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Salway T, Kinitz DJ, Kia H, Ashley F, Giustini D, Tiwana A, Archibald R, Mallakzadeh A, Dromer E, Ferlatte O, Goodyear T, Abramovich A. A systematic review of the prevalence of lifetime experience with 'conversion' practices among sexual and gender minority populations. PLoS One 2023; 18:e0291768. [PMID: 37792717 PMCID: PMC10550144 DOI: 10.1371/journal.pone.0291768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 08/25/2023] [Indexed: 10/06/2023] Open
Abstract
RATIONALE Conversion practices (CPs) refer to organized attempts to deter people from adopting or expressing non-heterosexual identities or gender identities that differ from their gender/sex assigned at birth. Numerous jurisdictions have contemplated or enacted legislative CP bans in recent years. Syntheses of CP prevalence are needed to inform further public health policy and action. OBJECTIVES To conduct a systematic review describing CP prevalence estimates internationally and exploring heterogeneity across country and socially relevant subgroups. METHODS We performed literature searches in eight databases (Medline, Embase, PsycInfo, Social Work Abstracts, CINAHL, Web of Science, LGBTQ+ Source, and Proquest Dissertations) and included studies from all jurisdictions, globally, conducted after 2000 with a sampling frame of sexual and gender minority (SGM) people, as well as studies of practitioners seeing SGM patients. We used the Hoy et al. risk of bias tool for prevalence studies and summarized distribution of estimates using median and range. RESULTS We identified fourteen articles that reported prevalence estimates among SGM populations, and two articles that reported prevalence estimates from studies of mental health practitioners. Prevalence estimates among SGM samples ranged 2%-34% (median: 8.5). Prevalence estimates were greater in studies conducted in the US (median: 13%), compared to Canada (median: 7%), and greater among transgender (median: 12%), compared to cisgender (median: 4%) subsamples. Prevalence estimates were greatest among people assigned male at birth, whether transgender (median: 10%) or cisgender (median: 8%), as compared to people assigned female at birth (medians: 5% among transgender participants, 3% among cisgender participants). Further differences were observed by race (medians: 8% among Indigenous and other racial minorities, 5% among white groups) but not by sexual orientation. CONCLUSIONS CPs remain prevalent, despite denouncements from professional bodies. Social inequities in CP prevalence signal the need for targeted efforts to protect transgender, Indigenous and racial minority, and assigned-male-at-birth subgroups.
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Affiliation(s)
- Travis Salway
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- Centre for Gender and Sexual Health Equity, Vancouver, British Columbia, Canada
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - David J. Kinitz
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Hannah Kia
- School of Social Work, University of British Columbia, Vancouver, British Columbia, Canada
| | - Florence Ashley
- Faculty of Law & Joint Centre for Bioethics, University of Toronto, Toronto, Ontario, Canada
| | - Dean Giustini
- Biomedical Branch Library, University of British Columbia, Vancouver, British Columbia, Canada
| | - Amrit Tiwana
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Reilla Archibald
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Amirali Mallakzadeh
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Elisabeth Dromer
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Olivier Ferlatte
- École de santé publique, Université de Montréal, Montréal, Quebec, Canada
- Centre de Recherche en Santé Publique, Université de Montréal et CIUSSS du Centre-Sud-de-l’Île-de-Montréal, Montréal, Quebec, Canada
| | - Trevor Goodyear
- Centre for Gender and Sexual Health Equity, Vancouver, British Columbia, Canada
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alex Abramovich
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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Calvet X, Cantera LM. Prevalence and Characteristics of Sexual Victimization among Gay and Bisexual Men: A Preliminary Study in Spain. Healthcare (Basel) 2023; 11:2496. [PMID: 37761693 PMCID: PMC10530702 DOI: 10.3390/healthcare11182496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 09/04/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023] Open
Abstract
Sexual violence is an understudied issue in the population of gay and bisexual men, although the existing articles to date demonstrate that it is a problem that merits public attention. This study aims to approach the problem of invisibility around the matter, as well as presenting a number of variables that have been usually overlooked in Spanish research or have not been assessed at all. Lifetime sexual victimization, sociodemographic characteristics, situational characteristics and social support were examined among 550 gay and bisexual males living in Spain using a self-administrated questionnaire. Results analysis show that 90.00% (87.18-92.38%) of participants reported at least one experience of unwanted insinuation, 87.27% (84.19-89.94%) reported at least one experience of sexual coercion, 64.00% (59.83-68.02%) reported at least one experience of sexual assault, and specifically 19.82% (16.57-23.40%) reported being raped during their lifetime. Significant differences have been found between some categories regarding gender identity, sexual orientation, age, race/ethnicity and educational level. Overall, these results showcase sexual violence as a pervasive problem in the Spanish gay and bisexual community.
