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DuBois LZ, Puckett JA, Jolly D, Powers S, Walker T, Hope DA, Mocarski R, Huit TZ, Lash BR, Holt N, Ralston A, Miles M, Capannola A, Tipton C, Eick G, Juster RP. Gender minority stress and diurnal cortisol profiles among transgender and gender diverse people in the United States. Horm Behav 2024; 159:105473. [PMID: 38190769 DOI: 10.1016/j.yhbeh.2023.105473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 12/13/2023] [Accepted: 12/14/2023] [Indexed: 01/10/2024]
Abstract
The field of behavioral neuroendocrinology has only begun to explore the lived experiences of transgender and gender diverse (TGD) people exposed to stigma. In light of escalating attacks and legislation targeting TGD people in the United States, it is crucial to examine the physiological pathways through which gender minority stressors become embodied, impact health, and contribute to health inequities. The Trans Resilience and Health Study included baseline data collection from fall 2019 to spring 2020 from a sample of 124 TGD people, reflecting a diversity of gender identities (e.g., trans masculine, trans feminine, and nonbinary) and ages (range = 19-70 years old; M = 34.10), living in Michigan, Nebraska, Oregon, and Tennessee. These analyses examine experiences of gender-related enacted stigma in association with hypothalamic-pituitary-adrenal (HPA)-axis functioning. Among those experiencing the highest levels of enacted stigma, findings show a blunted cortisol awakening response and sluggish daily decline that resulted in elevated concentrations at bedtime compared to those experiencing less enacted stigma. These results of flattened diurnal activity are consistent with an emergent literature on discrimination as a social determinant of potential stress pathophysiology. In contrast, community connectedness was associated with a larger, more dynamic cortisol awakening response. These findings emphasize the importance of incorporating gender-minority stress and resilience measures when studying HPA-axis functioning among TGD people.
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Affiliation(s)
- L Zachary DuBois
- Department of Anthropology, 1218 University of Oregon, Eugene, OR 97403, United States.
| | - Jae A Puckett
- Department of Psychology, Michigan State University, 316 Physics Road, East Lansing, MI 48824, United States.
| | - Dee Jolly
- Department of Anthropology, 1218 University of Oregon, Eugene, OR 97403, United States.
| | - Sally Powers
- Department of Psychological and Brain Sciences, University of Massachusetts at Amherst, 135 Hicks Way, Amherst, MA 01003, United States.
| | - Tian Walker
- Department of Anthropology, 1218 University of Oregon, Eugene, OR 97403, United States.
| | - Debra A Hope
- Department of Psychology, University of Nebraska-Lincoln, 238 Burnette Hall, Lincoln, NE 68588, United States; Office of Graduate Studies, University of Nebraska-Lincoln, Lincoln, NE 68588, United States.
| | - Richard Mocarski
- Office of Research, San José State University, One Washington Square, San José, CA, United States.
| | - T Zachary Huit
- Department of Psychology, University of Nebraska-Lincoln, 238 Burnette Hall, Lincoln, NE 68588, United States
| | - Brenna R Lash
- Department of Psychology, University of Nebraska-Lincoln, 238 Burnette Hall, Lincoln, NE 68588, United States
| | - Natalie Holt
- Department of Psychology, University of Nebraska-Lincoln, 238 Burnette Hall, Lincoln, NE 68588, United States
| | - Allura Ralston
- Department of Psychology, University of Nebraska-Lincoln, 238 Burnette Hall, Lincoln, NE 68588, United States
| | - Makinna Miles
- College of Public Health and Human Sciences, Oregon State University, 160 SW 26th St, Corvallis, OR 97331, United States
| | - A Capannola
- Department of Child & Family Studies, The University of Tennessee at Knoxville, 1215 W. Cumberland Ave., Knoxville, TN 37996, United States.
| | - Clove Tipton
- Department of Sociology, The University of Tennessee at Knoxville, 901 McClung Tower, Knoxville, TN 37996, United States.
| | - Geeta Eick
- Department of Anthropology, 1218 University of Oregon, Eugene, OR 97403, United States
| | - Robert-Paul Juster
- Department of Psychiatry and Addiction, University of Montreal, Research Center of the Montreal Mental Health University Institute, 7331 Hochelaga, FS-145-12, Montreal, Quebec H1N 3V2, Canada.
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Dibble KE, Murray SM, Baral SD, Zlotorzynska M, Wiginton JM, Stephenson R, Edwards OW, Lyons C, Rainey JC, Xue QL, Sanchez TH. Predicting salivary cortisol and sexual behavior stigma among MSM in the American Men's Internet Survey 2019. Sci Rep 2023; 13:18082. [PMID: 37872353 PMCID: PMC10593931 DOI: 10.1038/s41598-023-44876-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 10/12/2023] [Indexed: 10/25/2023] Open
Abstract
Physiological stress levels in response to sexual behavior stigma among men who have sex with men (MSM) in the United States (US) are understudied. The current study aims to explore the relationship between sexual behavior stigma and salivary cortisol both overall and stratified by race/ethnicity. If such an association exists, it may suggest that sexual behavior stigma can be physiologically measured or indicated by the presence of heightened salivary cortisol. A subsample of 667 MSM participants from the 2019 American Men's Internet Survey (AMIS; N = 10,129) submitted morning (AM) and evening (PM) saliva cortisol samples using at-home mail-in collection kits. Average daily cortisol and daily cortisol change were calculated; simple linear regressions estimated associations between cortisol measures and sexual behavior stigma characterized in four different ways (ever and recent experience of individual stigma items; average ever and recent experience of three stigma scales: stigma from family and friends, anticipated healthcare stigma, general social stigma). Participants reported a mean age of 36.0 years (SD = 14.9), with most being non-Hispanic white (n = 480, 72.0%), Hispanic (n = 164, 12.3%), or Black/African American (n = 146, 10.9%), and identified as homosexual/gay (n = 562, 84.3%). Reporting ever experiencing healthcare providers gossiping was significantly associated with higher PM cortisol (β = 0.12, p = 0.001) and higher average daily cortisol (β = 0.11, p = 0.004), while reporting ever experiencing police refusing to protect was associated with higher AM cortisol (β = 0.08, p = 0.03) and higher average daily cortisol (β = 0.09, p = 0.02). Recent experiences of stigma were not significant predictors of any measure of cortisol. Measures of salivary cortisol may be used to characterize sexual behavior stigma among MSM populations, however more insight is needed to determine its exact relationship and strength.
