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Yi M, Li X, Chiaramonte D, Sun S, Pan S, Soulliard Z, Eisenstadt BE, Ljótsson B, Hagaman A, Pachankis J. Guided internet-based LGBTQ-affirmative cognitive-behavioral therapy: A randomized controlled trial among sexual minority men in China. Behav Res Ther 2024; 181:104605. [PMID: 39029333 PMCID: PMC11371497 DOI: 10.1016/j.brat.2024.104605] [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: 01/11/2024] [Revised: 05/09/2024] [Accepted: 07/12/2024] [Indexed: 07/21/2024]
Abstract
OBJECTIVE LGBTQ-affirmative cognitive-behavioral therapy (CBT) addresses minority stress to improve sexual minority individuals' mental and behavioral health. This treatment has never been tested in high-stigma contexts like China using online delivery. METHOD Chinese young sexual minority men (n = 120; ages 16-30; HIV-negative; reporting depression and/or anxiety symptoms and past-90-day HIV-transmission-risk behavior), were randomized to receive 10 sessions of culturally adapted asynchronous LGBTQ-affirmative internet-based CBT (ICBT) or weekly assessments only. The primary outcome included HIV-transmission-risk behavior (i.e., past-30-day condomless anal sex). Secondary outcomes included HIV social-cognitive mechanisms (e.g., condom use self-efficacy), mental health (e.g., depression), and behavioral health (e.g., alcohol use), as well as minority stress (e.g., acceptance concerns), and universal (e.g., emotion regulation) mechanisms at baseline and 4- and 8-month follow-up. Moderation analyses examined treatment efficacy as a function of baseline stigma experiences and session completion. RESULTS Compared to assessment only, LGBTQ-affirmative ICBT did not yield greater reductions in HIV-transmission-risk behavior or social-cognitive mechanisms. However, LGBTQ-affirmative ICBT yielded greater improvements in depression (d = -0.50, d = -0.63) and anxiety (d = -0.51, d = -0.49) at 4- and 8-month follow-up, respectively; alcohol use (d = -0.40) at 8-month follow-up; and certain minority stress (e.g., internalized stigma) and universal (i.e., emotion dysregulation) mechanisms compared to assessment only. LGBTQ-affirmative ICBT was more efficacious for reducing HIV-transmission-risk behavior for participants with lower internalized stigma (d = 0.42). Greater session completion predicted greater reductions in suicidality and rumination. CONCLUSIONS LGBTQ-affirmative ICBT demonstrates preliminary efficacy for Chinese young sexual minority men. Findings can inform future interventions for young sexual minority men in contexts with limited affirmative supports.
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Affiliation(s)
- Mengyao Yi
- Xiangya School of Nursing, Central South University, Changsha, Hunan Province, China
| | - Xianhong Li
- Xiangya School of Nursing, Central South University, Changsha, Hunan Province, China.
| | | | - Shufang Sun
- Brown University School of Public Health, Providence, RI, USA
| | - Si Pan
- The Second Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | | | | | | | - Ashley Hagaman
- Yale School of Public Health, Yale University, New Haven, CT, USA
| | - John Pachankis
- Yale School of Public Health, Yale University, New Haven, CT, USA.
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Armstrong BN, Barman-Adhikari A, Shelton J, Hsu HT, Petering R, Bender K, Ferguson KM, Maria DS, Narendorf SC. Are social supports always protective? A seven-city study on heavy drinking among sexual and gender minority young adults experiencing homelessness. Drug Alcohol Depend 2024; 262:111404. [PMID: 39094383 DOI: 10.1016/j.drugalcdep.2024.111404] [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: 04/15/2024] [Revised: 07/11/2024] [Accepted: 07/14/2024] [Indexed: 08/04/2024]
Abstract
PURPOSE Sexual and gender minority (SGM) young adults are disproportionately impacted by homelessness and heavy drinking (i.e., having five or more drinks of alcohol in a row within a couple of hours). Social support, in general, is protective in reducing individuals' risk of heavy drinking. However, whether and how support from different sources may have different implications on heavy drinking among SGM young adults experiencing homelessness (SGM-YAEH) remains unclear. Informed by the risk amplification and abatement model (RAAM), this study examined the associations between support sources and heavy drinking among SGM-YAEH. METHODS A purposive sample of SGM-YAEH (N=425) recruited in homeless service agencies from seven major cities in the U.S. completed a self-administered computer-assisted anonymous survey. This survey covered heavy drinking behaviors and social network properties. Logistic regression models were conducted to identify social support sources associated with SGM-YAEH's heavy drinking. RESULTS Over 40 % of SGM-YAEH were involved in heavy drinking in the past 30 days. Receiving support from street-based peers (OR=1.9; 95 % CI=1.1, 3.2) and home-based peers (OR=1.7; 95 % CI=1.0, 2.8) were each positively associated with SGMYAEH heavy drinking risks. CONCLUSION This study was not able to identify the protective role social supports may play in reducing SGM-YAEH's heavy drinking. Furthermore, receiving support from network members was correlated with elevated heavy drinking risks among this population. As heavy drinking prevention programs develop interventions: they should use affirming and trauma approaches to promote protective social ties, as research points to its association in reducing alcohol use disparities among SGM-YAEH.
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Affiliation(s)
- Brandi N Armstrong
- School of Social Work, University of Missouri, 729 Clark Hall, Columbia, MO 65211, USA.
| | - Anamika Barman-Adhikari
- Graduate School of Social Work, University of Denver, 2148 S High Street, Denver, CO 80208, USA.
| | - Jama Shelton
- Silberman School of Social Work, Hunter College, 2180 Third Avenue, New York, NY 10035, USA.
| | - Hsun-Ta Hsu
- School of Social Work, University of North Carolina at Chapel Hill, 325 Pittsboro St, CB 3550, Chapel Hill, NC 27599, USA.
| | - Robin Petering
- Young People to the Front (YP2F), Inc., Los Angeles, CA 90029, USA.
| | - Kimberly Bender
- Graduate School of Social Work, University of Denver, 2148 S High Street, Denver, CO 80208, USA.
| | - Kristin M Ferguson
- School of Social Work, Arizona State University, 411 N. Central Avenue, Phoenix, AZ 85004, USA.
| | - Diane Santa Maria
- Cizik School of Nursing, University of Texas Health Science Center at Houston, 6901 Bertner Ave, Houston, TX 77030, USA.
| | - Sarah C Narendorf
- Graduate College of Social Work, University of Houston, 3511 Cullen Blvd, Houston, TX 77204, USA.
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Wright LE, Savage B, Watts SJ. Sexuality Minority Status, Victimization, Mental Health, and Substance Use. Subst Use Misuse 2024:1-13. [PMID: 39177190 DOI: 10.1080/10826084.2024.2392522] [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] [Indexed: 08/24/2024]
Abstract
Background: Prior research suggests that sexual minority status is related to victimization, mental health issues, and substance use. However, few studies have sought to connect these relationships in a way supported by theory, and fewer have utilized probability and/or nationally representative samples. Objective: The current study seeks to test the relationships among these variables, guided by general strain theory (GST). Methods: One wave of the National Longitudinal Study of Adolescent to Adult Health dataset (Add Health) (N = 14,121) and path modeling in Mplus are utilized. Results: Models run separately by race/ethnicity suggest that the relationship among these variables largely support expectations from GST, but with some notable differences by race/ethnicity. Conclusion: Results suggest a relationship among these variables that concurs with criminological theorizing. Implications and limitations are discussed.
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Affiliation(s)
- Lauren E Wright
- Department of Sociology and Political Science, Tennessee Tech University, Cookeville, Tennessee, USA
| | - Brenda Savage
- School of History and Social Science, LA Tech University, Ruston, Louisiana, USA
| | - Stephen J Watts
- Department of Criminology and Criminal Justice, University of Memphis, Memphis, Tennessee, USA
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4
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Xu Y, Hall WJ, Scott M, Gao Y, Chiang PC, Williams DY, Srivastava A, Ramon ME, Englert AR. Strategies for Coping with Minority Stress among Queer Young Adults: Usage Frequency, Associations with Demographics, and Mental Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:1052. [PMID: 39200662 PMCID: PMC11354887 DOI: 10.3390/ijerph21081052] [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] [Received: 06/28/2024] [Revised: 07/25/2024] [Accepted: 08/07/2024] [Indexed: 09/02/2024]
Abstract
Queer young adults report significantly higher levels of anxiety and depression than their heterosexual counterparts, which is linked to sexual minority stress. Therefore, it is important to understand the coping strategies employed by this population to navigate minority stress and how coping strategies may impact mental health outcomes. Drawing from a U.S. national diverse sample of 387 queer young adults (ages 18-39 years), we analyzed descriptive results of 11 behavioral strategies to cope with minority stress and used ordered logistic and linear regression to examine the following objectives: the frequency of the use of each coping strategy, and the associations between each strategy and demographic characteristics as well as depression and anxiety. Results revealed that avoidance and talking with friends were the most frequently utilized coping strategies, while prayer/religious activities and counseling/psychotherapy/support groups were infrequently used. We examined utilization preferences of coping strategies across demographic factors (e.g., assigned sex at birth and sexual orientation). The use of counseling/psychotherapy/support group was positively associated with mental health symptoms, while exercise and mindfulness/mediation were associated with lower mental health symptoms. Our findings provide insights for mental health researchers and professionals in selecting appropriate coping strategies for queer young adults in prevention and intervention efforts.
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Affiliation(s)
- Yinuo Xu
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (W.J.H.); (M.S.); (P.-C.C.); (D.Y.W.); (A.S.); (M.E.R.); (A.R.E.)
- School of Education, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA;
| | - William J. Hall
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (W.J.H.); (M.S.); (P.-C.C.); (D.Y.W.); (A.S.); (M.E.R.); (A.R.E.)
| | - McRae Scott
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (W.J.H.); (M.S.); (P.-C.C.); (D.Y.W.); (A.S.); (M.E.R.); (A.R.E.)
| | - Yutong Gao
- School of Education, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514, USA;
| | - Pin-Chen Chiang
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (W.J.H.); (M.S.); (P.-C.C.); (D.Y.W.); (A.S.); (M.E.R.); (A.R.E.)
| | - Denise Yookong Williams
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (W.J.H.); (M.S.); (P.-C.C.); (D.Y.W.); (A.S.); (M.E.R.); (A.R.E.)
| | - Ankur Srivastava
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (W.J.H.); (M.S.); (P.-C.C.); (D.Y.W.); (A.S.); (M.E.R.); (A.R.E.)
| | - Magdelene E. Ramon
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (W.J.H.); (M.S.); (P.-C.C.); (D.Y.W.); (A.S.); (M.E.R.); (A.R.E.)
| | - Adam R. Englert
- School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; (W.J.H.); (M.S.); (P.-C.C.); (D.Y.W.); (A.S.); (M.E.R.); (A.R.E.)
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Maroney MR, Levitt HM, Horne SG. Exploring the Efficacy of an Online Intervention in Processing Experiences of Heterosexism Among Autistic-LGBQ + Individuals. J Autism Dev Disord 2024; 54:2946-2959. [PMID: 37344732 DOI: 10.1007/s10803-023-06027-1] [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] [Accepted: 05/28/2023] [Indexed: 06/23/2023]
Abstract
This experimental study explored the use of online expressive writing interventions to cope with distress from heterosexist events among a sample of autistic-LBGQ + individuals. This study included an open writing condition and an emotion focused therapy guided writing condition. Over 89% of the participants indicated that the writing exercises were helpful in processing the event, with significant decreases for measures of depressive and trauma/stressor symptoms. A thematic analysis identified specific aspects of each condition that were helpful for participants in coping with heterosexist distress, such as the development of insight through the emotion-focused exercises. This low-demand exercise is promising as a solo exercise or as a therapy homework assignment, especially given the accessibility of this online intervention for autistic-LGBQ + people.
