Mental health help seeking patterns and associations among Australian same sex attracted women, trans and gender diverse people: a survey-based study

Sexual Identity Continuity and Change in a U.S. National Probability Sample of Sexual Minority Adults: Associations With Mental Health and Problematic Substance Use

OBJECTIVE

Sexual minority disparities in behavioral health (e.g., mental health and substance use) are well-established. However, sexual identity is dynamic, and changes are common across the life course (e.g., identifying with a monosexual [lesbian or gay] label and later with a plurisexual [queer, pansexual, etc.] label). This study assessed whether behavioral health risks coincide with sexual identity change among sexual minority people.

METHODS

Associations in a 3-year U.S. national probability sample of sexual minority adults were assessed between sexual minority identity change (consistently monosexual [N=400; 44.3% weighted], consistently plurisexual [N=239; 46.7% weighted], monosexual to plurisexual [N=19; 4.2% weighted], and plurisexual to monosexual [N=25; 4.8% weighted]) and five behavioral health indicators (psychological distress, social well-being, number of poor mental health days in the past month, problematic alcohol use, and problematic use of other drugs), controlling for demographic characteristics and baseline behavioral health.

RESULTS

Among female participants, monosexual-to-plurisexual identity change (vs. consistently monosexual identity) was associated with greater psychological distress (B=3.41, SE=1.13), lower social well-being (B=-0.61, SE=0.25), and more days of poor mental health in the past month (B=0.69 [Bexp=1.99], SE=0.23). Among male participants, plurisexual-to-monosexual identity change (vs. consistently plurisexual identity) was associated with lower social well-being (B=-0.56, SE=0.25), and identity change (regardless of type) was generally associated with increased problematic use of alcohol and other drugs.

CONCLUSIONS

Sexual identity change is an important consideration for sexual minority behavioral health research, with changes (vs. consistency) in identity being an important risk factor for compromised behavioral health. Prevention and treatment interventions may need to tailor messaging to sexual minority men and women differently.

LGBTQIA health in medical education: a national survey of Australian medical students

PURPOSE

Lesbian, gay, bisexual, transgender, queer, intersex and asexual (LGBTQIA) individuals experience poorer health outcomes than other individuals. Insufficient LGBTQIA health education of doctors in existing medical curricula contributes to these outcomes. We sought to explore medical students' experiences of content coverage and mode of delivery, as well as their preparedness, attitudes and learning needs regarding LGBTQIA health education in Australia.

METHODS

Using a conceptual framework specific to curricular development, we adapted a previous cross-sectional national survey. This included 28 questions (analysed statistically) and 5 free text responses (analysed deductively using Braun and Clarke's thematic analysis framework). Data was compared between LGBTQIA and non-LGBTQIA respondents, and clinical and preclinical students.

RESULTS

There were 913 participants from 21 of 23 medical schools, with most preclinical (55%) and clinical (89%) students reporting no teaching specific to LGBTQIA health. Reported content coverage was highest for sexual history taking (30%), and especially low for transgender and intersex health (< 16%), and intersectional LGBTQIA health (< 7%). Participants had positive attitudes towards LGBTQIA health, with 89% agreeing LGBTQIA topics were important and need to be covered in detail. Students desired longitudinal integration of LGBTQIA content, and LGBTQIA community involvement and case-based teaching that allows for interaction and questions. Self-perceived competency was low in all LGBTQIA health topics, although LGBTQIA participants reported higher preparedness than non-LGBTQIA participants.

CONCLUSIONS

Majority of survey participants reported limited teaching of LGBTQIA health-specific content, highlighting the limited coverage of LGBTQIA health in Australian medical schools. Participants expressed positive attitudes towards LGBTQIA content and broadly agreed with statements supporting increased integration of LGBTQIA health content within medical curricula.

Mental Healthcare Needs and Experiences of LGBT+ Individuals in Malaysia: Utility, Enablers, and Barriers

Access to mental healthcare is undoubtedly of major importance for LGBT+ people worldwide, given the high prevalence of mental health difficulties due to minority stress exposures. This study drew mixed-method survey data from the community-based KAMI Survey (n = 696) to examine the enablers, barriers, and unmet needs experiences of LGBT+ individuals in accessing mental healthcare services in Malaysia. First, we present findings from a series of descriptive analyses for sociodemographic differences in unmet needs for mental healthcare, barriers, and satisfaction levels with different types of mental healthcare. Next, we conducted an inductive thematic analysis of open-text comments (n = 273), with relevance drawn to Andersen's Behavioural Model of Healthcare. More than a quarter (29.5%) reported an unmet need for mental healthcare, and some groups (younger, asexual or queer, or participants living in non-major cities) reported higher unmet needs. More than three-fifths (60.5%) reported not knowing where to find culturally safe mental health professionals. The thematic analysis uncovered key contextual (e.g., mental health practitioners' stance, stigma, collaborative client-care) and individual (e.g., positive expectation of mental health services and anticipated stigma) attributes that influence healthcare experiences. Participants also identified resources that facilitate healthcare utilisation, such as affordability, availability of suitable professionals, and geographical considerations. The implications of our findings for the mental healthcare practices in Malaysia were outlined.

Suicidality associated with decreased help-seeking attitudes in college students: Implications for identifying and treating at-risk students

Suicide is a leading cause of death in college-aged youth, yet only half of all college students report engaging in professional mental health help-seeking. We examined how the various aspects of young adults' suicidality were associated with their openness to pursue professional mental health care in the future (i.e., "future help-seeking intentions"). Multilevel binary logistic regressions were tested in a sample of 24,446 U.S. college undergraduates with suicidality. The moderating effect of past service utilization on future help-seeking intentions was also tested. Strikingly, young people reporting past-year suicidal ideation, past-year suicidal attempts, and self-reported likelihood of a future suicide attempt demonstrated decreased likelihood of future help-seeking intentions, while those reporting prior diagnosis of a mental health condition and/or past service utilization demonstrated an increased likelihood. Past service utilization also significantly moderated the effect of suicide disclosure, such that youth reporting prior disclosure and prior professional treatment-seeking demonstrated greater odds of future help-seeking intentions relative to those who had disclosed suicidality but never utilized professional services. In order to mitigate the mental health crisis facing youth, further exploration is necessary to understand why students with suicidality do not report openness to seek help. It is also imperative to develop and implement novel strategies to identify at-risk students, understand and alleviate relevant barriers to treatment, and promote positive help-seeking attitudes and behaviors.