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Affiliation(s)
- Kate E Dibble
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room E6133, Baltimore, MD, 21205, USA.
| | - Sarah M Murray
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Stefan D Baral
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room E6133, Baltimore, MD, 21205, USA
| | - Maria Zlotorzynska
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - John Mark Wiginton
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Rob Stephenson
- Department of Systems, Populations, and Leadership, School of Nursing, and The Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, 48109, USA
| | - O Winslow Edwards
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - Carrie Lyons
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Jacob C Rainey
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Qian-Li Xue
- Johns Hopkins School of Medicine, Baltimore, MD, 21205, USA
| | - Travis H Sanchez
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
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Duncan DT, Cook SH, Wood EP, Regan SD, Chaix B, Tian Y, Chunara R. Structural racism and homophobia evaluated through social media sentiment combined with activity spaces and associations with mental health among young sexual minority men. Soc Sci Med 2023; 320:115755. [PMID: 36739708 PMCID: PMC10014849 DOI: 10.1016/j.socscimed.2023.115755] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 01/20/2023] [Accepted: 01/29/2023] [Indexed: 02/01/2023]
Abstract
BACKGROUND Research suggests that structural racism and homophobia are associated with mental well-being. However, structural discrimination measures which are relevant to lived experiences and that evade self-report biases are needed. Social media and global-positioning systems (GPS) offer opportunity to measure place-based negative racial sentiment linked to relevant locations via precise geo-coding of activity spaces. This is vital for young sexual minority men (YSMM) of color who may experience both racial and sexual minority discrimination and subsequently poorer mental well-being. METHODS P18 Neighborhood Study (n = 147) data were used. Measures of place-based negative racial and sexual-orientation sentiment were created using geo-located social media as a proxy for racial climate via socially-meaningfully-defined places. Exposure to place-based negative sentiment was computed as an average of discrimination by places frequented using activity space measures per person. Outcomes were number of days of reported poor mental health in last 30 days. Zero-inflated Poisson regression analyses were used to assess influence of and type of relationship between place-based negative racial or sexual-orientation sentiment exposure and mental well-being, including the moderating effect of race/ethnicity. RESULTS We found evidence for a non-linear relationship between place-based negative racial sentiment and mental well-being among our racially and ethnically diverse sample of YSMM (p < .05), and significant differences in the relationship for different race/ethnicity groups (p < .05). The most pronounced differences were detected between Black and White non-Hispanic vs. Hispanic sexual minority men. At two standard deviations above the overall mean of negative racial sentiment exposure based on activity spaces, Black and White YSMM reported significantly more poor mental health days in comparison to Hispanic YSMM. CONCLUSIONS Effects of discrimination can vary by race/ethnicity and discrimination type. Experiencing place-based negative racial sentiment may have implications for mental well-being among YSMM regardless of race/ethnicity, which should be explored in future research including with larger samples sizes.
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Affiliation(s)
- Dustin T Duncan
- Department of Epidemiology, Columbia University Mailman School of Public Health, NewYork, NY, USA
| | - Stephanie H Cook
- Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York, NY, USA; Department of Biostatistics, New York University School of Global Public Health, New York, NY, USA
| | - Erica P Wood
- Department of Social and Behavioral Sciences, New York University School of Global Public Health, New York, NY, USA
| | - Seann D Regan
- Department of Epidemiology, Columbia University Mailman School of Public Health, NewYork, NY, USA
| | - Basile Chaix
- French National Institute of Health and Medical Research (INSERM), Sorbonne Université, Institut Pierre Louis D'Epidémiologie et de Santé Publique IPLESP, Nemesis Team, F75012, Paris, France
| | - Yijun Tian
- Department of Computer Science and Engineering, New York University Tandon School of Engineering, New York, NY, USA
| | - Rumi Chunara
- Department of Biostatistics, New York University School of Global Public Health, New York, NY, USA; Department of Computer Science and Engineering, New York University Tandon School of Engineering, New York, NY, USA.
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Minority stress and sleep: How do stress perception and anxiety symptoms act as mediators for sexual minority men? Sleep Health 2023; 9:136-143. [PMID: 36697318 DOI: 10.1016/j.sleh.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 12/12/2022] [Accepted: 01/02/2023] [Indexed: 01/25/2023]
Abstract
OBJECTIVES Sexual minority men experience worse sleep than heterosexuals. Little is known about how minority stress may account for these differences. Therefore, the aims of this study are to (1) understand the relationship between minority stress and sleep disturbance in a sample of sexual minority men, and (2) test whether these relationships are mediated by generalized anxiety symptoms and perception of stress. METHODS In 2020, 239 sexual minority men were recruited to complete an online survey. Participants responded to scales assessing minority stress (ie, internalized homophobia, experiences of harassment, microaggressions), perception of stress, generalized anxiety symptoms, and sleep disturbance. Linear regressions were used to test the relationship between minority stress and sleep disturbance and to test generalized anxiety symptoms and perception of stress as mediators. RESULTS The final model was significant (F = 16.916, p < .001) and accounted for 43.5% of the variance in sleep disturbance. Generalized anxiety symptoms and perception of stress fully mediated the relationships between minority stress and sleep disturbance. CONCLUSIONS Findings from this study suggest the need for psychological intervention to improve sleep for sexual minority men. Future research should test this model longitudinally, and include objective measures of stress. Future interventions could target stress perception using mindfulness or cognitive-based interventions.
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Hastings PD, Guyer AE, Parra LA. Conceptualizing the Influence of Social and Structural Determinants of Neurobiology and Mental Health: Why and How Biological Psychiatry Can Do Better at Addressing the Consequences of Inequity. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2022; 7:1215-1224. [PMID: 35718087 DOI: 10.1016/j.bpsc.2022.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 05/17/2022] [Accepted: 06/06/2022] [Indexed: 06/15/2023]
Abstract
Psychiatry and allied disciplines have recognized the potency of structural and social determinants of mental health, yet there has been scant attention given to the roles of neurobiology in the links between structural and social determinants and mental health. In this article, we make the case for why greater attention must be given to structural and social determinants of biological psychiatry by researchers, practitioners, and policy-makers. After defining these terms and theoretical frameworks for considering their relevance in biological psychiatry, we review empirical research with marginalized and minoritized racial, ethnic, gender, sexual, and economic communities that reveals the ways in which structural and social determinants affect neurobiological functioning with implications for mental health. We give particular emphasis to developmental science and developmentally informed research, because structural and social determinants influence neurobiological adaptation and maturation across the lifespan. We conclude with recommendations for advancing research, practice, and policy that connect biological psychiatry with structural and social determinants of health. Foremost among these is diversifying the ranks of biological psychiatry, from classrooms through laboratories, hospitals, and community health centers. Transforming and advancing the understanding of the structural and social determinants of neurobiology and mental health is most likely to come through transforming the discipline itself.
