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Wootton AR, Sterzing PR, Mericle AA, Drabble LA, Cahoon LR, Hughes TL. Resilience Through Social Support: An Intersectional Analysis of Sexual Minority Women's Social Resources for Wellbeing. JOURNAL OF HOMOSEXUALITY 2024:1-21. [PMID: 38833648 DOI: 10.1080/00918369.2024.2360610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
Sexual minority women (SMW) are at higher risk for a range of health conditions (e.g. depression, anxiety, and alcohol use disorder) than heterosexual women. However, poor health outcomes do not occur for all SMW. Resilience provides a lens for understanding why some SMW maintain good mental and behavioral health despite the presence of multiple risk factors. Few studies have examined the resilience-promoting factor of social support in relation to depression, anxiety, and alcohol use disorder in SMW. There is a need for further research clarifying sources of social support (e.g. family, significant others, friends, LGBTQ+ community) associated with resilient outcomes for SMW. This study used data from a telephone-based survey of 520 SMW to examine the relationships between resilience and social support. We used multiple regression and tested for interactions with ethnoracial identity and sexual identity. Greater levels of overall social support were associated with greater resilience, as was social support from the LGBTQ+ community in particular. There were few differences in these relationships by ethnoracial identity, sexual identity, or their intersections. Interventions that increase social support across any of four support sources appear to have the potential to increase resilience and decrease mental and behavioral health risks for SMW.
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Affiliation(s)
- Angie R Wootton
- School of Social Welfare, University of California, Berkeley, California, USA
- School of Social Welfare, University at Albany, Albany, New York, USA
| | - Paul R Sterzing
- School of Social Welfare, University of California, Berkeley, California, USA
| | - Amy A Mericle
- Alcohol Research Group, Public Health Institute, Emeryville, California, USA
| | - Laurie A Drabble
- School of Social Work, San Jose State University College of Health and Human Sciences, San Jose, California, USA
| | - Linda R Cahoon
- School of Social Welfare, University at Albany, Albany, New York, USA
| | - Tonda L Hughes
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
- Center for Sexual and Gender Minority Health Research, Columbia University School of Nursing, New York, NY, USA
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Barboza-Salerno GE, Meshelemiah JCA. Associations between early child adversity and lifetime suicide attempts among gender diverse individuals: A moderated mediation. CHILD ABUSE & NEGLECT 2024; 149:106705. [PMID: 38422580 DOI: 10.1016/j.chiabu.2024.106705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 02/07/2024] [Accepted: 02/13/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND This study examines the effect of adverse childhood experiences (ACEs) on lifetime suicide attempts (LSA) across five gender subgroups (i.e., transgender men, transgender women, transgender non-binary, cisgender men and cisgender women). OBJECTIVE To examine (1) the prevalence of LSA across gender identity subgroups; (2) whether the association between ACEs and LSA is moderated by gender identity subgroup; (3) depressive symptoms, alcohol use disorder, social support, and social well-being as mechanisms linking ACEs with LSA; and (4) the moderating role of gender identity on the four putative mediators. PARTICIPANTS AND SETTINGS We used nationally representative data from a population-based survey of N = 1368 transgender and cisgender individuals collected between 2016 and 2019. METHODS Structural equation modeling was used to explore the indirect effect of depressive symptoms on the relation between ACEs and LSA, and the moderating impact of gender identity. RESULTS LSA was significantly more prevalent among transgender respondents (cisgender man = 5 %; cisgender woman = 9 %; transgender man = 42 %; transgender woman = 33 %; transgender non-binary = 37 %; p < 0.001). Individuals with more ACEs had a greater risk of engaging in LSA regardless of gender identity; however, moderation results showed that the impact of each additional ACE on LSA was stronger for individuals with transgender identities: the likelihood of engaging in LSA was statistically similar for transgender men with no ACEs and cisgender men with all 8 ACEs. Indirect effects of ACEs on LSA via depressive symptoms were also observed, and the mediating effect was moderated by gender identity. CONCLUSIONS By examining the mechanisms linking childhood adversity to LSA, this study demonstrates that not all ACEs impact gender minority subgroups equally.
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Affiliation(s)
- Gia E Barboza-Salerno
- The Ohio State University, College of Public Health & College of Social Work, 352 Cunz Hall, 1841 Neil Avenue, Columbus, OH 43210, United States of America.
| | - Jacquelyn C A Meshelemiah
- The Ohio State University, College of Social Work, 325D Stillman Hall, 1947 North College Road, Columbus, OH 43210, United States of America.
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3
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Barboza-Salerno GE, Remillard A. Early Child Adversity and Delinquent Behavior in Foster Care Youth: Do Future Expectations and Sexual Identity Moderate the Mediating Role of Posttraumatic Stress? JOURNAL OF CHILD & ADOLESCENT TRAUMA 2023; 16:945-957. [PMID: 38045844 PMCID: PMC10689334 DOI: 10.1007/s40653-023-00548-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/19/2023] [Indexed: 12/05/2023]
Abstract
Purpose Delinquency in youth is a significant public health concern for individuals who experienced adversity and complex trauma as children. The present study explored the longitudinal associations between adverse child experiences and future engagement in delinquent behavior. Methods Using a sample of 1,245 foster youth who are aging out of the child welfare system, mediation, moderation, and moderated mediation analysis was used to test the mechanistic role of post-traumatic stress symptoms and the moderating role of sexual identity and positive future expectations on engagement in delinquent behavior. Results Results showed a positive and significant association between adverse child experiences and engagement in delinquent behavior. Post-traumatic stress symptoms partially mediated the ACEs-delinquency relationship. In addition, sexual minority youth and youth who were less optimistic about the future, but who experienced more ACEs, were at risk for heightened levels of post-traumatic stress. Conclusions Interventions that promote positive future outlooks may minimize the psychological sequelae of early child adversity and delinquent behavior particularly when tailored to the needs of sexual minority youth.
