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Hicks EM, Niarchou M, Goleva S, Kabir D, Johnson J, Johnston KJ, Ciarcia J, Pathak GA, Smoller JW, Davis LK, Nievergelt CM, Koenen KC, Huckins LM, Choi KW. Comorbidity Profiles of Posttraumatic Stress Disorder Across the Medical Phenome. BIOLOGICAL PSYCHIATRY GLOBAL OPEN SCIENCE 2024; 4:100337. [PMID: 39050781 PMCID: PMC11268109 DOI: 10.1016/j.bpsgos.2024.100337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 04/09/2024] [Accepted: 04/19/2024] [Indexed: 07/27/2024] Open
Abstract
Background Previous epidemiological research has linked posttraumatic stress disorder (PTSD) with specific physical health problems, but the comprehensive landscape of medical conditions associated with PTSD remains uncharacterized. Electronic health records provide an opportunity to overcome clinical knowledge gaps and uncover associations with biological relevance that potentially vary by sex. Methods PTSD was defined among biobank participants (N = 145,959) in 3 major healthcare systems using 2 ICD code-based definitions: broad (≥1 PTSD or acute stress codes vs. 0; n cases = 16,706) and narrow (≥2 PTSD codes vs. 0; n cases = 3325). Using a phenome-wide association study design, we tested associations between each PTSD definition and all prevalent disease umbrella categories, i.e., phecodes. We also conducted sex-stratified phenome-wide association study analyses including a sex × diagnosis interaction term in each logistic regression. Results A substantial number of phecodes were significantly associated with PTSDNarrow (61%) and PTSDBroad (83%). While the strongest associations were shared between the 2 definitions, PTSDBroad captured 334 additional phecodes not significantly associated with PTSDNarrow and exhibited a wider range of significantly associated phecodes across various categories, including respiratory, genitourinary, and circulatory conditions. Sex differences were observed in that PTSDBroad was more strongly associated with osteoporosis, respiratory failure, hemorrhage, and pulmonary heart disease among male patients and with urinary tract infection, acute pharyngitis, respiratory infections, and overweight among female patients. Conclusions This study provides valuable insights into a diverse range of comorbidities associated with PTSD, including both known and novel associations, while highlighting the influence of sex differences and the impact of defining PTSD using electronic health records.
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Affiliation(s)
- Emily M. Hicks
- Pamela Sklar Division of Psychiatric Genetics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Maria Niarchou
- Vanderbilt University Medical Center, Vanderbilt Genetics Institute, Nashville, Tennessee
| | - Slavina Goleva
- Vanderbilt University Medical Center, Vanderbilt Genetics Institute, Nashville, Tennessee
| | - Dia Kabir
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Jessica Johnson
- Pamela Sklar Division of Psychiatric Genetics, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Keira J.A. Johnston
- Department of Psychiatry, Division of Molecular Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Julia Ciarcia
- Department of Psychiatry, Division of Molecular Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Gita A. Pathak
- Department of Psychiatry, Division of Molecular Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Jordan W. Smoller
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- Broad Institute of MIT and Harvard, Stanley Center for Psychiatric Research, Cambridge, Massachusetts
- Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Boston, Massachusetts
| | - Lea K. Davis
- Vanderbilt University Medical Center, Vanderbilt Genetics Institute, Nashville, Tennessee
| | - Caroline M. Nievergelt
- Department of Psychiatry, University of California San Diego, La Jolla, California
- Veterans Affairs San Diego Healthcare System, Center of Excellence for Stress and Mental Health, San Diego, California
- Veterans Affairs San Diego Healthcare System, Research Service, San Diego, California
| | - Karestan C. Koenen
- Broad Institute of MIT and Harvard, Stanley Center for Psychiatric Research, Cambridge, Massachusetts
- Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Laura M. Huckins
- Department of Psychiatry, Division of Molecular Psychiatry, Yale University School of Medicine, New Haven, Connecticut
| | - Karmel W. Choi
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - PGC/PsycheMERGE PTSD & Trauma EHR Working Group
- Pamela Sklar Division of Psychiatric Genetics, Icahn School of Medicine at Mount Sinai, New York, New York
- Vanderbilt University Medical Center, Vanderbilt Genetics Institute, Nashville, Tennessee
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
- Department of Psychiatry, Division of Molecular Psychiatry, Yale University School of Medicine, New Haven, Connecticut
- Broad Institute of MIT and Harvard, Stanley Center for Psychiatric Research, Cambridge, Massachusetts
- Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Boston, Massachusetts
- Department of Psychiatry, University of California San Diego, La Jolla, California
- Veterans Affairs San Diego Healthcare System, Center of Excellence for Stress and Mental Health, San Diego, California
- Veterans Affairs San Diego Healthcare System, Research Service, San Diego, California
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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Valentine SE, Gell-Levey IM, Godfrey LB, Livingston NA. The Associations Between Gender Minority Stressors and PTSD Symptom Severity Among Trauma-Exposed Transgender and Gender Diverse Adults. J Trauma Dissociation 2024; 25:422-435. [PMID: 38436077 PMCID: PMC11192609 DOI: 10.1080/15299732.2024.2323977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 11/20/2023] [Indexed: 03/05/2024]
Abstract
This study investigates associations between minority stressors, traumatic stressors, and post-traumatic stress disorder (PTSD) symptom severity in a sample of transgender and gender diverse (TGD) adults. We utilized surveys and clinical interview assessments to assess gender minority stress exposures and responses, and PTSD. Our sample (N = 43) includes adults who identified as a minoritized gender identity (i.e., 39.5% trans woman or woman, 25.6% trans man or man, 23.3% genderqueer or nonbinary, 11.6% other identity). All participants reported at least one traumatic event (i.e., life threat, serious injury, or sexual harm). The most common trauma events reported by the sample were sexual (39.5%) and physical violence (37.2%), with 40.9% of participants anchoring their symptoms to a discrimination-based event. PTSD symptom severity was positively correlated with both distal (r = 0.36, p = .017) and proximal minority stressors (r = 0.40, p < .01). Distal minority stress was a unique predictor of current PTSD symptom severity (b = 0.94, p = .017), however, this association was no longer significant when adjusting for proximal minority stress (b = 0.18, p = 0.046). This study suggests that minority stress, especially proximal minority stress, is associated with higher PTSD symptom severity among TGD adults.
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Affiliation(s)
- Sarah E. Valentine
- Department of Psychiatry, Boston Medical Center, Boston, MA
- Department of Psychiatry, Boston University School of Medicine, Boston, MA
| | | | | | - Nicholas A. Livingston
- Department of Psychiatry, Boston University School of Medicine, Boston, MA
- National Center for PTSD, Behavioral Science Division, Boston, MA
- US Department of Veteran Affairs, VA Boston Healthcare System, Boston, MA
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3
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Scherbakov D, Mollalo A, Lenert L. Stressful life events in electronic health records: a scoping review. J Am Med Inform Assoc 2024; 31:1025-1035. [PMID: 38349862 PMCID: PMC10990522 DOI: 10.1093/jamia/ocae023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 01/19/2024] [Accepted: 01/27/2024] [Indexed: 02/15/2024] Open
Abstract
OBJECTIVES Stressful life events, such as going through divorce, can have an important impact on human health. However, there are challenges in capturing these events in electronic health records (EHR). We conducted a scoping review aimed to answer 2 major questions: how stressful life events are documented in EHR and how they are utilized in research and clinical care. MATERIALS AND METHODS Three online databases (EBSCOhost platform, PubMed, and Scopus) were searched to identify papers that included information on stressful life events in EHR; paper titles and abstracts were reviewed for relevance by 2 independent reviewers. RESULTS Five hundred fifty-seven unique papers were retrieved, and of these 70 were eligible for data extraction. Most articles (n = 36, 51.4%) were focused on the statistical association between one or several stressful life events and health outcomes, followed by clinical utility (n = 15, 21.4%), extraction of events from free-text notes (n = 12, 17.1%), discussing privacy and other issues of storing life events (n = 5, 7.1%), and new EHR features related to life events (n = 4, 5.7%). The most frequently mentioned stressful life events in the publications were child abuse/neglect, arrest/legal issues, and divorce/relationship breakup. Almost half of the papers (n = 7, 46.7%) that analyzed clinical utility of stressful events were focused on decision support systems for child abuse, while others (n = 7, 46.7%) were discussing interventions related to social determinants of health in general. DISCUSSION AND CONCLUSIONS Few citations are available on the prevalence and use of stressful life events in EHR reflecting challenges in screening and storing of stressful life events.