Evaluation of an SMS Based Alcohol Intervention for Same Sex Attracted Women: A Randomized Controlled Trial to Examine Feasibility, Acceptability, and Efficacy

PURPOSE

The purpose of this randomized controlled trial (Trial registration ID: redacted) was to examine the feasibility, acceptability, and efficacy of the Step One program, an SMS-based alcohol intervention for same-sex attracted women (SSAW).

METHODS

Ninety-seven SSAW who scored ≥8 on the Alcohol Use Disorders Identification Test (AUDIT) were randomly allocated to receive the Step One program (n = 47; mean age = 36.79) or a weekly message containing a link to a website with health information and support services for LGBT individuals (n = 50; mean age = 34.08). Participants completed questionnaires on alcohol use, wellbeing, and help-seeking at baseline (T1), intervention completion (T2; 4 wk after baseline) and 12 wk post-intervention (T3). In addition, participants in the intervention condition completed feasibility and accessibility measures at T2, and a subsample (n = 10) was interviewed about acceptability at T3.

RESULTS

Across conditions, participants significantly reduced their alcohol intake and improved their wellbeing and help-seeking over time. However, there were no significant differences between the intervention and control condition. Furthermore, frequency of help-seeking was low; only four intervention group participants and three control group participants began accessing support between T1 and T3. Overall, our findings indicate the intervention would benefit from revision prior to implementation.

CONCLUSIONS

Our approach was consistent with best practice in the development of an ecologically valid intervention; however, this intervention, in its current form, lacks the complexity desired by its users to optimally facilitate alcohol reduction among SSAW. Keywords: Alcohol intervention; Intervention mapping framework; Randomized controlled trial (RCT); Same-sex attracted women; Short-message service (SMS).

Previous mental health care and help-seeking experiences: Perspectives from sexual and gender minority survivors of near-fatal suicide attempts

Sexual and gender minority (SGM) populations face heightened risk of suicide compared to their heterosexual and cisgender counterparts, and a previous suicide attempt is among the strongest predictors of suicide mortality. Despite this increased risk, limited research has explored mental health help-seeking behavior and previous mental health care experiences of SGM individuals among the highest risk for suicide-individuals with a recent, near-fatal suicide attempt. This study presents thematic analysis results of interviews with 22 SGM individuals who reported at least one near-fatal suicide attempt in the past 18 months. Identified themes were (a) factors that affect help-seeking for SGM individuals with a recent, near-fatal suicide attempt, including previous mental health care experiences, support systems, and structural barriers and facilitators; (b) hospitalization is not a one-size fits all solution; and (c) recommendations for improving care for this population. Findings demonstrate that anti-SGM stigma may magnify existing barriers to mental health care across all socioecological levels. Notably, participants cited a fear of loss of autonomy from inpatient hospitalization and previous discriminatory experiences when seeking mental health care as hampering help-seeking. Given increased risk for suicide mortality, this patient population is a necessary stakeholder in suicide prevention and intervention development and policy discussions affecting mental health care. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The influence of care continuity and disclosure of sexual orientation in general practice on lesbian, bi+ and queer cisgender women's engagement with mental health services

BACKGROUND

Lesbian, bisexual+ and queer (LBQ+) cisgender women have considerable unmet mental health needs. The aims of this study were to examine LBQ+ cisgender women's prior engagement with general practitioners (GPs), and how this relationship shaped their mental health service use.

METHOD

Data from 2707 cisgender LBQ+ women were drawn from a national survey of adults who are lesbian, gay, bisexual, trans, intersex, queer or questioning, asexual and other diverse sexuality and gender identities (LGBTIQA+) in Australia. Multivariable logistic regression analyses examined demographic predictors of continuity of care with GPs and GPs' awareness of LBQ+ women's sexual orientation. The relationship between these variables and recent mental health service use was then analysed, comparing LBQ+ women's engagement with services known to be LGBTIQA+ inclusive and those without an inclusive reputation.

RESULTS

LBQ+ cisgender women with a regular GP had greater odds of having accessed mental health services in the last 12months. Two-thirds had a regular GP, with the lowest odds among women aged 18-35years and highest odds among women with a disability. LBQ+ women who did not believe their regular GP knew of their sexuality had lower odds of having accessed LGBTIQA+ inclusive mental health services. These individuals were typically aged below 25years, bisexual+ or queer identified, had below undergraduate-level education, earned <$2000 AUD per week, or lived in an outer-suburban or regional area.

CONCLUSION

GPs may be missing opportunities to promote continuity of care through developing trusting relationships with specific sub-populations of LBQ+ women, which in turn appears to sustain inequitable access to mental health care. To offer appropriate care and referrals for this population, GPs should provide safe and inclusive environments to enable comfortable and supportive discussions about sexual orientation when this is relevant to a person's health care.

Psychological Distress, Resilience, and Help-Seeking Experiences of LGBTIQA+ People in Rural Australia

The aims of this paper were to explore mental health, the aspects associated with psychological distress and resilience, and the help-seeking experiences of LGBTIQA+ people. This research used a mixed-method approach using a survey and semi-structured interviews. The study was conducted in rural and remote Tasmania, Australia. Sixty-six participants completed the survey, and 30 participated in interviews. Participants reported a range of mental health concerns and varied experiences of accessing care and support in rural Australia. Depression and anxiety were the most common among participants. Almost half of all participants had attempted suicide in their lifetime, and just over a fifth had self-harmed. Two-thirds of the sample had high/very high psychological distress. For respondents, lacking social support was associated with increased psychological distress and low level of resilience. Public acceptance and social support enhanced interviewees' resilience. Interviewees experienced a lack of nearby mental health professionals, were unimpeded by operating hours, and trusted mental health professionals, which impacted help seeking and mental health. The findings indicate that acceptance, access and proximity to care, and mental health professionals' cultural competence would benefit rural Tasmanian LGBTIQA+ peoples' mental health. There is a need to improve public education, improve mental health professionals' curricula, and provide inclusive and tailored mental health care.

