Mental health and substance use among bisexual youth and non-youth in Ontario, Canada

Accidental substance-related acute toxicity deaths among youth in Canada: a descriptive analysis of a national chart review study of coroner and medical examiner data

INTRODUCTION

Substance-related acute toxicity deaths (ATDs) are a public health crisis in Canada. Youth are often at higher risk for substance use due to social, environmental and structural factors. The objectives of this study were to understand the characteristics of youth (aged 12-24 years) dying of accidental acute toxicity in Canada and examine the substances contributing to and circumstances surrounding youth ATDs.

METHODS

Data from a national chart review study of coroner and medical examiner data on ATDs that occurred in Canada between 2016 and 2017 were used to conduct descriptive analyses with proportions, mortality rates and proportionate mortality rates. Where possible, youth in the chart review study were compared with youth in the general population and youth who died of all causes, using census data.

RESULTS

Of the 732 youth who died of accidental acute toxicity in 2016-2017, most (94%) were aged 18 to 24 years. Youth aged 20 to 24 who were unemployed, unhoused or living in collective housing were overrepresented among accidental ATDs. Many of the youth aged 12 to 24 who died of accidental acute toxicity had a documented history of substance use. Fentanyl, cocaine and methamphetamine were the most common substances contributing to death, and 38% of the deaths were witnessed or potentially witnessed.

CONCLUSION

The findings of this study point to the need for early prevention and harm reduction strategies and programs that address mental health, exposure to trauma, unemployment and housing instability to reduce the harms of substance use on Canadian youth.

Sexual Identity Fluidity and Depressive Symptoms: Findings From a National Longitudinal Study of Sexual Minority Adolescents

PURPOSE

Sexual minority adolescents (SMAs) consistently report elevated risk of mental health symptoms, including depression. Sexual identities may change over time (referred as sexual identity fluidity), particularly during adolescence. This study examined the effect of sexual identity fluidity on depressive symptoms over time.

METHODS

National longitudinal data were analyzed from SMAs aged 14-17 years (N = 1,077) in the adolescent stress experiences over time study during an 18-month period. Multigroup time-varying covariate latent growth models were employed to examine the effect of sexual identity fluidity on depressive symptoms.

RESULTS

In the sample, 40% of SMAs reported at least 1 change in sexual identity during an 18-month period. Cisgender females reported sexual identity fluidity at a higher rate than their male counterparts (46.9% vs. 26.6%, respectively). In our first model (total sample), a change in sexual identity was associated with reporting fewer depressive symptoms (b = -0.591, p = .004). In our multigroup model (by sex assigned at birth), a change in sexual identity was significantly associated with reporting fewer depressive symptoms among cisgender females (b = -0.591, p < .01). However, there was no significant effect found among cisgender males. The models controlled for age and race or ethnicity.

DISCUSSION

The results add to the limited knowledge on the complex relationship between sexual identity fluidity and mental health risks over time among adolescents. Our results indicate that sexual identity development and change processes differ between cisgender females and males. The nuances associated with these sexual identity processes need further investigation.

Risk and Protective Factors for Intimate Partner Violence Against Bisexual Victims: A Systematic Scoping Review

Bisexual-identifying individuals appear to be at increased risk of experiencing intimate partner violence (IPV) compared to people of other sexualities. The purpose of this systematic scoping review was to examine risk and protective factors for the perpetration of IPV against bisexual victims and to provide a preliminary quality assessment of the included studies. A systematic search of academic and grey literature was conducted in February 2021. Inclusion criteria specified that study participants identified as bisexual, that the study examined risk or protective factors for IPV, and that findings were disaggregated by sexual identity. All potentially eligible references were independently screened by two reviewers, and conflicts settled by a third reviewer. Nine articles published between 2013 and 2021 met criteria for inclusion. Data extraction was completed for all included studies, and findings presented in a narrative synthesis. The review identified a number of risk factors, including bisexual identity, internalised homophobia, discrimination, partner gender, negative childhood experiences and non-monogamy. One study included consideration of a potentially protective factor. The majority of the included studies were cross-sectional in design. More longitudinal studies are needed to clarify temporality of the associations identified and better inform support and prevention efforts. Further implications for future research, policies and practise are discussed.

