not low, alcohol use levels. Alcohol use was positively related to physical IPV perpetration. No other risk factors or interactions were significantly related to physical or sexual IPV perpetration. Results were consistent with prior findings that linked internalized homophobia, alcohol use, and PTSD symptoms to IPV perpetration and highlight the interacting nature of these IPV perpetration risk factors. Comprehensive IPV interventions with LGBQ+ young adults should evaluate the impact of simultaneously targeting these multiple IPV risk factors considering their interacting contributions to IPV perpetration risk. More research is needed to examine the temporal relations between minority stress, PTSD symptoms, alcohol use, and IPV perpetration.

Evaluation of Traditional Risk Factors for Intimate Partner Violence among Sexual and Gender Minority Youth

Objective

Sexual and gender minority youth assigned female at birth (SGM-AFAB) experience higher rates of intimate partner violence (IPV) than heterosexual and cisgender youth. To inform efforts to reduce these disparities, we explored whether IPV risk factors identified in the general population are associated with IPV among SGM-AFAB young people.

Method

Using multiwave longitudinal data from a 400 SGM-AFAB youth (ages 16-20 at baseline), we estimated between- and within-persons effects of demographic/contextual characteristics (gender, sexual identity, race/ethnicity, socioeconomic status), developmental/background factors (childhood violence), and psychological/behavioral factors (antisocial behavior, depression, problematic alcohol and cannabis use) on a range of IPV experiences (victimization and perpetration of psychological, physical, sexual, and SGM-specific IPV).

Results

In this SGM-AFAB sample, IPV experiences were associated with many traditional risk factors identified in the general population, including race, economic stress, childhood violence, antisocial behavior, depression, and use of substances (particularly cannabis). In contrast to previous research, we did not find that SGM youth with transgender or gender nonbinary identities, or with bi- or pan-sexual identities, were at greater risk for IPV than other SGM youth. Very few putative risk factors were associated with SGM-specific IPV.

Conclusion

Findings suggest SGM youth could benefit from IPV prevention approaches that target common risk factors at multiple ecological levels (policies to reduce poverty and racism, parenting programs, interventions to reduce mental health and substance use problems). Continued research is needed to explore how risk for IPV among SGM-AFAB youth may vary by gender identity, sexual identity, and stigma-based experiences.

Associations Between Childhood Victimization, Adult Victimization, and Physical Health Among Sexually Diverse Adults at Different Stages of Life

Purpose: Research examining health disparities in sexually diverse populations is quite variable. The purpose of the present article was to shed light on the conflicting findings pertaining to minority stress and health by examining the potential impact of age, childhood victimization, and different measurements of health. Methods: The present research used data from the Generations Study, a questionnaire study of sexually diverse adults (ages 18-60) surveyed between 2016 and 2019. We modeled direct and indirect links among (1) childhood exposure to physical or sexual abuse, (2) adult exposure to victimization or harassment, and (3) adult physical health status, assessed both subjectively and objectively. Participants were 1398 sexually diverse adults (e.g., lesbian, gay, bisexual); the present work only utilizes wave one of the data collected in 2016. Results: We found that both childhood abuse and adult harassment/victimization predicted sexually diverse adults' health status, but these associations only manifested as diagnosable disease outcomes among adults over 50. Associations between childhood abuse and adult health were partly attributable to the fact that abuse-exposed children were disproportionately exposed to harassment and victimization as adults. Conclusion: Our research makes a novel contribution to our understanding of the health effects of stigma by pinpointing the multiple, cascading pathways through which adversity relates to health.

Open Trial of Trauma-Focused Psychodynamic Psychotherapy for Posttraumatic Stress Disorder Among LGBTQ Individuals

OBJECTIVE

Lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals report higher rates of exposure to traumatic events and posttraumatic stress disorder (PTSD) compared with heterosexual and cisgender individuals. No treatment outcomes research has focused on PTSD in the LGBTQ population. Trauma-focused psychodynamic psychotherapy (TFPP) is a brief, manualized, attachment- and affect-focused psychotherapy for PTSD. TFPP explicitly incorporates broad identity-related and societal factors into its conceptualization of trauma and its consequences, which may be especially helpful for LGBTQ patients with minority stress who seek affirmative care.

METHODS

Fourteen LGBTQ patients with PTSD, assessed with the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5), received 24 sessions of twice-weekly (12 weeks) TFPP via teletherapy provided by supervised early-career therapists inexperienced in the modality. Sessions were videotaped to monitor therapists' treatment adherence. Patients were assessed at baseline, week 5, termination (week 12), and 3 months posttreatment for PTSD symptoms (assessed with the CAPS-5) and secondary outcomes.

RESULTS

TFPP was well tolerated by patients, with 12 (86%) completing the intervention. CAPS-5-measured PTSD symptoms, including dissociation, significantly improved during treatment (mean decrease=-21.8, d=-1.98), and treatment gains were maintained at follow-up. Most patients experienced PTSD clinical response (N=10, 71%) or diagnostic remission (N=7, 50%). Patients generally experienced significant, concomitant improvements in complex PTSD symptoms, general anxiety, depression, and psychosocial functioning. Adherence to the intervention among therapists was high, with 93% of rated sessions meeting adherence standards.

CONCLUSIONS

TFPP shows promise in the treatment of PTSD among sexual and gender minority patients seeking LGBTQ-affirmative PTSD care.