Barriers and Facilitators to Mental Health Help-Seeking and Experiences with Service Use among LGBT+ University Students in Chile

Barriers limiting access to mental health care for lesbian, gay, bisexual, trans, and other sexual and gender minority (LGBT+) university students have not yet been explored in depth. The aim of this study was to explore the barriers and facilitators to mental health help seeking and experiences with service use among LGBT+ university students. Participants were 24 LGBT+ students between 18 and 23 years of age from a university in Chile. Individual semi-structured interviews were conducted and analysed using thematic content analysis. Multiple barriers and facilitators influence mental health help-seeking of LGBT+ students, with some of these barriers being explicitly related to LGBT+ issues (e.g., fear of discrimination or accessing specialised services). Perceived effectiveness of services was closely related to access safe/affirming care. Trans students reported more barriers to help-seeking and negative experiences with professionals than their cisgender peers. Perceptions of university mental health services as safe spaces for LGBT+ students were related to a positive perception of the university regarding LGBT+ issues. Knowing the factors that either hinder or facilitate help-seeking and characterising service use experiences in this population is useful for improving access to mental health services and for the development of policies that promote affirmative care for LGBT+ people.

Correlates of wanting to seek help for mental health and substance use concerns by sexual and gender minority young adults during the COVID-19 pandemic: A machine learning analysis

The COVID-19 pandemic has worsened the mental health and substance use challenges among many people who are Two Spirit, lesbian, gay, bisexual, transgender, queer, questioning, and intersex (2SLGBTQI+). We aimed to identify the important correlates and their effects on the predicted likelihood of wanting to seek help among 2SLGBTQI+ young adults for mental health or substance use concerns during the pandemic. A cross-sectional survey was conducted in 2020-2021 among 2SLGBTQI+ young adults aged 16-29 living in two Canadian provinces (Ontario and Quebec). Among 1414 participants, 77% (n = 1089) wanted to seek help for their mental health or substance use concerns during the pandemic, out of these, 69.8% (n = 760) reported delay in accessing care. We built a random forest (RF) model to predict the status of wanting to seek help, which achieved moderately high performance with an area under the receiver operating characteristic curve (AUC) of 0.85. The top 10 correlates of wanting to seek help were worsening mental health, age, stigma and discrimination, and adverse childhood experiences. The interactions of adequate housing with certain sexual orientations, gender identities and mental health challenges were found to increase the likelihood of wanting to seek help. We built another RF model for predicting risk of delay in accessing care among participants who wanted to seek help (n = 1089). The model identified a similar set of top 10 correlates of delay in accessing care but lacked adequate performance (AUC 0.61). These findings can direct future research and targeted prevention measures to reduce health disparities for 2SLGBTQI+ young adults.

Mental health among sexual and gender minorities: A Finnish population-based study of anxiety and depression discrepancies between individuals of diverse sexual orientations and gender minorities and the majority population

Substantial empirical evidence suggests that individuals who belong to sexual and gender minorities experience more anxiety and depression than heterosexual and cisgender people. Many previous studies have not, however, used population-based samples. There is also a shortage of evidence about certain sexual and gender minorities (e.g., nonbinary individuals). We examined differences in levels of anxiety and depression within sexual and gender minorities, as well as compared to the heterosexual and cisgender majority in a population-based Finnish sample (N = 8,589). We also explored if individuals who belong to both a gender and a sexual minority (double minority) reported higher rates of anxiety and depression than individuals who hold either a gender or a sexual minority status (single minority). Individuals who belonged to either a sexual or a gender minority overall experienced significantly higher rates of anxiety and depression than cisgender and heterosexual individuals. Among the different sexual and gender minorities, bisexual, emerging identity, and nonbinary individuals reported the highest rates of anxiety and depression. We found no differences in anxiety and depression between single minority and double minority individuals. Our results suggest that even though Finland is a country with an inclusive social climate, sexual and gender minorities are, nevertheless, disproportionately affected by mental health issues. The present study gives further support to the claim that individuals holding a sexual or gender minority status experience higher levels of depression and anxiety compared to cisgender and heterosexual individuals and pinpoints the need to acknowledge these issues both in the context of health care and in the society at large.

Exploring the experiences of alcohol service use among LGBTQ+ people in Scotland: A qualitative study

BACKGROUND

People who identify as LGBTQ+ are more likely to drink excessively compared to heterosexual and cisgender people. Perceived barriers to accessing alcohol services may further increase the potential for alcohol related harm for LGBTQ+ people. This qualitative study explores the experiences of LGBTQ+ people who have used alcohol services, including peer support groups, in Scotland and their suggestions for how alcohol services could be improved.

METHODS

Participants were recruited using social media adverts, dating websites, organisations that work with LGBTQ+ clients and snowball sampling. Participants' (n = 14) experiences of alcohol services and peer support groups were explored through semi-structured interviews. Data were analysed using the Framework Approach and thematic analysis.

RESULTS

Many participants thought their drinking was closely associated with their LGBTQ+ identity, as a response to shame, stigma, or family rejection. Some service users had positive experiences of alcohol services. However, participants were rarely asked about their sexuality / gender identity and some reported a lack of discussion about how identity might impact drinking. There were common views across the sample that barriers experienced by others in the LGBTQ+ community were amplified for trans people. Service users recommended that services need to signal LGBTQ+ inclusivity and provide a safe space to discuss multiple issues (e.g., alcohol use, mental health, gender identity). Participants highlighted the importance of alcohol-free spaces in the LGBTQ+ communities.