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Affiliation(s)
- Dmitry Scherbakov
- Biomedical Informatics Center, Medical University of South Carolina, Charleston, SC 29403, United States
| | - Abolfazl Mollalo
- Biomedical Informatics Center, Medical University of South Carolina, Charleston, SC 29403, United States
| | - Leslie Lenert
- Biomedical Informatics Center, Medical University of South Carolina, Charleston, SC 29403, United States
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Day S, Hay P, Tannous WK, Fatt SJ, Mitchison D. A Systematic Review of the Effect of PTSD and Trauma on Treatment Outcomes for Eating Disorders. TRAUMA, VIOLENCE & ABUSE 2024; 25:947-964. [PMID: 37125723 PMCID: PMC10913314 DOI: 10.1177/15248380231167399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
There is growing evidence of prior experiences of trauma and trauma-related symptoms among people with eating disorders; however, there is little understanding as to how post-traumatic stress disorder (PTSD) and exposure to traumatic events affect treatment outcomes. Without this knowledge, eating disorder clinicians are unable to tailor treatment to ensure good outcomes for the large percentage of this population that is affected by PTSD and trauma. This systematic review aimed to identify how PTSD and trauma exposure influence outcomes in eating disorder treatment. Systematic searches of PsycINFO, MEDLINE, PubMed, and Scopus databases identified 16 articles that met the inclusion criteria. The results indicated a negative effect on rates of eating disorder treatment completion and eating disorder psychopathology posttreatment. These findings were evident across studies that investigated the impact of a history of traumatic events as well as studies that investigated the impact of the presence of trauma-related symptoms seen in PTSD. Several methodological limitations were identified in the literature. These include: heterogeneous and unstandardized measures of PTSD and trauma, high attrition rates with follow-up, and insufficient data to enable comparisons by treatment setting, diagnostic presentation, and type of trauma exposure. The findings of this review have implications for future research and clinical care, including the importance of considering PTSD and trauma in assessment, treatment planning, and provision of both trauma-informed care and trauma-focused treatments for individuals with eating disorders.
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Affiliation(s)
- Sinead Day
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Phillipa Hay
- Translational Health Research Institute, School of Medicine, Western Sydney University, Penrith, NSW, Australia
- Mental Health Services Camden and Campbelltown Hospitals, South West Sydney Local Health District, NSW, Australia
| | - Wadad. Kathy Tannous
- Translational Health Research Institute, School of Business, Western Sydney University, Penrith, NSW, Australia
| | - Scott J. Fatt
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Deborah Mitchison
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
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Straub JJ, Paul KK, Bothwell LG, Deshazo SJ, Golovko G, Miller MS, Jehle DV. Risk of Suicide and Self-Harm Following Gender-Affirmation Surgery. Cureus 2024; 16:e57472. [PMID: 38699117 PMCID: PMC11063965 DOI: 10.7759/cureus.57472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2024] [Indexed: 05/05/2024] Open
Abstract
Introduction With the growing acceptance of transgender individuals, the number of gender affirmation surgeries has increased. Transgender individuals face elevated depression rates, leading to an increase in suicide ideation and attempts. This study evaluates the risk of suicide or self-harm associated with gender affirmation procedures. Methods This retrospective study utilized de-identified patient data from the TriNetX (TriNetX, LLC, Cambridge, MA) database, involving 56 United States healthcare organizations and over 90 million patients. The study involved four cohorts: cohort A, adults aged 18-60 who had gender-affirming surgery and an emergency visit (N = 1,501); cohort B, control group of adults with emergency visits but no gender-affirming surgery (N = 15,608,363); and cohort C, control group of adults with emergency visits, tubal ligation or vasectomy, but no gender-affirming surgery (N = 142,093). Propensity matching was applied to cohorts A and C. Data from February 4, 2003, to February 4, 2023, were analyzed to examine suicide attempts, death, self-harm, and post-traumatic stress disorder (PTSD) within five years of the index event. A secondary analysis involving a control group with pharyngitis, referred to as cohort D, was conducted to validate the results from cohort C. Results Individuals who underwent gender-affirming surgery had a 12.12-fold higher suicide attempt risk than those who did not (3.47% vs. 0.29%, RR 95% CI 9.20-15.96, p < 0.0001). Compared to the tubal ligation/vasectomy controls, the risk was 5.03-fold higher before propensity matching and remained significant at 4.71-fold after matching (3.50% vs. 0.74%, RR 95% CI 2.46-9.024, p < 0.0001) for the gender affirmation patients with similar results with the pharyngitis controls. Conclusion Gender-affirming surgery is significantly associated with elevated suicide attempt risks, underlining the necessity for comprehensive post-procedure psychiatric support.
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Affiliation(s)
- John J Straub
- Department of Emergency Medicine, University of Texas Medical Branch at Galveston, Galveston, USA
| | - Krishna K Paul
- Department of Emergency Medicine, University of Texas Medical Branch at Galveston, Galveston, USA
| | - Lauren G Bothwell
- Department of Emergency Medicine, University of Texas Medical Branch at Galveston, Galveston, USA
| | - Sterling J Deshazo
- Department of Emergency Medicine, University of Texas Medical Branch at Galveston, Galveston, USA
| | - Georgiy Golovko
- Department of Pharmacology, University of Texas Medical Branch at Galveston, Galveston, USA
| | - Michael S Miller
- Department of Psychiatry and Behavioral Services, University of Texas Medical Branch at Galveston, Galveston, USA
| | - Dietrich V Jehle
- Department of Emergency Medicine, University of Texas Medical Branch at Galveston, Galveston, USA
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Singh K, Wendt FR. Effects of sex and gender on the etiologies and presentation of select internalizing psychopathologies. Transl Psychiatry 2024; 14:73. [PMID: 38307846 PMCID: PMC10837201 DOI: 10.1038/s41398-024-02730-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 12/19/2023] [Accepted: 01/02/2024] [Indexed: 02/04/2024] Open
Abstract
The internalizing spectrum encompasses a subset of psychopathologies characterized by emotional liability, anhedonia, anxiousness, distress, and fear, and includes, among others, diagnoses of major depressive disorder (MDD), generalized anxiety disorder (GAD), and posttraumatic stress disorder (PTSD). In this review, we describe the vast body of work highlighting a role for sex and gender in the environment, symptom onset, genetic liability, and disorder progression and comorbidities of MDD, GAD, and PTSD. We also point the reader to different language used in diverse fields to describe sexual and gender minorities that may complicate the interpretation of emerging literature from the social sciences, psychiatric and psychological sciences, and genetics. Finally, we identify several gaps in knowledge that we hope serve as launch-points for expanding the scope of psychiatric studies beyond binarized sex-stratification. Despite being under-represented in genomics studies, placing emphasis on inclusion of sexual and gender diverse participants in these works will hopefully improve our understanding of disorder etiology using genetics as one tool to inform how biology (e.g., hormone concentration) and environmental variables (e.g., exposure to traumatic events) contribute to differences in symptom onset, pattern, and long-term trajectory.
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Affiliation(s)
- Kritika Singh
- Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Frank R Wendt
- Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
- Department of Anthropology, University of Toronto, Mississauga, ON, Canada.
