Recommendations for a Better Understanding of Sex and Gender in the Neuroscience of Mental Health.

There are prominent sex/gender differences in the prevalence, expression, and life span course of mental health and neurodiverse conditions. However, the underlying sex- and gender-related mechanisms and their interactions are still not fully understood. This lack of knowledge has harmful consequences for those with mental health problems. Therefore, we set up a cocreation session in a 1-week workshop with a multidisciplinary team of 25 researchers, clinicians, and policy makers to identify the main barriers in sex and gender research in the neuroscience of mental health. Based on this work, here we provide recommendations for methodologies, translational research, and stakeholder involvement. These include guidelines for recording, reporting, analysis beyond binary groups, and open science. Improved understanding of sex- and gender-related mechanisms in neuroscience may benefit public health because this is an important step toward precision medicine and may function as an archetype for studying diversity.

Associations between gender and health-related quality of life in people with IgE-mediated food allergy and their caregivers: A systematic review.

OBJECTIVE: Understanding factors that impact health-related quality of life (HRQL) is essential to inform personalised food allergy management. However, there are inconsistencies about the impact of gender on HRQL in food allergy. This review aimed to collate all investigations of the association between gender and total or subdomain HRQL scores of individuals with food allergy and their caregivers. DESIGN: This is a narrative systematic review. We descriptively synthesised and compared HRQL outcomes by participant and parent genders according to statistical and clinical significance. Study quality was assessed using the ROBINS-I, inclusive of all domains. Sensitivity analysis of non-interventional studies was conducted using the ROBINS-E. DATA SOURCES: A systematic search of Medline and Embase databases was conducted on 4 April 2022 and updated on 5 December 2023. ELIGIBILITY CRITERIA: Studies were eligible for inclusion if they reported original data on the association between any sex and/or gender and HRQL, as measured with any validated instrument, in populations with IgE-mediated food allergy. Interventional and non-interventional studies were eligible. RESULTS: A comparison of 34 eligible studies (10 interventional and 24 non-interventional) indicated females with food allergy (62.5% of studies of children, 83.3% of studies of adults) and mothers of children with food allergy (50% of studies of caregivers) experienced poorer self-reported baseline HRQL than their counterparts, notably in domains of physical, emotional or food anxiety-related well-being. Gender differences in child HRQL after food allergen immunotherapy were observed. However, selective reporting in included interventional studies meant the direction of this association could not be determined. The proxy-reported total HRQL of participants was not affected by caregiver gender, nor was caregiver HRQL likely impacted by child gender. CONCLUSIONS: Gender should be considered an important modifier of participant HRQL outcomes in food allergy studies. Purposeful exploration of HRQL in all genders is needed to fully understand the implications of this construct on the lived experience of food allergy. SYSTEMATIC REVIEW REGISTRATION: PROSPERO (CRD42022329901).

Engaging men in women's empowerment: impact of a complex gender transformative intervention on household socio-economic and health outcomes in the eastern democratic republic of the Congo using a longitudinal survey.

BACKGROUND: In the Democratic Republic of the Congo, women in (peri-)urban areas are commonly engaged in small trade, which allows them to meet the basic needs of their families. Microsaving approaches are a low-risk option to obtain financing for economic activities. A project combining men's sensitization on gender equity and women's empowerment through village savings and loan associations were implemented in North and South Kivu to raise the household economic level. OBJECTIVE: This study assessed how involving men in gender equity affects women's health and socio-economic outcomes, including food security. METHODS: A cohort study was conducted with 1812 women at the baseline; out of them 1055 were retrieved at the follow-up. Baseline data collection took place from May to December 2017 and the follow-up from July 2018 to January 2019. To identify socio-economic changes and changes of gender relations, linear and logistic regressions were run. RESULTS: Results showed that the household income improved with intervention (coefficient = 0.327; p = 0.002), while the capacity to pay high bills without contracting debts decreased (coefficient = 0.927; p = 0.001). We did not find enough statistically significant evidence of the influence of the intervention on skilled birth attendance (coefficient = 0.943; p = 0.135), or family planning use (coefficient = 0.216; p = 0.435) nor women's participation in the decision-making (coefficient = 0.033; p = 0.227) nor on couple's cohesion (coefficient = 0.024; p = 0.431). Food insecurity levels decreased over time regardless of being in the intervention or control area. CONCLUSION: Empowering women while sensitizing men on gender aspects improves financial well-being (income). Time, security, and strong politics of government recognizing and framing the approach are still needed to maximize the benefit of such projects on social factors such as women's participation in decision-making and social cohesion.

