Assessing health-related stereotype threats and mental healthcare experiences among a LGBT sample

Sexual and Reproductive Justice and Health Equity for LGBTQ+ Women

LGBTQ+ women have long been overlooked in sexual and reproductive health research. However, recent research has established that LGBTQ+ women have unique and specific needs that need to be addressed in order to improve effectiveness of sexual health education and practice with this historically and presently underserved population. Informed by a reproductive justice framework coupled with liberation psychology theory, this review discusses the current state of sexual and reproductive health and technologies among LGBTQ+ women. In particular, we focus on a range of HIV prevention and reproductive technologies and their use and promotion, including the internal condom, abortion, oral contraceptives, dapivirine ring, HIV pre-exposure prophylaxis, intrauterine device, and other less studied options, such as the contraceptive sponge. Grounded in an intersectional framing, this review acknowledges the intersecting systems of oppression that affect multiply marginalized women inequitably and disproportionately. A sociohistorical, critical lens is applied to acknowledge the well-documented racist origins of reproductive health technologies and ongoing coercive practices that have led to medical mistrust among marginalized and stigmatized communities, particularly racialized LGBTQ+ women, women with disabilities, and women who are poor or incarcerated. Moreover, we discuss the urgent need to center LGBTQ+ women in research and clinical care, community-engaged health promotion efforts, affirming non-heteronormative sexual health education, and health policies that prioritize autonomy and dismantle structural barriers for this population. We conclude with recommendations and future directions in this area to remedy entrenched disparities in health.

Healthcare stereotype threat, healthcare access, and health outcomes in a probability sample of U.S. transgender and gender diverse adults

Background

Health inequities among transgender and gender diverse (TGD) populations are well-documented and may be partially explained by the complex social power dynamics that lead to stigmatization. Healthcare Stereotype Threat (HCST) refers to the fear and threat of being perceived negatively based on identity-related stereotypes and may influence health and healthcare experiences. Few studies have investigated associations of HCST with healthcare access and health outcomes for TGD individuals.

Methods

We analyzed the U.S. Transgender Population Health Survey, a cross-sectional national probability sample of 274 TGD adults recruited April 2016-December 2018. Participants self-reported HCST through a 4-item scale. We estimated prevalence ratios (PR) for the association between HCST and binary healthcare access indicators and health outcomes using Poisson models with robust variance. Prevalence ratios (PR) were estimated using negative binomial models for the association between HCST and number of past-month poor physical and mental health days. Models adjusted for sociodemographics and medical gender affirmation.

Results

The mean age was 34.2 years; 30.9 % identified as transgender men, 37.8 % transgender women, and 31.3 % genderqueer/nonbinary. HCST threat was associated with increased prevalence of not having a personal doctor/healthcare provider (PR = 1.25; 95 %CI = 1.00-1.56) and reporting fair/poor general health vs good/very good/excellent health (PR = 1.92; 95 %CI = 1.37-2.70). Higher HCST was also associated with more frequent past-month poor physical (PR = 1.34; 95 %CI = 1.12-1.59) and mental (PR = 1.49; 95 %CI = 1.33-1.66) health days.

Conclusion

HCST may contribute to adverse healthcare access and health outcomes in TGD populations, though prospective studies are needed. Multilevel interventions are recommended to create safe, gender-affirming healthcare environments that mitigate HCST.

Barriers to sexual health care for sexually diverse Muslim men: a scoping review

Sexually diverse Muslim men (SDMM) are seen to present later and with more advanced symptoms of HIV and other sexually transmitted infections (STIs). The limited access to sexual healthcare services is attributed to the stigma associated with their multiple intersecting identities. We conducted a scoping review to synthesise research on barriers impeding SDMM's access to sexual health care. We used Arksey and O'Malley's five-stage framework as the methodology for the review. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses' extension for scoping reviews, was used as a guide for the presentation of the results. Searches conducted in EBSCOhost, Scopus, MEDLINE, Embase, CINAHL, Global Health, and Google Scholar yielded 1382 results, of which 18 studies were deemed eligible for this review. Bronfenbrenner's socioecological model was employed as a framework to analyse the studies. Through analysing the eligible studies, we identified factors operating at three different levels that can impede SDMM's access to sexual health care. Limited awareness and low-perceived risk of HIV/STIs, coupled with the fear of sexual identity disclosure might act as individual-level barriers to sexually diverse Muslim men's access to sexual health care. The experiences of discrimination within clinical settings were presented as a healthcare system-related issue discouraging SDMM from revisiting those services. Heteronormative and religious ideologies, homophobic government programs, and poverty might manifest in the more intimate domains of healthcare delivery, creating hostile spaces for SDMM. Intensive research and advocacy efforts are required to improve SDMM's access to sexual health care, which can reduce their risk of HIV/STIs.

