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Hempeler C, Schneider-Reuter L, Windel AS, Carlet J, Philipsen L, Juckel G, Gather J, Yeboah A, Faissner M. Intersectional Discrimination in Mental Health Care: A Systematic Review With Qualitative Evidence Synthesis. Psychiatr Serv 2024:appips20230252. [PMID: 38938095 DOI: 10.1176/appi.ps.20230252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Abstract
OBJECTIVE Discriminatory practices in mental health care undermine the right to health of marginalized service users. Intersectional approaches enable consideration of multiple forms of discrimination that occur simultaneously and remain invisible in single-axis analyses. The authors reviewed intersectionality-informed qualitative literature on discriminatory practices in mental health care to better understand the experiences of marginalized service users and their evaluation and navigation of mental health care. METHODS The authors searched EBSCO, PubMed, MEDLINE, and JSTOR for studies published January 1, 1989-December 14, 2022. Qualitative and mixed-methods studies were eligible if they used an intersectional approach to examine discrimination (experiences, mechanisms, and coping strategies) in mental health care settings from the perspective of service users and providers. A qualitative evidence synthesis with thematic analysis was performed. RESULTS Fifteen studies were included in the qualitative evidence synthesis. These studies represented the experiences of 383 service users and 114 providers. Most studies considered the intersections of mental illness with race, sexual and gender diversity, or both and were performed in the United States or Canada. Four themes were identified: the relevance of social identity in mental health care settings, knowledge-related concerns in mental health care, microaggressions in clinical practice, and service users' responses to discriminatory practices. CONCLUSIONS Discriminatory practices in mental health care lead to specific barriers to care for multiply marginalized service users. Universities and hospitals may improve care by building competencies in recognizing and preventing discrimination through institutionalized training.
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Affiliation(s)
- Christin Hempeler
- Institute for Medical Ethics and History of Medicine (Hempeler, Schneider-Reuter, Carlet, Philipsen, Gather) and Department of Psychiatry, Psychotherapy and Preventive Medicine (Juckel, Gather, Faissner), Ruhr University Bochum, Bochum, Germany; private practice for general medicine, Cologne, Germany (Windel); Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, Zurich (Carlet); private practice for psychiatry and psychotherapy, and psychodynamic supervision, Cologne, Germany (Yeboah); Institute of the History of Medicine and Ethics in Medicine, Charité-Universitätsmedizin Berlin, Berlin (Faissner)
| | - Lydia Schneider-Reuter
- Institute for Medical Ethics and History of Medicine (Hempeler, Schneider-Reuter, Carlet, Philipsen, Gather) and Department of Psychiatry, Psychotherapy and Preventive Medicine (Juckel, Gather, Faissner), Ruhr University Bochum, Bochum, Germany; private practice for general medicine, Cologne, Germany (Windel); Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, Zurich (Carlet); private practice for psychiatry and psychotherapy, and psychodynamic supervision, Cologne, Germany (Yeboah); Institute of the History of Medicine and Ethics in Medicine, Charité-Universitätsmedizin Berlin, Berlin (Faissner)
| | - Anne-Sophie Windel
- Institute for Medical Ethics and History of Medicine (Hempeler, Schneider-Reuter, Carlet, Philipsen, Gather) and Department of Psychiatry, Psychotherapy and Preventive Medicine (Juckel, Gather, Faissner), Ruhr University Bochum, Bochum, Germany; private practice for general medicine, Cologne, Germany (Windel); Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, Zurich (Carlet); private practice for psychiatry and psychotherapy, and psychodynamic supervision, Cologne, Germany (Yeboah); Institute of the History of Medicine and Ethics in Medicine, Charité-Universitätsmedizin Berlin, Berlin (Faissner)
| | - Jona Carlet
- Institute for Medical Ethics and History of Medicine (Hempeler, Schneider-Reuter, Carlet, Philipsen, Gather) and Department of Psychiatry, Psychotherapy and Preventive Medicine (Juckel, Gather, Faissner), Ruhr University Bochum, Bochum, Germany; private practice for general medicine, Cologne, Germany (Windel); Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, Zurich (Carlet); private practice for psychiatry and psychotherapy, and psychodynamic supervision, Cologne, Germany (Yeboah); Institute of the History of Medicine and Ethics in Medicine, Charité-Universitätsmedizin Berlin, Berlin (Faissner)
