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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Transgender Men and Pregnancy

Transgender people have experienced significant advances in societal acceptance despite experiencing continued stigma and discrimination. While it can still be difficult to access quality health care, and there is a great deal to be done to create affirming health care organizations, there is growing interest around the United States in advancing transgender health. 

The focus of this commentary is to provide guidance to clinicians caring for transgender men or other gender nonconforming people who are contemplating, carrying, or have completed a pregnancy. Terms transgender and gender nonconforming specifically refer to those whose gender identity (e.g., being a man) differs from their female sex assigned at birth. Many, if not most transgender men retain their female reproductive organs and retain the capacity to have children. 

Review of their experience demonstrates the need for preconception counseling that includes discussion of stopping testosterone while trying to conceive and during pregnancy, and anticipating increasing experiences of gender dysphoria during and after pregnancy. The clinical aspects of delivery itself fall within the realm of routine obstetrical care, although further research is needed into how mode and environment of delivery may affect gender dysphoria. Postpartum considerations include discussion of options for chest (breast) feeding, and how and when to reinitiate testosterone. 

A positive perinatal experience begins from the moment transgender men first present for care and depends on comprehensive affirmation of gender diversity.

Full article at:   http://goo.gl/Fo1LMb

By:  Juno Obedin-Maliver1,2 and Harvey J Makadon3,4

¹Department of Medicine, University of California San Francisco, San Francisco, CA, USA

²Department of Gynecology, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA

³National LGBT Health Education Center, The Fenway Institute, Boston, MA, USA

⁴Harvard Medical School, Boston, MA, USA

Harvey J Makadon, National LGBT Health Education Center, The Fenway Institute, 1340 Boylston Street, Boston, MA, USA

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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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A Cross Section Study to Determine the Prevalence of Antibodies against HIV Infection among Hepatitis B and C Infected Individuals

BACKGROUND: 

There are limited data regarding human immunodeficiency virus (HIV) prevalence among hepatitis B virus (HBV) or hepatitis C virus (HCV) infected individuals. The aim of this cross-sectional study is to determine the prevalence of HBV and HCV infection among HIV individuals;

METHODS: 

A total of 409 patients (126 HBV+ and 283 HCV+) referred to the Brazilian Reference Laboratory for Viral Hepatitis from 2010 to 2013 donated serum samples. Anti-HIV, HBsAg, anti-HBc, anti-HBs, anti-HBcIgM, anti-HBe, HBeAg, and anti-HCV antibodies were measured, and anti-HCV positive samples were tested for viral RNA and genotype;

RESULTS: 

The anti-HIV antibody prevalence was 10.31% and 4.59% among HBV+ and HCV+ patients, respectively. The HCV mean (SD) viral load was log 5.14 ± 1.64 IU/mL, and genotype I was most prevalent (163/283). Anti-HBs and anti-HBc were detected in 40% and 26% of HCV+ individuals, respectively. Among the HBV+ population, the presence of anti-HIV antibodies was associated with male gender, marital status (married), tattoo, sexual orientation, sexual practices (oral sex and anal sex), history of sexually transmitted diseases (STDs), history of viral hepatitis treatment, and a sexual partner with hepatitis or HIV. For the HCV+ group, the presence of anti-HIV antibodies was associated with female gender, marital status (married), anal intercourse, previous history of STDs, and number of sexual partners;

CONCLUSION: 

A high prevalence of anti-HIV antibodies was found among individuals with HBV and HCV, showing the importance of education programmes towards HIV infection among HBV- and HCV-infected individuals.

Full article at:   http://goo.gl/7pJhyw

By:  Flores GL1, de Almeida AJ2, Miguel JC3, Cruz HM4, Portilho MM5, de P Scalioni L6, Marques VA7, Lewis-Ximenez LL8, Lampe E9, Melo Villar L10.

