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Batista TS, Tavares FMDP, Gonçalves GP, Torres JL. Internalized homophobia and depression in homosexual and bisexual men and women: LGBT+ health survey, 2020. CIENCIA & SAUDE COLETIVA 2024; 29:e05412023. [PMID: 39194105 DOI: 10.1590/1413-81232024299.05412023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 11/27/2023] [Indexed: 08/29/2024] Open
Abstract
This study aimed to analyze the association between internalized homophobia and its domains and depression in homosexual and bisexual individuals and to quantify its results in depression. This is a cross-sectional online and anonymous study based on the LGBT+ health study conducted in Brazil from August to November, 2020, summing 926 respondents. Depression was self-reported. Internalized Homophobia was measured by the Brazilian Internalized Homophobia Scale for Gays and Lesbians, using 80% percentile to classify elevated total and by domain scores. Statistical analysis was based on Poisson Regression models with robust variance. Depression prevalence was 23.7%. The results revealed that internalized homophobia was positively associated with depression only among homosexuals (Prevalence Ratio (RP) = 1.80; 95% confidence interval (95%CI) 1.12-2.90). We found no statistical association for stigma and oppression domains. Population attributable fraction of depression was 2.3% (95%CI 0.1-4.5) in relation to internalized homophobia. Our findings highlight the need of controlling internalized homophobia to decrease the prevalence of depression among homosexuals.
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Affiliation(s)
| | | | | | - Juliana Lustosa Torres
- Departamento de Medicina Preventiva e Social, Faculdade de Medicina, UFMG. Belo Horizonte MG Brasil. Av. Professor Alfredo Balena 190, Santa Efigênia. 30130-100 Belo Horizonte MG Brasil.
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Ottesen TD, Wickersham JA, Lawrence JC, Antoniak S, Zezuilin O, Polonsky M, Antonyak S, Rozanova J, Dvoriak S, Pykalo I, Filippovych M, Altice FL. High rates of deferring antiretroviral treatment for patients with HIV and substance use disorders: Results from a national sample of HIV physicians in Ukraine. PLoS One 2024; 19:e0305086. [PMID: 39028735 PMCID: PMC11259278 DOI: 10.1371/journal.pone.0305086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 05/23/2024] [Indexed: 07/21/2024] Open
Abstract
BACKGROUND HIV incidence and mortality are increasing in Ukraine despite their reductions globally, in part due to suboptimal antiretroviral therapy (ART) coverage in key populations of people with HIV (PWH) where the epidemic is concentrated. As physicians are gatekeepers to ART prescription, stigma and discrimination barriers are understudied as a key to meeting HIV treatment targets in key populations. METHODS A national sample (N = 204) of ART-prescribing physicians in Ukraine were surveyed between August and November 2019. Participants underwent a series of randomized, hypothetical HIV clinical scenarios and decided whether to initiate or defer (or withhold) ART. Scenarios varied based on 5 distinct CD4 counts (CD4: 17, 176, 305, 470, or 520 cells/mL) and 10 different PWH key populations. Z scores and McNemar's test for paired samples were used to assess differences between key populations and CD4 count. Feeling thermometers were used to assess stigma-related measures toward key populations among physicians. RESULTS Physicians were highly experienced (mean = 19 years) HIV treaters, female (80.4%), and trained in infectious diseases (76.5%). Patients who drink alcohol (range: 21.6%-23.5%) or use (PWUD range: 16.7%-20.1%) or inject (PWID range: 15.5%-20.1%) drugs were most likely to have ART deferred, even at AIDS-defining CD4 counts. PWID maintained on methadone, however, were significantly (p<0.001) less likely to have ART deferred compared with those who were not (range: 7.8%-12.7%) on methadone. Men who have sex with men (range: 5.4%-10.8%), transgender women (range: 4.9%-11.3%), sex workers (range: 3.9%-10.3%),and having an HIV-uninfected sex partner (range: 3.9%-9.3%) had the lowest likelihood of ART deferral. Increasing levels of stigma (i.e., feeling thermometers) towards a key population was correlated with ART deferral (i.e., discrimination). CONCLUSIONS Despite international and Ukrainian guidelines recommending ART prescription for all PWH, irrespective of risk or CD4 count, ART deferral by experienced HIV experts remains high in certain key populations, especially in PWH and substance use disorders. Strategies that initiate ART immediately after diagnosis (i.e., rapid start antiretroviral therapy), independent of risk group, should be prioritized to truly mitigate the current epidemic.
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Affiliation(s)
- Taylor D. Ottesen
- Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, Yale School of Medicine, New Haven, Connecticut, United States of America
- Harvard Combined Orthopaedic Residency Program, Boston, MA, United States of America
| | - Jeffrey A. Wickersham
- Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Juliana C. Lawrence
- Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Sergii Antoniak
- L.V. Gromashevsky Institute of Epidemiology and Infectious Diseases of the National Academy of Medical Science of Ukraine, Kyiv, Ukraine
| | | | - Maxim Polonsky
- Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, Yale School of Medicine, New Haven, Connecticut, United States of America
- Keck Graduate Institute, Claremont, CA, United States of America
| | - Svitlana Antonyak
- L.V. Gromashevsky Institute of Epidemiology and Infectious Diseases of the National Academy of Medical Science of Ukraine, Kyiv, Ukraine
| | - Julia Rozanova
- Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, Yale School of Medicine, New Haven, Connecticut, United States of America
| | - Sergii Dvoriak
- Ukrainian Institute on Public Health Policy, Kyiv, Ukraine
| | - Iryna Pykalo
- Ukrainian Institute on Public Health Policy, Kyiv, Ukraine
| | | | - Fredrick L. Altice
- Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, Yale School of Medicine, New Haven, Connecticut, United States of America
- Department of Epidemiology of Microbial Diseases, Yale University School of Public Health, New Haven, Connecticut, United States of America
- Centre of Excellence in Research on AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia
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Hung YJ, Wu KCC, Chi YC, Yen CF, Chen YY. Association Between Egalitarian Gender Attitudes and Attitudes Toward Same-Sex Marriage: Findings from a National Representative Survey. JOURNAL OF HOMOSEXUALITY 2024:1-14. [PMID: 38864623 DOI: 10.1080/00918369.2024.2364227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2024]
Abstract
Egalitarian gender attitudes are linked to increased support for same-sex marriage, with previous studies mainly focusing on Western countries. Limited existing research from Asian countries often relied on non-representative, convenient samples. Taiwan, the first Asian country to legalize same-sex marriage in 2019, offers a valuable context. Since surveys before 2020 lacked questions on attitudes toward same-sex marriage, we utilized the 2020 PSFD data for a cross-sectional analysis. Logistic regression analyses were conducted to explore the relationship between gender attitudes (assessed through six questions) and attitudes toward same-sex marriage, along with examining the moderation effects of socio-demographic variables. The results revealed significant associations between embracing egalitarian gender attitudes and increased support for same-sex marriage (adjusted odds ratio [aOR] ranged from 1.34 to 2.08, 95% CI = [1.15, 2.45]). Moderation analysis indicated that this connection appeared to be more pronounced among younger individuals, those who were not currently married, and those with higher educational attainment. Individuals who are older, less educated, or married and hold negative views on gender equality should be targeted for efforts to enhance their support for same-sex marriage. Advocating for gender equality aligns with principles of equality, nondiscrimination, and recognizing fundamental rights for all, irrespective of sexual orientation.
