Sexual orientation and disclosure in relation to psychiatric symptoms, diurnal cortisol, and allostatic load

The socioecology of sexual minority stigma: Advancing theory on stigma-based mechanisms underlying sexual orientation-based disparities in health

Research in public health and psychology has identified sexual minority stigma-related risk factors that contribute to sexual orientation-based health disparities across settings and societies worldwide. Existing scholarship, however, has predominantly focused on these factors as independent, stand-alone risk factors, neglecting their interconnected nature across different levels. This article theoretically explores how sexual minority stigma may function as a multilevel socioecological system, by building on prevailing theories and emphasizing the interplay between structural, interpersonal, and intrapersonal stigma-related factors. Drawing on the minority stress and socioecological theories, three central tenets are proposed, namely 1) chronosystem with immediate, accumulating, or lasting effects across spatiotemporal contexts, 2) nested multilevel system with cross-level effects, and 3) mechanistic pathways linking stigma exposure to health. By providing a nuanced and comprehensive understanding of how sexual minority stigma may operate as a multilevel socioecological system, this article reflects on the novel implications of this interpretation for future research and aims to guide future conceptualizations and studies, acknowledging the complexity of sexual minority stigma exposure across historical contexts, societies, and the individual life course in shaping physical and mental health of sexual minorities. Limitations of current research and recommendations for future research are being discussed.

Disclosure to Whom Matters: Association Between Disclosure of Sexual Orientation and Mental Health Among Chinese LGB People

Objective

This study aimed to explore the association between disclosure of one's sexual orientation in different social contexts and mental health outcomes among LGB individuals.

Methods

This study used a nationwide sample of 7867 LGB individuals in the mainland of China.

Results

Findings revealed that the disclosure process was associated with positive consequences in several specific contexts such as schools, workplaces, and close friendships, but not in the family context. Bisexual individuals were less likely to be influenced by the disclosure process.

Conclusions

Professionals who work with LGB individuals need to be aware of the context-specific factors when facilitating disclosure decisions.

Postacute Care and Long-term Care for LGBTQ+ Older Adults

LGBTQ + older adults have a high likelihood of accessing nursing home care. This is due to several factors: limitations performing activities of daily living and instrumental activities of daily living, restricted support networks, social isolation, delay seeking assistance, limited economic resources, and dementia. Nursing home residents fear going in the closet, which can have adverse health effects. Cultivating an inclusive nursing home culture, including administration, staff, and residents, can help older LGBTQ + adults adjust and thrive in long-term care.

Associations Between Structural Stigma and Allostatic Load Among Sexual Minorities: Results From a Population-Based Study

OBJECTIVE

Structural forms of stigma and discrimination are associated with adverse health outcomes across numerous stigmatized groups, including lesbian, gay, and bisexual (LGB) individuals. However, the biological consequences of structural stigma among LGB populations are understudied. To begin to address this gap, we assessed associations between indicators of structural stigma (i.e., state-level policies) targeting LGB individuals and allostatic load (AL) indices representing physiological dysregulations.

METHODS

Pooled data from the continuous 2001-2014 National Health and Nutritional Examination Survey were analyzed (LGB: n = 864; heterosexual: n = 20,310). Ten state-level LGB-related policies (e.g., employment nondiscrimination protections, same-sex marriage) were used to operationalize structural stigma. A sex-specific AL index representing 11 immune, metabolic, and cardiovascular biomarkers was estimated. Multilevel models were used to examine associations between structural stigma and AL, net of nine individual-level characteristics (e.g., education, race/ethnicity, age, and health behaviors).

RESULTS

Sexual minority men living in states with low levels of structural stigma experienced significantly lower AL ( β = -0.45, p = .02) compared with sexual minority men living in states with high structural stigma (i.e., fewer protective policies). There was no significant association between structural stigma and AL among sexual minority women.

CONCLUSIONS

By demonstrating direct associations between structural stigma and indices of physiological dysregulation, our findings provide a mechanistic understanding of how the social environment can "get under the skin and skull" for sexual minority men in the United States. Future research should explore whether these mechanisms generalize to other marginalized groups exposed to structural stigma.

Sex and gender correlates of sexually polymorphic cognition

BACKGROUND

Sexually polymorphic cognition (SPC) results from the interaction between biological (birth-assigned sex (BAS), sex hormones) and socio-cultural (gender identity, gender roles, sexual orientation) factors. The literature remains quite mixed regarding the magnitude of the effects of these variables. This project used a battery of classic cognitive tests designed to assess the influence of sex hormones on cognitive performance. At the same time, we aimed to assess the inter-related and respective effects that BAS, sex hormones, and gender-related factors have on SPC.

METHODS

We recruited 222 adults who completed eight cognitive tasks that assessed a variety of cognitive domains during a 150-min session. Subgroups were separated based on gender identity and sexual orientation and recruited as follows: cisgender heterosexual men (n = 46), cisgender non-heterosexual men (n = 36), cisgender heterosexual women (n = 36), cisgender non-heterosexual women (n = 38), gender diverse (n = 66). Saliva samples were collected before, during, and after the test to assess testosterone, estradiol, progesterone, cortisol, and dehydroepiandrosterone. Psychosocial variables were derived from self-report questionnaires.

RESULTS

Cognitive performance reflects sex and gender differences that are partially consistent with the literature. Interestingly, biological factors seem to better explain differences in male-typed cognitive tasks (i.e., spatial), while psychosocial factors seem to better explain differences in female-typed cognitive tasks (i.e., verbal).

CONCLUSION

Our results establish a better comprehension of SPC over and above the effects of BAS as a binary variable. We highlight the importance of treating sex as a biological factor and gender as a socio-cultural factor together since they collectively influence SPC.

Predicting salivary cortisol and sexual behavior stigma among MSM in the American Men's Internet Survey 2019

Physiological stress levels in response to sexual behavior stigma among men who have sex with men (MSM) in the United States (US) are understudied. The current study aims to explore the relationship between sexual behavior stigma and salivary cortisol both overall and stratified by race/ethnicity. If such an association exists, it may suggest that sexual behavior stigma can be physiologically measured or indicated by the presence of heightened salivary cortisol. A subsample of 667 MSM participants from the 2019 American Men's Internet Survey (AMIS; N = 10,129) submitted morning (AM) and evening (PM) saliva cortisol samples using at-home mail-in collection kits. Average daily cortisol and daily cortisol change were calculated; simple linear regressions estimated associations between cortisol measures and sexual behavior stigma characterized in four different ways (ever and recent experience of individual stigma items; average ever and recent experience of three stigma scales: stigma from family and friends, anticipated healthcare stigma, general social stigma). Participants reported a mean age of 36.0 years (SD = 14.9), with most being non-Hispanic white (n = 480, 72.0%), Hispanic (n = 164, 12.3%), or Black/African American (n = 146, 10.9%), and identified as homosexual/gay (n = 562, 84.3%). Reporting ever experiencing healthcare providers gossiping was significantly associated with higher PM cortisol (β = 0.12, p = 0.001) and higher average daily cortisol (β = 0.11, p = 0.004), while reporting ever experiencing police refusing to protect was associated with higher AM cortisol (β = 0.08, p = 0.03) and higher average daily cortisol (β = 0.09, p = 0.02). Recent experiences of stigma were not significant predictors of any measure of cortisol. Measures of salivary cortisol may be used to characterize sexual behavior stigma among MSM populations, however more insight is needed to determine its exact relationship and strength.