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Affiliation(s)
- Xavier Calvet
- Social Psychology Area, Department of Social Psychology, Universitat Autònoma de Barcelona (UAB), 08193 Bellaterra, Barcelona, Spain;
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Delgado-Ron JA, Jeyabalan T, Watt S, Black S, Gumprich M, Salway T. Sampling Sexual and Gender Minority Youth With UnACoRN (Understanding Affirming Communities, Relationships, and Networks): Lessons From a Web-Based Survey. J Med Internet Res 2023; 25:e44175. [PMID: 36633900 PMCID: PMC9893884 DOI: 10.2196/44175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 12/21/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Periodic surveys of sexual and gender minority (SGM) populations are essential for monitoring and investigating health inequities. Recent legislative efforts to ban so-called conversion therapy make it necessary to adapt youth surveys to reach a wider range of SGM populations, including those <18 years of age and those who may not adopt an explicit two-spirit, lesbian, gay, bisexual, transgender, and queer (2S/LGBTQ) identity. OBJECTIVE We aimed to share our experiences in recruiting SGM youth through multiple in-person and online channels and to share lessons learned for future researchers. METHODS The Understanding Affirming Communities, Relationships, and Networks (UnACoRN) web-based survey collected anonymous data in English and French from 9679 mostly SGM respondents in the United States and Canada. Respondents were recruited from March 2022 to August 2022 using word-of-mouth referrals, leaflet distribution, bus advertisements, and paid and unpaid campaigns on social media and a pornography website. We analyzed the metadata provided by these and other online resources we used for recruitment (eg, Bitly and Qualtrics) and describe the campaign's effectiveness by recruitment venue based on calculating the cost per completed survey and other secondary metrics. RESULTS Most participants were recruited through Meta (13,741/16,533, 83.1%), mainly through Instagram; 88.96% (visitors: 14,888/18,179) of our sample reached the survey through paid advertisements. Overall, the cost per survey was lower for Meta than Pornhub or the bus advertisements. Similarly, the proportion of visitors who started the survey was higher for Meta (8492/18,179, 46.7%) than Pornhub (58/18,179, 1.02%). Our subsample of 7037 residents of Canada had a similar geographic distribution to the general population, with an average absolute difference in proportion by province or territory of 1.4% compared to the Canadian census. Our US subsample included 2521 participants from all US states and the District of Columbia. A total of CAD $8571.58 (the currency exchange rate was US $1=CAD $1.25) was spent across 4 paid recruitment channels (Facebook, Instagram, PornHub, and bus advertisements). The most cost-effective tool of recruitment was Instagram, with an average cost per completed survey of CAD $1.48. CONCLUSIONS UnACoRN recruited nearly 10,000 SGM youth in the United States and Canada, and the cost per survey was CAD $1.48. Researchers using online recruitment strategies should be aware of the differences in campaign management each website or social media platform offers and be prepared to engage with their framing (content selection and delivery) to correct any imbalances derived from it. Those who focus on SGM populations should consider how 2S/LGBTQ-oriented campaigns might deter participation from cisgender or heterosexual people or SGM people not identifying as 2S/LGBTQ, if relevant to their research design. Finally, those with limited resources may select fewer venues with lower cost per completed survey or that appeal more to their specific audience, if needed.
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Affiliation(s)
- Jorge Andrés Delgado-Ron
- Reaffirm Collaborative, Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Thiyaana Jeyabalan
- Reaffirm Collaborative, Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
- Department of Population Medicine, University of Guelph, Guelph, ON, Canada
| | - Sarah Watt
- Reaffirm Collaborative, Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Stéphanie Black
- Reaffirm Collaborative, Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Martha Gumprich
- Reaffirm Collaborative, Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Travis Salway
- Reaffirm Collaborative, Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
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Disparities in alcohol use and heavy episodic drinking among bisexual people: A systematic review, meta-analysis, and meta-regression. Drug Alcohol Depend 2022; 235:109433. [PMID: 35395502 DOI: 10.1016/j.drugalcdep.2022.109433] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 03/18/2022] [Accepted: 03/24/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Alcohol consumption is more prevalent among sexual minorities than among heterosexuals; however, differences between minority sexual orientation groups are understudied. This systematic review and meta-analysis aimed to summarize existing evidence on the prevalence of alcohol use among bisexual people compared to their lesbian/gay and heterosexual counterparts. METHODS A systematic review of literature from 1995 to May 2020 was performed using Medline, PsycInfo, and Embase (OVID), Scopus, CINHAL and LGBT Life (EBSCO), combining keywords for bisexuality and alcohol use. Peer-reviewed publications that reported quantitative data on alcohol use among bisexual people were included. A random-effects model was used to pool the prevalence of two outcomes: any alcohol use and heavy episodic drinking (HED). Subgroup analysis and random-effects meta-regression were used to explore heterogeneity. RESULTS Of 105 studies eligible for data extraction, the overall prevalence of alcohol use was higher among bisexuals compared to lesbian/gay and heterosexual people. For example, the prevalence of past-month HED was 30.0% (28.2, 31.8) among bisexual people versus 25.5% (23.8, 27.2) among lesbian/gay and 21.3% (19.6, 23.0) among heterosexual individuals. Pooled odds ratio estimates showed that bisexual people were more likely to report alcohol use and HED compared to their counterparts. Gender was a significant effect modifier in meta-regression analysis, with greater disparities among women than among men. CONCLUSIONS These results highlight the need for additional research to understand factors underlying bisexual people's greater risk, and particularly bisexual women, as well as alcohol use interventions that are targeted towards the specific needs of bisexual people.
