Sexual Orientation & Symptoms of Common Mental Disorder or Low Wellbeing: Combined Meta-Analysis of 12 UK Population Health Surveys

BACKGROUND:

Previous studies have indicated increased risk of mental disorder symptoms, suicide and substance misuse in lesbian, gay and bisexual (LGB) adults, compared to heterosexual adults. Our aims were to determine an estimate of the association between sexual orientation identity and poor mental health and wellbeing among adults from 12 population surveys in the UK, and to consider whether effects differed for specific subgroups of the population.

METHODS:

Individual data were pooled from the British Cohort Study 2012, Health Survey for England 2011, 2012 and 2013, Scottish Health Survey 2008 to 2013, Longitudinal Study of Young People in England 2009/10 and Understanding Society 2011/12. Individual participant meta-analysis was used to pool estimates from each study, allowing for between-study variation.

RESULTS:

Of 94,818 participants, 1.1 % identified as lesbian/gay, 0.9 % as bisexual, 0.8 % as 'other' and 97.2 % as heterosexual. Adjusting for a range of covariates, adults who identified as lesbian/gay had higher prevalence of common mental disorder when compared to heterosexuals, but the association was different in different age groups: apparent for those under 35 (OR = 1.78, 95 % CI 1.40, 2.26), weaker at age 35-54.9 (OR = 1.42, 95 % CI 1.10, 1.84), but strongest at age 55+ (OR = 2.06, 95 % CI 1.29, 3.31). These effects were stronger for bisexual adults, similar for those identifying as 'other', and similar for 'low wellbeing'.

CONCLUSIONS:

In the UK, LGB adults have higher prevalence of poor mental health and low wellbeing when compared to heterosexuals, particularly younger and older LGB adults. Sexual orientation identity should be measured routinely in all health studies and in administrative data in the UK in order to influence national and local policy development and service delivery. These results reiterate the need for local government, NHS providers and public health policy makers to consider how to address inequalities in mental health among these minority groups.

• Adults identifying as lesbian, gay, bisexual or ‘other’ are at increased risk of poor mental health and low wellbeing compared to those identifying as heterosexual.
• The association varies across the life course, with the lowest relative risks seen in midlife and the highest among older adults
• Our study used cross-sectional data suitable for estimating prevalence, but future studies should consider longitudinal patterns (such as onset and persistence of new mental health problems) and clarify mechanisms

Full article at:  http://goo.gl/c6MrVB

By:  Semlyen J1, King M2, Varney J3, Hagger-Johnson G4.

• 1Department of Psychology, London Metropolitan University, London, UK.
• 2Division of Psychiatry, UCL, London, UK.
• 3Public Health England, London, UK.
• 4Administrative Data Research Centre for England (ADRC-E), Farr Institute, UCL, London, NW1 2DA, UK. G.Hagger-Johnson@ucl.ac.uk.
• BMC Psychiatry. 2016 Mar 24;16(1):67. doi: 10.1186/s12888-016-0767-z. 

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Risk of Heavy Drinking among Sexual Minority Adolescents: Indirect Pathways through Sexual Orientation-Related Victimization & Affiliation with Substance-Using Peers

AIMS:

To test two indirect pathways through which sexual minority adolescents (SMAs) may be at risk for heavy episodic drinking (HED) including a socialization pathway via substance-using peer affiliations and social marginalization pathway via sexual minority-specific victimization and subsequent substance-using peer affiliations.

DESIGN:

Analysis of the first three waves (six-months apart) of a longitudinal adolescent health risk study (2011-2014). Participants were referred by medical providers or a screening system in providers' waiting rooms.

SETTING:

Two large urban adolescent health clinics in Pennsylvania and Ohio, USA.

PARTICIPANTS:

290 adolescents (ages 14-19, mean: 17) who were 71% female, 33% non-Hispanic White, and 34% SMAs.

MEASUREMENTS:

Self-reported sexual minority status (wave 1) and affiliation with substance-using peers (waves 1 and 2), and latent sexual-minority specific victimization (waves 1 and 2) and HED (waves 1 and 3) variables.

FINDINGS:

Using mediation analyses in a structural equation modeling framework, there was a significant indirect effect of sexual minority status (wave 1) on HED (wave 3) via affiliation with substance-using peers (wave 2; indirect effect = 0.03, 95%CI: 0.01, 0.07), after accounting for the indirect effect of sexual-orientation related victimization (wave 2; indirect effect = .10, 95%CI: 0.02-0.19). The social marginalization pathway was not supported as victimization (wave 1) was not associated with affiliation with substance-using peers (wave 2; β = -.04, p = .66). Sex differences in the indirect effects were not detected (ps > .10).