Association between the Expression of Sexual Orientation and/or Gender Identity and Mental Health Perceptions in the Peruvian LGBTI Population

INTRODUCTION

The non-expression of sexual orientation and gender identity can affect mental health in the lesbian, gay, bisexual, transgender, and intersex population in Peru.

METHOD

Secondary, observational, analytical, and cross-sectional analyses of data from the "First Virtual Survey on the LGBTI population" were conducted with a population (n = 11,345) of LGBTI adults aged 18 years old or more. The variables of mental health and expression of sexual orientation and/or gender identity were measured using a self-reported questionnaire that did not include a validated scale; questions with multiple alternatives that included "yes" and "no" options were used. Prevalence ratios (PR) and 95% confidence intervals (95% CI) were obtained by glm log Poisson regression models.

RESULTS

The median age of the participants was 25 years (IQR: 21-30), and the majority of the population identified as gay, followed by lesbian and bisexual. Individuals who expressed their sexual orientation and/or gender identity were 17% less likely to have had perceived mental health problems in the last 12 months (PR: 0.83, 95% CI: 0.76-0.90, p < 0.001).

CONCLUSIONS

The non-expression of sexual orientation and/or gender identity has a significant negative effect on the mental health problems of the LGBTI population. These results highlight the importance of promoting the expression of sexual orientation and gender identity in our community.

Gender and sex in eating disorders: A narrative review of the current state of knowledge, research gaps, and recommendations

INTRODUCTION

Eating disorders (EDs) have long been considered conditions exclusively affecting women, and studies in the ED field regularly exclude men. Research efforts are needed to better understand the role of gender and sex in EDs. This review describes the role of gender and sex in the development of EDs from a biopsychosocial perspective.

METHODS

The primary hypothesis of this narrative review is that gender and sex interact to influence ED risk. The literature review was conducted using the PubMed database.

RESULTS

This review first presents the general characteristics and prevalence of EDs according to gender and sex. Next, neurodevelopmental processes, neurobiology, gender roles, body image, and the minority stress model are addressed. Lastly, research perspectives to better include gender and sex in the field of EDs are discussed (e.g., representation of gender and sex diversities, development of appropriate assessment tools, and increasing awareness).

CONCLUSION

Although substantial knowledge gaps remain, there is a growing recognition of the importance of integrating gender and sex in ED research that holds promise for further development in the field.

A Qualitative Approach to Exploring the Impact of the Gay Identity Formation Process

Background

Most gay men experience difficulty in coming to terms with their sexual orientation, with their health, wellbeing, and quality of life potentially affected by unpleasant experiences often associated with the formation of their gay identity. It is therefore important for nurses to understand the needs of gay men so that they can accompany them and provide quality care during and after the identity formation process.

Objective

The aim of the study was to explore and describe the identity formation and coming out experiences of gay men.

Methods

A qualitative design with a constructivist naturalist approach was used. Data were collected through in-depth semi-structured interviews with five gay men with experience of the gay identity formation process, and data were analyzed using a thematic analysis method.

Results

The results show that the men needed support, as they reported feeling different and alone during the identity formation and coming out process, and that their mental health was affected. Fear of rejection, negative reactions, and disappointing people were the reasons that led the men not to disclose their sexual orientation to family, while those who had come out defined a feeling of liberation.

Conclusions

The gay identity formation process has potential impacts on health, wellbeing, and quality of life. Nurses need cultural competence training to be able to understand the needs of gay men, accompany them in the identity formation process, and provide individualized and non-heteronormative care. Nurses also need to participate in dismantling a heterosexist social structure.

Allostatic Load Measurement: A Systematic Review of Reviews, Database Inventory, and Considerations for Neighborhood Research

BACKGROUND

Neighborhoods are critical to understanding how environments influence health outcomes. Prolonged environmental stressors, such as a lack of green spaces and neighborhood socioeconomic disadvantage, have been associated with higher allostatic load levels. Since allostatic load levels experienced earlier in life have stronger associations with mortality risk, neighborhoods may be uniquely suited to monitor and mitigate the impacts of environmental stressors. Researchers often study allostatic load in neighborhoods by utilizing administrative boundaries within publicly accessible databases as proxies for neighborhoods.

METHODS

This systematic review of reviews aims to identify commonly used biomarkers in the measurement of allostatic load, compare measurement approaches, inventory databases to study allostatic load, and spotlight considerations referenced in the literature where allostatic load is studied in neighborhoods. The review was conducted using the search term "allostatic load" in the MEDLINE, CINAHL, and PsychINFO databases. The search results were filtered to include reviews.

RESULTS

The search returned 499 articles after deduplication. Overall, 18 synthesis reviews met the inclusion criteria and were retained for extraction. The synthesis reviews analyzed represented 238 studies published from 1995 to 2020. The original ten biomarkers were most often used to measure allostatic load. More recently, body mass index and C-reactive protein have additionally been frequently used to measure allostatic load burden.

CONCLUSIONS

The scientific contributions of this study are that we have identified a clear gap in geographic considerations when studying allostatic load. The implication of this study is that we have highlighted geographic concepts when conducting neighborhood-level research using administrative databases as a neighborhood proxy and outlined emerging future trends that can enable future study of allostatic load in the neighborhood context.

Conceptualizing the Influence of Social and Structural Determinants of Neurobiology and Mental Health: Why and How Biological Psychiatry Can Do Better at Addressing the Consequences of Inequity

Psychiatry and allied disciplines have recognized the potency of structural and social determinants of mental health, yet there has been scant attention given to the roles of neurobiology in the links between structural and social determinants and mental health. In this article, we make the case for why greater attention must be given to structural and social determinants of biological psychiatry by researchers, practitioners, and policy-makers. After defining these terms and theoretical frameworks for considering their relevance in biological psychiatry, we review empirical research with marginalized and minoritized racial, ethnic, gender, sexual, and economic communities that reveals the ways in which structural and social determinants affect neurobiological functioning with implications for mental health. We give particular emphasis to developmental science and developmentally informed research, because structural and social determinants influence neurobiological adaptation and maturation across the lifespan. We conclude with recommendations for advancing research, practice, and policy that connect biological psychiatry with structural and social determinants of health. Foremost among these is diversifying the ranks of biological psychiatry, from classrooms through laboratories, hospitals, and community health centers. Transforming and advancing the understanding of the structural and social determinants of neurobiology and mental health is most likely to come through transforming the discipline itself.

Social identity support, descriptive norms, and economic instability in PrEP engagement for emerging adult MSM in the United States

Rates of pre-exposure prophylaxis (PrEP) uptake for HIV prevention continue to increase rapidly among men who have sex with men (MSM) in the United States (U.S.); however, these increases have been slower among young MSM. Emerging adulthood (ages 18-25) is a time of transitions and social development, resulting in increased vulnerability to HIV. Analyzing data from a cross-sectional survey of emerging adult MSM (ages 18-25 years; n = 281) in the Mid-Atlantic urban metropolitan region of the U.S., we examined how social identity support, descriptive PrEP norms, and economic instability were related to PrEP engagement. In structural equation models, PrEP norms were directly associated with PrEP engagement (β = 0.29, 95% CI = [0.12,0.46]) and social identity support was indirectly associated with PrEP engagement through its association with descriptive PrEP norms (β = 0.18, 95% CI = [0.09,0.28]). Economic instability was not significantly associated with PrEP engagement, although a negative trend was present (β = -0.19, 95% CI = [-0.39,0.02]). Our results suggest that an integrative socioecological model is appropriate for the study of PrEP engagement among emerging adult MSM. Efforts to increase PrEP engagement should support community capacity building, amplify positive descriptive PrEP norms, and address unmet economic needs.

