Burden of psychiatric morbidity among lesbian, gay, and bisexual individuals in the California Quality of Life Survey.

In recent population-based surveys, minority sexual orientation has been identified as a potential risk indicator for psychiatric morbidity. However, methodological limitations in the studies to date have led to concerns that current estimates are biased due to inadequate measurement of sexual orientation and uncontrolled confounding from prevalent HIV infection. In the present study, the authors investigate associations between sexual orientation and mental health/substance use morbidity using information obtained from 2,272 individuals, including 652 sexual orientation minorities, age 18 to 72 years, interviewed in the California Quality of Life Survey. Results confirm that minority sexual orientation is a risk indicator for psychiatric morbidity. However, levels of increased risk vary within this subpopulation by both gender and patterns of sexual orientation expression. Among gay/bisexual men, much of this greater burden is related to concurrent HIV infection. Reducing excess mental health morbidity risk among sexual orientation minorities could result in possibly a 5% to 11% reduction in the burden of the disorders assessed here among the adult population. Sexual orientation represents an important, but relatively understudied, individual characteristic shaping risk for psychiatric morbidity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Working in a majority context: A structural model of heterosexism as minority stress in the workplace.

This study used the minority stress theory to develop models of antecedents and outcomes of heterosexism in the workplace. Heterosexism was assessed via the Workplace Heterosexist Experiences Questionnaire, a new scale assessing direct (e.g., anti-gay jokes) and indirect experiences (e.g., assumptions of heterosexuality). Structural equation modeling with two community samples (N?=?287) of gay, lesbian, and bisexual people indicated that heterosexism was best predicted by perceptions that the employer does not take heterosexism seriously (i.e., organizational climate). Experiencing heterosexism was associated with adverse psychological, health, and job-related outcomes, thus supporting the minority stress theory. In addition, outness was positively related to experiences of direct heterosexism but negatively related to indirect experiences. The minority stress theory is discussed in light of the mental health history of pathologizing homosexuality. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relationships over time between mental health symptoms and transmission risk among persons living with HIV.

Relationships between mental health symptoms (anxiety and depression) or a positive state of mind and behavior associated with HIV transmission (substance use and risky sexual behavior) were explored in a longitudinal study of persons living with HIV (PLH; N = 936) who were participants in a transmission-prevention trial. Bivariate longitudinal regressions were used to estimate the correlations between mental health symptoms and HIV-related transmission acts for 3 time frames: at the baseline interview, over 25 months, and from assessment to assessment. At baseline, mental health symptoms were associated with transmission acts. Elevated levels of mental health symptoms at baseline were associated with decreasing alcohol or marijuana use over 25 months. Over 25 months, an increasingly positive state of mind was associated with decreasing alcohol or marijuana use; an increasingly positive state of mind in the immediate intervention condition and increasing depressive symptoms in the lagged condition were related to increasing risky sexual behavior. Our findings suggest that mental health symptoms precede a decrease in substance use and challenge self-medication theories. Changes in mental health symptoms and sexual behavior occur more in tandem. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mental health and substance use disorders among Latino and Asian American lesbian, gay, and bisexual adults.

Growing evidence suggests that lesbian, gay, and bisexual adults may be at elevated risk for mental health and substance use disorders, possibly due to anti-gay stigma. Little of this work has examined putative excess morbidity among ethnic/racial minorities resulting from the experience of multiple sources of discrimination. The authors report findings from the National Latino and Asian American Survey (NLAAS), a national household probability psychiatric survey of 4,488 Latino and Asian American adults. Approximately 4.8% of persons interviewed identified as lesbian, gay, bisexual, and/or reported recent same-gender sexual experiences. Although few sexual orientation-related differences were observed, among men, gay/bisexual men were more likely than heterosexual men to report a recent suicide attempt. Among women, lesbian/bisexual women were more likely than heterosexual women to evidence positive 1-year and lifetime histories of depressive disorders. These findings suggest a small elevation in psychiatric morbidity risk among Latino and Asian American individuals with a minority sexual orientation. However, the level of morbidity among sexual orientation minorities in the NLAAS appears similar to or lower than that observed in population-based studies of lesbian, gay, and bisexual adults. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Offsetting risks: High school gay-straight alliances and lesbian, gay, bisexual, and transgender (LGBT) youth.

Lesbian, gay, bisexual, and transgender (LGBT) youth are at risk for engaging in negative health behaviors and for experiencing at-school victimization. Specific benefits of attending a high school with a gay-straight alliance (GSA), including lower levels of suicidality, have been published; however, it is unclear whether GSAs are related to lower levels of problematic substance use, depressive symptoms, and psychological distress. Using a sample of 145 LGBT youth recruited from college and university organizations for LGBT students, we examined whether attending a high school with a GSA was related to more positive school experiences and mental health outcomes for LGBT youth. The results indicate that youth who attended a high school with a GSA report significantly more favorable outcomes related to school experiences, alcohol use, and psychological distress. The implications of the findings are discussed as they relate to school psychologists. Important limitations of this study are reviewed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Mental health pathways from interpersonal violence to health-related outcomes in HIV-positive sexual minority men.