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7
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Singh RS, Landes SJ, Willging CE, Abraham TH, McFrederick P, Kauth MR, Shipherd JC, Kirchner JE. Implementation of LGBTQ+ affirming care policies in the Veterans Health Administration: preliminary findings on barriers and facilitators in the southern United States. Front Public Health 2024; 11:1251565. [PMID: 38352130 PMCID: PMC10861648 DOI: 10.3389/fpubh.2023.1251565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 12/14/2023] [Indexed: 02/16/2024] Open
Abstract
Background In the United States Department of Veterans Affairs (VA), veterans who are lesbian, gay, bisexual, transgender, queer, and similar gender and sexual minoritized people (LGBTQ+) experience health disparities compared to cisgender, heterosexual veterans. VA's LGBTQ+ Health Program created two healthcare policies on providing LGBTQ+ affirming care (healthcare that is inclusive, validating, and understanding of the LGBTQ+ population). The current project examines providers' barriers and facilitators to providing LGBTQ+ affirming care and LGBTQ+ veterans' barriers and facilitators to receiving LGBTQ+ affirming care. Methods Data collection and analysis were informed by the Consolidated Framework for Implementation Research, which was adapted to include three health equity domains. Data collection involved telephone interviews conducted with 11 VA providers and 12 LGBTQ+ veterans at one rural and one urban VA medical center, and one rural VA community clinic. Qualitative data were rapidly analyzed using template analysis, a data reduction technique. Results Providers described limited education, limited time, lack of experience with the population, and a lack of awareness of resources as barriers. Providers discussed comfort with consulting trusted peers, interest in learning more about providing LGBTQ+ affirming care, and openness and acceptance of the LGBTQ+ community as facilitators. LGBTQ+ veterans described a lack of provider awareness of their needs, concerns related to safety and discrimination, and structural discrimination as barriers. LGBTQ+ veterans described positive relationships with providers, knowledge of their own healthcare needs, and ability to advocate for their healthcare needs as facilitators. Although VA's LGBTQ+ affirming care policies are in place, providers and veterans noted a lack of awareness regarding specific healthcare processes. Conclusion Allowing more time and capacity for education and engaging LGBTQ+ veterans in determining how to improve their healthcare may be the path forward to increase adherence to LGBTQ+ affirming care policies. Engaging patients, especially those from marginalized backgrounds, in strategies focused on the uptake of policy may be a path to improve policy implementation. It is possible that creating truly collaborative structures in which patients, staff, providers, leadership, and policymakers can work together towards policy implementation may be a useful strategy. In turn, improved policy implementation would result in increased physical and mental health for LGBTQ+ veterans.
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Affiliation(s)
- Rajinder Sonia Singh
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR, United States
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, United States
- VA Behavioral Health Quality Enhancement Research Initiative, Central Arkansas Veterans Healthcare System, Little Rock, AR, United States
- South Central Mental Illness Research, Education and Clinical Center, Houston, TX, United States
| | - Sara J. Landes
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, United States
- VA Behavioral Health Quality Enhancement Research Initiative, Central Arkansas Veterans Healthcare System, Little Rock, AR, United States
- South Central Mental Illness Research, Education and Clinical Center, Houston, TX, United States
| | - Cathleen E. Willging
- Behavioral Health Research Center of the Southwest, Pacific Institute for Research and Evaluation, Albuquerque, NM, United States
| | - Traci H. Abraham
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR, United States
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, United States
- South Central Mental Illness Research, Education and Clinical Center, Houston, TX, United States
- Clinical Outcome Assessments, Clinical Outcomes Solutions, Chicago, IL, United States
| | - Pamela McFrederick
- South Central VA Health Care Network, Ridgeland, MS, United States
- LGBTQ+ Health Program, Department of Veterans Affairs, Washington, DC, United States
| | - Michael R. Kauth
- LGBTQ+ Health Program, Department of Veterans Affairs, Washington, DC, United States
- Baylor College of Medicine, Houston, TX, United States
| | - Jillian C. Shipherd
- LGBTQ+ Health Program, Department of Veterans Affairs, Washington, DC, United States
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, United States
| | - JoAnn E. Kirchner
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR, United States
- Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, United States
- VA Behavioral Health Quality Enhancement Research Initiative, Central Arkansas Veterans Healthcare System, Little Rock, AR, United States
- South Central Mental Illness Research, Education and Clinical Center, Houston, TX, United States
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8
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Scherbakov D, Mollalo A, Lenert L. Stressful life events in electronic health records: a scoping review. RESEARCH SQUARE 2023:rs.3.rs-3458708. [PMID: 37886439 PMCID: PMC10602151 DOI: 10.21203/rs.3.rs-3458708/v2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Objective Stressful life events, such as going through divorce, can have an important impact on human health. However, there are challenges in capturing these events in electronic health records (EHR). We conducted a scoping review aimed to answer two major questions: how stressful life events are documented in EHR and how they are utilized in research and clinical care. Materials and Methods Three online databases (EBSCOhost platform, PubMed, and Scopus) were searched to identify papers that included information on stressful life events in EHR; paper titles and abstracts were reviewed for relevance by two independent reviewers. Results 557 unique papers were retrieved, and of these 70 were eligible for data extraction. Most articles (n=36, 51.4%) were focused on the statistical association between one or several stressful life events and health outcomes, followed by clinical utility (n=15, 21.4%), extraction of events from free-text notes (n=12, 17.1%), discussing privacy and other issues of storing life events (n=5, 7.1%), and new EHR features related to life events (n=4, 5.7%). The most frequently mentioned stressful life events in the publications were child abuse/neglect, arrest/legal issues, and divorce/relationship breakup. Almost half of the papers (n=7, 46.7%) that analyzed clinical utility of stressful events were focused on decision support systems for child abuse, while others (n=7, 46.7%) were discussing interventions related to social determinants of health in general. Discussion and Conclusions Few citations are available on the prevalence and use of stressful life events in EHR reflecting challenges in screening and storing of stressful life events.
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Affiliation(s)
- Dmitry Scherbakov
- Biomedical Informatics Center, Department of Public Health Sciences, Medical University of South Carolina
| | - Abolfazl Mollalo
- Biomedical Informatics Center, Department of Public Health Sciences, Medical University of South Carolina
| | - Leslie Lenert
- Biomedical Informatics Center, Department of Public Health Sciences, Medical University of South Carolina
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9
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Wolfe HL, Boyer TL, Shipherd JC, Kauth MR, Jasuja GK, Blosnich JR. Barriers and Facilitators to Gender-affirming Hormone Therapy in the Veterans Health Administration. Ann Behav Med 2023; 57:1014-1023. [PMID: 37436725 DOI: 10.1093/abm/kaad035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND In 2011, the Veterans Health Administration (VHA) established a policy for the delivery of transition-related services, including gender-affirming hormone therapy (GAHT), for transgender and gender diverse (TGD) patients. In the decade since this policy's implementation, limited research has investigated barriers and facilitators of VHA's provision of this evidence-based therapy that can improve life satisfaction among TGD patients. PURPOSE This study provides a qualitative summary of barriers and facilitators to GAHT at the individual (e.g., knowledge, coping mechanisms), interpersonal (e.g., interactions with other individuals or groups), and structural (e.g., gender norms, policies) levels. METHODS Transgender and gender diverse patients (n = 30) and VHA healthcare providers (n = 22) completed semi-structured, in-depth interviews in 2019 regarding barriers and facilitators to GAHT access and recommendations for overcoming perceived barriers. Two analysts used content analysis to code and analyze transcribed interview data and employed the Sexual and Gender Minority Health Disparities Research Framework to organize themes into multiple levels. RESULTS Facilitators included having GAHT offered through primary care or TGD specialty clinics and knowledgeable providers, with patients adding supportive social networks and self-advocacy. Several barriers were identified, including a lack of providers trained or willing to prescribe GAHT, patient dissatisfaction with prescribing practices, and anticipated or enacted stigma. To overcome barriers, participants recommended increasing provider capacity, providing opportunities for continual education, and enhancing communication around VHA policy and training. CONCLUSIONS Multi-level system improvements within and outside the VHA are needed to ensure equitable and efficient access to GAHT.
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Affiliation(s)
- Hill L Wolfe
- Center for Health Equity Research and Promotion (CHERP), VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Pain Research, Informatics, Multi-morbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven, CT, USA
- Biomedical Informatics and Data Science, Yale School of Medicine, New Haven, CT, USA
| | - Taylor L Boyer
- Center for Health Equity Research and Promotion (CHERP), VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Jillian C Shipherd
- Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ+) Health Program, Veterans Health Administration, Washington D.C., USA
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA
| | - Michael R Kauth
- Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ+) Health Program, Veterans Health Administration, Washington D.C., USA
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Guneet K Jasuja
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA
- Section of General Internal Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA 02118, USA
| | - John R Blosnich
- Center for Health Equity Research and Promotion (CHERP), VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
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10
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Zelkowitz RL, Halverson TF, Patel TA, Beckham JC, Calhoun PS, Pugh MJ, Kimbrel NA. Nonsuicidal self-injury methods among U.S. Veterans: Latent class analysis and associations with psychosocial outcomes. Psychiatry Res 2023; 329:115558. [PMID: 37890405 DOI: 10.1016/j.psychres.2023.115558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 10/18/2023] [Accepted: 10/21/2023] [Indexed: 10/29/2023]
Abstract
Nonsuicidal self-injury (NSSI) is a debilitating concern among U.S. veterans, with wall/object-punching commonly endorsed as an NSSI method. We examined how this behavior relates to other NSSI methods and psychosocial outcomes. We conducted a latent class analysis (LCA) of NSSI methods among 1,138 Gulf War Era veterans, (77.9% male), 21.7% of whom endorsed lifetime NSSI. We categorized classes based on their associations with age, sex, combat and military sexual assault exposure, then examined the association of class membership with psychosocial indicators. LCA results supported four classes: 1) High punching/banging NSSI (2.5%); 2) Multimethod NSSI methods (6.3%); 3) High-risk, multimethod NSSI (3.1%); and 4) Low-risk NSSI (88.1%). Psychosocial indicators (suicide attempt, ideation, possible depressive or posttraumatic stress disorders, poor psychosocial functioning) were worse for members of the NSSI classes versus those in the low-risk group. A subset of U.S. veterans may engage in NSSI primarily via punching/banging methods. All patterns of NSSI engagement were associated with negative psychosocial outcomes relative to those in the low-risk class of the behavior.
