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Rathod SD, Annand PJ, Hosseini P, Guise A, Platt L. Epidemiological features of depression and anxiety among homeless adults with healthcare access problems in London, UK: descriptive cross-sectional analysis. BJPsych Open 2024; 10:e93. [PMID: 38686447 PMCID: PMC11060085 DOI: 10.1192/bjo.2024.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 02/12/2024] [Accepted: 02/23/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND In England in 2021, an estimated 274 000 people were homeless on a given night. It has long been recognised that physical and mental health of people who are homeless is poorer than for people who are housed. There are few peer-reviewed studies to inform health and social care for depression or anxiety among homeless adults in this setting. AIMS To measure the symptoms of depression and anxiety among adults who are homeless and who have difficulty accessing healthcare, and to describe distribution of symptoms across sociodemographic, social vulnerability and health-related characteristics. METHOD We completed structured questionnaires with 311 adults who were homeless and who had difficulty accessing healthcare in London, UK, between August and December 2021. We measured anxiety and depression symptoms using the 4-item Patient Health Questionnaire (PHQ-4) score. We compared median PHQ-4 scores across strata of the sociodemographic, social vulnerability and health-related characteristics, and tested for associations using the Kruskal-Wallis test. RESULTS The median PHQ-4 score was 8 out of 12, and 40.2% had scores suggesting high clinical need. Although PHQ-4 scores were consistently high across a range of socioeconomic, social vulnerability and health-related characteristics, they were positively associated with: young age; food insecurity; recent and historic abuse; joint, bone or muscle problems; and frequency of marijuana use. The most common (60%) barrier to accessing healthcare related to transportation. CONCLUSIONS Adults who are homeless and have difficulty accessing healthcare have high levels of depression and anxiety symptoms. Our findings support consideration of population-level, multisectoral intervention.
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Affiliation(s)
- Sujit D. Rathod
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - P. J. Annand
- Department of Sociology, University of Surrey, UK
| | - Paniz Hosseini
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Andrew Guise
- Department of Population Health Sciences, King's College London, UK
| | - Lucy Platt
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
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Winiker AK, Eschliman EL, Kisanga EP, Poku OB, Candelario J, Takahashi LM, Tobin K. Multilevel experiences of carceral violence in Los Angeles, California: first-hand accounts from a racially diverse sample of transgender women. CULTURE, HEALTH & SEXUALITY 2024; 26:159-173. [PMID: 36995142 PMCID: PMC10731923 DOI: 10.1080/13691058.2023.2194353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 03/20/2023] [Indexed: 03/31/2023]
Abstract
Transgender women face a disproportionate burden of carceral violence, or violence related to policing and the criminal legal system, with transgender women of colour experiencing even greater disparities. Several frameworks conceptualise the mechanisms through which violence impacts transgender women. However, none of them directly explore the role of carceral violence, particularly as it is experienced by transgender women themselves. Sixteen in-depth interviews were conducted with a racially/ethnically diverse sample of transgender women in Los Angeles between May and July 2020. Participants were between 23 - 67 years old. Participants identified as Black (n = 4), Latina (n = 4), white (n = 2), Asian (n = 2), and Native American (n = 2). Interviews assessed experiences of multilevel violence, including from police and law enforcement. Deductive and inductive coding methods were used to identify and explore common themes concerning carceral violence. Experiences of law enforcement-perpetrated interpersonal violence were common and included physical, sexual and verbal abuse. Participants also highlighted structural violence, including misgendering, the non-acceptance of transgender identities, and police intentionally failing to uphold laws that could protect transgender women. These results demonstrate the pervasive, multilevel nature of carceral violence perpetrated against transgender women and suggest avenues for future framework development, trans-specific expansions of carceral theory, and system-wide institutional change.
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Affiliation(s)
- Abigail K. Winiker
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Evan L. Eschliman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Edwina P. Kisanga
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ohemaa B. Poku
- HIV Center for Clinical and Behavioral Studies, Division of Gender, Sexuality, and Health, Columbia University and New York Psychiatric Institute, New York, NY, USA
| | | | - Lois M. Takahashi
- Sol Price School of Public Policy, University of Southern California, Sacramento, CA, USA
| | - Karin Tobin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Cusack M, Montgomery AE, Byrne T. Examining the Intersection of Housing Instability and Violence Among LGBTQ Adults. JOURNAL OF HOMOSEXUALITY 2023; 70:2943-2954. [PMID: 35700390 DOI: 10.1080/00918369.2022.2085936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
To assess the relationship between LGBTQ status and (1) current, recent, and lifetime experiences of housing instability, (2) risk of housing instability due to fears of interpersonal violence, and (3) perceived housing challenges, this study examined online survey data from individuals with a household income <$35,000 (N = 1,270). Analyses compared LGBTQ and cisgender heterosexual respondents using chi-square tests and logistic regression. Over their lifetime, LGBTQ respondents had increased odds of sleeping outdoors (adjusted odds ratios [AOR] = 1.580) or in a car (AOR = 1.465) because they had nowhere else to stay. They also had increased odds of reporting housing challenges related to violence from family/friends (AOR = 3.278), substance abuse (AOR = 3.063), and mental health (AOR = 2.048). Interventions serving LGBTQ adults should prioritize safety concerns and consider providing services to both individuals and families. In addition, providers should increase sensitivity toward issues of sexual orientation and gender identity and the unique needs of LGBTQ adults.