Objective: We examined mental health pathways between interpersonal violence (IPV) and health-related outcomes in HIV-positive sexual minority men engaged with medical care. Method: HIV-positive gay and bisexual men (N = 178) were recruited for this cross-sectional study from 2 public HIV primary care clinics that treated outpatients in an urban setting. Participants (M age = 44.1 years, 36% non-White) filled out a computer-assisted survey and had health-related data extracted from their electronic medical records. We used structural equation modeling to test associations among the latent factors of adult abuse and partner violence (each comprising indicators of physical, sexual, and psychological abuse) and the measured variables: viral load, health-related quality of life (HRQOL), HIV medication adherence, and emergency room (ER) visits. Mediation was tested for the latent construct mental health problems, comprising depression, anxiety, symptomatology of posttraumatic stress disorder, and suicidal ideation. Results: The final model demonstrated acceptable fit, χ2(123) = 157.05, p = .02, CFI = .95, TLI = .94, RMSEA = .04, SRMR = .06, accounting for significant portions of the variance in viral load (13%), HRQOL (41%), adherence (7%), and ER visits (9%), as well as the latent variable mental health problems (24%). Only 1 direct link emerged: a positive association between adult abuse and ER visits. Conclusions: Findings indicate a significant role of IPV and mental health problems in the health of people living with HIV/AIDS. HIV care providers should assess for IPV history and mental health problems in all patients and refer for evidence-based psychosocial treatments that include a focus on health behaviors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The impact of minority stress on mental health and substance use among sexual minority women.

Objective: We examined the direct and indirect impact of minority stress on mental health and substance use among sexual minority women. Method: A combination of snowball and targeted sampling strategies was used to recruit lesbian and bisexual women (N = 1,381) for a cross-sectional, online survey. Participants (M age = 33.54 years; 74% White) completed a questionnaire assessing gender expression, minority stressors (i.e., victimization, internalized homophobia, and concealment), social–psychological resources (i.e., social support, spirituality), and health-related outcomes. We used structural equation modeling to test associations among these factors, with gender expression as an antecedent and social–psychological resources as a mediator between minority stress and health. Results: The final model demonstrated acceptable fit, χ2(79) = 414.00, p confirmatory fit index = .93, Tucker–Lewis index = .91, standardized root-mean-square residual = .05, root-mean-square error of approximation = .06, accounting for significant portions of the variance in mental health problems (56%) and substance use (14%), as well as the mediator social–psychological resources (24%). Beyond indirect effects of minority stress on health outcomes, direct links emerged between victimization and substance use and between internalized homophobia and substance use. Conclusions: Findings indicate a significant impact of minority stressors and social–psychological resources on mental health and substance use among sexual minority women. The results improve understanding of the distinct role of various minority stressors and their mechanisms on health outcomes. Health care professionals should assess for minority stress and coping resources and refer for evidence-based psychosocial treatments. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

"I only read about myself on bathroom walls": the need for research on the mental health of lesbians and gay men

The very recent history of pathologizing homosexuality still has a strong impact on the public in general and mental health professionals in particular. In contrast to the early research on sexual reorientation of lesbians and gay men, there is relatively little empirical research on the mental health issues of lesbians and gay men. Whether researchers choose to define sexual orientation by sexual behavior, self-definition, or membership in lesbian and gay community groups will have an impact on the results. Research on mental health issues that include lesbians, gay men, and heterosexual women and men would allow an examination of the relative salience of gender versus sexual orientation. Finally, the experiences of lesbians and gay men in society may place them at increased risk for some mental health problems and may protect them from other mental health problems.     

Minority stress and mental health among Dutch LGBs: Examination of differences between sex and sexual orientation.

Minority stress is often cited as an explanation for greater mental health problems among lesbian, gay, and bisexual (LGB) individuals than heterosexual individuals. However, studies focusing on sex or sexual orientation differences in level of minority stress and its impact on mental health are scarce, even more so outside the United States. Performing secondary analyses on the data of a Dutch population study on sexual health, the present study examines the robustness of the minority stress model by explaining mental health problems among men and women with mostly or only same-sex sexual attraction, and men and women who are equally attracted to same-sex and opposite-sex partners in the “gay-friendly” Netherlands (N = 389; 118 gay men, 40 bisexual men, 184 lesbian women, and 54 bisexual women). Results showed that minority stress is also related to mental health of Dutch LGBs. Participants with a higher level of internalized homonegativity and those who more often encountered negative reactions from other people on their same-sex sexual attraction reported more mental health problems. Such negative reactions from others, however, had a stronger link with mental health among lesbian/gay than among bisexual participants. Openness about one's sexual orientation was related to better mental health among sexual minority women, but not among their male counterparts. Suggestions for future research, implications for counseling, and other societal interventions are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Stress and coping among gay men: Age and ethnic differences.