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Affiliation(s)
| | - Alexandria Remillard
- School of Public Affairs, 1420 Austin Bluffs Pkwy, Colorado Springs, CO 80918 USA
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Edwards OW, Lev E, Obedin-Maliver J, Lunn MR, Lubensky ME, Capriotti MR, Garrett-Walker JJ, Flentje A. Our pride, our joy: An intersectional constructivist grounded theory analysis of resources that promote resilience in SGM communities. PLoS One 2023; 18:e0280787. [PMID: 36735687 PMCID: PMC9897522 DOI: 10.1371/journal.pone.0280787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 12/20/2022] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Sexual and gender minority (SGM) communities, including lesbian, gay, bisexual, transgender, queer, intersex, asexual, and Two-Spirit people, have historically been researched from a deficits-based approach that fails to highlight the ways communities survive and thrive in the face of adversity. This study endeavored to create a model of resources that promote SGM resilience using a sample that amplified traditionally underrepresented perspectives, including individuals from racial and/or ethnic minority groups, trans and/or gender diverse individuals, individuals on the asexual spectrum, and older adults. METHODS Participant responses to three open-ended questions from The PRIDE Study's (an online national longitudinal cohort study of SGM people) 2018 Annual Questionnaire were analyzed using constructivist grounded theory. These questions examined what brings people joy and what they appreciate most about their SGM identity. Participants (n = 315) were randomly selected from a larger sample of people who had responded to demographic questions and at least one open-ended question (N = 4,030) in a manner to ensure diverse representation across race/ethnicity, gender identity, sexual orientation, age, and region of residence. RESULTS The proposed model includes social resources (Connecting with Others, Cultivating Family, Helping Others, Participating in Culture and Spirituality), affective generative resources (Engaging in Enriching Pursuits, Accessing Economic Resources), and introspective resources (Exploring One's Authentic Self, Persevering through Hardship) that are theorized to contribute to SGM resilience across the life course. CONCLUSIONS SGM communities may tap into various resources to promote resilience. As public health practitioners, we can help to foster this resilience by resourcing and supporting initiatives that foster social connection, create spaces for community members to engage with various types of enrichment, facilitate access to economic resources, and provide support and inclusion for all SGM community members.
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Affiliation(s)
- O. Winslow Edwards
- Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, California, United States of America
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, California, United States of America
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Eliot Lev
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, California, United States of America
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, California, United States of America
| | - Juno Obedin-Maliver
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, California, United States of America
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California, United States of America
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California, United States of America
| | - Mitchell R. Lunn
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, California, United States of America
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California, United States of America
- Department of Medicine, Division of Nephrology, Stanford University School of Medicine, Stanford, California, United States of America
| | - Micah E. Lubensky
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, California, United States of America
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, California, United States of America
| | - Matthew R. Capriotti
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California, United States of America
- Psychology Department, San Jose State University, San Jose, California, United States of America
| | - J. J. Garrett-Walker
- Department of Applied Psychology and Human Development, Ontario Institute for Studies in Education, University of Toronto, Toronto, Ontario, Canada
| | - Annesa Flentje
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, California, United States of America
- The PRIDE Study/PRIDEnet, Stanford University School of Medicine, Stanford, California, United States of America
- Department of Psychiatry, Alliance Health Project, School of Medicine, University of California, San Francisco, California, United States of America
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Handlovsky I, Ferlatte O, Kia H, Knight R, Broom A, Oliffe J. Processes underpinning survival in gay men living with HIV and a history of suicidality. SOCIOLOGY OF HEALTH & ILLNESS 2022; 44:1132-1148. [PMID: 35614527 DOI: 10.1111/1467-9566.13500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 05/08/2022] [Indexed: 06/15/2023]
Abstract
Gay men living with HIV represent a particularly high risk group for suicide; however, little is known about suicidality, specifically, resiliencies in the context of suicidality among this particular group of men. The current study draws on photovoice and grounded theory methods to examine the processes that underpin survival for gay men living with HIV who have experienced suicidality. Twenty-two Canadian-based gay men participated, taking photographs to depict and discuss their perspectives on resiliencies. Analyses revealed three processes that supported men's survival: (1) connecting to key supports, (2) finding sanctity in the outdoors, and (3) giving help as purposeful value-adding. Connecting to key supports highlighted the utility of connection and therapeutic communication, listening and support provided by friends, family and professionals. Finding sanctity in the outdoors emphasised the healing capacity of outdoor green spaces, and giving help as purposeful value-adding illustrated the meaning and purpose men derived from supporting others. These findings can inform public health and primary care interventions to foster gay men's resilience and coping, and ultimately suicide prevention efforts.