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Affiliation(s)
- Rachel L Zelkowitz
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA; Department of Psychiatry, Boston Chobanian & Avedisian School of Medicine, Boston, MA, USA.
| | - Tate F Halverson
- Durham Veterans Affairs Health Care System, Durham, NC, USA; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA
| | - Tapan A Patel
- Department of Psychology, Florida State University, Tallahassee, FL, USA
| | - Jean C Beckham
- Durham Veterans Affairs Health Care System, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA; VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, NC, USA
| | - Patrick S Calhoun
- Durham Veterans Affairs Health Care System, Durham, NC, USA; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA; VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, NC, USA
| | - Mary Jo Pugh
- VA Salt Lake City Healthcare System, Salt Lake City, UT, USA; Department of Medicine, School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Nathan A Kimbrel
- Durham Veterans Affairs Health Care System, Durham, NC, USA; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA; Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA; VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham, NC, USA
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11
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Fan CA, Upham M, Beaver K, Dashtestani K, Skiby MM, Pentel KZ, Rhew IC, Kauth MR, Shipherd JC, Kaysen D, Simpson T, Lehavot K. Recruiting Sexual and Gender Minority Veterans for Health Disparities Research: Recruitment Protocol of a Web-Based Prospective Cohort Study. JMIR Res Protoc 2023; 12:e43824. [PMID: 37782536 PMCID: PMC10580138 DOI: 10.2196/43824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 06/12/2023] [Accepted: 08/15/2023] [Indexed: 10/03/2023] Open
Abstract
BACKGROUND The Health for Every Veteran Study is the first Veterans Health Administration-funded, nationwide study on lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) veterans' health that relies exclusively on primary recruitment methods. This study aimed to recruit 1600 veterans with diverse sexual and gender identities to study the mental health and health risk behaviors of this population. A growing body of literature highlights the health inequities faced by LGBTQ+ veterans when compared with their heterosexual or cisgender peer groups. However, there is little to no guidance in the health disparities literature describing the recruitment of LGBTQ+ veterans. OBJECTIVE This paper provides an overview of the recruitment methodology of Health for Every Veteran Study. We describe the demographics of the enrolled cohort, challenges faced during recruitment, and considerations for recruiting LGBTQ+ veterans for health research. METHODS Recruitment for this study was conducted for 15 months, from September 2019 to December 2020, with the goal of enrolling 1600 veterans evenly split among 8 sexual orientation and gender identity subgroups: cisgender heterosexual women, cisgender lesbian women, cisgender bisexual women, cisgender heterosexual men, cisgender gay men, cisgender bisexual men, transgender women, and transgender men. Three primary recruitment methods were used: social media advertising predominantly through Facebook ads, outreach to community organizations serving veterans and LGBTQ+ individuals across the United States, and contracting with a research recruitment company, Trialfacts. RESULTS Of the 3535 participants screened, 1819 participants met the eligibility criteria, and 1062 completed the baseline survey to enroll. At baseline, 25.24% (268/1062) were recruited from Facebook ads, 40.49% (430/1062) from community outreach, and 34.27% (364/1062) from Trialfacts. Most subgroups neared the target enrollment goals, except for cisgender bisexual men, women, and transgender men. An exploratory group of nonbinary and genderqueer veterans and veterans with diverse gender identities was included in the study. CONCLUSIONS All recruitment methods contributed to significant portions of the enrolled cohort, suggesting that a multipronged approach was a critical and successful strategy in our study of LGBTQ+ veterans. We discuss the strengths and challenges of all recruitment methods, including factors impacting recruitment such as the COVID-19 pandemic, negative comments on Facebook ads, congressional budget delays, and high-volume surges of heterosexual participants from community outreach. In addition, our subgroup stratification offers important disaggregated insights into the recruitment of specific LGBTQ+ subgroups. Finally, the web-based methodology offers important perspectives not only for reaching veterans outside of the Veterans Health Administration but also for research studies taking place in the COVID-19-impacted world. Overall, this study outlines useful recruitment methodologies and lessons learned to inform future research that seeks to recruit marginalized communities. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/43824.
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Affiliation(s)
- Carolyn A Fan
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, United States
| | - Michelle Upham
- Health Services Research & Development (HSR&D) Center of Innovation (COIN), VA Puget Sound Health Care System, Seattle, WA, United States
| | - Kristine Beaver
- Health Services Research & Development (HSR&D) Center of Innovation (COIN), VA Puget Sound Health Care System, Seattle, WA, United States
| | - Krista Dashtestani
- Health Services Research & Development (HSR&D) Center of Innovation (COIN), VA Puget Sound Health Care System, Seattle, WA, United States
| | - Malachi M Skiby
- Downtown Emergency Service Center (DESC), Seattle, WA, United States
| | - Kimberly Z Pentel
- Pacific Northwest Individual and Couple Therapy, Seattle, WA, United States
| | - Isaac C Rhew
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, United States
| | - Michael R Kauth
- LGBTQ+ Health Program, Office of Patient Care Services, Veterans Health Administration, Washington, DC, United States
- South Central Mental Illness Research, Education and Clinical Center, Michael E DeBakey VA Medical Center, Houston, TX, United States
- Department of Psychiatry, Baylor College of Medicine, Houston, TX, United States
| | - Jillian C Shipherd
- LGBTQ+ Health Program, Office of Patient Care Services, Veterans Health Administration, Washington, DC, United States
- National Center for Posttraumatic Stress Disorder (PTSD), VA Boston Healthcare System, Boston, MA, United States
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
| | - Debra Kaysen
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States
- National Center for Posttraumatic Stress Disorder (PTSD), VA Palo Alto Health Care System, Palo Alto, CA, United States
| | - Tracy Simpson
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, United States
- Center of Excellence in Substance Abuse Treatment and Education (CESATE), VA Puget Sound Health Care System, Seattle, WA, United States
| | - Keren Lehavot
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, United States
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Zelkowitz RL, Kehle-Forbes SM, Smith BN, Vogt DS, Mitchell KS. Associations between DSM-5 posttraumatic stress disorder Criterion E2 endorsement and selected self-destructive behaviors in recent-era veterans: A focus on disordered eating. J Trauma Stress 2023; 36:1001-1009. [PMID: 37485630 DOI: 10.1002/jts.22960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 04/28/2023] [Accepted: 04/30/2023] [Indexed: 07/25/2023]
Abstract
Revisions to the posttraumatic stress disorder (PTSD) criteria in the DSM-5 included a new criterion in the alterations in arousal and reactivity cluster (i.e., engagement in reckless and self-destructive behaviors; Criterion E2). Despite its clinical significance, little is known about how this symptom corresponds to engagement in specific direct and indirect self-harm behaviors. We examined associations between E2 and self-reported recent engagement in direct and indirect self-harm behaviors, including disordered eating, which is not included in the prototypical E2 symptom scope, in a trauma-exposed sample of 1,010 recent-era veterans (61.5% self-identified women, 38.5% self-identified men). We also tested whether gender moderated these associations. We repeated analyses in a subsample of participants with clinically elevated PTSD symptoms. Participants self-reported past-month PTSD symptoms (PCL-5) as well as past-month nonsuicidal self-injury, suicidal ideation, suicide planning, fasting, purging, binge eating, compulsive exercise, and problematic alcohol and drug use. We found no evidence for moderation by gender for any of the behaviors examined in the main sample. However, after controlling for gender and demographic covariates, weighted logistic regressions showed small, significant associations between E2 score and direct self-harm behaviors, substance use, purging, and binge eating, aORs = 1.30-1.91. Criterion E2 was linked to behaviors included in the typical symptom scope (self-directed violence, substance use) and those that are not (disordered eating behaviors). Comprehensive screening for self-destructive behaviors, including disordered eating, among veteran men and women who endorse Criterion E2 is indicated.