CONCLUSIONS:

Sexual minority adolescents in the US appear to exhibit increased heavy episodic drinking via an indirect socialization pathway including affiliations with substance-using peers and a concurrent indirect pathway involving sexual minority-related victimization. The pathways appear to operate similarly for boys and girls.

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By:  Dermody SS1, Marshal MP2,3, Burton CM2, Chisolm DJ4.

• 1Department of Psychology, University of Pittsburgh.
• 2Department of Psychiatry, School of Medicine, University of Pittsburgh.
• 3Department of Pediatrics, School of Medicine, University of Pittsburgh.
• 4Department of Pediatrics, The Ohio State University and Nationwide Children's Hospital. 
• Addiction. 2016 Mar 28. doi: 10.1111/add.13409. 

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Bisexuality, Poverty & Mental Health: A Mixed Methods Analysis

Highlights

• Poverty is associated with poor mental health among bisexual people.
• Poverty is also associated with experiences of discrimination among bisexuals.
• Multiple pathways may link bisexuality, poverty, and mental health.
• Lack of affordable culturally competent services may sustain the disparities.

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.

Purchase full article at:   http://goo.gl/qFio1c

By:  Ross LE1, O'Gorman L2, MacLeod MA3, Bauer GR3, MacKay J4, Robinson M4.

• 1Dalla Lana School of Public Health, University of Toronto, 155 College St. Room 560, Toronto, Ontario, M5T 3M7, Canada; Social & Epidemiological Research Department, Centre for Addiction & Mental Health, 33 Russell St. Room T406, Toronto, Ontario, M5S 1R8, Canada. Electronic address: l.ross@utoronto.ca.
• 2School of Rural and Northern Health, Laurentian University, 935 Ramsey Lake Rd., Sudbury, Ontario, P3E 2C6, Canada.
• 3Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, Western University, Kresge Building Room K201, London, Ontario, N6A 5C1, Canada.
• 4Social & Epidemiological Research Department, Centre for Addiction & Mental Health, 33 Russell St. Room T406, Toronto, Ontario, M5S 1R8, Canada. 
• Soc Sci Med. 2016 Mar 10;156:64-72. doi: 10.1016/j.socscimed.2016.03.009

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The Association between AIDS-Related Stigma & Aggression Toward Gay Men & Lesbians

This study examined whether self-identified race and prior contact with a gay man or lesbian moderate the association between AIDS-related stigma and aggression toward gay men and lesbians when controlling for sexual prejudice. 

A regional, community-recruited sample of 194 heterosexual men (50% Black, 50% White) completed measures of AIDS-related stigma, sexual prejudice, and prior contact with gay men and lesbians. 

Regression analyses showed that AIDS-related stigma was positively associated with aggression toward gay men and lesbians among White men who reported no prior contact, but not among White men who endorsed prior contact and Black men regardless of prior contact. 

Findings suggest that intergroup contact may be a key component to reducing the effects of AIDS-related stigma towards stigmatized groups. Implications for aggression theory and intervention are discussed.

Purchase full article at:  http://goo.gl/qgvFsN

By:  Vincent W1, Peterson JL2, Parrott DJ2.

• 1Center for AIDS Prevention Studies, Division of Prevention Science, School of Medicine, University of California, San Francisco, California.
• 2Department of Psychology, Georgia State University, Atlanta, Georgia. 

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Adolescent Sexual Minority Girls Are at Elevated Risk for Use of Multiple Substances

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Scrutinizing Immutability: Research on Sexual Orientation and U.S. Legal Advocacy for Sexual Minorities

We review scientific research and legal authorities to argue that the immutability of sexual orientation should no longer be invoked as a foundation for the rights of individuals with same-sex attractions and relationships (i.e., sexual minorities). 

On the basis of scientific research as well as U.S. legal rulings regarding lesbian, gay, and bisexual (LGB) rights, we make three claims: 

• First, arguments based on the immutability of sexual orientation are unscientific, given what we now know from longitudinal, population-based studies of naturally occurring changes in the same-sex attractions of some individuals over time. 
• Second, arguments based on the immutability of sexual orientation are unnecessary, in light of U.S. legal decisions in which courts have used grounds other than immutability to protect the rights of sexual minorities. 
• Third, arguments about the immutability of sexual orientation are unjust, because they imply that same-sex attractions are inferior to other-sex attractions, and because they privilege sexual minorities who experience their sexuality as fixed over those who experience their sexuality as fluid. 

We conclude that the legal rights of individuals with same-sex attractions and relationships should not be framed as if they depend on a certain pattern of scientific findings regarding sexual orientation.