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Affiliation(s)
- Ingrid Handlovsky
- School of Nursing, University of Victoria, Victoria, British Columbia, Canada
- Institute on Aging & Lifelong Health, University of Victoria, Victoria, British Columbia, Canada
| | - Olivier Ferlatte
- École de Santé Publique de l'Université de Montréal, Montreal, Quebec, Canada
- Centre de Recherche en Santé Publique, Université de Montréal et CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, Quebec, Canada
| | - Hannah Kia
- UBC School of Social Work, Vancouver, British Columbia, Canada
| | - Rod Knight
- UBC Faculty of Medicine, Vancouver, British Columbia, Canada
- BC Centre for Substance Use, Vancouver, British Columbia, Canada
| | | | - John Oliffe
- UBC School of Nursing, Vancouver, British Columbia, Canada
- Department of Nursing, University of Melbourne, Melbourne, Australia
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6
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Foley JD, Stanton AM, Shepard C, Morris J, O'Cleirigh C, Potter J, Batchelder AW. Discrimination experiences, resilience, and cardiovascular disease risk factors among sexual minority women. J Behav Med 2022; 45:461-471. [PMID: 35503193 DOI: 10.1007/s10865-022-00320-7] [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: 06/01/2021] [Accepted: 04/03/2022] [Indexed: 11/29/2022]
Abstract
Resilience, or the process of adapting to adversity, may protect against the harmful effects of minority-related stressors on the cardiovascular health of sexual minority women (SMW). An online survey was conducted in a sample of cisgender, non-heterosexual women to evaluate resilience as a moderator of the association between discrimination experiences and key cardiovascular disease (CVD) risk factors: stress, tobacco-smoking, hazardous alcohol consumption, poor diet quality, physical inactivity, and sedentary behaviors. Overall, 191 women (mean age = 29.34, SD = 6.92; 84.5% White) completed the survey and met eligibility to be included in the data analysis. White race (b = - 6.71, SE = 2.49) and education (b = - 3.36, SE = 0.56) were each independently associated with fewer discrimination experiences. Latinx ethnicity was associated with more discrimination experiences (b = 9.34, SE = 2.61). Education was associated with greater resilience (b = 4.57, SE = 0.83). Multivariable regression models were adjusted for race, ethnicity, and education. Discrimination was associated with a higher likelihood of smoking in the past month (b = 0.04, SE = 0.02) and drinking at hazardous levels (b = 0.09, SE = 0.02). Resilience was associated with less stress (b = - 0.15, SE = 0.02), a lower likelihood of hazardous alcohol consumption (b = - 0.02, SE = 0.01) and less time spent engaging in sedentary behaviors (b = - 0.02, SE = 0.01). One moderation emerged, such that discrimination was negatively associated with stress for those low in resilience (b = - 1.75, SE = 0.58), and not associated with stress for those high in resilience. These findings may inform the development of CVD-risk reduction interventions for SMW, which could include both strategies to mitigate the effects of discrimination on substance use and coping skills to promote resilience.
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Affiliation(s)
- Jacklyn D Foley
- Massachusetts General Hospital/Harvard Medical School, Boston, USA. .,Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Square, Suite 701, Boston, MA, 02114, USA.
| | - Amelia M Stanton
- Massachusetts General Hospital/Harvard Medical School, Boston, USA
| | | | | | - Conall O'Cleirigh
- Massachusetts General Hospital/Harvard Medical School, Boston, USA.,The Fenway Institute, Fenway Health, Boston, USA
| | | | - Abigail W Batchelder
- Massachusetts General Hospital/Harvard Medical School, Boston, USA.,The Fenway Institute, Fenway Health, Boston, USA
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7
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McNair RP, Parkinson S, Dempsey D, Andrews C. Lesbian, gay and bisexual homelessness in Australia: Risk and resilience factors to consider in policy and practice. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e687-e694. [PMID: 34038599 DOI: 10.1111/hsc.13439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 03/11/2021] [Accepted: 04/28/2021] [Indexed: 06/12/2023]
Abstract
Lesbian, gay and bisexual (LGB) people are more likely than heterosexual people to experience homelessness. The study aimed to compare risk and resilience factors commonly associated with homelessness according to sexual identity to inform more LGB-inclusive and targeted policy and service provision in this area. The study involved analysis of data from two Australian surveys: the General Social Survey 2014 (n = 17,401) and the Journeys Home study (n = 1,659). Chi-squared analyses of the survey data compared LGB with heterosexual respondents. Bisexual respondents had a significantly earlier average age of first homelessness, and were more likely to have repeated episodes of homelessness than lesbian, gay or heterosexual respondents. Risk factors that were higher among bisexual people included family violence, conflict and rejection and substance use issues. LGB respondents were twice as likely to have experienced discrimination as heterosexual respondents, more likely to have experienced violence and have mental health problems. Conversely, resilience factors for LGB respondents included being more likely to access friends for support in times of crisis, and to be involved in civic or political groups. We suggest that LGB people at risk of homelessness need effective responses based on their risk and resilience factors, including targeted peer support and mainstream services that affirm and acknowledge their diverse sexual identities. Australian policies should encourage improved LGB data collection and specific service responses. Primary prevention approaches include educating families of origin about LGB identities and assertive outreach to prevent housing loss.