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Affiliation(s)
- Yan-Jiun Hung
- Taipei City Psychiatric Centre, Taipei City Hospital, Taipei City, Taiwan
| | - Kevin Chien-Chang Wu
- Graduate Institute of Medical Education and Bioethics, College of Medicine, National Taiwan University, Taipei City, Taiwan
- Department of Psychiatry, National Taiwan University Hospital, Taipei City, Taiwan
| | - Ying-Chen Chi
- Department of Healthcare Information and Management, Ming Chuan University, Taoyuan, Taiwan
| | - Cheng-Fang Yen
- Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Ying-Yeh Chen
- Taipei City Psychiatric Centre, Taipei City Hospital, Taipei City, Taiwan
- Institute of Public Health, School of Medicine, National Yang Ming Chiao Tung University, Taipei City, Taiwan
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Hatzenbuehler ML, Lattanner MR, McKetta S, Pachankis JE. Structural stigma and LGBTQ+ health: a narrative review of quantitative studies. Lancet Public Health 2024; 9:e109-e127. [PMID: 38307678 DOI: 10.1016/s2468-2667(23)00312-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 12/15/2023] [Accepted: 12/15/2023] [Indexed: 02/04/2024]
Abstract
Health disparities related to sexual orientation and gender identity exist across multiple outcomes. Scholarship has begun to evaluate whether structural stigma-ie, societal-level conditions, cultural norms, and institutional policies that constrain opportunities, resources, and wellbeing-contributes to health burdens among LGBTQ+ individuals. We conducted a comprehensive review of quantitative studies examining this hypothesis. We found 98 articles that linked objective (ie, non-self-reported) measures of structural stigma to mental (n=57), behavioural (ie, substance use; n=27; HIV/AIDS or sexually transmitted infection; n=20), and physical (n=20) health outcomes. There was generally consistent evidence that structural stigma increases risk of poor health among LGBTQ+ individuals. Several methodological strengths were identified, including the use of multiple measures (eg, laws or policies [59%, 58 of 98]), designs (eg, quasi-experiments [21%, 21 of 98]), and samples (eg, probability-based [56%, 55 of 98]). However, important gaps exist. Just over half of studies included area-level covariates or non-LGBTQ+ comparison groups, which are necessary to address alternative explanations for the observed associations. Additionally, while studies (n=90) have begun to identify candidate mechanisms, only nine (10%) formally tested mediation. We offer suggestions for future research to advance this literature, which has implications not only for the identification of structural determinants of LGBTQ+ health but also for the development of public health interventions that reduce LGBTQ+ health disparities.
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Affiliation(s)
| | - Micah R Lattanner
- Department of Public Health, Santa Clara University, Santa Clara, CA, USA
| | - Sarah McKetta
- Department of Population Medicine, Harvard University, Boston, MA, USA
| | - John E Pachankis
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
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Ibigbami OI, Oginni OA, Bradley C, Lusher J, Sam-Agudu NA, Folayan MO. A cross-sectional study on resilience, anxiety, depression, and psychoactive substance use among heterosexual and sexual minority adolescents in Nigeria. BMC Public Health 2023; 23:1759. [PMID: 37689625 PMCID: PMC10493016 DOI: 10.1186/s12889-023-16660-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 08/30/2023] [Indexed: 09/11/2023] Open
Abstract
BACKGROUND Mental health-related problems predispose alcohol and other psychoactive substances use as coping strategies. We assessed associations between resilience and anxiety symptoms, depressive symptoms, problematic alcohol, and multiple psychoactive substance use among sexual minority and heterosexual adolescents in Nigeria. METHODS This was a secondary analysis of a subset of data generated through an online cross-sectional study conducted between 16th and 31st of October 2020. Data extracted for adolescents in Nigeria age 13-19 years were: dependent variables (alcohol use using the CAGE test, multiple psychoactive substance use, depressive symptoms using the Patient Health Questionnaire-9, and anxiety symptoms using the Generalized Anxiety Disorder-7 measure); independent variables (resilience using the Connor-Davidson resilience scale and sexual identity), and confounding factors (age and sex). Associations between dependent and independent variables were determined using multivariable logistic regression analyses after controlling for confounders. RESULTS Of the 1419 adolescent participants, 593 (42%) were sexual minority individuals, 533 (37.6%) had high depressive symptoms, 381 (26.8%) had high anxiety symptoms, 177 (12.5%) had problematic alcohol use and 389 (27.4%) used multiple psychoactive substances. Resilience was significantly associated with lower odds of anxiety (AOR:0.96, 95% CI: 0.94-0.97, p < 0.001) and depressive (AOR:0.94, 95% CI: 0.92-0.96, p < 0.001) symptoms, problematic alcohol use (AOR:0.97, 95% CI: 0.95-0.99, p = 0.002), and multiple psychoactive substance use (AOR:0.95, 95% CI: 0.93-0.96, p < 0.001). Sexual minority adolescents had significantly higher odds of anxiety (AOR:4.14, 95% CI: 3.16-5.40, p < 0.001) and depressive symptoms (AOR:4.79; 95% CI: 3.73-6.15, p < 0.001), problematic alcohol use (AOR:2.48, 95% CI: 1.76-3.49, p < 0.001), and multiple psychoactive substance use (AOR:5.69, 95% CI: 4.34-7.47, p < 0.001). CONCLUSION Sexual minority adolescents and adolescents with low resilience have a higher need for interventions to reduce the risk of anxiety, depression, and the use of alcohol and other psychoactive substances.
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Affiliation(s)
| | | | - Cory Bradley
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | | | - Nadia Adjoa Sam-Agudu
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, USA
| | - Morenike Oluwatoyin Folayan
- Department of Child Dental Health, Obafemi Awolowo University, Ile-Ife, Nigeria.
- Oral Health Initiative, Nigerian Institute of Medical Research, Yaba, Lagos, Nigeria.
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Jafary H, Ashrafi E. Attachment and Emotion Regulation: A Cross-Cultural Comparative Study of Iranian and Dutch Gay Men. JOURNAL OF HOMOSEXUALITY 2023; 70:1348-1363. [PMID: 35030059 DOI: 10.1080/00918369.2021.2020545] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Negative beliefs and stigmatization of all that is not heterosexual still have an adverse impact on the mental health of the homosexual population in many countries. The purpose of the present study was to comparatively assess how sociocultural differences regarding the level of homosexuality acceptance impact the adult attachment dimensions and emotion regulation strategies among three groups of Iranian and Dutch gay men. A community sample of 124 gay men (40 of Iranians residing in their home country, 41 of Iranians immigrated to the Netherlands and 43 Dutch) participated in the study and completed Revised Adult Attachment Scale (RAAS) and Emotion Regulation Questionnaire (ERQ). MANOVA and follow-up post-hoc Tukey tests were conducted in order to analyze the data. Results demonstrated a noticeable difference in both studied variables, attachment dimensions (close, anxiety, and depend) and emotion regulation strategies (cognitive reappraisal and expressive suppression), among the three groups of participants. As the Iranian (residing in Iran) group showed the greatest levels of anxiety and emotional suppression with the lowest levels of close (convenience of getting intimate to others), depend (trust and depend on others to be availabale when needed) and cognitive reappraisal (ability to alter the emotion caused by an event, before experiencing it by reinterpreting the situation), while the highest levels of depend, close and cognitive reappraisal and the lowest levels of anxiety and emotional suppression were seen in the Dutch group. Finally, Iranian gay immigrants came half way between. This data highlights the role of cultural differences in terms of homosexuality acceptance or stigmatization, in the way gay men exhibit their attachment and manage their emotions either by reappraisal or suppression. Comparative cross-cultural studies are possibly able to open paths to new research on psychological factors of non-heterosexuals in different countries with various cultures and religions.