Previous studies suggest that perceived stigmatization of sexual minority status, ethnicity, and age are associated with negative mental health outcomes, and other studies suggest that coping styles may influence these outcomes. However, no studies have examined these relationships among gay men of varying ethnicities and age groups. Three hundred eighty-three Black and White, younger, middle-aged, and older adult gay men completed measures of perceived stigmatization, coping style, and mental health outcomes. Black older adult gay men reported significantly higher levels of perceived ageism than the older White group, significantly higher levels of perceived racism than the younger Black group, significantly higher levels of homonegativity than the younger Black and the White groups, and were more likely to use disengaged coping styles than White gay men. However, Black older adult gay men did not experience significantly higher levels of negative mental health outcomes. Results suggest that further research should examine how older Black gay men, who perceive higher levels of stigma while reporting greater use of less effective coping styles, do not appear to be experiencing more negative mental health outcomes as a result. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychological interventions with AIDS and HIV: Prevention and treatment.

In the decade since AIDS was first diagnosed, behavioral research has focused intensively on risk reduction change processes and, to a lesser extent, on mental health needs of persons with HIV conditions. Although research to date has yielded important findings for primary prevention efforts and has identified some psychological dimensions relevant to mental health interventions, there is a pressing need for much more systematic intervention outcome research in both the prevention/behavior change and emotional coping areas. Progress in these areas will be facilitated by better linkage of intervention approaches to behavioral theory; identification of intervention elements that produce HIV risk behavior change; evaluated field-testing of promising intervention models; continued focus on populations that remain at risk (such as gay men and iv drug users); and expansion of prevention efforts to urban, poor, and minority populations increasingly threatened as AIDS/HIV enters a "2nd wave." Although AIDS is still a relatively new problem, existing behavioral medicine conceptual models and intervention strategies can be adapted to meet the enormous challenges created by AIDS and HIV infection. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Social support, AIDS-related symptoms, and depression among gay men.

Examined the impact of social support and human immunodeficiency virus (HIV)-related conditions on depression among 508 gay men participating in the San Francisco Men's Health Study, a population-based prospective study of single men (aged 25–54 yrs). The number of HIV-related symptoms experienced significantly predicted depression cross-sectionally and 1 yr later. Satisfaction with each of 3 types of social support (emotional, practical, informational) was inversely correlated with depression. Men who were more satisfied with the social support they received were less likely to show increased depression 1 yr later. Degree of satisfaction with informational support appeared especially critical in buffering the stress associated with experiencing HIV symptoms. These findings offer valuable insight in understanding the psychological needs of gay men confronting the acquired immune deficiency syndrome (AIDS) crisis and have important practical implications for designing mental health services to meet those needs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Close relationships and elevated HIV risk behavior: Evidence and possible underlying psychological processes.

A review of research on AIDS preventive behavior indicates that minority and nonminority heterosexual adolescents and adults, gay men, injection drug users, and commercial sex workers are all less likely to practice safer sex with close relationship partners, compared with partners they perceive to be "casual" sexual partners. Because many individuals in close relationships have engaged in HIV risk behavior over extended periods of time and are unaware of their actual HIV status, practicing unprotected sexual intercourse with a committed relationship partner who is not tested for HIV appears to be a major and unrecognized source of HIV risk. This article reviews the evidence for higher levels of HIV risk behavior in close relationships and then presents relevant conceptual and empirical work to explore the psychological processes that may underlie risky sexual behavior in close relationships, using as a framework the information-motivation-behavioral skills model of preventive behavior. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prevalence of mental disorders, psychological distress, and mental services use among lesbian, gay, and bisexual adults in the United States.

Recent estimates of mental health morbidity among adults reporting same-gender sexual partners suggest that lesbians, gay men, and bisexual individuals may experience excess risk for some mental disorders as compared with heterosexual individuals. However, sexual orientation has not been measured directly. Using data from a nationally representative survey of 2,917 midlife adults, the authors examined possible sexual orientation-related differences in morbidity, distress, and mental health services use. Results indicate that gay-bisexual men evidenced higher prevalence of depression, panic attacks, and psychological distress than heterosexual men. Lesbian-bisexual women showed greater prevalence of generalized anxiety disorder than heterosexual women. Services use was more frequent among those of minority sexual orientation. Findings support the existence of sexual orientation differences in patterns of morbidity and treatment use. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

"Perceived group devaluation, depression, and HIV-risk behavior among Asian gay men": Correction to Chae and Yoshikawa (2008).