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By:  Diamond LM1, J Rosky C2.

• 1 Department of Psychology , University of Utah.
• 2 S. J. Quinney College of Law , University of Utah. 
• J Sex Res. 2016 Mar 17:1-29. 

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Place Matters: Contextualizing the Roles of Religion & Race for Understanding Americans' Attitudes About Homosexuality

As laws and policies related to homosexuality have evolved, Americans' attitudes have also changed. Race and religion have been established as important indicators of feelings about homosexuality. However, researchers have given almost no attention to how county characteristics shape Americans' attitudes. 

Using Hierarchical Linear Modeling techniques, we examine how personal characteristics and the religious and racial context of a county shape feelings about homosexuality drawing on data from the American National Election Survey and information about where respondents reside. 

We find that African Americans initially appear less tolerant than other racial groups, until we account for the geographical distribution of attitudes across the nation. 

Additionally, once we consider religious involvement, strength of belief, and religious affiliation African Americans appear to have warmer feelings about homosexuality than whites. Drawing on the moral communities' hypothesis, we also find that the strength of religiosity amongst county residents heightens the influence of personal religious beliefs on disapproving attitudes. 

There is also a direct effect of the proportion conservative Protestant, whereby people of all faiths have cooler attitudes towards homosexual individuals when they reside in a county with a higher proportion of conservative Protestants. 

Finally, we do not find any evidence for an African American cultural influence on attitudes.

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By:  Adamczyk A1, Boyd KA2, Hayes BE3.

• 1John Jay College of Criminal Justice and the Graduate Center, City University of New York, USA. Electronic address: AAdamczyk@jjay.cuny.edu.
• 2Department of Sociology, Philosophy, and Anthropology, The University of Exeter, UK.
• 3Department of Criminal Justice and Criminology, Sam Houston State University, USA. 
• Soc Sci Res. 2016 May;57:1-16. doi: 10.1016/j.ssresearch.2016.02.001. Epub 2016 Feb 8.

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Trajectories of Dating Violence: Differences by Sexual Minority Status & Gender

The purpose of this study was to examine how sexual minority status (as assessed using both identity and behavior) was associated with trajectories of dating violence. 

University students from a large Southwestern university completed questions on their sexual minority identity, the gender of their sexual partners, and about experiences of dating violence for six consecutive semesters (N = 1942). Latent growth curve modeling indicated that generally, trajectories of dating violence were stable across study participation. 

Sexual minority identity was associated with higher initial levels of dating violence at baseline, but also with greater decreases in dating violence across time. These differences were mediated by number of sexual partners. Having same and other-sex sexual partners was associated with higher levels of dating violence at baseline, and persisted in being associated with higher levels over time. 

No significant gender difference was observed regarding trajectories of dating violence.

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By:  Martin-Storey A1, Fromme K2.

• 1Département de Psychoéducation, Université de Sherbrooke, Pavillon A7, 2500 Boul. De L'Université, Sherbrooke, Quebec J1K 2R1, Canada. Electronic address: alexa.martin@gmail.com.
• 2Department of Psychology, University of Texas at Austin, 108 E Dean Keeton Stop A8000, Austin, TX 87812-1043, USA. 
• J Adolesc. 2016 Mar 16;49:28-37. doi: 10.1016/j.adolescence.2016.02.008.

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The National LGBT Cancer Action Plan: A White Paper of the 2014 National Summit on Cancer in the LGBT Communities

Despite growing social acceptance of lesbians, gay men, bisexuals, and transgender (LGBT) persons and the extension of marriage rights for same-sex couples, LGBT persons experience stigma and discrimination, including within the healthcare system. 

Each population within the LGBT umbrella term is likely at elevated risk for cancer due to prevalent, significant cancer risk factors, such as tobacco use and human immunodeficiency virus infection; however, cancer incidence and mortality data among LGBT persons are lacking. This absence of cancer incidence data impedes research and policy development, LGBT communities' awareness and activation, and interventions to address cancer disparities. 

In this context, in 2014, a 2-day National Summit on Cancer in the LGBT Communities was convened by a planning committee for the purpose of accelerating progress in identifying and addressing the LGBT communities' concerns and needs in the spheres of cancer research, clinical cancer care, healthcare policy, and advocacy for cancer survivorship and LGBT health equity. 

Summit participants were 56 invited persons from the United States, United Kingdom, and Canada, representatives of diverse identities, experiences, and knowledge about LGBT communities and cancer. Participants shared lessons learned and identified gaps and remedies regarding LGBT cancer concerns across the cancer care continuum from prevention to survivorship. 