[Gender Inequalities of the COVID-19 Pandemic: A Synthesis of Systematic Reviews with a Focus on Sexual and Gender Minorities]. / Geschlechtsspezifische Unterschiede und Ungleichheiten der COVID-19 Pandemie: Eine Synthese systematischer Reviews unter Einbeziehung sexueller und geschlechtlicher Minderheiten.

OBJECTIVE: From the very beginning of the COVID-19 pandemic, gender was shown to play a significant role in how people were affected by it, while aspects related to sexual and gender minorities (SGM) have been rather understudied. The aim of this review was to synthesize systematic reviews and meta-analyses that explicitly addressed the impact of gender within the context of the pandemic, with a focus on SGM. METHODS: We based the narrative synthesis of results on a literature search of PubMed. We included systematic reviews and meta-analyses as of 2019 with an identifiable gender comparison or SGM reference and a specified clinical outcome. RESULTS: The search yielded 2 658 hits; 29 systematic reviews were included for content synthesis. Of these, we identified 23 systematic reviews with gender comparisons and 8 related to SGM. Men showed higher prevalence, severity, and mortality of COVID-19 compared with women, but the psychological consequences of the COVID-19 pandemic affected women more compared with men. Evidence suggests that women are at higher risk for Long-COVID-19. SGM experienced increased mental health problems during the COVID-19 pandemic compared to the general population. DISCUSSION: It appears that biological and social risks led to differential susceptibility to infection and manifestation of COVID-19 disease and also accounted for differences in mortality between men and women. Insights on prevalence, disease burden, and mortality among SGM during the COVID-19 pandemic are lacking. This suggests an underrepresentation of SGM in COVID-19-related research. Despite the abundance of COVID-19 publications, gender effects have not often been explicitly and adequately studied. CONCLUSION: Future studies should examine gender differences and needs and concerns of SGM in mental disorders and further understudied entities like Long-COVID-19, to gain insights and help to provide preventive measures and adequate treatments for all, for potential future pandemics as well.

Gender Differences Regarding Self-Perceived Physical and Mental Health in Spanish University Sports and Physical Therapy Students after Termination of the COVID-19 Lockdown Period.

The COVID-19 pandemic was an unprecedented situation that raised concerns about the physical and mental health of adolescents. Several surveys demonstrated that post-lockdown, women reported more complaints and lower perceived quality of life compared to men. The aim of this study was to analyze gender differences in self-reported physical and mental health immediately after the second lock-down restrictions (July 2020 to December 2020) were suspended and physical exercise classes resumed after a break of several months. This was achieved using a comparative cross-sectional survey of over-18-year-old students from the faculties of Sports Science and Physical Therapy at the University of Cadiz (UCA) in Spain. Quality of life was assessed using two types of questionnaires. The first covered quality of nutrition (PREDIMED), and the second assessed emotional impact (SF12). Physical activity level was estimated using the International Physical Activity Questionnaire (IPAQ). Of the 166 participants in this study, about two-thirds were men. Men had a better perception of their overall health quality than women. In addition, men had significantly fewer limitations in performing activities of daily living than their female counterparts. In contrast, female university students had better coping strategies, that is, they were better able to handle the problems of daily life and did so with more composure, attention, and concentration. These findings highlight the differences in post-release recovery between men and women and can be used to develop programs to promote better living standards and services to reduce gender disparities, which can ultimately improve quality of life.

Everyday Sexual and Gender Minority Stress and Health: A Systematic Review of Experience Sampling Studies.

