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Lilly KJ, Satherley N, Sibley CG, Barlow FK, Greaves LM. Fixed or Fluid? Sexual Identity Fluidity in a Large National Panel Study of New Zealand Adults. JOURNAL OF SEX RESEARCH 2024; 61:1351-1366. [PMID: 38095580 DOI: 10.1080/00224499.2023.2289517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/11/2024]
Abstract
Sexual orientation has been defined as an enduring aspect of the self, but emerging evidence reveals that people's sexual attractions, behaviors, and identities can shift over time. To examine this possibility, we present a large longitudinal analysis of sexual orientation identity fluidity among New Zealand adults (Ntotal = 45,856; age = 18-99; lesbian, gay, bisexual, and other sexual minority (LGB+) ns = 746-3,387). Over seven years, 5.7% of participants changed sexual identities at least once. Change was bi-directional (i.e. toward and away from LGB+ identities) and most common in people who initially reported a plurisexual identity. Although women reported higher rates of plurisexuality than men, they were not more fluid in their identities, contradicting the notion of male fixedness and female plasticity in sexuality. Moreover, openness to experience was associated with increased odds of changing from a heterosexual to a plurisexual identity, while political liberalism and lower conscientiousness were associated with increased odds of changing from a heterosexual to a plurisexual identity and more identity changes over time. Overall, our study shows that sexual identity can be fluid into adulthood and has implications for how we understand contemporary human sexuality.
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Affiliation(s)
| | | | | | | | - Lara M Greaves
- School of Social Sciences, University of Auckland
- Political Science and International Relations, Victoria University of Wellington
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de Mattos Russo Rafael R, da Silva KP, de Souza Santos HG, Depret DG, Caravaca-Morera JA, Breda KML. Accuracy, potential, and limitations of probabilistic record linkage in identifying deaths by gender identity and sexual orientation in the state of Rio De Janeiro, Brazil. BMC Public Health 2024; 24:1475. [PMID: 38824562 PMCID: PMC11144332 DOI: 10.1186/s12889-024-19002-x] [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: 02/02/2024] [Accepted: 05/29/2024] [Indexed: 06/03/2024] Open
Abstract
BACKGROUND Globally, the counting of deaths based on gender identity and sexual orientation has been a challenge for health systems. In most cases, non-governmental organizations have dedicated themselves to this work. Despite these efforts in generating information, the scarcity of official data presents significant limitations in policy formulation and actions guided by population needs. Therefore, this manuscript aims to evaluate the accuracy, potential, and limits of probabilistic data relationships to yield information on deaths according to gender identity and sexual orientation in the State of Rio de Janeiro. METHODS This study evaluated the accuracy of the probabilistic record linkage to obtain information on deaths according to gender and sexual orientation. Data from two information systems were used from June 15, 2015 to December 31, 2020. We constructed nine probabilistic data relationship strategies and identified the performance and cutoff points of the best strategy. RESULTS The best data blocking strategy was established through logical blocks with the first and last names, birthdate, and mother's name in the pairing strategy. With a population base of 80,178 records, 1556 deaths were retrieved. With an area under the curve of 0.979, this strategy presented 93.26% accuracy, 98.46% sensitivity, and 90.04% specificity for the cutoff point ≥ 17.9 of the data relationship score. The adoption of the cutoff point optimized the manual review phase, identifying 2259 (90.04%) of the 2509 false pairs and identifying 1532 (98.46%) of the 1556 true pairs. CONCLUSION With the identification of possible strategies for determining probabilistic data relationships, the retrieval of information on mortality according to sexual and gender markers has become feasible. Based on information from the daily routine of health services, the formulation of public policies that consider the LGBTQ + population more closely reflects the reality experienced by these population groups.
