Sexual orientation and mental health disparities in US pre-teens: A longitudinal mediation study

Background

Sexual minority children are at increased risk for psychopathology compared to their heterosexual peers, but longitudinal studies are needed to determine whether sexual minority identification precedes (rather than co-occurs with) mental health disparities and what may drive these disparities during childhood. The current study examined the longitudinal associations between sexual orientation and mental health over two years in a cohort of U.S. pre-teens with two potential mediators (increased social problems and decreased perceived school safety).

Methods

We used data from Waves 1-3 (2016-2020) of the U.S. Adolescent Brain Cognitive Development study. Multiple linear regression and auto-regressive cross-lagged mediation models were used to examine longitudinal associations and mediation. Analyses accounted for customized sampling weights to correct for attrition and missing data.

Results

The analytic sample included 5,574 children (46.0% assigned female at birth, 55.1% non-Hispanic White). Across waves, beginning to identify as gay/bisexual (0.6-2.7% of sample) was associated with increased internalizing and externalizing problems, and consistently identifying as gay/bisexual (3.4-5.0% of sample) with increased internalizing problems, compared to consistently identifying as heterosexual. For those who consistently identified as gay/bisexual, the widening disparities in internalizing problems were partially explained by increased social problems and decreased perceived school safety.

Conclusions

The health disparities affecting sexual minority children include internalizing and externalizing problems, and are partially explained by increased social problems and decreased perceived school safety. These findings demonstrate that sexual minority identification precedes increases in mental health problems relative to heterosexual children, driven by peer difficulties and feelings of unsafety at school experienced by sexual minority children.

Psychiatric Comorbidity Among Sexual and Gender Minority Youth and Young Adults at Risk for Suicide

Background

Compared with peers, young sexual and gender minorities (SGM) are at a four to seven-fold increased risk of attempting suicide. Prior epidemiological studies, mainly focusing on monomorbid inequalities and without conducting diagnostic clinical interviews, have been unable to report robust data on psychiatric comorbidities among those who attempted suicide. The purpose of this presentation is to describe the presence of current psychiatric comorbidities among SGM youth and young adults at elevated risk for repeat suicide attempts.

Methods

A diverse convenience sample of SGM youth and young adults with a lifetime history of suicide attempts and current suicidal ideation was recruited for an open-phase suicide prevention trial in San Diego, CA. At baseline, participants underwent a 15-module DIAMOND interview for adults or computerized K-SADS for minors, and a battery of self-report questionnaires.

Results

Among the 31 participants (Mage = 22 years [Range: 16, 29]; 100% sexual, 52% gender, and 61% racial/ethnic minority), 27 (87%) participants met criteria for any mood disorder, 24 (77%) for any anxiety disorder, 16 (52%) for any trauma or stress disorder, and 2 (6%) for any psychotic disorder. One (3%) participant did not meet criteria for any psychiatric diagnoses, while five (16%) met criteria for a single and 25 (81%) for multiple diagnoses. The average number of diagnoses was 3.2 (Range: 0, 7). Additionally, 20 (65%) participants met the cut-off for likely ADHD, 20 (65%) for possible borderline personality disorder, and 21 (68%) for likely body dysmorphic disorder, with 11 (35%) within the 90th percentile for reference eating disorder severity.

Conclusions

The degree of psychiatric comorbidities in the sample of SGM youth and young adults at elevated risk for suicide was high. Beside direct suicide risk mitigation efforts, suicide prevention programs that target young SGM with a history of attempts should screen for untreated psychiatric disorders.

Key messages

• LGBTQ+ youth and young adults at elevated risk for repeat suicide attempts experience a high degree of psychiatric comorbity.

• Beyond suicide risk mitigation, LGBTQ+ youth suicide prevention programs should focus on untreated psychiatric comorbidities.

Feasibility and Acceptability of a Patient Navigation Intervention to Prevent Suicide in LGBTQ Youth and Young Adults

Background

Across Western countries, young LGBTQ+ individuals are at a four to seven-fold increased risk of attempting suicide, compared to the general public. Despite these substantial health disparities, no known empirically supported suicide prevention programs exist for this highly vulnerable population. Patient navigation (PN), as an intervention to assist people in overcoming barriers to care, paired with the Safety Planning Intervention (SPI), may be a promising intervention to target mechanisms (e.g., thwarted belongingness and suicide-related coping skills) that theoretically underlie suicide. The purpose of this presentation is to describe the developed intervention and present initial data on its feasibility and acceptability.

Methods

In collaboration with a Participatory Planning Group (PPG), an iterative process was used to develop a PN+SPI intervention to prevent suicide among at-risk LGBTQ+ youth and young adults. A mixed-methods case series was used to examine feasibility and acceptability of implementing the PN+SPI intervention over a three-month period of time.

Results

Theoretical models regarding suicidality and LGBTQ+ mental health along with PPG feedback have informed the development of the PN+SPI intervention, with 7 modules included in feasibility evaluation: 1) Introduction + SPI; 2) Minority Stress Psychoeducation; 3) Barriers to Mental Health Services; 4) Barriers to Community Resources; 5) Decision Making; 6) Crisis Intervention; and 7) Wrap Up.

Conclusions

This project has the potential for reducing mortality and morbidity due to suicide attempts among LGBTQ+ youth/emerging adults, who are one of the most vulnerable groups for attempting suicide globally. Given the brevity of the PN+SPI intervention and its emphasis on safety planning and accessing community resources, the PN+SPI intervention has high potential for wide dissemination and public health impact, should it demonstrate feasibility, acceptability, and preliminary efficacy.