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Affiliation(s)
- Paul D Hastings
- Department of Psychology, University of California Davis, Davis, California; Center for Mind and Brain, University of California Davis, Davis, California.
| | - Amanda E Guyer
- Center for Mind and Brain, University of California Davis, Davis, California; Department of Human Ecology, University of California Davis, Davis, California
| | - Luis A Parra
- School of Nursing, University of Michigan, Ann Arbor, Michigan
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Race moderates the association between adult attachment avoidance and the cortisol awakening response among young sexual minority men. Psychoneuroendocrinology 2022; 145:105899. [PMID: 36108460 DOI: 10.1016/j.psyneuen.2022.105899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 07/25/2022] [Accepted: 08/19/2022] [Indexed: 11/21/2022]
Abstract
Adult attachment, or the ways in which individuals develop and maintain trusting and loving relationships with peers and romantic partners, has been demonstrated to influence hypothalamic-pituitary-adrenal (HPA) axis functioning among young sexual minority men (YSMM). Theory and preliminary evidence suggest that differences in the lived experiences of White and Black sexual minority young adults may influence the way in which adult attachment influences the HPA-axis functioning. We sought to further this field of inquiry by examining if race moderates the association between adult attachment insecurity (i.e., avoidance and anxiety) and HPA-axis functioning among YSMM. Sixty-three YSMM participated in a 5-day daily diary study in which they completed a baseline survey to assess adult attachment orientation and provided saliva samples 4 times per day over a 5-day period in order to measure cortisol across the day. Three-level hierarchical linear modeling was used to examine the association between adult attachment, the cortisol awakening response (CAR), diurnal cortisol, and the moderating effect of race. We found no main effect of attachment anxiety or avoidance on HPA-axis functioning. However, we found that race moderated the association between adult attachment avoidance and the CAR such that Black YSMM with higher attachment avoidance had a lower CAR as compared to White YSMM. Results suggest that there may be key differences between White and Black YSMM men's lived experiences that should be explored in future research.
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Cook SH, Wood EP, Martinez V, Alvarez GM, Lazar J. Young men of color lower on adult attachment anxiety have higher carotid-intima media thickness compared to white young men: The exploration of an unexpected finding. Psychoneuroendocrinology 2022; 143:105825. [PMID: 35689986 DOI: 10.1016/j.psyneuen.2022.105825] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 06/01/2022] [Accepted: 06/02/2022] [Indexed: 11/17/2022]
Abstract
Cardiovascular disease (CVD) remains the number one cause of death among men in the United States. Emerging research demonstrates that socioemotional mechanisms such as adult attachment, or the ways in which individuals are able to form and maintain socioemotional bonds, may impact physical health via alterations in physiological stress functioning. However, there may be key differences in the relation between attachment and physical health by race and sexual orientation. Thus, this study sought to examine the potential moderating effect of race and sexual orientation on the association between adult attachment and carotid-intima media thickness (cIMT), a measure of subclinical cardiovascular disease, among young men. The sample consisted of 72 young men (mean [SD] age = 22.92 [3.23]: 30.6 % identified as White, 30.6 % as Black, and 38.8 % as Other), each of which were surveyed and underwent an ultrasound to measure cIMT. Ordinary Least Squares (OLS) regression was used in order to examine our study hypotheses. We first ran a main effects model to examine adult attachment's (i.e., anxiety and avoidance) association with mean cIMT. We then ran two interaction models with an interaction between race/ethnicity and adult-related attachment and sexual orientation and adult attachment. We found that race significantly moderated the association between attachment-related anxiety and mean cIMT in our study sample. However, we did not find evidence to suggest that race moderated the association between attachment-related avoidance and mean cIMT in our study sample. In comparison to White individuals, Black individuals and those who identified as "Other" race with lower scores on attachment-related anxiety had higher mean cIMT. Additionally, higher scores on attachment-related anxiety were associated with lower mean cIMT among Black and "Other" respondents, but not among White respondents. We did not find evidence to suggest that sexual orientation moderated the association between adult attachment and mean cIMT in our study sample. Our findings suggest that adult attachment anxiety may be protective for young men of color but not for White young men. Future research should utilize longitudinal study designs in order to better understand how adult attachment influences CVD risk among racially/ethnically diverse young men.
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Affiliation(s)
- Stephanie H Cook
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, USA; Department of Biostatistics, School of Global Public Health, New York University, New York, NY, USA.
| | - Erica P Wood
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, USA
| | - Valerie Martinez
- Department of Biostatistics, School of Global Public Health, New York University, New York, NY, USA
| | - Gabriella M Alvarez
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jason Lazar
- College of Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, USA; College of Molecular and Cell Biology and Neurology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA; School of Public Health, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
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Trujillo MA, Mendes WB. An ignored minority status: Consequences for sexual minorities living in a biased society. SOCIAL AND PERSONALITY PSYCHOLOGY COMPASS 2021. [DOI: 10.1111/spc3.12638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Michael A. Trujillo
- Department of Psychiatry University of California, San Francisco San Francisco California USA
| | - Wendy Berry Mendes
- Department of Psychiatry University of California, San Francisco San Francisco California USA
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Sattler FA, Nater UM, Mewes R. Gay men's stress response to a general and a specific social stressor. J Neural Transm (Vienna) 2021; 128:1325-1333. [PMID: 34313842 PMCID: PMC8423632 DOI: 10.1007/s00702-021-02380-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 07/02/2021] [Indexed: 11/02/2022]
Abstract
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.
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Affiliation(s)
- Frank A Sattler
- Department of Psychology, Clinic for Orthopedic Rehabilitation, Klinik am Homberg, Hans-Georg-Weg 2, 34537, Bad Wildungen, Germany
| | - Urs M Nater
- Department of Clinical and Health Psychology, Faculty of Psychology, University of Vienna, Liebiggasse 5, 1010, Wien, Austria.,Research Platform 'The Stress of Life (SOLE)', University of Vienna, Liebiggasse 5, 1010, Wien, Austria
| | - Ricarda Mewes
- Research Platform 'The Stress of Life (SOLE)', University of Vienna, Liebiggasse 5, 1010, Wien, Austria. .,Outpatient Unit for Research, Teaching and Practice, Faculty of Psychology, University of Vienna, Renngasse 6-8, 1010, Wien, Austria.
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Identifying diurnal cortisol profiles among young adults: Physiological signatures of mental health trajectories. Psychoneuroendocrinology 2021; 128:105204. [PMID: 33862309 DOI: 10.1016/j.psyneuen.2021.105204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 02/05/2021] [Accepted: 03/15/2021] [Indexed: 11/24/2022]
Abstract
Previous research has used cortisol, the major hormonal byproduct of the hypothalamic pituitary adrenal (HPA) axis system, to explore how environmental stressors influence daily physiological functioning. Most of the research focused on diurnal cortisol has examined specific cortisol markers, with little consideration of how different components of the diurnal pattern may co-occur. Morning level, cortisol awakening response (CAR), bedtime level, as well as the diurnal slope and total cortisol exposure throughout the day (area under the curve; AUC), are five common parameters of diurnal HPA axis functioning that have been individually linked to physical and mental health outcomes, with mixed results. The current study introduces a novel approach to capture heterogeneity in HPA axis activity by using latent profile analysis to generate empirically-derived, theoretically supported diurnal cortisol profiles based on all five indicators. We analyzed salivary cortisol data from 278 young adults during a time of heightened sociopolitical stress - the 2016 U.S. presidential election - and examined whether profiles differentially predicted mental health trajectories across six months. Findings suggest that a specific combination of cortisol parameters (i.e., flat slope, high AUC, and high CAR) may predict worse mental health risk over time. Overall, this work suggests that diurnal cortisol profiles likely reflect distinct physiological underpinnings with unique health consequences that may not be observed by studying individual cortisol parameters.
