BackgroundIn 2023, state legislatures across the United States introduced a record-breaking 510 anti-lesbian, gay, bisexual, transgender, and queer (LGBTQ+) bills. These anti-LGBTQ+ bills may increase chronic stress and ultimately affect their overall health, including subjective cognitive decline (SCD).MethodsCombining the 2019-2022 Behavioral Risk Factor Surveillance System (BRFSS) and 2017-2021 policy tallies, we conducted multivariable logistic regression analyses to explore the relationship between LGBTQ+ state policy environments (protective vs. restrictive) and SCD (yes vs. no) among sexual minority adults aged 45 years and older.ResultsAmong 10,487 sexual minority adults, 1,009 (9.9%) reported experiencing SCD. Participants from states with protective policies were less likely to report SCD than those from restrictive ones (adjusted odds ratio [AOR] = 0.63; 95% confidence interval [CI]: 0.46-0.88). Among those with SCD, individuals from protective states were more likely to discuss their cognitive issues with healthcare providers (AOR = 1.68; 95% CI: 1.04-2.72) and to receive the help they needed (AOR = 1.55; 95% CI: 1.05-2.29).ConclusionsSexual minority adults experiencing SCD were more likely to reside in states with restrictive LGBTQ+ policies. Conversely, those with SCD living in states with protective policies were more likely to access cognitive-related care and support.
IntroductionAttention-deficit/hyperactivity disorder (ADHD) is associated with substance use in adulthood. However, few studies have examined ADHD symptoms among young sexual minority men (YSMM), and even fewer have examined their associations with substance use.MethodUsing data from a diverse sample of 597 YSMM, we examined the prevalence of current clinically significant ADHD symptoms, as well as their associations with current substance use and age of first use.ResultsIn our sample of YSMM, 21.4% reported inattention, 32.2% reported hyperactivity/impulsivity, and 15.1% reported both using a 3-symptom threshold of clinically significant symptoms. Rates using the 5-symptom threshold in line with the DSM-5 were 8.2%, 9.2%, and 3.7%, respectively. Results of binary logistic, negative binomial, and zero-inflated negative binomial regressions indicated that ADHD symptoms were associated with greater likelihood of current substance use after controlling for sociodemographic characteristics. Results of Cox hazards regressions indicated that ADHD symptoms were associated with earlier age of first use.ConclusionADHD symptoms are prevalent among YSMM and associated with substance use. Practitioners should consider screening for ADHD and substance use among sexual minority youth. Prevention and intervention efforts should be tailored to meet the needs of YSMM.
Introduction Sexual and gender diverse (SGD) individuals experience significant health disparities; yet, more research is needed to understand the unique risks of individuals within this heterogeneous community. For instance, extant research suggests that bisexual, gender diverse, and racial and ethnically diverse SGD individuals may be at heightened risk for certain negative health outcomes. The present study aimed to examine whether racially and ethnically diverse adults within the heterogeneous SGD community differ in their depressive symptoms, suicidal ideation, and chronic health conditions (CHCs). Methods In 2021, Qualtrics Panels recruited 1329 U.S. adults from various SGD subgroups (389 heterosexual, 289 bisexual, 219 gay, 157 lesbian, and 275 gender diverse adults) and racial and ethnic subgroups (415 non-Hispanic White, 387 Hispanic or Latinx, 268 Black or African American, 252 Multiracial adults). Participants completed an online survey. Results After adjusting for covariates, SGD adults had higher depressive symptoms, were more likely to report frequent suicidal ideation, and reported more current CHCs compared to non-SGD adults (ps < .05). There were important variations within SGD and racial and ethnic subgroups, suggesting that bisexual, gender diverse, and multiracial adults experience worse mental and/or physical health. Conclusion The study findings and extant research underscore the need to examine how health disparity risk varies across SGD subgroups using an intersectional approach to best tailor research and intervention efforts.
