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Tse S, Chee K, Coleman TA, Coulombe S, Travers R. Exploring LGBT2Q+ Intracategorical Factors in Mental Health Service Utilization: Differences in Gender Modalities, Sexual Orientations, and Ethnoracial Groups in Canada. Community Ment Health J 2024:10.1007/s10597-024-01299-y. [PMID: 38850503 DOI: 10.1007/s10597-024-01299-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 05/19/2024] [Indexed: 06/10/2024]
Abstract
LGBT2Q+ (lesbian, gay, bisexual, transgender, Two-Spirit, queer, plus) Canadians face minority stressors that lead to higher mental health inequalities such as worse self-reported mental health and increased risk of mental health issues when compared to their heterosexual/straight and cisgender counterparts. However, there are within-group (intracategorical) differences within a community as large as LGBT2Q+ peoples. Guided by the Andersen Model of Healthcare Utilization, we sought to explore intracategorical differences in LGBT2Q+ Canadian predisposing, enabling, and need factors in mental health service utilization within the past year. Using data from the 2020 LGBT2Q+ Health Survey (N = 1542), modified Poisson logistic regression found that more polysexual respondents and trans/gender-diverse respondents were more likely to have utilized mental health services within the past year than their gay, lesbian, and cis male counterparts. As well, compared to White respondents, Indigenous respondents were more likely to have utilized mental health services, while other racialized respondents were associated with less utilization. Backwards elimination of Andersen model of healthcare utilization factors predicting mental health service utilization retained two predisposing factors (ethnoracial groups and gender modality) and two need factors (self-reporting living with a mood disorder and self-reporting living with an anxiety disorder). Results suggest that polysexual, trans and gender-diverse, and racialized LGBT2Q+ peoples have an increased need for mental health services due to increased specific minority stressors that cisgender, White, monosexual peoples do not face. Implications for healthcare providers are discussed on how to improve service provision to LGBT2Q+ peoples.
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Affiliation(s)
- Samson Tse
- Department of Psychology, Wilfrid Laurier University, Waterloo, ON, Canada.
| | - Kenny Chee
- Faculty of Social Works, University of Toronto, Toronto, ON, Canada
| | - Todd A Coleman
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, ON, Canada
| | - Simon Coulombe
- Department of Industrial Relations, Université Laval, Québec, QC, Canada
| | - Robb Travers
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, ON, Canada
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Gustafsson PE, Fonseca-Rodríguez O, Castel Feced S, San Sebastián M, Bastos JL, Mosquera PA. A novel application of interrupted time series analysis to identify the impact of a primary health care reform on intersectional inequities in avoidable hospitalizations in the adult Swedish population. Soc Sci Med 2024; 343:116589. [PMID: 38237285 DOI: 10.1016/j.socscimed.2024.116589] [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: 08/30/2023] [Revised: 12/07/2023] [Accepted: 01/09/2024] [Indexed: 02/10/2024]
Abstract
Primary health care (PHC) systems are a crucial instrument for achieving equitable population health, but there is little evidence of how PHC reforms impact equities in population health. In 2010, Sweden implemented a reform that promoted marketization and privatization of PHC. The present study uses a novel integration of intersectionality-informed and evaluative epidemiological analytical frameworks to disentangle the impact of the 2010 Swedish PHC reform on intersectional inequities in avoidable hospitalizations. The study population comprised the total Swedish population aged 18-85 years across 2001-2017, in total 129 million annual observations, for whom register data on sociodemographics and hospitalizations due to ambulatory care sensitive conditions were retrieved. Multilevel Analysis of Individual Heterogeneity and Discriminatory Analyses (MAIHDA) were run for the pre-reform (2001-2009) and post-reform (2010-2017) periods to provide a mapping of inequities. In addition, random effects estimates reflecting the discriminatory accuracy of intersectional strata were extracted from a series MAIHDAs run per year 2001-2017. The estimates were re-analyzed by Interrupted Time Series Analysis (ITSA), in order to identify the impact of the reform on measures of intersectional inequity in avoidable hospitalizations. The results point to a complex reconfiguration of social inequities following the reform. While the post-reform period showed a reduction in overall rates of avoidable hospitalizations and in age disparities, socioeconomic inequities in avoidable hospitalizations, as well as the importance of interactions between complex social positions, both increased. Socioeconomically disadvantaged groups born in the Nordic countries seem to have benefited the least from the reform. The study supports a greater attention to the potentially complex consequences that health reforms can have on inequities in health and health care, which may not be immediate apparent in conventional evaluations of either population-average outcomes, or by simple evaluations of equity impacts. Methodological approaches for evaluation of complex inequity impacts need further development.