Longitudinal Relations Between Childhood Maltreatment, Emotion Regulation Difficulties, and Suicidal Ideation and Non-Suicidal Self-Injury: An 18-Month Investigation of Psychiatrically Hospitalized Adolescents

Within the Dimensional Model of Adversity and Psychopathology, extant research shows that exposure to threat-including emotional, physical, and sexual abuse-is linked to psychopathology among adolescents; problems with emotion regulation may, at least in part, explain this association. Both theoretical and empirical work also suggests that emotion regulation difficulties-particularly access to emotion regulation strategies-may mediate the relation between threat and self-injurious thoughts and behavior, though no studies to date have explicitly tested this model. The current study tested relations between threat, limited access to emotion regulation strategies, and self-injurious thoughts and behaviors among high-risk youth across an 18-month follow-up. The sample consisted of 180 adolescents (Mage = 14.89; SD = 1.35; ages 12-17; 71.7% female; 78.9% White; 55.0% heterosexual) recruited from an inpatient psychiatric unit. Threat was assessed at baseline using the abuse subscales from Childhood Trauma Questionnaire. Access to emotion regulation strategies was assessed using the Difficulties in Emotion Regulation Scale at baseline, 6-, and 12-months. Presence (versus absence) of non-suicidal self-injury and suicidal ideation severity were assessed at baseline, 12-, and 18-months using the Self-Injurious Thoughts and Behaviors Interview and the Suicidal Ideation Questionnaire-JR, respectively. After accounting for baseline levels of the mediator, outcome, and depressive symptoms, structural equation models supported the role of 12-month access to emotion regulation strategies as a mediator between baseline threat and 18-month suicidal ideation and non-suicidal self-injury. Treatment aimed at bolstering access to emotion regulation strategies may help reduce suicide risk among youth who have experienced childhood abuse.

Associations Between Latent Classes of Trauma Exposure and Minority Stressors and Substance Use Among Cisgender Sexual Minority Women

Psychosocial stressors (e.g., minority stressors, trauma exposure) profoundly impact sexual minority women's (SMW's) risk of alcohol and other drug (AOD) use. However, research has not examined whether there are distinct typologies (i.e., patterns) of psychosocial stressors and whether these vary based on sociodemographic characteristics or are differentially associated with AOD outcomes (e.g., alcohol dependence) among SMW. This study aimed to identify latent classes of SMW reporting distinct typologies of psychosocial stressors and examine predictors and outcomes of latent classes of psychosocial stressors among SMW. Participants included a community sample of 602 SMW (Mage = 39.9, SD = 14.0; 74.0% lesbian; 37.4% White, 36.6% Black, 22.3% Latinx; 26.6% annual income ≤$14,999). Latent class analysis was used to identify typologies of psychosocial stressors. Regression analyses were employed to examine sociodemographic predictors and AOD outcomes of class membership. Three classes of psychosocial stressors emerged. Participants in Class 1 were likely to report relatively low adversity. SMW in Class 2, who reported childhood physical abuse (CPA), severe childhood sexual abuse, and adult physical assault, were vulnerable to discrimination and stigma consciousness. A distinct subgroup of SMW (Class 3) was at heightened risk of CPA, adult sexual assault (ASA), and stigma consciousness. Older SMW, Black SMW, and SMW with lower social support were more likely to be in classes characterized by higher adversity. Older SMW were at disproportionate risk of CPA and ASA. Different combinations of psychosocial stressors were uniquely associated with AOD outcomes. Findings underscore the importance of considering within-group heterogeneity in SMW's differential risk of psychosocial stressors and AOD outcomes. Routine screening of psychosocial stressors across several dimensions, brief interventions targeting AOD outcomes, and policies mitigating structural drivers of SMW's increased risk of trauma and minority stressors may be especially important for older SMW, Black SMW, and SMW who lack social support.

Sexual and gender minority adverse childhood experiences (SGM-ACEs), perceived social support, and adult mental health

BACKGROUND

Building on decades of research into the long-term developmental impacts of adverse childhood experiences (ACEs), researchers have called for expanding the ACEs framework to include experiences specific to minoritized identities. Recent empirical research has led to the development of a measure of sexual and gender minority adverse childhood experiences (SGM-ACEs). Within the SGM-specific ACEs framework, research on the long-term impact to adult mental health and the role of perceived social support are not well studied.

OBJECTIVE

The purpose of this paper was two-fold. First, examine whether SGM-ACEs adversely impact mental health in SGM adults. Second, examine the role of perceived social support in the association between SGM-ACEs and adult mental health.

PARTICIPANTS AND SETTING

Data were collected using a multifaceted sampling strategy. In total, 1819 self-identified SGM Texans completed an online survey inquiring about ACEs, SGM-ACEs, mental health, and demographic characteristics.

RESULTS

We estimated two competing structural equation models (SEM) examining the associations between SGM-ACEs and anxiety and depressive symptoms, and whether perceived social support may moderate or mediate his association. While both models demonstrated that SGM-ACEs were significantly associated with higher anxiety and depressive symptoms. However, we found more support for the mediation model such that SGM-ACEs had direct effects on anxiety and depressive symptoms, and an indirect effect on anxiety symptoms through family support.

CONCLUSIONS

Our findings confirmed that exposure to SGM-ACE is associated with poorer adult mental health. Additionally, SGM-ACEs exposure undermines SGM individuals' perceptions of family support, which increases symptoms of anxiety.

Sexual Relationship Violence Among Young, Partnered Sexual Minority Men in the United States

While there has been a growth in studies examining sexual violence among sexual minority men, little research attention has been paid to the experience of sexual violence among young sexual minority men (YSMM). In this article we analyze secondary data from the baseline of a pilot randomized control trial with 318 YSMM aged 15 to 24 years in the United States who were in relationships with other males to examine the associations between sexual minority-specific stigma and sociodemographic and relationship characteristics and experiences of intimate partner violence (IPV) and sexual IPV in their relationships. Approximately one-in-five participants reported experiencing any form of IPV and 6% reported sexual IPV in their current relationship. Participants who reported sexual minority-specific familial rejection (Adjusted Odds Rato (aOR) = 2.33, 95% confidence interval [CI] [1.03, 5.26], p < .05), internalized heterosexism (aOR = 3.17, 95% CI [1.45, 6.95], p < .01), and housing insecurity (aOR = 7.22, 95% CI [1.66, 31.34], p < .01) reported higher odds of sexual IPV in their relationship. Study findings point to the role of multiple sexual minority-specific forms of stigma in creating vulnerabilities for the experience of sexual IPV among YSMM, and highlight the need for continued research and interventions that address sexual minority-specific stigma and structural vulnerabilities to guide violence prevention efforts with YSMM.