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Affiliation(s)
- Meagan Cusack
- U.S. Department of Veterans Affairs, Center for Health Equility Research & Promotion, Philadelphia, Pennsylvania, USA
- School of Social Policy & Practice, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ann Elizabeth Montgomery
- Birmingham Veterans Affairs Medical Center, Birmingham, Alabama, USA
- School of Public Health, University of Alabama, Birmingham, Alabama, USA
| | - Thomas Byrne
- U.S. Department of Veterans Affairs, Center for Healthcare Outcomes & Implementation Research, Bedford, Massachusetts, USA
- School of Social Work, Boston University, Boston, Massachusetts, USA
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Ecker J, Aubry T, Sylvestre J. Experiences of LGBTQ Adults Who Have Accessed Emergency Shelters in a Large Urban City in Canada. SOCIAL WORK IN PUBLIC HEALTH 2022; 37:168-185. [PMID: 34542018 DOI: 10.1080/19371918.2021.1976345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
This study examines the experiences of adults who identify as LGBTQ (lesbian, gay, bisexual, transgender, queer) and who have accessed emergency shelters in an urban Canadian city. Twenty LGBTQ adults who were currently or formerly homeless participated in one qualitative interview. The interview protocol included questions on the participants' experiences accessing emergency shelters, with a focus on interactions with other emergency shelter residents. Data was analyzed using an iterative coding process. The results demonstrated that participants engage in various identity management strategies and encounter both positive and negative interactions with other emergency shelter residents. The results are discussed in terms of strategies to improve emergency shelter policies to be more inclusive of LGBTQ adults.
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Affiliation(s)
- John Ecker
- Canadian Observatory on Homelessness, York University, Toronto, Ontario, Canada
| | - Tim Aubry
- Centre for Research on Educational & Community Services and School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - John Sylvestre
- Centre for Research on Educational & Community Services and School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
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Rennie S, Chege W, Schrumpf LA, Luna F, Klitzman R, Moseki E, Brown B, Wakefield S, Sugarman J. HIV prevention research and COVID-19: putting ethics guidance to the test. BMC Med Ethics 2021; 22:6. [PMID: 33494754 PMCID: PMC7829648 DOI: 10.1186/s12910-021-00575-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 01/14/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Critical public health measures implemented to mitigate the spread of the novel coronavirus disease (COVID-19) pandemic have disrupted health research worldwide, including HIV prevention research. While general guidance has been issued for the responsible conduct of research in these challenging circumstances, the contours of the dueling COVID-19 and HIV/AIDS pandemics raise some critical ethical issues for HIV prevention research. In this paper, we use the recently updated HIV Prevention Trials Network (HPTN) Ethics Guidance Document (EGD) to situate and analyze key ethical challenges related to the conduct of HIV prevention research during the COVID-19 pandemic as well as identify potential areas for refinement of the guidance document based on this unprecedented state of affairs. MAIN BODY Necessary actions taken for HIV prevention research studies due to the COVID-19 pandemic involve an array of ethical issues including those related to: (1) risk mitigation; (2) behavior change; (3) compounding vulnerability; (4) community engagement; (5) trial reopening; and 6) shifting research priorities. CONCLUSIONS In the context of the dueling HIV and COVID-19 global pandemics, research teams and sponsors must be nimble in responding to the rapidly changing environment by being sensitive to the associated ethical issues. The HTPN EGD provides a rich set of tools to help identify, analyze and address many of these issues. At the same time, future refinements of the HPTN EGD and other research ethics guidance could be strengthened by providing explicit advice regarding the ethical issues associated with disrupted research and the reopening of studies. In addition, additional consideration should be given to appropriately balancing domains of risk (e.g., physical versus social), addressing the vulnerability of research staff and community partners, and responding to un-anticipatable ancillary care needs of participants and communities. Appropriately addressing these issues will necessitate conceptual work, which would benefit from the careful documentation of the actual ethical issues encountered in research, the strategies implemented to overcome them, and their success in doing so. Throughout all of these efforts, it is critical to remember that the HIV pandemic not be forgotten in the rush to deal with the COVID-19 pandemic.
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Affiliation(s)
- Stuart Rennie
- UNC Center for Bioethics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Wairimu Chege
- Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, USA
| | | | | | | | - Ernest Moseki
- Botswana Harvard AIDS Institute Partnership Princess Marina Hospital, Gaborone, Botswana
| | - Brandon Brown
- Center for Healthy Communities, University of California Riverside School of Medicine, Riverside, CA, USA
| | | | - Jeremy Sugarman
- Berman Institute of Bioethics, Johns Hopkins University, 1809 Ashland Ave, Baltimore, MD, 21205, USA.