Sexual minority health and allostatic load in the National Health and Nutrition Examination Survey: A systematic scoping review with intersectional implications

Understood largely from a minority stress framework, sexual minorities (SM) are hypothesized to suffer more physical and mental health burdens compared to their heterosexual counterparts. Several studies have used data from the National Health and Nutrition Examination Survey (NHANES) in the United States to assess SM health disparities and the 'wear and tear' of allostatic load. Because findings are generally mixed and sometimes contradictory with sexual minority stress theory, we endeavoured to explore existing NHANES studies of SM health. Our scoping review yielded a comprehensive analysis of all existing published articles (N = 43) that have used the NHANES to assess any outcome regarding SM health and well-being. Our synthesis confirms that SM sub-groups are significantly different from one another and from their heterosexual peers on several key health variables. Surprisingly, gay men appear to have the lowest allostatic load and no differences have yet been identified among women as a function of sexual identity/behavior. The existing literature suggests a need to use the NHANES more broadly and to include more psychosocial variables to better delineate sexual minority stress. This is especially important to consider at a physiological level in allostatic load research that should better include health behaviors available in NHANES and from other available datasets as moderators linking psychosocial exposures (e.g., minority stress) and health outcomes. Suggested future directions are proposed in an intersectional perspective that incorporates interactions among sex, gender, sexual identity/behaviors, race, ethnicity, age cohorts, socioeconomic status, and lived experiences.

Lived experience and allostatic load among transmasculine people living in the United States

BACKGROUND

Transgender and gender diverse people face significant stigma that can adversely affect their physical and mental health. However, the psychobiological link between lived experience and health has been underexplored in this population. We thus examine perceived distress, mental health, and physiological 'wear and tear' by indexing allostatic load (AL) and assess associations with a range of contextual and experiential factors from transmasculine people living in the United States.

METHODS

Sixty-five people who identified as transgender men or along a transmasculine spectrum, living in Massachusetts, Vermont, and Rhode Island participated in The Transition Experience Study (age: M=31.8, range 18-55), which examines lived experience of social and medical transition and embodied gender minority/marginalization stress among a sample of transmasculine people. Based on in-depth in-person interview and survey data and inspired by an ecological systems model, we created indices representing (1) perceived progressive geopolitical climate; (2) socio-demographic advantage; (3) social support and resources; (4) gender minority and marginalization stressors; and (5) health behaviors. The Perceived Stress Scale and psychological symptoms (depression, anxiety, insomnia) were also assessed. AL indexed 10 neuroendocrine, immune, cardiovascular, and metabolic biomarkers.

RESULTS

Regressions revealed that perceived stress and psychological symptoms were negatively correlated with progressive geopolitical climate (respectively B=-1.47, p = 0.19; B=-.77, p < .001) and positively correlated with gender minority and marginalization stressors (respectively B=1.51, p < .001; B =.38, p = .005). AL was negatively associated with perceived progressive geopolitical climate (B=-.55, p = .007) and socio-demographic advantage (B=-3.2, p = .001).

DISCUSSIONS

These findings underline the importance of assessing geopolitical context and indexing lived experiences and life domains along with biomarker sampling. Together, these enable the identification of psychobiological pathways to better nuance multi-level contributors to health and well-being and understand embodied inequalities. These analyses of embodied stigma inclusive of AL biomarkers thus provide a model to further research centering transgender people's health from youth through old age.

The application of allostasis and allostatic load in animal species: A scoping review

Principles of allostasis and allostatic load have been widely applied in human research to assess the impacts of chronic stress on physiological dysregulation. Over the last few decades, researchers have also applied these concepts to non-human animals. However, there is a lack of uniformity in how the concept of allostasis is described and assessed in animals. The objectives of this review were to: 1) describe the extent to which the concepts of allostasis and allostatic load are applied theoretically to animals, with a focus on which taxa and species are represented; 2) identify when direct assessments of allostasis or allostatic load are made, which species and contexts are represented, what biomarkers are used, and if an allostatic load index was constructed; and 3) detect gaps in the literature and identify areas for future research. A search was conducted using CABI, PubMed, Agricola, and BIOSIS databases, in addition to a complementary hand-search of 14 peer-reviewed journals. Search results were screened, and articles that included non-human animals, as well as the terms "allostasis" or "allostatic" in the full text, were included. A total of 572 articles met the inclusion criteria (108 reviews and 464 peer-reviewed original research). Species were represented across all taxa. A subset of 63 publications made direct assessments of allostatic load. Glucocorticoids were the most commonly used biomarker, and were the only biomarker measured in 25 publications. Only six of 63 publications (9.5%) constructed an allostatic load index, which is the preferred methodology in human research. Although concepts of allostasis and allostatic load are being applied broadly across animal species, most publications use single biomarkers that are more likely indicative of short-term rather than chronic stress. Researchers are encouraged to adopt methodologies used in human research, including the construction of species-specific allostatic load indexes.

Testing whether the combination of victimization and minority stressors exacerbate PTSD risks in a diverse community sample of sexual minority women

Informed by minority stress and intersectionality frameworks, we examined: 1) associations of sexual identity and race/ethnicity with probable diagnosis of post-traumatic stress disorder (PTSD-PD) among sexual minority women (SMW; e.g., lesbian, bisexual); and 2) potential additive and interactive associations of minority stressors (discrimination, stigma consciousness, and internalized homonegativity) and potentially traumatic childhood and adulthood events (PTEs) with PTSD-PD. Data come from a large and diverse community sample of SMW (N = 662; age range: 18-82; M = 40.0, SD = 14.0). The sample included 35.8% Black, 23.4% Latinx, and 37.2% White participants. Logistic regressions tested associations of sexual identity and race/ethnicity, minority stressors, and PTEs with PTSD-PD. More than one-third of SMW (37.2%) had PTSD-PD with significantly higher prevalence among bisexual, particularly White bisexual women, than lesbian women. Discrimination, stigma consciousness, and internalized homonegativity were each associated with higher odds of PTSD-PD, but only internalized homonegativity was additively associated with PTSD-PD in mutually adjusted models above and beyond effects of PTEs. No evidence for interactive effects between PTEs and minority stressors was found. In a diverse community sample of sexual minority women, PTSD is strongly associated with potentially traumatic childhood events and with minority stressors above and beyond the associations with other potentially traumatic events and stressors in adulthood. Our findings suggest a strong need for therapists to address the effects of stigma and homophobia in treatment for PTSD, as these minority stressors likely maintain and exacerbate the effects of past traumas.