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Affiliation(s)
| | - Kleison Pereira da Silva
- School of Nursing, Public Health Nursing Department, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Davi Gomes Depret
- School of Nursing, Public Health Nursing Department, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Karen Marie Lucas Breda
- Department of Nursing, College of Education, University of Hartford, Nursing & Health Professions. West Hartford, Connecticut, United States of America
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Stackhouse M. The rural side of the rainbow: Mental health and the intersections of geography, sexuality, and partnership. CANADIAN REVIEW OF SOCIOLOGY = REVUE CANADIENNE DE SOCIOLOGIE 2024; 61:131-152. [PMID: 38593268 DOI: 10.1111/cars.12470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
Lesbian, gay, and bisexual (LGB) persons tend to be geographically concentrated in larger metropolitan areas and research persistently observes LGB persons as a disadvantaged population for mental health outcomes when compared to their heterosexual counterparts. Conflicting evidence suggests that mental health risk exposures are greater for LGB people in rural spaces while other research posits that urban residency is more detrimental for LGB mental health. One positively contributing factor to the mental well-being of LGB persons is their partnership status. To date, no study estimates how partnership may ameliorate unfavourable mental health outcomes for LGB populations in urban and rural areas. Using 10 years of pooled data from the nationally representative Canadian Community Health Survey (CCHS), this study examines mental health and the intersection of sexuality, geographic residency, and partnership. Logistic regression models estimate the intersections of sexuality, geography, and partnership status on mental health, stratified by respondents' gender. Findings show partnered gay men in rural areas experiencing better mental health than their partnered heterosexual counterparts in the largest urban cities. Although not significant, the same pattern is observed for partnered lesbian women who do not experience a significant mental health disadvantage at any geographic level. Regardless of partnership and geographic space, bisexual men, and especially bisexual women, exhibit worse mental health outcomes compared to their heterosexual counterparts.
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Mamrath S, Greenfield M, Fernandez Turienzo C, Fallon V, Silverio SA. Experiences of postpartum anxiety during the COVID-19 pandemic: A mixed methods study and demographic analysis. PLoS One 2024; 19:e0297454. [PMID: 38451908 PMCID: PMC10919661 DOI: 10.1371/journal.pone.0297454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 01/04/2024] [Indexed: 03/09/2024] Open
Abstract
INTRODUCTION The first wave of the COVID-19 pandemic saw the reconfiguration of perinatal and maternity services, national lockdowns, and social distancing measures which affected the perinatal experiences of new and expectant parents. This study aimed to explore the occurrence of postpartum anxieties in people who gave birth during the pandemic. METHODS An exploratory concurrent mixed-methods design was chosen to collect and analyse the quantitative and qualitative data of an online survey during the first UK lockdown. The survey included the Postpartum Specific Anxiety Scale-Research Short Form-for use in global Crises [PSAS-RSF-C] psychometric tool, and open-ended questions in relation to changes in birth plans and feelings about those changes and giving birth in a pandemic. Differences in measured scores were analysed for the participant's ethnicity, sexual orientation and disability using independent Student's t-tests, and for age, the analysis was completed using Pearson's correlation. Qualitative data from open-ended questions were analysed using a template analysis. RESULTS A total of 1,754 new and expectant parents completed the survey between 10th and 24th April 2020, and 381 eligible postnatal women completed the psychometric test. We found 52.5% of participants reported symptoms consistent with a diagnosis of postnatal anxiety-significantly higher than the rates usually reported. Younger women and sexual minority women were more likely to score highly on the PSAS-RSF-C than their older or heterosexual counterparts (p<0.001). Younger participants reported anxieties in the 'infant safety and welfare' category, whilst lesbian, gay, bisexual, and pansexual participants scored highly in the 'psychosocial adjustment to motherhood' category. DISCUSSION Postpartum anxiety is under-reported, and demographic differences in the rates of postpartum anxiety are under-researched. This research demonstrates for the first time a difference in postpartum anxiety rates amongst sexual minority women.
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Affiliation(s)
- Simran Mamrath
- Department of Women & Children’s Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
| | - Mari Greenfield
- Department of Women & Children’s Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
- School of Health, Wellbeing and Social Care, Department of Wellbeing, Education, Languages and Social Care, The Open University, Milton Keynes, United Kingdom
| | - Cristina Fernandez Turienzo
- Department of Women & Children’s Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
| | - Victoria Fallon
- Department of Psychology, Institute of Population Health, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Sergio A. Silverio
- Department of Women & Children’s Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, United Kingdom
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Rosario M. Health Disparities by Sexual Orientation: Implications of Genetic and Environmental Explanations. JOURNAL OF SEX RESEARCH 2023; 60:600-604. [PMID: 36399067 PMCID: PMC10175091 DOI: 10.1080/00224499.2022.2144991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Xu and colleagues add to the growing research literature on the role of potential familial (i.e., genetic and shared environment) causes in sexual orientation and in the relation between sexual orientation and poor mental health, in which lesbian, gay, bisexual, and other sexual minority individuals have poorer mental health than heterosexual individuals. I address several implications of the findings by Xu et al. and others. First, the nuance or complexity of genetics is considered, given the implications of genetics for health via a single gene, epistasis, or epigenetics. Second, I highlight the magnitude of the genetic relation between sexual orientation and psychopathology, suggesting some, but not all, sexual minority individuals may differ from heterosexual individuals on psychiatric vulnerability. In turn, this suggests that research should identify for whom or under what circumstances the relation holds. Third, I underscore the need for a within-subjects design, in which attention turns to differences among sexual minority individuals. Fourth, the need to reevaluate Minority Stress Theory, the predominant theory accounting for health disparities by sexual orientation, is addressed because of the implications of genetics for health. Fifth, I acknowledge the concern attached to genetic research for potentially compounding the stigmatization already experienced by sexual minority individuals. Nevertheless, this research is occurring and will likely increase in volume. It will inform understanding of sexual minority individuals.