The role of adverse childhood experiences in suicide among sexual minority undergraduate students

This study explores the rates and odds of adverse childhood experiences (ACEs) and their relationship to suicide attempts in a sample of undergraduate students (n = 924, 71.6% women), comparing lesbian, gay and bisexual (LGB) youth to their heterosexual counterparts. Using propensity score matching, we matched 231 sexual minority and 603 heterosexual participants at a ratio of 1:3, based on gender, age, socioeconomic status, and religious beliefs. Sexual minority participants reported a significantly higher ACE score (M = 2.70 vs. 1.85; t = 4.93; p <.001; d = .391) and higher rates of all but one type of ACEs than their heterosexual counterparts. They also reported a higher prevalence and risk of suicide attempts (33.3% vs. 11.8% respectively, odds ratio = 3.73; p < .001). In logistic regression analysis, sexual minority status, emotional abuse and neglect, bias attack, having a household member with mental health problems, bullying and cyberbullying were significantly associated with suicide attempts.

Same-Sex Marriage and Common Mental Health Diagnoses: A Sibling Comparison and Adoption Approach

We aimed to test whether the association between same-sex marriage and common mental health diagnoses was explained by shared genetic and environmental familial influences using sibling comparison and adoption analyses. For the sibling comparison analysis, participants (1,177,712 men and 1,266,917 women) were individuals born in Sweden between 1932 and 1994 and had ever been recorded as married (in opposite-sex or same-sex marriages). For the adoption analysis, participants were 147,164 and 1,298 female-female full sibling and adoptive sibling pairs, respectively. Based on medical records, prescribed medication, and death certificates, depression, substance abuse, and suicide (completed and attempted) from age 18 years were identified. For both sexes, being in a same-sex marriage was associated with greater risk of depression, substance abuse, and suicide, compared with being in an opposite-sex marriage. Controlling for shared familial confounding reduced this difference by less than 20% in magnitude, but overall mental health disparities for individuals in same-sex marriages remained statistically significant. Among women, only the genetic correlation between same-sex marriage and depression was statistically significant (r = .33). Same-sex marriage, as a proxy for sexual orientation, was associated with increased risk of certain mental health diagnoses and shared familial confounding explained a small component of this association, depending on the diagnosis. The findings indicate that sexual orientation disparities in mental health outcomes may involve unmeasured factors, and a relatively small proportion should be considered that may be due to shared familial confounding relevant to both sexual orientation and psychopathology.

Internalized Homonegativity, Emotion Dysregulation, and Isolating Behaviors Perpetration among Gay and Lesbian Couples

Same-sex intimate partner violence (SSIPV) is a serious health concern and may manifest in various forms. Nevertheless, controlling behaviors of isolation are still poorly investigated. Due to their marginalized status, sexual minorities can face SSIPV-specific risk factors, such as internalized homonegativity, as well as general psychological stress factors, such as emotion dysregulation. While the literature is growing, there is still a lack of understanding of the complex pathways linking sexual minorities and minority stress to IPV and isolating controlling behavior. To fill this gap, we explored the relation between internalized homonegativity and controlling behaviors of isolation, assessing the mediating role of emotion dysregulation. In total, 120 gay and lesbian people (mean age = 33.8, SD = 11.5) involved in a same-sex relationship participated in the study. Results showed a direct and positive association between internalized homonegativity and difficulties in emotion regulation and a direct and positive association between emotion dysregulation and controlling behaviors of isolation; the mediating role of emotion dysregulation in the relation between internalized homonegativity and isolating controlling behaviors was supported as well. Emerging results can provide valuable information at the clinical level, although further studies are needed to confirm these preliminary findings.

Transphobic Adverse Childhood Experiences as a Determinant of Mental and Sexual Health for Young Trans Women in the San Francisco Bay Area

This study characterized the prevalence of transphobic adverse childhood experiences (ACEs) among young trans women (YTW) and assessed its relationship with poor mental health and sexual risk. A survey was administered between 2012 and 2014 to 300 YTW aged 16-24 living in the San Francisco Bay Area. Transphobic childhood verbal abuse, physical abuse, and high transphobic childhood adversity were endemic, and we found strong associations with depression, posttraumatic stress disorder, and any and receptive anal intercourse. ACEs may be critical social determinants of mental and sexual health for YTW and validated measures to screen for ACEs are needed, along with interventions that provide gender-affirmative support for parents.

Neuroticism and Sexual Orientation-Based Victimization as Mediators of Sexual Orientation Disparities in Mental Health

This study tested whether elevated risk of poorer mental health outcomes among nonheterosexual adolescents compared with heterosexual adolescents is plausibly explained by neuroticism and sexual orientation-based victimization. The Millennium Cohort Study, a large British prospective birth cohort, was used (4566 heterosexual boys, 77 bisexual boys, 129 homosexual boys, 96 asexual boys, 4444 heterosexual girls, 280 bisexual girls, 158 homosexual girls, and 182 asexual girls). We analyzed the following measures assessed at age 17 years: sexual orientation based on sexual attraction, neuroticism, sexual orientation-based victimization, self-harm attempts, and psychological well-being. Mediation analysis was undertaken separately by sex and yielded the following statistically significant findings: for both sexes, we found that bisexual and homosexual adolescents scored higher than heterosexual adolescents on neuroticism; for both sexes, bisexual and homosexual adolescents reported more negative psychological well-being scores and self-harm attempts compared with heterosexual adolescents, with total effects (standardized regression coefficients) ranging from .58 to .91; those associations were mediated through sexual orientation-based victimization and neuroticism scores, with the indirect effects (standardized regression coefficients) through sexual orientation-based victimization and neuroticism scores ranging from .09 to .26 and .16 to .55, respectively. Asexual adolescents did not differ significantly from their heterosexual counterparts in psychological well-being and self-harm attempts, with the total effects ranging from - .02 to .21. Sexual orientation-based victimization and neuroticism may both contribute to the sexual orientation-related disparities in psychological well-being and self-harm attempts. However, neuroticism appears to the more powerful factor.