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Affiliation(s)
- Rachel L Zelkowitz
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Shannon M Kehle-Forbes
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts, USA
- Center for Care Delivery and Outcomes Research, Minneapolis Veterans Affairs Health Care System, Minneapolis, Minnesota, USA
- Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Brian N Smith
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Dawne S Vogt
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Karen S Mitchell
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
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13
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Scheer JR, Behari K, Schwarz AA, Cascalheira CJ, Helminen EC, Pirog SA, Jaipuriyar V, Sullivan TP, Batchelder AW, Jackson SD. Expressive writing treatments to reduce PTSD symptom severity and negative alcohol-related outcomes among trauma-exposed sexual minority women and transgender/nonbinary people: Study protocol for a mixed-method pilot trial. Contemp Clin Trials Commun 2023; 35:101197. [PMID: 37671246 PMCID: PMC10475481 DOI: 10.1016/j.conctc.2023.101197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 07/21/2023] [Accepted: 08/18/2023] [Indexed: 09/07/2023] Open
Abstract
Background Sexual minority women (SMW) and transgender and/or nonbinary (TNB) individuals report an elevated prevalence of posttraumatic stress disorder (PTSD) symptoms and negative alcohol-related outcomes compared to heterosexual women and cisgender people. SMW and TNB individuals also face barriers to utilizing treatment, which can result in delayed or missed appointments. Accessible, feasible, and effective treatment approaches, such as web-based expressive writing (EW) treatments, are needed to address PTSD and negative alcohol-related outcomes in these populations. Method We describe the design of a mixed-method pilot randomized controlled trial which will compare an EW treatment adapted for SMW and TNB people (stigma-adapted EW) and trauma (i.e., non-adapted) EW with an active (neutral-event) control to determine acceptability and feasibility of a future fully powered randomized controlled trial. The sample will include 150 trauma-exposed SMW and TNB individuals from across the United States who will be randomly assigned to stigma-adapted EW (n = 50), trauma EW (n = 50), or control (n = 50). Participants will be assessed before treatment, one-week after the first writing session, and three-months after the first writing session. This paper identifies steps for evaluating the acceptability and feasibility of the proposed study and determining changes in outcomes resulting from adapted and non-adapted EW treatments to inform refinements. This paper also highlights our strategy for testing theory-driven mediators and moderators of treatment outcomes. Conclusions This mixed-method pilot trial will inform the first fully powered, self-administered, brief web-based treatment to reduce PTSD symptom severity and negative alcohol-related outcomes among trauma-exposed SMW and TNB individuals.
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Affiliation(s)
- Jillian R. Scheer
- Department of Psychology, Syracuse University, Syracuse, NY, 414 Huntington Hall, Syracuse, NY, 13244, USA
| | - Kriti Behari
- Department of Psychology, Syracuse University, Syracuse, NY, 414 Huntington Hall, Syracuse, NY, 13244, USA
| | - Aubriana A. Schwarz
- Department of Psychology, Syracuse University, Syracuse, NY, 414 Huntington Hall, Syracuse, NY, 13244, USA
| | - Cory J. Cascalheira
- Department of Counseling and Educational Psychology, New Mexico State University, Las Cruces, NM, 88003, USA
- VA Puget Sound Health Care System, Seattle, WA, 98108, USA
| | - Emily C. Helminen
- Department of Psychology, Syracuse University, Syracuse, NY, 414 Huntington Hall, Syracuse, NY, 13244, USA
| | - Sophia A. Pirog
- Department of Psychology, Syracuse University, Syracuse, NY, 414 Huntington Hall, Syracuse, NY, 13244, USA
| | - Virinca Jaipuriyar
- Department of Psychology, Syracuse University, Syracuse, NY, 414 Huntington Hall, Syracuse, NY, 13244, USA
| | - Tami P. Sullivan
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, 06501, USA
| | - Abigail W. Batchelder
- Harvard Medical School, Harvard University, Boston, MA, 02114, USA
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, 02114, USA
- The Fenway Institute, Fenway Health, Boston, MA, 02115, USA
| | - Skyler D. Jackson
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, 06501, USA
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14
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Marchese S, Huckins LM. Trauma Matters: Integrating Genetic and Environmental Components of PTSD. ADVANCED GENETICS (HOBOKEN, N.J.) 2023; 4:2200017. [PMID: 37766803 PMCID: PMC10520418 DOI: 10.1002/ggn2.202200017] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/28/2022] [Indexed: 09/29/2023]
Abstract
Trauma is ubiquitous, but only a subset of those who experience trauma will develop posttraumatic stress disorder (PTSD). In this review, it is argued that to determine who is at risk of developing PTSD, it is critical to examine the genetic etiology of the disorder and individual trauma profiles of those who are susceptible. First, the state of current PTSD genetic research is described, with a particular focus on studies that present evidence for trauma type specificity, or for differential genetic etiology according to gender or race. Next, approaches that leverage non-traditional phenotyping approaches are reviewed to identify PTSD-associated variants and biology, and the relative advantages and limitations inherent in these studies are reflected on. Finally, it is discussed how trauma might influence the heritability of PTSD, through type, risk factors, genetics, and associations with PTSD symptomology.
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Affiliation(s)
- Shelby Marchese
- Pamela Sklar Division of Psychiatric GenomicsIcahn School of Medicine at Mount SinaiNew YorkNY10029USA
- Department of Genetics and Genomic SciencesIcahn School of Medicine at Mount SinaiNew YorkNY10029USA
| | - Laura M. Huckins
- Pamela Sklar Division of Psychiatric GenomicsIcahn School of Medicine at Mount SinaiNew YorkNY10029USA
- Department of Genetics and Genomic SciencesIcahn School of Medicine at Mount SinaiNew YorkNY10029USA
- Department of PsychiatryIcahn School of Medicine at Mount SinaiNew YorkNY10029USA
- Seaver Autism Center for Research and TreatmentIcahn School of Medicine at Mount SinaiNew YorkNY10029USA
- Present address:
Department of PsychiatryYale University School of MedicineNew HavenCT06511USA
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15
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Keefe JR, Louka C, Moreno A, Spellun J, Zonana J, Milrod BL. Open Trial of Trauma-Focused Psychodynamic Psychotherapy for Posttraumatic Stress Disorder Among LGBTQ Individuals. Am J Psychother 2023; 76:115-123. [PMID: 37203147 DOI: 10.1176/appi.psychotherapy.20220037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
OBJECTIVE Lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals report higher rates of exposure to traumatic events and posttraumatic stress disorder (PTSD) compared with heterosexual and cisgender individuals. No treatment outcomes research has focused on PTSD in the LGBTQ population. Trauma-focused psychodynamic psychotherapy (TFPP) is a brief, manualized, attachment- and affect-focused psychotherapy for PTSD. TFPP explicitly incorporates broad identity-related and societal factors into its conceptualization of trauma and its consequences, which may be especially helpful for LGBTQ patients with minority stress who seek affirmative care. METHODS Fourteen LGBTQ patients with PTSD, assessed with the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5), received 24 sessions of twice-weekly (12 weeks) TFPP via teletherapy provided by supervised early-career therapists inexperienced in the modality. Sessions were videotaped to monitor therapists' treatment adherence. Patients were assessed at baseline, week 5, termination (week 12), and 3 months posttreatment for PTSD symptoms (assessed with the CAPS-5) and secondary outcomes. RESULTS TFPP was well tolerated by patients, with 12 (86%) completing the intervention. CAPS-5-measured PTSD symptoms, including dissociation, significantly improved during treatment (mean decrease=-21.8, d=-1.98), and treatment gains were maintained at follow-up. Most patients experienced PTSD clinical response (N=10, 71%) or diagnostic remission (N=7, 50%). Patients generally experienced significant, concomitant improvements in complex PTSD symptoms, general anxiety, depression, and psychosocial functioning. Adherence to the intervention among therapists was high, with 93% of rated sessions meeting adherence standards. CONCLUSIONS TFPP shows promise in the treatment of PTSD among sexual and gender minority patients seeking LGBTQ-affirmative PTSD care.