Increasing safe clinical spaces and the efforts of clinical research for uninsured and underinsured LGBTQIA2+ patients: A case study of the Rainbow Clinic - a student-run free LGBTQIA2+ clinic

LGBTQIA2+ patients often experience discrimination and hostility in healthcare spaces. Negative perceptions of healthcare can contribute to poor health outcomes in LGBTQIA2+ patients. This population is rarely included in clinical trials through a lack of inclusion in study protocols, informed consent, and trials not addressing their needs and demographics. Many clinical institutions have created LGBTQIA2+-specific clinics; however, few have successfully developed a free clinic dedicated to this population. A Rainbow Clinic was formed at an established student-run free clinic, utilizing the existing infrastructure. Dissemination of this clinic's creation can help others replicate similar initiatives.

Sleep disturbance and suicide risk among sexual and gender minority people

Sleep disturbance has emerged as an independent, mechanistic, and modifiable risk factor for suicide. Sexual and gender minority (SGM) people disproportionately experience sleep disturbance and are at higher risk of death by suicide relative to cisgender and/or heterosexual individuals. The present narrative review evaluates nascent research related to sleep disturbance and suicide-related thoughts and behaviors (STBs) among SGM populations, and discusses how experiences of minority stress may explain heightened risk among SGM people. Although there is a growing understanding of the link between sleep disturbance and STBs, most research has not been conducted in SGM populations or has not examined suicide as an outcome. Research is needed to examine whether and how aspects of sleep disturbances relate to STBs among SGM people in order to better tailor sleep treatments for SGM populations.

Optimizing a mindfulness-based intervention to alleviate stress from discrimination among young sexual and gender minorities of color: A study protocol

Background

Young sexual and gender minorities (SGMs) of color may face unique experiences of discrimination based on their intersectional positions (eg, discrimination based on both racial or ethnic identity and sexual identity). Emerging evidence suggests that mindfulness practices may reduce stress from discrimination and improve overall well-being among young SGM. Moreover, the omnipresence of smartphone access among racial or ethnic and sexual minority communities provides a method through which to administer mindfulness-based interventions among young SGMs of color.

Objective

This paper outlines the protocol of the Optimizing a Daily Mindfulness Intervention to Reduce Stress from Discrimination among Young Sexual and Gender Minorities of Color (REDUCE) study, a pilot optimization trial of a smartphone-based mindfulness intervention that was developed in conjunction with the Healthy Minds Program (HMP) with the aim of reducing stress from discrimination among young SGMs.

Methods

In total, 80 young (ages 18-29 years) SGMs of color will be enrolled in the study. The HMP is a self-guided meditation practice, and participants will be randomized to either a control condition or an intervention that uses a neuroscience-based approach to mindfulness. We will use the multiphase optimization strategy to assess which combination of mindfulness interventions is the most effective at reducing stress from discrimination among young SGMs of color. A combination of mindfulness-based meditation intervention components will be examined, comprising mindfulness-based practices of awareness, connection, and purpose. Awareness refers to the practice of self-awareness, which reduces the mind’s ability to be distracted and instead be present in the moment. Connection refers to the practice of connection with oneself and others and emphasizes on empathy and compassion with oneself and others. Purpose encourages goal-making in accordance with one’s values and management of behavior in accordance with these goals. In addition, we will assess the feasibility and acceptability of the HMP application among young SGMs of color.

Results

The REDUCE study was approved by the Institutional Review Board of New York University, and recruitment and enrollment began in the winter of 2021. We expect to complete enrollment by the summer of 2022. The results will be disseminated via social media, journal articles, abstracts, or presentations, as well as to participants, who will be given the opportunity to provide feedback to the researchers.

Conclusions

This optimization trial is designed to test the efficacy, feasibility, and acceptability of implementing an application-based, mindfulness-based intervention to reduce stress from discrimination and improve well-being among young SGMs of color. Evidence from this study will assist in the creation of a sustainable, culturally relevant mobile app–based mindfulness intervention to reduce stress from discrimination among young SGMs of color.

Trial Registration

Clinicaltrials.gov NCT05131360; https://clinicaltrials.gov/ct2/show/NCT05131360

International Registered Report Identifier (IRRID)

DERR1-10.2196/35593

Healthcare Stereotype Threat and Health Outcomes Among LGB Individuals

BACKGROUND/PURPOSE

Health disparities between sexual minorities and heterosexuals are well documented and have been explained by differential access to healthcare as well as exposure to discrimination. The current research examines the role that healthcare stereotype threat, or the fear of being judged by healthcare providers based on negative group stereotypes, plays in the health of LGB individuals.