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11
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Chen TA, Smith NG, Regan SD, Obasi EM, Anderson KF, Reitzel LR. Combining Global Positioning System (GPS) with saliva collection among sexual minority adults: A feasibility study. PLoS One 2021; 16:e0250333. [PMID: 33956852 PMCID: PMC8101753 DOI: 10.1371/journal.pone.0250333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 04/04/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND This is the first study, of which we are aware, to evaluate the feasibility and accessibility of simultaneous use of Global Positioning System (GPS) and saliva collection for biomarker assessment as an objective measure of stress physiology among sexual minority (lesbian, gay, bisexual, queer, and other non-heterosexual identities) individuals. The principal motivation for pairing GPS and saliva collection was to investigate how characteristics of the built and social environments along with participants' daily activity paths affect stress. This can contribute to a better understanding of health and health behaviors in the sexual minority community. METHODS A convenience sample of enrolled participants (N = 124) from Houston, Texas was asked to complete questionnaires, carry with them a GPS unit daily, and collect and store 6 samples of saliva at specific times across the span of a day prior to a second visit around one week later. RESULTS Of 124 participants, 16 participants (12.90%) provided no useable GPS data and 98 (79.03%) provided at least 4 days of data. More than three-fourths (n = 98, 79.03%) also provided complete saliva samples. CONCLUSIONS Our results show that the simultaneous use of GPS and saliva collection to assess sexual minority individuals' activity paths and stress level is feasible.
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Affiliation(s)
- Tzuan A. Chen
- HEALTH Research Institute, University of Houston, Houston, Texas, United States of America
- Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, Texas, United States of America
| | - Nathan Grant Smith
- HEALTH Research Institute, University of Houston, Houston, Texas, United States of America
- Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, Texas, United States of America
| | - Seann D. Regan
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, United States of America
| | - Ezemenari M. Obasi
- HEALTH Research Institute, University of Houston, Houston, Texas, United States of America
- Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, Texas, United States of America
| | - Kathryn Freeman Anderson
- HEALTH Research Institute, University of Houston, Houston, Texas, United States of America
- Department of Sociology, University of Houston, Houston, Texas, United States of America
| | - Lorraine R. Reitzel
- HEALTH Research Institute, University of Houston, Houston, Texas, United States of America
- Department of Psychological, Health, and Learning Sciences, University of Houston, Houston, Texas, United States of America
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Bartlett R, Sarnyai Z, Momartin S, Ooi L, Schwab SG, Matosin N. Understanding the pathology of psychiatric disorders in refugees. Psychiatry Res 2021; 296:113661. [PMID: 33373807 DOI: 10.1016/j.psychres.2020.113661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 12/16/2020] [Indexed: 10/22/2022]
Abstract
Displacement of people from their homes, families and countries is a current global crisis, with over 70 million people forcibly on the move. A substantial proportion of these people will end up in regions with a different language and culture, where they are registered as refugees or asylum seekers. Due to the underlying reasons for displacement (including conflicts, persecution or violation of human rights), displaced people are severely stress-exposed, which continues into their post-migration life and increases risk for developing psychiatric disorders such as post-traumatic stress disorder and other anxiety disorders and mood disorders. While landmark studies have illustrated the increased prevalence of psychopathology in asylum seeker and refugee populations following pre-/post-displacement stress, few studies add to our understanding of the basic biological mechanisms underpinning risk to psychiatric disorders in these populations. Additionally, the mechanisms underlying resilience despite significant adversity remain unclear. Understanding the molecular mechanisms underpinning the development of psychiatric disorders in refugees can propel treatments (both drug and non-drug) that are capable of influencing biology at the molecular level, and the design of interventions. In the following review, we summarise the status quo of research investigating the pathophysiology of psychiatric disorders in refugees, and propose new ways to address gaps in knowledge with multidisciplinary research.
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Affiliation(s)
- Rachael Bartlett
- Illawarra Health and Medical Research Institute, Northfields Ave, Wollongong, NSW 2522, Australia; Molecular Horizons and School of Chemistry and Molecular Bioscience, University of Wollongong, Northfields Ave, Wollongong, NSW 2522, Australia
| | - Zoltan Sarnyai
- Laboratory of Psychiatric Neuroscience, Centre for Molecular Discovery, Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD 4811, Australia
| | - Shakeh Momartin
- NSW Service for the Treatment and Rehabilitation of Torture and Trauma Survivors (STARTTS), 152-168 The Horsley Drive, Carramar, NSW 2163, Australia
| | - Lezanne Ooi
- Illawarra Health and Medical Research Institute, Northfields Ave, Wollongong, NSW 2522, Australia; Molecular Horizons and School of Chemistry and Molecular Bioscience, University of Wollongong, Northfields Ave, Wollongong, NSW 2522, Australia
| | - Sibylle G Schwab
- Illawarra Health and Medical Research Institute, Northfields Ave, Wollongong, NSW 2522, Australia; Molecular Horizons and School of Chemistry and Molecular Bioscience, University of Wollongong, Northfields Ave, Wollongong, NSW 2522, Australia
| | - Natalie Matosin
- Illawarra Health and Medical Research Institute, Northfields Ave, Wollongong, NSW 2522, Australia; Molecular Horizons and School of Chemistry and Molecular Bioscience, University of Wollongong, Northfields Ave, Wollongong, NSW 2522, Australia; Max Planck Institute of Psychiatry, Kraepelinstrasse 2-10, 80804 Munich, Germany.
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Keenan K, Berona J, Hipwell AE, Stepp SD, Romito MT. Validity of the Trier Social Stress Test in studying discrimination stress. Stress 2021; 24:113-119. [PMID: 32160797 PMCID: PMC7541629 DOI: 10.1080/10253890.2020.1741545] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
To test the validity of a modified Trier Social Stress Test (TSST) for studying stress reactivity in sexual minority women. Two hundred seventy-four female participants (66.4% Black American), half of whom identified as lesbian/gay or bisexual and half as heterosexual, completed the TSST with instructions to describe an experience of discrimination. Cortisol levels and negative emotion scores increased, and heart rate variability decreased in response to the TSST, and the magnitude of these responses varied as a function of sexual orientation and race. Women who discussed sexual orientation as a source of discrimination had greater increases in cortisol and negative mood following the TSST. The modified instructions did not compromise the validity of the TSST. Prompting participants to discuss specific sources of discrimination may be a useful adaptation of the TSST in studying minority stress reactivity. SUMMARY The goal of the present study was to adapt a widely used measure of stress reactivity to study the impact of experiences with discrimination on biological systems involved in regulating the stress response. The modification included asking women to discuss a time when they had been treated unfairly and to describe how they responded to that experience. The magnitude of response to the task varied as a function of sexual orientation and race, and the topics discussed, demonstrating usefulness of the modification for studying the impact of discrimination stress of physical health.