• 1Viral Hepatitis Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro 210360-040, Brazil. geane@ioc.fiocruz.br.
• 2Viral Hepatitis Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro 210360-040, Brazil. adilsonjoal@ioc.fiocruz.br.
• 3Viral Hepatitis Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro 210360-040, Brazil. julicm@ioc.fiocruz.br.
• 4Viral Hepatitis Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro 210360-040, Brazil. h.medina@ioc.fiocruz.br.
• 5Viral Hepatitis Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro 210360-040, Brazil. moyramp@ioc.fiocruz.br.
• 6Viral Hepatitis Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro 210360-040, Brazil. lescali@ioc.fiocruz.br.
• 7Viral Hepatitis Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro 210360-040, Brazil. vmarques@ioc.fiocruz.br.
• 8Viral Hepatitis Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro 210360-040, Brazil. llewis@ioc.fiocruz.br.
• 9Viral Hepatitis Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro 210360-040, Brazil. elampe@ioc.fiocruz.br.
• 10Viral Hepatitis Laboratory, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro 210360-040, Brazil. lvillar@ioc.fiocruz.br. 
• Int J Environ Res Public Health. 2016 Mar 11;13(3). pii: E314. doi: 10.3390/ijerph13030314.

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Body Satisfaction and Physical Appearance in Gender Dysphoria

Gender dysphoria (GD) is often accompanied by dissatisfaction with physical appearance and body image problems. The aim of this study was to compare body satisfaction with perceived appearance by others in various GD subgroups. 

Data collection was part of the European Network for the Investigation of Gender Incongruence. Between 2007 and 2012, 660 adults who fulfilled the criteria of the DSM-IV gender identity disorder diagnosis (1.31:1 male-to-female [MtF]:female-to-male [FtM] ratio) were included into the study. Data were collected before the start of clinical gender-confirming interventions. Sexual orientation was measured via a semi-structured interview whereas onset age was based on clinician report. Body satisfaction was assessed using the Body Image Scale. Congruence of appearance with the experienced gender was measured by means of a clinician rating. 

Overall, FtMs had a more positive body image than MtFs. Besides genital dissatisfaction, problem areas for MtFs included posture, face, and hair, whereas FtMs were mainly dissatisfied with hip and chest regions. Clinicians evaluated the physical appearance to be more congruent with the experienced gender in FtMs than in MtFs. Within the MtF group, those with early onset GD and an androphilic sexual orientation had appearances more in line with their gender identity. In conclusion, body image problems in GD go beyond sex characteristics only. 

An incongruent physical appearance may result in more difficult psychological adaptation and in more exposure to discrimination and stigmatization.

Full article at:   http://goo.gl/h6yHWx

By:  van de Grift TC1,2, Cohen-Kettenis PT3, Steensma TD3, De Cuypere G4, Richter-Appelt H5, Haraldsen IR6, Dikmans RE7, Cerwenka SC5, Kreukels BP3.

• 1Department of Medical Psychology, Center of Expertise on Gender Dysphoria, EMGO Institute for Health and Care Research, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands. t.vandegrift@vumc.nl.
• 2Department of Plastic, Reconstructive & Hand Surgery, VU University Medical Center, Amsterdam, The Netherlands. t.vandegrift@vumc.nl.
• 3Department of Medical Psychology, Center of Expertise on Gender Dysphoria, EMGO Institute for Health and Care Research, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.
• 4Center of Sexology and Gender Problems, Ghent University Hospital, Ghent, Belgium.
• 5Department of Sex Research and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
• 6Department of Neuropsychiatry and Psychosomatic Medicine, Division of Clinical Neuroscience, Rikshospitalet, Oslo, Norway.
• 7Department of Plastic, Reconstructive & Hand Surgery, VU University Medical Center, Amsterdam, The Netherlands. 
• Arch Sex Behav. 2016 Apr;45(3):607-17. doi: 10.1007/s10508-015-0657-3. Epub 2016 Jan 12.