| | - Lea Philipsen
- Institute for Medical Ethics and History of Medicine (Hempeler, Schneider-Reuter, Carlet, Philipsen, Gather) and Department of Psychiatry, Psychotherapy and Preventive Medicine (Juckel, Gather, Faissner), Ruhr University Bochum, Bochum, Germany; private practice for general medicine, Cologne, Germany (Windel); Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, Zurich (Carlet); private practice for psychiatry and psychotherapy, and psychodynamic supervision, Cologne, Germany (Yeboah); Institute of the History of Medicine and Ethics in Medicine, Charité-Universitätsmedizin Berlin, Berlin (Faissner)
| | - Georg Juckel
- Institute for Medical Ethics and History of Medicine (Hempeler, Schneider-Reuter, Carlet, Philipsen, Gather) and Department of Psychiatry, Psychotherapy and Preventive Medicine (Juckel, Gather, Faissner), Ruhr University Bochum, Bochum, Germany; private practice for general medicine, Cologne, Germany (Windel); Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, Zurich (Carlet); private practice for psychiatry and psychotherapy, and psychodynamic supervision, Cologne, Germany (Yeboah); Institute of the History of Medicine and Ethics in Medicine, Charité-Universitätsmedizin Berlin, Berlin (Faissner)
| | - Jakov Gather
- Institute for Medical Ethics and History of Medicine (Hempeler, Schneider-Reuter, Carlet, Philipsen, Gather) and Department of Psychiatry, Psychotherapy and Preventive Medicine (Juckel, Gather, Faissner), Ruhr University Bochum, Bochum, Germany; private practice for general medicine, Cologne, Germany (Windel); Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, Zurich (Carlet); private practice for psychiatry and psychotherapy, and psychodynamic supervision, Cologne, Germany (Yeboah); Institute of the History of Medicine and Ethics in Medicine, Charité-Universitätsmedizin Berlin, Berlin (Faissner)
| | - Amma Yeboah
- Institute for Medical Ethics and History of Medicine (Hempeler, Schneider-Reuter, Carlet, Philipsen, Gather) and Department of Psychiatry, Psychotherapy and Preventive Medicine (Juckel, Gather, Faissner), Ruhr University Bochum, Bochum, Germany; private practice for general medicine, Cologne, Germany (Windel); Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, Zurich (Carlet); private practice for psychiatry and psychotherapy, and psychodynamic supervision, Cologne, Germany (Yeboah); Institute of the History of Medicine and Ethics in Medicine, Charité-Universitätsmedizin Berlin, Berlin (Faissner)
| | - Mirjam Faissner
- Institute for Medical Ethics and History of Medicine (Hempeler, Schneider-Reuter, Carlet, Philipsen, Gather) and Department of Psychiatry, Psychotherapy and Preventive Medicine (Juckel, Gather, Faissner), Ruhr University Bochum, Bochum, Germany; private practice for general medicine, Cologne, Germany (Windel); Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, Zurich (Carlet); private practice for psychiatry and psychotherapy, and psychodynamic supervision, Cologne, Germany (Yeboah); Institute of the History of Medicine and Ethics in Medicine, Charité-Universitätsmedizin Berlin, Berlin (Faissner)
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Hurd L, Li LYK. "I Want to Grow Older With Dignity": Older LGBTQ+ Canadian Adults' Perceptions and Experiences of Aging. J Appl Gerontol 2024; 43:536-549. [PMID: 38105632 PMCID: PMC10981199 DOI: 10.1177/07334648231219414] [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: 06/08/2023] [Revised: 11/01/2023] [Accepted: 11/09/2023] [Indexed: 12/19/2023] Open
Abstract
The number of older LGBTQ+ adults is growing worldwide. Yet few studies outside of the United States have examined their experiences of aging. Drawing on the Health Equity Promotion Model and contextualized in Canada's unique socio-political history, our study used multiple, in-depth, qualitative interviews to examine 30 older Canadian LGBTQ+ adults' (aged 65-83) perceptions and experiences of growing older. Our descriptive thematic analysis identified three overarching categories: "Losses," "gains," and "needs." Losses referred to the changes in the participants' health, autonomy, and relationships that had occurred with age. Gains entailed positive later life changes, including increased wisdom, flexibility, and social connections. Finally, needs referred to those things that the participants deemed essential for aging well, namely, inclusive health care, meaningful activities, and supportive networks. We discuss the policy and practice implications of our findings for the fostering of health, well-being, and social inclusion amongst this often-marginalized population.