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Affiliation(s)
- Per E Gustafsson
- Department of Epidemiology and Global Health, Umeå University, Sweden.
| | | | - Sara Castel Feced
- Department of Microbiology, Pediatrics, Radiology, and Public Health, University of Zaragoza, Spain
| | | | | | - Paola A Mosquera
- Department of Epidemiology and Global Health, Umeå University, Sweden
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3
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Jakobsen MD, Bromseth J, Siverskog A, Krane MS. The provision of healthcare services to older LGBT adults in the Nordic countries: a scoping review. Scand J Prim Health Care 2023; 41:359-371. [PMID: 37602941 PMCID: PMC11001363 DOI: 10.1080/02813432.2023.2242713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 07/26/2023] [Indexed: 08/22/2023] Open
Abstract
OBJECTIVES Our objectives were to examine what is known about the provision of healthcare services to older LGBT adults in the Nordic countries, identify knowledge gaps, map implications of this research for the education of healthcare professionals and delivery of healthcare, and identify key future research priorities to advance policy and practice for older LGBT adults in this region. DESIGN We conducted searches in nine databases. Peer-reviewed articles and PhD theses published in and after 2002 written in English, Norwegian, Swedish or Danish languages were included. 41 studies met our inclusion criteria. However, only eight of these studies focused specifically on older LGBT adults. Therefore, to answer all research questions, five book chapters about older groups were also included. RESULTS There were few studies from countries other than Sweden and few quantitative studies. Bisexual people represented a neglected group in research. The studies included showed that healthcare personnel lack knowledge on LGBT issues, particularly about older LGBT adults and non-binary gender identification. Older LGBT adults frequently reported being met with cis- and heteronormative expectations in healthcare encounters. For transgender people, access to medical treatment has been managed by gatekeepers influenced by a binary understanding of gender. CONCLUSIONS Relevant measures to enhance practices are increased attention on LGBT issues in education; training of healthcare professionals; measures at the institutional level; and ensuring that transgender people identifying as non-binary receive the same quality of care as individuals identifying in a binary way.
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Affiliation(s)
| | | | - Anna Siverskog
- Department of Culture and Education, Södertörn University, Huddinge, Sweden
| | - Martin Sollund Krane
- Centre for Care Research North, UiT The Arctic University of Norway, Tromsø, Norway
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Huang Y, Chen D, Levin AM, Ahmedani BK, Frank C, Li M, Wang Q, Gui H, Sham PC. Cross-phenotype relationship between opioid use disorder and suicide attempts: new evidence from polygenic association and Mendelian randomization analyses. Mol Psychiatry 2023; 28:2913-2921. [PMID: 37340172 DOI: 10.1038/s41380-023-02124-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 05/23/2023] [Accepted: 06/07/2023] [Indexed: 06/22/2023]
Abstract
Clinical epidemiological studies have found high co-occurrence between suicide attempts (SA) and opioid use disorder (OUD). However, the patterns of correlation and causation between them are still not clear due to psychiatric confounding. To investigate their cross-phenotype relationship, we utilized raw phenotypes and genotypes from >150,000 UK Biobank samples, and genome-wide association summary statistics from >600,000 individuals with European ancestry. Pairwise association and a potential bidirectional relationship between OUD and SA were evaluated with and without controlling for major psychiatric disease status (e.g., schizophrenia, major depressive disorder, and alcohol use disorder). Multiple statistical and genetics tools were used to perform epidemiological association, genetic correlation, polygenic risk score prediction, and Mendelian randomizations (MR) analyses. Strong associations between OUD and SA were observed at both the phenotypic level (overall samples [OR = 2.94, P = 1.59 ×10-14]; non-psychiatric subgroup [OR = 2.15, P = 1.07 ×10-3]) and the genetic level (genetic correlation rg = 0.38 and 0.5 with or without conditioning on psychiatric traits, respectively). Consistently, increasing polygenic susceptibility to SA is associated with increasing risk of OUD (OR = 1.08, false discovery rate [FDR] =1.71 ×10-3), and similarly, increasing polygenic susceptibility to OUD is associated with increasing risk of SA (OR = 1.09, FDR = 1.73 ×10-6). However, these polygenic associations were much attenuated after controlling for comorbid psychiatric diseases. A combination of MR analyses suggested a possible causal association from genetic liability for SA to OUD risk (2-sample univariable MR: OR = 1.14, P = 0.001; multivariable MR: OR = 1.08, P = 0.001). This study provided new genetic evidence to explain the observed OUD-SA comorbidity. Future prevention strategies for each phenotype needs to take into consideration of screening for the other one.