A Quantitative Intersectional Exploration of Sexual Violence and Mental Health among Bi + People: Looking within and across Race and Gender

Young bisexual people report disparities related to mental health and sexual violence compared to their heterosexual and gay/lesbian peers. However, the majority of research in these areas does not employ an intersectional design, despite evidence that health outcomes vary by race and gender within bi + populations. The goal of this paper is to provide an intersectionally-informed exploration of the prevalence of sexual violence among a diverse sample of 112 bi + people age 18-26, as well as descriptive data on stigma, mental health, and social support. Most (82%) of participants reported at least once experience of sexual violence since the age of 16. Sexual violence was positively associated with sexual stigma, anxiety, depression, and suicidality. Nonbinary participants reported greater prevalence of violence, exposure to stigma, and worse mental health outcomes relative to cisgender participants. Nonbinary BIPOC participants reported higher levels of anxiety and depression than cisgender BIPOC participants.

Sexual Violence and Mental Health among Young Bi+ and Lesbian Women and Gender Minoritized People

Introduction

Sexual minoritized people report worse mental health and are at risk of sexual violence compared to their heterosexual peers.

Method

We conducted a survey to explore sexual stigma, sexual violence, and mental health among 326 bi+ and lesbian women and gender minoritized people age 18-25.

Results

Mental health did not differ by sexual identity; sexual stigma and violence were associated with negative mental health symptoms, as were identifying as BIPOC, as trans or nonbinary, or having less formal education.

Conclusion

Sexual stigma and violence are related to mental health among young bi+ and lesbian women and gender minoritized people.

Polysubstance use poisoning deaths in Canada: an analysis of trends from 2014 to 2017 using mortality data

Background

Over the past decade, rates of drug poisoning deaths have increased dramatically in Canada. Current evidence suggests that the non-medical use of synthetic opioids, stimulants and patterns of polysubstance use are major factors contributing to this increase.

Methods

Counts of substance poisoning deaths involving alcohol, opioids, other central nervous system (CNS) depressants, cocaine, and CNS stimulants excluding cocaine, were acquired from the Canadian Vital Statistics Death Database (CVSD) for the years 2014 to 2017. We used joinpoint regression analysis and the Cochrane-Armitage trend test for proportions to examine changes over time in crude mortality rates and proportions of poisoning deaths involving more than one substance.

Results

Between 2014 and 2017, the rate of substance poisoning deaths in Canada almost doubled from 6.4 to 11.5 deaths per 100,000 population (Average Annual Percent Change, AAPC: 23%, p < 0.05). Our analysis shows this was due to increased unintentional poisoning deaths (AAPC: 26.6%, p < 0.05) and polysubstance deaths (AAPC: 23.0%, p < 0.05). The proportion of unintentional poisoning deaths involving polysubstance use increased significantly from 38% to 58% among males (p < 0.0001) and 40% to 55% among females (p < 0.0001). Polysubstance use poisonings involving opioids and CNS stimulants (excluding cocaine) increased substantially during the study period (males AAPC: 133.1%, p < 0.01; females AAPC: 118.1%, p < 0.05).

Conclusions

Increases in substance-related poisoning deaths between 2014 and 2017 were associated with polysubstance use. Increased co-use of stimulants with opioids is a key factor contributing to the epidemic of opioid deaths in Canada.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-12678-z.

Relationship between sociodemographics, healthcare providers' competence and healthcare access among two-spirit, gay, bisexual, queer and other men who have sex with men in Manitoba: results from a community-based cross-sectional study

OBJECTIVE

Little is known about barriers to healthcare access for two-spirit, gay, bisexual and queer (2SGBQ+) men in Manitoba.

DESIGN

Data were drawn from a community-based, cross-sectional survey designed to examine health and healthcare access among 2SGBQ+ men.

SETTING

Community-based cross-sectional study in Manitoba, Canada.

PARTICIPANTS

Community-based sample of 368 2SGBQ+ men.

OUTCOMES

Logistic regression analyses assessed the relationship between sociodemographics, healthcare discrimination, perceived healthcare providers' 2SGBQ+ competence/knowledge and two indicators of healthcare access (analytic outcome variables): (1) having a regular healthcare provider and (2) having had a healthcare visit in the past 12 months.