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Affiliation(s)
- Laura Hurd
- School of Kinesiology, The University of British Columbia, Vancouver, BC, Canada
| | - Lynda Y. K. Li
- Department of Physical Therapy, The University of British Columbia, Vancouver, BC, Canada
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Birch L, Bindert A, Macias S, Luo E, Nwanah P, Green N, Stamps J, Crooks N, Singer RM, Johnson R, Singer RB. When Stigma, Disclosure, and Access to Care Collide: An Ethical Reflection of mpox Vaccination Outreach. Public Health Rep 2024; 139:379-384. [PMID: 37846098 PMCID: PMC11037228 DOI: 10.1177/00333549231201617] [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: 10/18/2023] Open
Abstract
Experiences of stigma in health care encounters among LGBTQ+ populations (lesbian, gay, bisexual, transgender, and queer and questioning) have long been a barrier to care. Marginalization and historically grounded fears of stigmatization have contributed to a reluctance to disclose sexual behavior and/or gender identity to health care providers. We reflect on how student nurses grappled with the ethics of patient disclosure while providing mobile outreach in Chicago for mpox (formerly monkeypox) from fall 2022 to spring 2023. Student nurses addressed how requiring disclosure of sexual behavior or sexual orientation may serve as a barrier to accessing preventive care, such as mpox vaccination. Accounts of stigma and criminalization experienced by LGBTQ+ people provide insight on challenges historically associated with disclosure in health care.
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Affiliation(s)
- Lane Birch
- College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Adam Bindert
- College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Susy Macias
- College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Ellis Luo
- College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Patrick Nwanah
- College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Noel Green
- Department of Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA
| | - Jahari Stamps
- Southside Health Advocacy Resource Partnership, Chicago, IL, USA
| | - Natasha Crooks
- Department of Human Development Nursing Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Rebecca M. Singer
- Department of Population Health Nursing Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Robin Johnson
- Department of Human Development Nursing Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Randi Beth Singer
- Department of Human Development Nursing Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
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Chen M, Cao X, Wang A, Zhu Y, Lu G, Zhang L, Shen L. A global perspective on risk factors for social isolation in community-dwelling older adults: A systematic review and meta-analysis. Arch Gerontol Geriatr 2024; 116:105211. [PMID: 37837787 DOI: 10.1016/j.archger.2023.105211] [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] [Received: 05/18/2023] [Revised: 09/16/2023] [Accepted: 09/23/2023] [Indexed: 10/16/2023]
Abstract
PURPOSE Older people's physical and mental health are now significantly impacted by social isolation, a major threat to public health. Our goal was to identify the connections between risk factors and social isolation among this population across various geographic areas. METHODS Seven databases were thoroughly searched, from their inception until April 2023. Inclusion and exclusion criteria were used to choose the studies. For the included cross-sectional studies, we used the Agency for Healthcare Research and Quality (AHRQ) to assess the probability of bias, and the Newcastle-Ottawa scale for the cohort studies. The statistical analysis was performed using STATA 15 to calculate pooled odds ratios (OR) and 95% CI. RESULTS All 3043 papers were carefully examined, and 42 satisfied the criteria for inclusion. The results indicated that multi-domain risk factors and social isolation among older persons worldwide are significantly correlated. These multi-domain risk factors included biological factors, socioeconomic factors, and psychological and behavioral factors. It is also important to note that these factors may vary from region to region. CONCLUSION Many domain factors were linked to social isolation in older individuals living in communities throughout the world. To develop effective strategies for controlling social isolation, it is crucial to conduct assessments of social isolation risk factors in local communities.