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Affiliation(s)
- Yunqi Huang
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, Sichuan, China
- West China Brain Research Center, West China Hospital of Sichuan University, Chengdu, Sichuan, China
- Sichuan Clinical Medical Research Center for Mental Disorders, Chengdu, Sichuan, China
| | - Dongru Chen
- Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, MI, USA
| | - Albert M Levin
- Department of Public Health Sciences, Henry Ford Health, Detroit, MI, USA
| | - Brian K Ahmedani
- Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, MI, USA
- Behavioral Health Services and Psychiatry Research, Henry Ford Health, Detroit, MI, USA
| | - Cathrine Frank
- Behavioral Health Services and Psychiatry Research, Henry Ford Health, Detroit, MI, USA
| | - Miaoxin Li
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Qiang Wang
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
- West China Brain Research Center, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
- Sichuan Clinical Medical Research Center for Mental Disorders, Chengdu, Sichuan, China.
| | - Hongsheng Gui
- Center for Health Policy and Health Services Research, Henry Ford Health, Detroit, MI, USA.
- Behavioral Health Services and Psychiatry Research, Henry Ford Health, Detroit, MI, USA.
| | - Pak-Chung Sham
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong SAR, China
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Allen J, Cotter-Roberts A, Darlington O, Dyakova M, Masters R, Munford L. Understanding health inequalities in Wales using the Blinder-Oaxaca decomposition method. Front Public Health 2022; 10:1056885. [PMID: 36589980 PMCID: PMC9797964 DOI: 10.3389/fpubh.2022.1056885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 11/18/2022] [Indexed: 12/23/2022] Open
Abstract
Background Throughout Wales and the world, health inequality remains a problem that is interconnected with a wider and complex social, economic and environmental dynamic. Subsequently, action to tackle inequality in health needs to take place at a structural level, acknowledging the constraints affecting an individual's (or community's) capability and opportunity to enable change. While the 'social determinants of health' is an established concept, fully understanding the composition of the health gap is dependent on capturing the relative contributions of a myriad of social, economic and environmental factors within a quantitative analysis. Method The decomposition analysis sought to explain the differences in the prevalence of these outcomes in groups stratified by their ability to save at least £10 a month, whether they were in material deprivation, and the presence of a limiting long-standing illness, disability of infirmity. Responses to over 4,200 questions within the National Survey for Wales (n = 46,189; 2016-17 to 2019-20) were considered for analysis. Variables were included based on (1) their alignment to a World Health Organization (WHO) health equity framework ("Health Equity Status Report initiative") and (2) their ability to allow for stratification of the survey sample into distinct groups where considerable gaps in health outcomes existed. A pooled Blinder-Oaxaca model was used to analyse inequalities in self-reported health (fair/poor health, low mental well-being and low life satisfaction) and were stratified by the variables relating to financial security, material deprivation and disability status. Results The prevalence of fair/poor health was 75% higher in those who were financially insecure and 95% higher in those who are materially deprived. Decomposition of the outcome revealed that just under half of the health gap was "explained" i.e., 45.5% when stratifying by the respondent's ability to save and 46% when stratifying by material deprivation status. Further analysis of the explained component showed that "Social/Human Capital" and "Income Security/Social Protection" determinants accounted the most for disparities observed; it also showed that "Health Services" determinants accounted the least. These findings were consistent across the majority of scenarios modeled. Conclusion The analysis not only quantified the significant health gaps that existed in the years leading up to the COVID-19 pandemic but it has also shown what determinants of health were most influential. Understanding the factors most closely associated with disparities in health is key in identifying policy levers to reduce health inequalities and improve the health and well-being across populations.