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McKenzie C, Mulé NJ, Khan M. Where Is LGBTQ+ in Ontario's Health Care Policies and Programs? SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2022; 19:610-621. [PMID: 33903805 PMCID: PMC8060909 DOI: 10.1007/s13178-021-00577-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/06/2021] [Indexed: 05/07/2023]
Abstract
INTRODUCTION The LGBTQ+ community experiences health inequities that are linked to the social determinants of health (SDH), though the full extent of these health inequities is not fully understood. METHODS This study is a comparative thematic content analysis of the Ontario Ministry of Health and Long-Term Care's (MOHLTC) website and the websites of each of the 14 local health integration networks (LHINs) in 2009 and 2017. It provides a snapshot and evaluation of the amount and type of online content concerning LGBTQ+-specific health needs and determines how well the programs and services aligned with the Ministry's stated priorities and population health/SDH philosophy. RESULTS We found very little content that suggested a population health approach on the Ministry's website. We also found very little LGBTQ+-specific content on the LHINs' websites in both periods, with two notable exceptions in 2017. Our analysis revealed a persistent emphasis on HIV/AIDS risk containment in the LGBTQ + community over the two periods. CONCLUSIONS We argue that to promote healthy equity, the MOHLTC needs to acknowledge inequalities and intervene through political and social mechanisms that extend beyond HIV.
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Affiliation(s)
- Cameron McKenzie
- Faculty of Social Work, Wilfrid Laurier University, Brantford, ON Canada
| | - Nick J. Mulé
- School of Social Work, York University, Toronto, ON Canada
| | - Maryam Khan
- Faculty of Social Work, Wilfrid Laurier University, Kitchener, ON Canada
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Salway T, Butt ZA, Wong S, Abdia Y, Balshaw R, Rich AJ, Ablona A, Wong J, Grennan T, Yu A, Alvarez M, Rossi C, Gilbert M, Krajden M, Janjua NZ. A Computable Phenotype Model for Classification of Men Who Have Sex With Men Within a Large Linked Database of Laboratory, Surveillance, and Administrative Healthcare Records. Front Digit Health 2021; 2:547324. [PMID: 34713035 PMCID: PMC8521949 DOI: 10.3389/fdgth.2020.547324] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 09/02/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Most public health datasets do not include sexual orientation measures, thereby limiting the availability of data to monitor health disparities, and evaluate tailored interventions. We therefore developed, validated, and applied a novel computable phenotype model to classify men who have sex with men (MSM) using multiple health datasets from British Columbia, Canada, 1990-2015. Methods: Three case surveillance databases, a public health laboratory database, and five administrative health databases were linked and deidentified (BC Hepatitis Testers Cohort), resulting in a retrospective cohort of 727,091 adult men. Known MSM status from the three disease case surveillance databases was used to develop a multivariable model for classifying MSM in the full cohort. Models were selected using "elastic-net" (GLMNet package) in R, and a final model optimized area under the receiver operating characteristics curve. We compared characteristics of known MSM, classified MSM, and classified heterosexual men. Findings: History of gonorrhea and syphilis diagnoses, HIV tests in the past year, history of visit to an identified gay and bisexual men's clinic, and residence in MSM-dense neighborhoods were all positively associated with being MSM. The selected model had sensitivity of 72%, specificity of 94%. Excluding those with known MSM status, a total of 85,521 men (12% of cohort) were classified as MSM. Interpretation: Computable phenotyping is a promising approach for classification of sexual minorities and investigation of health outcomes in the absence of routinely available self-report data.