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Affiliation(s)
- Meredith R Maroney
- Counselling Psychology, Werklund School of Education, University of Calgary, Calgary, AB, T2N 1N4, Canada.
| | - Heidi M Levitt
- Department of Psychology, University of Massachusetts, Boston, USA
| | - Sharon G Horne
- Department of Counseling and School Psychology, University of Massachusetts, Boston, USA
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6
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Ehlke SJ, Fitzer SA, Stamates AL, Kelley ML. Distal and Proximal Minority Stressors on Patterns of Tobacco and Cannabis Use Among Young Bisexual Women. SUBSTANCE USE & ADDICTION JOURNAL 2024; 45:390-396. [PMID: 38258836 PMCID: PMC11209863 DOI: 10.1177/29767342231222246] [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: 01/24/2024]
Abstract
BACKGROUND Bisexual women have high rates of tobacco and cannabis use, but few studies have examined co-use behavior in this population. Although the role of distal minority stressors (eg, discrimination) on substance use has been examined, fewer studies have examined proximal minority stressors (eg, negative sexual identity self-schemas). The current study was a secondary data analysis that examined patterns of tobacco and cannabis use, and the role of distal (instability of bisexuality, sexual irresponsibility of bisexual people, and hostility toward bisexual people) and proximal (illegitimacy of bisexuality, anticipated binegativity, internalized binegativity, and identity affirmation) bisexual-specific minority stressors among bisexual women. METHODS Participants were 224 young (aged 18-30 years old) self-identified bisexual women who reported on their past 30-day tobacco and cannabis use and completed measures of distal and proximal bisexual-specific minority stressors. Participants were categorized into one of 4 patterns: no use, tobacco use only, cannabis use only, and tobacco and cannabis co-use. RESULTS The most common pattern of past 30-day use was tobacco and cannabis co-use (39.1%). Results from a multinomial logistic regression revealed that bisexual women who reported higher illegitimacy of bisexuality, a proximal minority stressor, were significantly more likely to engage in tobacco and cannabis co-use, relative to no use. DISCUSSION Bisexual women have particularly high rates of substance use, with tobacco and cannabis co-use as the most common pattern. Incorporating the role of proximal minority stressors, and specifically, beliefs about the legitimacy of bisexuality, may be an important target of substance use interventions for bisexual women.
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Affiliation(s)
- Sarah J. Ehlke
- Department of Psychology, Old Dominion University, Norfolk, VA, USA
- Virginia Consortium Program in Clinical Psychology, Norfolk, VA, USA
| | | | - Amy L. Stamates
- Department of Psychology, University of Rhode Island, Kingston, RI, USA
| | - Michelle L. Kelley
- Department of Psychology, Old Dominion University, Norfolk, VA, USA
- Virginia Consortium Program in Clinical Psychology, Norfolk, VA, USA
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Brown SL, Chen Q, Valencia EMH, Victor SE, Scott LN. A Prospective Examination of Sexual Orientation and Suicidal and Nonsuicidal Self-Injurious Thoughts and Behaviors Among a Diverse Sample of At-risk Young Adult Women. PSYCHOLOGY OF SEXUAL ORIENTATION AND GENDER DIVERSITY 2024; 11:280-293. [PMID: 39100883 PMCID: PMC11293462 DOI: 10.1037/sgd0000593] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/06/2024]
Abstract
Minoritized sexual orientation is an established correlate for suicide ideation (SI) and nonsuicidal self-injury (NSSI); however, prospective associations between sexual orientation and SI and NSSI is limited. The current study builds on existing literature by examining sexual orientation as a prospective distal risk factor for SI and NSSI risk among a diverse sample of young women after adjusting for histories of SI and/or NSSI and empirically supported correlates and risk factors. Participants were 135 young adult women (aged 18-24), who were predominately Black with approximately half of the sample experiencing poverty. Participants completed an interview that assessed SI and NSSI at baseline and 6- and 12-month follow-ups. A single item was used to collect participants' self-identified sexual orientation at baseline. Minoritized sexual orientation was strongly associated with NSSI history and future SI and NSSI, adjusting for baseline correlates and predictors of interest. Psychological and physical victimization, race, and poverty were non-significant prospective predictors of SI and NSSI. Race and poverty did not moderate the associations between sexual orientation and follow-up SI and NSSI. These findings suggest young adult women who self-identify as lesbian, gay, bisexual, queer, or questioning (LGBQ) are more likely than those who identify as heterosexual to experience both SI and NSSI in the following year. Sexual orientation should be part of a culturally-informed comprehensive risk assessment. A culturally-informed intersectionality approach may be necessary to identify culturally-specific risk and resiliency factors for SI and NSSI that can guide effective prevention and intervention strategies for LGBQ individuals.
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Affiliation(s)
- Sarah L. Brown
- University of Pittsburgh School of Medicine, Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O’Hara Street, Pittsburgh, PA 15213
| | - Qi Chen
- University of Pittsburgh School of Medicine, Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O’Hara Street, Pittsburgh, PA 15213
| | - Evelyn M. Hernandez Valencia
- University of Pittsburgh School of Medicine, Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O’Hara Street, Pittsburgh, PA 15213
| | - Sarah E. Victor
- Texas Tech University, Department of Psychological Sciences, Mail Stop 2051, Texas Tech University, Lubbock, TX 79409-2051
| | - Lori. N Scott
- University of Pittsburgh School of Medicine, Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O’Hara Street, Pittsburgh, PA 15213
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Chang CJ, Livingston NA, Rashkovsky KT, Harper KL, Kuehn KS, Khalifian C, Harned MS, Tucker RP, Depp CA. A Scoping Review of Suicide Prevention Interventions for Lesbian, Gay, Bisexual, Transgender, Queer, and Other Sexual and Gender Minority Individuals. LGBT Health 2024. [PMID: 38722250 DOI: 10.1089/lgbt.2023.0262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024] Open
Abstract
Purpose: This scoping review summarizes the literature on suicide-specific psychological interventions among lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) people to synthesize existing findings and support future intervention research and dissemination. Methods: Electronic databases PsycInfo and PubMed were searched for reports of psychological intervention studies with suicide-related outcome data among LGBTQ+ people. A total of 1269 articles were screened, and 19 studies met inclusion criteria (k = 3 examined suicide-specific interventions tailored to LGBTQ+ people, k = 4 examined nontailored suicide-specific interventions, k = 11 examined minority stress- or LGBTQ+ interventions that were not suicide-specific, and k = 1 examined other types of interventions). Results: Synthesis of this literature was made challenging by varied study designs, and features limit confidence in the degree of internal and external validity of the interventions evaluated. The only established suicide-specific intervention examined was Dialectical Behavior Therapy, and minority stress- and LGBTQ-specific interventions rarely targeted suicidal thoughts and behaviors (STBs). Nevertheless, most interventions reviewed demonstrated support for feasibility and/or acceptability. Only five studies tested suicide-related outcome differences between an LGBTQ+ group and a cisgender/heterosexual group. These studies did not find significant differences in STBs, but certain subgroups such as bisexual individuals may exhibit specific treatment disparities. Conclusion: Given the dearth of research, more research examining interventions that may reduce STBs among LGBTQ+ people is critically needed to address this public health issue.
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Affiliation(s)
- Cindy J Chang
- Veterans Affairs San Diego Healthcare System, U.S. Department of Veterans Affairs, San Diego, California, USA
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
| | - Nicholas A Livingston
- National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, Boston, Massachusetts, USA
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Katerine T Rashkovsky
- Veterans Affairs San Diego Healthcare System, U.S. Department of Veterans Affairs, San Diego, California, USA
| | - Kelly L Harper
- National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, Boston, Massachusetts, USA
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Kevin S Kuehn
- Department of Medicine, University of California San Diego, San Diego, California, USA
| | - Chandra Khalifian
- Veterans Affairs San Diego Healthcare System, U.S. Department of Veterans Affairs, San Diego, California, USA
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
| | - Melanie S Harned
- VA Puget Sound Health Care System, US Department of Veterans Affairs, Seattle, Washington, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Raymond P Tucker
- Department of Psychology, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Colin A Depp
- Veterans Affairs San Diego Healthcare System, U.S. Department of Veterans Affairs, San Diego, California, USA
- Department of Psychiatry, University of California San Diego, San Diego, California, USA
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Pachankis JE, Hatzenbuehler ML, Klein DN, Bränström R. The Role of Shame in the Sexual-Orientation Disparity in Mental Health: A Prospective Population-Based Study of Multimodal Emotional Reactions to Stigma. Clin Psychol Sci 2024; 12:486-504. [PMID: 38938414 PMCID: PMC11210704 DOI: 10.1177/21677026231177714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Abstract
Despite the prominence of shame in stigma theories, its role in explaining population-level mental health disparities between the stigmatized and non-stigmatized has not been investigated. We assessed shame explicitly (via self-report) and implicitly (via a behavioral task) in a prospective, representative cohort of sexual minority and heterosexual young adults in Sweden (baseline n=2,222). Compared to heterosexuals, sexual minorities evidenced higher explicit and implicit shame, which explained sexual orientation disparities in depression, social anxiety, and suicidal thoughts. Among sexual minorities, there was an indirect effect of shame in the association between interpersonal stigma (i.e., past-year family rejection and childhood bullying) and later experiences of adverse mental health; an indirect effect did not exist for the related construct, internalized stigma. Results suggest extending existing stigma theories to consider emotions like shame as characteristic reactions to stigma and guide the search for treatment targets focused on reducing the mental health sequelae of stigma.
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Affiliation(s)
- John E Pachankis
- Department of Social and Behavioral Sciences, Yale School of Public Health
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10
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Eaton LA, Huedo-Medina T, Earnshaw VA, Kalichman M, Watson RJ, Driver R, Chandler CJ, Kalinowski J, Kalichman SC. Randomized Clinical Trial of Stigma Counseling and HIV Testing Access Interventions to Increase HIV Testing Among Black Sexual Minority Men and Transwomen. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024; 25:650-660. [PMID: 37898978 DOI: 10.1007/s11121-023-01603-4] [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] [Accepted: 10/17/2023] [Indexed: 10/31/2023]
Abstract
Advances in HIV prevention tools have outpaced our ability to ensure equitable access to these tools. Novel approaches to reducing known barriers to accessing HIV prevention, such as stigma and logistical-related factors, are urgently needed. To evaluate the efficacy of a randomized controlled trial with four intervention arms to address barriers to HIV/STI testing uptake (primary outcome) and PrEP use, depression, and HIV test results (secondary outcomes). We tested a 2 × 2 research design: main effect 1-stigma-focused vs. health information evaluation-focused counseling, main effect 2-offering HIV/STI testing appointments in person vs. at home with a counselor via video chat, and the interaction of the main effects. Participants (N = 474) residing in the southeastern USA were screened and enrolled in a longitudinal trial. Intervention efficacy was established using generalized linear modeling with binomial or Poisson distributions. Intervention efficacy demonstrated an increase in HIV/STI testing uptake when testing was made available at home with a counselor via video chat vs. in person (83% vs. 75% uptake, p < .05), and participants were also more likely to test positive for HIV over the course of the study in the at-home condition (14.5% vs. 9.4%, p < .05). Stigma-focused counseling resulted in lower depression scores and greater uptake of PrEP among participants < 30 years of age when compared with health information counseling (15.4% vs. 9.6%, p < .05). In order to prevent further disparities between HIV prevention advances and access to HIV prevention tools, we must prioritize improvements in linking people to care. Novel interventions, such as those proposed here, offer a practical, evidence-based path to addressing long-standing barriers to HIV prevention strategies. Trial registration: NCT03107910.