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Affiliation(s)
- James Allen
- World Health Organization Collaborating Centre on Investment for Health and Well-Being, Public Health Wales, Cardiff, United Kingdom,*Correspondence: James Allen
| | - Andrew Cotter-Roberts
- World Health Organization Collaborating Centre on Investment for Health and Well-Being, Public Health Wales, Cardiff, United Kingdom
| | - Oliver Darlington
- World Health Organization Collaborating Centre on Investment for Health and Well-Being, Public Health Wales, Cardiff, United Kingdom
| | - Mariana Dyakova
- World Health Organization Collaborating Centre on Investment for Health and Well-Being, Public Health Wales, Cardiff, United Kingdom
| | - Rebecca Masters
- World Health Organization Collaborating Centre on Investment for Health and Well-Being, Public Health Wales, Cardiff, United Kingdom
| | - Luke Munford
- School of Health Sciences, University of Manchester, Manchester, United Kingdom
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Cech EA. The intersectional privilege of white able-bodied heterosexual men in STEM. SCIENCE ADVANCES 2022; 8:eabo1558. [PMID: 35704581 PMCID: PMC9200289 DOI: 10.1126/sciadv.abo1558] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 05/02/2022] [Indexed: 05/13/2023]
Abstract
A foundational assumption of science, technology, engineering, and math (STEM) inequality research is that members of the most well represented demographic group-white able-bodied heterosexual men (WAHM)-are uniquely privileged in STEM. But is this really the case? Using survey data of U.S. STEM professionals (N = 25,324), this study examines whether WAHM experience better treatment and rewards in STEM compared with members of all 31 other intersectional gender, race, sexual identity, and disability status categories. Indicating systematic advantages accompanying WAHM status, WAHM experience more social inclusion, professional respect, and career opportunities, and have higher salaries and persistence intentions than STEM professionals in 31 other intersectional groups. Decomposition analyses illustrate that these advantages operate in part as premiums-benefits attached to WAHM status that cannot be attributed to variation in human capital, work effort, and other factors. These findings motivate research and policy efforts to move beyond a single axis paradigm to better understand and address intersectional (dis)advantages in STEM.
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Affiliation(s)
- Erin A Cech
- Department of Sociology and Department of Mechanical Engineering (by courtesy), University of Michigan, Ann Arbor, MI 48109, USA
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Silveri G, Schimmenti S, Prina E, Gios L, Mirandola M, Converti M, Fiorillo A, Pinna F, Ventriglio A, Galeazzi GM, Sherriff N, Zeeman L, Amaddeo F, Paribello P, Pinna F, Giallanella D, Gaggiano C, Ventriglio A, Converti M, Fiorillo A, Galeazzi GM, Marchi M, Arcolin E, Fiore G, Mirandola M, Schimmenti S, Silveri G, Prina E, Amaddeo F, Bragazzi NL. Barriers in care pathways and unmet mental health needs in LGBTIQ + communities. Int Rev Psychiatry 2022; 34:215-229. [PMID: 36151825 DOI: 10.1080/09540261.2022.2075256] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Lesbian, gay, bisexual, transgender, intersex, queer people and minority gender identities and sexualities (LGBTIQ+) are often stigmatized and experience discrimination in health care settings, leading to poorer mental health outcomes and unmet needs compared to heterosexual and cisgendered peers. It is thus imperative that mental health providers consider and address structural challenges in order to reduce mental health inequalities of this population. This narrative review assessed the barriers that may prevent access to care and the pathways for care in LGBTIQ + communities. PubMed, PsycInfo, Embase, and Scopus were searched for papers published between December 2021 and February 2022. A total of 107 papers were included with studies reflecting five themes: (1) Unmet mental health needs; (2) Young people; (3) Substance abuse and addiction; (4) Barriers and pathways to care; and (5) Interventions. Findings demonstrate that LGBTIQ + people experience stigmatization and higher rates of substance misuse and mental ill health, which may lead to barriers in accessing health care services, and fewer tailored interventions being provided. These findings have implications for policy, health care screening, and how specialist services are structured. Substantial gaps in the evidence-base exist, and future research should examine how mental health care providers can challenge social issues that maintain discriminatory and stigmatizing practices, and support LGBTIQ + individuals to sustain their resilience.