Childhood Experiences and Mental Health of Sexual Minority Adults: Examining Three Models

Three models of recalled childhood gender nonconformity (GNC) and maltreatment are proposed to explain disparities in current psychological distress and lifetime suicidality among sexual minority individuals, using a United States probability sample of cisgender lesbian/gay (n = 701), bisexual (n = 606), and other (e.g., queer, n = 182) adults. Indirect effects indicated that lesbian/gay individuals were more likely than bisexual individuals to experience maltreatment and suicidal ideation as childhood GNC increased. Other indirect effects found that bisexual individuals reported more psychological distress and greater likelihood of lifetime suicidal ideation and attempts than lesbian/gay individuals as maltreatment increased. The direct effects of sexual orientation were stronger than the indirect effects via maltreatment or GNC, with bisexual individuals reporting more maltreatment, distress, and suicidality than lesbian/gay individuals. Significant findings for individuals with other identities were similar to those of bisexual individuals. Adjusted findings were comparable for women and men. The findings indicated that sexual minority individuals reported experiences consistent with sexual minority stress during early developmental periods, before being aware of their sexual orientation. It is necessary to understand the early lived experiences of sexual minority individuals, differences between lesbian/gay and bisexual individuals in those experiences, and their implications for adaptation.

Clinic screening for adverse childhood experiences in people living with HIV to Improve Care Delivery

Adverse childhood experiences (ACEs) are associated with negative health outcomes; however, screening for ACEs is not routinely performed among people living with HIV (PLWH). We conducted a single-center, cross-sectional pilot study to define the (1) prevalence of ACEs in PLWH and (2) acceptability of ACEs screening in routine out-patient clinical care. One hundred participants completed screening: median age of participants was 49 years (interquartile range: 38.5-59.5), 73% male, 66% Non-Hispanic Black/African American, and 47% gay/lesbian. Clinically significant ACEs score, defined as ≥4, was reported in 51%. High ACEs score was more common among participants <50 years old (64.7% vs. 36.7%; p < 0.01), but the prevalence of ACEs ≥4 did not differ by gender, race, ethnicity, or sexual orientation. Among participants with ≥4 ACEs, 44.4% screened negative on both PHQ-9 and PC-PTSD screens. The majority of participants (89%) reported a positive experience with ACEs screening. The prevalence of clinically significant ACEs in this clinic population of PLWH was more than twice that reported in the general population. Routine ACEs screening can improve delivery of trauma-informed care in the HIV primary care setting.

Perceptions of Contexts of Intimate Partner Violence Among Young, Partnered Gay, Bisexual and Other Men Who Have Sex With Men in the United States

There has been a growth in research illustrating that gay, bisexual, and other men who have sex with men (GBMSM) experience intimate partner violence (IPV) at rates that are comparable to those among heterosexual women. However, the majority of research on IPV among same-sex male couples has focused on adults, and research on the experience of IPV among younger men (those aged under 18), remains at a nascent stage, despite knowledge that IPV is often common among younger men. This article adds to the growing body of literature on IPV among young GBMSM (YGBMSM) through of an analysis of qualitative data from in-depth interviews (IDI) with GBMSM aged 15-19 (n = 30) in romantic relationships partnerships. The study sought to explore issues of relationship development, relationship contexts, and understandings of IPV. More than one-half of the sample reported experiencing some form of IPV in their current or past relationships. Participants described a range of experiences of IPV, including physical IPV, emotional IPV, sexual IPV, and controlling behaviors. Emotional IPV in the form of negative comments and controlling behaviors such as jealousy were the most commonly reported forms of violence behaviors. Although few participants reported experiencing physical or sexual IPV, several discussed concerns about giving, and partners' acknowledging, sexual consent. Antecedents to IPV included wanting or feeling pressured to participate in normative development milestones, short-lived relationships, and societal stigma. Interventions that develop content on IPV and that reflect the lived realities of YGBMSM who are experiencing their first relationships are urgently needed. Study findings also support the need for training teachers, health care providers, and parents to identify signs of IPV and provide them with the knowledge and skills to talk to YGBMSM about relationships and violence to reduce IPV.

Parental Support, Depressive Symptoms, and LGBTQ Adolescents: Main and Moderation Effects in a Diverse Sample

OBJECTIVE

Research has documented the importance of parental support as a protective factor against depressive symptoms among lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth. In this study, we assessed the relations between LGBTQ-specific parental support and depressive symptoms.

METHOD

Participants were 6,837 LGBTQ youth (ages 13-17) with diverse racial and ethnic, gender, and sexual identities. Main effect and moderation analyses examined interactions between LGBTQ-specific parental support with demographic variables on depressive symptoms, considering demographics as moderators.

RESULTS

We found that participants of color reported less LGBTQ-specific parental support than their White counterparts, that transgender and genderqueer participants reported less LGBTQ-specific parental support than their cisgender counterparts, and that non-monosexual participants reported less LGBTQ-specific parental support than their monosexual counterparts. Disparities in depressive symptoms were found for individuals who identified as Native American and Latinx, non-monosexual, and transgender and genderqueer, such that these groups reported higher levels of depressive symptoms. Further, we found a significant interaction between LGBTQ-specific parental support and ethnicity, with LGBTQ-specific parental support being less strongly associated with participants who identified as Latinx compared to those who did not identify as Latinx. We also found a significant interaction between LGBTQ-specific parental support and gender identity, with LGBTQ-specific parental support being more strongly related to depressive symptoms among participants who did not identify as boys compared to cisgender boys .