RESULTS

In multivariate analyses, living in Brandon (adjusted OR (AOR)=0.08, 95% CI 0.03 to 0.22), small cities (AOR=0.20, 95% CI 0.04 to 0.98) and smaller towns (AOR=0.26, 95% CI 0.08 o 0.81) in Manitoba (compared with living in Winnipeg), as well as having a healthcare provider with poor (AOR=0.19, 95% CI 0.04 to 0.90) or very poor competence/knowledge (AOR=0.03, 95% CI 0.03 to 0.25) of 2SGBQ+ men's issues (compared with very good competence) was associated with lower odds of having a regular healthcare provider. Living in Brandon (AOR=0.05, 95% CI 0.02 to 0.17) and smaller towns (AOR=0.25, 95% CI 0.67 to 0.90) in Manitoba (compared with living in Winnipeg) was associated with lower odds of having a healthcare visit in the past 12 months, while identifying as a gay man compared with bisexual (AOR=12.57, 95% CI 1.88 to 83.97) was associated with higher odds of having a healthcare visit in the past 12 months.

CONCLUSIONS

These findings underscore the importance of reducing the gap between the healthcare access of rural and urban 2SGBQ+ men, improving healthcare providers' cultural competence and addressing their lack of knowledge of 2SGBQ+ men's issues.

Negative Social Experiences Mediate the Relationship between Sexual Orientation and Mental Health

The lesbian-gay-bisexual (LGB) population experiences a higher rate of psychopathology than the non-LGB population. Minority stress theory (MST) suggests that this pattern of findings is due to the increased negativity that LGB individuals face; however, MST is often employed as a post-hoc explanation for health inequalities as opposed to an a priori approach that explicitly tests this idea and has not been examined in the context of Canadian sexual minorities. Using the 2012 Canadian Community Health Survey-Mental Health (CCHS-MH), we tested the MST on a sample 22,495 Canadians (n = 21,995 non-LGB; n = 500 LGB). Results indicated that respondents' scores on the Negative Social Interactions scale (NSI) partially mediated the relationship between LGB status and both depression and satisfaction with life. The findings suggest that a substantial component of the relationship between sexual orientation and mental health is influenced by deleterious social exchanges.

Internalized Binegativity, LGBQ+ Community Involvement, and Definitions of Bisexuality

Bisexual people can internalize stigma from both heterosexual and gay/lesbian communities, which often occurs in the form of monosexism, the belief that people should only be attracted to one gender. Although community involvement is protective for lesbian, gay, bisexual, and queer+ (LGBQ+) people, bisexual people may benefit more from bisexual-specific communities than LGBQ+ communities because of monosexism. Further, how bisexual people define their identity may be related to internalized binegativity, especially given the historical invisibility of bisexuality in mainstream media and recent debates about the definition of bisexuality within LGBQ+ communities. We examined LGBQ+ and bisexual-specific community involvement, definitions of bisexuality, and internalized binegativity among an online sample of 816 bisexual adults. Multivariate regression analyses showed that those with spectrum definitions, which acknowledged the nuanced understanding of sex, gender, and sexuality, reported lower internalized binegativity than those with binary definitions, which described sexuality as consistent with mainstream norms. Involvement in LGBQ+ communities, but not bisexual communities, was associated with lower internalized binegativity. There was no interaction between the type of definition and type of community involvement. Our results suggest that broad community involvement may be protective for internalized binegativity, but findings should be considered in light of a lack of well-funded, local bisexual communities. The current study adds to a growing literature on sexual minority stressors among bisexual people, a population that continues to be understudied.