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Glick JL, Lopez A, Pollock M, Theall KP. Housing insecurity and intersecting social determinants of health among transgender people in the USA: A targeted ethnography. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2020; 21:337-349. [PMID: 34993513 PMCID: PMC8726680 DOI: 10.1080/26895269.2020.1780661] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Background: Housing is an important social determinant of health (SDOH). Transgender people face a unique blend of discrimination and compromised social services, putting them at risk for housing insecurity and associated public health concerns. Aims: This targeted ethnography explores housing insecurity as a SDOH among transgender people in the U.S. Methods: In-depth interviews were conducted with transgender people (n = 41) throughout the U.S.A., identified through purposive sampling. A semi-structured guide was used to elicit personal stories and peer accounts of insecure housing experiences and coping strategies. Interviews were audio recorded and transcribed. Data was coded, sorted, and analyzed for key themes. Results: Responses revealed pervasive housing insecurity and inter-related challenges. Respondents discussed how intersecting identities create unique constellations of vulnerability, which "intersect like a star." Financial insecurity and interpersonal rejection were lead housing insecurity causes, often resulting in psychological strain, which was sometimes addressed with substances and sexual risk-taking. These factors were cyclically accompanied by financial and employment insecurity and a cascade of unmet social needs. Social support facilitated coping. Discussion: Findings support increasing transgender housing security intervention resources that address intersecting and cyclical discrimination, trauma, housing, employment, and health issues.
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Affiliation(s)
- Jennifer L. Glick
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Alex Lopez
- Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Miranda Pollock
- School of Medicine, Section of Community and Population Medicine, Louisiana State University Health Sciences Center – New Orleans, New Orleans, Louisiana, USA
| | - Katherine P. Theall
- Global Community Health and Behavioral Sciences and LSUHSC Comprehensive Alcohol and HIV Research Center (CARC), Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
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Sevelius JM, Gutierrez-Mock L, Zamudio-Haas S, McCree B, Ngo A, Jackson A, Clynes C, Venegas L, Salinas A, Herrera C, Stein E, Operario D, Gamarel K. Research with Marginalized Communities: Challenges to Continuity During the COVID-19 Pandemic. AIDS Behav 2020; 24:2009-2012. [PMID: 32415617 PMCID: PMC7228861 DOI: 10.1007/s10461-020-02920-3] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Jae M Sevelius
- Center of Excellence for Transgender Health, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
| | - Luis Gutierrez-Mock
- Center of Excellence for Transgender Health, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Sophia Zamudio-Haas
- Center of Excellence for Transgender Health, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Breonna McCree
- Center of Excellence for Transgender Health, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Azize Ngo
- Center of Excellence for Transgender Health, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Akira Jackson
- Center of Excellence for Transgender Health, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Carla Clynes
- Center of Excellence for Transgender Health, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Luz Venegas
- Center of Excellence for Transgender Health, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Arianna Salinas
- Center of Excellence for Transgender Health, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Cinthya Herrera
- Center of Excellence for Transgender Health, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Ellen Stein
- Center of Excellence for Transgender Health, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Don Operario
- School of Public Health, Brown University, Providence, RI, USA
| | - Kristi Gamarel
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
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Brown MJ, Patterson R. Subjective Cognitive Decline Among Sexual and Gender Minorities: Results from a U.S. Population-Based Sample. J Alzheimers Dis 2020; 73:477-487. [PMID: 31796675 PMCID: PMC7299090 DOI: 10.3233/jad-190869] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The risk of dementia and mild cognitive impairment between older adults in same-sex relationships and those in opposite-sex relationships have been found to be statistically not different. However, studies examining subjective cognitive decline (SCD) among sexual and gender minority populations (SGM) are lacking. The primary objective was to determine if SGM report greater SCD compared to non-SGM populations in a U.S. population-based sample of non-institutionalized adults aged 45 and older. The secondary objective was to assess the association between gender and SCD. Cross-sectional data were obtained from the 2016 Behavioral Risk Factor Surveillance System (n = 36,734). There were 1,094 SGM adults in the sample. Descriptive statistics examined sociodemographic characteristics and their distribution by SCD and SGM status. Crude and multivariable logistic regression models were used to determine the association between SGM status, gender, and SCD. Adjusted models controlled for age, race/ethnicity, income, education, employment, marital status, depression, and diabetes. Statistically significant differences in SGM status and SCD existed by age, race/ethnicity, education, employment, marital status, and depression. Differences in SCD also existed by income and diabetes status. There was no statistically significant association between SGM status and SCD (OR: 0.88; 95% CI: 0.63-1.24). However, men had 64% higher odds (OR: 1.64; 95% CI: 1.44-1.88) of reporting SCD compared to women. Future studies examining the potential reasons for this null association, including resilience and/or premature aging are warranted. Future research assessing potential reasons for gender differences in SCD, whether physiological or environmental, is also needed.
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Affiliation(s)
- Monique J. Brown
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC
- Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC
- Office for the Study on Aging, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Robert Patterson
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC
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