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Affiliation(s)
- Kate Keenan
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
| | - Johnny Berona
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
| | - Alison E Hipwell
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Stephanie D Stepp
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
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Mereish EH, Miranda R. A Preliminary Experimental Study of Minority Stress, Startle Reactivity, and Alcohol Use among Heavy Drinking Sexual Minority Young Adults. Subst Use Misuse 2021; 56:162-168. [PMID: 33222602 DOI: 10.1080/10826084.2020.1846197] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Sexual minorities (e.g. lesbian, gay, bisexual) are at increased risk for alcohol use disorder (AUD) compared to heterosexuals. The minority stress model postulates that disparities in AUD stem, in part, from stress specific to sexual minorities (e.g. heterosexism). However, little research has examined psychophysiological markers of minority stress reactivity and how psychophysiological stress reactivity is associated with lifetime minority stress and alcohol use among sexual minorities. Emotion modulation of the startle response is a well-established paradigm for capturing psychophysiological stress reactivity under controlled laboratory conditions. Purpose: This preliminary study is the first to use the startle experimental paradigm to examine psychophysiological reactivity to stigma among sexual minorities. Procedures: Sexual minority participants (N = 20; 55% female), aged 18 to 27 years (M = 21.80, SD = 2.65), were recruited from the community. We compared startle reactivity in response to three types of stimuli (stigma, negative, and neutral) among heavy drinking sexual minority young adults. Although statistically underpowered, we also explored the associations between startle reactivity and self-reported drinking behaviors and lifetime minority stress. Results: Both stigma and general unpleasant stimuli produced more psychophysiological stress reactivity than neutral stimuli among sexual minorities. Psychophysiological stress reactivity was correlated with greater quantity of drinks reported on drinking days in the past month, but not greater frequency. Additionally, lifetime exposure to minority stress was associated with a blunted reactivity to stigma stimuli. Conclusions: These findings provide methodological advances and important implications for minority stress theory and alcohol use among sexual minorities.
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Affiliation(s)
- Ethan H Mereish
- Department of Health Studies, American University, Washington, DC, USA.,Center for Alcohol and Addiction Studies (CAAS), Brown University, Providence, Rhode Island, USA
| | - Robert Miranda
- Center for Alcohol and Addiction Studies (CAAS), Brown University, Providence, Rhode Island, USA
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Parra LA, Hastings PD. Challenges to Identity Integration Indirectly Link Experiences of Heterosexist and Racist Discrimination to Lower Waking Salivary Cortisol in Sexually Diverse Latinx Emerging Adults. Front Psychol 2020; 11:228. [PMID: 32161561 PMCID: PMC7053485 DOI: 10.3389/fpsyg.2020.00228] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 01/31/2020] [Indexed: 01/25/2023] Open
Abstract
Heterosexist and racist discrimination may adversely impact neurobiological processes implicated in the physical and psychosocial well-being of sexually diverse Latinx people. Yet, little is known about how experiences of both heterosexist and racist discrimination are associated with adrenocortical and psychological functioning in groups of people with multiply marginalized social group identities. Through the application of the intersectionality, minority stress, and allostatic load frameworks, it was hypothesized that experiences of heterosexist and racist discrimination would be associated with disruptions to diurnal salivary cortisol patterns and challenges to identity integration. A group of sexually diverse (self-identified lesbian, gay, bisexual, and queer) Latinx emerging adults (N = 51; ages 18-29, M = 24.06 years; SD = 2.73) provided saliva samples and completed a series of questionnaires during a four-day testing protocol. Heterosexist and racist discrimination were both positively associated with challenges to identity integration. Challenges to identity integration, in turn, were associated with lower intercepts of diurnal cortisol slopes, and heterosexist and racist discrimination were indirectly associated with lower cortisol intercepts via challenges to identity integration. These findings suggest that experiences of heterosexist and racist discrimination may interconnect by challenging sexual and ethnic/racial identity integration and disrupting adaptive adrenocortical regulation among sexually diverse Latinx emerging adults.
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Affiliation(s)
- Luis Armando Parra
- Department of Human Ecology, University of California, Davis, Davis, CA, United States
- Center for Mind and Brain, University of California, Davis, Davis, CA, United States
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, United States
| | - Paul David Hastings
- Center for Mind and Brain, University of California, Davis, Davis, CA, United States
- Department of Psychology, University of California, Davis, Davis, CA, United States
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Wood EP, Cook SH. Father support is protective against the negative effects of perceived discrimination on CRP among sexual minorities but not heterosexuals. Psychoneuroendocrinology 2019; 110:104368. [PMID: 31539836 DOI: 10.1016/j.psyneuen.2019.06.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 06/28/2019] [Accepted: 06/28/2019] [Indexed: 01/03/2023]
Abstract
BACKGROUND Exposure to sexual orientation-related discrimination among sexual minorities may lead to elevated levels of C-reactive protein (CRP) as compared to their heterosexual counterparts. However, little is known about factors that may buffer the association between discrimination and CRP among sexual minorities versus heterosexuals. The current study examined if the association between discrimination, sexual orientation, and CRP differed across levels of social support from one's father/father-figure or mother/mother-figure between sexual minorities and heterosexuals. METHODS Data came from Wave IV of the National Longitudinal Study of Adolescent to Adult Health (Add Health). The sample sizes for father support and mother support was 3167 and 3575, respectively. Participants ranged in age from 24 to 33 years. Stratified linear regression models examined if father and mother support moderated the association between discrimination and CRP among sexual minorities and heterosexuals. RESULTS Father support significantly moderated the association between discrimination and CRP among sexual minorities but not heterosexuals. Sexual minorities with higher father support and who experienced discrimination had lower CRP as compared to those with lower father support and who experienced discrimination. Mother support did not moderate the association between discrimination and CRP among either sexual minorities or heterosexuals. CONCLUSION Father support may mitigate the negative effects of stress from discrimination on CRP among sexual minorities. Future research should further examine the potential differential role that father support may play in reducing cardiovascular risk among sexual minorities versus heterosexuals who experience discrimination.
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Affiliation(s)
- Erica P Wood
- Department of Biostatistics, College of Global Public Health, New York University, New York University, United States; Department of Social and Behavioral Sciences, College of Global Public Health, New York University, United States
| | - Stephanie H Cook
- Department of Biostatistics, College of Global Public Health, New York University, New York University, United States; Department of Social and Behavioral Sciences, College of Global Public Health, New York University, United States.