Syndemic Profiles and Sexual Minority Men's HIV-Risk Behavior: A Latent Class Analysis

Syndemic theory posits that "syndemic conditions" (e.g., alcohol misuse, polydrug use, suicidality) co-occur among sexual minority men and influence HIV-risk behavior, namely HIV acquisition and transmission risk. To examine how four syndemic conditions cluster among sexual minority men and contribute to HIV-risk behavior, we conducted latent class analysis (LCA) to: (1) classify sexual minority men (n = 937) into subgroups based on their probability of experiencing each syndemic condition; (2) examine the demographic (e.g., race/ethnicity) and social status (e.g., level of socioeconomic distress) characteristics of the most optimally fitting four syndemic classes; (3) examine between-group differences in HIV-risk behavior across classes; and (4) use syndemic class membership to predict HIV-risk behavior with sexual minority men reporting no syndemic conditions as the reference group. The four classes were: (1) no syndemic, (2) alcohol misuse and polydrug use syndemic, (3) polydrug use and HIV syndemic, and (4) alcohol misuse. HIV-risk behavior differed across these latent classes. Demographic and social status characteristics predicted class membership, suggesting that syndemic conditions disproportionately co-occur in vulnerable subpopulations of sexual minority men, such as those experiencing high socioeconomic distress. When predicting HIV-risk behavior, men in the polydrug use and HIV syndemic class were more likely (Adjusted Risk Ratio [ARR] = 2.93, 95% CI: 1.05, 8.21) and men in the alcohol misuse class were less likely (ARR = 0.17, 95% CI: 0.07, 0.44) to report HIV-risk behavior than were men in the no syndemic class. LCA represents a promising methodology to inform the development and delivery of tailored interventions targeting distinct combinations of syndemic conditions to reduce sexual minority men's HIV-risk behavior.

LGBTQ+ Aging Research in Canada: A 30-Year Scoping Review of the Literature

Canada has a unique socio-political history concerning the inclusion of lesbian, gay, bisexual, transgender, and queer (LGBTQ+) people. With aging populations, understanding diverse groups of older adults is paramount. We completed a systematic search and scoping review of research in Canada to quantify and articulate the scale and scope of research on LGBTQ+ aging. Our search identified over 4000 results and, after screening for relevance, our review focused on 70 articles. Five major themes in the literature on LGBTQ+ aging in Canada were identified: (1) risk, (2) HIV, (3) stigma, and discrimination as barriers to care, (4) navigating care and identity, (5) documenting the history and changing policy landscapes. Most of the articles were not focused on the aging, yet the findings are relevant when considering the lived experiences of current older adults within LGBTQ+ communities. Advancing the evidence on LGBTQ+ aging involves improving the quality of life and aging experiences for LGBTQ+ older adults through research.

Young people's perceptions of substance use norms and attitudes in the LGBT community

OBJECTIVES

Sexual minority young people (SMYP) show higher levels of substance use than their heterosexual counterparts. This study aims to test potential LGBT community-specific reasons assumed to affect substance use and their relationships to LGBT community participation/connectedness and substance use behaviour.

METHODS

Eight LGBT community-specific reasons for substance use were tested in an online survey with 1,556 SMYP.

RESULTS

Respondents agreed that the LGBT community had liberal attitudes towards substance use (80.5%, n=1,079) and that the media portrayed substance use as a part of the community culture (66.5%, n=904). Participants disagreed that excessive partying is a part of the community (34.7%, n=470). Significant but weak correlations between reasons and community participation/connectedness or personal substance use behaviour were found. Subgroup analyses indicated male and gay/lesbian participants showed differential agreement levels to some of the reasons.

CONCLUSION

Young people's perceptions of substance use within the LGBT community are not associated with community participation/connectedness or personal substance use. Implications for public health: Further research is needed to better understand what factors lead to elevated levels of substance use in SMYP. This may assist in the development of adequate public health responses. Targeting problematic beliefs may have little impact on substance use in SMYP.

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

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

Violence and substance use in sexual minorities: Data from the Second Brazilian National Alcohol and Drugs Survey (II BNADS)

OBJECTIVE

To describe the prevalence of substance use and the associations between adverse early life experiences, sexual behaviour and violence in sexual minority (SM) individuals.

METHODS

The Brazilian National Alcohol and Drugs Survey is a probabilistic household survey performed in 2012, collecting data from 4067 Brazilians aged 14 years and older.