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Affiliation(s)
- Lisa A Eaton
- Human Development and Family Sciences, University of Connecticut, 2006 Hillside Rd, Storrs, CT, 06279-1248, USA.
| | | | - Valerie A Earnshaw
- Human Development and Family Sciences, University of Delaware, Newark, DE, USA
| | | | - Ryan J Watson
- Human Development and Family Sciences, University of Connecticut, 2006 Hillside Rd, Storrs, CT, 06279-1248, USA
| | - Redd Driver
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Cristian J Chandler
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jolaade Kalinowski
- Human Development and Family Sciences, University of Connecticut, 2006 Hillside Rd, Storrs, CT, 06279-1248, USA
| | - Seth C Kalichman
- Psychological Sciences, University of Connecticut, Storrs, CT, USA
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11
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Roldán P, Matijczak A, Goffnett J. Negative Associations between Minority Stressors and Self-Reported Health Status among Sexual Minority Adults Living in Colombia. Healthcare (Basel) 2024; 12:429. [PMID: 38391805 PMCID: PMC10887566 DOI: 10.3390/healthcare12040429] [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: 11/30/2023] [Revised: 01/29/2024] [Accepted: 02/04/2024] [Indexed: 02/24/2024] Open
Abstract
Colombia has extensive laws prohibiting discrimination against sexual minority people. However, violence and discrimination toward sexual minorities are still frequent. While a growing body of research shows that sexual minority people experience elevated rates of discrimination and domestic abuse globally, little research has been conducted on these issues affecting sexual minorities in Colombia specifically. Using minority stress theory as a conceptual framework, this paper aims to fill this gap by examining the prevalence of experiencing intimate partner violence (IPV) and witnessed discrimination and the relationship of these stressors to self-reported health among a national sample of sexual minority Colombians. We found that bisexual individuals experienced higher rates of physical and sexual IPV, compared to lesbian and gay individuals. Additionally, sexual minority Colombians who experienced IPV and witnessed discrimination were more likely to report having poorer health, compared to those who had not. We discuss the implications of our findings for future research and clinicians working with sexual minority clients.
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Affiliation(s)
- Paola Roldán
- School of Social Work, Virginia Commonwealth University, Richmond, VA 23220, USA
| | - Angela Matijczak
- School of Social Work, Virginia Commonwealth University, Richmond, VA 23220, USA
| | - Jacob Goffnett
- School of Social Work, Virginia Commonwealth University, Richmond, VA 23220, USA
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Yang Y, Ye Z, Li W, Sun Y, Dai L. Efficacy of psychosocial interventions to reduce affective symptoms in sexual and gender minorities: a systematic review and meta-analysis of randomized controlled trials. BMC Psychiatry 2024; 24:4. [PMID: 38166855 PMCID: PMC10762931 DOI: 10.1186/s12888-023-05451-y] [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: 05/24/2023] [Accepted: 12/08/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) individuals are more likely than cisgender heterosexuals to experience mental, physical, and sexual health issues. A promising contemporary strategy to address the issue of affective symptoms in sexual and gender minorities (SGM) is psychosocial intervention. OBJECTIVE To systematically evaluate the effect of psychosocial interventions on the improvement of affective symptoms in SGM, and to provide a reference for the implementation of effective psychological interventions for SGM with affective symptoms. METHODS Between the date of database construction until December 10, 2022, a computerized search of the English-language literature published both nationally and worldwide was done. 8 literature databases and 3 additional gray databases were searched. We gathered randomized controlled trials that used psychological interventions for SGM. To evaluate risk bias in included papers in accordance with Cochrane cooperation criteria, we used Review Manager 5.4 software. In conjunction with post-test and follow-up data, mean differences were standardized using Stata 12.0 software. Subgroup analysis was used to investigate the cause of heterogeneity. The study was conducted strictly in accordance with PRISMA guidelines, and it was registered on the PROSPERO platform (CRD42023408610). RESULTS This review covered 18 research, and 14 studies were included in the meta-analysis. A total of 1194 study cases, including 706 cases from the control group and 488 cases from the experimental group, were included in these investigations. Compared to the control group, the psychosocial intervention group had significantly lower levels of depression (standardized mean difference (SMD) = -0.17;95% CI = [-0.30, -0.04]; p = 0.012) and anxiety (SMD = -0.22; 95% CI = [-0.41, -0.04]; p = 0.01), but no significant differences were found for distress (SMD = -0.19; 95% CI = [-0.45,0.07]; p = 0.021). CONCLUSION According to this study, psychosocial interventions helped lessen the symptoms of depression and anxiety in SGM but had no significant effect on their psychological distress. To assess the impact of psychological intervention on SGM, more randomized controlled trials with larger sample sizes and numerous follow-up times should be done.
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Affiliation(s)
- Yawen Yang
- Research Center for Psychological and Health Sciences, China University of Geosciences, Wuhan, Wuhan, Hubei Province, 430074, China
- Psychosomatic Department, Wuhan Mental Health Center, Wuhan, China
- Psychosomatic Department, Wuhan Hospital for Psychotherapy, Wuhan, China
| | - Zhiyu Ye
- Research Center for Psychological and Health Sciences, China University of Geosciences, Wuhan, Wuhan, Hubei Province, 430074, China
- Psychosomatic Department, Wuhan Mental Health Center, Wuhan, China
- Psychosomatic Department, Wuhan Hospital for Psychotherapy, Wuhan, China
| | - Wentian Li
- Research Center for Psychological and Health Sciences, China University of Geosciences, Wuhan, Wuhan, Hubei Province, 430074, China
- Psychosomatic Department, Wuhan Mental Health Center, Wuhan, China
- Psychosomatic Department, Wuhan Hospital for Psychotherapy, Wuhan, China
| | - Ye Sun
- Psychosomatic Department, Wuhan Mental Health Center, Wuhan, China
- Psychosomatic Department, Wuhan Hospital for Psychotherapy, Wuhan, China
| | - Lisha Dai
- Research Center for Psychological and Health Sciences, China University of Geosciences, Wuhan, Wuhan, Hubei Province, 430074, China.
- Psychosomatic Department, Wuhan Mental Health Center, Wuhan, China.
- Psychosomatic Department, Wuhan Hospital for Psychotherapy, Wuhan, China.
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Keski-Rahkonen A. Eating disorders in transgender and gender diverse people: characteristics, assessment, and management. Curr Opin Psychiatry 2023; 36:412-418. [PMID: 37781981 DOI: 10.1097/yco.0000000000000902] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
PURPOSE OF REVIEW This review summarizes recent research on eating disorders among gender minorities, transgender and gender diverse people. The focus is on research published in 2022 and the first half of 2023. RECENT FINDINGS Up to 1.2% of young people and 0.3-0.5% of adults identify as transgender, and 2.7-8.4% of young people and 0.3-4.5% of adults report some degree of gender diversity. About 20-50% of transgender and gender diverse people report engaging in disordered eating and >30% screen positive for eating disorder symptoms, and 2-12% have received an eating disorder diagnosis from a health professional. Many transgender and gender diverse people describe eating disorder symptoms as a way of coping with gender dysphoria. They also report high levels of mental and behavioral symptoms, particularly mood and anxiety disorders, suicidal thoughts and behaviors, trauma-related symptoms and disorders, alcohol and substance use, and autism. Gender minorities frequently experience discrimination, victimization, and violence, primarily sexual and physical violence. The minority stress model attributes mental health symptoms to these factors. Promising interventions based on the minority stress model have recently become available, but more research is needed on how to support transgender and gender diverse people with eating disorders. To manage eating disorders in this population, gender-affirming care should be combined with specialist eating disorder treatment. SUMMARY Gender minorities are at high risk for eating disorders. Future studies should assess what is the most appropriate treatment for transgender and gender diverse people with eating disorders.
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Fowler JA, Buckley L, Muir M, Viskovich S, Paradisis C, Zanganeh P, Dean JA. Digital mental health interventions: A narrative review of what is important from the perspective of LGBTQIA+ people. J Clin Psychol 2023; 79:2685-2713. [PMID: 37528773 DOI: 10.1002/jclp.23571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/19/2023] [Accepted: 07/15/2023] [Indexed: 08/03/2023]
Abstract
OBJECTIVES Digital mental health interventions are a promising therapeutic modality to provide psychological support to LGBTQIA+ (lesbian, gay, bisexual, trans, Queer, intersex, asexual, plus other gender, sexual, and romantic minority identities) people. The aim of this narrative review is to explore how the LGBTQIA+ community has been engaged in the design of digital mental health interventions, how content has been tailored to the LGBTQIA+ community, and features identified as important by LGBTQIA+ participants. METHODS A total of 33 studies were included in this review from a larger yield of 1933 identified from systematic searches of five databases (PsycINFO, PubMed, Scopus, CINAHAL, and Medline). Data were analyzed narratively and using content analysis. RESULTS Only half of the studies reported engaging the LGBTQIA+ community in intervention designs. Interventions have been tailored in a variety of ways to support LGBTQIA+ individuals-such as through affirming imagery, recruitment through LGBTQIA+ networks, and designing content to focus specifically on LGBTQIA+ issues. A range of features were identified as important for participants, namely how content was tailored to LGBTQIA+ experiences, providing connection to community, and links to other relevant LGBTQIA+ resources. While not a primary aim, results also showed that a wide range of digital modalities can significantly improve a range of mental health problems. CONCLUSION Digital interventions are an acceptable and effective form of therapeutic intervention, but future research needs to focus on meaningful engagement of community members to inform design and implementation.
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Affiliation(s)
- James A Fowler
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Lisa Buckley
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Miranda Muir
- Faculty of Health and Behavioral Sciences, School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
| | - Shelley Viskovich
- Faculty of Health and Behavioral Sciences, School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
| | - Chris Paradisis
- Faculty of Health and Behavioral Sciences, School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
| | - Parnian Zanganeh
- Faculty of Health and Behavioral Sciences, School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
| | - Judith A Dean
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Poche Centre for Indigenous Health, The University of Queensland, Brisbane, Queensland, Australia
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Scheer JR, Behari K, Schwarz AA, Cascalheira CJ, Helminen EC, Pirog SA, Jaipuriyar V, Sullivan TP, Batchelder AW, Jackson SD. Expressive writing treatments to reduce PTSD symptom severity and negative alcohol-related outcomes among trauma-exposed sexual minority women and transgender/nonbinary people: Study protocol for a mixed-method pilot trial. Contemp Clin Trials Commun 2023; 35:101197. [PMID: 37671246 PMCID: PMC10475481 DOI: 10.1016/j.conctc.2023.101197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 07/21/2023] [Accepted: 08/18/2023] [Indexed: 09/07/2023] Open
Abstract
Background Sexual minority women (SMW) and transgender and/or nonbinary (TNB) individuals report an elevated prevalence of posttraumatic stress disorder (PTSD) symptoms and negative alcohol-related outcomes compared to heterosexual women and cisgender people. SMW and TNB individuals also face barriers to utilizing treatment, which can result in delayed or missed appointments. Accessible, feasible, and effective treatment approaches, such as web-based expressive writing (EW) treatments, are needed to address PTSD and negative alcohol-related outcomes in these populations. Method We describe the design of a mixed-method pilot randomized controlled trial which will compare an EW treatment adapted for SMW and TNB people (stigma-adapted EW) and trauma (i.e., non-adapted) EW with an active (neutral-event) control to determine acceptability and feasibility of a future fully powered randomized controlled trial. The sample will include 150 trauma-exposed SMW and TNB individuals from across the United States who will be randomly assigned to stigma-adapted EW (n = 50), trauma EW (n = 50), or control (n = 50). Participants will be assessed before treatment, one-week after the first writing session, and three-months after the first writing session. This paper identifies steps for evaluating the acceptability and feasibility of the proposed study and determining changes in outcomes resulting from adapted and non-adapted EW treatments to inform refinements. This paper also highlights our strategy for testing theory-driven mediators and moderators of treatment outcomes. Conclusions This mixed-method pilot trial will inform the first fully powered, self-administered, brief web-based treatment to reduce PTSD symptom severity and negative alcohol-related outcomes among trauma-exposed SMW and TNB individuals.