CONCLUSION

The study has clear practice and policy implications. Alcohol services should provide a safe space for LGBTQ+ people and clearly indicate that. Service providers should be trained to discuss potential connections between LGBTQ+ identity and substance use. At a broader level, alcohol-free social spaces would help reduce alcohol-related harm in LGBTQ+ communities.

Correlates of Support Utilization After Experiencing a Sexual Assault Among College Women and Men

Though previous research has examined survivors' use of formal and informal services, less research has looked at whether sexual orientation, race, and different sexual assault types (e.g., coercive) are associated with seeking support services. The purpose of this study is to examine factors associated with utilizing services or support from informal sources (e.g., telling a friend) and formal sources (e.g., psychological counseling) following a sexual assault. Data were gathered in Fall and Spring of 2019-2020 from undergraduate students at a Midwestern university. Logistic regression results showed that heterosexual students had 56% lower odds of using informal supports, while females were 2.05 times more likely to have used informal supports compared to their counterparts. Students who reported more heavy drinking had 37% lower odds of using informal supports compared to their counterparts. Those who experienced physical and incapacitated sexual assault were 2.09 times and 3.60 times more likely to have used informal supports, respectively. Additionally, older students were 1.35 times more likely to have used formal supports compared to younger students, whereas heterosexual students had 67% lower odds of using formal supports compared to sexual minority students. Those with greater PTSD symptoms were 1.07 times more likely to access formal services. Finally, students with greater depressive symptoms had 8% lower odds of using formal supports. Identifying college students who are less likely to access support services following a sexual assault has important implications for targeted prevention and intervention.

Lesbian, gay and bisexual homelessness in Australia: Risk and resilience factors to consider in policy and practice

Lesbian, gay and bisexual (LGB) people are more likely than heterosexual people to experience homelessness. The study aimed to compare risk and resilience factors commonly associated with homelessness according to sexual identity to inform more LGB-inclusive and targeted policy and service provision in this area. The study involved analysis of data from two Australian surveys: the General Social Survey 2014 (n = 17,401) and the Journeys Home study (n = 1,659). Chi-squared analyses of the survey data compared LGB with heterosexual respondents. Bisexual respondents had a significantly earlier average age of first homelessness, and were more likely to have repeated episodes of homelessness than lesbian, gay or heterosexual respondents. Risk factors that were higher among bisexual people included family violence, conflict and rejection and substance use issues. LGB respondents were twice as likely to have experienced discrimination as heterosexual respondents, more likely to have experienced violence and have mental health problems. Conversely, resilience factors for LGB respondents included being more likely to access friends for support in times of crisis, and to be involved in civic or political groups. We suggest that LGB people at risk of homelessness need effective responses based on their risk and resilience factors, including targeted peer support and mainstream services that affirm and acknowledge their diverse sexual identities. Australian policies should encourage improved LGB data collection and specific service responses. Primary prevention approaches include educating families of origin about LGB identities and assertive outreach to prevent housing loss.

Bridging Across the Digital Divide: Identifying the Extent to Which LGBTIQ+ Health Service Websites Engage Culturally and Linguistically Diverse (CALD) Users

eHealth is promoted as a viable platform for health service provision, as it can deliver relevant information instantaneously and anonymously, whilst circumventing geographical and discriminatory barriers that can occur in face-to-face settings. Lesbian, gay, bisexual, transgender, intersex and queer (LGBTIQ+) communities stand to benefit greatly from eHealth services, however, the way in which culturally and linguistically diverse (CALD) LGBTIQ+ users are included within eHealth service provision is currently unknown. The current study observed the way in which Australian LGBTIQ+ health service websites are inclusive of CALD users. Quantitative content analysis was performed on 19 Australian LGBTIQ+ health service websites, with a focus on translation of services and materials, English and digital literacy, and CALD specific resources. Results showed limited translated information across all websites, an absence of translation tools embedded in the home page, as well as moderate to high levels of digital and English literacy required, and largely absent CALD specific resources. These results suggest that Australian LGBTIQ+ health service websites are not currently meeting the unique needs of their CALD constituents. Increased availability of translation services, navigation tools, and CALD LGBTIQ+ stakeholder inclusion during website development is recommended to ensure more equitable access for CALD LGBTIQ+ communities.

Depression, Anxiety, and Help-Seeking Among NCAA Division III Athletes at a Historically Women’s College

This study explored depression, anxiety, and help-seeking at a National Collegiate Athletic Association Division III historically women’s college in the United States, while taking into account gender identities outside of male and female. An online survey including the Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and help-seeking measures were completed by 109 student-athletes. Participants’ ages ranged from 18 to 22. Within the sample, 59.7% of participants identified as LGBTQIA+ (lesbian, gay, bisexual, transgender, queer, intersex, asexual, among other identities) and 8.3% identified as genderqueer/gender-nonconforming. A total of 33.0% of the participants reported symptoms of depression, while 28.5% reported symptoms of anxiety. Genderqueer/gender-nonconforming athletes reported higher rates of anxiety than athletes who identified as women. Higher rates of depression and anxiety were related to higher levels of formal help-seeking. The results indicate that student-athletes at a historically women’s college may be experiencing higher levels of depression and anxiety than student-athletes in other contexts and have more positive views toward help-seeking. Student-athletes who identify outside of the gender binary may be at higher risk for anxiety.