This white paper presents background on each of the Summit themes and 16 recommendations covering the following: sexual orientation and gender identity data collection in national and state health surveys and research on LGBT communities and cancer, the clinical care of LGBT persons, and the education and training of healthcare providers...

Recommendations

1. Add SOGI questions to all national health surveys and promote SOGI data collection in diverse healthcare settings so as to better understand psychosocial, behavioral, and medical risk factors that can increase LGBT persons' cancer risk and to examine health outcomes and disparities in each LGBT community.
2. Organize stakeholders and promote education within the NIH and its institutes, centers, and offices, and in particular the NCI, about the health and cancer needs of LGBT communities to arm with facts and sensitize decision-makers who help set scientific and funding priorities.
3. Overcome the gap in financial support of research to develop and test cancer prevention and control interventions targeted and tailored to LGBT communities by issuing research funding opportunities specific to the population.
4. Increase the amount of federal funding dedicated to LGBT cancer research. Furthermore, assure that career development and training grants for under-represented populations in the workforce include those identifying as LGBT and with potential for conducting high-quality cancer research with LGBT communities.ⁱ
5. Address the absence of SEER cancer registry data on SOGI. SEER should consider partnering with cancer researchers to pilot test such an effort, perhaps within a region or state, to identify and overcome barriers to standard collection of SOGI data.
6. Recognize intersectionality within the LGBT communities when conducting cancer research by assessing and examining the impact of SOGI, race, ethnicity, class, disability/ability, and other sociodemographic factors on cancer outcomes across the cancer care continuum.

Recommendations

1. Increase research to document elevated cancer risks and cancer screening disparities in LGBT communities.
2. Develop psychosocial and educational support groups specifically for LGBT survivors and caregivers, and when this is not feasible, assure the cultural competence of professional support service providers to better meet the needs of LGBT communities.
3. Improve care coordination for LGBT patients, survivors, and caregivers through the integration of LGBT community resources. These resources include culturally competent oncologists, primary care and specialty physicians, mental health providers, and other professional providers.
4. Educate healthcare providers about the unique cooccurring conditions that LGBT cancer patients may present in their care settings.
5. Ensure that palliative and end-of-life care addresses the specific legal and psychosocial needs of LGBT communities.
6. Support efforts to increase insurance coverage for LGBT communities, with a focus on the transition and cancer care needs of transgender communities.

Recommendations

1. Develop accreditation agency standards for the provision of culturally competent care to LGBT people and to assure professional training in LGBT cultural competence and health for providers of primary care, cancer screening and treatment, and cancer survivorship healthcare both during their academic training and for those already working in the field. This can be best accomplished by working with LGBT-focused organizations and other content experts in these areas.
2. Educate LGBT communities about their increased cancer risks and the importance of appropriate cancer screening and early detection through outreach by cancer experts through tailored lectures, print materials, internet content, mass media messaging, and other means that will effectively engage the community.
3. Increase representation of LGBT persons in leadership positions and throughout the workforce. The workforce pipeline draws from many streams, but for there to be greater LGBT representation at all levels of the cancer healthcare continuum and in health policy and research, efforts are needed to welcome, include, and develop the potential of LGBT persons within the under-represented populations in the workforce. This will entail collecting SOGI data to track the effectiveness of such efforts, as well as targeting for recruitment of LGBT-identified persons in academic and training programs and assuring that they will experience LGBT-affirmative environments and mentoring opportunities in their new settings.
4. Initiate a comprehensive effort to identify and modify healthcare organization policies that are not inclusive or pose barriers to patient-centered cancer care for LGBT persons. These policies may range from how to manage the comfort and confidentiality of transgender patients presenting for cancer screening based on gender-specific anatomy to providing culturally sensitive psychosocial support for LGBT cancer survivors. Systemic changes promoting equity in LGBT cancer care are more likely to be implemented when an independent prestigious organization advocates such changes and more so when mandated by an accrediting or certifying organization. Furthermore, by instituting collaborations with LGBT advocacy and professional groups, healthcare organizations can establish a lifeline when addressing internal LGBT-related policies, procedures, and patient concerns.

Full article at:   http://goo.gl/2Gl9sl

By:  Jack E. Burkhalter, PhD,1,* Liz Margolies, LCSW,2,* Hrafn Oli Sigurdsson, PhD, NP, PMHNP-BC,3 Jonathan Walland, LLB,4 Asa Radix, MD, MPH,5 David Rice, RN, PhD,6 Francisco O. Buchting, PhD,7 Nelson F. Sanchez, MD,8 Michael G. Bare, MPH,9 Ulrike Boehmer, PhD,10 Sean Cahill, PhD,11 Tomas L. Griebling, MD, MPH,12 Diane Bruessow, PA-C, DFAAPA,13 and Shail Maingi, MD14

¹Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York.