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Affiliation(s)
- Jillian R. Scheer
- Department of Psychology, Syracuse University, Syracuse, NY, 414 Huntington Hall, Syracuse, NY, 13244, USA
| | - Kriti Behari
- Department of Psychology, Syracuse University, Syracuse, NY, 414 Huntington Hall, Syracuse, NY, 13244, USA
| | - Aubriana A. Schwarz
- Department of Psychology, Syracuse University, Syracuse, NY, 414 Huntington Hall, Syracuse, NY, 13244, USA
| | - Cory J. Cascalheira
- Department of Counseling and Educational Psychology, New Mexico State University, Las Cruces, NM, 88003, USA
- VA Puget Sound Health Care System, Seattle, WA, 98108, USA
| | - Emily C. Helminen
- Department of Psychology, Syracuse University, Syracuse, NY, 414 Huntington Hall, Syracuse, NY, 13244, USA
| | - Sophia A. Pirog
- Department of Psychology, Syracuse University, Syracuse, NY, 414 Huntington Hall, Syracuse, NY, 13244, USA
| | - Virinca Jaipuriyar
- Department of Psychology, Syracuse University, Syracuse, NY, 414 Huntington Hall, Syracuse, NY, 13244, USA
| | - Tami P. Sullivan
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, 06501, USA
| | - Abigail W. Batchelder
- Harvard Medical School, Harvard University, Boston, MA, 02114, USA
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, 02114, USA
- The Fenway Institute, Fenway Health, Boston, MA, 02115, USA
| | - Skyler D. Jackson
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, 06501, USA
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Pachankis JE, Soulliard ZA, Layland EK, Behari K, Seager van Dyk I, Eisenstadt BE, Chiaramonte D, Ljótsson B, Särnholm J, Bjureberg J. Guided LGBTQ-affirmative internet cognitive-behavioral therapy for sexual minority youth's mental health: A randomized controlled trial of a minority stress treatment approach. Behav Res Ther 2023; 169:104403. [PMID: 37716019 PMCID: PMC10601985 DOI: 10.1016/j.brat.2023.104403] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 07/16/2023] [Accepted: 09/04/2023] [Indexed: 09/18/2023]
Abstract
OBJECTIVE LGBTQ-affirmative cognitive-behavioral therapy (CBT) addresses the adverse impacts of minority stress. However, this treatment has rarely been tested in randomized controlled trials with LGBTQ youth and never using an asynchronous online platform for broad reach. This study examined the feasibility, acceptability, preliminary efficacy, and multi-level stigma moderators of LGBTQ-affirmative internet-based CBT (ICBT). METHOD Participants were 120 LGBTQ youth (ages 16-25; 37.5% transgender or non-binary; 75.8% assigned female at birth; 49.2% non-Latino White) living across 38 U.S. states and reporting depression and/or anxiety symptoms. Participants were randomized to receive 10 sessions of LGBTQ-affirmative ICBT or only complete 10 weekly assessments of mental and behavioral health and minority stress; all completed measures of psychological distress, depression, anxiety, suicidal thoughts, alcohol use, and HIV-transmission-risk behavior at baseline and 4 and 8 months post-baseline; 20 LGBTQ-affirmative ICBT participants completed a qualitative interview regarding intervention acceptability. RESULTS Participants randomized to LGBTQ-affirmative ICBT completed, on average, 6.08 (SD = 3.80) sessions. Participants reported that LGBTQ-affirmative ICBT was helpful and engaging and provided suggestions for enhancing engagement. Although most outcomes decreased over time, between-group comparisons were small and non-significant. LGBTQ-affirmative ICBT was more efficacious in reducing psychological distress than assessment-only for participants in counties high in anti-LGBTQ bias (b = -1.73, p = 0.001, 95% CI [-2.75, -0.70]). Session dosage also significantly predicted reduced depression and anxiety symptoms. CONCLUSIONS LGBTQ-affirmative ICBT represents a feasible and acceptable treatment. Future research can identify more efficacious approaches and modalities for engaging LGBTQ youth, especially those living under stigmatizing conditions, who might benefit most.
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Affiliation(s)
| | | | | | | | | | | | | | - Brjánn Ljótsson
- Division for Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Sweden
| | - Josefin Särnholm
- Division for Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Sweden
| | - Johan Bjureberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Sweden
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Shen J, Rubin A, Cohen K, Hart E, Sung J, McDanal R, Roulston C, Sotomayor I, Fox K, Schleider J. Randomized evaluation of an online single-session intervention for minority stress in LGBTQ+ adolescents. Internet Interv 2023; 33:100633. [PMID: 37635950 PMCID: PMC10457524 DOI: 10.1016/j.invent.2023.100633] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/26/2023] [Accepted: 06/06/2023] [Indexed: 08/29/2023] Open
Abstract
Background LGBTQ+ youth face myriad adverse health outcomes due to minority stress, creating a need for accessible, mechanism-targeted interventions to mitigate these minority stress-related risk factors. We tested the effectiveness and acceptability of Project RISE, an online single-session intervention designed to ameliorate internalized stigma and improve other outcomes among LGBTQ+ youth. We hypothesized that youth assigned to RISE (versus a control) would report significantly reduced internalized stigma and increased identity pride at post-intervention and at two-week follow-up and would find RISE acceptable. Methods We recruited adolescents nationally through Instagram advertisements in May 2022 (N = 538; M age = 15.06, SD age = 0.97). Participants were randomly assigned to RISE or an information-only control and completed questionnaires pre-intervention, immediately post-intervention, and two weeks post-intervention. Inclusion criteria included endorsing: (1) LGBTQ+ identity, (2) age 13-16, (3) English fluency (4) Internet access, and (5) subjective negative impact of LGBTQ+ stigma. Results Relative to participants in the control condition, participants who completed RISE reported significant decreases in internalized stigma (d = -0.49) and increases in identity pride (d = 0.25) from pre- to immediately post-intervention, along with decreased internalized stigma (d = -0.26) from baseline to two-week follow-up. Participants rated both RISE and the information-only control as highly, equivalently acceptable. Conclusions RISE appears to be an acceptable and useful online SSI for LGBTQ+ adolescents, with potential to reduce internalized stigma in both the short- and longer-term. Future directions include evaluating effects of Project RISE over longer follow-ups and in conjunction with other mental health supports.
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Affiliation(s)
- J. Shen
- Department of Psychology, Stony Brook University, United States of America
| | - A. Rubin
- Department of Psychology, University of Denver, United States of America
| | - K. Cohen
- Department of Psychology, Stony Brook University, United States of America
| | - E.A. Hart
- Department of Psychology, University of Denver, United States of America
| | - J. Sung
- Department of Psychology, Stony Brook University, United States of America
| | - R. McDanal
- Department of Psychology, Stony Brook University, United States of America
| | - C. Roulston
- Department of Psychology, Stony Brook University, United States of America
| | - I. Sotomayor
- Department of Psychology, Stony Brook University, United States of America
| | - K.R. Fox
- Department of Psychology, University of Denver, United States of America
| | - J.L. Schleider
- Department of Psychology, Stony Brook University, United States of America
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, United States of America
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Pachankis JE, Jackson SD. A Developmental Model of the Sexual Minority Closet: Structural Sensitization, Psychological Adaptations, and Post-closet Growth. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:1869-1895. [PMID: 35978203 PMCID: PMC9935753 DOI: 10.1007/s10508-022-02381-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 05/11/2022] [Accepted: 07/11/2022] [Indexed: 05/15/2023]
Abstract
Across the lifespan, most sexual minority individuals experience the closet-a typically prolonged period in which no significant others know their sexual identity. This paper positions the closet as distinct from stigma concealment given its typical duration in years and absolute removal from sources of support for an often-central identity typically during a developmentally sensitive period. The Developmental Model of the Closet proposed here delineates the vicarious learning that takes place before sexual orientation awareness to shape one's eventual experience of the closet; the stressors that take place after one has become aware of their sexual orientation but has not yet disclosed it, which often takes place during adolescence; and potential lifespan-persistent mental health effects of the closet, as moderated by the structural, interpersonal, cultural, and temporal context of disclosure. The paper outlines the ways in which the model both draws upon and is distinct from earlier models of sexual minority identity formation and proposes several testable hypotheses and future research directions, including tests of multilevel interventions.
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Affiliation(s)
- John E Pachankis
- Department of Social and Behavioral Sciences, Yale School of Public Health, 60 College Street, Suite 316, New Haven, CT, 06510, USA.
| | - Skyler D Jackson
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
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Löchner J, Platt B, Starman-Wöhrle K, Takano K, Engelmann L, Voggt A, Loy F, Bley M, Winogradow D, Hämmerle S, Neumeier E, Wermuth I, Schmitt K, Oort F, Schulte-Körne G. A randomized controlled trial of a preventive intervention for the children of parents with depression: mid-term effects, mediators and moderators. BMC Psychiatry 2023; 23:455. [PMID: 37344778 DOI: 10.1186/s12888-023-04926-2] [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: 09/26/2022] [Accepted: 06/05/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND In a parallel randomized controlled trial the effectiveness of the family- and group-based cognitive-behavioural "Gug-Auf" intervention in preventing depression in children of depressed parents was evaluated. We hypothesized that the intervention would be associated with reduced incidence of depression at 15 months as well as with reduced symptom severity at 6, 9, and 15 months. We also explored the role of a number of mediators and moderators. METHODS Families were included if a parent (n = 100, mean age = 46.06, 61% female) had experienced depression and children (n = 135, aged 8-17 years, 53% female) had no mental illness. Families (91.5% German) were randomly allocated (50:50 block-wise; stratified by child age and parental depression) to the 12-session "GuG-Auf" intervention or no intervention. Outcomes were assessed (on an intention-to-treat basis) at 0-(T1), 6-(T2), 9-(T3) and 15-months (T4) after baseline. Primary outcome (onset of depression; T4) was assessed with standardized (blinded) clinical interviews. Secondary (unblinded) outcome was risk of depression (at T2-T4) indicated by self- and parent-reported symptoms of internalizing, externalizing and depressive disorder. Potential mediators were emotion regulation, attributional style, knowledge of depression and parenting style. Potential moderators were parental depression severity and negative life events. RESULTS None of the children who received the intervention developed depression, whereas two of those in the control group did. The intervention significantly reduced depression risk (indicated by severity of self-reported internalizing symptoms) at T3 (p = .027, d = -0.45) and T4 (p = .035, d = -0.44). Both groups showed reduced depressive symptoms (p = .029, d = -0.44). Cognitive problem-solving and negative parenting emerged as mediators. There was no evidence that the intervention was associated with parent-reported internalizing symptoms or externalizing symptoms. No adverse events were observed. CONCLUSIONS Children of parents with depression showed an increase in self-reported (but not parent-reported) internalizing symptoms over time. This increase was not present in children who received the GuG-Auf intervention. The intervention was not associated with changes in externalizing symptoms. Conclusions regarding prevention of the onset of depression were not possible. Despite some limitations in the generalizability, these findings contribute to reducing the burden of youth depression. REGISTRATION The trial was registered on 16/04/2014 at ClinicalTrials.gov ( NCT02115880 ) and study protocol published in BMC Psychiatry ( https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-014-0263-2 ).
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Affiliation(s)
- Johanna Löchner
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
- Department of Child and Adolescent Psychiatry, University Hospital, Eberhard-Karls-University, Tübingen, Germany
| | - Belinda Platt
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU Munich, Munich, Germany.
| | - Kornelija Starman-Wöhrle
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Keisuke Takano
- Human Informatics and Interaction Research Institute (HIIRI), National Institute of Advanced Industrial Science and Technology (AIST), Tsukuba, Japan
| | - Lina Engelmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Alessandra Voggt
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Fabian Loy
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Mirjam Bley
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Dana Winogradow
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Stephanie Hämmerle
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Esther Neumeier
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Inga Wermuth
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Katharina Schmitt
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Frans Oort
- Faculty of Social and Behavioral Sciences, Universiteit van Amsterdam, Amsterdam, Netherlands
| | - Gerd Schulte-Körne
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
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Bhugra D, Smith A, Liebrenz M, Ventriglio A, Gnanapragasam SN, Buadze A, Pemberton M, Poulter D. "Otherness", otherism, discrimination, and health inequalities: entrenched challenges for modern psychiatric disciplines. Int Rev Psychiatry 2023; 35:234-241. [PMID: 37267034 DOI: 10.1080/09540261.2023.2192275] [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: 03/14/2023] [Accepted: 03/14/2023] [Indexed: 06/03/2023]
Abstract
Identity is a complex concept that can be informed by various factors, involving biological, psychological, experiential, and social influences. Specifically, one's social identity refers to the ways in which individuals can adopt attributes from established collective categories, like cultural identities, ethnic identities, gender identities, and class identities, amongst others. Social identity can encompass unique and diverse interactions at an individual level, known as micro-identities, that may be selectively expressed, hidden, or downplayed, contingent on distinct sociocultural settings. However, the formation of social identity is recurrently defined in opposition to perceptions of the Other, which can entail adverse paradigms of marginalisation, stigma, and discrimination. Although this theory of Otherness has been developed across different fields, particularly sociology, it may be important in psychiatric contexts as it can engender inherent risk factors and mental health inequalities. Consequently, this paper seeks to bring attention towards these issues, exploring the construction of Otherness and its detrimental outcomes for psychiatry, such as systemic discrimination and disparities in therapeutic support, alongside recommended initiatives to mitigate against the effects of Otherness. This may require multifactorial approaches that include cultural competency training, interventions informed by micro-identities and intersectionality, patient advocacy, and structural changes to mental health policy.
