Sexual orientation and treatment-seeking for depression in a multilingual worldwide sample

Treatment Utilization for Posttraumatic Stress Disorder in a National Sample of Veterans and Nonveterans

OBJECTIVE

The current study sought to compare rates of posttraumatic stress disorder (PTSD) treatment utilization (medication and psychotherapy) among veterans and nonveterans-and to investigate which factors are associated with treatment utilization among veterans versus nonveterans.

METHODS

Participants were 2775 individuals (veteran, n=2508; nonveteran, n=267) meeting criteria for probable PTSD (determined by the PTSD Checklist) drawn from a nationwide, population-based survey. Participants reported demographic information, trauma history, mental health symptoms, insurance coverage, and treatment history.

RESULTS

Analyses revealed that the majority of veterans and nonveterans with probable PTSD had not received any PTSD treatment (56% of veterans and 86% of nonveterans). Population-weighted logistic regression models demonstrated that veterans with probable PTSD were substantially more likely to receive medication and psychotherapy for PTSD than nonveterans with probable PTSD. Logistic regression models demonstrated that, among veterans, having Veterans Affairs health care coverage was most strongly associated with receiving PTSD medication and psychotherapy. Black (vs. White) veterans were less likely to have received PTSD medication and psychotherapy. In contrast, among nonveterans, being married or divorced (vs. never married) was most strongly associated with receiving PTSD medication, and reporting a history of sexual trauma was most strongly associated with receiving PTSD psychotherapy.

CONCLUSION

Given that most individuals do not receive PTSD treatment, additional understanding of treatment barriers and facilitators for both veterans and nonveterans is needed to improve intervention reach.

Prevalence of depressive symptoms among dental students is influenced by sex, academic performance, smoking exposure, and sexual orientation

Aim: To estimate the prevalence and associated factors of self-reported depressive symptoms in undergraduate and graduate dental students. Methods: The Depression, Anxiety and Stress Scale (DASS-21) was applied, and only the depression domain was verified. A structured questionnaire was used to collect sociodemographic, behavioral, and COVID-19 pandemic-related fear variables. Academic performance was assessed based on academic records, ranging from 0 (worst possible grade) to 10 (best possible grade). Respondents included 408 regularly enrolled dental students. Bi- and multivariate analyses were performed using Poisson regression with robust variance to verify the association between at least moderate depressive symptoms and independent variables. Results: The prevalence of at least moderate depression was 40.5% among undergraduate students and 26% among graduate students. The prevalence of fear and anxiety due to the COVID-19 pandemic was 96.1% among undergraduate students and 93.5% among graduate students. In the final multivariate analysis, being female (prevalence ratio [PR]:2.01; 95% confidence interval [95%CI]:1.36–2.96) was associated with a higher PR for depression. Conversely, no exposure to smoking (PR:0.54; 95%CI:0.36–0.82) and a final academic performance average ≥7.0 (PR:0.56; 95%CI:0.41–0.76) was associated with a lower PR for depression. Finally, among graduate students, a non-heterosexual orientation was associated with a higher PR for depression (PR:6.70; 95%CI:2.21–20.29). Conclusion: Higher rates of depression symptoms were observed in female undergraduates, students with lower academic performance and smoking exposure, and graduate dental students with a non-heterosexual orientation.

Testing whether the combination of victimization and minority stressors exacerbate PTSD risks in a diverse community sample of sexual minority women

Informed by minority stress and intersectionality frameworks, we examined: 1) associations of sexual identity and race/ethnicity with probable diagnosis of post-traumatic stress disorder (PTSD-PD) among sexual minority women (SMW; e.g., lesbian, bisexual); and 2) potential additive and interactive associations of minority stressors (discrimination, stigma consciousness, and internalized homonegativity) and potentially traumatic childhood and adulthood events (PTEs) with PTSD-PD. Data come from a large and diverse community sample of SMW (N = 662; age range: 18-82; M = 40.0, SD = 14.0). The sample included 35.8% Black, 23.4% Latinx, and 37.2% White participants. Logistic regressions tested associations of sexual identity and race/ethnicity, minority stressors, and PTEs with PTSD-PD. More than one-third of SMW (37.2%) had PTSD-PD with significantly higher prevalence among bisexual, particularly White bisexual women, than lesbian women. Discrimination, stigma consciousness, and internalized homonegativity were each associated with higher odds of PTSD-PD, but only internalized homonegativity was additively associated with PTSD-PD in mutually adjusted models above and beyond effects of PTEs. No evidence for interactive effects between PTEs and minority stressors was found. In a diverse community sample of sexual minority women, PTSD is strongly associated with potentially traumatic childhood events and with minority stressors above and beyond the associations with other potentially traumatic events and stressors in adulthood. Our findings suggest a strong need for therapists to address the effects of stigma and homophobia in treatment for PTSD, as these minority stressors likely maintain and exacerbate the effects of past traumas.