Psychological resilience and diurnal salivary cortisol in young adulthood

BACKGROUND

Adversity exposure and the negative psychological responses that often result have been linked with poor physical health outcomes and deteriorative physiological processes, like dysregulated circulating cortisol. Individuals exposed to early adversity who also demonstrate positive psychological functioning may be characterized as psychologically resilient, but few studies have evaluated whether psychological resilience may disrupt the health-damaging effects of adversity. We tested the hypothesis that among young adults exposed to early adversity, those who are psychologically resilient may manifest more normative diurnal cortisol patterns relative to those who experience more psychological distress.

METHODS

Data are from Growing Up Today Study I participants who provided information on psychological resilience and diurnal salivary cortisol (n = 916). Psychological resilience was derived from self-report questionnaires administered between 2007 and 2010, and salivary cortisol was obtained from saliva samples collected between 2011 and 2014. The predictor of interest, psychological resilience, was defined using two domains: (1) adversity exposure measured via a count of 7 potential psychosocial adversities experienced before age 18, and (2) psychological health in young adulthood measured via a composite score reflecting low psychological distress and high positive affect. The outcome was mean log-transformed diurnal salivary cortisol across 4 samples from one day. Linear regressions evaluated associations of adversity, psychological health, and their potential multiplicative interaction with mean diurnal log-transformed cortisol, adjusting for baseline socio-demographic variables and biological and behavioral factors from the day of saliva sampling.

RESULTS

Relatively few individuals with high adversity demonstrated positive psychological health. Both adversity exposure and psychological health were independently associated with mean log cortisol levels. Models stratified by lower versus higher adversity suggested complex relationships with cortisol, however the interaction between adversity and psychological health was not statistically significant. High adversity was associated with blunted cortisol levels, regardless of psychological health. Conversely, among those with lower adversity, overall levels of cortisol were higher and psychological health associated with more normative, lower cortisol levels.

CONCLUSIONS

Psychological resilience domains were independently associated with diurnal salivary cortisol in young adulthood. High burden of early adversity may disrupt the physiological stress system, while psychological health may be associated with more normative cortisol levels when adversity is low.

Development and psychometric properties of the sexual and gender minority adverse childhood experiences (SGM-ACEs): Effect on sexual and gender minority adult mental health

BACKGROUND

Research has consistently shown a relationship between adverse childhood experiences (ACEs) and poor mental health outcomes, and recent research shows that sexual and gender minority (SGM) individuals are at increased risk for ACEs. Moreover, SGM individuals may experience unique ACEs. Increased risk for exposure to traditional and SGM-specific ACEs are related to heterosexism.

OBJECTIVE

The purpose of this paper is two-fold. First, establish the need for an SGM specific ACEs framework that accounts for exposure to heterosexism. Second, assess the psychometric properties of the SGM-ACEs scale.

PARTICIPANTS AND SETTING

Data were collected using a multifaceted sampling strategy. In total, 1725 self-identified SGM Texans completed an online survey about ACEs, SGM-ACEs, mental health diagnoses, and demographic characteristics.

RESULTS

The most commonly reported SGM-ACEs were seeing or hearing of other SGM being physical harmed (71.2%), being bullied in school for being SGM (67.9%), and hearing religious leaders say homophobic, biphobic, or transphobic things (60.8%). The EFA showed that 7-items loaded onto a single factor and the CFA indicated a good model fit, with items showing a significant factor loading higher than 0.60. SGM-ACE showed adequate to good psychometric properties and predicted depression (AOR = 1.49, CI = 1.20, 1.86), anxiety (AOR = 1.61, CI = 1.25, 2.00), and PTSD (AOR = 1.97, CI = 1.47, 2.66), when controlling for ACEs and demographic factors.

CONCLUSIONS

The 7-item SGM-ACEs measure is a psychometrically sound and unidimensional measure that can be quickly used to assess common adverse childhood experiences related to heterosexism.

Allostatic load as a predictor of response to repetitive transcranial magnetic stimulation in treatment resistant depression: Research protocol and hypotheses

Treatment resistant depression is challenging because patients who fail their initial treatments often do not respond to subsequent trials and their course of illness is frequently marked by chronic depression. Repetitive transcranial magnetic stimulation (rTMS) is a well-established treatment alternative, but there are several limitations that decreases accessibility. Identifying biomarkers that can help clinicians to reliably predict response to rTMS is therefore necessary. Allostatic load (AL), which represents the 'wear and tear' on the body and brain which accumulates as an individual is exposed to chronic stress could be an interesting staging model for TRD and help predict rTMS treatment response. We propose an open study which aims to test whether patients with a lower pre-treatment AL will have a stronger antidepressant response to 4 week-rTMS treatment. We will also assess the relation between healthy lifestyle behaviors, AL, and rTMS treatment response. Blood samples for AL parameters will be collected before the treatment. The AL indices will summarize neuroendocrine (cortisol, Dehydroepiandrosterone), immune (CRP, fibrinogen, ferritin), metabolic (glycosylated hemoglobin, total cholesterol, high-density lipoprotein, low-density lipoprotein, triglycerides, uric acid, body mass index, waist circumference), and cardiovascular (heart rate, systolic and diastolic blood pressure) functioning. Mood assessment (Montgomery-Åsberg Depression Rating Scale and Inventory of Depressive symptomatology) will be measured before the treatment and at two-week intervals up to 4 weeks. With the help of different lifestyle questionnaires, a healthy lifestyle index (i.e., a single score based on lifestyle factors) will be created. We will use linear and logistic regressions to assess AL in relation to changes in mood score. Hierarchical regression will be done in order to assess the association between AL, healthy lifestyle index and mood score. Long-lasting and unsuccessful antidepressant trials may increase the chance of not responding to future trials of antidepressants and it can therefore increase treatment resistance. It is essential to identify reliable biomarkers that can predict treatment responses.

Examining the Interplay between Queerness and Teacher Wellbeing: A Qualitative Study Based on Foreign Language Teacher Trainers

Oftentimes, teachers who identify themselves as LGTBIQ+ may feel unsafe at work, which may upset their wellbeing and destabilize their key psychological traits. Hence, feelings such as insecurity, lack of self-confidence, anxiety, and fear are on loop in their everyday lives. Thus, in this study we pursued an examination of the interplay between sexual orientation and teacher wellbeing in a cohort of seven university foreign language teacher trainers in a Spanish context. To gain insight into this issue, a qualitative study in line with the ecological paradigm was designed for the elaboration of semi-structured in-depth interviews and for the analysis of results. The main findings display teacher wellbeing as a complex interwoven system in which sexual orientation had played a core role in their identities, competences, private and professional relationships, and in the cultural and political spheres. We conclude by stating that although homophobic discrimination was a hard trial to overcome, the psychosocial capital of the participants allowed them to transform this negativity into positive assets such as queer activism in their private and political lives and in their profession as foreign language teacher trainers.

Exploring the sex and gender correlates of cognitive sex differences

The correlates of cognitive sex differences are yet to be fully understood. Many biological and psychosocial factors modulate these cognitive abilities leading to mixed results in the scientific literature. The current study aims to explore the different parameters potentially influencing cognitive abilities acting in synergy. Sex and gender correlates of cognitive functioning were assessed in a sample of individuals ages 18 to 45 years (N = 87) from diverse sexual orientations. Sex hormones were assessed via saliva samples at four timepoints throughout the testing. Gender roles, sexual orientation and socio-demographics were measured via self-report questionnaires. Participants completed mental rotation and verbal fluency tasks. Men performed better than women at mental rotation, while no significant difference was found for verbal fluency. Significant positive associations were observed between estradiol and word fluency for the naturally cycling women compared to the women using oral contraception. While controlling for sex hormones, a significant interaction effect of sex by gender roles was identified for mental rotation among masculine women. These exploratory results suggest an effect principally driven by sex and sex hormones on cognitive performance that will need to be furthered with larger studies.