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Affiliation(s)
- Dinesh Bhugra
- Institute of Psychiatry, Psychology and Neurosciences, Kings College, London, UK
| | - Alexander Smith
- Department of Forensic Psychiatry, University of Bern, Bern, Switzerland
| | - Michael Liebrenz
- Department of Forensic Psychiatry, University of Bern, Bern, Switzerland
| | | | | | - Ana Buadze
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, Specialized Outpatient Clinic for ADHD, University of Zurich, Zurich, Switzerland
| | - Max Pemberton
- Specialist Registrar, Camden and Islington NHS Foundation Trust, London
| | - Daniel Poulter
- South London and Maudsley Foundation NHS Trust, London, UK
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21
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Mereish EH, Peters JR, Brick LAD, Killam MA, Yen S. A daily diary study of minority stressors, suicidal ideation, nonsuicidal self-injury ideation, and affective mechanisms among sexual and gender minority youth. JOURNAL OF PSYCHOPATHOLOGY AND CLINICAL SCIENCE 2023; 132:372-384. [PMID: 36996184 PMCID: PMC10164073 DOI: 10.1037/abn0000813] [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: 04/01/2023]
Abstract
Sexual and gender minority youth (SGMY) are at greater risk than their heterosexual and cisgender counterparts for suicidal thoughts and behaviors (STB) and nonsuicidal self-injury (NSSI). Unique stressors (i.e., minority stressors) specific to SGMY's stigmatized identities such as discrimination or concealment of one's identity are posited to explain these disparities. However, there is limited research examining the associations among minority stressors, affective mediating processes, and STB and NSSI in SGMY's daily lives. We conducted a 28-day daily diary study to test the mediating effects of daily negative and positive affect and emotion dysregulation between minority stressors and STB and NSSI among SGMY who were recruited from clinical and community settings. Participants were 92 SGMY, aged 12-19 years old (M = 16.45; SD = 1.81; 64% cisgender; 69% White). Results indicated that on days SGMY experienced external and internalized minority stressors, they reported greater intensity of suicidal and nonsuicidal self-injurious ideation and affective distress (i.e., greater negative affect, lower positive affect, and more emotion dysregulation). Greater affective reactivity processes were associated with greater suicidal and nonsuicidal self-injurious ideation intensity on the same day. Most of the within-person associations between external and internalized minority stressors and ideation intensity were mediated by heightened negative affect and emotion dysregulation but not lower positive affect. Our results provide the first evidence of these associations among SGMY, advance the minority stress model, and have implications for clinical interventions as we identified modifiable affective mechanisms. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Ethan H Mereish
- Lavender Lab, Department of Psychology, University of Maryland
| | - Jessica R Peters
- Department of Psychiatry and Human Behavior, Warren Alpert Brown Medical School, Brown University
| | - Leslie A D Brick
- Department of Psychiatry and Human Behavior, Warren Alpert Brown Medical School, Brown University
| | - Matthew A Killam
- Beth Israel Deaconess Medical Center, Department of Psychiatry, Harvard Medical School
| | - Shirley Yen
- Department of Psychiatry and Human Behavior, Warren Alpert Brown Medical School, Brown University
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22
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Expósito-Campos P, Pérez-Fernández JI, Salaberria K. Empirically supported affirmative psychological interventions for transgender and non-binary youth and adults: A systematic review. Clin Psychol Rev 2023; 100:102229. [PMID: 36512905 DOI: 10.1016/j.cpr.2022.102229] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 07/30/2022] [Accepted: 11/22/2022] [Indexed: 11/30/2022]
Abstract
Research suggests that transgender and non-binary (TGNB) individuals experience lower levels of psychological well-being than the general population. Although practice recommendations and guidelines exist, there is a paucity of studies evaluating the effects of psychological interventions on this group. This systematic review aimed to synthesize and analyze existing empirical affirmative psychological interventions for TGNB individuals to assess their efficacy. Eight databases (PubMed, Web of Science, PsycINFO, Scopus, LILACS, Cochrane, ProQuest, Google Scholar) were searched from January 2010 to June 2022 to identify relevant studies. Included studies needed to be randomized controlled trials, quasi-experimental, or uncontrolled pre-post. Twenty-two articles were included, of which eight had TGNB participants only, two had mixed samples with separated outcome data for TGNB participants, and 12 had mixed samples with no disaggregated data. Experimental designs, participant samples, assessed variables, and type of interventions varied widely across studies, thus preventing comparisons. Overall results suggest improvements in psychological distress, depression, anxiety, suicidality, substance-related risk behaviors, coping skills/emotion regulation, stress appraisal, self-esteem, self-acceptance, social support, minority stress, resilience, hope, positive identity, and identity acceptance, although conclusions are limited by moderate-to-high risk of bias. Future research should implement more consistent and rigorous methodological designs to assess and compare intervention efficacy.
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Affiliation(s)
- Pablo Expósito-Campos
- Department of Clinical and Health Psychology and Research Methods, Faculty of Psychology, University of the Basque Country, Tolosa Hiribidea 70, 20018 Donostia-San Sebastián, Gipuzkoa, Spain; Predoctoral Research Fellowship Program of the Department of Education of the Government of the Basque Country, Spain.
| | - José Ignacio Pérez-Fernández
- Department of Clinical and Health Psychology and Research Methods, Faculty of Psychology, University of the Basque Country, Tolosa Hiribidea 70, 20018 Donostia-San Sebastián, Gipuzkoa, Spain
| | - Karmele Salaberria
- Department of Clinical and Health Psychology and Research Methods, Faculty of Psychology, University of the Basque Country, Tolosa Hiribidea 70, 20018 Donostia-San Sebastián, Gipuzkoa, Spain
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23
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Guo L. The delayed, durable effect of expressive writing on depression, anxiety and stress: A meta-analytic review of studies with long-term follow-ups. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2023; 62:272-297. [PMID: 36536513 DOI: 10.1111/bjc.12408] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/17/2022] [Accepted: 11/22/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Expressive writing is a promising tool to heal the wounds with words. AIMS This meta-analysis evaluated the current state of efficacy of expressive writing on depression, anxiety and stress symptoms among healthy and subclinical samples. MATERIALS AND METHODS Thirty-one experimental studies (N = 4012) with randomized controlled trials and follow-up assessments were analysed. RESULTS Results showed that expressive writing had an overall small but significant effect (Hedges' g = -0.12, 95% CI [-0.21, -0.04]) on reducing symptoms of depression, anxiety and stress. Change score analyses suggested that the intervention effect emerged after a delay, as evidenced by assessments at follow-up periods. Moderator analyses indicated that the effect sizes varied as a function of one intervention feature: interval. Studies that implemented short intervals (1-3 days) between writing sessions yielded stronger effects (Gdiff = -0.18, p = .01) relative to studies that implemented medium intervals (4-7 days) or long intervals (>7 days). The effects of expressive writing remained consistent across other intervention features including focus, instruction, number of sessions, topic repetition and delivery mode. DISCUSSION Together, these findings provide evidence for the delayed, durable effect of expressive writing and underscore the importance of scheduling writing sessions at short intervals. CONCLUSION Implications for incorporating expressive writing into clinical practice and daily life are discussed.
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Affiliation(s)
- Lin Guo
- Languages, Literatures and Linguistics Department, Syracuse University, Syracuse, New York, USA
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24
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Victor SE, Trieu TH, Seymour NE. Associations with LGBTQ+ mental health disparities during the COVID-19 pandemic. PSYCHOLOGY & SEXUALITY 2023. [DOI: 10.1080/19419899.2023.2179938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Affiliation(s)
| | - Terry H. Trieu
- Texas Tech University, Department of Psychological Sciences
| | - Nicole E. Seymour
- Center for Behavioral Medicine, Missouri Department of Mental Health
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25
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Xin Y, Schwarting CM, Wasef MR, Davis AK. Exploring the intersectionality of stigma and substance use help-seeking behaviours among lesbian, gay, bisexual, transgender, queer, questioning or otherwise gender or sexuality minority (LGBTQ+) individuals in the United States: A scoping review. Glob Public Health 2023; 18:2277854. [PMID: 37939481 DOI: 10.1080/17441692.2023.2277854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 10/26/2023] [Indexed: 11/10/2023]
Abstract
Problematic substance use (SU) is a significant issue among LGBTQ+ individuals, but rates of treatment/help-seeking in this population remain low. This review aimed to investigate literature about intersectional stigma of SU and LGBTQ+ identity and its impact on SU help-seeking behaviours in the U.S. Eligible studies from eight-database were included if peer-reviewed, in English, from the U.S., published between 2000 and 2022, focused on SU, stigma, SU help-seeking behaviours, among LGBTQ+ adults. Of 458 search results, 50 underwent full-text review, 12 were included in the final sample. Minority Stress Theory emerged as a relevant theoretical framework. Findings revealed that increased SU as a coping strategy was associated with minority stress. Intersectional stigma negatively impacted SU treatment experience among LGBTQ+ individuals, leading to avoidance of help-seeking or poor treatment outcomes. Patterns of SU and impact of stigma among LGBTQ+ individuals differ, wherein bisexual and transgender individuals reported significantly more treatment barriers and unique stressors. LGBTQ+ individuals reported earlier age of SU onset and were more likely to encounter opportunities for SU. This review highlights the impact of intersectional stigma on SU help-seeking behaviour among LGBTQ+ individuals in the U.S. Recommendations are provided for future clinical practice, research, and policy to better support LGBTQ+ individuals.
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Affiliation(s)
- Yitong Xin
- Center for Psychedelic Drug Research and Education, College of Social Work, The Ohio State University, Columbus, OH, USA
| | - Corrine M Schwarting
- Department of Psychology, Psychology Department, Iowa State University, Ames, IA, USA
| | - Mary R Wasef
- Center for Psychedelic Drug Research and Education, College of Social Work, The Ohio State University, Columbus, OH, USA
| | - Alan K Davis
- Center for Psychedelic Drug Research and Education, College of Social Work, The Ohio State University, Columbus, OH, USA
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26
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Li G, Archer Lee Y, Krampitz E, Lin X, Atilla G, Nguyen KC, Rosen HR, Tham CZ, Chen FS. Computer passwords as a timely booster for writing-based psychological interventions. Internet Interv 2022; 30:100572. [PMID: 36118138 PMCID: PMC9474853 DOI: 10.1016/j.invent.2022.100572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 08/22/2022] [Accepted: 09/05/2022] [Indexed: 12/01/2022] Open
Abstract
Writing-based psychological interventions have been widely implemented to produce adaptive change, e.g., through self-affirmation (reminding people of their most important values). To maintain the long-term effects of these interventions, we developed a form of intervention boosters-using user-customized computer passwords to convey the therapeutic messages. We examined whether computer passwords could enhance the effect of a self-affirmation intervention on the psychological well-being of sexual minority undergraduate students as they begin university. Participants were randomly assigned to either complete a self-affirmation writing exercise and create a self-affirming computer password to use for 6 weeks or complete a control writing exercise and create a control computer password. We found that frequency of password usage moderated the intervention effect, such that frequent use of self-affirming passwords buffered decreases in psychological well-being over the study period. These findings suggest that passwords can serve as a low-cost, low-burden, and timely booster for writing-based psychological interventions.