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Affiliation(s)
- Travis Salway
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.,British Columbia Centre for Disease Control, Vancouver, BC, Canada.,Centre for Gender and Sexual Health Equity, Vancouver, BC, Canada
| | - Zahid A Butt
- British Columbia Centre for Disease Control, Vancouver, BC, Canada.,School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Stanley Wong
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Younathan Abdia
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Robert Balshaw
- George and Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, MB, Canada
| | - Ashleigh J Rich
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Aidan Ablona
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Jason Wong
- British Columbia Centre for Disease Control, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Troy Grennan
- British Columbia Centre for Disease Control, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Amanda Yu
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Maria Alvarez
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Carmine Rossi
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Mark Gilbert
- British Columbia Centre for Disease Control, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Mel Krajden
- British Columbia Centre for Disease Control (BCCDC) Public Health Laboratory, Vancouver, BC, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Naveed Z Janjua
- British Columbia Centre for Disease Control, Vancouver, BC, Canada.,George and Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, MB, Canada
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Storm S, Deuba K, Shrestha R, Pandey LR, Dahal D, Shrestha MK, Pokhrel TN, Marrone G. Social and structural factors associated with depression and suicidality among men who have sex with men and transgender women in Nepal. BMC Psychiatry 2021; 21:476. [PMID: 34587934 PMCID: PMC8479926 DOI: 10.1186/s12888-021-03477-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 09/13/2021] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION The prevalence of depression and suicidality is high among men who have sex with men (MSM) and transgender women (TGW) worldwide. Stigma and discrimination are likely contributing factors. More research is needed in low-income, non-English speaking countries to assess the effects of social and structural factors on depression and suicidality among MSM and TGW. METHODS Nepalese MSM and TGW (n = 340) were recruited using a respondent-driven sampling design and filled out a survey questionnaire. The outcomes were depression and suicidality. Data was analyzed using bivariate and multivariable logistic regression. RESULTS More than half of the participants (59%) suffered from depression. Severe depression was more common among TGW compared to MSM (41 and 20%, respectively). When it comes to suicidality, TGW had higher lifetime prevalence of suicidal thoughts compared to MSM (32 and 5%, respectively). Depression was positively associated with sex work both for MSM (AOR: 7.9; 95% CI 3.4-18.2) and TGW (AOR: 6.5; 95% CI: 2.3-18.2). MSM who were evicted by family had high odds of suicidal thoughts (AOR: 6.2; 95% CI: 1.3-28.8). For TGW, suicidality was associated with being cheated and threatened (AOR: 3.9; 95% CI: 1.2-12.5) and having forced to marry a female (AOR: 2.2; 95% CI 1.1-5.1). CONCLUSIONS Nepalese MSM and TGW suffer from a high degree of mental and psychosocial health issues. Future studies should focus on intervention research and on collecting data from a larger variety of gender and sexual minorities.
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Affiliation(s)
- Sanna Storm
- grid.4714.60000 0004 1937 0626Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Keshab Deuba
- National Centre for AIDS and STD Control/Global Fund Programs, Kathmandu, Nepal.
| | | | - Lok Raj Pandey
- grid.500537.4National Centre for AIDS and STD Control, Ministry of Health and Population, Kathmandu, Nepal
| | - Deepak Dahal
- grid.500537.4National Centre for AIDS and STD Control, Ministry of Health and Population, Kathmandu, Nepal
| | - Madan Kumar Shrestha
- grid.500537.4National Centre for AIDS and STD Control, Ministry of Health and Population, Kathmandu, Nepal
| | - Tara Nath Pokhrel
- grid.500537.4Family Welfare Division, Department of Health Services, Ministry of Health and Population, Kathmandu, Nepal
| | - Gaetano Marrone
- grid.4714.60000 0004 1937 0626Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
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Mahon CP, Lombard-Vance R, Kiernan G, Pachankis JE, Gallagher P. Social Anxiety Among Sexual Minority Individuals: A Systematic Review. PSYCHOLOGY & SEXUALITY 2021. [DOI: 10.1080/19419899.2021.1936140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Conor P Mahon
- School of Psychology, Dublin City University, Dublin, Ireland
| | - Richard Lombard-Vance
- Department of Psychology and Assisting Living & Learning Institute, Maynooth University, Ireland
| | - Gemma Kiernan
- School of Nursing, Psychotherapy, and Community Health, Dublin City University, Dublin, Ireland
| | - John E. Pachankis
- Department of Social and Behavioral Sciences, Yale University School of Public Health, New Haven, CT, USA
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Kinitz DJ, Salway T, Kia H, Ferlatte O, Rich AJ, Ross LE. Health of two-spirit, lesbian, gay, bisexual and transgender people experiencing poverty in Canada: a review. Health Promot Int 2021; 37:6306809. [PMID: 34148086 DOI: 10.1093/heapro/daab057] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Two-spirit, lesbian, gay, bisexual and transgender (2SLGBTQ+) people are disproportionately represented among those experiencing poverty. Both 2SLGBTQ+ people and people experiencing poverty face poorer health outcomes and greater difficulty accessing healthcare. Evidence of intersectional impacts of 2SLGBTQ+ status and poverty on health can help to inform economic and health policy. The objective of this review is to determine what is known about the health of 2SLGBTQ+ people in Canada experiencing poverty. Following the PRISMA framework, we searched and summarized Canadian literature on 2SLGBTQ+ poverty indexed in Medline, Sociological Abstracts, PsycInfo and EconList (N = 33). 2SLGBTQ+ poverty-related literature remains sparse but is expanding as illustrated by the fact that most (31/33) studies were published in the past decade. Half the studies analysed poverty as a focal variable and half as a covariate. Intersectionality theory assists in understanding the three health-related themes identified-healthcare access, physical health and mental health and substance use-as these outcomes are shaped by intersecting social structures that result in unique forms of discrimination. Those at the intersection of poverty and 2SLGBTQ+ status face poorer health outcomes than other 2SLGBTQ+ people in Canada. Discrimination was an overarching finding that explained persistent associations between 2SLGBTQ+ status, poverty and health. Research that directly interrogated the experiences of 2SLGBTQ+ populations experiencing poverty was sparse. In particular, there is a need to conduct research on underrepresented 2SLGBTQ+ sub-groups who are disproportionately impacted by poverty, including transgender, bisexual and two-spirit populations.