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Juster RP, de Torre MB, Kerr P, Kheloui S, Rossi M, Bourdon O. Sex Differences and Gender Diversity in Stress Responses and Allostatic Load Among Workers and LGBT People. Curr Psychiatry Rep 2019; 21:110. [PMID: 31630247 DOI: 10.1007/s11920-019-1104-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Measuring biological sex differences and socio-cultural gender diversity provides insights into individual variation in stress physiology and the development of "sex-specific" diseases. PURPOSE OF REVIEW: In this selective review, we summarize recent findings that assess sex and gender in relation to the stress hormone cortisol and multi-systemic physiological dysregulation called allostatic load. The focus of this research centers on workers as well as sexual and gender minorities as these populations provide unique insights into sex and gender at various levels of analysis from the micro-level to the macro-level. RECENT FINDINGS: Male/female sex, sex hormones, gender identity, gender roles, and sexual orientation are all variables that are distinctly correlated with stress physiology. Beyond identifying patterns of vulnerability to stress-related diseases, pathways towards resilience are of high priority in emerging literature. Stress scientists must account for both sex and gender in biobehavioral research. Future directions should assess macro-level constructs like institutionalized gender, occupational sex composition, and structural stigma to better understand the social determinants of health.
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Affiliation(s)
- Robert-Paul Juster
- Department of Psychiatry and Addiction, University of Montreal, Montreal, Canada.
- Research Center of the Montreal Mental Health University Institute, Montreal, Canada.
- Center on Sex*Gender, Allostasis, and Resilience (CESAR), Montreal, Canada.
- , Montréal, Canada.
| | - Margot Barbosa de Torre
- Research Center of the Montreal Mental Health University Institute, Montreal, Canada
- Center on Sex*Gender, Allostasis, and Resilience (CESAR), Montreal, Canada
- Department of Biomedical Sciences, University of Montreal, Montreal, Canada
| | - Philippe Kerr
- Department of Psychiatry and Addiction, University of Montreal, Montreal, Canada
- Research Center of the Montreal Mental Health University Institute, Montreal, Canada
- Center on Sex*Gender, Allostasis, and Resilience (CESAR), Montreal, Canada
| | - Sarah Kheloui
- Department of Psychiatry and Addiction, University of Montreal, Montreal, Canada
- Research Center of the Montreal Mental Health University Institute, Montreal, Canada
- Center on Sex*Gender, Allostasis, and Resilience (CESAR), Montreal, Canada
| | - Mathias Rossi
- Department of Psychiatry and Addiction, University of Montreal, Montreal, Canada
- Research Center of the Montreal Mental Health University Institute, Montreal, Canada
- Center on Sex*Gender, Allostasis, and Resilience (CESAR), Montreal, Canada
| | - Olivier Bourdon
- Research Center of the Montreal Mental Health University Institute, Montreal, Canada
- Center on Sex*Gender, Allostasis, and Resilience (CESAR), Montreal, Canada
- Department of Psychology, University of Quebec in Montreal, Montreal, Canada
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Boileau K, Barbeau K, Sharma R, Bielajew C. Ethnic differences in diurnal cortisol profiles in healthy adults: A meta-analysis. Br J Health Psychol 2019; 24:806-827. [PMID: 31250487 DOI: 10.1111/bjhp.12380] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 05/02/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE Cortisol is a well-known biomarker of the physiological stress system; atypical cortisol patterns have been linked to many psychological and physiological illnesses. Previous studies have found vast health disparities among ethnic groups; however, studies examining the relationship between cortisol and ethnicity have found mixed results. This meta-analysis investigated whether there are differences in diurnal cortisol outcomes among ethnic groups, while considering the moderating roles of various individual factors and methodological approaches. METHODS Search phrases were entered into MEDLINE, PsycINFO, EMBASE, Cochrane Library, CINAHL, Scopus, and Web of Science. Effect sizes were extracted for ten diurnal cortisol outcomes, including waking, 30 min after waking, cortisol awakening response, slope, area under the curve, urinary twenty-four-hour secretion, total cortisol output, and midday, evening, and bedtime concentrations, for eight ethnic group comparisons, including Asians, Blacks, Hispanics, Indigenous people, Whites, Minority and Majority groups, and Multiethnic groups. Moderator analyses, including variables such as gender, age, and number of cortisol collection time points, were conducted. RESULTS There were significant ethnic differences in diurnal cortisol profiles, including cortisol awakening responses, with more robust differences in ethnic comparisons that included White participants. Differences in diurnal cortisol profiles were also moderated by gender, mean age, and sample size. CONCLUSIONS This meta-analysis supports the notion that ethnic groups exhibit distinct diurnal cortisol profiles, which, according to the biopsychosocial model of health, may be a result of unique sociocultural experiences. The limitations of this meta-analysis and future directions for stress research with various ethnic groups are discussed. Statement of contribution What is already known on this subject? Studies have found vast health disparities among ethnic groups. Psychological and physiological illnesses and atypical diurnal cortisol profiles are strongly correlated. Studies have examined the relationship between diurnal cortisol rhythms and ethnicity, but findings are mixed. What does this study add? This study is a systematic examination of the relationship between diurnal cortisol rhythm and ethnicity. Psychosocial and methodological factors moderate the relationship between diurnal cortisol output and ethnicity. This study provides insight on factors that contribute to health disparities among ethnic groups.
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Affiliation(s)
- Kayla Boileau
- School of Psychology, University of Ottawa, Ontario, Canada
| | - Kheana Barbeau
- School of Psychology, University of Ottawa, Ontario, Canada
| | - Rupali Sharma
- School of Psychology, University of Ottawa, Ontario, Canada
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Mays VM, Juster RP, Williamson TJ, Seeman TE, Cochran SD. Chronic Physiologic Effects of Stress Among Lesbian, Gay, and Bisexual Adults: Results From the National Health and Nutrition Examination Survey. Psychosom Med 2019; 80:551-563. [PMID: 29952935 PMCID: PMC6214815 DOI: 10.1097/psy.0000000000000600] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Social disadvantage is associated with markers of physiological dysregulation, which is linked to disease trajectories. Chronic experiences with discrimination are thought to result in the accumulation of physiological "wear and tear" known as allostatic load (AL) among socially marginalized populations such as sexual minorities. Using a nationally representative US sample, we examined whether (1) people who self-identified as homosexual or bisexual display higher levels of AL than heterosexual individuals and (2) subgroups of sexual identity would further differ from each other as a consequence of distinct experiences of marginalization. METHODS We use data from the 2001-2010 National Health and Nutrition Examination Survey. Employing multivariate regression methods with sex-specific analyses, we examined AL score differences among lesbian/gay (n = 211), bisexual (n = 307), homosexually experienced (n = 424), and exclusively heterosexual (n = 12,969) individuals, adjusting for possible confounding due to demographics, health indicators, and, among men, HIV infection status. RESULTS Results indicate that elevated AL was more common in bisexual men compared with exclusively heterosexual men (adjusted β = 0.25, 95% confidence interval [CI] = 0.05 to 0.44), with significantly higher levels of glycosylated hemoglobin A1c (adjusted odd ratio = 3.51, 95% CI = 1.46-7.92) and systolic blood pressure (adjusted odd ratio = 2.07, 95% CI = 1.02 to 4.18). Gay-identified men evidenced significantly lower AL (adjusted β = -0.22, 95% CI = -0.41 to -0.04). No significant differences in AL were observed among women. CONCLUSIONS These findings indicate that physiological dysregulation is more common in bisexual males compared with all other men. The results are discussed with regard to differences in health outcomes between individuals with different sexual orientations.