METHODS

LGB individuals (N = 1507) in three age cohorts were recruited via random digit dialing to participate in a larger study on sexual minority health. Participants completed measures assessing healthcare stereotype threat, lifetime health diagnoses, life satisfaction, and number of bad physical health days and personal distress in the past 30 days.

RESULTS

Healthcare stereotype threat was associated with higher psychological distress and number of reported bad physical health days. Additionally, the Younger and Middle cohorts reported more stereotype threat than the Older cohort, but reported significantly higher levels of life satisfaction in the face of this threat than those in the Older cohort.

CONCLUSIONS

Healthcare stereotype threat was related to poorer mental and physical health among LGB individuals; this was true when these outcomes were assessed over the past 30 days but not when they were assessed in general. Cohort differences in healthcare stereotype threat suggest potential important within group variation that needs further investigating. The research broadens the contexts to which stereotype threat is relevant and establishes a stressor related to LGB health.

The views and experiences of bisexual people regarding their psychosocial support needs: a qualitative evidence synthesis

WHAT IS KNOWN ON THE SUBJECT?: Bisexual people experience significantly poorer mental health and higher rates of self-harm and suicidality than their gay, lesbian or heterosexual counterparts. Although little is understood about why these disparities exist, bisexual people have been found to have unique life experiences that separate them from other sexual minority groups. Despite these health disparities and unique experiences, in research and in clinical settings, bisexual people are often incorporated under the LGBTQI+ umbrella and their needs are not seen as being different to those of other sub-groups. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This paper brings together the findings of the small but growing body of literature reporting on the psychosocial support needs of bisexual people. The findings reported on herein provide novel insights, collated and synthesized that will prove valuable to policy makers, service providers and researchers. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: This paper clearly illustrates that bisexual people experience significant barriers to accessing the support services they need and that current competent service provision for this population is severely limited. The findings presented in this paper shed light on the unique psychosocial needs of bisexual people and highlight the need for practice change to reduce barriers to service access and ensure inclusive and culturally competent care for this community. ABSTRACT: Introduction Despite consistent evidence of poor mental health among what is a relatively large population group, research examining bisexual mental health remains sparse. Aim To identify the psychosocial needs of people who are bisexual and establish factors that may support or inhibit access to appropriate psychosocial interventions and supports. Method A qualitative evidence syntheses of the empirical evidence. Results A total of 15 papers were included in the review. The PRISMA process was used. Following data analysis, four main themes emerged that were (a) experiences of being bisexual, (b) mental health experiences and concerns, (c) service access and responses and (iv) communities and supports. Discussion Bisexual people have unique and specific psychosocial support needs that relate to, but are also different from, the needs of the broader LGBTIQ+ community. This study provides valuable insights into how future policy, practice, education and training and research can better address the needs of this highly vulnerable group. Implications for Practice This study highlights the psychosocial complexities associated with bisexuality and provides evidence for the need for improvement in current support services to ensure inclusivity and culturally competent care.

Mental health challenges of lesbian, gay, bisexual and transgender people: An integrated literature review

Lesbian, gay, bisexual and transgender (LGBT) individuals are often stigmatised and discriminated against. This population is expected to experience poorer mental health outcomes compared with heterosexual and cis-gendered people, a phenomenon healthcare providers need to take note of and act upon. This study aimed to explore and describe the mental health challenges of LGBT people. An integrative literature search was conducted. The following electronic databases were searched: Academic Search Premier, Africa-Wide Information, Business Source Premier, eBook Collection (EBSCOhost), E-Journals, ERIC, Family & Society Studies Worldwide, Health Source: Nursing/Academic Edition, Humanities Source, MasterFILE Premier, MEDLINE, PsycARTICLES, Social Work Abstracts, TOC Premier, WorldCat.org, Taylor and Francis Journals, Biomed Central and Wiley Online Library. An internet search was also carried out using Google and Google Scholar databases. The following search terms were identified: 'LGBT' OR 'LGBT community' AND 'mental health challenges/problems' OR 'mental/psychiatric illness'. The reviewed literature comprised research conducted globally between 2010 and 2019. From the 2545 titles, 345 abstracts were examined, resulting in 57 articles. The 57 full-text articles were examined to verify whether they addressed the scope of the literature review, of them, 21 addressed the mental health challenges of LGBT people. Lesbian, gay, bisexual and transgender people experience the following mental health challenges: emotional distress, stigmatisation, victimisation, discrimination and barriers to accessing healthcare services. The results showed that although LGBT has been legalised in many countries, LGBT communities still experience significant mental health challenges. Healthcare providers are in a position to address challenges related to social and healthcare structures and act as advocates in order to promote the mental health of LGBT individuals.