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Affiliation(s)
- David J Kinitz
- Social and Behavioural Health Sciences Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Travis Salway
- Faculty of Health Science, Simon Fraser University, Burnaby, Canada
| | - Hannah Kia
- School of Social Work, University of British Columbia, Vancouver, Canada
| | - Olivier Ferlatte
- École de santé publique, Université de Montréal and Centre de recherche en santé publique, Université de Montréal et CIUSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada
| | - Ashleigh J Rich
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Lori E Ross
- Social and Behavioural Health Sciences Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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Mijas M, Grabski B, Blukacz M, Davies D. Sexual Health Studies in Gay and Lesbian People: A Critical Review of the Literature. J Sex Med 2021; 18:1012-1023. [PMID: 33947648 DOI: 10.1016/j.jsxm.2021.02.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 02/15/2021] [Accepted: 02/22/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The subject of gay and lesbian sexual health seems to be highly understudied, at least partially due to general limitations inherent in the studies of sexuality as well as heteronormative bias and difficulties in reaching out to these populations. AIM To critically review the studies on gay and lesbian sexual health in order to identify the existing gaps and biases in the scope and general construction of the published research. METHODS The dataset comprised 556 peer-reviewed articles identified through Medline search. Key studies characteristics were extracted according to the codebook developed for this study and analyzed descriptively. OUTCOMES The outcomes included: research methodology, study design, sampling, research topic and diversity inclusion in studied populations. RESULTS The majority of the studies were quantitative (70.5%), cross-sectional (83.6%) and used convenience sampling (83.2%). Most papers focused on HIV/STI risk behaviors, vulnerabilities and risk navigation (26.3%). The least often found topic captured the sexual function of gay and lesbian participants in older age (0.5%). Over 68% of papers relied on male samples and studies on female-only samples comprised less than 13%. Most studies did not recruit a specific age group (77.7%) and included information about ethnicity of study participants (62%). Information about education (58.7%) or other indicators of socioeconomic status (52.8%) was less often reported. CLINICAL TRANSLATION The methodological limitations of prevailing study designs, sampling procedures and the composition of samples, as well as extensive areas of omission confine the clinical utility of existing research. STRENGTHS & LIMITATIONS This study offers critical insights into the most significant challenges associated with studies on gay and lesbian sexual health. Medline-only database search, the inclusion of English-written papers exclusively and limited scope (gay and lesbian sexuality only) of the review constitute the most significant limitations. CONCLUSIONS Gay and lesbian sexual health is an understudied field characterized by primary focus on HIV/STI and paucity of higher quality research including diverse subpopulations. Mijas M, Grabski B, Blukacz M, et al. Sexual Health Studies in Gay and Lesbian People: A Critical Review of the Literature. J Sex Med 2021;XXX:XXX-XXX.
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Affiliation(s)
- Magdalena Mijas
- Jagiellonian University, Faculty of Philosophy, Institute of Psychology, Krakow, Poland; Jagiellonian University Medical College, Faculty of Health Sciences, Institute of Public Health, Krakow, Poland.
| | - Bartosz Grabski
- Jagiellonian University Medical College, Department of Psychiatry, Sexology Lab, Krakow, Poland
| | - Mateusz Blukacz
- Jagiellonian University Medical College, Faculty of Health Sciences, Institute of Public Health, Krakow, Poland; University of Silesia in Katowice, Institute of Psychology, Katowice, Poland
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Salway T, Gesink D, Ferlatte O, Rich AJ, Rhodes AE, Brennan DJ, Gilbert M. Age, period, and cohort patterns in the epidemiology of suicide attempts among sexual minorities in the United States and Canada: detection of a second peak in middle adulthood. Soc Psychiatry Psychiatr Epidemiol 2021; 56:283-294. [PMID: 32789562 DOI: 10.1007/s00127-020-01946-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 08/07/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Sexual minority adults experience fivefold greater risk of suicide attempt, as compared with heterosexuals. Establishing age-specific epidemiological patterns of suicide is a prerequisite to planning interventions to redress the sexual orientation suicide inequity, and such patterns must be carefully interpreted in light of correlated period and cohort effects. We, therefore, combined US and Canadian data (1985-2017) from primary (two pooled multi-year national surveys, N = 15,477 and N = 126,463) and secondary (published, meta-analytic, N = 122,966) sources to separately estimate age, period, and cohort trends in self-reported suicide attempts among sexual minorities. METHODS Age- and gender-stratified cross-sectional data were used to infer age and cohort effects. Age-collapsed meta-analyzed data were used to infer period effects among sexual minorities of all genders. RESULTS We identified a bimodal age distribution in recent suicide attempts for sexual minorities across genders, though more pronounced among sexual minority men: one peak in adolescence (18-20 years of age for both genders) and one peak nearing mid-life (30-35 years of age for men; 35-40 years of age for women). This pattern was also apparent using recall data within birth cohorts of sexual minority men, suggesting it is not an artifact of birth cohort effects. Finally, we observed decreasing trends in lifetime suicide attempt prevalence estimates for both sexual minorities and heterosexuals, though these decreases did not affect the magnitude of the sexual orientation disparity. CONCLUSION In the context of exclusively adolescent-focused suicide prevention interventions for sexual minorities, tailored suicide prevention for sexual minority adults should be pursued throughout the life course.