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Affiliation(s)
- Ruth P McNair
- Department of General Practice, The University of Melbourne, Carlton, VIC, Australia
| | | | - Deborah Dempsey
- Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Cal Andrews
- The University of Melbourne, Carlton, VIC, Australia
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8
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Fraser G, Brady A, Wilson MS. Mental health support experiences of rainbow rangatahi youth in Aotearoa New Zealand: results from a co-designed online survey. J R Soc N Z 2022. [DOI: 10.1080/03036758.2022.2061019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Gloria Fraser
- School of Psychology, Victoria University of Wellington, Wellington, New Zealand
| | - Anita Brady
- School of English, Film, Theatre, Media Studies, and Art History, Victoria University of Wellington, Wellington, New Zealand
| | - Marc S. Wilson
- School of Psychology, Victoria University of Wellington, Wellington, New Zealand
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9
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Lagana` L, Balian OA, Nakhla MZ, Zizumbo J, Greenberg S. A preliminary model of health regarding sexual and ethnic minority older adults. CULTURE, HEALTH & SEXUALITY 2021; 23:333-348. [PMID: 32133922 PMCID: PMC7773154 DOI: 10.1080/13691058.2019.1710566] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 12/27/2019] [Indexed: 05/28/2023]
Abstract
Older individuals with sexual/gender minority and minority racial/ethnic identities typically face unique challenges, along with opportunities to overcome these obstacles. Published studies on the difficulties faced by sexual and gender minorities are available; however, research on older adults with both racial/ethnic minority and sexual and gender minority identities is rarer. These individuals must confront various forms of discrimination related to ageism, homophobia and racism. Resilience likely plays a role in the ability to manage and survive multiple challenges and discriminatory experiences, yet targeted research on these populations is lacking. This paper offers a preliminary model that incorporates prevalent threats to these populations' well-being and their deleterious psychosocial correlates, especially, whenever available, the unique challenges that older individuals must face when age, sexual orientation and race/ethnicity intersect. Recommendations are made to optimise the expansion and empirical testing of this preliminary model.
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Affiliation(s)
- Luciana Lagana`
- Department of Psychology, California State University Northridge, CA, USA
| | - Ovsanna A. Balian
- Doctoral Program in Psychological and Brain Sciences, University of Delaware, Newark, DE, USA
| | - Marina Z. Nakhla
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego (SDSU/UCSD), San Diego, CA, USA
| | - Juan Zizumbo
- Department of Psychology, California State University Northridge, CA, USA
| | - Shayna Greenberg
- Department of Psychology, California State University Northridge, CA, USA
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10
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Coulombe S, Pacheco T, Cox E, Khalil C, Doucerain MM, Auger E, Meunier S. Risk and Resilience Factors During the COVID-19 Pandemic: A Snapshot of the Experiences of Canadian Workers Early on in the Crisis. Front Psychol 2020; 11:580702. [PMID: 33343455 PMCID: PMC7744587 DOI: 10.3389/fpsyg.2020.580702] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 10/28/2020] [Indexed: 01/10/2023] Open
Abstract
Research highlights several risk and resilience factors at multiple ecological levels that influence individuals’ mental health and wellbeing in their everyday lives and, more specifically, in disaster or outbreak situations. However, there is limited research on the role of these factors in the early days of the COVID-19 crisis. The present study examined if and how potential risk factors (i.e., reduction in income, job insecurity, feelings of vulnerability to contracting the virus, lack of confidence in avoiding COVID-19, compliance with preventative policies) and resilience factors (i.e., trait resilience, family functioning, social support, social participation, and trust in healthcare institutions) are associated with mental health and well-being outcomes, and whether these resilience factors buffer (i.e., moderate) the associations between risk factors and said outcomes. One to two weeks after the government recommended preventative measures, 1,122 Canadian workers completed an online questionnaire, including multiple wellbeing outcome scales in addition to measures of potential risk and resilience factors. Structural equation models were tested, highlighting that overall, the considered risk factors were associated with poorer wellbeing outcomes, except social distancing which was associated with lower levels of stress. Each of the potential resilience factors was found to have a main effect on one or more of the wellbeing outcomes. Moderation analysis indicated that in general these resilience factors did not, however, buffer the risk factors. The findings confirm that the COVID-19 crisis encompasses several stressors related to the virus as well as to its impact on one’s social, occupational, and financial situation, which put people at risk for lower wellbeing as early as one to two weeks after the crisis began. While several resilience factors emerged as positively related to wellbeing, such factors may not be enough, or sufficiently activated at that time, to buffer the effects of the numerous life changes required by COVID-19. From an ecological perspective, while mental health professionals and public health decision-makers should offer/design services directly focused on mental health and wellbeing, it is important they go beyond celebrating individuals’ inner potential for resilience, and also support individuals in activating their environmental resources during a pandemic.