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Affiliation(s)
- Hanieh Jafary
- Department of Psychology, Faculty of Humanities, University of Science and Culture, Tehran, Iran
| | - Emad Ashrafi
- Department of Psychology, Faculty of Humanities, University of Science and Culture, Tehran, Iran
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Wang H, Molina JM, Dray-Spira R, Schmidt AJ, Hickson F, van de Vijver D, Jonas KJ. Spatio-temporal changes in pre-exposure prophylaxis uptake among MSM in mainland France between 2016 and 2021: a Bayesian small area approach with MSM population estimation. J Int AIDS Soc 2023; 26:e26089. [PMID: 37221971 PMCID: PMC10206410 DOI: 10.1002/jia2.26089] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 04/25/2023] [Indexed: 05/25/2023] Open
Abstract
INTRODUCTION In France, oral pre-exposure prophylaxis (PrEP) for HIV prevention has been publicly available since 2016, mainly targeting at men who have sex with men (MSM). Reliable and robust estimations of the actual PrEP uptake among MSM on a localized level can provide additional insights to identify and better reach marginalized MSM within current HIV prevention service provision. This study used national pharmaco-epidemiology surveillance data and regional MSM population estimations to model the spatio-temporal distribution of PrEP uptake among MSM in France 2016-2021 to identify marginalized MSM at risk for HIV and increase their PrEP uptake. METHODS We first applied Bayesian spatial analyses with survey-surveillance-based HIV incidence data as a spatial proxy to estimate the size of (1) regional HIV-negative MSM populations and (2) MSM who could be eligible for PrEP use according to French PrEP guidelines. We then applied Bayesian spatio-temporal ecological regression modelling to estimate the regional prevalence and relative probability of the overall- and new-PrEP uptake from 2016 to 2021 across France. RESULTS HIV-negative and PrEP-eligible MSM populations vary regionally across France. Île-de-France was estimated to have the highest MSM density compared to other French regions. According to the final spatio-temporal model, the relative probability of overall PrEP uptake was heterogeneous across France but remained stable over time. Urban areas have higher-than-average probabilities of PrEP uptake. The prevalence of PrEP use increased steadily (ranging from 8.8% [95% credible interval 8.5%;9.0%] in Nouvelle-Aquitaine to 38.2% [36.5%;39.9%] in Centre-Val-de-Loire in 2021). CONCLUSIONS Our results show that using Bayesian spatial analysis as a novel methodology to estimate the localized HIV-negative MSM population is feasible and applicable. Spatio-temporal models showed that despite the increasing prevalence of PrEP use in all regions, geographical disparities and inequalities of PrEP uptake continued to exist over time. We identified regions that would benefit from greater tailoring and delivery efforts. Based on our findings, public health policies and HIV prevention strategies could be adjusted to better combat HIV infections and to accelerate ending the HIV epidemic.
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Affiliation(s)
- Haoyi Wang
- Department of Work and Social Psychology, Maastricht University, Maastricht, the Netherlands
- Viroscience Department, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Jean-Michel Molina
- Department of Infectious Diseases, Hôpital Saint-Louis, University of Paris Cité, Paris, France
| | - Rosemary Dray-Spira
- EPI-PHARE, French National Agency for Medicines and Health Products Safety (ANSM) and French National Health Insurance (CNAM), Saint-Denis, France
| | - Axel J Schmidt
- Sigma Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Ford Hickson
- Sigma Research, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Kai J Jonas
- Department of Work and Social Psychology, Maastricht University, Maastricht, the Netherlands
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Xu Y, Rahman Q, Hiyoshi A, Montgomery S. Same-Sex Marriage and Common Mental Health Diagnoses: A Sibling Comparison and Adoption Approach. JOURNAL OF SEX RESEARCH 2023; 60:585-595. [PMID: 36399099 DOI: 10.1080/00224499.2022.2120597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
We aimed to test whether the association between same-sex marriage and common mental health diagnoses was explained by shared genetic and environmental familial influences using sibling comparison and adoption analyses. For the sibling comparison analysis, participants (1,177,712 men and 1,266,917 women) were individuals born in Sweden between 1932 and 1994 and had ever been recorded as married (in opposite-sex or same-sex marriages). For the adoption analysis, participants were 147,164 and 1,298 female-female full sibling and adoptive sibling pairs, respectively. Based on medical records, prescribed medication, and death certificates, depression, substance abuse, and suicide (completed and attempted) from age 18 years were identified. For both sexes, being in a same-sex marriage was associated with greater risk of depression, substance abuse, and suicide, compared with being in an opposite-sex marriage. Controlling for shared familial confounding reduced this difference by less than 20% in magnitude, but overall mental health disparities for individuals in same-sex marriages remained statistically significant. Among women, only the genetic correlation between same-sex marriage and depression was statistically significant (r = .33). Same-sex marriage, as a proxy for sexual orientation, was associated with increased risk of certain mental health diagnoses and shared familial confounding explained a small component of this association, depending on the diagnosis. The findings indicate that sexual orientation disparities in mental health outcomes may involve unmeasured factors, and a relatively small proportion should be considered that may be due to shared familial confounding relevant to both sexual orientation and psychopathology.
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Affiliation(s)
- Yin Xu
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University
- Department of Sociology & Psychology, School of Public Administration, Sichuan University
| | - Qazi Rahman
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London
| | - Ayako Hiyoshi
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University
- Department of Public Health Sciences, Stockholm University
- Department of Epidemiology and Public Health, University College London
| | - Scott Montgomery
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University
- Department of Epidemiology and Public Health, University College London
- Clinical Epidemiology Division, Karolinska Institutet
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Buczak-Stec E, König HH, Hajek A. Sexual Orientation and Psychosocial Factors in Terms of Loneliness and Subjective Well-Being in Later Life. THE GERONTOLOGIST 2023; 63:338-349. [PMID: 35724421 DOI: 10.1093/geront/gnac088] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The aim of our study was to fill the gap in knowledge regarding the association between sexual orientation and psychosocial outcomes (loneliness and subjective well-being) based on nationally representative samples. RESEARCH DESIGN AND METHODS Cross-sectional data collected in 2017 were taken from a nationally representative sample of individuals in the second half of life (>40 years) in Germany (n = 4,785, average age 66.4 years, standard deviation [SD]: 10.5 years). Outcomes were assessed using well-established tools (life satisfaction: Satisfaction with Life Scale; positive and negative affect: Positive and Negative Affect Schedule; loneliness: De Jong Gierveld Loneliness Scale). Sexual orientation was dichotomized (heterosexual; sexual minorities including gay/lesbian, bisexual, and other). Analyses were adjusted for socioeconomic factors, lifestyle-related factors, and health-related factors. RESULTS In total, around 7.8% of respondents belonged to sexual minorities. Adjusted for various several socioeconomic, lifestyle-related and health-related covariates, linear regressions showed that sexual minority older adults reported higher loneliness scores (β = 0.07, p < .05), whereas sexual orientation was not associated with subjective well-being (life satisfaction, as well as positive and negative affect). Furthermore, our analysis showed that gender, age, marital status, and depressive symptoms were consistently associated with loneliness and subjective well-being. DISCUSSION AND IMPLICATIONS In accordance with minority stress theory, our study showed that sexual minority older adults report higher loneliness scores. This finding is important as loneliness has become widely acknowledged as a new geriatric giant, which could increase, for example, the risk of morbidity and mortality. Moreover, reducing loneliness is important for successful aging.