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Affiliation(s)
- Travis Salway
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall 11300, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada. .,Clinical Prevention Services, British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada. .,Centre for Gender and Sexual Health Equity, 1190 Hornby Street, 11th Floor, Vancouver, BC, V6Z 2K5, Canada.
| | - Dionne Gesink
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Room 500, Toronto, ON, M5T 3M7, Canada
| | - Olivier Ferlatte
- École de santé Publique, Université de Montréal, 7101 Park Avenue, Montreal, QC, H3N 1X9, Canada.,Centre de Recherche en santé Publique, Université de Montréal et CIUSS du Centre-Sud-de-l'Île-de-Montréal, 1301, rue Sherbrooke Est, Montreal, QC, H3L 1M3, Canada
| | - Ashleigh J Rich
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Anne E Rhodes
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Room 500, Toronto, ON, M5T 3M7, Canada.,Department of Psychiatry, University of Toronto, 585 University Avenue, Toronto, ON, M5G 2N2, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, St. Joseph's Healthcare Hamilton, West 5th Campus, Administration-B3, 100 West 5th, Hamilton, ON, L8N 3K7, Canada.,Offord Centre for Child Studies, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - David J Brennan
- Factor-Inwentash School of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada
| | - Mark Gilbert
- Clinical Prevention Services, British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada.,School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
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12
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Kneale D, Thomas J, French R. Inequalities in Health and Care Among Lesbian, Gay, and Bisexual People Aged 50 and Older in the United Kingdom: A Systematic Review and Meta-analysis of Sources of Individual Participant Data. J Gerontol B Psychol Sci Soc Sci 2020; 75:1758-1771. [PMID: 32474585 PMCID: PMC7489108 DOI: 10.1093/geronb/gbaa071] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES Modeling the health and care trajectories of lesbian, gay, and bisexual (LGB) is essential to identify inequalities and support needs, yet because of the small sample of LGB people in any one survey, current evidence relies on studies that have poor generalizability and low power. This study assesses the magnitude of health inequalities among older LGB people across 10 outcomes, informed by evidence on the health trajectories and distinct LGB history of the United Kingdom. METHOD A systematic review was conducted of representative data sources on older LGB and heterosexual people's health and care status in the United Kingdom. Individual Participant Data (IPD) meta-analysis was employed to synthesize data from up to 25 different sources. To account for the intricacies of individual data sets, the analysis employed a two-stage approach where an odds ratio and standard error was calculated for each data set individually, before being meta-analyzed through DerSimonian and Laird random effects models. RESULTS Among men aged 50+, being gay, bisexual, or having another nonheterosexual orientation is associated with an increased risk of reporting long-term illness and health-related limitations. Indicators of mental health also suggest that gay and bisexual men are more likely to report low life satisfaction and to have attempted suicide over their life time. Among women, differences are apparent with regards to self-rated health as well as with engagement with risky health behaviors. DISCUSSION The findings corroborate the minority stress theory, but they also generate new questions for researchers around when and how these inequalities emerge.
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Affiliation(s)
- Dylan Kneale
- EPPI-Centre, UCL Institute of Education, University College London, UK
| | - James Thomas
- EPPI-Centre, UCL Institute of Education, University College London, UK
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13
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The Disparities in Mental Health between Gay and Bisexual Men Following Positive HIV Diagnosis in China: A One-Year Follow-Up Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17103414. [PMID: 32422918 PMCID: PMC7277388 DOI: 10.3390/ijerph17103414] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 05/08/2020] [Accepted: 05/12/2020] [Indexed: 12/22/2022]
Abstract
This study aimed to determine the change in mental health (depression and anxiety) among HIV-positive gay and bisexual men (GBM) one year after diagnosis and the disparities in trajectories of mental health between them. The potential factors contributing to the disparities were also investigated. This was a one-year follow-up study focusing on the mental health of newly diagnosed HIV-positive individuals. Participants rated their depression, anxiety, stress, and social support levels at baseline and one year later. Information on the utilization of mental healthcare and the initiation of antiretroviral therapy (ART) after diagnosis was collected at one-year follow-up. A total of 171 and 87 HIV-positive gay and bisexual men, respectively, completed two-time points surveys in this study. The depressive and anxiety symptoms experienced by HIV-positive GBM improvement one year after diagnosis. These improvements tended to be smaller in gay participants. Other factors including mental health care utilization and ART status during the one-year follow-up period, changes in social stress scores and objective social support scores were also associated with the changes in depression and anxiety, and all these factors, except for change in objective support, were found to be statistically different between HIV-positive GBM. Special attention should be given to the mental health of HIV-positive gay men. Promoting HIV-positive gay men to assess to mental health services and ART may be important for these populations to improve mental health. Enhancing social support and reducing stress levels may also be necessary for the vulnerable HIV-positive sexual minority groups.