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Affiliation(s)
- Simon Coulombe
- Department of Industrial Relations, Université Laval, Quebec City, QC, Canada
| | - Tyler Pacheco
- Department of Psychology, Wilfrid Laurier University, Waterloo, ON, Canada
| | - Emily Cox
- Department of Psychology, Wilfrid Laurier University, Waterloo, ON, Canada
| | - Christine Khalil
- Department of Psychology, Wilfrid Laurier University, Waterloo, ON, Canada
| | - Marina M Doucerain
- Department of Psychology, Université du Québec à Montréal, Montreal, QC, Canada
| | - Emilie Auger
- Department of Industrial Relations, Université Laval, Quebec City, QC, Canada
| | - Sophie Meunier
- Department of Psychology, Université du Québec à Montréal, Montreal, QC, Canada
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11
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Wen J, Yeh TP, Xie H, Yu X, Tang J, Chen Y. Resilience, self-esteem, self-efficacy, social support, depression and ART adherence among people living with HIV in Sichuan, China. AIDS Care 2020; 33:1414-1421. [PMID: 33025792 DOI: 10.1080/09540121.2020.1828800] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
ABSTRACTAIDS has had physical, psychological and social consequences on People living with HIV (PLWH) with the result that the challenges and adversity they face have significantly increased. Resilience helps individuals cope with these adversities and difficulties. For PLWH to face increased challenges and setbacks created by AIDS, they are required to have resilience. This paper presents research carried out in China aiming to examine the relationships among resilience, self-esteem, self-efficacy, social support, depression and antiretroviral therapy (ART) adherence in PLWH. A cross-sectional study using a convenience sample was conducted and 223 PLWH were recruited from 2 hospitals and 1 Center of Disease Control in Sichuan, China, from May to August 2018. The present research found that resilience was positively affected by self-esteem, self-efficacy and social support, and negatively predicted depression and positively predicted ART adherence. Resilience plays a mediating role between influential factors (self-esteem, self-efficacy and social support) and adaptive outcomes (depression and ART adherence). It suggests that resilience should be considered as a factor in intervention designed to reduce PLWH's depression and improve ART adherence. Improving self-esteem, self-efficacy and social support could enhance resilience.
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Affiliation(s)
- Jing Wen
- Department of Obstetrics Nursing, West China Second University Hospital, Sichuan University, Key Laboratory of Birth Defects and Related Diseases of Women and Children Sichuan University, Ministry of Education, West China Nursing School, Sichuan University, Chengdu, People's Republic of China.,School of Nursing, Southwest Medical University, Luzhou, People's Republic of China
| | - Tzu-Pei Yeh
- School of Nursing, China Medical University, Taichung, Taiwan.,Department of Nursing, China Medical University Hospital, Taichung, Taiwan
| | - Hong Xie
- Department of Obstetrics Nursing, West China Second University Hospital, Sichuan University, Key Laboratory of Birth Defects and Related Diseases of Women and Children Sichuan University, Ministry of Education, West China Nursing School, Sichuan University, Chengdu, People's Republic of China
| | - Xingli Yu
- School of Nursing, Southwest Medical University, Luzhou, People's Republic of China
| | - Jian Tang
- School of Nursing, Southwest Medical University, Luzhou, People's Republic of China
| | - Yanhua Chen
- School of Nursing, Southwest Medical University, Luzhou, People's Republic of China.,Department of Nursing, The Affiliated Hospital of Southwest Medical University, Luzhou, People's Republic of China
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12
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Handlovsky I, Bungay V, Johnson J, Oliffe J. Overcoming adversity: a grounded theory of health management among middle-aged and older gay men. SOCIOLOGY OF HEALTH & ILLNESS 2020; 42:1566-1580. [PMID: 32579289 DOI: 10.1111/1467-9566.13145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This article presents findings from a grounded theory study in which we explored how self-identifying gay men between 40 and 76 years of age manage their health in the context of homophobia, heteronormativity and discrimination. Data were collected with 25 men over a 6-month period in a large urban setting in Western Canada. A preliminary theory of health management is discussed, consisting of the central phenomenon of overcoming adversity. Three thematic processes are considered that illustrate how adversity and health management are situated within the interrelationships of historical and ongoing discrimination inclusive of and external to the healthcare encounter, the complexity of men's illnesses, and the temporal aspects of HIV epidemics and treatments that occurred throughout their lives. These themes include: advocating for health needs, knowing about health issues and treatments, and engaging in health promoting practices. These findings help to address a gap in knowledge concerning health management among older gay men and support that initiatives aimed at health care with gay men must appreciate the systemic role of discrimination, while supporting men's individual efforts in actively managing their health.
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Affiliation(s)
| | | | - Joy Johnson
- Simon Fraser Faculty of Health Sciences, Burnaby, BC, Canada
| | - John Oliffe
- UBC School of Nursing, Vancouver, BC, Canada
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13
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Goodyear T, Mniszak C, Jenkins E, Fast D, Knight R. "Am I gonna get in trouble for acknowledging my will to be safe?": Identifying the experiences of young sexual minority men and substance use in the context of an opioid overdose crisis. Harm Reduct J 2020; 17:23. [PMID: 32228646 PMCID: PMC7106659 DOI: 10.1186/s12954-020-00365-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 03/13/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND North America and other parts of the globe are in the midst of a public health emergency related to opioid overdoses and a highly contaminated illicit drug supply. Unfortunately, there is a substantial gap in our understandings about how this crisis affects key populations not conventionally identified within overdose-related surveillance data. This gap is particularly pronounced for gay, bisexual, and other men who have sex with men (sexual minority men)-a population that experiences substance use-related inequities across adolescence and young adulthood. METHODS We draw on in-depth semi-structured interviews conducted in 2018 with a diverse sample (N = 50) of sexual minority men ages 15-30 who use substances and live in Vancouver, Canada, to identify how patterns and contexts of substance use are occurring in the context of the opioid overdose crisis. RESULTS Our analysis revealed three themes: awareness, perceptions, and experiences of risk; strategies to mitigate risk; and barriers to safer substance use. First, participants described how they are deeply impacted by the contaminated illicit drug supply, and how there is growing apprehension that fatal and non-fatal overdose risk is high and rising. Second, participants described how procuring substances from "trustworthy" drug suppliers and other harm reduction strategies (e.g., drug checking technologies, Naloxone kits, not using alone) could reduce overdose risk. Third, participants described how interpersonal, service-related, and socio-structural barriers (e.g., drug criminalization and the lack of a regulated drug supply) limit opportunities for safer substance use. CONCLUSIONS Equity-oriented policies and programming that can facilitate opportunities for safer substance use among young sexual minority men are critically needed, including community- and peer-led initiatives, access to low-barrier harm reduction services within commonly frequented social spaces (e.g., Pride, night clubs, bathhouses), nonjudgmental and inclusive substance use-related health services, the decriminalization of drug use, and the provision of a safe drug supply.