A biopsychosocial framework for understanding sexual and gender minority health: A call for action

The number of US adults identifying as lesbian, gay, bisexual, transgender, or a different sexual identity has doubled since 2008, and about 40 % of the sexual and gender minority population identify as people of color. Minority stress theory posits that sexual and gender minorities are at particular risk for stress via stigma and discrimination at the structural, interpersonal, and individual levels. This stress, in turn, elevates the risk of adverse health outcomes across several domains. However, there remains a conspicuously limited amount of research on the psychoneuroimmunology of stress among sexual and gender minorities. We developed the Biopsychosocial Minority Stress Framework which posits that sexual minority status leads to unique experiences of minority stress which results in adverse health behavioral factors, elevated psychological distress and sleep disturbance, and immune dysregulation. Moderators in the model include both individual differences and intersectional identities. There is a crucial need to understand the biological-psychological axis of stress among the increasingly visible sexual and gender minority population to increase their health, longevity, and quality of life.

Dysregulated by stigma: Cortisol responses to repeated psychosocial stress in gay and heterosexual men

BACKGROUND

Research on pathways linking stigma with health inequalities affecting sexual minority populations, focused predominantly on exploring the hypothalamic-pituitary-adrenocortical (HPA) dysregulation profiles associated with chronic stress. One of such profiles reflecting a state of increased susceptibility to disease, and not yet studied among sexual minority individuals, is impaired habituation to repeated stress of the same type. In this study we explored whether sexual identity modulates endocrine stress responses and stress responses habituation in healthy heterosexual and gay men. We also explored the associations between perceived sexual minority stigma and cortisol response to stress in the latter group.

METHODS

Gay (N = 49) and heterosexual (N = 40) men, aged 24.4 years, were confronted twice with the Trier Social Stress Test and provided 5 salivary cortisol samples for each of the two testing sessions. A multilevel mixed-effects approach was used to model the cortisol curve throughout the two-day procedure. Habituation to repeated stress was conceptualized as the decrease in the total cortisol levels as well as the change in the cortisol curvilinearity between the first and the second testing session.

RESULTS

Gay participants were characterized by significantly higher cortisol levels throughout both laboratory visits. Their cortisol levels were also predicted by perceived rejection from family due to minority sexual identity, and stigma-related vicarious trauma. Although neither group showed habituation defined as the decrease in cortisol level, the shape of the cortisol curve changed between both visits only in the heterosexual participants.

CONCLUSIONS

Increased cortisol levels observed in gay men are predicted by minority stressors. Combined with non-habituation, the upregulation of the HPA axis may constitute a physiological pathway linking stigma to adverse health outcomes.

Same-Sex Partnership and Cardiovascular Disease in Men: The Role of Risk Factors in Adolescence

Purpose: We aimed to examine if same-sex partnership in men is associated with cardiovascular disease (CVD) and whether this relationship can be explained by accumulated risk factors in late adolescence using causal mediation analysis. Methods: All men born in Sweden between 1952 and 1956, who participated in mandatory Swedish military service conscription assessments, and had ever been recorded as being in an opposite-sex marriage or a legally recognized same-sex partnership were included (n = 156,612). Hospital-diagnosed CVD between ages 31 and 58 years was identified using medical records. Men were grouped into an opposite-sex marriage category or a same-sex partnership category based on marital status. Risk factors for CVD in late adolescence were identified using five biomarkers (systolic and diastolic blood pressure, pulse pressure, body mass index, and erythrocyte sedimentation rate) obtained at a conscription examination between ages 16 and 20 years. Birth year, childhood socioeconomic characteristics, physical and psychological characteristics in late adolescence, and mental health before the onset of CVD were treated as potential confounders. Results: Being in a same-sex partnership was associated with increased CVD risk compared with being in an opposite-sex marriage after controlling for potential confounders and risk factors; hazard ratio = 1.61, 95% confidence interval (CI) = 1.27-2.04. The risk factors in late adolescence explained 6.36% (95% CI = 2.72-12.74) of the increased CVD risk associated with being in same-sex partnerships compared with being in opposite-sex marriages. Conclusions: CVD risk factors accumulated by late adolescence may only partially account for the association between same-sex partnerships and cardiovascular health.

Allostatic Load Among Black Sexual Minority Women

Background: Allostatic load is the physiological deterioration that accumulates as the body responds to stress, resulting in disparities in chronic disease. Although perceptions of stress vary, marginalization and social disadvantage are associated with elevated allostatic load. Allostatic load is understudied in the multiply marginalized populations of sexual minority Black women. Methods: We used data from six waves of the National Health and Nutrition Examination Survey (2001-2010, 2015-2016) to identify heterosexual (n = 78), lesbian (n = 21), and bisexual (n = 57) Black women. We quantified allostatic load using nine biomarkers, and compared mean allostatic load across the three groups, adjusting for age, educational attainment, income, and country of birth to account for possible confounding. Results: We found no significant differences in allostatic load among heterosexual, lesbian, and bisexual Black women. Conclusions: These findings suggest that sexual orientation may not contribute to within-group differences in allostatic load among Black women, a group previously noted to have elevated allostatic load.

Gay men's stress response to a general and a specific social stressor

Gay men show altered psychobiological stress responses and exhibit a higher prevalence of mental disorders than their heterosexual counterparts. Both of these findings are likely due to gay-specific discrimination. Since it has not yet been determined whether gay-specific stress is more noxious than general stress, we tested whether gay men react more strongly to gay-specific socially stressful stimuli than to general socially stressful stimuli. N = 33 self-identified gay men (mean = 26.12 years of age, SD = 5.89), 63.6% of whom were in a relationship with a man, participated in an experimental within-group study, in which they were exposed to the Trier Social Stress Test (TSST) as well as a gay-specific TSST in a randomized order. Salivary cortisol and testosterone were assessed at five time points during the laboratory tests and perceived stress was assessed at four time points. According to psychobiological and perceived stress indices, the participants reacted similarly to a gay-specific and general social stressor. There were no significant differences in the outcomes, either when looking at pre-post-test differences or when comparing the overall stress responses. Given that the response to a gay-specific social stressor was equally pronounced as the one to a general social stressor, programs aiming to decrease minority stress but overlooking general stress are likely to yield only partial improvements in gay men's mental health. Instead, we suggest helping gay men cope with both forms of stress through building social support, assertiveness, and mindfulness skills, as well as decreasing emotional dysregulation.

Family Support and Sociocultural Factors on Depression among Black and Latinx Sexual Minority Men

Family-based approaches are critical for improving health outcomes in sexual minority men (SMM) of color. Yet, it is unclear how family context, internalized homophobia, and stress influence mental health outcomes among sexual minority men of color. From a cross-sectional sample of 448 participants, aged 16-24 years, survey data were analyzed to examine rates of family social support, the perception of sexuality by family, the stressfulness of life events, internalized homophobia, and other contextual variables on depression using linear regression. Our results indicated that an 86% increase in family social support was related to a -0.14 decrease in depression (ß = -0.14, p = 0.004). In addition, SMM who were separated by family and friends because of their sexuality were statistically significant and positively associated with depression (ß = 0.09, p < 0.001). Findings from our study suggest that the influence from the microsystem is salient in modifying mental health outcomes for SMM of color.