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Affiliation(s)
- Vickie M Mays
- From the Departments of Psychology and Health Policy and Management (Mays), Fielding School of Public Health University of California, Los Angeles; University of Montreal, Department of Psychiatry and Addiction (Juster), Montreal; University of California, Los Angeles (Williamson); UCLA School of Medicine and Fielding School of Public Health (Seeman), University of California, Los Angeles; and Department of Epidemiology, Fielding School of Public Health and Department of Statistics (Cochran), University of California, Los Angeles
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Beach L, Bartelt E, Dodge B, Bostwick W, Schick V, Fu TCJ, Friedman MR, Herbenick D. Meta-Perceptions of Others' Attitudes Toward Bisexual Men and Women Among a Nationally Representative Probability Sample. ARCHIVES OF SEXUAL BEHAVIOR 2019; 48:191-197. [PMID: 30446861 PMCID: PMC6467292 DOI: 10.1007/s10508-018-1347-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 11/03/2018] [Accepted: 11/07/2018] [Indexed: 05/12/2023]
Abstract
Researchers posit that negative attitudes, prejudice, and discrimination (i.e., binegativity) from heterosexual and gay/lesbian individuals may contribute to health disparities among bisexual individuals relative to heterosexual and gay/lesbian individuals. Recent studies have focused on gay, lesbian, and heterosexual people's (e.g., "others") attitudes toward bisexual people. No studies have investigated how bisexual individuals perceive others' attitudes toward bisexual people, which are generally known as "meta-perceptions." As part of the 2015 National Survey of Sexual Health and Behavior, we collected data from a nationally representative probability sample of 2999 adults, including from a subsample of 33 men and 61 women self-identified as bisexual. The Bisexualities: Indiana Attitudes Scale-bisexual (BIAS-b), a modified 5-item scale assessing bisexual people's perceptions of others' attitudes toward bisexual individuals, was included and was followed by an open-ended text box question. Quantitative scale data were analyzed using descriptive and gamma regression methods. Two coders thematically analyzed the open-ended text box data. The internal consistency of the BIAS-b was high (Cronbach's α = 0.85). An exploratory factor analysis supported a one-factor solution. Participants responded to statements regarding others' attitudes toward them as bisexual people, including the domains of confusion, HIV/STD risk, incapability of monogamy, promiscuity, and instability ("just a phase"). Participants' text box descriptions largely aligned with these five domains, with the exception of HIV/STD risk. Additionally, some participants reported others' positive perceptions of them as bisexual individuals. In sum, we observed a range of meta-perceptions, primarily neutral to negative, but also including some relatively positive. These results show the need for interventions to promote acceptance of bisexual individuals among heterosexual and gay/lesbian individuals.
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Affiliation(s)
- Lauren Beach
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Elizabeth Bartelt
- Center for Sexual Health Promotion, School of Public Health, Indiana University, Bloomington, IN, 47405, USA
| | - Brian Dodge
- Center for Sexual Health Promotion, School of Public Health, Indiana University, Bloomington, IN, 47405, USA.
| | - Wendy Bostwick
- Department of Health Systems Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Vanessa Schick
- Department of Management, Policy and Community Health, University of Texas Health Sciences Center, Houston, TX, USA
| | - Tsung-Chieh Jane Fu
- Center for Sexual Health Promotion, School of Public Health, Indiana University, Bloomington, IN, 47405, USA
| | - M Reuel Friedman
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Debby Herbenick
- Center for Sexual Health Promotion, School of Public Health, Indiana University, Bloomington, IN, 47405, USA
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Austin SB, Rosario M, McLaughlin KA, Roberts AL, Sarda V, Yu K, Missmer S, Anatale-Tardiff L, Scherer EA. Sexual orientation and salivary alpha-amylase diurnal rhythms in a cohort of U.S. young adults. Psychoneuroendocrinology 2018; 97:78-85. [PMID: 30015008 PMCID: PMC6138569 DOI: 10.1016/j.psyneuen.2018.07.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 07/03/2018] [Accepted: 07/04/2018] [Indexed: 12/25/2022]
Abstract
Sexual minorities in the United States are at elevated risk of prejudice, discrimination, and violence victimization due to stigma associated with their sexual orientation. These stressors may contribute to physiological stress responses and changes in the regulation of the sympathetic nervous system (SNS). To date, no studies have examined the associations among minority sexual orientation, recent stressful events, and diurnal salivary alpha-amylase (sAA) patterns. The present study included 1663 young adults ages 18-32 years (31% men, 69% women) from the Growing Up Today Study, a prospective cohort of U.S. youth. Participants provided five saliva samples over the course of one day to estimate diurnal sAA patterns. Sexual orientation groups included completely heterosexual with no same-sex partners (CH; referent), mostly heterosexual/completely heterosexual with same-sex partners, and gay/lesbian/bisexual (LB or GB). Sex-stratified multilevel models were fit to evaluate the association of sexual orientation with diurnal patterns of log sAA. The association of recent stressful events was also evaluated. Among women, sexual minorities scored significantly higher than CH on perceived stress and number of stressful events in the past month (p < 0.05). Among men, sexual minorities scored higher than CH on perceived stress but not recent stressful events. In multivariable models, recent stressful events were not associated with sAA patterns, but significant sexual orientation group differences in sAA diurnal rhythm were observed among women though not among men. Compared to CH women, LB showed a blunted awakening response and elevated sAA levels across the day, both indicators consistent with SNS dysregulation. Findings suggest dysregulation of stress physiology in LB women, but not other sexual minority women or men, relative to same-sex heterosexuals. Observed dysregulation may relate to exposure among LB women to chronic stressors associated with sexual orientation stigma, although these relations and differences by sex warrant further study.