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Affiliation(s)
- Trevor Goodyear
- British Columbia Centre on Substance Use, 400-1045 Howe St, Vancouver, BC, V6Z 2A9, Canada
- School of Nursing, University of British Columbia, Vancouver, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Caroline Mniszak
- British Columbia Centre on Substance Use, 400-1045 Howe St, Vancouver, BC, V6Z 2A9, Canada
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Emily Jenkins
- School of Nursing, University of British Columbia, Vancouver, Canada
| | - Danya Fast
- British Columbia Centre on Substance Use, 400-1045 Howe St, Vancouver, BC, V6Z 2A9, Canada
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Rod Knight
- British Columbia Centre on Substance Use, 400-1045 Howe St, Vancouver, BC, V6Z 2A9, Canada.
- Department of Medicine, University of British Columbia, Vancouver, Canada.
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Handlovsky I, Bungay V, Oliffe J, Johnson J. A qualitative investigation of mental health promotion among aging gay men. J Ment Health 2019; 29:321-327. [PMID: 31682541 DOI: 10.1080/09638237.2019.1677874] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Gay men, particularly middle aged and older men (over 40 years of age) experience a disproportionate burden of mental health issues compared to heterosexual men. Despite ample evidence that chronic exposure to structural and interpersonal discrimination negatively affect their mental health, little is known from gay men's perspectives how they understand mental health or their strategies to address their mental health concerns.Aim: This study's aim was to investigate how middle aged and older gay men experience their mental health and the mitigation strategies used to promote mental health.Method: Semi-structured interviews were conducted with 25 men who self-identified as gay. Data were analyzed using an interpretive descriptive approach.Results: Three overarching themes that best illustrate how men perceived their mental health and manage their mental health concerns were identified: gaining perspective, engaging with health services, and promoting and maintaining mental health.Conclusions: This study provides insight into how gay men come to acknowledge the validity of their mental health concerns, engage with health services, and their participation in other activities deemed essential for mental health promotion. These findings are ideally poised to inform development of health resources to promote and protect the mental health of aging gay men.
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Affiliation(s)
| | - Vicky Bungay
- Canada Research Chair Tier III, UBC School of Nursing, Vancouver, Canada
| | - John Oliffe
- Research, UBC School of Nursing, Vancouver, Canada
| | - Joy Johnson
- Simon Fraser Faculty of Health Sciences, Burnaby, Canada
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Bowling J, Baldwin A, Schnarrs PW. Influences of health care access on resilience building among transgender and gender non-binary individuals. Int J Transgend 2019; 20:205-217. [PMID: 32999607 DOI: 10.1080/15532739.2019.1595807] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background: Health care disparities between transgender/gender non-binary individuals and the general population are well-documented and related to both interpersonal and institutional discrimination. Resilience has been found to buffer the negative health effects of discrimination among gender diverse individuals as well as other stigmatized populations. Aims : The purpose of this study was to identify and understand resilience related to health and health care among a community sample of transgender and gender non-binary individuals in the southern United States. Methods: We conducted 35 longitudinal photo elicitation interviews with 21 participants among a community sample of transgender and gender non-binary individuals in the Southern US. Interview transcripts were coded using thematic analysis and themes were organized according to the Resilience Activation Framework. Results: Overall, individual and community-level resources within the domains of social and human capital were frequently activated to navigate challenges related to seeking and receiving health care. Lack of access to resources in economic and political capital domains constrained resilience. Discussion: This work demonstrates how stakeholders can identify target areas for interventions and policy change aimed at improving resilience in transgender and gender non-binary communities by utilizing the Resilience Activation Framework. In our sample, we found that resources should be directed toward building economic and political capital at the community level so participants have the ability and opportunity to marshal such resources.
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Affiliation(s)
- Jessamyn Bowling
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Aleta Baldwin
- Department of Kinesiology, Health & Nutrition, The University of Texas at San Antonio, San Antonio, TX, USA
| | - Phillip W Schnarrs
- Division of Community Engagement and Health Equity, Department of Population Health, Dell Medical School, The University of Texas at Austin, Austin, TX
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Handlovsky I, Bungay V, Oliffe J, Johnson J. Developing Resilience: Gay Men's Response to Systemic Discrimination. Am J Mens Health 2018; 12:1473-1485. [PMID: 29683025 PMCID: PMC6142121 DOI: 10.1177/1557988318768607] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 02/26/2018] [Accepted: 03/02/2018] [Indexed: 11/16/2022] Open
Abstract
Gay men experience marked health disparities compared to heterosexual men, associated with profound discrimination. Resilience as a concept has received growing attention to increase understanding about how gay men promote and protect their health in the presence of adversity. Missing in this literature are the perspectives and experiences of gay men over 40 years. This investigation, drawing on grounded theory methods, examined how gay men over 40 years of age develop resilience over the course of their lives to promote and protect their health. In-depth interviews were undertaken with 25 men ranging between 40 and 76 years of age who experienced an array of health concerns including depression, anxiety, suicidality, and HIV. Men actively resist discrimination via three interrelated protective processes that dynamically influence the development of resilience over their life course: (a) building and sustaining networks, (b) addressing mental health, and (c) advocating for respectful care encounters. Initiatives to promote and protect the health of gay men must be rooted in the recognition of the systemic role of discrimination, while supporting men's resilience in actively resisting discrimination.