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Measuring Attitudes About Hate: Development of the Hate Crime Beliefs Scale

Employing the federal Hate Crimes Prevention Act (HCPA) of 2009 and other such legislation as a backdrop, the present study evaluated the nature of beliefs about hate-crime legislation, offenders, and victims. In addition, it investigated construct validity (i.e., political beliefs and prejudice) and predictive validity (i.e., blame attribution and sentencing recommendations). 

A total of 403 U.S. adults completed measures of prejudice and an initial pool of 50 items forming the proposed Hate Crime Beliefs Scale (HCBS). Participants were randomly assigned to read one of four hate-crime vignettes, which varied in regard to type of prejudice (racial-, sexual orientation-, transgender-, and religion-based prejudices) and then responded to blame and sentencing questions. 

Factor analyses of the HCBS resulted in four sub-scales: Negative Views (i.e., higher scores reflect negative views of legislation and minority group protection), Offender Punishment (i.e., higher scores suggest endorsement of greater punishment), Deterrence (i.e., greater scores denote support for hate-crime legislation as a deterrent of more violence), and Victim Harm (i.e., higher scores reflect pro-victim attitudes). Greater pro-legislation and pro-victim beliefs were related to liberal political beliefs and less prejudicial attitudes, with some exceptions. 

Controlling for a number of demographic, situational, and attitudinal covariates, the Negative Views sub-scale displayed predictive utility, such that more negative views of legislation/minority group protection were associated with elevated victim blame, as well as lower perpetrator blame and sentencing recommendations. 

Results are discussed in the context of hate-crime research and policy, with additional implications considered for trial strategy, modern prejudice, and blame attribution theory.

Purchase full article at: http://goo.gl/uj6heU

By:  Cabeldue MK1, Cramer RJ2, Kehn A3, Crosby JW4, Anastasi JS4.

• 1Fairleigh Dickinson University, Teaneck, NJ, USA cabeldue@student.fdu.edu.
• 2Old Dominion University, Norfolk, VA, USA.
• 3University of North Dakota, Grand Forks, ND, USA.
• 4Sam Houston State University, Huntsville, TX, USA. 
• J Interpers Violence. 2016 Mar 6. pii: 0886260516636391. 

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Let's Talk About Gay Sex: Gay & Bisexual Men's Sexual Communication with Healthcare Professionals After Prostate Cancer

Although sexual changes after prostate cancer (PCa) have specific meanings and consequences for gay and bisexual (GB) men, little is known about how GB men navigate sexual well-being support. 

We surveyed 124 GB men with PCa and 21 male partners, and interviewed a sub-sample of 46 GB men and 7 male partners, to examine GB men's experiences of sexual communication with healthcare professionals (HCPs) since the onset of PCa. GB men perceived a number of deficits in HCPs communication: medical support dominated sexual and psychological support; heterosexuality of GB patients was often assumed; sexual orientation disclosure was problematic; and GB men perceived rejection or lack of interest and knowledge from a majority of HCPs with regard to gay sexuality and the impact of PCa on GB men. Facilitators of communication were acknowledgement of sexual orientation and exploration of the impact of PCa on GB men. 

In order to target improved support for GB men with PCa, it is concluded that HCPs need to address issues of hetero-centricism within PCa care by improving facilitation of sexual orientation disclosure, recognising that GB men with PCa might have specific sexual and relational needs, and increasing knowledge and comfort discussing gay sexuality and gay sexual practices.

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By:  Rose D1, Ussher JM1, Perz J1.

• 1Centre for Health Research, School of Medicine, Western Sydney University, Sydney, NSW, Australia. 
• Eur J Cancer Care (Engl). 2016 Feb 26. doi: 10.1111/ecc.12469.

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Sexual Orientation Disparities in Physical Health: Age & Gender Effects in a Population-Based Study

Background

Recent studies have identified substantial health disparities between lesbian, gay, and bisexual (LGB) individuals compared to heterosexuals. However, possible variation in sexual orientation health disparities by age and according to gender remains largely unexplored.