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Affiliation(s)
- Gu Li
- Faculty of Arts and Sciences, NYU Shanghai, Shanghai 200122, China,Social Development Group, NYU Shanghai, Shanghai 200122, China,Center for Global Health Equity, NYU Shanghai, Shanghai 200122, China,Department of Psychology, University of British Columbia, Vancouver, BC V6T 1Z4, Canada,Corresponding author at: NYU Shanghai, 1555 Century Avenue, Pudong New Area, Shanghai 200122, China.
| | - Yeeun Archer Lee
- Department of Psychology, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Elizabeth Krampitz
- Department of Psychology, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Xiaohan Lin
- Faculty of Arts and Sciences, NYU Shanghai, Shanghai 200122, China,Department of Psychology, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Gorkem Atilla
- Department of Psychology, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Kien C. Nguyen
- Faculty of Arts and Sciences, NYU Shanghai, Shanghai 200122, China,Department of Psychology, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Hannah R. Rosen
- Department of Psychology, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Clarinne Z.E. Tham
- Department of Psychology, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Frances S. Chen
- Department of Psychology, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
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27
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Price MA, Hollinsaid NL. Future Directions in Mental Health Treatment with Stigmatized Youth. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2022; 51:810-825. [PMID: 36007234 PMCID: PMC9835015 DOI: 10.1080/15374416.2022.2109652] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Stigma refers to societally-deemed inferiority associated with a circumstance, behavior, status, or identity. It manifests internally, interpersonally, and structurally. Decades of research indicate that all forms of stigma are associated with heightened risk for mental health problems (e.g., depression, PTSD, suicidality) in stigmatized youth (i.e., children, adolescents, and young adults with one or more stigmatized identities, such as youth of Color and transgender youth). Notably, studies find that stigmatized youth living in places with high structural stigma - defined as laws/policies and norms/attitudes that hurt stigmatized people - have a harder time accessing mental health treatment and are less able to benefit from it. In order to reduce youth mental health inequities, it is imperative for our field to better understand, and ultimately address, stigma at each of these levels. To facilitate this endeavor, we briefly review research on stigma and youth mental health treatment, with an emphasis on structural stigma, and present three future directions for research in this area: (1) directly addressing stigma in treatment, (2) training therapists in culturally responsive care, and (3) structural interventions. We conclude with recommendations for best practices in broader mental health treatment research.
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Affiliation(s)
- Maggi A. Price
- School of Social Work, Boston College, Boston, MA
- Department of Psychology, Harvard University, Cambridge, MA
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28
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Herrmann WJ, Oeser P, Buspavanich P, Lech S, Berger M, Gellert P. Loneliness and depressive symptoms differ by sexual orientation and gender identity during physical distancing measures in response to COVID-19 pandemic in Germany. Appl Psychol Health Well Being 2022; 15:80-96. [PMID: 35666060 PMCID: PMC9348355 DOI: 10.1111/aphw.12376] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 05/14/2022] [Indexed: 11/28/2022]
Abstract
During the COVID-19 pandemic, physical distancing measures to prevent transmission of the virus have been implemented. The effect of physical distancing measures on loneliness especially for vulnerable groups remained unclear. Thus, we aimed to investigate loneliness in relation with depressive symptoms among lesbian, gay, bisexual, trans, inter, asexual, and queer (LGBT) persons compared with cis-heterosexual persons during the pandemic. We conducted an online survey during the first two waves of the COVID-19 pandemic in Germany. The survey contained self-categorizations regarding sexual orientation and gender identity, questions on loneliness, social contacts, depressive symptoms, and healthcare. Descriptive and regression analysis and propensity score matching across cohorts was conducted using R; 2641 participants took part in first wave of the survey and 4143 participants in the second wave. The proportion of lonely people was higher in the second wave compared with the first wave. LGBT persons were more lonely than cis-heterosexual persons. In both waves, being LGBT was associated with depressive symptoms, but loneliness mediated the effect, even when adjusting for social contacts. Psychologists and other practitioners should be aware that LGBT clients might have an increased risk for loneliness and depressive symptoms and of the potential burden of the pandemic measures.
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Affiliation(s)
- Wolfram J. Herrmann
- Institute of General PracticeCharité ‐ Universitätsmedizin BerlinBerlinGermany,Münster School of HealthFH MünsterMünsterGermany
| | - Philip Oeser
- Institute of General PracticeCharité ‐ Universitätsmedizin BerlinBerlinGermany
| | - Pichit Buspavanich
- Gender in Medicine (GiM)Charité ‐ Universitätsmedizin BerlinBerlinGermany,Department of Psychiatry, Psychotherapy and PsychosomaticsBrandenburg Medical School Theodor FontaneNeuruppinGermany,Department of Psychiatry and PsychotherapyCharité ‐ Universitätsmedizin BerlinBerlinGermany,Institute of Sexology and Sexual MedicineCharité – Universitätsmedizin BerlinBerlinGermany,Faculty of Health Sciences BrandenburgJoint Faculty of the University of Potsdam, Brandenburg University of Technology Cottbus‐Senftenberg and Brandenburg Medical SchoolPotsdamGermany
| | - Sonia Lech
- Department of Psychiatry, Psychotherapy and PsychosomaticsBrandenburg Medical School Theodor FontaneNeuruppinGermany,Department of Psychiatry and PsychotherapyCharité ‐ Universitätsmedizin BerlinBerlinGermany,Institute of Medical Sociology and Rehabilitation ScienceCharité ‐ Universitätsmedizin BerlinBerlinGermany
| | - Maximilian Berger
- Department of Psychiatry, Psychotherapy and PsychosomaticsBrandenburg Medical School Theodor FontaneNeuruppinGermany,Department of Psychiatry and PsychotherapyCharité ‐ Universitätsmedizin BerlinBerlinGermany
| | - Paul Gellert
- Institute of Medical Sociology and Rehabilitation ScienceCharité ‐ Universitätsmedizin BerlinBerlinGermany
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29
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Price MA, Weisz JR, McKetta S, Hollinsaid NL, Lattanner MR, Reid AE, Hatzenbuehler ML. Meta-analysis: Are Psychotherapies Less Effective for Black Youth in Communities With Higher Levels of Anti-Black Racism? J Am Acad Child Adolesc Psychiatry 2022; 61:754-763. [PMID: 34371101 PMCID: PMC8818051 DOI: 10.1016/j.jaac.2021.07.808] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 07/13/2021] [Accepted: 07/30/2021] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To examine whether anti-Black cultural racism moderates the efficacy of psychotherapy interventions among youth. METHOD A subset of studies from a previous meta-analysis of 5 decades of youth psychotherapy randomized controlled trials was analyzed. Studies were published in English between 1963 and 2017 and identified through a systematic search. The 194 studies (N = 14,081 participants; age range, 2-19) across 34 states comprised 2,678 effect sizes (ESs) measuring mental health problems (eg, depression) targeted by interventions. Anti-Black cultural racism was operationalized using a composite index of 31 items measuring explicit racial attitudes (obtained from publicly available sources, eg, General Social Survey) aggregated to the state level and linked to the meta-analytic database. Analyses were conducted with samples of majority-Black (ie, ≥50% Black) (n = 36 studies) and majority-White (n = 158 studies) youth. RESULTS Two-level random-effects meta-regression analyses indicated that higher anti-Black cultural racism was associated with lower ESs for studies with majority-Black youth (β = -0.2, 95% CI [-0.35, -0.04], p = .02) but was unrelated to ESs for studies with majority-White youth (β = 0.0004, 95% CI [-0.03, 0.03], p = .98), controlling for relevant area-level covariates. In studies with majority-Black youth, mean ESs were significantly lower in states with the highest anti-Black cultural racism (>1 SD above the mean; Hedges' g = 0.19) compared with states with the lowest racism (<1 SD below the mean; Hedges' g = 0.60). CONCLUSION Psychotherapies tested with samples of majority-Black youth were significantly less effective in states with higher (vs lower) levels of anti-Black cultural racism, suggesting that anti-Black cultural racism may be one contextual moderator of treatment effect heterogeneity.
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Affiliation(s)
- Maggi A. Price
- Harvard University, Cambridge, Massachusetts,Boston College, Massachusetts
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30
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Pachankis JE, Harkness A, Maciejewski KR, Behari K, Clark KA, McConocha E, Winston R, Adeyinka O, Reynolds J, Bränström R, Esserman DA, Hatzenbuehler ML, Safren SA. LGBQ-affirmative cognitive-behavioral therapy for young gay and bisexual men's mental and sexual health: A three-arm randomized controlled trial. J Consult Clin Psychol 2022; 90:459-477. [PMID: 35482652 PMCID: PMC9446477 DOI: 10.1037/ccp0000724] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Effective Skills to Empower Effective Men (ESTEEM) represents the first intervention to address the psychological pathways through which minority stress undermines young sexual minority men's (SMM's) mental and sexual health using transdiagnostic cognitive-behavioral therapy. This study compared the efficacy of ESTEEM against two existing interventions. METHOD Participants were young HIV-negative SMM (N = 254; ages = 18-35; 67.2% racial/ethnic minority) experiencing a depression, anxiety, and/or stress-/trauma-related disorder and past-90-day HIV transmission risk behavior. After completing HIV testing and counseling, participants were randomized to receive 10-session ESTEEM (n = 100); 10-session community-based LGBQ-affirmative counseling (n = 102); or only HIV testing and counseling (n = 52). RESULTS For the primary outcome of any HIV transmission risk behavior at 8 months, ESTEEM was not significantly associated with greater reduction compared to HIV testing and counseling (risk ratio [RR] = 0.89, p = .52). Supportive analyses of the frequency of HIV transmission risk behavior at 8 months showed a nonsignificant difference between ESTEEM compared to HIV testing and counseling (RR = 0.69) and LGBQ-affirmative counseling (RR = 0.62). For secondary outcomes (e.g., depression, anxiety, substance use, suicidality, number of mental health diagnoses) at 8 months, ESTEEM had a larger effect size than the two comparison conditions, but these comparisons did not reach statistical significance when adjusting for the false discovery rate. Observed effect sizes for condition comparisons were smaller than the effect sizes used to power the study. In exploratory analyses, ESTEEM showed promise for reducing comorbidity. CONCLUSIONS Because the control conditions were associated with stronger effects than anticipated, and given the heterogeneous nature of transdiagnostic outcomes, the study possessed insufficient power to statistically detect the consistently small-to-moderate benefit of ESTEEM compared to the two control conditions. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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31
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Morris DDA, Fernandes V, Rimes KA. Sexual minority service user perspectives on mental health treatment barriers to care and service improvements. Int Rev Psychiatry 2022; 34:230-239. [PMID: 36151833 DOI: 10.1080/09540261.2022.2051445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Sexual minorities (individuals with a lesbian, gay, bisexual, queer, or other non-heterosexual identity) are at elevated risk of developing common mental health disorders relative to heterosexual people, yet have less favourable mental health service experiences and poorer treatment outcomes. We investigated the experiences of sexual minority service users accessing mental health services for common mental health problems (e.g. depression or anxiety) in the UK. We recruited 26 sexual minority adults with experiences of being referred to Improving Access to Psychological Therapies (IAPT) or primary care counselling services. Semi-structured interviews explored participants' experiences of service use and views on service development. Interviews were analysed using thematic analysis. Barriers to effective relationships with practitioners included service users' fears surrounding disclosure, and practitioners' lack of understanding and/or neglect of discussions around sexuality. Regarding service development, participants highlighted the value of seeing practitioners with shared identities and experiences, visible signs of inclusivity, sexual minority training, tailored supports, and technological adjuncts. Our findings offer insights into possible contributory factors to treatment inequalities, and highlight potential methods for improving service provision for sexual minorities.