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Abstract
We examined factors associated with reporting sex with men among men who inject drugs in Vancouver, Canada. Data were drawn from three open prospective cohorts of people who use drugs between 2005 and 2014. Generalized estimating equations were used to identify factors associated with reporting non-transactional sex with men (MSM) in the previous 6 months. Of 1663 men who used injection drugs, 225 (13.5%) were MSM over the study period. Sex with men was independently associated with younger age [Adjusted Odds Ratio (AOR) = 0.96], childhood sexual abuse (AOR = 2.65), sex work (AOR = 3.33), crystal methamphetamine use (AOR = 1.30), borrowing used syringes (AOR = 1.39), inconsistent condom use (AOR = 1.76), and HIV seropositivity (AOR = 3.82). MSM were less likely to be Hepatitis C-positive (AOR = 0.43) and to have accessed addiction treatment in the previous 6 months (AOR = 0.83) (all p < 0.05). Findings highlight vulnerabilities and resiliencies among MSM-PWID and indicate a need for trauma-informed and affirming harm reduction and substance use treatment services for MSM-PWID.
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15
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Salway TJ, Morgan J, Ferlatte O, Hawkins B, Lachowsky NJ, Gilbert M. A Systematic Review of Characteristics of Nonprobability Community Venue Samples of Sexual Minority Individuals and Associated Methods for Assessing Selection Bias. LGBT Health 2019; 6:205-215. [DOI: 10.1089/lgbt.2018.0241] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Travis J. Salway
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Jeffrey Morgan
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
- Community-Based Research Centre, Vancouver, British Columbia, Canada
| | - Olivier Ferlatte
- British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada
| | - Blake Hawkins
- Interdisciplinary Studies Graduate Program, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nathan J. Lachowsky
- Community-Based Research Centre, Vancouver, British Columbia, Canada
- School of Public Health and Social Policy, University of Victoria, Victoria, British Columbia, Canada
| | - Mark Gilbert
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
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16
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Abstract
OBJECTIVES To examine associations between sleep duration and health outcomes among distinct groups of sexual minority adults. METHODS Using data from the 2014 Behavioral Risk Factor Surveillance System, we compared sleep duration (very short: ≤ 5 hr; short: 6 hr; normal: 7-8 hr; and long: ≥ 9 hr per day) between cisgender straight adults and distinct groups of sexual minorities. We further examined associations between sleep duration and 10 chronic health conditions among sexual minorities. RESULTS Of 146,893 respondents, 142,507 (96.2%) were cisgender straight, and 4,386 (3.8%) were lesbian, gay, bisexual, transgender (LGBT). Overall, 17.3% of LGBT respondents reported very short sleep per day, compared with 12.2% for cisgender straight respondents (p < 0.0001). Among LGBT populations, the prevalence of very short sleep varied significantly among distinct groups, ranging from 13.2% among transgender female to male adults to 35.5% among transgender gender nonconforming adults. Very short sleep was further associated with increased odds of having stroke (aOR = 4.1, 95% CI [2.2-7.6]), heart attack (aOR = 3.0, CI [1.6-5.8]), coronary heart disease (aOR = 3.1, 95% CI [1.5-6.2]), asthma (aOR = 1.7, 95% CI [1.1-2.4]), chronic obstructive pulmonary disease (aOR = 2.5, CI [1.5-4.0]), arthritis (aOR = 2.1, CI [1.4-3.0]), and cancer (aOR = 1.8, 95% CI [1.0-3.2]) among sexual minorities. Disparities in the prevalence of stroke, heart attack, coronary health disease, COPD, diabetes, obesity, arthritis, and cancer were found among LGBT populations. CONCLUSIONS Sexual minorities have a higher prevalence of sleep deprivation as compared with their straight counterparts. Sleep deprivation varies by sexual identity and gender. Very short sleep duration is associated with some chronic health conditions among LGBT populations. Promotion of sleep health education and routine medical assessment of sleep disorders are critically needed for sexual minority adults.
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Affiliation(s)
- Hongying Dai
- a Health Services & Outcomes Research , Children's Mercy Hospital , Kansas City , Missouri.,b Department of Biomedical & Health Informatics , University of Missouri , Kansas City , Missouri.,c Department of Pediatrics , University of Missouri , Kansas City , Missouri
| | - Jianqiang Hao
- d College of Business, Bellevue University , Omaha , Nebraska
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17
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Tran NK, Welles SL. Four Decades of Epidemiologic Science on HIV Infection and Disease, and Its Impact on Public Health Practice and Policy for Sexual and Gender Minority Persons. Dela J Public Health 2019; 5:64-71. [PMID: 34467031 PMCID: PMC8396754 DOI: 10.32481/djph.2019.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Even at the cusp of the second decade of the new millennia, HIV continues to be a significant public health challenge for sexual and gender minorities (SGM). Men who have sex with men and transgender women, in particular, continue to report higher rates of HIV incidence compared to their heterosexual counterparts, while facing significant barriers to comprehensive sexual healthcare. In Delaware, HIV infection impacts a substantial number of individuals with approximately 14.5 incident cases per 100,000. This ranks Delaware as the 14th highest for HIV incidence among U.S. states. However, the largest healthcare provider in Delaware, Christiana Care Health System, has created many health initiatives to support the health needs of SGM and those living with HIV. The current sustained rate of HIV infection indicates the need for enhanced epidemiologic work to identify HIV cases in subgroups of diverse sexuality and gender identity, collaboration within and across research institution and community organizations, as well as engagement in creative solutions that target the multiple levels of factors contributing to HIV incidence. In addition, it is imperative that local agencies and health organizations continue to support these communities of SGM individuals during the current sociopolitical climate of the national U.S. government.