Knowledge of Chosen Family History and Depressive Symptoms in Sexual Minority Women

Recent work on intergenerational memory has revealed a positive association between family of origin knowledge and wellbeing in adolescents. However, little is known about the generalizability of these data, as significantly less attention has focused on autobiographical memory sharing and wellbeing in historically marginalized communities. Given the high incidence of familial rejection and abandonment within the LGBTQIA + community, close relationships with individuals outside of one’s family of origin, chosen families, often serve as an important source of social support. This study sought to examine the relationship between knowledge of a close non-family member and wellbeing among emerging adult sexual minority women (SMW) according to their gender presentation. A community sample from New York City comprised of heterosexual women (n = 50), masculine-presenting SMW (n = 50), and feminine presenting SMW (n = 50) completed measures associated with their knowledge of their family of origin, knowledge of a close non-family member, as well as self-reported measures of depression, emotion regulation, and socio-demographic questions. Family of origin knowledge was associated with lower levels of depression only among heterosexual women. However, heterosexual and SMW who knew more about their close non-family member reported lower levels of depression. Additionally, emotion regulation (cognitive reappraisals) mediated the relationship between knowing more about one’s chosen family and lower depressive symptom severity among heterosexual women, but this relationship was only significant for SMW who were at least moderately open about their sexuality. These findings extend the literature on the benefits of memory sharing to historically marginalized communities by showing that memory sources outside of one’s family of origin may be particularly important. Additionally, these data begin to shed light on potential mediating factors, such as emotion regulation and openness about one’s sexual identity, that underlie the links between memory sharing and metrics of wellbeing. Taken together, in contexts in which there may not be opportunities to learn about family history from one’s family of origin, it appears that access to stories from someone close outside of one’s family is also associated with lower levels of depression.

Spirituality and Religious Engagement, Community Involvement, Outness, and Family Support: Influence on LGBT+ Muslim Well-Being

The current study utilized data from the Social Justice Sexuality Project to investigate influences on psychological well-being of LGBT+ Muslims (N = 75) in the United States. Specifically, path analyses were used to examine the association between spiritual and religious engagement, LGBT community involvement, outness, and family support with psychological well-being. Control variables included lifespan Islam involvement, age, income, and the age at which the participant came out to themselves. Findings illustrate spiritual and religious engagement, outness, and income were all positively related to psychological well-being. Moreover, individuals who had converted to Islam but were not raised in the faith had significantly lower psychological well-being than those who had a consistent experience with Islam from their childhood until the time of the study. The present investigation provides critical contributions to the study of gender and sexual minorities in the United States and the experiences of currently practicing LGBT+ Muslims and those who were raised Muslim. Clinical implications and future research suggestions are discussed.

Combining Global Positioning System (GPS) with saliva collection among sexual minority adults: A feasibility study

BACKGROUND

This is the first study, of which we are aware, to evaluate the feasibility and accessibility of simultaneous use of Global Positioning System (GPS) and saliva collection for biomarker assessment as an objective measure of stress physiology among sexual minority (lesbian, gay, bisexual, queer, and other non-heterosexual identities) individuals. The principal motivation for pairing GPS and saliva collection was to investigate how characteristics of the built and social environments along with participants' daily activity paths affect stress. This can contribute to a better understanding of health and health behaviors in the sexual minority community.

METHODS

A convenience sample of enrolled participants (N = 124) from Houston, Texas was asked to complete questionnaires, carry with them a GPS unit daily, and collect and store 6 samples of saliva at specific times across the span of a day prior to a second visit around one week later.

RESULTS

Of 124 participants, 16 participants (12.90%) provided no useable GPS data and 98 (79.03%) provided at least 4 days of data. More than three-fourths (n = 98, 79.03%) also provided complete saliva samples.

CONCLUSIONS

Our results show that the simultaneous use of GPS and saliva collection to assess sexual minority individuals' activity paths and stress level is feasible.

Sexual minority status, social adversity and risk for psychotic disorders-results from the GROUP study

BACKGROUND

Lesbian, bisexual, or gay individuals (LBGs) have an increased risk for mental health problems compared to heterosexuals, but this association has sparsely been investigated for psychotic disorders. The aim of this study was: (1) to examine whether LBG sexual orientation is more prevalent in individuals with a non-affective psychotic disorder (NAPD) than in people without a psychotic disorder; and if so, (2) to explore possible mediating pathways.

METHODS

Sexual orientation was assessed in the 6-year follow-up assessment of the Dutch Genetic Risk and Outcome of Psychosis study (GROUP), a case-control study with 1547 participants (582 patients with psychotic disorder, 604 siblings, and 361 controls). Binary logistic regression analyses were used to calculate the risk of patients with a psychotic disorder being LBG, compared to siblings and controls. Perceived discrimination, history of bullying, childhood trauma (CT), and sexual identity disclosure were investigated as potential mediating variables.

RESULTS

The proportion of individuals with LBG orientation was 6.8% in patients (n = 40), 4.3% in siblings (n = 26), and 2.5% in controls (n = 10). The age- and gender-adjusted odds ratio of LBG for patients was 1.57 (95% CI 1.08-2.27; p = 0.019), compared to siblings and controls. Discrimination, bullying, and CT all partially mediated this association.

CONCLUSIONS

Adverse social experiences related to sexual minority status may increase the risk for NAPD. Sexual identity, behavior, and difficulties need more attention in everyday clinical practice.

Concepts of Neuroinflammation and Their Relationship With Impaired Mitochondrial Functions in Bipolar Disorder

Bipolar disorder (BD) is a chronic psychiatric disease, characterized by frequent behavioral episodes of depression and mania, and neurologically by dysregulated neurotransmission, neuroplasticity, growth factor signaling, and metabolism, as well as oxidative stress, and neuronal apoptosis, contributing to chronic neuroinflammation. These abnormalities result from complex interactions between multiple susceptibility genes and environmental factors such as stress. The neurocellular abnormalities of BD can result in gross morphological changes, such as reduced prefrontal and hippocampal volume, and circuit reorganization resulting in cognitive and emotional deficits. The term "neuroprogression" is used to denote the progressive changes from early to late stages, as BD severity and loss of treatment response correlate with the number of past episodes. In addition to circuit and cellular abnormalities, BD is associated with dysfunctional mitochondria, leading to severe metabolic disruption in high energy-demanding neurons and glia. Indeed, mitochondrial dysfunction involving electron transport chain (ETC) disruption is considered the primary cause of chronic oxidative stress in BD. The ensuing damage to membrane lipids, proteins, and DNA further perpetuates oxidative stress and neuroinflammation, creating a perpetuating pathogenic cycle. A deeper understanding of BD pathophysiology and identification of associated biomarkers of neuroinflammation are needed to facilitate early diagnosis and treatment of this debilitating disorder.