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Affiliation(s)
- Margaret Rosario
- Department of Psychology, The City University of New York—The City College and Graduate Center, 160 Convent Avenue, New York, NY 10031, United States
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Castaneda J, Poma N, Mougenot B, Herrera-Añazco P. Association between the Expression of Sexual Orientation and/or Gender Identity and Mental Health Perceptions in the Peruvian LGBTI Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20095655. [PMID: 37174174 PMCID: PMC10178142 DOI: 10.3390/ijerph20095655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 11/20/2022] [Accepted: 12/04/2022] [Indexed: 05/15/2023]
Abstract
INTRODUCTION The non-expression of sexual orientation and gender identity can affect mental health in the lesbian, gay, bisexual, transgender, and intersex population in Peru. METHOD Secondary, observational, analytical, and cross-sectional analyses of data from the "First Virtual Survey on the LGBTI population" were conducted with a population (n = 11,345) of LGBTI adults aged 18 years old or more. The variables of mental health and expression of sexual orientation and/or gender identity were measured using a self-reported questionnaire that did not include a validated scale; questions with multiple alternatives that included "yes" and "no" options were used. Prevalence ratios (PR) and 95% confidence intervals (95% CI) were obtained by glm log Poisson regression models. RESULTS The median age of the participants was 25 years (IQR: 21-30), and the majority of the population identified as gay, followed by lesbian and bisexual. Individuals who expressed their sexual orientation and/or gender identity were 17% less likely to have had perceived mental health problems in the last 12 months (PR: 0.83, 95% CI: 0.76-0.90, p < 0.001). CONCLUSIONS The non-expression of sexual orientation and/or gender identity has a significant negative effect on the mental health problems of the LGBTI population. These results highlight the importance of promoting the expression of sexual orientation and gender identity in our community.
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Affiliation(s)
- Jane Castaneda
- Medical School, Universidad Peruana de Ciencias Aplicadas, Lima 15023, Peru
| | - Nicanor Poma
- Medical School, Universidad Peruana de Ciencias Aplicadas, Lima 15023, Peru
| | - Benoit Mougenot
- Centro de Excelencia en Investigaciones Económicas y Sociales en Salud, Universidad San Ignacio de Loyola, Lima 15024, Peru
- Facultad de Ciencias Empresariales, Universidad San Ignacio de Loyola, Lima 15024, Peru
| | - Percy Herrera-Añazco
- Medical School, Universidad Peruana de Ciencias Aplicadas, Lima 15023, Peru
- Red Internacional en Salud Colectiva y Salud Intercultural, Mexico City 56900, Mexico
- Instituto de Evaluación de Tecnologías en Salud e Investigación, Seguro Social de Salud, Lima 14072, Peru
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Bränström R, Narusyte J, Svedberg P. Sexual-orientation differences in risk of health-related impaired ability to work and to remain in the paid workforce: a prospective population-based twin study. BMC Public Health 2023; 23:454. [PMID: 36890524 PMCID: PMC9996859 DOI: 10.1186/s12889-023-15384-6] [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: 07/22/2022] [Accepted: 03/06/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Studies consistently show an increased risk of poor health among sexual minorities (i.e., those identifying as lesbian, gay, bisexual [LGB] or other non-heterosexuals individuals), as compared to those identifying as heterosexual. It is largely unknown whether the increased risk of mental and physical health problems among sexual minorities is also reflected in an increased risk of health-related impaired ability to work, in terms of sickness absence (SA) and disability pension (DP), or successfully remain in the paid workforce. This study made use of a large sample of Swedish twins with self-reported information about sexual behavior in young adulthood to examine sexual orientation difference in SA and DP during a 12-year follow-up period. METHOD Data from the Swedish Twin project of Disability pension and Sickness absence (STODS), including Swedish twins born 1959-1985 was used (N = 17,539; n = 1,238 sexual minority). Self-report survey data on sexual behavior was linked to information about SA and DP benefits from the MicroData for Analysis of the Social Insurance database (MiDAS), the National Social Insurance Agency. Sexual orientation differences in SA and DP between 2006 and 2018 was analyzed, as well as, the influence of sociodemographic, social stress exposure (i.e., victimization, discrimination), mental health treatment, and family confounding on these differences. RESULTS Compared to heterosexuals, sexual minorities were more likely to having experienced SA and having been granted DP. The odds were highest for DP, where sexual minorities were 58% more likely to having been granted DP