DISCUSSION

We discuss how to assess the impact of interlocking systems of oppression when working with LGBTQ youth and their parental figures.

Sexualities and Geographic Mobility Between Childhood and Adulthood in the United States

Though research suggests that sexual minorities (e.g., nonheterosexual individuals) are more geographically mobile in the transition to adulthood than their heterosexual counterparts, quantitative estimates are rare and previously used data sources have significant limitations. Using data from the National Longitudinal Study of Adolescent to Adult Health (N = 11,705) that directly measure sexualities across dimensions (i.e., identity, behavior, and attraction), I examine variation in geographic mobility between childhood (ages 11-17) and adulthood (ages 26-34) across various sexualities (e.g., gay/lesbian and bisexual). Three findings emerge. First, mobility varies across sexualities. Individuals with gay/lesbian identity, same-sex behavior, and same-sex attraction are more geographically mobile than individuals with heterosexual identity, different-sex behavior, and different-sex attraction, respectively. By contrast, individuals with bisexual identity, both-sex behavior, and both-sex attraction tend to be statistically indistinct from individuals with heterosexual identity, different-sex behavior, and different-sex attraction, respectively. Second, mobility differences are largest and most prevalent when sexualities are operationalized according to identity. Third, evidence suggests that the effects of gay/lesbian identity, same-sex behavior, and same-sex attraction on mobility are larger for men than for women. In providing the first quantitative estimates of geographic mobility differences across broader sexual minority and heterosexual populations, this study expands inquiry related to sexualities and mobility.

Rethinking minority stress: A social safety perspective on the health effects of stigma in sexually-diverse and gender-diverse populations

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.

Disparities in alcohol use and heavy episodic drinking among bisexual people: A systematic review, meta-analysis, and meta-regression

BACKGROUND

Alcohol consumption is more prevalent among sexual minorities than among heterosexuals; however, differences between minority sexual orientation groups are understudied. This systematic review and meta-analysis aimed to summarize existing evidence on the prevalence of alcohol use among bisexual people compared to their lesbian/gay and heterosexual counterparts.

METHODS

A systematic review of literature from 1995 to May 2020 was performed using Medline, PsycInfo, and Embase (OVID), Scopus, CINHAL and LGBT Life (EBSCO), combining keywords for bisexuality and alcohol use. Peer-reviewed publications that reported quantitative data on alcohol use among bisexual people were included. A random-effects model was used to pool the prevalence of two outcomes: any alcohol use and heavy episodic drinking (HED). Subgroup analysis and random-effects meta-regression were used to explore heterogeneity.

RESULTS

Of 105 studies eligible for data extraction, the overall prevalence of alcohol use was higher among bisexuals compared to lesbian/gay and heterosexual people. For example, the prevalence of past-month HED was 30.0% (28.2, 31.8) among bisexual people versus 25.5% (23.8, 27.2) among lesbian/gay and 21.3% (19.6, 23.0) among heterosexual individuals. Pooled odds ratio estimates showed that bisexual people were more likely to report alcohol use and HED compared to their counterparts. Gender was a significant effect modifier in meta-regression analysis, with greater disparities among women than among men.

CONCLUSIONS

These results highlight the need for additional research to understand factors underlying bisexual people's greater risk, and particularly bisexual women, as well as alcohol use interventions that are targeted towards the specific needs of bisexual people.

Lesbian, gay and bisexual homelessness in Australia: Risk and resilience factors to consider in policy and practice

Lesbian, gay and bisexual (LGB) people are more likely than heterosexual people to experience homelessness. The study aimed to compare risk and resilience factors commonly associated with homelessness according to sexual identity to inform more LGB-inclusive and targeted policy and service provision in this area. The study involved analysis of data from two Australian surveys: the General Social Survey 2014 (n = 17,401) and the Journeys Home study (n = 1,659). Chi-squared analyses of the survey data compared LGB with heterosexual respondents. Bisexual respondents had a significantly earlier average age of first homelessness, and were more likely to have repeated episodes of homelessness than lesbian, gay or heterosexual respondents. Risk factors that were higher among bisexual people included family violence, conflict and rejection and substance use issues. LGB respondents were twice as likely to have experienced discrimination as heterosexual respondents, more likely to have experienced violence and have mental health problems. Conversely, resilience factors for LGB respondents included being more likely to access friends for support in times of crisis, and to be involved in civic or political groups. We suggest that LGB people at risk of homelessness need effective responses based on their risk and resilience factors, including targeted peer support and mainstream services that affirm and acknowledge their diverse sexual identities. Australian policies should encourage improved LGB data collection and specific service responses. Primary prevention approaches include educating families of origin about LGB identities and assertive outreach to prevent housing loss.

Understanding the Link Between Adolescent Same-Gender Contact and Unintended Pregnancy: The Role of Early Adversity and Sexual Risk Behavior

Past research suggests an apparent paradox: Women who engage in same-gender sexual behavior show higher rates of unintended pregnancy than women with exclusive other-gender sexual behavior. Such women also have disproportionate rates of early adversity (both harshness, such as abuse or neglect, and unpredictability, such as father absence). We used the Add Health data (N = 5,617 cisgender women) to examine the relative contributions of early adversity, adolescent same-gender sexual behavior, and general sexual risk behavior to women's risks for adult unintended pregnancy. Women who engaged in adolescent same-gender sexual behavior were more likely to report childhood adversity, and both childhood adversity and adolescent same-gender behavior made independent contributions to subsequent rates of unintended pregnancy. The association between adolescent same-gender sexual behavior and adult unintended pregnancy was partially attributable to the fact that women with adolescent same-gender sexual behavior engaged in greater sexual risk behavior more broadly. These findings suggest that same-gender sexual behavior in adolescence may relate to a broader set of sexual risk behaviors that augment future risk for unintended pregnancy, independent of sexual identity. We draw on life history theory to explain this pattern of results and suggest directions for future research.

