Stress,Stigma, and Sexual Minority Status: The Intersectional Ecology Model of LGBTQ Health

One of the four overarching goals of Healthy People 2020 is to achieve health equity, eliminate health disparities, and improve the health of all groups, including the health of lesbian, gay, bisexual, transgender, and questioning (LGBTQ) populations. In 2011, the Institute of Medicine (IOM) released a report that drew attention to the unique health disparities experienced by sexual minorities and underscored the need for a comprehensive approach to sexual minority health research. This article proposes a new model of LGBTQ health to help measure, explore, explain, and predict the impact of sexual minority status on health outcomes. The Intersectional Ecology Model of LGBTQ Health (IEM) demonstrates how the relentless hypervigilance of LGBTQ individuals in a heteronormative society impacts health outcomes through the primary vehicles of stigma and chronic, elevated stress. The purpose of the IEM is to guide future research and enhance public health practice for LGBTQ populations.     

Integrated care workforce development: university-community collaboration

ABSTRACT

Behavioral health workforce shortages to provide quality care services for children, adolescents, and transitional age youth are well established. This paper highlights the workforce shortage and the need to infuse interprofessional education to engage in integrated care for children, adolescents and transitional age youth with behavioral health needs. A specialized training curriculum to build behavioral health workforce in Nevada was conceptualized and delivered through 10 workshops under the auspices of the Health Resources & Services Administration (HRSA) funded Behavioral Health Workforce Education and Training (BHWET) grant funded in 2014. To train existing workforce and in alignment with the spirit of the grant to build behavioral health workforce and existing workforce, workshops were extended to social service providers in the community. In an effort to enhance university-community collaboration, workshop presenters were invited from various units in the University and from social service agencies in the community. Implications of such training are addressed from a policy, practice, research, and university-community collaboration perspective.     

Avenues for Future Minority Stress and Substance Use Research among Sexual and Gender Minority Populations

Sexual and gender minority individuals (lesbian, gay, bisexual, transgender, queer [LGBTQ]) experience elevated rates of minority stress and associated substance use relative to their heterosexual and cisgender counterparts. Although the minority stress–substance use relationship is well documented, less is currently known regarding day-to-day minority stress and substance use risk processes. Rather than criticize existing literature, this review highlights future directions and advocates for the use of experience sampling methodology as a valuable research tool regarding real-time data capture. Greater utilization of this methodology is encouraged and expected to improve understanding of daily minority stress processes, and provide insight into real-time risk monitoring and intervention strategies.     

Health Care Reform and the Behavioral Health Workforce

Health care reform will increase the number of individuals who have access to substance abuse services. This impending influx of consumers has the potential of overwhelming the service capacity of providers within the field. Provisions included in the reform legislation might fall short of their intended goal to expand the number of service providers needed to deliver services. This article discusses unmet treatment need in the United States, the current numbers of service providers, and provisions within the reform legislation to increase the labor force. Recommendations are set forth that could help expand the number of providers in the field.     

HIV Prevention,Gender and Sexual Health

Abstract

Drawing on a review of relevant literature as well as global experience, this paper focuses on aspects of the growing feminisation of the HIV epidemic, especially the combination of age and gender which makes young women particularly vulnerable to HIV. It also briefly touches upon the gender-constructed vulnerability of young men. The linkages between gender, sexual health and HIV-and what works to forge these linkages-have now been well established. Not acting on the basis of this knowledge in order to avert millions of infections and deaths due to HIV, is no longer an option.     

Family Phone Therapy in University Counseling and Psychological Service Centers: A Family Systems Approach

Abstract

This paper offers family phone therapy as a method for student mental health practitioners to overcome the obstacle of geographic distance between students and their families when family therapy is the treatment of choice. The issues of confidentiality, triangulation, diversionary conversation, and mixed communication, which present unique concerns when engaging in family phone therapy, are introduced and strategies to deal with them are discussed. A case example is presented to demonstrate the utility of family phone therapy in dealing with problems that students who use university mental health services can typically experience. Finally, implications of dealing with students' developmental tasks from an individual or family systems perspective are discussed.     

Time to ask and tell: Voices of older gay and bisexual male veterans regarding community services

ABSTRACT

This participatory action study involved lesbian, gay, bisexual, transgender, and queer (LGBTQ) veterans in determining community-based service needs for health and wellness, illuminating perspectives of older LGBTQ veterans regarding community services. This study explored veterans' perceptions of being LGBTQ later in life. The study included data from interviews with gay and bisexual male veterans ages 51 to 87. Participants valued engagement as part of community. Their recommendations for action included communal meals, transportation, housing, and the coming-out process. Community services facilitated community engagement to support health and wellness for LGBTQ older veterans. The authors used participatory action research (PAR), a method of systematic inquiry integrating the perspective of persons living the experience, to organize the study. Further PAR is recommended to implement community services to meeting health and wellness needs of participants.     