IntroductionWe examined the intersection of attention-deficit/hyperactivity disorder (ADHD) and sexual/gender minority (SM/GM) identity in college students.MethodsSecondary analysis of the American College Health Association-National College Health Assessment (ACHA-NCHA) III data was utilized. Participants were 82,000+ college students from 75 universities. We used ACHA-NCHA-III measures including demographics, self-reported ADHD, and mental health.ResultsWe found a 14.5% prevalence of ADHD in the SM group, compared to a 7.5% rate among the heterosexual group and a 23.9% prevalence of ADHD in the GM group, compared to an 8.6% rate among the cisgender group. College students who endorsed SM/GM identities and an ADHD diagnosis had the highest levels of loneliness and suicidality.ConclusionSM/GM identities are more prevalent in college students with ADHD and are associated with loneliness and suicidality.
IntroductionStudies from Western countries claim LGBTQ+ people face mental health burdens. It remains unclear in Japan. This study aimed to examine mental health challenges among LGBTQ+ individuals in Japan.MethodsJACSIS (Japan COVID-19 and Society Internet Survey) 2022 participants were categorized in cisgender-heterosexual, gay-identifying, lesbian-identifying, bisexual-identifying, questioning, transgender and nonbinary. Associations between psychological distress, loneliness, social isolation. and quality of life (QOL) were analyzed using multivariable adjusted regression models compared to cisgender-heterosexual people.ResultsAll LGBTQ+ subgroups experienced psychological distress and lower QOL. Gay-identifying and questioning people experienced social isolation, while lesbian-identifying people were associated with reduced social isolation. Bisexual-identifying, questioning, and nonbinary people experienced loneliness, while gay-identifying people were associated with reduced loneliness.ConclusionSocial isolation and loneliness differ among LGBTQA+ subgroups and require subpopulation-specific research and health interventions.
Purpose: Alcohol usage in response to discrimination continues to be a critically important health behavior that remains largely unaddressed among young sexual minority men (YSMM). Thus, the current investigation seeks to address how daily racial discrimination events are associated with daily alcohol use behaviors among a diverse sample of YSMM. Methods: 108 YSMM engaged in a 5-day survey diary protocol between 2016 and 2019. Four 3-min momentary diaries and one 12-minute nightly diary was administered via an online survey each day. Multi-level logistic regression examined the association between daily racial discrimination and alcohol use. Results: Results indicated that those who reported experiencing racial discrimination had 2.89 the odds of using alcohol in the next moment as compared to those who did not (odds ratio (OR)=2.89, p < 0.001). Conclusion: Results suggest that racial discrimination has same-day implications for YSMM's alcohol-related behaviors. Findings highlight the need for culturally tailored interventions considering unique experiences of YSMM at the intersection of multiple marginalized identities.
ObjectiveThis qualitative study aims to examine the mental health experiences and intervention preferences of SGM asylum seekers in North America.MethodWe interviewed 15 SGM asylum seekers with a particular focus on their preferences regarding different formats of group mental health interventions. Additionally, we interviewed therapists who have worked with SGM asylum seekers in group therapy settings.Resultsvia thematic analysis, we identified the following major themes to consider when designing mental health interventions for this population: stressors and mental health symptoms; experiences with and attitudes toward therapy, preferences regarding group content, format, composition, and leadership; and concerns regarding therapy. Participants very were interested in group therapy, including online group therapy, preferred skills-based therapy, and groups with other SGM asylum seekers who were not from their own country. Participants wanted access to individual support outside of the group setting and were hesitant to have past traumatic experiences discussed in a group setting.ConclusionThese findings suggest virtual group therapy that includes skills-based content is an acceptable mental health intervention for SGM asylum seekers and group structure, content, and delivery should address their specific preferences and concerns.