compared to heterosexuals. The higher odds for SA due to any diagnosis could largely be explained by sociodemographic factors. The higher odds of SA due to mental diagnosis could partially be explained by increased risk of being exposed to discrimination and victimization, and partially by having received treatment with antidepressant medication. The higher odds of being granted DP could also partially be explain by increased risk of being exposed to social stress and treatment with antidepressant medication. CONCLUSION To our knowledge, this is the first study to report on sexual orientation differences in risk of SA and DP in a population-based sample. We found higher period prevalence of both SA and DP among sexual minorities as compared to heterosexuals. The higher odds of SA and DP could partially or fully be explained by sexual orientation differences in sociodemographic factors, exposure to social stress, and antidepressant treatment for depression. Future studies can extend these findings by continuing to investigate risk factors for SA and DP among sexual minorities and how such factors can be reduced.
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Affiliation(s)
- Richard Bränström
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Nobels väg 9, 171 77, Stockholm, Sweden.
| | - Jurgita Narusyte
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Pia Svedberg
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Klittmark S, Malmquist A, Karlsson G, Ulfsdotter A, Grundström H, Nieminen K. When complications arise during birth: LBTQ people's experiences of care. Midwifery 2023; 121:103649. [PMID: 37003045 DOI: 10.1016/j.midw.2023.103649] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 01/30/2023] [Accepted: 02/09/2023] [Indexed: 03/02/2023]
Abstract
OBJECTIVE To explore the care experiences of lesbian, bisexual, transgender, and queer (LBTQ) people during births where complications have arisen. DESIGN Data were collected through semi-structured interviews with self-identified LBTQ people who had experienced obstetrical and/or neonatal complications. SETTING Interviews were conducted in Sweden. PARTICIPANTS A total of 22 self-identified LBTQ people participated. 12 had experienced birth complications as the birth parent and ten as the non-birth parent. FINDINGS Most participants had felt invalidated as an LBTQ family. Separation of the family due to complications elevated the number of hetero/cisnormative assumptions, as new encounters with healthcare professionals increased. Dealing with normative assumptions was particularly difficult in stressful and vulnerable situations. A majority of the birth parents experienced disrespectful treatment from healthcare professionals that violated their bodily integrity. Most participants experienced lack of vital information and emotional support, and expressed that the LBTQ identity made it harder to ask for help. CONCLUSIONS Disrespectful treatment and deficiencies in care contributed to negative experiences when complications arose during birth. Trusting care relationships are important to protect the birth experience in case of complications. Validation of the LBTQ identity and access to emotional support for both birth and non-birth parents are crucial for preventing negative birth experiences. IMPLICATIONS FOR PRACTICE To reduce minority stress and create conditions for a trusting relationship, healthcare professionals should specifically validate the LBTQ identity, strive for continuity of carer and zero separation of the LBTQ family. Healthcare professionals should make extensive efforts to transfer LBTQ related information between wards.
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Adams LM, Miller AB. Mechanisms of Mental-Health Disparities Among Minoritized Groups: How Well Are the Top Journals in Clinical Psychology Representing This Work? Clin Psychol Sci 2022; 10:387-416. [PMID: 35602543 PMCID: PMC9122282 DOI: 10.1177/21677026211026979] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
We have known for decades that mental health disparities exist among minoritized groups, including race, ethnicity, sexual identities, gender identity and expression, ability, and others. Theories and frameworks that incorporate stressors unique to the experiences of minoritized groups, such as the biopsychosocial model of racism (Clark et al, 1999) and minority stress model (Meyer, 2003), offer testable mechanisms that may help explain, in part, mental health disparities. However, research addressing mechanisms of these disparities is still scarce and is not well represented in our top clinical psychology journals. This review critically examines the extent to which top tier clinical psychology journals publish work examining mechanisms of mental health disparities among minoritized populations. We find very few studies have been published in top clinical psychology journals that address mechanisms of mental health disparities. We examine potential reasons for this and discuss recommendations for future research.