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Affiliation(s)
- Giada Silveri
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Simone Schimmenti
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Eleonora Prina
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | | | - Massimo Mirandola
- Department of Diagnostics and Public Health, Infectious Diseases Section, University of Verona, Verona, Italy.,School of Sport and Health Sciences, University of Brighton, Brighton, UK
| | | | - Andrea Fiorillo
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Federica Pinna
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Antonio Ventriglio
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Gian Maria Galeazzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.,Department of integrated activity of Mental Health and Pathological Dependencies, USL-IRCSS company of Reggio Emilia, Reggio Emilia, Italy
| | - Nigel Sherriff
- School of Sport and Health Sciences, University of Brighton, Brighton, UK.,Centre for Transforming Sexuality and Gender, University of Brighton, Brighton, UK
| | - Laetitia Zeeman
- School of Sport and Health Sciences, University of Brighton, Brighton, UK.,Centre for Transforming Sexuality and Gender, University of Brighton, Brighton, UK
| | - Francesco Amaddeo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | | | - Pasquale Paribello
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Federica Pinna
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Daniela Giallanella
- Department of Clinical and Experimental, University di Foggia, Foggia, Italy
| | - Costanza Gaggiano
- Department of Clinical and Experimental, University di Foggia, Foggia, Italy
| | - Antonio Ventriglio
- Department of Clinical and Experimental, University di Foggia, Foggia, Italy
| | | | - Andrea Fiorillo
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Gian Maria Galeazzi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Mattia Marchi
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Elisa Arcolin
- Department of Mental Health and Drug Abuse, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Gianluca Fiore
- Department of Mental Health and Drug Abuse, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Massimo Mirandola
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Simone Schimmenti
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Giada Silveri
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Eleonora Prina
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Francesco Amaddeo
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Nicola Luigi Bragazzi
- Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, Ontario, Canada
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Broman N, Prever F, di Giacomo E, Jiménez-Murcia S, Szczegielniak A, Hansson H, Håkansson A. Gambling, Gaming, and Internet Behavior in a Sexual Minority Perspective. A Cross-Sectional Study in Seven European Countries. Front Psychol 2022; 12:707645. [PMID: 35498152 PMCID: PMC9045133 DOI: 10.3389/fpsyg.2021.707645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 11/23/2021] [Indexed: 12/02/2022] Open
Abstract
Background Addictive behavior of gambling, gaming and internet activity is partly a new research domain and has not been well investigated with regard to sexual minority populations. Although health disparities between sexual minorities and the general population are well documented, there is a lack of inclusion of sexual minorities in both research and clinic. Among lesbian, gay and bisexual populations certain features could be present that play a role for the development of addictive behaviors, such as social isolation and increased risk of other psychiatric problems. The aim of this study was to investigate problem gambling, problem gaming and problematic internet behavior in a European context and if it is affected by sexual orientation status. Methods An online web-survey was distributed among web-panels in England, Poland, Switzerland, Italy, Spain, Denmark, and Sweden in 2017-2018. Result 10 983 complete answers were collected. 7.1% of the participants had a sexual minority status (n = 774). Regression models found that there was no difference in gambling, gaming and internet behavior among heterosexual and sexual minority men. Sexual minority women were associated with problematic gambling and gaming behavior, when also controlling for age and nationality. When also controlling for psychological distress, women defining as having another sexual minority status than lesbian and bisexual remained significant for having a problematic gaming behavior (AOR = 2.3). Conclusion An awareness of female sexual minority perspectives is relevant in facilities treating behavioral addiction as well as in future research in behavioral addiction. More research is needed in problematic gambling and gaming behavior in different sexual minority populations with regard to psychiatric comorbidity and living conditions. An inclusion of sexual minority groups defining as other than gay and bisexual is needed in future research. No significant differences were found between heterosexual and sexual minority men in adjusted analysis in this study.
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Affiliation(s)
- Niroshani Broman
- Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden
- Gambling Disorder Unit, Malmö Addiction Center, Region Skåne, Malmö, Sweden
| | - Fulvia Prever
- National Health System (NHS), Addiction Department, Milan, Italy
- SUN(N)COOP Scientific Director “Women and Gambling Project,” Milan, Italy
| | - Ester di Giacomo
- Section of Forensic Psychiatry, King’s College London, Institute of Psychiatry, London, United Kingdom
- School of Medicine and Surgery, University of Milan Bicocca, Milan, Italy
- Psychiatric Department -Azienda Socio-Sanitaria Territoriale (ASST), Monza, Italy
| | - Susana Jiménez-Murcia
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain
- Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Madrid, Spain
- Department of Clinical Sciences, Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Anna Szczegielniak
- Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Helena Hansson
- Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden
| | - Anders Håkansson
- Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden
- Gambling Disorder Unit, Malmö Addiction Center, Region Skåne, Malmö, Sweden
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Clark KA, Björkenstam C, Kosidou K, Björkenstam E. Psychological Distress, Suicidal Ideation, and Suicide Attempt Among Lesbian, Gay, and Bisexual Immigrants: Population-Based Findings from the Stockholm Public Health Cohort. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:3563-3574. [PMID: 34725752 PMCID: PMC9308978 DOI: 10.1007/s10508-021-01997-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 03/25/2021] [Accepted: 03/27/2021] [Indexed: 06/13/2023]
Abstract
In a large, population-based sample in Sweden, we sought to examine mental health disparities between lesbian, gay and bisexual (LGB) and heterosexual individuals with different immigration statuses. We conducted a population-based study including 1799 LGB and 69,324 heterosexual individuals, recruited in 2010 and 2014 as part of the Stockholm Public Health Cohort. Data were obtained from self-administered surveys that were linked to nationwide registers. We examined associations between mental health outcomes (i.e., psychological distress, suicidal ideation, and suicide attempt) and sexual orientation (LGB versus heterosexual), immigration status (immigrant versus Nordic-born), and their interaction. Sex-stratified weighted multivariable logistic regression analyses were used to calculate adjusted odds ratios with 95% confidence intervals. LGB individuals demonstrated substantially elevated odds of all mental health outcomes compared to heterosexuals; immigrants reported moderately elevated odds of psychological distress and suicide attempt, but not suicidal ideation, compared to Nordic-born individuals. Interaction terms between sexual orientation and immigration status were significant at p < 0.05 for psychological distress for both sexes and for suicidal ideation and attempt among women. Unexpectedly, models probing interactions generally demonstrated that Nordic-born LGB individuals demonstrated greater risk of psychological distress, suicidal ideation, and suicide attempt than did immigrant LGB individuals, especially among women. Supplemental analyses showed that Nordic-born bisexual women demonstrated the highest risk of all studied outcomes. Being LGB in Sweden is generally a stronger risk factor for poor mental health among Nordic-born than immigrant populations. These findings call for future intersectionality-focused research to delineate the unique cultural, social, and psychological factors associated with mental health and resilience among LGB immigrants.
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Affiliation(s)
- Kirsty A Clark
- Department of Medicine, Health, and Society, Vanderbilt University, Nashville, TN, 37235, USA.
| | | | - Kyriaki Kosidou
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Center for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
| | - Emma Björkenstam
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Community Health Sciences, Fielding School of Public Health and California Center for Population Research, University of California Los Angeles, Los Angeles, CA, USA
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Fagrell Trygg N, Månsdotter A, Gustafsson PE. Intersectional inequalities in mental health across multiple dimensions of inequality in the Swedish adult population. Soc Sci Med 2021; 283:114184. [PMID: 34229136 DOI: 10.1016/j.socscimed.2021.114184] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 06/24/2021] [Accepted: 06/26/2021] [Indexed: 10/21/2022]
Abstract
Intersectionality has recently gained traction in health inequality research emphasizing multiple intersecting dimensions of inequality as opposed to the traditional unidimensional approaches. In this study inequalities in mental health were estimated across intersections of gender, income, education, occupation, country of birth, and sexual orientation. The outcomes and inequalities of intersectional strata were disentangled analogously to the possibilities described by intersectionality theory; as a result of either of the two inequality dimensions, as a result of the sum the dimensions, or as a unique outcome not equaling the sum. Furthermore the study examined the discriminatory accuracy of the six inequality dimensions as well as the intersectional space comprising 64 strata. The study population (N = 52,743) consists of a yearly random sample of the Swedish population 26-84 years between 2010 and 2015, from The Health on Equal Terms survey. Mental health was measured through a self-administered General Health Questionnaire (GHQ)-12, and sociodemographics through survey and linked register data. Intersectional inequalities in mental health were estimated for all pairwise combinations of inequality dimensions by joint inequalities, excess intersectional inequalities and referent inequalities. The findings of the study found that the sum of dimensions contributed to the overall (joint) inequality in mental health rather than a reinforced adverse effect of multiple disadvantages or the contribution by a single dimension. Nevertheless, the dimension of income was found to be the most important in terms of relative contribution. The discriminatory accuracy was low indicating that policy action targeting mental health should be universal rather than focusing on particular groups. The results highlight the unpredictable inequality patterns revealed by an intersectional approach, even for a single health outcome and within one country, and illustrate the need for empirical investigations into the actual population patterns in health that appear in the intersections of multiple disadvantages.
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Affiliation(s)
- Nadja Fagrell Trygg
- Department of Epidemiology and Global Health, Umeå University, 901 87, Umeå, Sweden.
| | - Anna Månsdotter
- Department of Epidemiology and Global Health, Umeå University, 901 87, Umeå, Sweden.
| | - Per E Gustafsson
- Department of Epidemiology and Global Health, Umeå University, 901 87, Umeå, Sweden.