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Affiliation(s)
- Meiqian Chen
- Department of Scientific Research, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, 1558 Sanhuan North Road, Huzhou, Zhejiang, 313000, China; School of Medicine and Nursing, Huzhou University,759 Erhuan East Road, Huzhou, Zhejiang, 313000, China
| | - Xiang Cao
- School of Medicine and Nursing, Huzhou University,759 Erhuan East Road, Huzhou, Zhejiang, 313000, China
| | - Afeng Wang
- School of Medicine and Nursing, Huzhou University,759 Erhuan East Road, Huzhou, Zhejiang, 313000, China
| | - Yi Zhu
- School of Medicine and Nursing, Huzhou University,759 Erhuan East Road, Huzhou, Zhejiang, 313000, China
| | - Guanzhen Lu
- Department of Scientific Research, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, 1558 Sanhuan North Road, Huzhou, Zhejiang, 313000, China; School of Medicine and Nursing, Huzhou University,759 Erhuan East Road, Huzhou, Zhejiang, 313000, China.
| | - Li Zhang
- Department of Scientific Research, Huzhou Central Hospital, Affiliated Central Hospital Huzhou University, 1558 Sanhuan North Road, Huzhou, Zhejiang, 313000, China
| | - Lijuan Shen
- School of Medicine and Nursing, Huzhou University,759 Erhuan East Road, Huzhou, Zhejiang, 313000, China
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Guest MA, Hunter EG, Schoenberg NE. Making Home: The Role of Social Networks on Identity, Health, and Quality of Life Among Rural Lesbian and Gay Older Adults. Innov Aging 2023; 7:igad082. [PMID: 37727599 PMCID: PMC10506171 DOI: 10.1093/geroni/igad082] [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: 04/06/2023] [Indexed: 09/21/2023] Open
Abstract
Background and Objectives Gay and lesbian older persons face a host of health inequalities related to their identity as they age. Challenges to health access and appropriate social support may be even more exacerbated for those living in rural environments; this may be due to the lack of supportive and affirming social connections. This project aimed to explore and describe the social networks and the relationship of these social networks to identity, health, and quality of life of gay and lesbian individuals in rural communities. Research Design and Methods Social network data on network type, size, and social capital were collected and supplemented by quantitative questionnaires relating to health, quality of life, marginalization, and identity. Results Participants (N = 25) were recruited from three states. Thirteen participants self-identified as gay and 12 as lesbian. All but one identified as non-Hispanic White. The average age of all participants was 60.32 years. Findings indicate that rural gay and lesbian individuals develop networks with little consideration for network members' acceptance of their identity. Participants reported an average network size of 9.32 individuals. Gay men reported higher perceptual affinity (.69) than lesbian participants (.62). Lesbian networks showed significantly (p = .0262) greater demographic similarity (.58) than aging gay men's networks (.55). Aging gay men (.89) reported statistically stronger (p = .0078) network ties than aging lesbian females (.78). Among participants in this study, network size is not correlated with the health and quality of life of rural aging lesbian and gay individuals. Still, personal identity congruence does appear to relate to health and quality of life. Discussion and Implications The findings highlight the collective need to continue research into sexual minority aging and rural sexual minority aging, particularly employing novel methods.