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Tan KKH, Wilson AB, Flett JAM, Stevenson BS, Veale JF. Mental health of people of diverse genders and sexualities in Aotearoa/New Zealand: Findings from the New Zealand Mental Health Monitor. Health Promot J Austr 2021; 33:580-589. [PMID: 34543490 DOI: 10.1002/hpja.543] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 09/14/2021] [Indexed: 11/07/2022] Open
Abstract
ISSUES ADDRESSED To examine the mental health inequities, and social exclusion and isolation and protective factor differences between people of diverse genders and sexualities (lesbian/gay, bisexual, gender diverse and takatāpui) and cisgender and heterosexual people in Aotearoa/New Zealand. METHODS We employed data from the pooled probability sample of 2016 and 2018 New Zealand Mental Health Monitor. The sample comprised of 2938 people at least 15 years old, of which 93 had diverse gender and sexuality identities. Generalised linear models were used to test for differences in mental health (current and lifetime mental distress, depression, anxiety, self-harm and suicide), social exclusion and isolation, and friend and family support for people of diverse genders and sexualities. We also conducted exploratory linear regression analyses to examine whether mental health difficulties were associated with social exclusion and isolation and friend/family support. RESULTS People of diverse genders and sexualities had high rates of mental health difficulties across all variables we examined. For example, people identifying as diverse genders and sexualities had three times the risk of considering self-harm and suicide than their cisgender and heterosexual counterparts (22% vs 5%; RR = 3.12). People of diverse genders and sexualities also scored an average of 6.08 points higher on the 27-point PHQ-9 depression scale when they had experienced social isolation, and 4.01 points higher when they experienced social exclusion. CONCLUSION Our results are consistent with current literature on the large mental health inequities faced by people of diverse genders and sexualities. SO WHAT?: Policy makers and health care providers in Aotearoa/New Zealand should consider the negative mental health consequences of social exclusion and isolation for people of diverse genders and sexualities.
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Affiliation(s)
- Kyle K H Tan
- Trans Health Research Lab, School of Psychology, University of Waikato, Hamilton, New Zealand
| | | | - Jayde A M Flett
- Te Hiringa Hauora/Health Promotion Agency, Wellington, New Zealand
| | | | - Jaimie F Veale
- Trans Health Research Lab, School of Psychology, University of Waikato, Hamilton, New Zealand
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Pharr JR. Health Disparities Among Lesbian, Gay, Bisexual, Transgender, and Nonbinary Adults 50 Years Old and Older in the United States. LGBT Health 2021; 8:473-485. [PMID: 34534016 DOI: 10.1089/lgbt.2021.0009] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: The purpose of this study was to examine health disparities among LGBT and nonbinary adult subgroups of those 50 years old and older. Methods: This was a cross-sectional analysis of data from the 2019 Behavioral Risk Factor Surveillance System survey. Access to health care, disabilities, health risk and healthy behaviors, and general health and chronic diseases and conditions were compared between gay men, bisexual men, lesbian/gay women, bisexual women, transgender women, transgender men, and nonbinary adults 50 years old and older. Rao-Scott corrected chi-square tests were utilized to determine significant differences between subgroups using weighted data. Multiple comparisons adjusted p values (Bonferroni) analyses were conducted when chi-square tests were significant. Results: Health disparities were identified among subgroups of LGBT and nonbinary older adults, with those who identified as nonbinary or as transgender women being the most vulnerable. Older nonbinary adults, transgender women, and bisexual men were more likely to not have a personal doctor or to not have had a medical checkup in the past 2 years, and nonbinary older adults were more likely to report disabilities, poor mental and physical health, depression, and asthma. Conclusion: Public health professionals and health care providers can use this information to target interventions to specific groups. Subgroup analyses of LGBT and nonbinary adults who are 50 years old and older need to continue with a focus on the most vulnerable groups. In addition, more research is needed that disaggregates transgender and nonbinary older adults to identify the unique health concerns of each group.