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Affiliation(s)
- John R Keefe
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, New York City (Keefe, Milrod); Department of Psychiatry, Weill Cornell Medical College, New York City (Keefe, Moreno, Spellun, Zonana, Milrod); Department of Psychiatry, New York-Presbyterian/Weill Cornell Medical Center, New York City (Louka); Silver Hill Hospital, New Canaan, Connecticut (Zonana)
| | - Charalambia Louka
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, New York City (Keefe, Milrod); Department of Psychiatry, Weill Cornell Medical College, New York City (Keefe, Moreno, Spellun, Zonana, Milrod); Department of Psychiatry, New York-Presbyterian/Weill Cornell Medical Center, New York City (Louka); Silver Hill Hospital, New Canaan, Connecticut (Zonana)
| | - Andrew Moreno
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, New York City (Keefe, Milrod); Department of Psychiatry, Weill Cornell Medical College, New York City (Keefe, Moreno, Spellun, Zonana, Milrod); Department of Psychiatry, New York-Presbyterian/Weill Cornell Medical Center, New York City (Louka); Silver Hill Hospital, New Canaan, Connecticut (Zonana)
| | - Jessica Spellun
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, New York City (Keefe, Milrod); Department of Psychiatry, Weill Cornell Medical College, New York City (Keefe, Moreno, Spellun, Zonana, Milrod); Department of Psychiatry, New York-Presbyterian/Weill Cornell Medical Center, New York City (Louka); Silver Hill Hospital, New Canaan, Connecticut (Zonana)
| | - Jess Zonana
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, New York City (Keefe, Milrod); Department of Psychiatry, Weill Cornell Medical College, New York City (Keefe, Moreno, Spellun, Zonana, Milrod); Department of Psychiatry, New York-Presbyterian/Weill Cornell Medical Center, New York City (Louka); Silver Hill Hospital, New Canaan, Connecticut (Zonana)
| | - Barbara L Milrod
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, New York City (Keefe, Milrod); Department of Psychiatry, Weill Cornell Medical College, New York City (Keefe, Moreno, Spellun, Zonana, Milrod); Department of Psychiatry, New York-Presbyterian/Weill Cornell Medical Center, New York City (Louka); Silver Hill Hospital, New Canaan, Connecticut (Zonana)
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Hicks EM, Niarchou M, Goleva S, Kabir D, Ciarcia J, Smoller JW, Davis LK, Nievergelt CM, Koenen KC, Huckins LM, Choi KW. Comorbidity Profiles of Posttraumatic Stress Disorder Across the Medical Phenome. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.08.25.23294572. [PMID: 37693435 PMCID: PMC10491282 DOI: 10.1101/2023.08.25.23294572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
Background Prior epidemiological research has linked PTSD with specific physical health problems, but the comprehensive landscape of medical conditions associated with PTSD remains uncharacterized. Electronic health records (EHR) provide an opportunity to overcome prior clinical knowledge gaps and uncover associations with biological relevance that potentially vary by sex. Methods PTSD was defined among biobank participants (total N=123,365) in a major healthcare system using two ICD code-based definitions: broad (1+ PTSD or acute stress codes versus 0; NCase=14,899) and narrow (2+ PTSD codes versus 0; NCase=3,026). Using a phenome-wide association (PheWAS) design, we tested associations between each PTSD definition and all prevalent disease umbrella categories, i.e., phecodes. We also conducted sex-stratified PheWAS analyses including a sex-by-diagnosis interaction term in each logistic regression. Results A substantial number of phecodes were significantly associated with PTSDNarrow (61%) and PTSDBroad (83%). While top associations were shared between the two definitions, PTSDBroad captured 334 additional phecodes not significantly associated with PTSDNarrow and exhibited a wider range of significantly associated phecodes across various categories, including respiratory, genitourinary, and circulatory conditions. Sex differences were observed, in that PTSDBroad was more strongly associated with osteoporosis, respiratory failure, hemorrhage, and pulmonary heart disease among male patients, and with urinary tract infection, acute pharyngitis, respiratory infections, and overweight among female patients. Conclusions This study provides valuable insights into a diverse range of comorbidities associated with PTSD, including both known and novel associations, while highlighting the influence of sex differences and the impact of defining PTSD using EHR.
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Affiliation(s)
- Emily M Hicks
- Pamela Sklar Division of Psychiatric Genetics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Maria Niarchou
- Vanderbilt University Medical Center, Vanderbilt Genetics Institute, Nashville, TN, USA
| | - Slavina Goleva
- Vanderbilt University Medical Center, Vanderbilt Genetics Institute, Nashville, TN, USA
| | - Dia Kabir
- Massachusetts General Hospital, Department of Psychiatry, Boston, MA, USA
| | - Julia Ciarcia
- Department of Psychiatry, Division of Molecular Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Jordan W Smoller
- Massachusetts General Hospital, Department of Psychiatry, Boston, MA, USA
- Broad Institute of MIT and Harvard, Stanley Center for Psychiatric Research, Cambridge, MA
- Massachusetts General Hospital, Psychiatric and Neurodevelopmental Genetics Unit (PNGU), Boston, MA
| | - Lea K Davis
- Vanderbilt University Medical Center, Vanderbilt Genetics Institute, Nashville, TN, USA
| | - Caroline M Nievergelt
- University of California San Diego, Department of Psychiatry, La Jolla, CA
- Veterans Affairs San Diego Healthcare System, Center of Excellence for Stress and Mental Health, San Diego, CA
- Veterans Affairs San Diego Healthcare System, Research Service, San Diego, CA
| | - Karestan C Koenen
- Broad Institute of MIT and Harvard, Stanley Center for Psychiatric Research, Cambridge, MA
- Massachusetts General Hospital, Psychiatric and Neurodevelopmental Genetics Unit (PNGU), Boston, MA
- Harvard T.H. Chan School of Public Health, Department of Epidemiology, Boston, MA, US
| | - Laura M Huckins
- Department of Psychiatry, Division of Molecular Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Karmel W Choi
- Massachusetts General Hospital, Department of Psychiatry, Boston, MA, USA
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Webermann AR, Nester MS, Gianoli MO, Black AC, Rosen MI, Mattocks KM, Portnoy GA. Compensation and Pension Exams for Military Sexual Trauma-Related Posttraumatic Stress Disorder: Examiner Perspectives, Clinical Impacts on Veterans, and Strategies. Womens Health Issues 2023; 33:428-434. [PMID: 37003918 DOI: 10.1016/j.whi.2023.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 02/06/2023] [Accepted: 02/24/2023] [Indexed: 04/01/2023]
Abstract
BACKGROUND It is estimated that in one in three women veterans experience military sexual trauma (MST), which is strongly associated with posttraumatic stress disorder (PTSD). A 2018 report indicated the Veterans Benefits Administration (VBA) processed approximately 12,000 disability claims annually for PTSD related to MST, most of which are filed by women. Part of the VBA adjudication process involves reviewing information from a Compensation and Pension (C&P) exam, a forensic diagnostic evaluation that helps determine the relationship among military service, diagnoses, and current psychosocial functioning. The quality and outcome of these exams may affect veteran well-being and use of Veterans Health Administration (VHA) mental health care, but no work has looked at examiner perspectives of MST C&P exams and their potential clinical impacts on veteran claimants. METHODS Thirteen clinicians ("examiners") who conduct MST C&P exams through VHA were interviewed. Data were analyzed using rapid qualitative methods. RESULTS Examiners described MST exams as more clinically and diagnostically complex than non-MST PTSD exams. Examiners noted that assessing "markers" of MST (indication that MST occurred) could make veterans feel disbelieved; others raised concerns related to malingered PTSD symptoms. Examiners identified unique challenges for veterans who underreport MST (e.g., men and lesbian, gay, bisexual, transgender, and queer [LGBTQ+] veterans), and saw evaluations as a conduit to psychotherapy referrals and utilization of VHA mental health care. Last, examiners used strategies to convey respect and minimize retraumatization, including a standardized process and validating the difficulty of the process. CONCLUSIONS Examiners' responses offer insight into a process entered by thousands of veterans annually with PTSD. Strengthening the MST C&P process is a unique opportunity to enhance trust in the VBA claims process and increase likelihood of using VHA mental health care, especially for women veterans.