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Affiliation(s)
- Elżbieta Buczak-Stec
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg Center for Health Economics, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg Center for Health Economics, Hamburg, Germany
| | - André Hajek
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg Center for Health Economics, Hamburg, Germany
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Damiris IK, Allen A. Exploring the Relationship between Early Adaptive Schemas and Sexual Satisfaction. INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2023; 35:13-29. [PMID: 38596764 PMCID: PMC10903692 DOI: 10.1080/19317611.2022.2155897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 10/15/2022] [Accepted: 11/24/2022] [Indexed: 04/11/2024]
Abstract
Rationale Early maladaptive schemas (EMS) develop from unmet core emotional needs during childhood and adolescence. EMS influence the way individuals perceive themselves and others, while also sharing associations with various sexual difficulties. Contrastingly, Early Adaptive Schemas (EAS) develop when core emotional needs are met. Yet, the potential influence of EAS on sexual wellbeing remains underinvestigated. Objective The current study assessed the relationship between EAS and sexual satisfaction as a primary component of sexual wellbeing. Method The study design was an online, cross-sectional survey. Participants included 732 adults (Mage = 32.05, SDage = 9.30), who completed self-report questionnaires assessing sexual satisfaction and EAS. Results Two, three-step hierarchical regressions evaluated the effect of EAS on sexual satisfaction, controlling for several potentially confounding variables. Results indicated that the only EAS that was associated with sexual satisfaction in both men and women was Realistic Expectations. EAS of Social Belonging and Success were associated with sexual satisfaction for women alone, whereas Self-Compassion was for men. Conclusion Findings provide preliminary evidence that EAS are associated with sexual satisfaction. As such, schema therapy may be a useful therapeutic framework for improving sexual satisfaction, when indicated.
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Affiliation(s)
- Isabella K. Damiris
- School of Health and Behavioral Sciences, University of the Sunshine Coast, Sunshine Coast, Australia
| | - Andrew Allen
- School of Health and Behavioral Sciences, University of the Sunshine Coast, Sunshine Coast, Australia
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Gmelin JOH, De Vries YA, Baams L, Aguilar-Gaxiola S, Alonso J, Borges G, Bunting B, Cardoso G, Florescu S, Gureje O, Karam EG, Kawakami N, Lee S, Mneimneh Z, Navarro-Mateu F, Posada-Villa J, Rapsey C, Slade T, Stagnaro JC, Torres Y, Kessler RC, de Jonge P. Increased risks for mental disorders among LGB individuals: cross-national evidence from the World Mental Health Surveys. Soc Psychiatry Psychiatr Epidemiol 2022; 57:2319-2332. [PMID: 35851652 PMCID: PMC9636102 DOI: 10.1007/s00127-022-02320-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 06/20/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Lesbian, gay, and bisexual (LGB) individuals, and LB women specifically, have an increased risk for psychiatric morbidity, theorized to result from stigma-based discrimination. To date, no study has investigated the mental health disparities between LGB and heterosexual AQ1individuals in a large cross-national population-based comparison. The current study addresses this gap by examining differences between LGB and heterosexual participants in 13 cross-national surveys, and by exploring whether these disparities were associated with country-level LGBT acceptance. Since lower social support has been suggested as a mediator of sexual orientation-based differences in psychiatric morbidity, our secondary aim was to examine whether mental health disparities were partially explained by general social support from family and friends. METHODS Twelve-month prevalence of DSM-IV anxiety, mood, eating, disruptive behavior, and substance disorders was assessed with the WHO Composite International Diagnostic Interview in a general population sample across 13 countries as part of the World Mental Health Surveys. Participants were 46,889 adults (19,887 males; 807 LGB-identified). RESULTS Male and female LGB participants were more likely to report any 12-month disorder (OR 2.2, p < 0.001 and OR 2.7, p < 0.001, respectively) and most individual disorders than heterosexual participants. We found no evidence for an association between country-level LGBT acceptance and rates of psychiatric morbidity between LGB and heterosexualAQ2 participants. However, among LB women, the increased risk for mental disorders was partially explained by lower general openness with family, although most of the increased risk remained unexplained. CONCLUSION These results provide cross-national evidence for an association between sexual minority status and psychiatric morbidity, and highlight that for women, but not men, this association was partially mediated by perceived openness with family. Future research into individual-level and cross-national sexual minority stressors is needed.
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Affiliation(s)
- Jan-Ole H. Gmelin
- Department of Developmental Psychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS Groningen, The Netherlands
| | - Ymkje Anna De Vries
- Department of Developmental Psychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS Groningen, The Netherlands
- Interdisciplinary Center Psychopathology and Emotion Regulation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Laura Baams
- Department of Pedagogy and Educational Sciences, University of Groningen, Groningen, The Netherlands
| | | | - Jordi Alonso
- Health Services Research Unit, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain
- Pompeu Fabra University (UPF), Barcelona, Spain
- CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Guilherme Borges
- National Institute of Psychiatry Ramón de la Fuente Muñiz, Mexico City, Mexico
| | | | - Graca Cardoso
- Lisbon Institute of Global Mental Health and Chronic Diseases Research Center, NOVA Medical School, NOVA University of Lisbon, Lisbon, Portugal
| | - Silvia Florescu
- National School of Public Health, Management and Development, Bucharest, Romania
| | - Oye Gureje
- Department of Psychiatry, University College Hospital, Ibadan, Nigeria
| | - Elie G. Karam
- Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University, Beirut, Lebanon
- Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Center, Beirut, Lebanon
- Institute for Development Research Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
| | - Norito Kawakami
- Department of Digital Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Sing Lee
- Department of Psychiatry, Chinese University of Hong Kong, Tai Po, Hong Kong
| | - Zeina Mneimneh
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI USA
| | - Fernando Navarro-Mateu
- IDRAAC, Beirut, Lebanon
- UDIF-SM, Subdirección General de Planificación, Innovación y Cronicidad, Servicio Murciano de Salud, IMIB-Arrixaca, CIBERESP-Murcia, Murcia, Spain
| | - José Posada-Villa
- Colegio Mayor de Cundinamarca University, Faculty of Social Sciences, Bogota, Colombia
| | - Charlene Rapsey
- Department of Psychological Medicine, University of Otago, Dunedin, Otago New Zealand
| | - Tim Slade
- The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Sydney, Australia
| | - Juan Carlos Stagnaro
- Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Yolanda Torres
- Center for Excellence on Research in Mental Health, CES University, Medellin, Colombia
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, MA USA
| | - Peter de Jonge
- Department of Developmental Psychology, University of Groningen, Groningen, The Netherlands
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12
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Xu Y, Rahman Q, Montgomery S. Same-Sex Partnership and Cardiovascular Disease in Men: The Role of Risk Factors in Adolescence. LGBT Health 2021; 9:18-26. [PMID: 34448627 DOI: 10.1089/lgbt.2021.0183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
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.