Sexual Concerns and Counseling Needs of Normal Men Attending a University Student Health Service

Abstract

The responses of 582 male university students attending the UCLA Student Health Service for medical evaluation are presented. Of these students, 37% (215) were freshmen and varsity athletes having pretraining physicals, and 63% (367) were students being evaluated in the SHS primary care clinics. A self-report questionnaire examined the frequency of sexual problems experienced by the respondents and their partners. The most common concerns expressed about themselves were orgasmic difficulties, feeling too interested in sex, and trouble getting and keeping erections. Forty-one percent of the SHS group and 33% of the athletes group had sexual concerns, and, of these, 55% and 40% respectively wanted help with their problems. Specific counseling needs of students were also evaluated.     

Exploring Gender and Racial/Ethnic Differences in the Effects of Child Sexual Abuse

Child sexual abuse (CSA) has been linked to a number of adverse effects including hypersexuality (HYP), substance use (SUB), suicidality (SUI), and depression (DEP). Despite a plethora of research on CSA, little is known about how it affects adolescents and the cultural factors that influence their coping styles. This study was founded on social-cultural coping theory and the model of traumagenic dynamics of sexual abuse, suggesting that CSA consequences lead to maladaptive coping mechanisms influenced by sociocultural factors. Using archival data, loglinear analysis was conducted to examine gender differences within racial/ethnic groups in HYP, SUI, DEP, and SUB among adolescent survivors of CSA in a National sample of 13,583 male and female high school students. The purpose of the study was to identify differences in the effects of CSA as manifested by variations of maladaptive coping across racial/ethnic groups and gender. Boys were significantly more likely to use substances, while girls were more likely to experience depressive symptoms and suicidality. Notably, this study did not reveal any significant racial/ethnic differences in adolescent coping. These findings can inform treatment planning and interventions for adolescents who may present with DEP, SUI, SUB, or risky sexual behaviors, but may have underlying trauma from CSA. This study contributes to the knowledge base about the processes that take place within adolescent CSA survivors, shedding light on cultural nuances among adolescent coping and informing culturally competent practice.     

Gender Differences in the Path From Sexual Victimization to HIV Risk Behavior Among Homeless Youth

ABSTRACT

Experiencing sexual victimization prior to becoming homeless is common among homeless youth and is associated with increased HIV risk behavior. This study examined mediating variables that underlie this association, adding to the understanding of gender differences in these paths. Participants were homeless youth in Los Angeles recruited through service access centers who completed a computerized self-administered interview in English or Spanish using an iPad. Findings indicate a high presence of sexual victimization across both genders. Female participants experienced posttraumatic stress disorder and subsequent engagement with exchange sex, whereas male participants were primarily involved in substance use risk pathways. Results indicate paths in the association between sexual victimization and HIV risk behavior differ between male and female homeless youth. Gender-specific, mental-health-informed interventions targeting sexual risk reduction are warranted.     

Mental Health Service Delivery to Sexual Minority and Gender Non-Conforming Students in Schools: A Winnicottian Approach

Current research highlights the increased risk factors that sexual minority (lesbian, gay, bisexual) and gender minority (transgender/gender non-conforming) students face as compared to their heterosexual and cisgender peers. These risk factors include higher rates of depression, suicide, substance use, school dropout, sexually transmitted infections, experiences with bullying on school campuses and increased risk of homelessness. Although this research has aided our understanding of the needs and risks of this population of youth, few articles have emerged from these data which offer a comprehensive theoretical approach to work clinically with these adolescents in school-based settings. This article explores how school mental health staff can address the behavioural health needs of sexual and gender minority students through the adoption of a Winnicottian theoretical approach. With an intensive focus on academic achievement, schools have historically been limited in their usage of evidence-based data to create programs which adequately address the mental health needs of student populations on their campuses. Yet, sexual and gender minority students are likely to be present in almost every school in the country. Schools can serve as gateways to mental health access and can offer innovative and culturally responsive practices across racial, ethnic, class, and geographic lines. As the single largest holders of the student population in the United States, schools have the ability to play a significant role in mental health service provision for sexual and gender minority youth.     