Purpose

To examine physical health disparities between LGB and heterosexual individuals in a general population sample in Sweden, to explore potential age and gender differences in these disparities, and to test potential mechanisms underlying any observed disparities.

Method

Between 2008 and 2013, 60,922 individuals (16–84 years of age) responded to nationwide population-based health surveys. In the sample, 430 (0.7 %) individuals self-identified as gay/lesbian and 757 (1.3 %) self-identified as bisexual. Logistic and negative binomial regression analyses were used to explore health disparities based on sexual orientation.

Results

Overall, LGB individuals were more likely to report worse self-rated health as well as more physical health symptoms (e.g., pain, insomnia, dermatitis, tinnitus, intestinal problems) and conditions (e.g., diabetes, asthma, high blood pressure) compared to heterosexuals. However, these physical health disparities differed by age. Disparities were largest among adolescents and young adults and generally smallest in older age groups. Health behaviors and elevated reports of exposure to perceived discrimination, victimization, and threats of violence among sexual minorities partially explained the sexual orientation disparities in physical health.

Conclusions

Age emerged as an important effect modifier of physical health disparities based on sexual orientation. Gender-specific findings suggest that sexual orientation disparities persist into adulthood for women but are gradually attenuated for older age groups; in contrast, for men, these disparities disappear starting with young adults. These results support a developmental model of minority stress and physical health among LGB individuals.

Below:  Proportion of men and women reporting poor/fair health by sexual orientation showing differences by age group

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

By:  Richard Bränström, Mark L. Hatzenbuehler, and John E. Pachankis

Department of Clinical Neuroscience, Karolinska Institutet, Berzelius väg 3, 171 77 Stockholm, Sweden

Department of Sociomedical Sciences, Columbia University, New York, NY USA

Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT USA

Richard Bränström, Phone: 46 7 681 117 21, Email: es.ik@mortsnarb.drahcir.

Corresponding author.

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Disparities in Depressive Symptoms Between Heterosexual and Lesbian, Gay, and Bisexual Youth in a Dutch Cohort: The TRAILS Study

Lesbian, gay, and bisexual (LGB) youth experience elevated levels of depressive symptoms compared to heterosexual youth. 

This study examined how differences in depressive symptoms between heterosexual and LGB youth developed from late childhood to early adulthood. The association between sexual orientation and depressive symptoms was estimated from age 11 to 22 using data from the TRacking Adolescents’ Individual Lives Survey, a longitudinal Dutch cohort study. 

Of the 1738 respondents (54.8 % girls) that provided information on sexual orientation, 151 self-identified as LGB. In line with the Minority Stress Framework, it was tested whether self-reported peer victimization and parental rejection mediated the association between sexual orientation and depressive symptoms. 

Results indicated that LB girls and bisexuals were at increased risk of depressive symptoms already at age 11. The difference increased over time and was related to pubertal development in girls and bisexual individuals. 

Furthermore, self-reported peer victimization (for both boys and girls), as well as parental rejection (for girls/bisexuals), mediated the association between sexual orientation and depressive symptoms. 

The authors conclude that already in late childhood, associations between sexual orientation and depressive symptoms are found, partly due to minority stress mechanisms.

Below:  Depressive symptoms by sexual orientation and gender

Below:  Depressive symptoms for heterosexuals, gays/lesbians and bisexuals

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

By:  Chaïm la Roi, Tina Kretschmer, Jan Kornelis Dijkstra, René Veenstra, and Albertine J. Oldehinkel

Department of Sociology, Interuniversity Center for Social Science Theory and Methodology (ICS), University of Groningen, Grote Rozenstraat 31, 9712 TG Groningen, The Netherlands

Department of Pedagogy and Educational Science, University of Groningen, Grote Rozenstraat 38, 9712 TJ Groningen, The Netherlands

Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands

Chaïm la Roi, Phone: +31503638938, Email: ln.gur@ior.al.c.

Corresponding author.

J Youth Adolesc. 2016; 45: 440–456. Published online 2016 Jan 9. doi:  10.1007/s10964-015-0403-0

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