Internalized homophobia, self-esteem, social support and depressive symptoms among sexual and gender minority women in Taiwan: An online survey

WHAT IS KNOWN ON THE SUBJECT?: Sexual minority individuals are more likely to experience depressive disorders than heterosexual individuals. Factors associated with depressive symptoms among sexual minority individuals have been explored and examined; however, there is a limited evidence to understand the factors among sexual minority women in non-western countries. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: To the best our knowledge, this is the first study examining internalized homophobia, self-esteem, social support and depressive symptoms among sexual minority women in Taiwan. Sexual minority women at risk of having depressive symptoms had a higher level of internalized homophobia, lower self-esteem and fewer support from partners, friends, and families. Specifically, being single, being a student and having a higher personal income increased the risk of having depressive symptoms among sexual minority women. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental health practitioners and nurses should be aware of and assess sexual minority women's level of internalized homophobia, self-esteem, and received social support to reduce the risk of depressive symptoms and thus help prevent suicidal ideation. LGBT sex education and government involvement are essential to buffer the negative influences of a homophobic society on the mental health of sexual minority women. ABSTRACT: Introduction Sexual minority women are more likely to report depressive symptoms than sexual minority men. However, there is a lack of evidence to understand factors associated with depressive symptoms among sexual minority women in non-western countries. Aim This study examined internalized homophobia, self-esteem, social support and depressive symptoms among Taiwanese sexual minority women. Method A total of 581 Taiwanese sexual minority women (Age range 20-48 years old, Mean 26.96, SD 5.718) completed an online survey. Results Taiwanese sexual minority women at risk of having depressive symptoms had a higher level of internalized homophobia and lower self-esteem. Perceived support from participants' partners, friends and families was related to lower risk of depressive symptoms. Being single, being a student and having a higher personal income were also found to increase the risk of having depressive symptoms among the women. Discussion Mental health interventions are essential for sexual minority women with internalized homophobia and low self-esteem. Implications for Practice Mental health practitioners and nurses should be aware of and assess the concerns that sexual minority women have regarding healthcare services and provide culturally competent care to reduce the risk of depressive symptoms.

Câncer de mama e homossexualidade feminina

Devido aos avanços dos tratamentos oncológicos, a sobrevida das pacientes com neoplasias mamárias tem aumentado significativamente, o que impõe a necessidade de compreender seus aspectos psicossociais. Diferenças de gênero e orientação sexual favorecem a ocorrência de desigualdades dentro dos serviços de saúde. Este estudo teve por objetivo analisar a produção científica nacional e internacional sobre variáveis relacionadas à saúde de mulheres lésbicas com câncer de mama. O levantamento bibliográfico foi realizado a partir das bases LILACS, PubMed, CINAHL e PsycINFO. Foram selecionados 20 artigos publicados entre 2007 e 2017. A análise permitiu delinear os temas: repercussões físicas e psicológicas do tratamento, enfrentamento, riscos de morbidade e mortalidade, qualidade de vida, menopausa e estudos de base populacional. A literatura explora de que modo a doença e o tratamento impactam de forma diferenciada a qualidade de vida de mulheres lésbicas acometidas por câncer de mama. Esse conhecimento é fundamental para subsidiar um cuidado sensível às necessidades dos segmentos minoritários da população.

Risk and protective factors for the development of gambling-related harms and problems among Australian sexual minority men

Background

Sexual minority men (SMM) often experience stressful social environments dominated by stigma and discrimination. SMM are typically more likely than heterosexual men to engage in certain risky behaviours such as problem gambling. This study aimed to compare gambling behaviour among SMM and examine potential risk factors (erroneous gambling cognitions, gambling outcome expectancies, hazardous alcohol use, impulsivity, and psychological distress; as well as perceived stigma and discrimination for the SMM participants) and potential protective factors (resilience, social support, and community connectedness) for problem gambling severity and gambling-related harms among SMM living in Australia.

Methods

An online survey, with an over-representation of SMM participants and problem, moderate-risk, and low-risk gamblers, was completed by 101 SMM (mean age = 28.5) and 207 heterosexual men (mean age = 26.4).

Results

SMM were found to have significantly lower levels of problem gambling severity compared with heterosexual men, and report significantly lower gambling participation, frequencies and expenditure on any gambling activity, casino table games, horse racing/greyhound betting, sports betting, and keno. However, in the SMM group, 38.3% were classified in the problem gambling category of the Problem Gambling Severity Index and 27.6% were classified in the moderate-risk gambling category. There were no significant differences between groups in gambling-related harms. Multiple regression analyses revealed that problem gambling severity and related harms were independently predicted by higher levels of impulsivity and erroneous gambling cognitions for both groups.

Conclusions

Lower frequency of gambling behaviours among SMM and similar risk factors predicting problem gambling severity/harms for both groups suggests that problem gambling is not pronounced among SMM. This study adds new evidence to the gambling literature which can be used as comparative benchmarks for future research.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40359-021-00597-4.

Treatment outcomes of a lesbian, gay, bisexual, transgender and queer alcohol and other drug counselling service in Australia: A retrospective analysis of client records

INTRODUCTION

Substance use disorders are more prevalent among lesbian, gay, bisexual, transgender and queer (LGBTQ) people than among their heterosexual and cisgender peers. There has been limited alcohol and other drug (AOD) treatment research with LGBTQ people outside of North America. This study aimed to examine the treatment outcomes of clients attending a LGBTQ-specific AOD counselling service in Australia (ACON's Substance Support Service) and compare their client profile and treatment outcomes with LGBTQ and non-LGBTQ clients of similar mainstream services.

METHODS

This study was a retrospective analysis of the health records of 284 ACON clients and 1011 clients of five mainstream services in 2016-2018. Clients completed clinical interviews at treatment entry and periodically throughout treatment and completed measures of substance use, severity of dependence, psychological distress and quality of life.

RESULTS

Most ACON clients were seeking treatment for methamphetamine (58%) and alcohol use (26%). Among ACON clients, there were reductions in past month days of substance use and severity of dependence between treatment entry and counselling sessions 4, 8 and 12 (all P < 0.001). There were statistically significant reductions in psychological distress and improved quality of life among ACON clients. Despite ACON and the mainstream services having similar treatment approaches, their client profiles were markedly different in terms of sociodemographic characteristics, substance use and source of referral, which precluded comparison of treatment outcomes.

DISCUSSION AND CONCLUSIONS

ACON's clients showed reduced substance use and improved psychosocial wellbeing during treatment. The findings support the provision of LGBTQ-specific AOD services.