Introduction:We aimed to identify socioenvironmental determinants of alcohol use among Black sexually minoritized men (SMM) and transgender women (TW). Method:Data were from the Neighborhoods and Networks (N2) cohort study among Black SMM and TW (01/2018-08/2020). We used stepwise negative binomial regression to identify associations with alcohol use. Result:Among our sample of 142 Black SMM and TW (agemean=24±4 years), 68% reported past month alcohol use. Adverse childhood experiences (IRR=1.10;95%CI=1.03-1.18), GAD-7 (IRR=1.03;95%CI=1.00-1.07), and community violence (IRR=1.06;95%CI=1.02-1.10), were positively associated with alcohol use. Conclusion:Multilevel alcohol reduction interventions can consider reducing community violence and increasing access to mental health services.
BackgroundThe transition into adulthood for sexual and gender minority emerging adults (SGM EA) in the United States, along with stressors of stigma experiences, may contribute to the disproportionate mental illness risk, specifically depression, suicidal ideation, anxiety, and substance use compared to their cisgender heterosexual peers. Critical narratives may provide the means as an individual intervention to address these concerns.MethodsUsing data from a randomized trial (NCT05899218), this pilot study explored the implementation outcomes and feasibility of individual critical narratives (CN) for SGM EA of color through a convergent mixed methods design. Participants completed a survey and interview at baseline and then were randomized in a 1:1 ratio to either the Photo-Novella or Digital story condition. Participants were given 4 wk to create their narrative. They then completed a follow-up survey and interview.ResultsParticipants (N = 15; mean age of 20.70; SD = 1.81) reported that critical narratives were feasible (16.60, SD = 2.46), acceptable (17.26, SD = 3.15), and appropriate (17.47, SD = 2.39). Participants stated in interviews that they enjoyed creating narratives and that this was an activity that they would recommend to others.DiscussionOverall, critical narratives as an individual activity are feasible, acceptable, and have potential to impact mental health outcomes for SGM EA of color. Future research should examine the effectiveness of CN in addressing mental health outcomes that impact SGM EA of color.
IntroductionMedia dissemination of anti-LGBT+ sentiments is commonplace in Malaysia. This study examines the prevalence of negative media exposure among LGBT+ people in Malaysia, the association between negative media exposure and mental health outcomes, and the role of negative future expectations for societal unacceptance as a mediator of the association.MethodDrawing data from a cross-sectional survey of Malaysia-based LGBT+ adults (n = 675; mean age = 27.78), we conducted a series of regression and mediation analyses to determine whether exposure to negative media messages was predictive of heightened levels of negative future expectations, depression, non-suicidal self-injury, and suicidality.ResultsMore than two-thirds (76%) saw negative LGBT-related messages regularly on newspapers, television, and social media in the past year. Frequent exposure of negative messages on media platforms was positively associated with depression, NSSI, and suicidal ideation. Negative future expectations partially mediated the relationship between exposure to negative messages and mental health outcomes.ConclusionsThe study highlights the role of negative media messages as a social determinant of mental health inequities for LGBT+ people. The findings call for a multi-level intervention to mobilize members in government sectors, healthcare settings, and academic institutions to discern and actively challenge disinformation targeting LGBT+ communities.
IntroductionPrevious research has demonstrated that concealment of a minority sexual orientation is correlated with poorer mental health. Impostor phenomenon may mediate this link. This is the first study to empirically examine impostor phenomenon among sexual minority adults.MethodFive hundred and ninety-nine sexual minority adults (Mage = 27.62) were recruited through social media advertisements and snowball sampling. Participants completed an online survey assessing concealment, impostor phenomenon, depressive symptoms, anxiety symptoms, and internalized homonegativity.ResultsConsistent with previous research, concealment predicted both depression and anxiety. Impostor phenomenon meditated the association between concealment and depression and concealment and anxiety. However, internalized homonegativity did not moderate the associations between concealment and mental health outcomes or concealment and impostor phenomenon.ConclusionThis study fills an important gap in the literature by introducing the construct of impostor phenomenon to the field of sexual minority mental health. When working with sexual minority clients, therapists should ask about their clients' concealment behaviors and experiences with impostor phenomenon.