Sexual and gender minority stress is associated with negative physical and mental health outcomes, such as hypertension and depression. Expanding on previous reviews of the literature on cross-sectional and long-term prospective associations between sexual and gender minority stress and health outcomes, the current systematic review synthesizes the evidence on how everyday sexual and gender minority stress relates to momentary changes in health. The findings of 53 experience sampling studies published between 2007 and 2022 suggest that daily and momentary within-persons fluctuations in minority stressors are associated with cognitive-emotional (e.g., affect, suicidality), behavioral (e.g., substance use), social (e.g., relationship satisfaction), and physical health outcomes (e.g., somatic symptoms). These findings suggest that sexual and gender minority stress is a dynamic process that can vary within individuals over time and significantly impact everyday mental and physical health. We discuss the implications of these findings for minority stress theory, LGBTQ+ health research, LGBTQ+ affirming therapy, and prevention initiatives. The current experience sampling literature is limited by a lack of attention to gender minority stress and a focus on a limited range of health outcomes. Methodological and theoretical considerations for future experience sampling research are discussed in light of these limitations.

Trends in Health Care Coverage and Out-Of-Pocket Cost Barriers: A Gender Comparison.

Objective: The presence of disparities in access to health care and insurance coverage can have a tremendous impact on health care outcomes. Programs like the Affordable Care Act were implemented to improve health care access and to address the existing inequities. The objective of this study was to identify any disparities that exist between males and females regarding health care coverage and out-of-pocket cost to health care. Methods: This analysis was a cross-sectional study using the Behavioral Risk Factor Surveillance System survey data collected between 2013 and 2018. The primary predictor was sex assigned at birth (with the binary option of male vs. female). The primary outcome was adequate health coverage. Survey participants who indicated that they had health insurance with no out-of-pocket cost barriers to receiving medical care were considered to have adequate health coverage, while participants who did not meet these criteria were considered to have inadequate health coverage. Covariates measured were age, race/ethnicity, educational level, employment status, and annual household income. SAS survey procedures and weighting methods were used to measure the association between the sex and adequate health coverage, after controlling for covariates. Results: The data spanning 6 years included 2,249,749 adults, of whom 1,898,097 (84.4%) had adequate health coverage. Females made up 55.8% (N = 1,256,243) of the total sample. About 32.6% (N = 733,216) survey participants were aged ≥65 years. Most respondents, 77.6%, were White (Non-Hispanic). Across the 6-year period, females were more likely to have health insurance but with out-of-pocket costs that served as a barrier to their medical care (adjusted odds ratios with 95% CI from 2013 to 2018 were 1.36 [1.29-1.43], 1.38 [1.32-1.46], 1.31 [1.24-1.38], 1.33 [1.26-1.40], and 1.32 [1.25-1.40], respectively). Conclusions: Females were more likely than males to indicate an out-of-pocket cost barrier to medical care despite having health insurance.

Protocol for a scoping review on technology use and sexual and gender minority youth and mental health.

INTRODUCTION: Research indicates that sexual and gender minority youth [SGMY] may engage more with information communication technologies [ICTs] more than their non-SGMY counterparts Craig SL et al. 2020. While scholarship generally explores youth's use of ICTs, there are gaps in scholarship that connect SGMY, their ICT engagement and influences to mental health. This scoping review will synthesize the literature that connects these core concepts in order to better understand the influence ITCs have on the mental health of SGMY and to develop a more fulsome understanding of this emerging area of literature. METHODS AND ANALYSIS: Following the scoping review framework of Arksey and O'Malley, the search will be conducted in the PsycINFO [Ovid interface, 1980-], MEDLINE [Ovid interface, 1948-], CINAHL [EBSCO interface, 1937-], Sociological Abstracts [ProQuest interface, 1952-], Social Services Abstracts [ProQuest interface, 1979-], and Scopus. Descriptive summaries and thematic analysis will summarize the articles that meet the inclusion criteria using an extraction table. ETHICS AND DISSEMINATION: The review outlined in this paper provides an overview of information that exists on the technology use of SGMY, ICTs and the interconnection with mental health. Results will be disseminated through peer reviewed journals and national and international conferences. As information collected for this paper as is retrieved from publicly available sources, ethics approval is not required.