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Affiliation(s)
- Yin Xu
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Qazi Rahman
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Scott Montgomery
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden.,Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.,Department of Epidemiology and Public Health, University College London, London, United Kingdom
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13
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Lin HC, Chen YL, Ko NY, Chang YP, Lu WH, Yen CF. Perception of Attitudes of the General Population toward Homosexuality in Taiwan: Roles of Demographic Factors, Mental Health, and Social Debates on Legalizing Same-Sex Marriage. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052618. [PMID: 33807845 PMCID: PMC7967317 DOI: 10.3390/ijerph18052618] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 02/28/2021] [Accepted: 03/04/2021] [Indexed: 11/18/2022]
Abstract
The aims of this online survey study were to examine the associations of demographic characteristics (gender, age, and sexual orientation), mental health status, and point in time of the survey (i.e., the beginning of the social debates on legalizing same-sex marriage vs. the end of the social debates) with people’s perception of the attitudes of the general population in Taiwan toward homosexuality. A two-wave internet survey was conducted using Facebook to gather information regarding people’s perception of the population’s attitudes toward homosexuality among 4562 participants. The five-item Brief Symptom Rating Scale was used for assessing mental health status. The results indicated that participants perceived the population as having a lower acceptance at the end of the social debates on legalizing same-sex marriage than at the beginning of the social debates; gender moderated the decline in perceived acceptance. The results also indicated that poor mental health and heterosexual orientation were significantly associated with a lower perception of the population’s homosexuality acceptance in both waves of the survey. The factors related to perceived homosexuality acceptance need to be considered in developing programs to increase the population’s homosexuality acceptance.
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Affiliation(s)
- Huang-Chi Lin
- Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan;
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung 80708, Taiwan
| | - Yi-Lung Chen
- Department of Healthcare Administration, Asia University, Taichung 41354, Taiwan;
- Department of Psychology, Asia University, Taichung 41354, Taiwan
| | - Nai-Ying Ko
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan;
| | - Yu-Ping Chang
- School of Nursing, The State University of New York, University at Buffalo, Buffalo, NY 14260, USA;
| | - Wei-Hsin Lu
- Department of Psychiatry, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi City 60002, Taiwan
- Correspondence: (W.-H.L.); (C.-F.Y.); Tel.: +8-86-5276-5041 (W.-H.L.); +8-86-7312-4941 (C.-F.Y.)
| | - Cheng-Fang Yen
- Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan;
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung 80708, Taiwan
- Correspondence: (W.-H.L.); (C.-F.Y.); Tel.: +8-86-5276-5041 (W.-H.L.); +8-86-7312-4941 (C.-F.Y.)
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Douglass RP, Conlin SE, Duffy RD. Beyond Happiness: Minority Stress and Life Meaning Among LGB Individuals. JOURNAL OF HOMOSEXUALITY 2020; 67:1587-1602. [PMID: 31006354 DOI: 10.1080/00918369.2019.1600900] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Scholars have recently started to examine how minority stressors are associated with wellbeing outcomes among lesbian, gay, and bisexual (LGB) people. Such studies have examined mainly hedonic wellbeing, and those that have investigated eudaimonic wellbeing have tended to use composite measures. The present study draws from this literature to examine how minority stressors are associated with a key indicator of eudaimonic wellbeing: life meaning. Drawing from the minority stress model, we examined these associations using structural equation modeling among 266 LGB adults. Expectations of rejection and identity concealment, but not discrimination or internalized homophobia, had significant negative associations with life meaning. Discrimination had negative indirect associations with life meaning via expectations of rejection and concealment. Our results highlight the nuanced relations that exist between minority stressors and life meaning and highlight the need to move beyond composite measures of wellbeing. Implications for clinical practice and directions for research are discussed.
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Affiliation(s)
- Richard P Douglass
- Department of Psychology, University of Florida , Gainesville, Florida, USA
| | - Sarah E Conlin
- Department of Psychology, University of Florida , Gainesville, Florida, USA
| | - Ryan D Duffy
- Department of Psychology, University of Florida , Gainesville, Florida, USA
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15
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Szél Z, Kiss D, Török Z, Gyarmathy VA. Hungarian Medical Students' Knowledge About and Attitude Toward Homosexual, Bisexual, and Transsexual Individuals. JOURNAL OF HOMOSEXUALITY 2020; 67:1429-1446. [PMID: 31034340 DOI: 10.1080/00918369.2019.1600898] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Discrimination that LGBTQ individuals experience in health care settings might affect their health and intention of using health care services. However, health needs of LGBTQ patients are still inappropriately addressed in the medical curriculum. First-, third-, and fourth-year medical students (N = 569) from the four Hungarian medical universities participated in a study in 2017 to assess knowledge about homosexuality, homonegativity, and their attitude as health care professionals toward sexual minorities. We found that higher levels of knowledge about homosexuality were associated with lower levels of homonegativity, upper-grade level in university, not being religious, and having close LGBTQ acquaintances. Our results suggest that it may be necessary to introduce LGBTQ themes in the medical curricula (not only in Hungary, but also in other countries) in order to improve the knowledge and attitude of medical students and thereby improve the health care of LGBTQ individuals.
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Affiliation(s)
- Zsuzsanna Szél
- Institute of Behavioural Sciences, Semmelweis University , Budapest, Hungary
| | - Dániel Kiss
- Doctoral School of Psychology, ELTE Eötvös Loránd University , Budapest, Hungary
- Institute of Psychology, ELTE Eötvös Loránd University , Budapest, Hungary
| | - Zsófia Török
- Department of Public Health, Semmelweis University , Budapest, Hungary
| | - V Anna Gyarmathy
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health , Baltimore, Maryland, USA
- Károly Rácz School of PhD Studies, Semmelweis University , Budapest, Hungary
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Verbal victimisation, depressive symptoms, and suicide risk among sexual minority adults in France: results from the nationally-representative 2017 Health Barometer survey. Soc Psychiatry Psychiatr Epidemiol 2020; 55:1073-1080. [PMID: 32055898 DOI: 10.1007/s00127-020-01848-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 02/03/2020] [Indexed: 10/25/2022]
Abstract
PURPOSE Our study estimates rates of depressive symptoms and suicide risk according to sexual minority status, and examines the mediating effect of verbal victimisation in the association between sexual minority status and mental health outcomes. METHOD Analysis is based on data from the 2017 French Health Barometer, a general population phone survey, which recruited 25,198 adults aged 18-75 years. Data were weighted to be representative of the French adult population. Four mental health outcomes occurring in the preceding year or currently were examined in relation to sexual minority status using multivariate logistic regressions: (a) current depressive symptoms, (b) having experienced a major depressive episode, (c) suicidal ideation, and (d) suicide attempt. Further we conducted mediation analyses to evaluate the contribution that verbal victimisation experienced in the preceding year has in the association between sexual minority status and the listed outcomes. All analyses were also stratified by sex. RESULTS Sexual minority adults were more likely to experience verbal victimisation in the last year compared to heterosexual individuals (22% vs 11.4%). They were also more likely to have experienced each of the four mental health outcomes, even after adjusting for potential confounders. In adjusted mediation analysis, verbal victimisation in the preceding year was found to significantly mediate the association between sexual orientation and mental health outcome with mediated proportions varying between 15 and 22%. CONCLUSION Sexual minority individuals are more at risk of depressive symptoms and suicidal ideation compared to heterosexuals, and this may be partially mediated by verbal victimisation.