Addressing the biological embedding of early life adversities (ELA) among adults through mindfulness: Proposed mechanisms and review of converging evidence

Early life adversities (ELA) are prevalent and have a profound and adverse impact across the lifespan, including on age-related health outcomes, yet interventions to remediate its adverse impact are scarce. This paper presents evidence for mindfulness training to reduce the elevated mental and physical health risks linked to ELA among adults by targeting biological mechanisms of ELA leading to these adverse health outcomes. We first provide a brief overview of ELA, its adverse health impacts, and mechanisms that might be responsible. Next, we review converging evidence that demonstrates that mindfulness training influences key biological pathways involved in ELA-linked negative health consequences, including (a) brain networks involved in self-regulation, (b) immunity and inflammation, (c) telomere biology, and (d) epigenetic modifications. Further, we review preliminary evidence from mindfulness-based trials that focused on populations impacted by ELA. We discuss limitations of this review and provide recommendations for future research. If effective, a mindfulness-based approach could be an important public health strategy for remediating the adverse mental and physical health consequences of ELA.

Differences by sexual orientation in treatment outcome and satisfaction with treatment among inpatients of a German psychiatric clinic

A wealth of research suggests that sexual minority individuals experience stigma and lack of sexual minority specific competencies in mental health care, which could lead to less optimal treatment outcome. However, most related research suffers from methodological limitations, such as selected samples, retrospective design, or not assessing treatment outcome. To overcome some of these limitations, we explored if sexual minority patients have poorer treatment outcome and are less satisfied with treatment in a mental health care setting not specialized in sexual minority issues. The analytical sample comprised 5609 inpatients, including 11% sexual minority patients, from a German psychiatric clinic. Outcomes were improvement in well-being and depression from admission to discharge, and satisfaction with treatment judged at discharge. Nearly all sexual orientation differences were in a direction hinting at less improvement of depression and well-being and less satisfaction among sexual minority compared to heterosexual patients. However, the differences were generally small and not statistically significant. Stigma and lacking sexual orientation specific competency in healthcare may not be universally present or not as severe as studies with other research designs suggested. However, this needs to be investigated in more clinical settings by including sexual orientation as part of the routine assessment. Moreover, adequate sexual-minority specific competencies are important in any case, not just to prevent that sexual minority patients benefit less from treatment.

Using systemic interventions to reduce intimate partner violence or child maltreatment: A systematic review of publications between 2010 and 2019

This systematic review seeks to understand the effectiveness of systemic interventions to reduce Intimate Partner Violence (IPV) or child maltreatment published between January 2010 and December 2019. We found nine studies reviewing systemic interventions for IPV and 12 studies reviewing systemic interventions for child maltreatment. In our discussion, we added relevant articles published before 2010 to determine the overall state of the evidence for these interventions. We determined that parent training programs with in vivo coaching components for child maltreatment meet the criteria for well-established interventions. Relationship education approaches are probably efficacious. Parent education and family therapy programs to reduce child maltreatment, and cognitive behavioral couples treatment to reduce IPV are possibly efficacious interventions. Programs based on "naturalistic" couples therapy for IPV are experimental interventions. This review also highlights limitations in this research in addressing the needs of marginalized couples and families.

Sexual orientation differences in childhood sexual abuse, suicide attempts, and DSM-5 alcohol, tobacco, other drug use, and mental health disorders in the US

BACKGROUND

Childhood sexual abuse (CSA) contributes to increased risk of substance use and mental health disorders in the general population.

OBJECTIVE

To assess the prevalence and associations of CSA and suicide attempts, substance use, and mental health disorders as a function of sex (female, male) and sexual orientation (lesbian, gay, bisexual, heterosexual-identified with same-sex attraction and/or behavior, heterosexual-identified without same-sex attraction and/or behavior, and unsure).

PARTICIPANTS AND SETTING

Data were collected using structured diagnostic face-to-face interviews in a nationally representative sample of 36,309 US adults.

METHODS

We used descriptive statistics and logistic regression modeling to analyze data from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-III).

RESULTS

Childhood sexual abuse was most prevalent among sexual minorities, especially bisexual females. Nearly one-third of bisexual females (30.6%) reported experiencing two or more types of CSA, p < .001. Among all participants, exposure to one or more types of CSA was associated with greater odds of lifetime suicide attempts, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) alcohol, tobacco or other drug use disorder, and mental health disorders, after adjusting for other childhood adversity/maltreatment and general life stressors.

CONCLUSIONS

Sexual minority females and males in the US are more likely than their heterosexual counterparts to report CSA. Higher risk of suicide attempts and DSM-5 alcohol, tobacco, other drug use, and mental health disorders in adulthood was directly associated with CSA, particularly among bisexual females. Health professionals working with individuals who have experienced CSA should assess these risks and intervene as needed.

Substance use and sexual minority status: examining the mediating roles of stress and emotion dysregulation in young adult women

Sexual minority women (SMW) report higher rates of substance use and disorder across the lifespan, and greater levels of minority stress in adolescence and young adulthood. Minority stress mediation models propose that higher levels of social stressors may increase emotion dysregulation, which in turn increases the propensity toward substance misuse. Few studies, however, have prospectively examined the impact of stressors and emotion dysregulation among SMW on early and escalating substance use. This longitudinal study examined whether emotion dysregulation and social stress mediated the association between sexual minority status and developing substance use (ages 17 through 22 years) in a sample of 2,201 heterosexual and 246 SMW participants in the Pittsburgh Girls Study. Results supported serial mediation processes of marijuana use risk: SMW reported higher levels of social stress in late adolescence, which in turn predicted greater emotion dysregulation that was associated with greater marijuana use by young adulthood.