RESULTS

3.4% of the sample declared themselves as sexual minorities, 53.8% female, 66.5% single, mean age of 29.5 years (standard deviation 16.0 years). A high prevalence of alcohol dependence (15.2%) and binge drinking (22.2%) was identified in the SM group. Respondents were more likely to use crack cocaine and hallucinogens, to have been involved in child prostitution, child sexual abuse and to report suicidal ideation in the previous year. Respondents were also more likely to engage in unprotected sex compared to non-sexual minorities. Nearly one-third referred to having suffered homophobic discrimination in their lives. Respondents also reported higher rates of domestic violence (18.9%) and urban violence (18%) among the SM.

CONCLUSION

The findings reinforce that violence directed at individuals in the Brazilian SM community begins early in life and persists into adulthood when compared to non-sexual minorities. This population is also more exposed to substance use disorders.

Using Social Networks to Understand and Overcome Implementation Barriers in the Global HIV Response

BACKGROUND

Despite the development of several efficacious HIV prevention and treatment methods in the past 2 decades, HIV continues to spread globally. Uptake of interventions is nonrandomly distributed across populations. Such inequality is socially patterned and reinforced by homophily arising from both social selection (becoming friends with similar people) and influence (becoming similar to friends).

METHODS

We conducted a narrative review to describe how social network analysis methods-including egocentric, sociocentric, and respondent-driven sampling designs-provide tools to measure key populations, to understand how epidemics spread, and to evaluate intervention take-up.

RESULTS

Social network analysis-informed designs can improve intervention effectiveness by reaching otherwise inaccessible populations. They can also improve intervention efficiency by maximizing spillovers, through social ties, to at-risk but susceptible individuals. Social network analysis-informed designs thus have the potential to be both more effective and less unequal in their effects, compared with social network analysis-naïve approaches. Although social network analysis-informed designs are often resource-intensive, we believe they provide unique insights that can help reach those most in need of HIV prevention and treatment interventions.

CONCLUSION

Increased collection of social network data during both research and implementation work would provide important information to improve the roll-out of existing studies in the present and to inform the design of more data-efficient, social network analysis-informed interventions in the future. Doing so will improve the reach of interventions, especially to key populations, and to maximize intervention impact once delivered.

Bisexual Women's Experience of Microaggressions and Microaffirmations: A Community-Based, Mixed-Methods Scale Development Project

In order to better serve bisexual women, clinicians and researchers need tools that accurately reflect and capture bisexual women's experiences of stigma and affirmation. These tools are essential as research indicates that bisexual women experience poorer mental health than either heterosexual or lesbian women. Our community-based study developed and psychometrically evaluated the Bisexual Microaggression and Microaffirmation Scales for Women (BMMS-W). We held focus groups and advisory committee meetings with bisexual women to identify common experiences of microaggressions and microaffirmations and drafted over 200 potential survey items. Exploratory factor analysis of data from 382 participants across Canada and the U.S. yielded five microaggression factors (dismissal; mistrust; sexualization; social exclusion; and denial of complexity) and four microaffirmation factors (acceptance; social support; recognition of bisexuality and biphobia; and emotional support). Confirmatory factor analysis of data from a separate sample of 323 participants across Canada and the U.S. tested the model. The development of the BMMS-W responds to calls to examine the distinctiveness of bisexual women's experience and gives mental health service providers and researchers a tool to better understand their experiences.

Substance Use Patterns of Gay and Bisexual Men in the Momentum Health Study

Research with male sexual minorities frequently combines gay and bisexual men as Men Who Have Sex with Men or Gay and Bisexual Men. When analyzed separately, bisexual men consistently feature negative health differentials, exemplified by higher substance use levels. This interpretation is not clear-cut because studies may combine bisexual men and women, use different dimensions of sexual orientation to define bisexuality, and/or not consider number of sexual partners as a possible confounding factor. This study conducted separate bivariate and multivariate analyses comparing gay to bisexual Momentum Study participants based on self-identity, sexual attraction, and sexual behavior, while controlling for number of sexual partners and sociodemographic, psychosocial, and sexual behavior measures. The study hypothesized that, regardless of definition, bisexual men feature higher substance use levels compared to gay men. Bivariate analyses revealed significantly higher ( p < .05) use among bisexual men for multiple substances in all samples. Nonprescription stimulants and heroin were significant in all multivariate logistic regression models. In contrast, all bisexual samples reported lower use of erectile dysfunction drugs and poppers, substances associated with anal sex among gay men. Subsequent analysis linked these results to lower levels of anal sex in all bisexual samples. Bivariate analyses also revealed that bisexual men featured significantly lower educational levels, annual incomes, and Social Support Scales scores and higher Anxiety and Depression Sub-Scale Scores. In summary, findings revealed bisexual men's distinctive substance use, sexual behavior, psychosocial, and sociodemographic profiles, and are important for tailoring specific health programs for bisexual men.