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Affiliation(s)
- Marc Aaron Guest
- Center for Innovation in Healthy and Resilient Aging, Arizona State University, Phoenix, Arizona, USA
| | - Elizabeth G Hunter
- College of Public Health, University of Kentucky, Lexington, Kentucky, USA
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Bristowe K, Timmins L, Braybrook D, Marshall S, Pitman A, Johnson K, Day E, Clift P, Rose R, Yi D, Yu P, Gao W, Roach A, Almack K, King M, Harding R. LGBT+ partner bereavement and appraisal of the Acceptance-Disclosure Model of LGBT+ bereavement: A qualitative interview study. Palliat Med 2023; 37:221-234. [PMID: 36428276 PMCID: PMC9896255 DOI: 10.1177/02692163221138620] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Support from social networks is vital after the death of a partner. Lesbian, gay, bisexual and/or transgender (LGBT+) people can face disenfranchisement and isolation in bereavement. The Acceptance-Disclosure Model (of LGBT+ bereavement) posits that experiences are shaped by the extent to which individuals feel able to disclose their bereavement to others, and whether that loss is acknowledged appropriately. AIM To explore LGBT+ specific experiences of partner bereavement; determine decision-making processes regarding disclosure of relationships/identities; and appraise the Acceptance-Disclosure Model using primary qualitative data. DESIGN Exploratory in-depth qualitative interview study positioned within a social constructivist paradigm. Data were analysed using inductive and deductive reflexive thematic analysis. SETTING/PARTICIPANTS 21 LGBT+ people from across England bereaved of their civil partner/spouse. RESULTS Participants described LGBT+ specific stressors in bereavement: lack of recognition of their loss; inappropriate questioning; unwanted disclosure of gender history; and fears of discrimination when accessing support. Disclosure of LGBT+ identities varied across social networks. Some participants described hiding their identities and bereavement to preserve relationships, and challenging intersections between LGBT+ identities and other aspects of culture or self. These findings provide primary evidence to support the Acceptance-Disclosure Model. CONCLUSIONS LGBT+ people face additional stressors in bereavement. Not all LGBT+ people want to talk directly about their relationships/identities. Sensitive exploration of support needs, aligned with preferences around disclosure of identities, can help foster trust. Five recommendations for inclusive practice are presented. Further research should consider whether the Acceptance-Disclosure Model has utility to explain bereavement experiences for other isolated or disenfranchised groups.
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Affiliation(s)
- Katherine Bristowe
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, Bessemer Road, London, UK
| | | | - Debbie Braybrook
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, Bessemer Road, London, UK
| | - Steve Marshall
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, Bessemer Road, London, UK
- King’s College Hospital NHS Foundation Trust, Denmark Hill, London, UK
| | - Alexandra Pitman
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, St. Pancras Hospital, London, UK
| | - Katherine Johnson
- Social and Global Studies Centre, Royal Melbourne Institute of Technology, Melbourne, VIC, Australia
| | | | - Paul Clift
- Patient and Public Involvement, London, UK
| | - Ruth Rose
- Patient and Public Involvement, London, UK
| | - Deokhee Yi
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, Bessemer Road, London, UK
| | - Peihan Yu
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, Bessemer Road, London, UK
| | - Wei Gao
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, Bessemer Road, London, UK
| | - Anna Roach
- Great Ormond Street Institute of Child Health, Faculty of Population Health Sciences, London, UK
| | - Kathryn Almack
- School of Health and Social Work, University of Hertfordshire, Hatfield, Hertfordshire, UK
| | - Michael King
- Division of Psychiatry, University College London, London, UK
| | - Richard Harding
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, Bessemer Road, London, UK
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Anderson JG, Flatt JD, Cicero EC, Kittle K, Myers CR, Rose KM, Wharton W. Inclusive Care Practices and Policies Among Sexual and Gender Minority Older Adults. J Gerontol Nurs 2022; 48:6-15. [PMID: 36441066 PMCID: PMC10441248 DOI: 10.3928/00989134-20221107-03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
As the health care and well-being of sexual and gender minority (SGM; i.e., lesbian, gay, bisexual, and/or transgender or gender non-binary) people in the United States receive federal and local-level attention, SGM older adults and caregivers continue to be left out of important health policy and care conversations. The current article describes policy issues and affirmative strategies related to inclusive care practices among SGM older adults and caregivers. In addition to the broader policies considered related to health and well-being, we include a discussion of local-level policy strategies to mitigate discrimination and promote inclusive care for SGM older adults and caregivers. [Journal of Gerontological Nursing, 48(12), 6-15.].
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