Study design and interventions for a peer-delivered motivational interviewing group treatment for sexual and gender minority male sexual trauma survivors

Sexual abuse of boys and men is a public health problem that has received relatively little attention from clinical scholars and researchers. Given unique pathways for development of and recovery from trauma-related emotional distress, sexual abuse survivors who identify as men may require distinct psychosocial interventions to engage in formal mental health care and assist in symptom reduction. This paper describes the rationale for and methodology of a randomized controlled trial comparing the effectiveness of Motivational Interviewing (MI) versus MI with affirmative care (MI-AC) for sexual and gender minority men who have been sexually traumatized. This study is designed to randomly assign 356 participants to either condition of six online group sessions delivered by two trained peers with lived experience of sexual trauma. Assessments will be conducted at baseline, post-treatment, 60- and 120-day follow-up. The primary hypotheses are that participants assigned to MI-AC, compared to those in MI only, will report reduced symptoms of depression and increased levels of engagement in formal mental health treatment. Additional hypotheses relate to secondary outcome variables, including post-traumatic stress disorder, suicidality, and substance use.

Assessment of Research on Intimate Partner Violence (IPV) Among Sexual Minorities in the United States

Although sexual minority couples experience intimate partner violence (IPV) similar to or higher than heterosexual couples, not much attention has been given to LGBTQ couples. Using content analysis, this integrative review seeks to examine the state of scholarly literature regarding IPV among LGBTQ+ communities in the United States. For studies to be eligible for inclusion in this review, studies were required to focus on LGBTQ+ populations within the United States, published in English, involved violence between intimate partners, were the result of peer-reviewed, original research, and were published between years 2008 and 2018. Using SocIndex as the search database, a total of 46 peer-reviewed journal articles met the inclusion criteria. This study found that most studies employed quantitative research designs aiming to examine the statistical relationship between IPV and other variables by using surveys. Demographic information of the participants was mostly used as predictors of IPV, whereas health-related risky behaviors were mostly used as outcomes variables that were associated with IPV. Theoretical frameworks, methodology, and policy suggestions used in each study were examined in depth. A discussion of future studies and policy implications follows the findings of this study.

Review: Prevalence of Addictions among Transgender and Gender Diverse Subgroups

We conducted an analysis of the prevalence of substance and behavioral addictions across different transgender and gender diverse (TGD) subgroups. We performed a scoping review using MEDLINE and Google Scholar databases and examined 12 addictions, including alcohol, nicotine, cannabis, illicit drugs, gambling, eating/food, internet, sex, love, exercise, work, and shopping. We presented prevalence rates for each addiction as a function of an individual’s gender identity (stratified into transgender females, transgender males, and gender nonconforming), and used cisgender women and men as reference groups. We included 55 studies in our final analysis, the majority of which investigated substance use disorders among TGD subgroups. Overall findings indicated that substantial differences in substance use exist among US TGD subgroups. There were far fewer publications that examined the prevalence of behavioral addictions across TGD subgroups. However, despite limited research in this area, findings still suggest that notable differences in behavioral addictions may exist between individual TGD subgroups. The conclusions of our review may provide clinicians with a better ability to screen for and treat at-risk individuals within the TGD community.

Development and Initial Validation of Three Culturally Sensitive Measures of Intimate Partner Violence for Sexual and Gender Minority Populations

Measures of intimate partner violence (IPV) have largely been developed and validated in heterosexual, cisgender samples, with little attention to whether these measures are culturally appropriate for sexual and gender minority (SGM) populations. However, rates of IPV are two to three times higher among SGM than heterosexual populations, highlighting the importance of culturally appropriate measures of IPV for SGM populations. In this article, after reviewing key problems with the use of existing IPV measures with SGM samples, we describe the development of a toolkit of new and adapted measures of IPV for use with SGM assigned female at birth (SGM-AFAB) populations, including an adapted version of the Conflict Tactics Scale-Revised, an adapted measure of coercive control, and the newly developed SGM-Specific IPV Tactics Measure. Using data from a sample of 352 SGM-AFAB individuals, we then test the psychometric properties of these three measures, including their factor structures, internal reliability, and convergent/divergent validity. Results provide initial evidence of the reliability and validity of each measure. Together, these three measures comprise a culturally appropriate and psychometrically validated measurement toolkit for studying a broad range of IPV tactics among SGM-AFAB that will help build a foundation for more in-depth research into IPV in SGM populations.

Gay men's stress response to a general and a specific social stressor

Gay men show altered psychobiological stress responses and exhibit a higher prevalence of mental disorders than their heterosexual counterparts. Both of these findings are likely due to gay-specific discrimination. Since it has not yet been determined whether gay-specific stress is more noxious than general stress, we tested whether gay men react more strongly to gay-specific socially stressful stimuli than to general socially stressful stimuli. N = 33 self-identified gay men (mean = 26.12 years of age, SD = 5.89), 63.6% of whom were in a relationship with a man, participated in an experimental within-group study, in which they were exposed to the Trier Social Stress Test (TSST) as well as a gay-specific TSST in a randomized order. Salivary cortisol and testosterone were assessed at five time points during the laboratory tests and perceived stress was assessed at four time points. According to psychobiological and perceived stress indices, the participants reacted similarly to a gay-specific and general social stressor. There were no significant differences in the outcomes, either when looking at pre-post-test differences or when comparing the overall stress responses. Given that the response to a gay-specific social stressor was equally pronounced as the one to a general social stressor, programs aiming to decrease minority stress but overlooking general stress are likely to yield only partial improvements in gay men's mental health. Instead, we suggest helping gay men cope with both forms of stress through building social support, assertiveness, and mindfulness skills, as well as decreasing emotional dysregulation.