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Hopwood M, Cama E, de Wit J, Treloar C. Stigma, Anxiety, and Depression Among Gay and Bisexual Men in Mixed-Orientation Marriages. QUALITATIVE HEALTH RESEARCH 2020; 30:622-633. [PMID: 31315511 DOI: 10.1177/1049732319862536] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The mental health of gay and bisexual men in mixed-orientation marriages is poorly understood. In this article, the authors explore the development of anxiety and depression among gay and bisexual men in heterosexual marriages. Sixteen men, living in the Australian states of New South Wales, Queensland, Victoria, and Tasmania were interviewed throughout 2016 and 2017. An analysis of interviews identified four main themes, namely, compulsory heterosexuality, existential distress, compartmentalization, and integration and resolution. Participants reported experiencing anxiety and depression, which were exacerbated by the stigmatization of same-sex attraction and by an overwhelming distress from feelings of shame and guilt regarding their marital infidelity. Findings indicate that gay and bisexual men in mixed-orientation marriages develop anxiety and depression in response to the exigencies of compulsory heterosexuality and the compartmentalizing of same-sex attraction and identity during heterosexual marriage. Coming-out as same-sex attracted resolved men's distress by facilitating an integrative self-structure.
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Affiliation(s)
- Max Hopwood
- UNSW Sydney, Sydney, New South Wales, Australia
| | - Elena Cama
- UNSW Sydney, Sydney, New South Wales, Australia
| | - John de Wit
- UNSW Sydney, Sydney, New South Wales, Australia
- Utrecht University, Utrecht, The Netherlands
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Scroggs B, Durtschi J, Busk M, Goodcase E, Jones DL. Within-minority group discomfort in lesbian, gay, and bisexual emerging adults of color: Implications for group identification and well-being. JOURNAL OF GAY & LESBIAN MENTAL HEALTH 2020. [DOI: 10.1080/19359705.2019.1703869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Barrett Scroggs
- Department of Human Development and Family Studies, Pennsylvania State University, Mont Alto, Pennsylvania, USA
| | - Jared Durtschi
- School of Family Studies and Human Services, Kansas State University, Manhattan, Kansas, USA
| | - Michelle Busk
- School of Family Studies and Human Services, Kansas State University, Manhattan, Kansas, USA
| | - Eric Goodcase
- School of Family Studies and Human Services, Kansas State University, Manhattan, Kansas, USA
| | - Denzel L. Jones
- Department of Applied Psychology, Antioch University, New England, Keene, New Hampshire, USA
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Lin IH, Ko NY, Huang YT, Chen MH, Lu WH, Yen CF. Effect of Same-Sex Marriage Referendums on the Suicidal Ideation Rate among Nonheterosexual People in Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16183456. [PMID: 31533353 PMCID: PMC6765861 DOI: 10.3390/ijerph16183456] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 09/13/2019] [Accepted: 09/16/2019] [Indexed: 12/29/2022]
Abstract
: Taiwan held voter-initiated referendums to determine same-sex marriage legalization on 24 November 2018. This study aims to compare suicidal ideation rates in heterosexual and nonheterosexual participants of a first-wave survey (Wave 1, 23 months before the same-sex marriage referendums) and a second-wave survey (Wave 2, one week after the same-sex marriage referendums) in Taiwan and to examine the influence of gender, age, and sexual orientation on the change in suicidal ideation rates in nonheterosexual participants. In total, 3286 participants in Wave 1 and 1370 participants in Wave 2 were recruited through a Facebook advertisement. Each participant completed an online questionnaire assessing suicidal ideation. The proportions of heterosexual and nonheterosexual participants with suicidal ideation were compared between the Wave 1 and Wave 2 surveys. Suicidal ideation rates between participants in the Wave 1 and Wave 2 surveys were further compared by stratifying nonheterosexual participants according to gender, age, and sexual orientation. Nonheterosexual participants in the Wave 2 survey had a higher suicidal ideation rate than those in the Wave 1 survey, whereas no difference was observed in suicidal ideation rates between heterosexual participants in Wave 2 and Wave 1. Nonheterosexual participants who were female, younger, gay, lesbian, and bisexual in Wave 2 had a higher suicidal ideation rate than those in Wave 1. The suicidal ideation rate significantly increased in nonheterosexual participants experiencing the same-sex marriage referendums in Taiwan. Whether civil rights of sexual minority individuals can be determined through referendums should be evaluated.
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Affiliation(s)
- I-Hsuan Lin
- Department of Psychiatry, Yuan's General Hospital, Kaohsiung 80249, Taiwan.
| | - Nai-Ying Ko
- Departments of Nursing, College of Medicine, National Cheng Kung University and Hospital, Tainan 70101, Taiwan.
- Center of Infection Control, National Cheng Kung University Hospital, Tainan 70101, Taiwan.
| | - Yu-Te Huang
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong RM543, Hong Kong.
| | - Mu-Hong Chen
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei 11217, Taiwan.
- Division of Psychiatry, School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan.
| | - Wei-Hsin Lu
- Department of Psychiatry, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi City 60002, Taiwan.
- Department of Senior Citizen Service Management, Chia Nan University of Pharmacy and Science, Tainan 60002, Taiwan.
| | - Cheng-Fang Yen
- Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan.
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung 80708, Taiwan.
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20
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Huang YT, Chen MH, Hu HF, Ko NY, Yen CF. Role of mental health in the attitude toward same-sex marriage among people in Taiwan: Moderating effects of gender, age, and sexual orientation. J Formos Med Assoc 2019; 119:150-156. [PMID: 30954329 DOI: 10.1016/j.jfma.2019.03.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 01/03/2019] [Accepted: 03/14/2019] [Indexed: 11/24/2022] Open
Abstract
PURPOSE The aims of the study were to examine the role of mental health in peoples' attitude toward same-sex marriage in Taiwan, as well as the moderating effects of gender, age, and sexual orientation on the association between mental health and attitude toward same-sex marriage. METHODS In total, 3235 participants were recruited through a Facebook advertisement. Each participant completed a questionnaire assessing attitude toward same-sex marriage and a 5-item Brief Symptom Rating Scale (BSRS-5). Multiple regression analysis was performed to investigate the association between mental health and attitude toward same-sex marriage. RESULTS Poor mental health was significantly associated with a low level of support for same-sex marriage. Age and sexual orientation moderated the association between mental health state and support for same-sex marriage. A significant association between poor mental health and a low level of support for same-sex marriage was observed only in older participants but not in younger participants. Moreover, a significant association between poor mental health and a low level of support for same-sex marriage was indicated only in heterosexual participants but not in non-heterosexual participants. CONCLUSION Our findings suggest that poor mental health was significantly associated with opposition to same-sex marriage. This relationship is more pronounced among older and heterosexual people.