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Affiliation(s)
- Jennifer R Pharr
- Department of Environmental and Occupational Health, School of Public Health, University of Nevada, Las Vegas, Las Vegas, Nevada, USA
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Mijas M, Blukacz M, Koziara K, Kasparek K, Pliczko MP, Galbarczyk A, Jasienska G. Dysregulated by stigma: Cortisol responses to repeated psychosocial stress in gay and heterosexual men. Psychoneuroendocrinology 2021; 131:105325. [PMID: 34171795 DOI: 10.1016/j.psyneuen.2021.105325] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 05/05/2021] [Accepted: 06/10/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Research on pathways linking stigma with health inequalities affecting sexual minority populations, focused predominantly on exploring the hypothalamic-pituitary-adrenocortical (HPA) dysregulation profiles associated with chronic stress. One of such profiles reflecting a state of increased susceptibility to disease, and not yet studied among sexual minority individuals, is impaired habituation to repeated stress of the same type. In this study we explored whether sexual identity modulates endocrine stress responses and stress responses habituation in healthy heterosexual and gay men. We also explored the associations between perceived sexual minority stigma and cortisol response to stress in the latter group. METHODS Gay (N = 49) and heterosexual (N = 40) men, aged 24.4 years, were confronted twice with the Trier Social Stress Test and provided 5 salivary cortisol samples for each of the two testing sessions. A multilevel mixed-effects approach was used to model the cortisol curve throughout the two-day procedure. Habituation to repeated stress was conceptualized as the decrease in the total cortisol levels as well as the change in the cortisol curvilinearity between the first and the second testing session. RESULTS Gay participants were characterized by significantly higher cortisol levels throughout both laboratory visits. Their cortisol levels were also predicted by perceived rejection from family due to minority sexual identity, and stigma-related vicarious trauma. Although neither group showed habituation defined as the decrease in cortisol level, the shape of the cortisol curve changed between both visits only in the heterosexual participants. CONCLUSIONS Increased cortisol levels observed in gay men are predicted by minority stressors. Combined with non-habituation, the upregulation of the HPA axis may constitute a physiological pathway linking stigma to adverse health outcomes.
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Affiliation(s)
- Magdalena Mijas
- Department of Environmental Health, Faculty of Health Sciences, Jagiellonian University Medical College, 8 Skawinska St., PL 31066 Krakow, Poland; Institute of Psychology, Faculty of Philosophy, Jagiellonian University, 6 Ingardena St., PL 30060 Krakow, Poland.
| | - Mateusz Blukacz
- Department of Environmental Health, Faculty of Health Sciences, Jagiellonian University Medical College, 8 Skawinska St., PL 31066 Krakow, Poland; Institute of Psychology, University of Silesia in Katowice, 53 Grazynskiego St., PL 40126 Katowice, Poland
| | - Karolina Koziara
- Institute of Psychology, Faculty of Philosophy, Jagiellonian University, 6 Ingardena St., PL 30060 Krakow, Poland
| | - Krzysztof Kasparek
- Institute of Sociology, Center for Evaluation and Analysis of Public Policies, Jagiellonian University, 52 Grodzka St., PL 30962 Krakow, Poland
| | - Mateusz Piotr Pliczko
- Sexology Lab, Department of Psychiatry, Jagiellonian University Medical College, 21a Kopernika St., PL 31501 Krakow, Poland
| | - Andrzej Galbarczyk
- Department of Environmental Health, Faculty of Health Sciences, Jagiellonian University Medical College, 8 Skawinska St., PL 31066 Krakow, Poland
| | - Grazyna Jasienska
- Department of Environmental Health, Faculty of Health Sciences, Jagiellonian University Medical College, 8 Skawinska St., PL 31066 Krakow, Poland
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Diamond LM. The New Genetic Evidence on Same-Gender Sexuality: Implications for Sexual Fluidity and Multiple Forms of Sexual Diversity. JOURNAL OF SEX RESEARCH 2021; 58:818-837. [PMID: 33620277 DOI: 10.1080/00224499.2021.1879721] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
In September of 2019, the largest-ever (N = 477,522) genome-wide-association study of same-gender sexuality was published in Science. The primary finding was that multiple genes are significantly associated with ever engaging in same-gender sexual behavior, accounting for between 8-25% of variance in this outcome. Yet an additional finding of this study, which received less attention, has more potential to transform our current understanding of same-gender sexuality: Specifically, the genes associated with ever engaging in same-gender sexual behavior differed from the genes associated with one's relative proportion of same-gender to other-gender behavior. I review recent research on sexual orientation and sexual fluidity to illustrate how these findings speak to longstanding questions regarding distinctions among subtypes of same-gender sexuality (such as mostly-heterosexuality, bisexuality, and exclusive same-gender experience). I conclude by outlining directions for future research on the multiple causes and correlates of same-gender expression.