²National LGBT Cancer Network, New York, New York.

³Nursing Professional Development, Memorial Sloan Kettering Cancer Center, New York, New York.

⁴The Office of General Counsel, Memorial Sloan Kettering Cancer Center, New York, New York.

⁵Callen-Lorde Community Health Center, New York, New York.

⁶City of Hope, Duarte, California.

⁷Buchting Consulting, Oakland, California; Horizons Foundation, San Francisco, California.

⁸Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.

⁹Grassroots Change, Oakland, California.

¹⁰Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts.

¹¹The Fenway Institute, Boston, Massachusetts.

¹²Department of Urology, School of Medicine, University of Kansas, Kansas City, Kansas.

¹³Healthy Transitions, LLC, Stirling, New Jersey.

¹⁴St. Peter's Health Partners Cancer Care, Troy, New York.

Corresponding author.

^*Cofirst authors.

Address correspondence to:, Jack E. Burkhalter, PhD, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, 7th Floor, New York, NY 10022,

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Barriers to Health Care among Adults Identifying as Sexual Minorities: A US National Study

OBJECTIVES:

To assess the extent to which lesbian, gay, and bisexual (LGB) adults aged 18 to 64 years experience barriers to health care.

METHODS:

We used 2013 National Health Interview Survey data on 521 gay or lesbian (291 men, 230 women), 215 bisexual (66 men, 149 women), and 25 149 straight (11 525 men, 13 624 women) adults. Five barrier-to-care outcomes were assessed (delayed or did not receive care because of cost, did not receive specific services because of cost, delayed care for noncost reasons, trouble finding a provider, and no usual source of care).

RESULTS:

Relative to straight adults, 

• gay or lesbian and bisexual adults had higher odds of delaying or not receiving care because of cost. 
• Bisexual adults had higher odds of delaying care for noncost reasons, 
• and gay men had higher odds than straight men of reporting trouble finding a provider. 

By contrast, gay or lesbian women had lower odds of delaying care for noncost reasons than straight women. 

• Bisexual women had higher odds than gay or lesbian women of reporting 3 of the 5 barriers investigated.

CONCLUSIONS:

Members of sexual minority groups, especially bisexual women, are more likely to encounter barriers to care than their straight counterparts

Purchase full article at:   http://goo.gl/gUQfhv

By:  Dahlhamer JM1, Galinsky AM1, Joestl SS1, Ward BW1.

1The authors are with the National Center for Health Statistics, Hyattsville, MD

Am J Public Health. 2016 Mar 17:e1-e7.

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Unintended Pregnancy, Depression, and Hazardous Drinking in a Community-Based Sample of Sexual Minority Women

CONTEXT:

Unintended pregnancy is a stressful life event with important implications for women's health. Little research has examined sexual minority women's (SMW; lesbian, bisexual, mostly heterosexual) experiences of unintended pregnancy, and no studies have examined the relationship between unintended pregnancy, mental health, and negative coping behaviors in this population.

METHODS:

We used the Chicago Health and Life Experiences of Women (CHLEW) Study (n = 454), a diverse sample of SMW, to examine the relationship between self-reported unintended pregnancy, depressive symptoms, and hazardous drinking. We used generalized linear model-building techniques and adjusted for key sociodemographic controls, as well as unintended pregnancy risk factors, including childhood physical and sexual abuse and age of sexual debut.

RESULTS:

Twenty-four percent of the sample reported an unintended pregnancy. SMW who reported unintended pregnancies also reported significantly more depressive symptoms and greater risk of hazardous drinking. Adjusting for childhood abuse explained the relationship between unintended pregnancy and depressive symptoms, but not the relationship between unintended pregnancy and hazardous drinking.

CONCLUSIONS:

Unintended pregnancy among SMW is an understudied topic. Our results suggest that unintended pregnancy is not uncommon among SMW and highlight the need for more research to investigate the mechanisms that link unintended pregnancy to depression and to hazardous drinking within this population.

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By:  Everett BG1, McCabe KF2, Hughes TL3.

• 1 Department of Sociology, University of Utah, Salt Lake City, Utah.
• 2 Department of Sociology, University of Illinois at Chicago, Chicago, Illinois.
• 3 Department of Health Systems Science, University of Illinois at Chicago, Chicago, Illinois. 
• J Womens Health (Larchmt). 2016 Mar 15.

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