Mental Health and Health Risk Behaviors of Active Duty Sexual Minority and Transgender Service Members in the United States Military

Purpose: The aim of this study was to examine health risk behaviors and mental health outcomes among sexual minority and transgender active duty military service members and their heterosexual and cisgender counterparts. Methods: Participants (N = 544) were recruited by using respondent-driven sampling between August 2017 and March 2018 and completed an online survey by using validated measures of cigarette smoking, alcohol use, anxiety, depression, post-traumatic stress disorder (PTSD), and suicidality. Bayesian random intercept multiple logistic regressions were used to understand differences between sexual minority participants and heterosexual participants as well as between transgender participants and both their cisgender sexual minority and cisgender heterosexual peers. Results: Cisgender sexual minority women service members were more likely to meet criteria for problematic alcohol use (adjusted odds ratio [aOR] = 10.11) and cigarette smoking (aOR = 7.12) than cisgender heterosexual women. Cisgender sexual minority men had greater odds of suicidality (aOR = 4.73) than their cisgender heterosexual counterparts. Transgender service members had greater odds of anxiety, PTSD, depression, and suicidality than their cisgender peers. Conclusion: Military researchers and policymakers who seek to improve the overall health and well-being of sexual minority and transgender service members should consider programs and policies that are tailored to specific health outcomes and unique sexual minority and transgender subgroups.

Validity of the Trier Social Stress Test in studying discrimination stress

To test the validity of a modified Trier Social Stress Test (TSST) for studying stress reactivity in sexual minority women. Two hundred seventy-four female participants (66.4% Black American), half of whom identified as lesbian/gay or bisexual and half as heterosexual, completed the TSST with instructions to describe an experience of discrimination. Cortisol levels and negative emotion scores increased, and heart rate variability decreased in response to the TSST, and the magnitude of these responses varied as a function of sexual orientation and race. Women who discussed sexual orientation as a source of discrimination had greater increases in cortisol and negative mood following the TSST. The modified instructions did not compromise the validity of the TSST. Prompting participants to discuss specific sources of discrimination may be a useful adaptation of the TSST in studying minority stress reactivity. SUMMARY The goal of the present study was to adapt a widely used measure of stress reactivity to study the impact of experiences with discrimination on biological systems involved in regulating the stress response. The modification included asking women to discuss a time when they had been treated unfairly and to describe how they responded to that experience. The magnitude of response to the task varied as a function of sexual orientation and race, and the topics discussed, demonstrating usefulness of the modification for studying the impact of discrimination stress of physical health.

A Preliminary Experimental Study of Minority Stress, Startle Reactivity, and Alcohol Use among Heavy Drinking Sexual Minority Young Adults

Sexual minorities (e.g. lesbian, gay, bisexual) are at increased risk for alcohol use disorder (AUD) compared to heterosexuals. The minority stress model postulates that disparities in AUD stem, in part, from stress specific to sexual minorities (e.g. heterosexism). However, little research has examined psychophysiological markers of minority stress reactivity and how psychophysiological stress reactivity is associated with lifetime minority stress and alcohol use among sexual minorities. Emotion modulation of the startle response is a well-established paradigm for capturing psychophysiological stress reactivity under controlled laboratory conditions. Purpose: This preliminary study is the first to use the startle experimental paradigm to examine psychophysiological reactivity to stigma among sexual minorities. Procedures: Sexual minority participants (N = 20; 55% female), aged 18 to 27 years (M = 21.80, SD = 2.65), were recruited from the community. We compared startle reactivity in response to three types of stimuli (stigma, negative, and neutral) among heavy drinking sexual minority young adults. Although statistically underpowered, we also explored the associations between startle reactivity and self-reported drinking behaviors and lifetime minority stress. Results: Both stigma and general unpleasant stimuli produced more psychophysiological stress reactivity than neutral stimuli among sexual minorities. Psychophysiological stress reactivity was correlated with greater quantity of drinks reported on drinking days in the past month, but not greater frequency. Additionally, lifetime exposure to minority stress was associated with a blunted reactivity to stigma stimuli. Conclusions: These findings provide methodological advances and important implications for minority stress theory and alcohol use among sexual minorities.

Biocultural approaches to transgender and gender diverse experience and health: Integrating biomarkers and advancing gender/sex research

Transgender and gender diverse (TGD) people are increasingly visible in U.S. communities and in national media. With this increased visibility, access to gender affirming healthcare is also on the rise, particularly for urban youth. Political backlash and entrenchment in a gender binary, however, continue to marginalize TGD people, increasing risk for health disparities. The 2016 National Institute of Health recognition of sexual and gender minority people as a health disparities population increases available funding for much-needed research. In this article, we speak to the need for a biocultural human biology of gender/sex diversity by delineating factors that influence physiological functioning, mental health, and physical health of TGD people. We propose that many of these factors can best be investigated with minimally invasively collected biomarker samples (MICBS) and discuss how to integrate MICBS into research inclusive of TGD people. Research use of MICBS among TGD people remains limited, and wider use could enable essential biological and health data to be collected from a population often excluded from research. We provide a broad overview of terminology and current literature, point to key research questions, and address potential challenges researchers might face when aiming to integrate MCIBS in research inclusive of transgender and gender diverse people. We argue that, when used effectively, MICBS can enhance human biologists' ability to empirically measure physiology and health-related outcomes and enable more accurate identification of pathways linking human experience, embodiment, and health.

Allostatic load and women's brain health: A systematic review

Allostatic load represents the 'wear and tear' of chronic stress on the brain and body that may differ between men and women. A small but growing number of studies are assessing allostatic load in relation to mental health. The objective of this systematic review was to (1) assess sex differences in allostatic load and (2) identify allostatic load associations that are specific to women. We systematically searched for allostatic load studies that included psychosocial causes and/or psychiatric consequences. Our search focused on allostatic load studies that disaggregated by sex and that include women. Sixty-two studies were included in this systematic review. First, men appear to have higher allostatic load than women. Second, women show gender-specific variation for numerous factors such as age, race/ethnicity, adversities, social support, and health behaviors that influence associations between allostatic load and mental health. Recommendations are made to guide researchers advance sex and gender approaches.

Sexual orientation concealment and mental health: A conceptual and meta-analytic review

Identity concealment affects all sexual minority individuals, with potentially complex mental health implications. Concealing a sexual minority identity can simultaneously generate the stress of hiding, protect against the stress of discrimination, and keep one apart from sexual minority communities and their norms and supports. Not surprisingly, existing studies of the association between sexual orientation concealment and mental health problems show contradictory associations-from positive to negative to null. This meta-analysis attempts to resolve these contradictions. Across 193 studies (n = 92,236) we find a small positive association between sexual orientation concealment and internalizing mental health problems (i.e., depression, anxiety, distress, problematic eating; ESr = 0.126; 95% CI [0.102, 0.151]) and a small negative association between concealment and substance use problems (ESr = -0.061; 95% CI [-0.096, -0.026]). The association between concealment and internalizing mental health problems was larger for those studies that assessed concealment as lack of open behavior, those conducted recently, and those with younger samples; it was smaller in exclusively bisexual samples. Year of data collection, study location, and sample gender, education, and racial/ethnic composition did not explain between-study heterogeneity. Results extend existing theories of stigma and sexual minority mental health, suggesting potentially distinct stress processes for internalizing problems versus substance use problems, life course fluctuations in the experience of concealment, distinct experiences of concealment for bisexual individuals, and measurement recommendations for future studies. Small overall effects, heavy reliance on cross-sectional designs, relatively few effects for substance use problems, and the necessarily coarse classification of effect moderators in this meta-analysis suggest future needed methodological advances to further understand the mental health of this still-increasingly visible population. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Neighborhood perceptions and allostatic load: Evidence from Midlife in the United States study