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Pharr JR, Batra K. Propensity Score Analysis Assessing the Burden of Non-Communicable Diseases among the Transgender Population in the United States Using the Behavioral Risk Factor Surveillance System (2017-2019). Healthcare (Basel) 2021; 9:healthcare9060696. [PMID: 34207713 PMCID: PMC8226537 DOI: 10.3390/healthcare9060696] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/01/2021] [Accepted: 06/07/2021] [Indexed: 01/02/2023] Open
Abstract
Research to assess the burden of non-communicable diseases (NCDs) among the transgender population needs to be prioritized given the high prevalence of chronic conditions and associated risk factors in this group. Previous cross-sectional studies utilized unmatched samples with a significant covariate imbalance resulting in a selection bias. Therefore, this cross-sectional study attempts to assess and compare the burden of NCDs among propensity score-matched transgender and cisgender population groups. This study analyzed Behavioral Risk Factor Surveillance System data (2017–2019) using complex weighting procedures to generate nationally representative samples. Logistic regression was fit to estimate propensity scores. Transgender and cisgender groups were matched by sociodemographic variables using a 1:1 nearest neighbor matching algorithm. McNemar, univariate, and multivariate logistic regression analyses were conducted among matched cohorts using R and SPSS version 26 software. Compared with the cisgender group, the transgender group was significantly more likely to have hypertension (31.3% vs. 27.6%), hypercholesteremia (30.8% vs. 23.7%), prediabetes (17.3% vs. 10.3%), and were heavy drinkers (6.7% vs. 6.0%) and smokers (22.4% vs. 20.0%). Moreover, the transgender group was more than twice as likely to have depression (aOR: 2.70, 95% CI 2.62–2.72), stroke (aOR: 2.52 95% CI 2.50–2.55), coronary heart disease (aOR: 2.77, 95% CI 2.74–2.81), and heart attack (aOR: 2.90, 95% CI 2.87–2.94). Additionally, the transgender group was 1.2–1.7 times more likely to have metabolic and malignant disorders. Differences were also found between transgender subgroups compared with the cisgender group. This study provides a clear picture of the NCD burden among the transgender population. These findings offer an evidence base to build health equity models to reduce disparities among transgender groups.
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Affiliation(s)
- Jennifer R. Pharr
- Department of Environmental and Occupational Health, School of Public Health, University of Nevada, Las Vegas, NV 89119, USA
- Correspondence:
| | - Kavita Batra
- Office of Research, Kirk Kerkorian School of Medicine, University of Nevada, Las Vegas, NV 89102, USA;
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Exercise as a Mitigator of Poor Mental Health Among Lesbian, Gay, and Bisexual Adults. J Phys Act Health 2021; 18:548-556. [PMID: 33848980 DOI: 10.1123/jpah.2020-0703] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 01/29/2021] [Accepted: 02/01/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION There is a positive association between exercise and improved mental health in the general population. Although there is a greater burden of psychological distress among lesbian, gay, and bisexual (LGB) people, little is known about the association between exercise and mental health in this population. The authors explored the association between exercise and poor mental health reported by LGB adults in the United States. METHODS Our analyses used data from the 2017 Behavioral Risk Factor Surveillance System survey. Multiple regression analyses were used to determine the association between exercising and mental health days adjusting for sociodemographic characteristics. RESULTS Data were available for 6371 LGB participants. LGB adults who participated in any exercise reported almost 1.0 day less of poor mental health in the past 30 days compared with LGB adults who did not exercise (P ≤ .01). LGB adults who met one or both of the physical activity guidelines had between 1.2 and 1.7 days less of poor mental health compared with those who did not meet the guidelines (P ≤ .01). CONCLUSION Fewer days of poor mental health were reported by LGB adults who exercised. Determining whether physical activity interventions, including aerobic and strengthening exercises, could improve mental health outcomes in LGB adults should be studied.