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Affiliation(s)
- Yu-Te Huang
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong
| | - Mu-Hong Chen
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Division of Psychiatry, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Huei-Fan Hu
- Department of Psychiatry, Tainan Municipal Hospital (Managed by Show Chwan Medical Care Corporation), Tainan, Taiwan.
| | - Nai-Ying Ko
- Departments of Nursing, College of Medicine, National Cheng Kung University and Hospital, Tainan, Taiwan; Center of Infection Control, National Cheng Kung University Hospital, Tainan, Taiwan.
| | - Cheng-Fang Yen
- Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
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Henriques A, Silva S, Severo M, Fraga S, Ramos E. The Influence of Question Wording on Interpersonal Trust. METHODOLOGY-EUROPEAN JOURNAL OF RESEARCH METHODS FOR THE BEHAVIORAL AND SOCIAL SCIENCES 2019. [DOI: 10.1027/1614-2241/a000164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Abstract. We aimed to evaluate the impact of two question wordings, one more directive (reference, European Social Survey ) and one less directive (modified version), on self-reported trust. Using a randomly equivalent groups design, young adults ( n = 1,681) from the EPITeen cohort completed one of two questionnaires to evaluate trust. The final score ranged between 0 (lowest) and 30 (highest). Cronbach’s alphas were computed to assess reliability, and invariance tests were conducted to test the equivalence of both versions. Lower levels of interpersonal trust were attained with the reference version [ M ( SD):14.4(5.3) vs. 15.6(4.8); p < .001 and p = .005 for mean and variance comparison]. The reference version had better reliability (α = .742 vs. .686; p = .006). Strict invariance was achieved between the two formats, and similar effects of sociodemographic variables on trust were obtained, independently of the version used. The reference version presented better reliability than the modified one, supporting its ability to measure levels of trust among young adults.
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Affiliation(s)
- Ana Henriques
- EPIUnit – Instituto de Saúde Pública, Universidade do Porto, Portugal
| | - Susana Silva
- EPIUnit – Instituto de Saúde Pública, Universidade do Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Portugal
| | - Milton Severo
- EPIUnit – Instituto de Saúde Pública, Universidade do Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Portugal
| | - Sílvia Fraga
- EPIUnit – Instituto de Saúde Pública, Universidade do Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Portugal
| | - Elisabete Ramos
- EPIUnit – Instituto de Saúde Pública, Universidade do Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Portugal
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Villar F, Serrat R, de Sao José JM, Montero M, Giuliani MF, Carbajal M, da Cassia Oliveira R, Nina-Estrella R, Curcio CL, Alfonso A, Tirro V. Disclosing Lesbian and Gay Male Sexual Orientation in Later Life: Attitudes of Younger and Older Generations in Eight Latin American Countries. JOURNAL OF HOMOSEXUALITY 2018; 66:1546-1569. [PMID: 30235078 DOI: 10.1080/00918369.2018.1503462] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The purpose of this research was to explore attitudes toward older lesbians and gay men disclosing their sexual preferences in eight Latin American countries. The sample consisted of 1,539 participants belonging to three age groups (18-29 years, 60-69 years, and 70 years and over). Their answers to two open-ended questions were content-analyzed, and binary logistic regressions were run on the extreme attitudinal categories. Results showed that although most attitudes were positive, a solid percentage of participants still expressed different kinds of derogatory attitudes. Men (as compared to women) and participants who were more religious and less educated tended to hold more negative attitudes toward lesbians and gay men. Both older samples were more prejudiced than the younger one, and attitudes also varied according to country. There was a general trend showing more positive attitudes toward older lesbians and gay men in those countries where sexual minorities' rights are better assured, which suggests that measures to protect sexual minorities and to make sexual diversity in older age visible could be advisable.
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Affiliation(s)
- Feliciano Villar
- a Department of Cognition, Development, and Educational Psychology, University of Barcelona , Barcelona , Spain
| | - Rodrigo Serrat
- a Department of Cognition, Development, and Educational Psychology, University of Barcelona , Barcelona , Spain
| | | | - María Montero
- c Faculty of Psychology, National Autonomous University of México , City of México , México
| | - María Florencia Giuliani
- d National Council for Technical and Scientific Research (CONICET), Mar del Plata National University , Mar del Plata , Argentina
| | - Maria Carbajal
- e Social Psychology Institute, University of la República , Montevideo , Uruguay
| | | | - Ruth Nina-Estrella
- g Department of Psychology, University of Puerto Rico , San Juan , Puerto Rico
| | | | - Alina Alfonso
- i Centre of Demographic Studies, University of La Habana , La Habana , Cuba
| | - Victoria Tirro
- j Faculty of Psychology, Central University of Venezuela , Caracas , Venezuela
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23
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Babyar J. Equitable health: let's stick together as we address global discrimination, prejudice and stigma. ACTA ACUST UNITED AC 2018; 76:44. [PMID: 30167306 PMCID: PMC6103873 DOI: 10.1186/s13690-018-0291-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 06/19/2018] [Indexed: 12/31/2022]
Abstract
Tackling discrimination permanently in healthcare is not insurmountable. It is achievable. Discrimination is costly in lives, in healthcare delivery and waste, in human capital, in financial resource and even in healthcare improvement initiatives that do not adequately account for its impact. Healthcare must understand the underlying inequalities each faces from the start and tailor care toward equal health outcomes. Solutions have been offered and should be funded and evaluated. Additionally, a global plan to address discrimination and bias in healthcare must be consistent, accountable and be shaped around standardized tools and measures. The idea that an individual is better or more important than another has no place in today’s world, particularly in health. Therefore, it is critical that each is provided his or her individual needs to achieve best outcomes. It is critical for healthcare to advance health equity. Global healthcare must do its part to be a team leader on this issue.
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Zsila Á, Pagliassotti D, Urbán R, Orosz G, Király O, Demetrovics Z. Loving the love of boys: Motives for consuming yaoi media. PLoS One 2018; 13:e0198895. [PMID: 29902228 PMCID: PMC6002055 DOI: 10.1371/journal.pone.0198895] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 05/28/2018] [Indexed: 11/28/2022] Open
Abstract
In recent years, yaoi has been increasingly popular among youth interested in Japanese media such as anime and manga. Yaoi is defined as commercial and fan-created media that thematically focus on the romantic love between two men, often in a sexually explicit way. Despite the widespread popularity of this Japanese subgenre, there is a lack of empirical studies on the motives for consuming yaoi media that analyze the full range of motives using reliable research methods. The present study aimed to explore and operationalize the motives for yaoi media consumption based on previous qualitative research (Pagliassotti, 2008). Using an online survey, 724 yaoi consumers (58% male; Mage = 30.1 years, SD = 10.4) completed the Yaoi Consumption Motives Questionnaire (YCMQ). According to confirmatory factor analyses, the bi-factor model of nine motives yielded closer fit to the data than the theoretically proposed, first-order ten-factor model and a second-order nine-factor model. The nine-factor YCMQ demonstrated strong psychometric properties in terms of factor structure, internal consistency, and measurement invariance. These results indicate that the 31-item YCMQ is an appropriate instrument to assess individuals’ motives for consuming yaoi media.