Barriers in care pathways and unmet mental health needs in LGBTIQ + communities

Lesbian, gay, bisexual, transgender, intersex, queer people and minority gender identities and sexualities (LGBTIQ+) are often stigmatized and experience discrimination in health care settings, leading to poorer mental health outcomes and unmet needs compared to heterosexual and cisgendered peers. It is thus imperative that mental health providers consider and address structural challenges in order to reduce mental health inequalities of this population. This narrative review assessed the barriers that may prevent access to care and the pathways for care in LGBTIQ + communities. PubMed, PsycInfo, Embase, and Scopus were searched for papers published between December 2021 and February 2022. A total of 107 papers were included with studies reflecting five themes: (1) Unmet mental health needs; (2) Young people; (3) Substance abuse and addiction; (4) Barriers and pathways to care; and (5) Interventions. Findings demonstrate that LGBTIQ + people experience stigmatization and higher rates of substance misuse and mental ill health, which may lead to barriers in accessing health care services, and fewer tailored interventions being provided. These findings have implications for policy, health care screening, and how specialist services are structured. Substantial gaps in the evidence-base exist, and future research should examine how mental health care providers can challenge social issues that maintain discriminatory and stigmatizing practices, and support LGBTIQ + individuals to sustain their resilience.

Factor analysis of depression symptoms across five broad cultural groups

INTRODUCTION

Core symptoms of depression are likely universal, however cultural groups differ in their experience of the condition. The purpose of this study was to examine differences and similarities of depression symptom groupings between broad cultural groups.

METHOD

6,982 adults took part in an online multilingual depression screening study, and completed an 18-item major depression screener. Participants were categorized into five broad cultural groups by language and country of residence: Spanish speakers from Latin America (n = 3,411); English speakers from Southeast Asia (n = 1,265); Russian speakers from the former Soviet bloc (n = 642); English speakers from English-speaking Western countries (n = 999); and Chinese speakers from China (n = 665). Principal components analysis with promax rotation was used.

RESULTS

Both similarities and noteworthy differences in symptom clustering between groups were observed. For instance, though suicide-related items formed a separate cluster for most cultures, for the Latin-American group, worthlessness loaded with suicidality. Changes in appetite and changes in weight tended to load on different factors (except for Chinese and Russian groups). Hypersomnia tended to load with psychomotor agitation, and core depression symptoms tended to load with physical symptoms (except for the Russian group).

LIMITATIONS

Depression was assessed by a self-report measure aligned to DSM-IV.

CONCLUSION

The analysis contributes to a nuanced understanding of depression manifestations of various cultures, which may inform culturally sensitive clinical practice.

Indigeneity, diversity, and equity in Internet interventions: Could ISRII contribute to making health care a universal human right?

This article is a partially revised version of a keynote address presented at the 10th Scientific Meeting of the International Society for Research on Internet Interventions (ISRII) in Auckland, New Zealand. It addresses six points: 1) the meanings of indigeneity, diversity, and equity, 2) the strong emotional reactions elicited by the inequities experienced by indigenous groups throughout the world, 3) the aspirations of members of ISRII in terms of what we would like our field to accomplish to address these inequities, 4) the United Nations goal of making health care a universal human right, 5) the difficulties encountered by other health sciences in attempting to include diverse populations into major studies, and 6) ways in which the Internet interventions and digital health field could include indigeneity, diversity, and equity in our work, and by doing so, contribute to the United Nations goal of making health care a universal human right. The authors suggest that providing access to health care to all people, no matter where they are on the socioeconomic continuum, is a key strategy to pursue. The field of Internet interventions could contribute by creating digital apothecaries that would develop, evaluate, and disseminate evidence-based Massive Open Online Interventions to anyone in the world who needs them.

Self-reported sexual orientation among undergraduates of 10 universities in Guangzhou, China

Few studies have investigated the distribution of sexual orientation among Chinese university students and identified the socio-demographic factors associated with sexual orientation. For the present study, we administered a paper-based, 5-point, self-report, sexual orientation scale to a stratified, random sample of 9071 undergraduates across all 10 universities in Guangzhou Higher Education Mega Center, Guangzhou, China. Multivariable ordinal regression analysis was used to explore the relationship between demographic factors and sexual orientation. A total of 8320 respondents completed the survey. Of 8182 valid respondents, 80.6% self-reported as exclusively heterosexual, 12.6% self-reported as mostly heterosexual, 5.4% self-reported as bisexual, 0.7% self-reported as mostly homosexual, and 0.8% self-reported as exclusively homosexual. About one fifth of male students and one fourth of female students reported some degree of divergence from exclusive heterosexuality. This indicates that in China there are a large number of university students who are potentially involved in same-sex sexual attraction.