Prevalence of Depression and Anxiety Among Bisexual People Compared to Gay, Lesbian, and Heterosexual Individuals:A Systematic Review and Meta-Analysis

Over the past decade, evidence has accumulated to suggest that bisexual people experience higher rates of poor mental health outcomes compared to both heterosexual and gay/lesbian individuals. However, no previous meta-analyses have been conducted to establish the magnitude of these disparities. To address this research gap, we conducted a systematic review and meta-analysis of studies that reported bisexual-specific data on standardized measures of depression or anxiety. Of the 1,074 full-text articles reviewed, 1,023 were ineligible, predominantly because they did not report separate data for bisexual people (n = 562 studies). Ultimately, 52 eligible studies could be pooled in the analysis. Results indicate that across both outcomes, there is a consistent pattern of lowest rates of depression and anxiety among heterosexual people, while bisexual people exhibit higher or equivalent rates in comparison to lesbian/gay people. On the basis of empirical and theoretical literature, we propose three interrelated contributors to these disparities: experiences of sexual orientation-based discrimination, bisexual invisibility/erasure, and lack of bisexual-affirmative support. Implications for interventions to improve the health and well-being of bisexual people are proposed.

The long-term mental health risk associated with non-heterosexual orientation

AIMS

Findings that describe the mental health risk associated with non-heterosexual orientation in young and middle-aged adults are from cross-sectional designs or fail to discriminate homosexual and bisexual orientations. This study examines the mental health risk of homosexual and bisexual orientation over an 8-year period.

METHODS

Participants were from the age-cohort study, the Personality and Total Health Through Life Project, were observed twice every 4 years, and aged 20-24 (n = 2353) and 40-44 (n = 2499) at baseline.

RESULTS

Homosexual orientation was unrelated to long-term depression risk. Risk for anxiety and depression associated with homosexual and bisexual orientations, respectively, were attenuated in fully-adjusted models. Bisexual orientation risk associated with anxiety was partially attenuated in fully-adjusted models.

CONCLUSIONS

Non-heterosexual orientation was not a major risk factor for long-term mental health outcomes. Instead, those with a non-heterosexual orientation were more likely to experience other mental health risk factors, which explain most of the risk observed amongst those with a non-heterosexual orientation.

Results of a Pilot Study to Ameliorate Psychological and Behavioral Outcomes of Minority Stress Among Young Gay and Bisexual Men

Project PRIDE (Promoting Resilience In Discriminatory Environments) is an 8-session small group intervention aimed at reducing negative mental and behavioral health outcomes resulting from minority stress. This study reports the results of a one-armed pilot test of Project PRIDE, which aimed to examine the feasibility and potential for efficacy of the intervention in a sample of 33 gay and bisexual men aged 18 to 25. The intervention appeared feasible to administer in two different sites and all participants who completed posttreatment (n = 22) or follow-up (n = 19) assessments reported high satisfaction with the intervention. Small to large effect sizes were observed for increases in self-esteem; small effect sizes were found for decreases in loneliness and decreases in minority stress variables; and small and medium effect sizes were found for reductions in alcohol use and number of sex partners, respectively. Overall, Project PRIDE appears to be a feasible intervention with promise of efficacy.

Reproductive coercion, sexual risk behaviours and mental health symptoms among young low-income behaviourally bisexual women: implications for nursing practice

AIMS AND OBJECTIVES

To describe prevalence of reproductive coercion, sexual risk behaviours and mental health symptoms among women reporting lifetime sexual experiences with men and women compared to peers reporting sex exclusively with men.