Addressing Syndemics and Self-care in Individuals with Uncontrolled HIV: An Open Trial of a Transdiagnostic Treatment

Interventions addressing syndemics and ART adherence are needed for individuals with uncontrolled HIV and psychosocial problems. Twenty-seven participants with detectable HIV plasma viral load (PVL) or recent STI participated in an open trial of transdiagnostic adherence counseling and cognitive behavioral therapy. Outcomes were collected at baseline, 4-, and 8-months. Log PVL improved from baseline to 4-month (γ = - 1.13, 95% CI - 1.72, - 0.55, p < 0.001) and 8-month (γ = - 0.93, 95% CI - 1.57, - 0.30, p = 0.006), with more participants suppressed at 4- (χ2(1) = 9.09, p = 0.001) and 8-month (χ2(1) = 5.14, p = 0.016). Self-reported adherence improved across major assessments (γ = 0.87, 95% CI 0.28, 1.46, p = .005); Wisepill adherence did not. Negative affect declined during treatment (γ = - 0.28, 95% CI - 0.40, - 0.16, p < 0.001), with improvement at 4- (γ = - 4.34, 95% CI - 6.99, - 1.69, p = 0.002) but not 8-month. Positive affect trended positively during treatment and from baseline to 4-month, with significant 8-month improvement (γ = 3.84, 95% CI 0.33, 7.44, p = 0.04). Depressive symptoms did not change. In a complicated sample of participants selected for uncontrolled HIV, the intervention yielded improved PVL and self-reported adherence. Efforts to end HIV should improve upon strategies such as these, addressing syndemics. Registration: clinicaltrial.gov: NCT02696681.

Body mass index and early CD4 T-cell recovery among adults initiating antiretroviral therapy in North America, 1998-2010

OBJECTIVES

Adipose tissue affects several aspects of the cellular immune system, but prior epidemiological studies have differed on whether a higher body mass index (BMI) promotes CD4 T-cell recovery on antiretroviral therapy (ART). The objective of this analysis was to assess the relationship between BMI at ART initiation and early changes in CD4 T-cell count.

METHODS

We used the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) data set to analyse the relationship between pre-treatment BMI and 12-month CD4 T-cell recovery among adults who started ART between 1998 and 2010 and maintained HIV-1 RNA levels < 400 copies/mL for at least 6 months. Multivariable regression models were adjusted for age, race, sex, baseline CD4 count and HIV RNA level, year of ART initiation, ART regimen and clinical site.

RESULTS

A total of 8381 participants from 13 cohorts contributed data; 85% were male, 52% were nonwhite, 32% were overweight (BMI 25-29.9 kg/m(2) ) and 15% were obese (BMI > 30 kg/m(2) ). Pretreatment BMI was associated with 12-month CD4 T-cell change (P < 0.001), but the relationship was nonlinear (P < 0.001). Compared with a reference of 22 kg/m(2) , a BMI of 30 kg/m(2) was associated with a 36 cells/μL [95% confidence interval (CI) 14, 59 cells/μL] greater CD4 T-cell count recovery among women and a 19 cells/μL (95% CI 9, 30 cells/μL) greater recovery among men at 12 months. At a BMI > 30 kg/m(2) , the observed benefit was attenuated among men to a greater degree than among women, although this difference was not statistically significant.

CONCLUSIONS

A BMI of approximately 30 kg/m(2) at ART initiation was associated with greater CD4 T-cell recovery at 12 months compared with higher or lower BMI values, suggesting that body composition may affect peripheral CD4 T-cell recovery.

Prothrombin fragment 1 X 2 X 3, a major product of prothrombin activation in human plasma

The conversion of the blood coagulation zymogen prothrombin to thrombin is associated with the production of several cleavage intermediates and products. In contrast to earlier studies of prothrombin cleavage in chemically defined systems, the current investigation examines the fragmentation of human prothrombin in normal plasma. Radiolabeled prothrombin was added to platelet-poor relipidated normal human plasma, and clotting was initiated with the addition of Ca(II) and kaolin. Analysis of the radiolabeled prothrombin cleavage products by polyacrylamide gel electrophoresis in the presence of dodecyl sulfate and beta-mercaptoethanol identified a heretofore unobserved product of prothrombin activation with an apparent molecular weight of 45,000. This product was identified as fragment 1 X 2 X 3, the NH2-terminal 286 amino acids of prothrombin. The product was isolated from a prothrombin digest by immunoaffinity chromatography using anti-prothrombin:Ca(II) antibodies and by preparative gel electrophoresis. Its amino-terminal sequence is identical to that of prothrombin. Digestion of this product with either Factor Xa or thrombin yields, at a minimum, fragment 1 X 2 and fragment 1. Amino-terminal sequence analysis of the products obtained by digestion with Factor Xa of the unknown activation product indicated 3 amino acid residues at each cycle consistent with the presence of fragment 1, fragment 2, and fragment 3. To unambiguously identify the COOH-terminal amino acid sequence of the product, its factor Xa digestion products were separated by reverse-phase high performance liquid chromatography. Edman degradation of one peptide revealed the complete sequence of fragment 3. On this basis, we identify the Mr 45,000 polypeptide as fragment 1 X 2 X 3 and indicate that it is a prominent product of prothrombin conversion to thrombin when activation occurs in plasma.