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Affiliation(s)
- Aliya R Webermann
- VA Connecticut Healthcare System, West Haven, Connecticut; Yale School of Medicine, New Haven, Connecticut.
| | - M Shae Nester
- University of North Carolina at Greensboro, Greensboro, North Carolina
| | - Mayumi O Gianoli
- VA Connecticut Healthcare System, West Haven, Connecticut; Yale School of Medicine, New Haven, Connecticut; University of Connecticut School of Medicine, Farmington, Connecticut
| | - Anne C Black
- VA Connecticut Healthcare System, West Haven, Connecticut; Yale School of Medicine, New Haven, Connecticut
| | - Marc I Rosen
- VA Connecticut Healthcare System, West Haven, Connecticut; Yale School of Medicine, New Haven, Connecticut
| | - Kristin M Mattocks
- VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts; University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Galina A Portnoy
- VA Connecticut Healthcare System, West Haven, Connecticut; Yale School of Medicine, New Haven, Connecticut
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Scheer JR, Helminen EC, Cascalheira CJ, Jaipuriyar V, Shaw TJ, Zabelski S, Behari K, Pirog S, Batchelder AW, Possemato K, Hughes TL, Sullivan TP. Probable PTSD, PTSD symptom severity, and comorbid PTSD and hazardous drinking among sexual minority women compared to heterosexual women: A meta-analysis. Clin Psychol Rev 2023; 102:102283. [PMID: 37150043 PMCID: PMC10205673 DOI: 10.1016/j.cpr.2023.102283] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 01/24/2023] [Accepted: 04/20/2023] [Indexed: 05/09/2023]
Abstract
Posttraumatic stress disorder (PTSD) is more prevalent among sexual minority women (SMW) than among heterosexual women. PTSD risk varies among SMW, but no meta-analysis has clarified sexual identity-related disparities in probable PTSD among women or SMW's heterogeneity in PTSD risk. SMW are also at pronounced risk of comorbid PTSD and hazardous drinking (HD). However, the difference in comorbid PTSD/HD between SMW and heterosexual women is understudied. This meta-analysis aimed to provide a comprehensive understanding of differences between SMW and heterosexual women and among SMW across demographic characteristics. Peer-reviewed publications that were written in English and reported quantitative data on PTSD specific to SMW were included. Eligible publications (n = 45) were identified through a systematic search of 11 electronic databases, supplemented by a search of reference lists of relevant papers. We found that probable PTSD, PTSD symptom severity, and probable comorbid PTSD/HD are highly prevalent among SMW, with SMW of color, transgender and gender diverse people, and bi+ women (e.g., bisexual, pansexual, queer) being at greatest risk. These results emphasize the need to improve accurate assessment of trauma-related sequelae among SMW and to develop, disseminate, and implement culturally sensitive treatments to reduce PTSD and comorbid PTSD/HD among at-risk SMW.
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Affiliation(s)
- Jillian R Scheer
- Department of Psychology, Syracuse University, 414 Huntington Hall, Syracuse, NY 13244, USA.
| | - Emily C Helminen
- Department of Psychology, Syracuse University, 414 Huntington Hall, Syracuse, NY 13244, USA; College of Health Science and Technology, Rochester Institute of Technology, USA
| | - Cory J Cascalheira
- Department of Psychology, Syracuse University, 414 Huntington Hall, Syracuse, NY 13244, USA; Department of Counseling & Educational Psychology, New Mexico State University, Las Cruces, NM, USA
| | - Virinca Jaipuriyar
- Department of Psychology, Syracuse University, 414 Huntington Hall, Syracuse, NY 13244, USA
| | - Thomas J Shaw
- Department of Psychology, Virginia Polytechnic Institute and State University, Blacksburg, VA, USA
| | - Sasha Zabelski
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
| | - Kriti Behari
- Department of Psychology, Syracuse University, 414 Huntington Hall, Syracuse, NY 13244, USA
| | - Sophia Pirog
- Department of Psychology, Syracuse University, 414 Huntington Hall, Syracuse, NY 13244, USA
| | - Abigail W Batchelder
- Harvard Medical School, Harvard University, Boston, MA, USA; Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Kyle Possemato
- VA Center for Integrated Healthcare, Syracuse Veterans Affairs Medical Center, Syracuse, NY, USA
| | - Tonda L Hughes
- School of Nursing and Department of Psychiatry, Columbia University, New York, NY, USA; Columbia University School of Nursing Center for Sexual and Gender Minority Research, New York, NY, USA
| | - Tami P Sullivan
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
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19
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Hicks EM, Seah C, Cote A, Marchese S, Brennand KJ, Nestler EJ, Girgenti MJ, Huckins LM. Integrating genetics and transcriptomics to study major depressive disorder: a conceptual framework, bioinformatic approaches, and recent findings. Transl Psychiatry 2023; 13:129. [PMID: 37076454 PMCID: PMC10115809 DOI: 10.1038/s41398-023-02412-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 03/17/2023] [Accepted: 03/24/2023] [Indexed: 04/21/2023] Open
Abstract
Major depressive disorder (MDD) is a complex and heterogeneous psychiatric syndrome with genetic and environmental influences. In addition to neuroanatomical and circuit-level disturbances, dysregulation of the brain transcriptome is a key phenotypic signature of MDD. Postmortem brain gene expression data are uniquely valuable resources for identifying this signature and key genomic drivers in human depression; however, the scarcity of brain tissue limits our capacity to observe the dynamic transcriptional landscape of MDD. It is therefore crucial to explore and integrate depression and stress transcriptomic data from numerous, complementary perspectives to construct a richer understanding of the pathophysiology of depression. In this review, we discuss multiple approaches for exploring the brain transcriptome reflecting dynamic stages of MDD: predisposition, onset, and illness. We next highlight bioinformatic approaches for hypothesis-free, genome-wide analyses of genomic and transcriptomic data and their integration. Last, we summarize the findings of recent genetic and transcriptomic studies within this conceptual framework.
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Affiliation(s)
- Emily M Hicks
- Pamela Sklar Division of Psychiatric Genomics, Departments of Psychiatry and of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, 10029, USA
- Nash Family Department of Neuroscience, Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, New York, 10029, USA
| | - Carina Seah
- Pamela Sklar Division of Psychiatric Genomics, Departments of Psychiatry and of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, 10029, USA
- Nash Family Department of Neuroscience, Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, New York, 10029, USA
| | - Alanna Cote
- Pamela Sklar Division of Psychiatric Genomics, Departments of Psychiatry and of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, 10029, USA
| | - Shelby Marchese
- Pamela Sklar Division of Psychiatric Genomics, Departments of Psychiatry and of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, 10029, USA
| | - Kristen J Brennand
- Pamela Sklar Division of Psychiatric Genomics, Departments of Psychiatry and of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, 10029, USA
- Nash Family Department of Neuroscience, Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, New York, 10029, USA
- Department of Genetics, Yale University School of Medicine, New Haven, CT, 06511, USA
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, 06511, USA
| | - Eric J Nestler
- Nash Family Department of Neuroscience, Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, New York, 10029, USA
| | - Matthew J Girgenti
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, 06511, USA.
| | - Laura M Huckins
- Pamela Sklar Division of Psychiatric Genomics, Departments of Psychiatry and of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, 10029, USA.
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, 06511, USA.
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20
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Hahn H, Burkitt KH, Kauth MR, Shipherd JC, Blosnich JR. Primary sources of health care among LGBTQ+ veterans: Findings from the Behavioral Risk Factor Surveillance System. Health Serv Res 2023; 58:392-401. [PMID: 36331086 PMCID: PMC10012229 DOI: 10.1111/1475-6773.14096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE This study examined the primary source of health care between veterans with lesbian, gay, bisexual, queer and similar identities (LGBTQ+) and non-LGBTQ+ veterans. DATA SOURCES AND STUDY SETTING Veterans (N = 20,497) from 17 states who completed the CDC's Behavioral Risk Factor Surveillance System from 2016 to 2020, including the Sexual Orientation and Gender Identity and Health Care Access modules. STUDY DESIGN We used survey-weighted multiple logistic regression to estimate average marginal effects of the prevalence of utilization of Veteran's Health Administration (VHA)/military health care reported between LGBTQ+ and non-LGBTQ+ veterans. Prevalence estimates were adjusted for age group, sex, race and ethnicity, marital status, educational attainment, employment status, survey year, and US state. DATA COLLECTION METHODS Study data were gathered via computer-assisted telephone interviews with probability-based samples of adults aged 18 and over. Data are publicly available. PRINCIPAL FINDINGS Overall, there was not a statistically significant difference in estimated adjusted prevalence of primary use of VHA/military health care between LGBTQ+ and non-LGBTQ+ veterans (20% vs. 23%, respectively, p = 0.13). When examined by age group, LGBTQ+ veterans aged 34 and younger were significantly less likely to report primary use of VHA/military health care compared to non-LGBTQ+ veterans (25% vs. 44%, respectively; p = 0.009). Similarly, in sex-stratified analyses, fewer female LGBTQ+ veterans than female non-LGBTQ+ veterans reported VHA/military health care as their primary source of care (13% vs. 29%, respectively, p = 0.003). Implications and limitations to these findings are discussed. CONCLUSIONS Female and younger LGBTQ+ veterans appear far less likely to use VHA/military for health care compared to their cisgender, heterosexual peers; however, because of small sample sizes, estimates may be imprecise. Future research should corroborate these findings and identify potential reasons for these disparities.