Allostatic load, which represents the cumulative wear and tear on physiological systems resulting from long-term exposure to stress, provides a theoretical framework that can be applied to understand the association between neighborhood conditions and health outcomes. Within allostatic load theory perception plays a key role, as the cognitive appraisal process associated with one's perceptions determines whether external stimuli-such as neighborhood conditions-are deemed threatening or benign. With data from the Midlife Development in the United States, this study employed structural equation modeling to assess the association between neighborhood perceptions and cumulative, systems-level allostatic load scores. The findings demonstrate that neighborhood perception, as operationalized as a combination of perceived trust in neighbors, perceived neighborhood safety, and perceived neighborhood conditions, was inversely associated with allostatic load even when controlling for objective neighborhood conditions.

Psychological Distress, Felt Stigma, and HIV Prevention in a National Probability Sample of Sexual Minority Men

Purpose: We assessed how psychological distress and felt stigma (perceived sexual minority stigma in one's community) are associated with key HIV prevention outcomes in a U.S. national probability sample of sexually active, HIV-negative sexual minority men. Methods: Using data from the Generations study (2017-2018, N = 285), the present study assessed the effects of psychological distress and felt stigma and their interaction on three HIV prevention outcomes: testing for HIV as per Centers for Disease Control and Prevention guidelines (once or more in the past year), use of latex barriers (e.g., condoms), and familiarity with pre-exposure prophylaxis (PrEP). Results: In main effects models, neither psychological distress nor felt stigma was associated with any of the screening and prevention outcomes. However, the interaction between psychological distress and felt stigma was associated with each outcome. Specifically, at higher levels of felt stigma, greater psychological distress was associated with lower odds of HIV testing (exponentiated coefficient = 0.93, confidence interval [95% CI] 0.87-1.00), use of latex barriers (exponentiated coefficient = 0.92, 95% CI 0.86-0.99), and familiarity with PrEP (exponentiated coefficient = 0.90, 95% CI 0.82-0.98). Conclusion: These findings highlight the importance of felt stigma in shaping the association between psychological distress and engagement in HIV screening and prevention and offer important considerations for future HIV prevention research and interventions.

Biopsychosocial Mechanisms Linking Gender Minority Stress to HIV Comorbidities Among Black and Latina Transgender Women (LITE Plus): Protocol for a Mixed Methods Longitudinal Study

Background

Black and Latina transgender women (TW) experience a disparate burden of HIV and related comorbidities, including poor mental health and cardiovascular disease (CVD) risks. Pervasive multilevel stigma and discrimination operate as psychosocial stressors for TW living with HIV and shape health disparities for this population. Gender-affirming hormone therapy (GAHT) is commonly used by TW to facilitate alignment of the body with gender identity; in the context of stigma, GAHT may both improve mental health and increase CVD risks.

Objective

This study aims to quantify the longitudinal relationship between stigma and chronic stress among black and Latina TW living with HIV. Secondary objectives include identifying pathways linking chronic stress to HIV comorbidities and exploring chronic stress as a mediator in the pathway linking stigma and GAHT to CVD comorbidities.

Methods

This US-based mixed methods longitudinal study will enroll a prospective cohort of 200 black and Latina TW living with HIV, collecting quantitative survey data, qualitative interviews, and biomarkers of chronic stress. Interviewer-administered surveys will include validated psychosocial measures of self-reported stigma and discrimination, perceived stress, CVD risk factors, mental health, access to gender-affirming care, coping, and social support. Medical record abstraction will collect data on GAHT use, CD4 count, HIV viral load, antiretroviral therapy, treatment, and comorbid conditions. Clinical measures will include physiological biomarkers as well as salivary and blood-based biomarkers of chronic stress. Survey data will be collected every 6 months (baseline, and 6, 12, 18, and 24 months), and biospecimens will be collected at baseline and at 12 and 24 months. A purposive subsample (stratified by use of GAHT and presence of depressive symptoms) of 20 to 30 TW living with HIV will be invited to participate in in-depth interviews at 6 and 18 months to explore experiences of intersectional stigma, chronic stress, and the role of GAHT in their lives.

Results

This study was funded by the National Institute on Minority Health and Health Disparities in December 2018. The study community advisory board and scientific advisors provided critical input on study design. Recruitment began in October 2019 (n=29 participants as of submission) and data collection will continue through 2022, with publication of baseline results anticipated summer 2021.

Conclusions

This study will focus on black and Latina TW living with HIV, an understudied health disparities population, advance both stigma and intersectionality research, and move chronic stress physiology research toward a more nuanced understanding of sex and gender. The comprehensive methodology will support the exploration of the role of exogenous estrogen in the pathways between stress and HIV comorbidities, elucidating the role of GAHT in the stress-health relationship. Finally, this study will provide longitudinal evidence of the impact of stigma-related chronic stress on the lives of black and Latina TW living with HIV integrating qualitative and quantitative data with psychosocial, clinical, and biological measures.

International Registered Report Identifier (IRRID)

DERR1-10.2196/17076

Minimally-invasive methods for examining biological changes in response to chronic stress: A scoping review

BACKGROUND

Nurse researchers are increasingly interested in incorporating biological indicators related to chronic stress, or repeated or constant exposure to psychological stressors. Minimally invasive collection methods may improve access to vulnerable populations.

OBJECTIVE

To map biological indicators measured through minimally invasive methods investigating biological changes in response to chronic stress.

DESIGN, DATA SOURCES, AND METHODS

The paper seeks to answer two questions: What are the characteristics of the minimally-invasive methods used to measure the biological correlates of chronic stress? What are the limitations regarding the use of the minimally-invasive methods and/or biological indicators identified above? Authors completed a scoping review following guidelines from the Joanna Briggs Institute Manual and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for Scoping Reviews. A literature search was completed in PubMed, PsycINFO, and Scopus. 2518 articles were screened and 145 studies were included. Data were extracted using a standardized extraction tool, compiled, and coded.

RESULTS

Studies included minimally-invasive methods to measure the hypothalamic-adrenal-pituitary axis (N = 173), immune and inflammatory markers (N = 118), and adult neurogenesis (N = 6). Cortisol was most frequently measured (N = 136), usually in saliva (N = 86). Studies included a variety of limitations for the methods and indicators, including concerns about timing and accuracy of collection, frequency of sampling, and controlling for acute stressors.

CONCLUSIONS

Nurse researchers have access to many minimally-invasive methods to measure altered biological processes related to chronic stress. A gap identified by this review is the paucity of minimally-invasive methods for investigating neurogenesis; the measurement of brain derived neurotrophic factor in plasma is a distal proxy and further research is needed to test the response of peripheral levels to psychosocial stress interventions. Additionally, while this scoping review allows nurse researchers to consider possible biological indicators to include in their research, future research is still needed on some of the basic premises of stress research, including agreement on the conceptualization of chronic stress.