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Affiliation(s)
- Daniel D A Morris
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Vanessa Fernandes
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Katharine A Rimes
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
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32
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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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33
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Ren D, Wang Y, Han M, Zhang Y, Cai C, Liu K, Li R, Liu H, Ou J, Wang Y, Han J, Chen R. Internet-based interventions to promote help-seeking for mental health in LGBTQ+ young adults: Protocol for a randomized controlled trial. Internet Interv 2022; 28:100524. [PMID: 35342718 PMCID: PMC8943403 DOI: 10.1016/j.invent.2022.100524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/08/2022] [Accepted: 03/11/2022] [Indexed: 11/26/2022] Open
Abstract
Background Compared to its cis-heterosexual counterpart, the sexual and gender minority (SGM) population is disproportionately susceptible to mental health problems, including depression, anxiety, and minority stress. They are also facing unique help-seeking barriers when in need of support. Past research has shown promising results in using interventions to promote help-seeking intentions and attitudes of the cis-heterosexual population. However, there were no known help-seeking interventions targeting the SGM population. This protocol illustrates a study design to test the efficacy of a newly-developed internet-based program aimed to promote help-seeking for mental health in LGBTQ+ young adults. Methods This study is a randomized controlled trial that aims to promote and improve the SGM young adults' help-seeking by integrating animated psychoeducational videos, group discussion, and the SGM youth help-seeking brochure. Primary outcomes, including help-seeking intentions and attitudes, will be measured at baseline, post-intervention, one-month post-intervention, and three-month post-intervention. The secondary outcomes, including help-seeking stigma, help-seeking literacy, mental health literacy, and help-seeking behaviors, will be measured at the same time points. Discussion This is an internet-based, multi-dimensional, and integrative intervention tailored to the needs of the SGM population. It addresses an important gap in the current landscape of mental health promotion for the SGM population. The findings from this trial will provide new knowledge on promoting help-seeking among the SGM population, paving the road for future research that focuses on addressing mental health issues faced by the SGM population. Trial registration Chictr.org.cn: ChiCTR2100053248.
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Affiliation(s)
- Daixi Ren
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Yinzhe Wang
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Meng Han
- Vanke School of Public Health, Tsinghua University, Beijing, China
- Department of Medical Psychology, The School of Health Humanities, Peking University, Beijing, China
| | - Yanwen Zhang
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Chengxi Cai
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Kunxu Liu
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Runan Li
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Hailan Liu
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Jianjun Ou
- National Clinical Research Center for Mental Disorders, Department of Psychiatry, and China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Yuanyuan Wang
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, China; School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, China
- Division of Psychology, Faculty of Health and Life Sciences, De Montfort University, Leicester, UK
| | - Jin Han
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Runsen Chen
- Vanke School of Public Health, Tsinghua University, Beijing, China
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Engagement With Personalized Feedback for Emotional Distress Among College Students at Elevated Suicide Risk. Behav Ther 2022; 53:365-375. [PMID: 35227410 PMCID: PMC8894794 DOI: 10.1016/j.beth.2021.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 10/06/2021] [Accepted: 10/09/2021] [Indexed: 11/21/2022]
Abstract
Depression and suicidal ideation have substantially increased among college students, yet many students with clinically significant symptoms do not perceive their distress as warranting mental health services. Personalized feedback (PF) interventions deliver objective data, often electronically, comparing an individual's reported symptoms or behaviors to a group norm. Several studies have shown promise for PF interventions in the context of mood and depression, yet little is known regarding how, and for whom, mood-focused PF interventions might be best deployed. The primary aim of this study was to examine the sociodemographic, clinical, and treatment-seeking factors associated with reviewing PF reports on emotional distress among college students (N = 1,673) screening positive for elevated suicide risk and not receiving mental health treatment. Results indicated that PF engagement was greatest among those with higher depression scores, and those reporting privacy/stigma concerns as barriers to treatment. Sexual minority students were more likely to review their PF than heterosexual students. Taken together, PF interventions may be a useful tool for engaging those with greater clinical acuity, and those hesitant to seek in-person care. Further research is warranted to examine the circumstances in which PF interventions might be used in isolation, or as part of a multitiered intervention strategy.
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Dat NT, Mitsui N, Asakura S, Takanobu K, Fujii Y, Toyoshima K, Kako Y, Kusumi I. The Effectiveness of Self-Esteem-Related Interventions in Reducing Suicidal Behaviors: A Systematic Review and Meta-Analysis. Front Psychiatry 2022; 13:925423. [PMID: 35782451 PMCID: PMC9240430 DOI: 10.3389/fpsyt.2022.925423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 05/20/2022] [Indexed: 11/13/2022] Open
Abstract
UNLABELLED Suicide is a serious social issue and is often treated using psychological interventions. The current systematic review and meta-analysis aimed to investigate the effectiveness of self-esteem-related interventions on suicidal behaviors. A systematic literature search for randomized controlled trials (RCTs) including a self-esteem component was conducted on 29 May 2021 and updated on 4 April 2022. In total, 12 studies were included in the systematic review and five studies were included in the meta-analysis. Small effect sizes were found for suicidal ideation at post intervention [g = -0.24, 95% CI (-0.48, 0.00)] and a 3-month follow-up [g = -0.36, 95% CI (-0.62, -0.11)]. However, these results should be interpreted cautiously due to the limited number of included studies and varied sample population. In conclusion, the current review suggests that future intervention studies should incorporate self-esteem enhancement in the treatment of suicidal behaviors, especially for suicidal ideation. SYSTEMATIC REVIEW REGISTRATION https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=250882.
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Affiliation(s)
- Nguyen Tan Dat
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Nobuyuki Mitsui
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Satoshi Asakura
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Japan.,The Department of Psychiatry, Health Care Center of Hokkaido University, Sapporo, Japan
| | - Keisuke Takanobu
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Yutaka Fujii
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Japan.,The Department of Psychiatry, Health Care Center of Hokkaido University, Sapporo, Japan
| | - Kuniyoshi Toyoshima
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Yuki Kako
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Ichiro Kusumi
- Department of Psychiatry, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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Derringer JC, Biddle MJ. Potential directions for farm stress research: A systematic review of educational interventions to reduce psychosocial stress among farm and rural populations. J Rural Health 2021; 38:554-573. [PMID: 34784068 DOI: 10.1111/jrh.12633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Despite prevalence of high psychosocial stress and suicide among farm and rural populations, few studies exist that measure effectiveness of stress reduction interventions. PURPOSE To (1) compare studies with educational interventions on psychosocial stress as measured by reliable and valid instruments in farm and rural populations and (2) identify educational strategies utilized among effective interventions. METHODS This systematic review was conducted across 4 electronic databases and Google Scholar to identify research that reported outcomes of stress reduction educational interventions among farm and rural populations. Original research articles published in English between January 1980 and October 2020 were included. Literature was excluded that: (1) used cognitive behavioral therapy, (2) reported outcomes of post-traumatic distress disorders, and (3) examined clinical guidelines or policy change. Extracted data included study characteristics, outcomes, and delivery methodology. FINDINGS Title and abstract screening resulted in 256 manuscripts assessed for inclusion criteria. The final selection of 22 studies were categorized into 2 educational intervention delivery methods: home/community setting or virtual. Fourteen out of 22 studies reported significant stress reduction. Virtual interventions had the most promising impact on psychosocial stress with significant reduction reported in 4 of 6 studies; however, mixed results were found among all delivery methods. CONCLUSIONS Educational interventions may reduce psychosocial stress among farm and rural populations, though important questions remain. We recommend future research should focus on barriers to participation, development of measurement tools, and consistent outcome measurement.
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Affiliation(s)
- Julie C Derringer
- College of Nursing, University of Kentucky, Lexington, Kentucky, USA
| | - Martha J Biddle
- College of Nursing, University of Kentucky, Lexington, Kentucky, USA
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37
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Hatzenbuehler ML, Pachankis JE. Does Stigma Moderate the Efficacy of Mental- and Behavioral-Health Interventions? Examining Individual and Contextual Sources of Treatment-Effect Heterogeneity. CURRENT DIRECTIONS IN PSYCHOLOGICAL SCIENCE 2021. [DOI: 10.1177/09637214211043884] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
In this article, we argue that stigma may be an important, but heretofore underrecognized, source of heterogeneity in treatment effects of mental- and behavioral-health interventions. To support this hypothesis, we review recent evidence from randomized controlled trials and spatial meta-analyses suggesting that stigma may predict not only who responds more favorably to these health interventions (i.e., individuals with more stigma experiences), but also the social contexts that are more likely to undermine intervention effects (i.e., communities with greater structural stigma). By highlighting the potential role of personal and contextual stigma in shaping response to interventions, our review paves the way for additional research.
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Affiliation(s)
| | - John E. Pachankis
- Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University
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38
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Berona J, Whitton S, Newcomb ME, Mustanski B, Gibbons R. Predicting the Transition From Suicidal Ideation to Suicide Attempt Among Sexual and Gender Minority Youths. Psychiatr Serv 2021; 72:1261-1267. [PMID: 34346732 PMCID: PMC8570968 DOI: 10.1176/appi.ps.202000497] [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: 11/30/2022]
Abstract
OBJECTIVE Sexual and gender minority youths are more likely to consider, attempt, and die by suicide than are heterosexual and cisgender youths, yet little is known about how to predict future attempts or transitions from suicidal thoughts to behaviors. Additionally, adaptive measurement of psychopathology is a promising approach that may help characterize risk in this population. This study examined the validity of the Computerized Adaptive Test for Suicide Scale (CAT-SS) in predicting suicide attempts and the transition from suicidal ideation to attempt. METHODS The CAT-SS was administered to participants of two ongoing cohort studies of sexual and gender minority adolescents and young adults (N=1,006). Survival analyses examined longitudinal associations between CAT-SS scores and time to suicide attempt. Analyses were conducted for the full sample and stratified by those with and without a history of suicidal ideation, with comparisons between adaptive and static measures of depressive symptoms. RESULTS The CAT-SS predicted future suicide attempts in the overall sample (hazard ratio [HR]=1.34, 95% confidence interval [CI]=1.03-1.74). Among youths without a history of suicidal ideation, social support reduced the risk for attempts (HR=0.66, 95% CI=0.45-0.96). Among youths with a history of ideation, predictors of the transition from suicidal thoughts to attempts included baseline CAT-SS score (HR=1.51, 95% CI=1.06-2.15) and victimization (HR=2.48, 95% CI=1.10-5.59). CONCLUSIONS Risk and protective factors for suicide attempts differed between youths with and without a history of suicidal thoughts. The CAT-SS had validity in predicting future risk of the sample overall and of youths with suicidal ideation.
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Affiliation(s)
- Johnny Berona
- Department of Psychiatry and Behavioral Neuroscience (Berona), and Center for Health Statistics, Departments of Medicine, Public Health Sciences, and Comparative Human Development (Gibbons), University of Chicago, Chicago; Department of Psychology, University of Cincinnati, Cincinnati (Whitton); Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, and Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Berona, Newcomb, Mustanski)
| | - Sarah Whitton
- Department of Psychiatry and Behavioral Neuroscience (Berona), and Center for Health Statistics, Departments of Medicine, Public Health Sciences, and Comparative Human Development (Gibbons), University of Chicago, Chicago; Department of Psychology, University of Cincinnati, Cincinnati (Whitton); Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, and Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Berona, Newcomb, Mustanski)
| | - Michael E Newcomb
- Department of Psychiatry and Behavioral Neuroscience (Berona), and Center for Health Statistics, Departments of Medicine, Public Health Sciences, and Comparative Human Development (Gibbons), University of Chicago, Chicago; Department of Psychology, University of Cincinnati, Cincinnati (Whitton); Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, and Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Berona, Newcomb, Mustanski)
| | - Brian Mustanski
- Department of Psychiatry and Behavioral Neuroscience (Berona), and Center for Health Statistics, Departments of Medicine, Public Health Sciences, and Comparative Human Development (Gibbons), University of Chicago, Chicago; Department of Psychology, University of Cincinnati, Cincinnati (Whitton); Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, and Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Berona, Newcomb, Mustanski)
| | - Robert Gibbons
- Department of Psychiatry and Behavioral Neuroscience (Berona), and Center for Health Statistics, Departments of Medicine, Public Health Sciences, and Comparative Human Development (Gibbons), University of Chicago, Chicago; Department of Psychology, University of Cincinnati, Cincinnati (Whitton); Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, and Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago (Berona, Newcomb, Mustanski)
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39
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Fenton MP, Forthun LF, Aristild S, Vasquez KB. The Role of the Rural Context in the Transition to Adulthood: A Scoping Review. ADOLESCENT RESEARCH REVIEW 2021; 7:101-126. [PMID: 34127948 PMCID: PMC8190761 DOI: 10.1007/s40894-021-00161-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 05/11/2021] [Indexed: 06/12/2023]
Abstract
Rural adolescents are transitioning to adulthood in the context of growing disparities. To advance research on the social, behavioral, and contextual factors that influence rural young adult development, this study conducted a scoping review. The review sought to identify how researchers defined rural and how/which theories guided their work; how they integrated the rural context into the research design and methods; and how they used variables, concepts, and outcomes to measure rural experiences. Included articles were published between January 2009 and November 2020, included young adults ages 18-29, measured adult role achievement and/or behavioral health outcomes and reported on these outcomes for young adults, and focused on a rural sample within the United States. A systematic search of four databases resulted in 25 empirical articles for the inductive, qualitative analysis. Most studies used atheoretical approaches focusing on outcomes related to adult social roles, substance use, and mental health. Five themes emerged focused on the definitions of rural, the level of integration into the research design and method, and variables salient to the rural experience. These results reveal that future research should clearly define the rural context and better integrate the rural context into the conceptualization, design, methods, and implications of the empirical research.