"It's the nature of the beast": Community resilience among gender diverse individuals

Marginalization causes gender diverse individuals to experience increased stress compared with cisgender individuals, such as social stigma and discrimination, which can lead to poor physical and mental health outcomes. This population uses various resources to cope with these challenges, including community social support. This qualitative research aimed to understand how gender diverse individuals perceive their community resilience. Supported by a community partner organization, we recruited N = 20 gender diverse participants for semi-structured interviews analyzed through inductive thematic qualitative analysis. The data revealed similarities with community resilience factors observed among other minority groups as well as novelty. Themes emerged on both individual and group levels and include strengths (e.g., opening to the group, role modeling for resilience, and group resources) and threats to community resilience (e.g., social anxiety, physical health conditions, and stigma). This paper informs the development of community resilience interventions in the context of gender diversity.

Suicidality, self-harm, and their correlates among transgender and cisgender people living in Aotearoa/New Zealand or Australia

BACKGROUND

Transgender people experience high rates of suicidality and self-harm. Past research has established a range of correlates of suicidality/self-harm among transgender people but little is known about whether these correlates are similar for transgender and cisgender people.

AIMS

The aim of this study was to test whether a range of potential demographic and psychosocial correlates of suicidality/self-harm hold for both transgender and cisgender people living in Aotearoa/New Zealand and Australia.

METHODS

An online survey was completed by 700 adults living in Aotearoa/New Zealand (n = 328) or Australia (n = 372). Targeted advertising was used to recruit transgender respondents (n = 392) and cisgender respondents (n = 308). Participants completed questions about demographics, discrimination (the Everyday Discrimination Scale), distress (the Kessler-10 scale), social support (the Multi-Dimensional Scale of Perceived Social Support), resilience (the Brief Resilience Scale), suicidality (the Suicidal Ideation Attributes Scale and other questions about ideation/attempts), and self-harm (the Deliberate Self-Harm Inventory).

RESULTS

Lifetime suicidal ideation, lifetime suicide attempts, and lifetime self-harm were more common among transgender participants. Discrimination was associated with lifetime suicide attempts and lifetime self-harm, particularly for transgender participants. Distress was consistently associated with recent suicidality and self-harm for transgender participants. Younger cisgender participants were more likely to report lifetime self-harm. Recent suicidal ideation was associated with lower social support among transgender participants but with lower resilience among cisgender participants.

DISCUSSION

These findings reaffirm and expand on past research on suicidality/self-harm among transgender or cisgender people and demonstrate the relevance of tackling discrimination and distress experienced by transgender people. In addition, the findings highlight the importance of meeting additional social support needs among transgender people to help prevent suicide and self-harm.

A Qualitative Investigation of Engagement in Mental Health Services Among Black and Hispanic LGB Young Adults

OBJECTIVE

Little attention has been paid to engagement in mental health services among racially and ethnically diverse youths who identify as a sexual minority, despite research indicating that they face significant mental health disparities. In this study, the authors assessed the service use experiences of black and Hispanic lesbian, gay, and bisexual (LGB) young adults to identify factors that promoted or hindered their engagement.

METHODS

Semistructured interviews with 38 young adults regarding past and present experiences with mental health services were analyzed thematically for perceived challenges to and support for engagement. Participants' service use histories were reviewed for significant interruptions in services reported over the past year.

RESULTS

Seventeen participants (45%) reported disengagement despite continuing to need services. Factors that influenced engagement were identified across four domains: personal, social environment, accessibility, and provider characteristics. Stigma related to sexual orientation and cultural attitudes presented engagement barriers, whereas providers who were knowledgeable about sexual-minority issues were important engagement promoters. Additional barriers to engagement were ambivalence about treatment efficacy, lack of family support, and difficulty finding suitable and affordable care. Peers who identified as a sexual minority helped participants locate LGB-affirming services. Rapport with providers and health care autonomy assisted participants to manage barriers to engagement.

CONCLUSIONS

These findings offer insights about factors that can influence engagement with treatment among black and Hispanic LGB young adults. The findings reveal important provider competencies and can inform interventions to improve engagement and reduce mental health inequities among these youths.

Motivations for sexual identity concealment and their associations with mental health among bisexual, pansexual, queer, and fluid (bi+) individuals

Bisexual and other non-monosexual (bi+) people are at increased risk for depression and anxiety compared to both heterosexual and gay/lesbian people. Bi+ people are also more likely to conceal their sexual orientation than gay/lesbian people are, and concealment is generally associated with negative mental health outcomes. Despite evidence that concealment is a particularly salient stressor for bi+ people, there has been a lack of attention to their motivations for concealment. As such, the goal of the current study was to examine the associations among concealment, motivations for concealment, and depression and generalized anxiety symptoms in a sample of 715 bi+ people who completed an online survey. Nearly half of participants endorsed purposely trying to conceal their bi+ identity in their day-to-day life, and concealment was significantly associated with higher levels of depression and generalized anxiety. Using exploratory factor analysis, we identified two motivations for concealment: intrapersonal motivations (e.g., one's bi+ identity not being a central part of one's overall identity, not being comfortable with being bi+) and interpersonal motivations (e.g., concern about being judged or treated negatively, concern about putting oneself at risk of physical harm). Interpersonal motivations were significantly associated with higher levels of depression and generalized anxiety, whereas intrapersonal motivations were not. In sum, while concealment may generally be associated with negative mental health outcomes, this may only be the case for those who conceal out of concern for discrimination and victimization. These findings highlight the importance of examining bi+ people's motivations for concealing their sexual orientation in order to understand the extent to which they experience negative mental health outcomes.

Survey of Chinese persons managing depressive symptoms: Help-seeking behaviours and their influencing factors

OBJECTIVES

To explore help-seeking behaviours of Chinese persons managing depressive symptoms and factors that influence these behaviours.

METHODS

A survey of residents living in communities in Wuhan, China was conducted using stratified random sampling. The Patient Health Questionnaire (PHQ-2), the Actual Help-Seeking Questionnaire (AHSQ) and a socio-demographic questionnaire were completed by participants. Descriptive statistics were analyzed. A multiple linear regression model was used to explore factors associated with help-seeking behaviours.