BACKGROUND

Reproductive coercion, a global public health problem, is understudied among sexual minority women. Violence against women remains high among women who have sex with women and men. Rates of sexual and physical violence among this population are higher than women reporting exclusive sexual partnerships with either men or women. Nurses and other healthcare providers often do not conduct comprehensive sexual histories; assumptions related to a sex partner's gender may provide indications of broader health implications.

DESIGN

Cross-sectional survey of low-income Black women ages 18-25 recruited from six community-based sites for a parent study focused on intimate partner violence and health.

METHODS

We analysed survey data from participants who reported lifetime sexual experiences with men and women (N = 42) and compared their outcomes to those of women reporting sexual experiences with men only (N = 107).

RESULTS

A greater proportion of women who have sex with women and men reported experiencing reproductive coercion. Women who have sex with women and men also reported a greater number of lifetime intimate partner physical and sexual violence experiences, traded sex for resources, and had post-traumatic stress disorder symptoms.

CONCLUSIONS

Findings provide vital information that can inform nursing clinical practice, specifically related to history-taking, screening protocols and counselling strategies for intimate partner violence and mental health among women who have sex with women and men.

RELEVANCE TO CLINICAL PRACTICE

Strategies for addressing reproductive coercion and intimate partner violence as well as the health consequences among women who have sex with women and men in clinical and community-based settings should include a longitudinal understanding of sexual behaviour and gender of sex partners.

Positive Identity Experiences of Young Bisexual and Other Nonmonosexual People: A Qualitative Inquiry

The majority of LGBTQ psychological research focuses on dysfunction. The exclusion of strengths-based perspectives in LGBTQ psychology limits the understanding of LGBTQ mental health. In this article we report experiences that young bisexual and other nonmonosexual people perceive as affirming of their sexual identity. A 28-day, daily diary study was used to investigate whether bisexual-identified participants encountered positive experiences related to their sexual identity, and which type of experiences they perceived to be positive. Using a constructivist grounded theory approach, participants' experiences were organized according to a social ecological model. Experiences were reported at the intrapersonal, interpersonal, and institutional levels, but most positive sexual identity experiences occurred at the interpersonal level. Implications for positive health outcome research and the integration of positive psychology with LGBTQ psychology are discussed, as well as study limitations.

Life stress as a mediator and community belonging as a moderator of mood and anxiety disorders and co-occurring disorders with heavy drinking of gay, lesbian, bisexual, and heterosexual Canadians

PURPOSE

To examine the extent to which sexual identity disparities in mental health outcomes (anxiety disorder, mood disorder, anxiety-mood disorder, and co-occurring anxiety or mood disorder and heavy drinking) are mediated by life stress or moderated by a sense of community belonging.

METHODS

This study pooled data from a large, national, multi-year sample of Canadians aged 18-59 years, who self-identified as lesbian, gay, bisexual, or heterosexual (N = 222,548). A series of stratified binary mediation models were fitted. Significance of the indirect effect was determined by using bootstrapping to obtain standard errors and confidence intervals.

RESULTS

Sexual minority (versus heterosexual) respondents were significantly more likely to describe their lives as stressful, their sense of community belonging as weak, and had significantly greater odds of the negative mental health outcomes. Perceived life stress partially mediated the effects of sexual identity on the mental health outcomes. The differences between the mediated effects for the gay/lesbian and bisexual subgroups were statistically significant (all p < 0.05). When stratified by sense of community belonging, life stress mediated the relationship with mood disorders for the gay/lesbian group, where a strong sense of community belonging was associated with greater odds of mood disorders for gay/lesbian versus heterosexual respondents.

CONCLUSIONS

These mediation and moderated mediation models provide further evidence for a social patterning of the mental health disparities experienced by sexual minorities in Canada.

Addressing gaps on risk and resilience factors for alcohol use outcomes in sexual and gender minority populations

ISSUES

In 2011, the Institute of Medicine released a report that constituted the first comprehensive effort by a federal body to understand the current state of science pertinent to the health needs of sexual and gender minority populations. This mini-review summarises recent empirical, methodological and theoretical advances in alcohol-related research among to lesbian, gay, bisexual and transgender (LGBT) populations and highlights progress towards addressing gaps, with a particular interest in those identified by the Institute of Medicine report.