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Affiliation(s)
- Melissa Pearman Fenton
- Department of Family, Youth and Community Sciences, University of Florida, 3041 McCarty D, PO BOX 110310, Gainesville, FL 32611 USA
| | - Larry F. Forthun
- Department of Family, Youth and Community Sciences, University of Florida, 3041 McCarty D, PO BOX 110310, Gainesville, FL 32611 USA
| | - Saprina Aristild
- Morsani College of Medicine, University of South Florida, 12901 Bruce B. Downs Blvd. MDC BOX 40, Tampa, FL 33612 USA
| | - Katherine B. Vasquez
- Department of Family, Youth and Community Sciences, University of Florida, 3041 McCarty D, PO BOX 110310, Gainesville, FL 32611 USA
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Khan AG, Kamruzzaman M, Rahman MN, Mahmood M, Uddin MA. Quality of life in the COVID-19 outbreak: influence of psychological distress, government strategies, social distancing, and emotional recovery. Heliyon 2021; 7:e06407. [PMID: 33688587 PMCID: PMC7923947 DOI: 10.1016/j.heliyon.2021.e06407] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 10/09/2020] [Accepted: 02/26/2021] [Indexed: 12/13/2022] Open
Abstract
Considering the severity of the effects of COVID-19 on psychological health and quality of life, the present study investigates the direct effects of government strategies and social distancing and the moderating effect of emotional recovery on psychological distress and quality of life using the tenets of the theory of attachment and learned helplessness. The snowball sampling technique was used to recruit respondents from Bangladesh who completed a self-administered questionnaire via Google Forms, which provided cross-sectional data. The results revealed that both social distancing and government strategies have significant negative influences on psychological distress. Besides, government strategies have a significant positive influence on social distancing. Although psychological distress has a significant negative influence on quality of life, emotional recovery shows no moderating effect on the relationship between psychological distress and quality of life during the COVID-19 pandemic. The study provides insights for regulatory bodies and policymakers for developing effective policy interventions to ensure the well-being of people during this pandemic. Finally, the study highlights the implications for both theory and practice and a few notes for further research.
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Affiliation(s)
- Abdul Gaffar Khan
- Department of Management, Mawlana Bhashani Science and Technology University, Tangail 1902, Bangladesh
| | - Md. Kamruzzaman
- Dept. of Applied Nutrition and Food Technology, Islamic University, Kushtia 7003, Bangladesh
| | - Md. Nannur Rahman
- Dept. of Food Technology and Nutritional Science, Mawlana Bhashani Science and Technology University, Tangail 1902, Bangladesh
| | | | - Md. Aftab Uddin
- Department of Human Resource Management, University of Chittagong, Chattogram 4331, Bangladesh
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41
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Bränström R, Pachankis JE. Country-level structural stigma, identity concealment, and day-to-day discrimination as determinants of transgender people's life satisfaction. Soc Psychiatry Psychiatr Epidemiol 2021; 56:1537-1545. [PMID: 33582826 PMCID: PMC8429389 DOI: 10.1007/s00127-021-02036-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 01/29/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Discriminatory laws, policies, and population attitudes, surrounding transgender people vary greatly across countries, from equal protection under the law and full acceptance to lack of legal recognition and open bias. The consequences of this substantial between-country variation on transgender people's health and well-being is poorly understood. We therefore examined the association between structural stigma and transgender people's life satisfaction across 28 countries. METHODS Data from transgender participants (n = 6771) in the 2012 EU-LGBT-survey regarding identity concealment, day-to-day discrimination, and life satisfaction were assessed. Structural stigma was measured using publicly available data regarding each country's discriminatory laws, policies, and population attitudes towards transgender people. RESULTS Multilevel models showed that country-level structural stigma was associated with lower life satisfaction, an association largely explained by higher levels of identity concealment in higher-structural-stigma countries. Yet identity concealment was also associated with lower day-to-day discrimination and therefore protected against even lower life satisfaction. CONCLUSION The results emphasize the importance of changing discriminatory legislation and negative population attitudes to improve transgender people's life satisfaction, and also highlight targets for intervention at interpersonal and individual levels.
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Affiliation(s)
- Richard Bränström
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Nobels väg 9, 171 77, Stockholm, Sweden.
| | - John E Pachankis
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
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42
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Pachankis JE, Mahon CP, Jackson SD, Fetzner BK, Bränström R. Sexual orientation concealment and mental health: A conceptual and meta-analytic review. Psychol Bull 2020; 146:831-871. [PMID: 32700941 PMCID: PMC8011357 DOI: 10.1037/bul0000271] [Citation(s) in RCA: 129] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Identity concealment affects all sexual minority individuals, with potentially complex mental health implications. Concealing a sexual minority identity can simultaneously generate the stress of hiding, protect against the stress of discrimination, and keep one apart from sexual minority communities and their norms and supports. Not surprisingly, existing studies of the association between sexual orientation concealment and mental health problems show contradictory associations-from positive to negative to null. This meta-analysis attempts to resolve these contradictions. Across 193 studies (n = 92,236) we find a small positive association between sexual orientation concealment and internalizing mental health problems (i.e., depression, anxiety, distress, problematic eating; ESr = 0.126; 95% CI [0.102, 0.151]) and a small negative association between concealment and substance use problems (ESr = -0.061; 95% CI [-0.096, -0.026]). The association between concealment and internalizing mental health problems was larger for those studies that assessed concealment as lack of open behavior, those conducted recently, and those with younger samples; it was smaller in exclusively bisexual samples. Year of data collection, study location, and sample gender, education, and racial/ethnic composition did not explain between-study heterogeneity. Results extend existing theories of stigma and sexual minority mental health, suggesting potentially distinct stress processes for internalizing problems versus substance use problems, life course fluctuations in the experience of concealment, distinct experiences of concealment for bisexual individuals, and measurement recommendations for future studies. Small overall effects, heavy reliance on cross-sectional designs, relatively few effects for substance use problems, and the necessarily coarse classification of effect moderators in this meta-analysis suggest future needed methodological advances to further understand the mental health of this still-increasingly visible population. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Kaniuka AR, Job SA, Brooks BD, Williams SL. Gratitude and lower suicidal ideation among sexual minority individuals: theoretical mechanisms of the protective role of attention to the positive. THE JOURNAL OF POSITIVE PSYCHOLOGY 2020. [DOI: 10.1080/17439760.2020.1818814] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Andrea R. Kaniuka
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Sarah A. Job
- Department of Psychology, East Tennessee State University, Johnson City, TN, USA
| | - Byron D. Brooks
- Department of Psychology, East Tennessee State University, Johnson City, TN, USA
| | - Stacey L. Williams
- Department of Psychology, East Tennessee State University, Johnson City, TN, USA
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Bromberg DJ, Mayer KH, Altice FL. Identifying and managing infectious disease syndemics in patients with HIV. Curr Opin HIV AIDS 2020; 15:232-242. [PMID: 32487816 PMCID: PMC7376494 DOI: 10.1097/coh.0000000000000631] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW We will present recent articles focusing on HIV synergistic interactions with other sexually transmitted infections, tuberculosis, and hepatitis, as well as recent advances in the study of social and behavioral determinants that facilitate this clustering of infectious disease. For each synergistic interaction, we highlight evidence-based interventions that clinicians and policymakers should consider to tackle HIV and infectious disease syndemics. RECENT FINDINGS Significant advances in understanding the behavioral and structural determinants of HIV and other infectious disease synergisms have been made in the past years. Intervention strategies based on these new models have also been developed. It is now well understood that treating infectious disease syndemics will require a multidisciplinary and multipronged approach. SUMMARY HIV is synergistic with multiple other infectious diseases because the risk behaviors that lead to HIV acquisition may be similar to the other infections. The influence of HIV on the other infection may be due to immunosuppression associated with disease progression resulting in increased susceptibility (e.g., HIV and tuberculosis), especially when patients are not virologically suppressed using antiretroviral therapy. In reverse, another infectious disease may, when not treated, influence HIV disease progression. Social/structural determinants like homelessness, mass incarceration, and structural discrimination precipitate psychiatric comorbidity, substance use, and risky sex behavior which lead to the spread and co-occurrence of infectious disease.
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Affiliation(s)
- Daniel J Bromberg
- Department of Social and Behavioral Sciences, Yale University School of Public Health
- Yale Center for Interdisciplinary Research on AIDS, Yale University, New Haven, Connecticut
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Frederick L Altice
- Yale Center for Interdisciplinary Research on AIDS, Yale University, New Haven, Connecticut
- Section of Infectious Diseases, Department of Medicine, Yale University School of Medicine
- Department of Epidemiology of Microbial Diseases, Yale University School of Public Health, New Haven, Connecticut, USA
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45
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Pachankis JE, McConocha EM, Clark KA, Wang K, Behari K, Fetzner BK, Brisbin CD, Scheer JR, Lehavot K. A transdiagnostic minority stress intervention for gender diverse sexual minority women's depression, anxiety, and unhealthy alcohol use: A randomized controlled trial. J Consult Clin Psychol 2020; 88:613-630. [PMID: 32437174 PMCID: PMC7597069 DOI: 10.1037/ccp0000508] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To remedy the notable gap in evidence-based treatments for sexual minority women, this study tested the efficacy of a minority-stress-focused cognitive-behavioral treatment intended to improve this population's mental and behavioral health. METHOD The intervention, EQuIP (Empowering Queer Identities in Psychotherapy), was adapted from a transdiagnostic cognitive-behavioral treatment as also recently adapted for sexual minority men. Sexual minority women at risk of mental and behavioral health problems (n = 19) and expert providers with this population (n = 12) shaped the treatment's development, including by supporting its primary focus on universal and minority-stress-focused processes underlying this population's disproportionately poor mental and behavioral health. The resulting treatment was then delivered to young adult sexual minority women (n = 60; M age = 25.58; 41.67% racial/ethnic minority; 43.33% transgender/nonbinary) experiencing depression/anxiety and past 90-day heavy alcohol use. RESULTS Compared to waitlist (n = 30), participants randomized to immediately receive EQuIP (n = 30) experienced significantly reduced depression and anxiety (d = 0.85, 0.86, respectively); effects for alcohol use problems were smaller (d = 0.29) and marginally significant. In pre- to post-intervention pooled analyses, effect sizes for minority stress processes (mean d = .25) and universal risk factors (mean d = .48), through which the treatment was expected to work, were small and moderate, respectively, and in the expected direction. CONCLUSIONS This study provides initial support for a minority-stress-focused transdiagnostic cognitive-behavioral treatment for sexual minority women. These first results can launch exploration of other mechanisms and modalities through which to equip this population with evidence-based support. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
| | | | | | - Katie Wang
- Department of Social and Behavioral Sciences
| | | | | | | | | | - Keren Lehavot
- Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care
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