RESULTS

Of the 1785 respondents, 672 (37.6%) reported that they experienced depressive symptoms during the past year, and of these respondents, 517 (76.9%) indicated that they sought assistance. Among help-seeking sources utilized by participants, informal help was sought most frequently (72.9%), followed by hotline/Internet assistance (14.3%), mental health professionals (MHPs) (7.9%) and general physicians (GPs) (3.7%). The results of multilinear regression analysis showed that participants who were adults (aged 25-64 years), attended junior and high school (7-12 years education), and lived in urban areas were more likely to seek additional assistance for their depressive symptoms.

CONCLUSION

Mental health promotion and education efforts are needed to improve the public's mental health literacy and to promote appropriate utilization of informal sources of assistance in managing depressive symptoms such as a hotline or the Internet. Further interventions need to be considered to reinforce use of social supports and mental health professionals, especially in rural areas.

Health Disparities Among Mid-to-Older Deaf LGBTQ Adults Compared with Mid-to-Older Deaf Non-LGBTQ Adults in the United States

Purpose: To compare chronic health and mental health conditions between mid-to-older deaf lesbian, gay, bisexual, transgender, and queer (LGBTQ) and mid-to-older non-LGBTQ adults who are 45 years or older. Methods: Medical conditions and mental health disorders data were gathered from 981 mid-to-older deaf adults (178 LGBTQ and 803 non-LGBTQ) who took the Health Information National Trends Survey in American Sign Language between 2015 and 2019. Modified Poisson regression with robust standard errors was used to calculate relative risk estimates and 95% confidence intervals for all medical conditions and mental health disorders with self-reported LGBTQ status as the main predictor, adjusting for known health correlates. Results: Consistent with the LGBTQ health disparity in the general population, our study findings indicated health disparities for certain medical conditions (e.g., lung disease, arthritis, and comorbidity) and mental health disorders (e.g., depression and anxiety) among mid-to-older deaf LGBTQ compared with non-LGBTQ deaf adults. Conclusion: Like the LGBTQ counterparts in the general population, deaf LGBTQ adults may require more frequent and comprehensive health care services. Culturally and linguistically competent care by providers may be invaluable in reducing such health inequities, particularly when provider education and training is undertaken through an intersectional framework that considers the interaction and context of multiple patient and provider social identities.

Heteronormative models of health-care delivery: investigating staff knowledge and confidence to meet the needs of LGBTIQ+ people

Health services internationally are reconsidering whether current service delivery models are inclusive and responsive to lesbian, gay, bisexual, trans* and gender diverse, intersex, and/or queer (LGBTIQ+) identifying individuals. A survey was conducted to establish a baseline needs analysis, as part of an LGBTIQ+ workforce development program, on perceived staff knowledge and confidence in a multi-site public mental health service in Melbourne, Australia. The survey comprising multiple choice, 5-point Likert scale ratings, and short answer sections was administered to mental health staff attending training at their place of work. Workplaces included: community clinics, residential services, acute inpatient services, service development, and research departments. Perceptions of self-confidence and knowledge, and further support needs expressed, were examined through analyzing quantitative and qualitative responses in feedback following the education sessions. The sample comprised 85 respondents; the majority female (66%), with a good representation of staff across age brackets. While the majority of staff identified as heterosexual (68%), LGBTIQ+ individuals were represented. Though 64% of staff surveyed noted that opportunities exist in the workplace to discuss LGBTIQ+ issues, a desire to increase knowledge was expressed by 94% of staff. Staff attitudes, knowledge, confidence, and support needs should be carefully considered at organizational and leadership levels, to ensure health services foster LGBTIQ+ responsive service delivery models and practices.

How Gender Identity and Treatment Progress Impact Decision-Making, Psychotherapy and Aftercare Desires of Trans Persons

The gender identity of trans individuals influences their treatment preferences, and this in turn seems to affect their individual treatment progress. However, there has been no research which—next to the impact of gender identity on treatment desires—has also investigated the influence of treatment progress using a measure which assumes various possible transition pathways of trans persons.Therefore, an online community survey of trans people was conducted in Germany in 2015. Data were collected via an online survey from a non-clinical sample of n = 415 trans individuals (over half assigned female at birth), aged 16–76 (Mean (M) = 38.12). Almost one fifth of participants embraced non-binary or genderqueer (NBGQ) identities. Participants progressed 60.77% (standard deviation (SD) = 35.21) through treatment at point of data collection, as measured by the individual treatment progress score (ITPS). All participants, especially participants assigned male at birth, differed significantly in desire to participate in decision-making processes based on transition progress; individuals without treatment experience had less desire to decide treatment plans. NBGQ participants assigned male at birth in early stages of transition had significantly more desire for psychotherapy during transition than participants of the same identity in later transition stages. All participants, especially binary participants, significantly differed in desire for aftercare based on transition progress; individuals without treatment experience indicated more desire for aftercare. Results indicate health professionals should expect changing treatment desires in trans individuals at various stages of transition, particularly at treatment start, and based on gender identity.

Effectiveness of a culturally tailored SMS alcohol intervention for same-sex attracted women: protocol for an RCT

BACKGROUND

There is a large disparity between alcohol treatment access and prevalence of hazardous drinking among same-sex attracted women (SSAW). Yet, this population typically report low satisfaction with care and a reluctance to attend mainstream health services. Currently, there are few culturally tailored services for SSAW available despite evidence indicating that many feel uncomfortable in mainstream services. This paper describes the protocol of a randomised controlled trial aimed at examining the impact of a culturally sensitive four-week short message service (SMS) alcohol intervention on SSAW's alcohol intake, wellbeing, and engagement with alcohol treatment.