APPROACH

Articles published since 2011 were identified from PsycINFO and PubMed database searches, using various combinations of keyword identifiers (alcohol, alcohol abuse, substance abuse, LGBT, lesbian, gay, bisexual, transgender). Reference sections of included articles were also examined for additional citations.

KEY FINDINGS

Recent empirical work has contributed to a greater understanding of sub-group differences within this diverse population. Evidence has supported theorised influences that can account for alcohol-related disparities, yet important gaps remain. Studies that examine the role of gender identity and its intersection with sexual identity within transgender and gender non-conforming sub-populations are lacking. Methodological advances in this literature have begun to allow for examinations of how minority-specific and general risk factors of alcohol misuse may contribute to patterns of alcohol involvement over time and within social-relational contexts

CONCLUSIONS

The recommendations made in the current mini-review are meant to facilitate future collaborative efforts, scale development, thoughtful methodological design and analysis and theoretically driven nuanced hypotheses to better understand, and ultimately address, alcohol-related disparities among sexual and gender minority populations. [Talley AE, Gilbert PA, Mitchell J, Goldbach J, Marshall BDL, Kaysen D. Addressing gaps on risk and resilience factors for alcohol use outcomes in sexual and gender minority populations. Drug Alcohol Rev 2016;35:484-493].

Occurrence of multiple mental health or substance use outcomes among bisexuals: a respondent-driven sampling study

Background

Bisexual populations have higher prevalence of depression, anxiety, suicidality and substance use than heterosexuals, and often than gay men or lesbians. The co-occurrence of multiple outcomes has rarely been studied.

Methods

Data were collected from 405 bisexuals using respondent-driven sampling. Weighted analyses were conducted for 387 with outcome data. Multiple outcomes were defined as 3 or more of: depression, anxiety, suicide ideation, problematic alcohol use, or polysubstance use.

Results

Among bisexuals, 19.0 % had multiple outcomes. We did not find variation in raw frequency of multiple outcomes across sociodemographic variables (e.g. gender, age). After adjustment, gender and sexual orientation identity were associated, with transgender women and those identifying as bisexual only more likely to have multiple outcomes. Social equity factors had a strong impact in both crude and adjusted analysis: controlling for other factors, high mental health/substance use burden was associated with greater discrimination (prevalence risk ratio (PRR) = 5.71; 95 % CI: 2.08, 15.63) and lower education (PRR = 2.41; 95 % CI: 1.06, 5.49), while higher income-to-needs ratio was protective (PRR = 0.44; 0.20, 1.00).

Conclusions

Mental health and substance use outcomes with high prevalence among bisexuals frequently co-occurred. We find some support for the theory that these multiple outcomes represent a syndemic, defined as co-occurring and mutually reinforcing adverse outcomes driven by social inequity.

Bisexuality, poverty and mental health: A mixed methods analysis

Bisexuality is consistently associated with poor mental health outcomes. In population-based data, this is partially explained by income differences between bisexual people and lesbian, gay, and/or heterosexual individuals. However, the interrelationships between bisexuality, poverty, and mental health are poorly understood. In this paper, we examine the relationships between these variables using a mixed methods study of 302 adult bisexuals from Ontario, Canada. Participants were recruited using respondent-driven sampling to complete an internet-based survey including measures of psychological distress and minority stress. A subset of participants completed a semi-structured qualitative interview to contextualize their mental health experiences. Using information regarding household income, number of individuals supported by the income and geographic location, participants were categorized as living below or above the Canadian Low Income Cut Off (LICO). Accounting for the networked nature of the sample, participants living below the LICO had significantly higher mean scores for depression and posttraumatic stress disorder symptoms and reported significantly more perceived discrimination compared to individuals living above the LICO. Grounded theory analysis of the qualitative interviews suggested four pathways through which bisexuality and poverty may intersect to impact mental health: through early life experiences linked to bisexuality or poverty that impacted future financial stability; through effects of bisexual identity on employment and earning potential; through the impact of class and sexual orientation discrimination on access to communities of support; and through lack of access to mental health services that could provide culturally competent care. These mixed methods data help us understand the income disparities associated with bisexual identity in population-based data, and suggest points of intervention to address their impact on bisexual mental health.