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Affiliation(s)
| | | | - John Oliffe
- UBC School of Nursing, Vancouver, BC, Canada
| | - Joy Johnson
- Vice President Research, Simon Fraser Faculty of Health Sciences, Burnaby, BC, Canada
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17
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Peter T. Mind the gap: predicting the positive mental health of adult sexual minority Canadians. Health Promot Int 2018; 33:665-675. [PMID: 28369550 DOI: 10.1093/heapro/dax016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The goal of the study is to investigate possible predictors of positive mental health, and whether they differ across sexual identity adult groups. Using data from the 2012 Canadian Community Health Survey on Mental Health, multivariate analyses were conducted, including interaction terms, to assess the effects of sexual orientation on various mental illness, health-risk behaviors, and sociological indicators and their correlations with positive mental health. Substantial effect sizes were observed across all sexual identity groups for psychological distress, social provisions and sense of belonging in terms of their influence on positive mental health. However, various mental health disorders, suicidality, and whether or not care needs were being met varied considerably in the disaggregated analysis, suggesting that there are key differences among sexual minority groups when it comes to predicting positive mental health. This study represents perhaps the largest population-based analysis of positive mental health, which is both theoretically informed and psychometrically verified, on sexual minority adults. Findings raise important concerns regarding the lower than average levels of positive mental health for all sexual minorities, which may be explained, at least in part, to the health care system's tendency to focus primarily on individual treatment needs rather than broader socio-structural aspects within a mental health promotion framework.
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Affiliation(s)
- Tracey Peter
- Sociology, University of Manitoba, Winnipeg, Canada
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18
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Colpitts E, Gahagan J. "I feel like I am surviving the health care system": understanding LGBTQ health in Nova Scotia, Canada. BMC Public Health 2016; 16:1005. [PMID: 27658489 PMCID: PMC5034675 DOI: 10.1186/s12889-016-3675-8] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 09/16/2016] [Indexed: 11/18/2022] Open
Abstract
Background Currently, there is a dearth of baseline data on the health of lesbian, gay, bisexual, transgender, and queer (LGBTQ) populations in the province of Nova Scotia, Canada. Historically, LGBTQ health research has tended to focus on individual-level health risks associated with poor health outcomes among these populations, which has served to obscure the ways in which they maintain their own health and wellness across the life course. As such, there is an urgent need to shift the focus of LGBTQ health research towards strengths-based perspectives that explore the complex and resilient ways in which LGBTQ populations promote their health. Methods This paper discusses the findings of our recent scoping review as well as the qualitative data to emerge from community consultations aimed at developing strengths-based approaches to understanding and advancing LGBTQ pathways to health across Nova Scotia. Results Our scoping review findings demonstrated the lack of strengths-based research on LGBTQ health in Nova Scotia. Specifically, the studies examined in our scoping review identified a number of health-promoting factors and a wide variety of measurement tools, some of which may prove useful for future strengths-based health research with LGBTQ populations. In addition, our community consultations revealed that many participants had negative experiences with health care systems and services in Nova Scotia. However, participants also shared a number of factors that contribute to LGBTQ health and suggestions for how LGBTQ pathways to health in Nova Scotia can be improved. Conclusions There is an urgent need to conduct research on the health needs, lived experiences, and outcomes of LGBTQ populations in Nova Scotia to address gaps in our knowledge of their unique health needs. In moving forward, it is important that future health research take an intersectional, strengths-based perspective in an effort to highlight the factors that promote LGBTQ health and wellness across the life course, while taking into account the social determinants of health.
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Affiliation(s)
- Emily Colpitts
- Gender and Health Promotion Studies Unit, School of Health and Human Performance, Dalhousie University, Stairs House, 6230 South Street, P.O. Box 15000, Halifax, NS, B3H 4R2, Canada
| | - Jacqueline Gahagan
- Gender and Health Promotion Studies Unit, School of Health and Human Performance, Dalhousie University, Stairs House, 6230 South Street, P.O. Box 15000, Halifax, NS, B3H 4R2, Canada.
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Abstract
Rates of depression and anxiety are disproportionately high among lesbians and gay men, and stigma-related stress is thought to be a major factor. While reducing stigma remains a priority, developing ways to assist lesbians and gay men to build resilience to stigma-related stress is also a growing priority among policymakers and health professionals. This article summarizes major conceptual work and research on resilience among lesbians and gay men, including key findings from a nationwide online survey involving 2,793 Australian lesbians and gay men aged 16 years and older that examined demographic and psychosocial factors related to resilience. Research on resilience in gay and lesbian populations is currently a small field but appears to be growing. As recommended in this article, further work is needed to identify circumstances in which lesbians and gay men display resilience to stigma-related stress and to systematically test resilience training programmes that help to prevent depression and anxiety in these at-risk populations.