METHODS

A randomised controlled trial comparing a culturally tailored SMS intervention (The Step One Program) with a generic 'thank you' message, and a nested qualitative study to further explore the intervention's feasibility and acceptability. The Step One Program was co-designed using an Intervention Mapping framework and engaging potential consumers in the developmental process. Participants are block randomised (1:1 ratio) and followed up at the completion of the intervention and at 12 weeks post-intervention. The primary outcomes are alcohol reduction (as measured by the Alcohol Use Disorders Identification Test and self-reported alcohol intake), wellbeing (as measured by the Personal Wellbeing Index - Adult), and help-seeking (as measured by the number of alcohol services accessed and frequency of access). Upon completion of the 12-week post-intervention survey, participants in the intervention group were contacted via email regarding a phone interview on intervention acceptability.

DISCUSSION

This study may have important implications for clinical practice, improve healthcare access and equity for SSAW, and provide direction for future research in this field. The outcomes of the current study may stimulate the development of other culturally tailored health programs for SSAW. The results will inform whether individually tailoring the messages according to content and delivery frequency may be warranted to increase its acceptability.

TRIAL REGISTRATION

This trial was registered with the Australian New Zealand Clinical Trials Registry (trial ID: ACTRN12617000768392 ).

Treatment experiences among LGBT veterans with discrimination-based trauma exposure: A pilot study

Past research suggests that rates of trauma exposure and Posttraumatic Stress Disorder (PTSD) are elevated among lesbian, gay, bisexual, and transgender (LGBT) veterans compared to heterosexual and cisgender veterans. Given higher rates of trauma exposure and PTSD, and the culture associated with the Department of Defense's history of policies excluding LGBT people, it is important to understand if LGBT veterans are seeking PTSD treatment following discrimination-based traumatic events, where they seek care, and if they are satisfied with treatment. This study aimed to describe the experiences of discrimination-based trauma-exposed LGBT veterans' (n = 47) experiences with PTSD treatment, including location of treatment (Veterans Health Administration [VHA] versus non-VHA) and satisfaction with care. The majority of veterans had received a PTSD diagnosis from a health-care provider in their lifetimes (78.72%, n = 37), and over half reported currently experiencing PTSD symptoms. Approximately 47% of LGBT veterans with discrimination-based trauma histories preferred to seek PTSD treatment exclusively at VHA (46.81%) or with a combination of VHA and non-VHA services (38.30%). Veterans who received PTSD treatment exclusively from VHA reported higher satisfaction ratings (7.44 on 0-9 scale) than veterans who received PTSD treatment exclusively from outside VHA (5.25 on 0-9 scale). For veterans who sought PTSD treatment at both VHA and non-VHA facilities, there were no significant differences regarding satisfaction ratings for their PTSD treatment in the two settings. Results are discussed in terms of VHA's continued efforts to establish equitable, patient-centered health care for all veterans and the importance of non-VHA facilities to recognize veteran identities.

Health service use by same-sex attracted Australian women for alcohol and mental health issues: a cross-sectional study

Background

Same-sex attracted women (SSAW) have higher rates of alcohol and mental health problems than heterosexual women, but utilisation of and satisfaction with treatment is limited.

Aim

This study investigated the influences on health service use for alcohol and mental health problems among SSAW.

Design & setting

The Gelberg-Andersen behavioural model of health service utilisation was used to generate outcome variables.

Method

A convenience sample of 521 community-connected Australian SSAW completed an online survey. Health service use according to sexual identity was compared using χ² analysis. Binary logistic regression examined associations between the independent variables with treatment utilisation.

Results

Reports of alcohol treatment were very low. Only 41.1% of participants with service need had utilised mental health and alcohol treatment. Bisexual women (adjusted odds ratio [AOR] = 2.76) and those with ‘other’ identities (AOR = 2.38) were more likely to use services than lesbian women. Enablers to service use were having a regular GP (AOR = 3.02); disclosure of sexuality to the GP (AOR = 2.42); lesbian, gay, bisexual and transgender (LGBT) community-connectedness (AOR = 1.11); and intimate partner violence ([IPV] AOR = 2.51). Social support was associated with a reduction in treatment use (AOR = 0.97). Significant access barriers included not feeling ready for help, and previous negative experiences related to sexual identity.

Conclusion

Disclosing sexual identity to a regular, trusted GP correlated with improved utilisation of alcohol and mental health treatment for SSAW. The benefits of seeking help for alcohol use, and of accessing LGBT-inclusive GPs to do so, should be promoted to SSAW.

A tailored compassion-focused therapy program for sexual minority young adults with depressive symotomatology: study protocol for a randomized controlled trial

Background

Lesbian, gay, and bisexual (LGB) men and women represent one of the highest-risk populations for depressive symptomatology and disorders, with young LGB adults being at greatest risk. To date, there have been no randomized controlled trials (RCT) to specifically target depressive symptoms in young LGB adults. This is despite research highlighting unique predictors of depressive symptomatology in this population. Here we outline a protocol for an RCT that will test the preliminary efficacy of a tailored compassion-focused therapy (CFT) intervention for young LGB adults compared with a self-directed cognitive behavioral therapy (CBT) program with no specific tailoring for LGB individuals.

Methods

The CFT intervention consists of 8 units with self-directed reading and activities tailored to LGB young adults, and 8 x weekly 1-hour consultations with a therapist. The CBT intervention consists of 8 units with self-guided reading and activities, with 1 x 1-hour session with a therapist at the mid-point of therapy. Fifty LGB individuals with scores of 13 or above on the Beck Depression Inventory-II will be randomized to either the CFT or CBT condition. The primary outcome measure is depressive symptomatology. Secondary outcome measures are symptoms of anxiety, suicidal ideation, internalized homophobia, self-compassion, and shame and guilt proneness. Assessments will occur at pre-intervention, post-intervention, and at 3-month post-intervention.

Discussion

This study is an RCT to test the preliminary efficacy of an LGB-tailored compassion-focused intervention for young LGB adults with depressive symptomatology. If this intervention is efficacious, this could begin to address the substantial mental health disparities amongst sexual minorities.

Trial registration

ACTRN12616001018404. Prospective registration, registered 02/08/2016.