The influence of emotional reactions and compliance with Ministry of Health guidelines during the COVID-19 pandemic in Israel: a longitudinal study of gender differences.

This study sought to examine gender differences in emotional reactions and compliance with Ministry of Health (MOH) guidelines during the COVID-19 pandemic in Israel, with the goal of gaining a deeper understanding of these gender-related variations throughout the lockdown periods. A longitudinal study comprising 2509 participants was conducted during two of Israel's lockdowns: 1424 participants completed a questionnaire during the first lockdown (23 April-5 May 2020); of these, 1085 completed a follow-up questionnaire during the second lockdown (September 30-October 10, 2020). Participants exhibited higher levels of compliance with MOH guidelines (e.g., wearing face masks, maintaining social distancing) and knowledge about COVID-19 during the second lockdown, whereas they exhibited more negative emotional reactions during the first lockdown. Female participants scored higher than male participants on all measures. Multiple regression results showed that about 21% of the variance in compliance with MOH guidelines was explained by lockdown type (i.e., first or second), gender, and age, while knowledge and negative emotional reactions added another 19% to the explained variance. The results suggest that the impact of the pandemic on emotional reactions decreased over time, with people exhibiting greater compliance with MOH guidelines and more knowledge about COVID-19. Moreover, the behavioral and psychological impact of the pandemic was greater on women than on men. The results suggest that healthcare professionals should pay more attention to mental health issues during a pandemic. Moreover, policymakers should focus on women as a vulnerable group and suggest appropriate solutions to reduce their emotional distress. Furthermore, governments and employers should provide greater flexibility and support for single mothers during the pandemic. In addition, gender inequality during lockdowns may place women at greater risk of psychological distress.

The Health Needs of Sexual and Gender Minority Migrant Women in the United States: A Scoping Review.

Purpose: This scoping review characterizes the peer-reviewed evidence on the health of first-generation sexual and gender minority (SGM) migrant women to the United States and identifies research gaps and future priorities. Methods: On February 1, 2022, the following databases were searched: PubMed (MEDLINE), Embase, CINAHL Plus with Full Text, APA PsycINFO, and PAIS Index. Primary research studies based in the United States, in English, on first-generation SGM migrants (i.e., immigrants, refugees, asylum seekers) were included. Gray literature and review articles were excluded. Health outcome data were not extracted from nonbinary populations nor transgender men. Themes were generated using qualitative content analysis. Results: Thirty-three studies were reviewed, most were qualitative, and 11 focused on transgender women migrants (especially from Latin America), while only one was exclusively on sexual minority women (SMW) migrants. Premigration experiences of violence and discrimination were linked to high prevalence rates of post-traumatic stress disorder, depression, and anxiety. Postmigration stressors included lack of educational and employment opportunities, reduced access to social services, and experiences of stigma and discrimination, which were also associated with the development of depressive symptoms. Transgender women migrants reported not seeking formal medical care, given a lack of gender-affirming services and insurance resulting in reliance on unsafe informal care networks for hormone therapy and feminization procedures. Conclusion: Future interventions should focus on fostering social support networks of SGM migrant women to help improve their mental health outcomes. Research priorities should include studies on SMW migrants and more quantitative research that could identify additional health needs (i.e., sexual health) of SGM migrant women.

Sexual and gender minority health-related content in geriatric fellowships.

INTRODUCTION: Despite a growing number of older lesbian, gay, bisexual transgender, and queer (LGBTQ) adults in the United States, education on care for this vulnerable population has historically been inadequate across all levels of training. This research assessed the extent of LGBTQ education in geriatric medicine fellowship curricula across the United States. METHODS: We designed a survey to anonymously collect information from geriatric medicine fellowship programs on LGBTQ curricular content. Eligible participants included all 160 fellowship directors on record with the American Geriatrics Society. The survey addressed demographics of the fellowship program, current state of inclusion of LGBTQ content in didactic curricula and in clinical settings, and other available training opportunities. RESULTS: Out of those contacted, 80 (50%) completed the survey. Of the programs surveyed, 60 (75%) were housed in internal medicine, 19 (24%) were in family medicine, and one was in their own department. Forty-seven fellowships (59%) reported some formal didactic session (e.g., lecture or case based), with the majority of these programs (72%) featuring 1-2 h of formal instruction. Forty-five programs (56%) reported offering no formal clinical experiences. There was less than 50% coverage for all surveyed topics in the required curriculum (range 46% for discrimination to 9% for gender affirming care). Time and lack of expertise were cited as the main barriers to content inclusion. CONCLUSIONS: Curricular content regarding care for LGBTQ older adults is inadequate in geriatric medicine fellowships. Faculty development of current educators and providing standardized guidelines and curricula are steps toward addressing this deficit.