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Masa R, Shangani S, Operario D. Socioeconomic Status and Psychosocial Resources Mediate Racial/Ethnic Differences in Psychological Health Among Gay and Bisexual Men: A Longitudinal Analysis Using Structural Equation Modeling. Am J Mens Health 2021; 15:15579883211001197. [PMID: 33724073 PMCID: PMC7970305 DOI: 10.1177/15579883211001197] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A large body of research demonstrates disparities in psychological health attributed to sexual minority identity, racial/ethnic minority identity, and socioeconomic status (SES). Fewer studies have explicated the role of these multiple attributes on psychological health and explored the role of SES and psychosocial resources in determining outcomes. We analyzed data from Project STRIDE, a longitudinal survey involving a diverse sample of gay and bisexual adult men (n = 198). Using structural equation modeling, we tested hypothesized direct and indirect effects of race/ethnicity, SES, and three psychosocial mediational variables (collective self-efficacy, everyday discrimination, internalized homophobia) on two outcome variables-psychological and social well-being-assessed at 1-year follow-up. Our model indicated that: (1) race/ethnicity and SES were significantly associated with each other and with each psychosocial mediator; (2) higher SES was directly and indirectly associated with both measures of well-being; and (3) collective self-esteem and everyday discrimination mediated the association between SES and both measures of well-being. The model also indicated that racial/ethnic associations with psychological mediators and outcomes are evident in the context of SES, but these effects might be suppressed when the model does not consider SES. Findings highlight the critical role of SES and race/ethnicity in determining the psychological and social well-being of sexual minority men. Specification of mediating variables-collective self-efficacy, everyday discrimination, internalized homophobia-indicates potential intervention targets to improve psychological and social health in sexual minority men. Associations between race/ethnicity and SES support the need for intersectional frameworks in addressing the health of sexual minority men.
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Affiliation(s)
- Rainier Masa
- School of Social Work, University of North Carolina, Chapel Hill, NC, USA
| | - Sylvia Shangani
- School of Community and Environmental Health, Old Dominion University, Norfolk, VA, USA
| | - Don Operario
- School of Public Health, Brown University, Providence, RI, USA
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12
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Amroussia N, Pearson JL, Gustafsson PE. What drives us apart? Decomposing intersectional inequalities in cigarette smoking by education and sexual orientation among U.S. adults. Int J Equity Health 2019; 18:109. [PMID: 31315627 PMCID: PMC6637561 DOI: 10.1186/s12939-019-1015-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 07/07/2019] [Indexed: 11/12/2022] Open
Abstract
Background Socio-economic and sexual orientation inequalities in cigarette smoking are well-documented; however, there is a lack of research examining the social processes driving these complex inequalities. Using an intersectional framework, the current study examines key processes contributing to inequalities in smoking between four intersectional groups by education and sexual orientation. Methods The sample (28,362 adults) was obtained from Wave 2 (2014–2015) of the Population Assessment of Tobacco and Health (PATH) Study. Four intersectional positions were created by education (high- and low-education) and sexual orientation (heterosexual or lesbian, gay, bisexual, or queer/questioning (LGBQ). The joint inequality, the referent socio-economic inequality, and the referent sexual orientation inequality in smoking were decomposed by demographic, material, tobacco marketing-related, and psychosocial factors using non-linear Oaxaca decomposition. Results Material conditions made the largest contribution to the joint inequality (9.8 percentage points (p.p.), 140.9%), referent socio-economic inequality (10.01 p.p., 128.4%), and referent sexual orientation inequality (4.91 p.p., 59.8%), driven by annual household income. Psychosocial factors made the second largest contributions to the joint inequality (2.12 p.p., 30.3%), referent socio-economic inequality (2.23 p.p., 28.9%), and referent sexual orientation inequality (1.68 p.p., 20.5%). Referent sexual orientation inequality was also explained by marital status (20.3%) and targeted tobacco marketing (11.3%). Conclusion The study highlights the pervasive role of material conditions in inequalities in cigarette smoking across multiple dimensions of advantage and disadvantage. This points to the importance of addressing material disadvantage to reduce combined socioeconomic and sexual orientation inequalities in cigarette smoking.