IntroductionSelf-ratings of mental health in the U.S. have declined, particularly for QTBIPOC individuals due to the global pandemic and racial unrest.MethodsThe authors examined the experiences of burnout and wellness among 17 QTBIPOC clinicians at two QTBIPOC-led and QTBIPOC-centered community-based therapy group practices. The participants completed the Copenhagen Burnout Inventory (CBI) as well as participated in one of five focus groups. The CBI was analyzed using descriptive statistics while the focus groups were coded using thematic analysis.ResultsMajor themes included high levels of personal burnout and work-related burnout, perceptions of how clinician identity impacts therapeutic work, financial wellness, the power of community, impact of virtual therapy on wellness, and sustainability of clinical hours.ConclusionHelping QTBIPOC community-based therapy group practices create sustainable careers for QTBIPOC therapists so they do not burnout and leave the profession is critical.
ObjectiveThis study aims to evaluate the effectiveness of trauma-informed group therapy for LGBTQIA+ people who experienced trauma due to the February 6, 2023 earthquake.MethodThe study was conducted between June and July 2023 with a group of 20 LGBTQIA+ people aged 24-32. In addition to a Personal Information Form, the Depression, Anxiety, and Stress Scale (DASS-21) and the Multidimensional Trauma Scale/Post-Traumatic Symptom Scale (PTSS) were administered to the participants as pre- and post-tests. The therapy entailed eight sessions and outcomes tested using a wait list control group.ResultsAt the conclusion of the group therapy, a significant difference was observed in the total scores of the Depression, Anxiety, and Stress Scale (DASS-21) and the Multidimensional Trauma Scale/Post-Traumatic Symptom Scale (PTSS) for LGBTQIA+ people in the experimental group.ConclusionThe findings provide preliminary support for the effectiveness of trauma-informed group therapy in addressing the mental health needs of LGBTQIA+ people affected by the earthquake. Given the study's limitations, including the small sample size and challenges in accessing this population, further research is needed to validate these results and explore additional therapeutic interventions tailored to the unique experiences and needs of LGBTQIA+ people with trauma exposure.
Introduction:High body mass index (BMI) can be a barrier to accessing gender-affirming surgery (GAS). Method:This case report discusses the mental health implications of being denied GAS based on BMI in a transgender woman presenting to psychiatric care integrated with primary care. Subsequently, we summarize existing literature regarding GAS and mental health. Result:Existing literature on GAS outcomes robustly demonstrates the mental health benefits of undergoing desired GAS and does not support using BMI to determine surgical candidacy. Conclusion:This case highlights why psychiatrists and other mental health clinicians should be concerned about BMI serving as a barrier to our patients accessing GAS.
IntroductionLesbian and Gay People (LGP) and people of the Global Majority (GM) experience minority stressors. Identifying as a Lesbian and Gay Person of the Global Majority (LGP-GM) creates complex minority stressors.MethodA thematic synthesis of 16 qualitative studies exploring LGP-GM experiences of minority stressors using the lens of Minority Stress Theory was conducted.ResultsFour analytical themes emerged: Intersectionality: Navigating the queer scene as an LGP-GM, Intersectionality: Navigating GM spaces as an LGP-GM, Internal intersectional identity conflict and Lack of connection to culture, religion, and others.Conclusion:Unique minority stressors are identified for LGP-GM, clinical implications and future research are discussed.
BackgroundSituations in which a patient refuses to share a hospital room with a transgender individual raise significant ethical and policy questions.AimsThe present study sought to determine whether hospitals in New York City have established policies to address roommate refusal.MethodsThe authors obtained the policies of New York hospitals through direct solicitation and through review of public sources.ResultsThe authors found that only three of the fifteen largest hospitals in New York City appear to have rooming policies that address patients who decline to share rooms with transgender patients.DiscussionThe absence of such policies is an oversight, which raises significant concerns for the welfare of transgender patients. At a time when ensuring equity for transgender patients is drawing the increased attention that it merits, addressing the absence of such rooming policies is a crucial step toward protecting the wellbeing of this vulnerable population and furthering transgender-affirming care.