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Pitman A, Marston L, Lewis G, Semlyen J, McManus S, King M. The mental health of lesbian, gay, and bisexual adults compared with heterosexual adults: results of two nationally representative English household probability samples. Psychol Med 2021; 52:1-10. [PMID: 33592165 DOI: 10.1017/s0033291721000052] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Evidence on inequalities in mental health in lesbian, gay, and bisexual people arises primarily from non-random samples. AIMS To use a probability sample to study change in mental health inequalities between two survey points, 7 years apart; the contribution of minority stress; and whether associations vary by age, gender, childhood sexual abuse, and religious identification. METHODS We analysed data from 10 443 people, in two English population-based surveys (2007 and 2014), on common mental disorder (CMD), hazardous alcohol use, and illicit drug use. Multivariable models were adjusted for age, gender, and economic factors, adding interaction terms for survey year, age, gender, childhood sexual abuse, and religious identification. We explored bullying and discrimination as mediators. RESULTS Inequalities in risks of CMD or substance misuse were unchanged between 2007 and 2014. Compared to heterosexuals, bisexual, and lesbian/gay people were more likely to have CMD, particularly bisexual people [adjusted odds ratio (AOR) = 2.86; 95% CI 1.83-4.46], and to report alcohol misuse and illicit drug use. When adjusted for bullying, odds of CMD remained elevated only for bisexual people (AOR = 3.21; 95% CI 1.64-6.30), whilst odds of alcohol and drug misuse were unchanged. When adjusted for discrimination, odds of CMD and alcohol misuse remained elevated only for bisexual people (AOR = 2.91; 95% CI 1.80-4.72; and AOR = 1.63; 95% CI 1.03-2.57 respectively), whilst odds of illicit drug use remained unchanged. There were no interactions with age, gender, childhood sexual abuse, or religious identification. CONCLUSIONS Mental health inequalities in non-heterosexuals have not narrowed, despite increasing societal acceptance. Bullying and discrimination may help explain the elevated rate of CMD in lesbian women and gay men but not in bisexual people.
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Affiliation(s)
- Alexandra Pitman
- UCL Division of Psychiatry, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
- Camden and Islington NHS Foundation Trust, St Pancras Hospital, London, NW1 0PE, UK
| | - Louise Marston
- UCL Research Department of Primary Care and Population Health, Royal Free Hospital, Rowland Hill Street, London, NW3 2PF, UK
| | - Gemma Lewis
- UCL Division of Psychiatry, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Joanna Semlyen
- Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, NR4 7TJ, UK
| | - Sally McManus
- NatCen Social Research, 35 Northampton Square, London, EC1V 0AX, UK
- School of Health Sciences, City University, Northampton Square, London, EC1V 0HB, UK
| | - Michael King
- UCL Division of Psychiatry, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
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Mijas M, Koziara K, Galbarczyk A, Jasienska G. Cardiovascular Disease Risk in Bears and Other Gay Men: A Descriptive Study from Poland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:1044. [PMID: 33503945 PMCID: PMC7908132 DOI: 10.3390/ijerph18031044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 01/20/2021] [Accepted: 01/22/2021] [Indexed: 12/29/2022]
Abstract
A risk of cardiovascular disease (CVD) is increased by multiple factors including psychosocial stress and health behaviors. Sexual minority men who identify as Bears form a subculture distinguished by characteristics associated with increased CVD risk such as elevated stress and high body weight. However, none of the previous studies comprehensively investigated CVD risk in this population. Our study compared Bears (N = 31) with other gay men (N = 105) across a wide range of CVD risk factors. Logistic regression and analysis of covariance (ANCOVA) models were performed to compare both groups concerning behavioral (e.g., physical activity), medical (e.g., self-reported hypertension), and psychosocial (e.g., depressiveness) CVD risk factors. Bears were characterized by older age and higher body mass index (BMI) than the control group. We also observed higher resilience, self-esteem, as well as greater prevalence of self-reported hypertension, diabetes, and hypercholesterolemia in Bears. None of these differences remained statistically significant after adjusting for age and, in the case of self-reported diagnosis of diabetes, both age and BMI. Our study demonstrates that Bears are characterized by increased CVD risk associated predominantly with older age and higher BMI. Health promotion interventions addressed to this community should be tailored to Bears' subcultural norms and should encourage a healthier lifestyle instead of weight loss.
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Affiliation(s)
- Magdalena Mijas
- Department of Environmental Health, Faculty of Health Sciences, Jagiellonian University Medical College, 8 Skawinska St., PL 31066 Krakow, Poland; (A.G.); (G.J.)
| | - Karolina Koziara
- Institute of Psychology, Faculty of Philosophy, Jagiellonian University, 6 Ingardena St., PL 30060 Krakow, Poland;
| | - Andrzej Galbarczyk
- Department of Environmental Health, Faculty of Health Sciences, Jagiellonian University Medical College, 8 Skawinska St., PL 31066 Krakow, Poland; (A.G.); (G.J.)
| | - Grazyna Jasienska
- Department of Environmental Health, Faculty of Health Sciences, Jagiellonian University Medical College, 8 Skawinska St., PL 31066 Krakow, Poland; (A.G.); (G.J.)
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