Systemic inflammation as a driver of health disparities among sexually-diverse and gender-diverse individuals

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.

Associations Among Childhood Household Dysfunction, Sexual Orientation, and DSM-5 Alcohol, Tobacco and Other Substance Use Disorders in Adulthood: Evidence From a National U.S. Survey

OBJECTIVES

This study examined the associations between childhood household dysfunction and adulthood past-year DSM-5 alcohol, tobacco, and other substance use disorders across sexual orientation subgroups (eg, lesbian/gay, bisexual, and heterosexual).

METHODS

Prevalence estimates were based on National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-III) data collected from structured diagnostic face-to-face interviews in a nationally representative sample of 36,309 U.S. adults. Multivariable regression was used to examine associations between childhood household dysfunction and past-year substance use disorders in adulthood.

RESULTS

Sexual minorities, particularly sexual minority women, reported higher rates of childhood household dysfunction (eg, parental/household history of substance-related problems) and adulthood DSM-5 alcohol, tobacco, and substance use disorders. Results of multivariable analyses indicated that childhood histories of parental/household substance-related problems were associated with greater odds of past-year substance use disorders among sexual minorities than heterosexuals, and that such histories may moderate differences among sexual orientation subgroups. The risk of substance use disorders among sexual minority women relative to exclusively heterosexual women (ie, heterosexual-identified women without same-sex attraction or behavior) remained high, even when accounting for household dysfunction. In contrast, there were no such differences between sexual minority men and exclusively heterosexual men.

CONCLUSIONS

Sexual minorities are more likely to have childhood household dysfunction which in turn is associated with a higher risk of developing DSM-5 alcohol, tobacco, and substance use disorders in adulthood, especially among sexual minority women. Healthcare providers who care for individuals raised in dysfunctional households should carefully assess risk for substance use disorders and intervene as needed.

Health Behavior Differences Between Male and Female U.S. Military Personnel by Sexual Orientation: The Importance of Disaggregating Lesbian, Gay, and Bisexual Groups

INTRODUCTION

The aims of the study are to identify health-related behaviors associated with sexual orientation among active duty military personnel and to compare those behaviors when lesbian, gay, and bisexual (LGB) groups are aggregated and disaggregated.

MATERIALS AND METHODS

We used public data from the 2015 Health-Related Behavior Survey of Active Duty Military Personnel. Binomial logistic regression analyses were used to examine differences between and within heterosexual, same-sex, and bisexual groups as predicted by the following correlates: demographic characteristics, physical activity, substance use, probable mood disorders, unwanted sexual contact, physical abuse, suicidal behaviors, and sexually transmitted infection (STI).

RESULTS

In univariate analyses, rates of lifetime unwanted sexual contact and lifetime suicidal ideation were significantly higher for bisexual females compared to other groups. The results of regression analyses differed depending on whether LGB groups were aggregated or disaggregated. Aggregated LGB versus heterosexual model found significant differences with respect to unwanted sexual contact, lifetime suicide attempt, STI, smoking, and marijuana use. Disaggregated models found different patterns of significant correlates, e.g., correlates comparing gays to heterosexual males were STI, sexual contact, lifetime suicide attempt, and age; correlates comparing lesbians to heterosexual females were heavy drinking, probable post-traumatic stress disorder, ever used marijuana, lifetime suicide attempt, lifetime physical abuse, and smoking.

CONCLUSION

The findings are consistent with those of previous research showing highest risk for suicidal behaviors and substance abuse among bisexual individuals. We recommend that future studies and clinical care consider LGB sexual identities as heterogeneous groups; otherwise, risks for adverse health behaviors may be overlooked.

Childhood trauma and bullying-victimization as an explanation for differences in mental disorders by sexual orientation

Sexual minority individuals are more likely to have mental disorders, including mood, anxiety, and substance use disorders, compared to heterosexual individuals. Whether experiencing trauma or bullying-victimization during childhood explains these differences is currently unclear. We used a psychiatric epidemiological general population-based study to assess whether childhood trauma severity and bullying-victimization before age 16 explains the difference by sexual attraction in mental disorders. Data from the Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2; N = 6392) were used to examine (1) whether same/both-sex attraction and predominantly other-sex attraction is linked to self-reports of childhood trauma (types and severity) and bullying-victimization, and (2) whether these experiences explain differences between these groups in lifetime and 12-month prevalence of DSM-IV disorders assessed by the Composite International Diagnostic Interview 3.0. Same/both-sex attracted individuals reported a higher childhood trauma severity score compared to exclusively other-sex attracted individuals (B = 0.93, SE = 0.20, p < .001), and were more likely to report bullying-victimization (OR = 2.51 95%CI[1.68, 3.74]). DSM-IV disorders were more prevalent among same/both-sex attracted individuals than among exclusively other-sex attracted individuals (ORs ranged from 1.57 to 4.68). There were no differences in DSM-IV disorders for predominantly other-sex attracted individuals. Childhood trauma severity explained between 9.0% and 57.0% of significant indirect associations between same/both-sex attraction and DSM-IV disorders. Sexual minority individuals experience more types of, and more severe childhood trauma, and are more likely to experience bullying-victimization. These negative experiences partly explained disparities in mental disorders.

The Annual Examination for Lesbian, Gay, and Bisexual Patients

The annual examination is a comprehensive evaluation of patients in which all aspects of health and well-being are considered, including proper screening, appropriate preventive care, and recommendations and resources for healthy living. Clinicians commonly avoid certain topics with lesbian, gay, bisexual, transgender, and queer (LGBTQ) patients because they may be unprepared to address their health needs. Therefore, clinicians should learn how to conduct an LGBTQ-friendly annual examination in order to provide high-quality care. This article focuses on both the general and unique health needs of lesbian, gay, bisexual, and queer patients; care for transgender and gender-diverse patients is considered elsewhere.