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Affiliation(s)
- Nguyen K Tran
- Department of Epidemiology & Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA
| | - Seth L Welles
- Department of Epidemiology & Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA
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18
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Salway T, Plöderl M, Liu J, Gustafson P. Effects of Multiple Forms of Information Bias on Estimated Prevalence of Suicide Attempts According to Sexual Orientation: An Application of a Bayesian Misclassification Correction Method to Data From a Systematic Review. Am J Epidemiol 2019; 188:239-249. [PMID: 30188991 DOI: 10.1093/aje/kwy200] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 08/27/2018] [Indexed: 11/13/2022] Open
Abstract
Multiple epidemiologic studies demonstrate a disparity in suicide risk between sexual minority (lesbian, gay, bisexual) and heterosexual populations; however, both "exposure" (sexual minority status) and outcome (suicide attempts) may be affected by information bias related to errors in self-reporting. We therefore applied a Bayesian misclassification correction method to account for possible information biases. A systematic literature search identified studies of lifetime suicide attempts in sexual minority and heterosexual adults, and frequentist meta-analysis was used to generate unadjusted estimates of relative risk. A Bayesian model accounting for prior information about sensitivity and specificity of exposure and outcome measures was used to adjust for misclassification biases. In unadjusted frequentist analysis, the relative risk of lifetime suicide attempt comparing sexual minority with heterosexual groups was 3.38 (95% confidence interval: 2.65, 4.32). In Bayesian reanalysis, the estimated prevalence was slightly reduced in heterosexual adults and increased in sexual minority adults, yielding a relative risk of 4.67 (95% credible interval: 3.94, 5.73). The disparity in lifetime suicide attempts between sexual minority and heterosexual adults is greater than previously estimated, when accounting for multiple forms of information bias. Additional research on the impact of information bias in studies of sexual minority health should be pursued.
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Affiliation(s)
- Travis Salway
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Martin Plöderl
- Department of Crisis Intervention and Suicide Prevention, Paracelsus Medical University, Salzburg, Austria
- Department of Clinical Psychology, University Clinic of Psychiatry, Psychotherapy, and Psychosomatics, Paracelsus Medical University, Salzburg, Austria
| | - Juxin Liu
- Department of Mathematics and Statistics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Paul Gustafson
- Department of Statistics, University of British Columbia, Vancouver, British Columbia, Canada
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Salway T, Ross LE, Fehr CP, Burley J, Asadi S, Hawkins B, Tarasoff LA. A Systematic Review and Meta-Analysis of Disparities in the Prevalence of Suicide Ideation and Attempt Among Bisexual Populations. ARCHIVES OF SEXUAL BEHAVIOR 2019; 48:89-111. [PMID: 29492768 DOI: 10.1007/s10508-018-1150-6] [Citation(s) in RCA: 111] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 11/24/2017] [Accepted: 01/07/2018] [Indexed: 05/12/2023]
Abstract
Sexual minorities are at increased risk of suicide; however, it is unclear whether there are within-sexual minority differences in risk across specific sexual identities-notably between bisexual and lesbian/gay subgroups. We therefore conducted a systematic review and meta-analysis to quantify associations between bisexual identity and self-reported suicide ideation and attempt and the moderation of these associations by gender/sex, age, sampling strategy, and measurement of sexuality. Abstracts and full texts were independently screened by two reviewers, resulting in a total of 46 studies that met inclusion criteria and reported 12-month or lifetime prevalence estimates for suicide ideation or attempt. A consistent gradient was observed across all four outcomes, whereby bisexual respondents reported the highest proportion of suicide ideation or attempt, lesbian/gay respondents the next highest proportion, and heterosexual respondents the lowest proportion. Random-effects meta-analysis comparing bisexual individuals with lesbian/gay individuals yielded odds ratios (ORs) ranging between 1.22-1.52 across the four outcomes examined. Between-study variability in ORs was large. Thirty-one percent of heterogeneity was explained by sample type (e.g., probability vs. non-probability) and 17% by gender/sex. ORs were consistently larger for women (range: 1.48-1.95, all statistically significant at p < .05) than for men (range: 1.00-1.48, all p > .05), suggesting that gender/sex moderates the association between bisexual identity and suicide risk. Within-sexual minority differences in suicide risk may be attributed to structural and interpersonal experiences of monosexism, bisexual erasure and invisibility, or lack of bisexual-affirming social support, each of which may be experienced differently across gender/sex identities.
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Affiliation(s)
- Travis Salway
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
- Clinical Prevention Services, BC Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada.
| | - Lori E Ross
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Charles P Fehr
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Joseph Burley
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Shayan Asadi
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Blake Hawkins
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Lesley A Tarasoff
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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