Perceptions of Physical Sexual Health Among Young Men Who Have Sex with Men with a Previous History of Childhood Sexual Abuse

Childhood sexual abuse (CSA) has been reported to be disproportionately higher among young men who have sex with men (YMSM) than among heterosexual men. Most research and public health programs among YMSM CSA survivors have been mainly infectious disease-based, and research on the physical sexual health among this group is limited. This study sought to further understand components of physical sexual health among YMSM with CSA histories. Sixteen participants were recruited, and through a phenomenological approach, semi-structured interviews were conducted. Four themes were found, participants (1) reported a one-dimensional definition of sexual health; (2) had limitations in health insurance hindering preventative care; (3) described reoccurring anal pain during sexual intercourse; and (4) conveyed a positive perception of sexual satisfaction. These findings indicate a need for healthcare providers, health educators, and researchers to increase awareness about the comprehensive needs of YMSM with CSA histories.     

Sexual Minority Women's Gender Identity and Expression: Challenges and Supports

Sexual minority women were divided into four groups to study their gender identities (butch and femme), and gender expression (traditionally gendered and non-traditionally gendered women who do not identify as butch or femme). Experiences of heterosexist events (discrimination, harassment, threats of violence, victimization, negative emotions associated with these events), mental health (self esteem, stress, depression), and supports for a sexual minority identity (social support, outness, internalized homophobia) were examined across these groups. Findings suggested that butch-identified women experienced more heterosexist events than femme women or women with non-traditional gender expressions. There were no differences in mental health variables.     

Men's Reproductive and Sexual Health

Abstract

A broad definition of men's reproductive and sexual health (MRSH) includes medical (pathophysiological) matters such as sexually transmitted infections (STIs), developmental anomalies, malignancy, trauma, and infertility. It also includes psychosocial concerns: sexuality, contraception, disease prophylaxis, developmental and lifecycle issues, tobacco and drug use, sexual identity and orientation, and partnership issues. College men, of whom a large majority are sexually active, have a range of MRSH needs, including some that are particular to their age and social environment. To reach men effectively requires approaches that are somewhat different from those used with women. Clinicians in college health services are in an excellent position to help young men recognize the importance of reproductive health and sexual responsibility. College health services therefore should offer men screening; clinical diagnosis and treatment for MRSH conditions; and information, education, and counseling services, in a manner designed to meet their unique needs.     

Mental Health and Behavioral Outcomes of Sexual and Nonsexual Child Maltreatment Among Child Welfare-Involved Youth

Our research team used the nationally representative National Survey of Child and Adolescent Well-Being II to explore the differences in mental health and behavioral outcomes between children who enter the child welfare system with substantiated sexual abuse and those who enter with exclusively nonsexual maltreatment. The sample included 380 children between the ages of 8 to 17.5 who were substantiated for maltreatment (sexual and nonsexual) and had the same caregivers at both wave 1 and 2 (n = 380). Results show that the average age of children in the sample was 11 years old, and the results corroborate literature that has indicated children and youth with histories of childhood sexual abuse experience significantly more post-traumatic stress disorder symptoms than children with histories of nonsexual maltreatment. This finding held after controlling for baseline trauma symptoms and all covariates, including race, age, placement type, and caregiver characteristics. Childhood sexual abuse was not significantly related to an increase in behavioral symptoms after controlling for covariates. Implications for research and practice are offered.     

Sexual and Gender Identity Disorders

Abstract

The author responds to Hill et al.'s “Gender Identity Disorders in Childhood and Adolescence: A Critical Inquiry” and Moser and Kleinplatz's “DSM-IV-TRand the Paraphilias: An Argument for Removal.” The author sees the paper as raising the issue of whether there are any cases for which sexual and gender identity diagnoses are appropriate. The author believes a central issue is how does one decide that something is just unusual (normal variation) or something is disordered (pathological). The author believes the concept of “medical disorder” can be applied to human behavior and gives examples to support that view. The author supports an essentialist view that some “things” (like being human and modes of sexual expression) have properties or qualities that are invariable and represent the true essence of the “thing.” From this perspective, the author finds the arguments for eliminating the categories of GID and paraphilias from the DSM as weak at best.     

The Effects of Sexual Orientation,Gender Identity,and Gender Role on the Mental Health of Women in Taiwan's T-Po Lesbian Community

SUMMARY

We obtained via the Internet a convenience sample of Taiwanese heterosexual (n = 287) and sexual minority females (n = 260). A significantly greater percentage of sexual minorities (lesbian and bisexual females) than heterosexuals reported they had used tobacco or alcohol. Relative to heterosexuals, sexual minorities were significantly more likely to report a serious suicide attempt. Overall, gender identity (masculine, feminine, and androgynous) and gender role (butch, femme, and pure or undifferentiated) were poor discriminators of lesbian mental health. Differences between sexual minorities and heterosexuals were more robust than were the variations in gender identities and gender roles among lesbian and bisexual women. We discuss the implications of these findings for further clinical research.