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Affiliation(s)
- Anthony Lyons
- a Australian Research Centre in Sex, Health and Society, La Trobe University , Melbourne, Victoria , Australia
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20
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Colpitts E, Gahagan J. The utility of resilience as a conceptual framework for understanding and measuring LGBTQ health. Int J Equity Health 2016; 15:60. [PMID: 27048319 PMCID: PMC4822231 DOI: 10.1186/s12939-016-0349-1] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 04/01/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Historically, lesbian, gay, bisexual, transgender and queer (LGBTQ) health research has focused heavily on the risks for poor health outcomes, obscuring the ways in which LGBTQ populations maintain and improve their health across the life course. In this paper we argue that informing culturally competent health policy and systems requires shifting the LGBTQ health research evidence base away from deficit-focused approaches toward strengths-based approaches to understanding and measuring LGBTQ health. METHODS We recently conducted a scoping review with the aim of exploring strengths-based approaches to LGBTQ health research. Our team found that the concept of resilience emerged as a key conceptual framework. This paper discusses a subset of our scoping review findings on the utility of resilience as a conceptual framework in understanding and measuring LGBTQ health. RESULTS The findings of our scoping review suggest that the ways in which resilience is defined and measured in relation to LGBTQ populations remains contested. Given that LGBTQ populations have unique lived experiences of adversity and discrimination, and may also have unique factors that contribute to their resilience, the utility of heteronormative and cis-normative models of resilience is questionable. Our findings suggest that there is a need to consider further exploration and development of LGBTQ-specific models and measures of resilience that take into account structural, social, and individual determinants of health and incorporate an intersectional lens. CONCLUSIONS While we fully acknowledge that the resilience of LGBTQ populations is central to advancing LGBTQ health, there remains much work to be done before the concept of resilience can be truly useful in measuring LGBTQ health.
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Affiliation(s)
- Emily Colpitts
- Gender and Health Promotion Studies Unit, School of Health and Human Performance, Dalhousie University, Stairs House, P.O. Box 15000, 6230 South Street, Halifax, N.S, B3H 4R2, Canada
| | - Jacqueline Gahagan
- Gender and Health Promotion Studies Unit, School of Health and Human Performance, Dalhousie University, Stairs House, P.O. Box 15000, 6230 South Street, Halifax, N.S, B3H 4R2, Canada.
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Gahagan J, Colpitts E. Understanding and Measuring LGBTQ Pathways to Health: A Scoping Review of Strengths-Based Health Promotion Approaches in LGBTQ Health Research. JOURNAL OF HOMOSEXUALITY 2016; 64:95-121. [PMID: 27043161 DOI: 10.1080/00918369.2016.1172893] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Health research traditionally has focused on the health risks and deficits of lesbian, gay, bisexual, transgender, and queer (LGBTQ) populations, obscuring the determinants that can promote health across the life course. Recognizing, appropriately measuring, and rendering visible these determinants of health is paramount to informing appropriate and engaging health policies, services, and systems for LGBTQ populations. The overarching purpose of this article is to provide an overview of the findings of a scoping review aimed at exploring strengths-based health promotion approaches to understanding and measuring LGBTQ health. Specifically, this scoping review examined peer-reviewed, published academic literature to determine (a) existing methodological frameworks for studying LGBTQ health from a strengths-based health promotion approach, and (b) suggestions for future methodological approaches for studying LGBTQ health from a strengths-based health promotion approach. The findings of this scoping review will be used to inform the development of a study aimed at assessing the health of and improving pathways to health services among LGBTQ populations in Nova Scotia, Canada.
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Affiliation(s)
- Jacqueline Gahagan
- a Health Promotion Division, Gender and Health Promotion Studies Unit, School of Health and Human Performance , Dalhousie University , Halifax , Nova Scotia , Canada
| | - Emily Colpitts
- a Health Promotion Division, Gender and Health Promotion Studies Unit, School of Health and Human Performance , Dalhousie University , Halifax , Nova Scotia , Canada
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22
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Neville S, Adams J, Cook C. Using internet-based approaches to collect qualitative data from vulnerable groups: reflections from the field. Contemp Nurse 2015; 52:657-668. [PMID: 26394073 DOI: 10.1080/10376178.2015.1095056] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Undertaking qualitative research with vulnerable populations is a complex and challenging process for researchers. Traditional and common modes of collecting qualitative data with these groups have been via face-to-face recorded interviews. METHODS This article reports on three internet-based data collection methods; email and synchronous online interviews, as well as online qualitative survey. RESULTS The key characteristics of using email, sychronous online interviews and an online qualitative survey including the strengths and limitations of each are presented. Reflections and insights on the use of these internet-based data collection methods are provided to encourage researchers to embrace technology and move away from using traditional face-to-face interviews when researching with vulnerable populations. CONCLUSION Using the internet to collect qualitative data offers additional ways to gather qualitative data over traditional data collection methods. The use of alternative interview methods may encourage participation of vulnerable participants.
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Affiliation(s)
- Stephen Neville
- a Department of Nursing , Auckland University of Technology , Private Bag 92006, Auckland , New Zealand
| | - Jeffery Adams
- b SHORE and Whariki Research Centre , Massey University , Albany Campus, Auckland , New Zealand
| | - Catherine Cook
- c School of Nursing , Massey University , Albany Campus, Auckland , New Zealand
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