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Affiliation(s)
- S Bryn Austin
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, MA, United States; Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States; Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, United States.
| | - Margaret Rosario
- Department of Psychology, The City University of New York-The City College and Graduate Center, New York, NY, United States
| | - Katie A McLaughlin
- Department of Psychology, University of Washington, Seattle, WA, United States
| | - Andrea L Roberts
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Vishnudas Sarda
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, MA, United States
| | - Kimberly Yu
- Department of Psychology, Arizona State University, Tempe, AZ, United States
| | - Stacey Missmer
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States; Department of Obstetrics, Gynecology, and Reproductive Biology, College of Human Medicine, Michigan State University, East Lansing, MI, United States
| | - Laura Anatale-Tardiff
- Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Emily A Scherer
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Hanover, NH, United States
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Mountcastle HD, Park SH, Al-Ajlouni YA, Goedel WC, Cook S, Lupien S, Obasi EM, Hale L, Jean-Louis G, Redline S, Duncan DT. Stress levels are associated with poor sleep health among sexual minority men in Paris, France. Sleep Health 2018; 4:436-441. [DOI: 10.1016/j.sleh.2018.07.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Revised: 06/02/2018] [Accepted: 07/17/2018] [Indexed: 10/28/2022]
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Parra LA, Hastings PD. Integrating the Neurobiology of Minority Stress with an Intersectionality Framework for LGBTQ-Latinx Populations. New Dir Child Adolesc Dev 2018; 2018:91-108. [PMID: 29978937 PMCID: PMC6320723 DOI: 10.1002/cad.20244] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 10/19/2017] [Accepted: 03/25/2018] [Indexed: 01/25/2023]
Abstract
The comprehensive lived experiences of lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals of color remain invisible in neurobiological studies of LGBTQ populations. Models of minority stress posit that LGBTQ and Latinx individuals experience and internalize sexual, ethnic, racial, and gender discrimination, which may adversely impact mental and physical health. However, the current minority stress models predominantly focus on single categorical social identities and do not account for interlocking systems and processes of oppression based on features of sexuality, race, ethnicity, sex, and gender, as explained by an intersectionality framework in feminist theory. Thus, it remains unclear how LGBTQ people of color internalize and navigate multiple cultural, institutional, and societal stressors, and, furthermore, how these sources of stress may affect health and well-being. A potential mechanism for this adverse internalization process is through the effects of stress on neurobiological regulation. This review will apply an intersectionality framework to the examination of how heterosexism, racism, and cissexism, as systems of oppression, create LGBTQ and Latinx lived experiences, and the differential impacts of these inequalities on neurobiological stress regulation. The overarching goal of this manuscript is to advocate for the application of intersectionality theory to advance the ecological validity of biopsychosocial models of multiple-minority stress.
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Kreski NT, Park SH, Safren SA, Goedel WC, Morganstein JG, Chaix B, Duncan DT. Is neighborhood safety associated with depression symptoms, anxiety symptoms, and psychological distress among gay, bisexual, and other men who have sex with men? JOURNAL OF GAY & LESBIAN MENTAL HEALTH 2018. [DOI: 10.1080/19359705.2018.1463583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- Noah T. Kreski
- Spatial Epidemiology Lab, Department of Population Health, New York University School of Medicine, New York, New York, USA
| | - Su Hyun Park
- Spatial Epidemiology Lab, Department of Population Health, New York University School of Medicine, New York, New York, USA
| | - Steven A. Safren
- Department of Psychology, College of Arts and Sciences, University of Miami, Miami, Florida, USA
| | - William C. Goedel
- Spatial Epidemiology Lab, Department of Population Health, New York University School of Medicine, New York, New York, USA
| | - Jace G. Morganstein
- Spatial Epidemiology Lab, Department of Population Health, New York University School of Medicine, New York, New York, USA
| | - Basile Chaix
- UPMC Université Paris 06, Pierre Louis Institute of Epidemiology and Public Health, Paris, France
- Inserm, Pierre Louis Institute of Epidemiology and Public Health, Paris, France
| | - Dustin T. Duncan
- Spatial Epidemiology Lab, Department of Population Health, New York University School of Medicine, New York, New York, USA
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Cook SH, Pruessner JC, Lupien SJ, Juster RP. Sexual orientation moderates the association between parental overprotection and stress biomarker profiles. PSYCHOLOGY & SEXUALITY 2018. [DOI: 10.1080/19419899.2018.1470105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Stephanie H. Cook
- College of Global Public Health, New York University, New York, NY, USA
| | - Jens C. Pruessner
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
- Department of Psychology, University of Constance, Constance, Germany
| | - Sonia J. Lupien
- Department of Psychiatry, University of Montreal, Montreal, Quebec, Canada
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Khan M, Ilcisin M, Saxton K. Multifactorial discrimination as a fundamental cause of mental health inequities. Int J Equity Health 2017; 16:43. [PMID: 28257630 PMCID: PMC5336641 DOI: 10.1186/s12939-017-0532-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 02/14/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The theory of fundamental causes explains why health disparities persist over time, even as risk factors, mechanisms, and diseases change. Using an intersectional framework, we evaluated multifactorial discrimination as a fundamental cause of mental health disparities. METHODS Using baseline data from the Project STRIDE: Stress, Identity, and Mental Health study, we examined the health effects of discrimination among individuals who self-identified as lesbian, gay, or bisexual. We used logistic and linear regression to assess whether multifactorial discrimination met the four criteria designating a fundamental cause, namely that the cause: 1) influences multiple health outcomes, 2) affects multiple risk factors, 3) involves access to resources that can be leveraged to reduce consequences of disease, and 4) reproduces itself in varied contexts through changing mechanisms. RESULTS Multifactorial discrimination predicted high depression scores, psychological well-being, and substance use disorder diagnosis. Discrimination was positively associated with risk factors for high depression scores: chronic strain and total number of stressful life events. Discrimination was associated with significantly lower levels of mastery and self-esteem, protective factors for depressive symptomatology. Even after controlling for risk factors, discrimination remained a significant predictor for high depression scores. Among subjects with low depression scores, multifactorial discrimination also predicted anxiety and aggregate mental health scores. CONCLUSIONS Multifactorial discrimination should be considered a fundamental cause of mental health inequities and may be an important cause of broad health disparities among populations with intersecting social identities.
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Affiliation(s)
- Mariam Khan
- Public Health Program, Santa Clara University, 500 El Camino Real, Santa Clara, CA, 95053, USA
| | - Misja Ilcisin
- Public Health Program, Santa Clara University, 500 El Camino Real, Santa Clara, CA, 95053, USA
| | - Katherine Saxton
- Department of Biology, Santa Clara University, 500 El Camino Real, Santa Clara, CA, 95053, USA.
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Williams SG. Mental Health Issues Related to Sexual Orientation in a High School Setting. J Sch Nurs 2017; 33:383-392. [PMID: 28049365 DOI: 10.1177/1059840516686841] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
High school students are maturing physically, psychosocially, and sexually. Some may be unsure of their sexual orientation. The purpose of the study was to determine whether students who self-identified as homosexual-lesbian/gay, bisexual (LGB), and unsure of sexual orientation had more stressful life events (SLEs), perceived stress, bullying victimization, and depressive symptoms as compared to heterosexual peers. Cortisol was examined to determine whether levels were within normal range for age and followed a normal diurnal rhythm. This correlational design included five surveys to assess n = 143 ninth graders. LGB and unsure students had more SLEs, perceived stress, bullying victimization, and depressive symptoms than heterosexual peers. All participants had normal cortisol levels, with the majority having normal diurnal rhythms. School nurses should consider more training about LGB and unsure students. Additional outreach, support, screening, or referrals for LGB and unsure students are warranted if the school nurse suspects depressive symptoms.
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