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Affiliation(s)
- Hunter Hahn
- Center for Health Equity Research and PromotionVA Pittsburgh Healthcare SystemPittsburghPennsylvaniaUSA
- Department of PsychologyThe Ohio State UniversityColumbusOhioUSA
| | - Kelly H. Burkitt
- Center for Health Equity Research and PromotionVA Pittsburgh Healthcare SystemPittsburghPennsylvaniaUSA
| | - Michael R. Kauth
- Center for Innovations in Quality, Effectiveness and SafetyMichael E. DeBakey VA Medical Center, HSR&D Center of InnovationHoustonTexasUSA
- Lesbian, Gay, Bisexual, Transgender and Queer (LGBTQ+) Health ProgramOffice of Patient Care Services, Veterans Health AdministrationWashingtonDCUSA
- Department of Psychiatry and Behavioral SciencesBaylor College of MedicineHoustonTexasUSA
| | - Jillian C. Shipherd
- Lesbian, Gay, Bisexual, Transgender and Queer (LGBTQ+) Health ProgramOffice of Patient Care Services, Veterans Health AdministrationWashingtonDCUSA
- Department of PsychiatryBoston University School of MedicineBostonMassachusettsUSA
- National Center for PTSDVA Boston Healthcare SystemBostonMassachusettsUSA
| | - John R. Blosnich
- Center for Health Equity Research and PromotionVA Pittsburgh Healthcare SystemPittsburghPennsylvaniaUSA
- Suzanne Dworak‐Peck School of Social WorkUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
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21
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Jasuja GK, Reisman JI, Rao SR, Wolfe HL, Hughto JMW, Reisner SL, Shipherd JC. Social Stressors and Health Among Older Transgender and Gender Diverse Veterans. LGBT Health 2023; 10:148-157. [PMID: 36454239 PMCID: PMC10081710 DOI: 10.1089/lgbt.2022.0012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Purpose: Health disparities in transgender and gender diverse (TGD) veterans compared with cisgender veterans have been documented. However, there is a paucity of literature focused on older TGD veterans. We assessed health conditions and social stressors in older TGD veterans compared with matched cisgender veterans. Methods: Using gender identity disorder diagnosis codes, we identified 1244 TGD veterans (65+ years of age) receiving care in the Veterans Health Administration (VHA) from 2006 to 2018. These TGD veterans were then matched to 3732 cisgender veterans based on age, VHA site, and date of care in VHA. Results: In adjusted models, TGD veterans compared with cisgender veterans were less likely to have alcohol use disorder (adjusted odds ratio [AOR; 95% confidence interval]: [0.70; 0.58-0.85]), drug use disorder (0.59; 0.47-0.74), tobacco use (0.75; 0.65-0.86), and anxiety (0.74; 0.62-0.90). However, compared with cisgender veterans, TGD veterans were more likely to experience depression (1.63; 1.39-1.93), Alzheimer's disease (8.95; 4.25-18.83), cancer (1.83; 1.56-2.14), violence (1.82; 1.14-2.91), social/familial problems (2.45; 1.99-3.02), lack of access to care/transportation (2.23; 1.48-3.37), and military sexual trauma (2.59; 1.93-3.46). Furthermore, compared with cisgender veterans, TGD veterans were more likely to have documentation of a higher count of social stressors: 1 or more stressors (1.64; 1.38-1.95) and 2 or more stressors (1.22; 1.01-1.49). Conclusion: Despite significant disparities in social stressors and health conditions compared with cisgender veterans, TGD veterans had a lower likelihood of substance use and anxiety. Interventions are needed to mitigate social stressors and improve health among the older TGD veteran population.
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Affiliation(s)
- Guneet K Jasuja
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA.,Section of General Internal Medicine, Boston University School of Medicine, Boston, Massachusetts, USA.,Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Joel I Reisman
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA
| | - Sowmya R Rao
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Hill L Wolfe
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, Massachusetts, USA.,Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Jaclyn M W Hughto
- Departments of Behavioral and Social Sciences and Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA.,Center for Health Promotion and Health Equity, Brown University, Providence, Rhode Island, USA.,The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
| | - Sari L Reisner
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA.,General Medicine, Harvard Medical School, Boston, Massachusetts, USA.,Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Jillian C Shipherd
- National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts, USA.,LGBTQ+ Health Program, Office of Patient Care Services, Department of Veterans Affairs, Washington, District of Columbia, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
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22
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Lehavot K, Beaver K, Rhew I, Dashtestani K, Upham M, Shipherd J, Kauth M, Kaysen D, Simpson T. Disparities in Mental Health and Health Risk Behaviors for LGBT Veteran Subgroups in a National U.S. Survey. LGBT Health 2022; 9:543-554. [PMID: 35766966 DOI: 10.1089/lgbt.2022.0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Purpose: This study examined differences in mental health and health risk behaviors across sexual orientation and gender identity among U.S. veterans. Methods: Veterans were recruited through targeted social media advertising, community organizations, and listservs to complete an online survey (N = 1062). Generalized linear regression was used to evaluate differences in outcomes between subgroups, which included cisgender heterosexual men and women, lesbian women, gay men, bisexual men and women, transgender men and women, and veterans with other gender identities. Results: Transgender men and women reported a significantly higher prevalence of lifetime suicide plans and attempts compared to all other subgroups within the respective genders. Beyond this finding, patterns of all outcomes varied by gender. Compared to other subgroups of men, transgender men reported higher prevalence of posttraumatic stress disorder, whereas cisgender gay men reported higher prevalence of lifetime cocaine use and positive human immunodeficiency virus (HIV) status. Within the women subgroups, all LGBT subgroups reported higher prevalence of lifetime smoking and past-year marijuana use compared to heterosexual women. Cisgender lesbian women also reported higher prevalence of past-month heavy episodic drinking, and cisgender bisexual women reported higher prevalence of lifetime cocaine and stimulant use compared to other groups. Conclusion: Transgender women and men reported significantly higher prevalence of lifetime suicide plans and attempts than other groups, highlighting this as an area in need of urgent public health attention. Other disparity patterns indicated the importance of examining subgroups within the LGBT veteran community.
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Affiliation(s)
- Keren Lehavot
- Health Services Research & Development (HSR&D) Center of Innovation (COIN), VA Puget Sound Health Care System, Seattle, Washington, USA.,Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, Washington, USA.,Department of Health Systems and Population Health, University of Washington, Seattle, Washington, USA
| | - Kristine Beaver
- Health Services Research & Development (HSR&D) Center of Innovation (COIN), VA Puget Sound Health Care System, Seattle, Washington, USA
| | - Isaac Rhew
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Krista Dashtestani
- Health Services Research & Development (HSR&D) Center of Innovation (COIN), VA Puget Sound Health Care System, Seattle, Washington, USA
| | - Michelle Upham
- Health Services Research & Development (HSR&D) Center of Innovation (COIN), VA Puget Sound Health Care System, Seattle, Washington, USA
| | - Jillian Shipherd
- LGBTQ+ Health Program, Office of Patient Care Services, Veterans Health Administration, Washington, District of Columbia, USA.,National Center for Posttraumatic Stress Disorder, VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Michael Kauth
- LGBTQ+ Health Program, Office of Patient Care Services, Veterans Health Administration, Washington, District of Columbia, USA.,South Central Mental Illness Research, Education and Clinical Center, Michael E. DeBakey VA Medical Center, Houston, Texas, USA.,Department of Psychiatry, Baylor College of Medicine, Houston, Texas, USA
| | - Debra Kaysen
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA
| | - Tracy Simpson
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, Washington, USA.,Center of Excellence in Substance Abuse Treatment and Education (CESATE), VA Puget Sound Health Care System, Seattle, Washington, USA.,Mental Illness Research, Education, and Clinical Center (MIRECC), VA Puget Sound Health Care System, Seattle, Washington, USA
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