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Affiliation(s)
- Nada Amroussia
- Division of Social and Behavioral Health, University of Nevada, Reno, USA.
| | - Jennifer L Pearson
- Division of Social and Behavioral Health/Health Administration and Policy, University of Nevada, Reno, USA.,Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Per E Gustafsson
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Nystedt T, Rosvall M, Lindström M. Sexual orientation, suicide ideation and suicide attempt: A population-based study. Psychiatry Res 2019; 275:359-365. [PMID: 30959384 DOI: 10.1016/j.psychres.2019.04.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 04/03/2019] [Accepted: 04/03/2019] [Indexed: 01/12/2023]
Abstract
The aim is to investigate associations between sexual orientation and experience of suicide thoughts and suicide attempts. The 2012 public health survey in Scania, southern Sweden, is a cross-sectional population-based study including 28,029 participants aged 18-80 with 51.7% participation. The associations between sexual orientation and experience of suicide thoughts and attempts were investigated in multiple logistic regressions. A 8.2% proportion of men and 11.3% of women reported suicide thoughts more than a year ago, and 4.0% of men 4.1% of women had experienced such thoughts during the past year. A 2.6% proportion of men and 4.6% of women reported suicide attempt more than a year ago, and 0.6% of men and 0.7% of women during the past year. In the age- and multiple adjusted models, bisexual and homosexual men and bisexual women had significantly higher odds ratios of suicide thoughts than heterosexual men and women. Bisexual and homosexual men and bisexual women had significantly higher odds ratios of suicide attempt than heterosexual men and women. After multiple adjustments these patterns largely remained. The results indicate that bisexual men and women and homosexual men have an increased risk of experience of suicide thoughts and suicide attempt.
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Affiliation(s)
- Tanya Nystedt
- Social Medicine and Health Policy, Department of Clinical Sciences in Malmö, Lund University, S-205 02 Malmö, Sweden
| | - Maria Rosvall
- Social Medicine and Health Policy, Department of Clinical Sciences in Malmö, Lund University, S-205 02 Malmö, Sweden; Department of Community Medicine and Public Health, Institute of Medicine, University of Gothenburg, Sweden; Primary Health Care, Västra Götaland, Sweden
| | - Martin Lindström
- Social Medicine and Health Policy, Department of Clinical Sciences in Malmö, Lund University, S-205 02 Malmö, Sweden; Center for Primary Health Care Research, Skåne, Malmö, Sweden.
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Boldis BV, San Sebastián M, Gustafsson PE. Unsafe and unequal: a decomposition analysis of income inequalities in fear of crime in northern Sweden. Int J Equity Health 2018; 17:110. [PMID: 30068322 PMCID: PMC6090991 DOI: 10.1186/s12939-018-0823-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Accepted: 07/13/2018] [Indexed: 11/30/2022] Open
Abstract
Background Fear of crime is not solely an individual concern, but as a social determinant of health structured by gender it also poses a threat to public health. Social inequalities are thought to represent a breeding ground for fear of crime, which subsequently may contribute to social inequalities in health. However, little research has focused on social inequalities in fear of crime, particularly in Sweden where the level of fear of crime and income and gender inequalities are comparatively low. With a conceptual model as a point of departure, the present study aimed to estimate and decompose income-related inequalities and explore gender differences in fear of crime in northern Sweden. Methods Participants (N = 22,140; 10,220 men and 11,920 women aged 16 to 84 years) came from the Health on Equal Terms cross-sectional survey with linked register data, carried out in the four northernmost counties of Sweden in 2014. Disposable income was used as the socio-economic indicator, fear of crime as the binary outcome variable, and sociodemographic characteristics, residential context, socio-economic and material conditions and psychosocial conditions as explanatory factors. Concentration curve and concentration index were used to estimate the income inequality in fear of crime, and decomposition analysis to identify the key determinants of the inequalities, in collapsed and gender-stratified analyses. Results Substantial gender differences were found in the prevalence of fear of crime (20.8% in women and 3.5% and men) and among the contributing factors to fear of crime. Additionally, the analyses revealed considerable income inequalities in fear of crime in the northern Swedish context (C = − 0.219). Gender, socio-economic and material, and psychosocial conditions explained the most in income inequalities of fear of crime in the total population. Conclusions The existing gender and socio-economic inequities need to be approached as a greater structural problem to mitigate inequalities in fear of crime. Further research is needed to reveal more aspects of income inequalities in fear of crime and to develop efforts to create safe environments for all.
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Affiliation(s)
- Beáta Vivien Boldis
- Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, 901 87, Umeå, Sweden.
| | - Miguel San Sebastián
- Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, 901 87, Umeå, Sweden
| | - Per E Gustafsson
- Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, 901 87, Umeå, Sweden
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