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Affiliation(s)
- Ágnes Zsila
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
- Doctoral School of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
- * E-mail:
| | - Dru Pagliassotti
- California Lutheran University, Thousand Oaks, California, United States of America
| | - Róbert Urbán
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Gábor Orosz
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
- Institute of Cognitive Neuroscience and Psychology, Research Centre for Natural Sciences, Hungarian Academy of Sciences, Budapest, Hungary
| | - Orsolya Király
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Zsolt Demetrovics
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
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Perales F, Todd A. Structural stigma and the health and wellbeing of Australian LGB populations: Exploiting geographic variation in the results of the 2017 same-sex marriage plebiscite. Soc Sci Med 2018; 208:190-199. [PMID: 29853260 DOI: 10.1016/j.socscimed.2018.05.015] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 04/23/2018] [Accepted: 05/04/2018] [Indexed: 10/14/2022]
Abstract
RATIONALE Lesbian, gay, or bisexual (LGB) people experience poorer life outcomes than heterosexual people, with ongoing debates about the aetiology of these differences. Minority stress theory draws attention to the importance of structural stigma, which concerns hostile social environments for sexual minorities that constrain their opportunity structures. Yet few studies have operationalised structural stigma and tested its influence, with most focusing on the US context; even fewer studies examine the underlying mechanisms. OBJECTIVE This study expands the available evidence to Australia, which constitutes an interesting case study due to the implementation in late 2017 of a national postal plebiscite on same-sex marriage legislation. It also adds to knowledge by theorising and testing the mediating role of perceived social support in explaining the association between structural stigma and the life outcomes of LGB people. METHOD The analyses leverage geographical variation at the electorate level (n = 150) in the share of 'No' voters in the plebiscite as a measure of structural stigma. This aggregate-level information is merged to individual-level data from the Household, Income and Labour Dynamics in Australia Survey, a large, national probability sample (n∽15,000). RESULTS Multilevel regression models yield results which are consistent with minority stress theory and previous US scholarship: LGB people report comparatively worse life satisfaction, mental health and overall health in constituencies with higher shares of 'No' voters, controlling for a large set of individual- and aggregate-level confounds. Perceived social support mediates a large portion of the effects of structural stigma on LGB outcomes. CONCLUSION These findings have significant implications for policy and practice, highlighting the need for interventions aimed at reducing community levels of structural stigma and increasing social support to LGB populations.
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Affiliation(s)
- Francisco Perales
- Institute for Social Science Research, The University of Queensland, Building C, 80 Meiers Rd, Indooroopilly, QLD 4068, Australia.
| | - Abram Todd
- Institute for Social Science Research, The University of Queensland, Building C, 80 Meiers Rd, Indooroopilly, QLD 4068, Australia.
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Conlin SE, Douglass RP, Ouch S. Discrimination, Subjective Wellbeing, and the Role of Gender: A Mediation Model of LGB Minority Stress. JOURNAL OF HOMOSEXUALITY 2017; 66:238-259. [PMID: 29072528 DOI: 10.1080/00918369.2017.1398023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The present study examined the link between discrimination and the three components of subjective wellbeing (positive and negative affect and life satisfaction) among a cisgender sample of lesbian, gay, and bisexual (LGB) adults. Specifically, we investigated internalized homonegativity and expectations of rejection as potential mediators of the links between discrimination and subjective wellbeing among a sample of 215 participants. Results from our structural equation model demonstrated a strong, positive direct link between discrimination and negative affect. Discrimination also had small, negative indirect effects on life satisfaction through our two mediators. Interestingly, neither discrimination nor our two mediators were related with positive affect, demonstrating the need for future research to uncover potential buffers of this link. Finally, our model evidenced configural, metric, and scalar invariance, suggesting that our model applies well for both women and men. Practical implications and future directions for research are discussed.
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Affiliation(s)
- Sarah E Conlin
- a Department of Psychology , University of Florida , Gainesville , Florida , USA
| | - Richard P Douglass
- a Department of Psychology , University of Florida , Gainesville , Florida , USA
| | - Staci Ouch
- a Department of Psychology , University of Florida , Gainesville , Florida , USA
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Gustafsson PE, Linander I, Mosquera PA. Embodying pervasive discrimination: a decomposition of sexual orientation inequalities in health in a population-based cross-sectional study in Northern Sweden. Int J Equity Health 2017; 16:22. [PMID: 28109196 PMCID: PMC5251217 DOI: 10.1186/s12939-017-0522-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 01/13/2017] [Indexed: 12/01/2022] Open
Abstract
Background Studies from Sweden and abroad have established health inequalities between heterosexual and non-heterosexual people. Few studies have examined the underpinnings of such sexual orientation inequalities in health. To expand this literature, the present study aimed to employ decomposition analysis to explain health inequalities between people with heterosexual and non-heterosexual orientation in Sweden, a country with an international reputation for heeding the human rights of non-heterosexual people. Methods Participants (N = 23,446) came from a population-based cross-sectional survey in the four northernmost counties in Sweden in 2014. Participants completed self-administered questionnaires, covering sexual orientation, mental and general physical health, social conditions and unmet health care needs, and sociodemographic data was retrieved from total population registers. Sexual orientation inequalities in health were decomposed by Blinder-Oaxaca decomposition analysis. Results Results showed noticeable mental and general health inequalities between heterosexual and non-heterosexual orientation groups. Health inequalities were partly explained (total explained fraction 64-74%) by inequalities in degrading treatment (24-26% of the explained fraction), but to a considerable degree also by material conditions (38-45%) and unmet care needs (25-43%). Conclusions Psychosocial experiences may be insufficient to explain and understand health inequalities by sexual orientation in a reputedly ‘gay-friendly’ setting. Less overt forms of structural discrimination may need to be considered to capture the pervasive material discrimination that seems to underpin the embodiment of sexual minority inequalities. This ought to be taken into consideration in research, policy-making and monitoring aiming to work towards equity in health across sexual orientations.
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Affiliation(s)
- Per E Gustafsson
- Department of Public Health and Clinical Medicine, Unit of Epidemiology and Global Health, Umeå University, SE-901 87, Umeå, Sweden.
| | - Ida Linander
- Department of Public Health and Clinical Medicine, Unit of Epidemiology and Global Health, Umeå University, SE-901 87, Umeå, Sweden
| | - Paola A Mosquera
- Department of Public Health and Clinical Medicine, Unit of Epidemiology and Global Health, Umeå University, SE-901 87, Umeå, Sweden
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