Reports an error in "Perceived group devaluation, depression, and HIV-risk behavior among Asian gay men" by David H. Chae and Hirokazu Yoshikawa (Health Psychology, 2008[Mar], Vol 27[2], 140-148). In the aforementioned article, the second sentence of the Results portion of the abstract should read: Among participants most attracted to Whites, group devaluation was associated with higher levels of nonprimary partner UAI; but was associated with lower levels of nonprimary partner UAI among those most attracted to non-Whites. (The following abstract of the original article appeared in record 2008-03424-002.) Objective: This study examined depressive mood and HIV-risk behavior in relation to perceived group devaluation and group identity. Design: Cross-sectional survey of 192 Asian gay men. Main Outcome Measures: Depressive mood assessed using the Centers for Epidemiological Studies Depression Scale (CES-D) and self-reported receptive or insertive unprotected anal intercourse (UAI) in the past 3 months. Results: Group devaluation was positively associated with depressive mood. Among participants most attracted to Whites, group devaluation was associated with higher levels of nonprimary partner UAI, among those most attracted to non-Whites. Among participants reporting higher levels of group devaluation, those with more positive personal evaluations of the Asian gay community had lower levels of total UAI compared to those with more negative personal evaluations of the Asian gay community. Conclusions: Results suggest that group devaluation is associated with higher levels of depressive mood among Asian gay men. Asian gay men most attracted to non-Whites or hold more positive evaluations of their group may be buffered from the influence of high perceived group devaluation on UAI. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Perceived group devaluation, depression, and HIV-risk behavior among Asian gay men.

[Correction Notice: An erratum for this article was reported in Vol 27(3) of Health Psychology (see record 2008-08834-013). In the aforementioned article, the second sentence of the Results portion of the abstract should read: Among participants most attracted to Whites, group devaluation was associated with higher levels of nonprimary partner UAI; but was associated with lower levels of nonprimary partner UAI among those most attracted to non-Whites.] Objective: This study examined depressive mood and HIV-risk behavior in relation to perceived group devaluation and group identity. Design: Cross-sectional survey of 192 Asian gay men. Main Outcome Measures: Depressive mood assessed using the Centers for Epidemiological Studies Depression Scale (CES-D) and self-reported receptive or insertive unprotected anal intercourse (UAI) in the past 3 months. Results: Group devaluation was positively associated with depressive mood. Among participants most attracted to Whites, group devaluation was associated with higher levels of nonprimary partner UAI, among those most attracted to non-Whites. Among participants reporting higher levels of group devaluation, those with more positive personal evaluations of the Asian gay community had lower levels of total UAI compared to those with more negative personal evaluations of the Asian gay community. Conclusions: Results suggest that group devaluation is associated with higher levels of depressive mood among Asian gay men. Asian gay men most attracted to non-Whites or hold more positive evaluations of their group may be buffered from the influence of high perceived group devaluation on UAI. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Stigma, social context, and mental health: Lesbian and gay couples across the transition to adoptive parenthood.

This is the first study to examine change in depression and anxiety across the first year of adoptive parenthood in same-sex couples (90 couples: 52 lesbian, 38 gay male). Given that sexual minorities uniquely contend with sexual orientation-related stigma, this study examined how both internalized and enacted forms of stigma affect the mental health of lesbians and gay men during the transition to parenthood. In addition, the role of contextual support was examined. Higher perceived workplace support, family support, and relationship quality were related to lower depressive and anxious symptoms at the time of the adoption, and higher perceived friend support was related to lower anxiety symptoms. Lower internalized homophobia and higher perceived neighborhood gay-friendliness were related to lower depressive symptoms. Finally, individuals with high internalized homophobia who lived in states with unfavorable legal climates regarding gay adoption experienced the steepest increases in depressive and anxious symptoms. Findings have important implications for counselors working with sexual minorities, especially those experiencing the transition to parenthood. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Interpersonal predictors of depression trajectories in women with HIV.

This article tests an interpersonal model of depression symptom trajectories tailored to the experiences of women with HIV. Specifically, the authors examined how bereavement, maternal role difficulty, HIV-related social isolation, and partner conflict predicted change in depressive symptoms over 5 years in 761 women with HIV, controlling for sociodemographic and clinical health factors. Of these interpersonal characteristics, partner conflict emerged as a robust predictor of change in depressive symptoms in growth curve and cross-lag models. Results highlight the need for interventions focusing on interpersonal issues, particularly intimate relationships, in women with HIV. (PsycINFO Database Record (c) 2010 APA, all rights reserved)