Community-based support to improve mental health and wellbeing in older sexually and gender diverse people: a scoping review.

OBJECTIVES: This scoping review seeks to identify what community-based support is used by older sexually and gender diverse (SGD) people, that aims to improve mental health/wellbeing. METHODS: A scoping review was conducted using the Arksey and O'Malley framework. APA PsycInfo, Embase, MEDLINE, PubMed, and Scopus were searched. Key information was extracted and entered into a structured coding sheet before being summarized. RESULTS: Seventeen studies were included (41% observational qualitative and 35% observational quantitative). The most commonly used community-based support was lesbian, gay, bisexual and transgender (LGBT) social groups. A range of practices were reported in five studies, including in SGD affirming religious congregations and mind-body practices. Two studies reported the use of formal programmes, with one based on a group initiative. Positive outcomes included feeling connected, improved social support and mental health, and coping with illness. Five studies reported null or negative findings, including a lack of acceptance. Most studies used categories for sex and gender inaccurately, and lacked detail when describing community-based support. CONCLUSION: The use of community-based support by older SGD people is underexplored. More interventions designed for and by this community are needed, along with experimental research to draw conclusions on effectiveness to improve mental health or wellbeing.

Minority stress and mental health in European transgender and gender diverse people: A systematic review of quantitative studies.

The current study aimed at systematically reviewing evidence on the relationships between gender minority stress and mental health outcomes among European transgender and gender diverse (TGD) individuals. A systematic search was conducted in PsycINFO, PubMED, Scopus, and Google Scholar. It was based on Boolean operators to combine terms related to minority stress, TGD identities, and mental health. Thirty studies were identified as eligible. The results confirmed that gender minority stress factors are significantly related with mental health problems among European TGD individuals. Distal stressors were identified as strongly associated with poorer mental health, with gender-related discrimination emerging as the most documented risk factor. The significant role of proximal stressors was also highlighted, with some mediation analyses detecting an indirect effect on mental health. However, identity concealment appeared unrelated to mental health outcomes. Resilience-promoting factors buffering the impact of stressors were also identified, including self-esteem, pride, transitioning, and social support. Conversely, data on community connectedness as a source of resilience were inconclusive. The studies reviewed have several limitations, including lack of longitudinal designs, sampling bias, variability in measurement methods, and unaccounted ethnic variables. Research and clinical recommendations in this field are reported.

Gender as a social and structural variable: research perspectives from the National Institutes of Health (NIH).

Gender is a social and structural variable that encompasses multiple domains, each of which influences health: gender identity and expression, gender roles and norms, gendered power relations, and gender equality and equity. As such, gender has far-reaching impacts on health. Additional research is needed to continue delineating and untangling the effects of gender from the effects of sex and other biological variables. The National Institutes of Health (NIH) vision for women's health is a world in which the influence of sex and/or gender are integrated into the health research enterprise. However, much of the NIH-supported research on gender and health has, to date, been limited to a small number of conditions (e.g., HIV, mental health, pregnancy) and locations (e.g., sub-Saharan Africa; India). Opportunities exist to support transdisciplinary knowledge transfer and interdisciplinary knowledge building by advancing health-related social science research that incorporates best practices from disciplines that have well-established methods, theories, and frameworks for examining the health impacts of gender and other social, cultural, and structural variables.

Gender encompasses multiple domains, each of which influences health: identity and expression; roles and norms; relations; and power. This commentary focuses on gender-related research at the National Institutes of Health (NIH); identifies areas of opportunity for future health research efforts on gender; and articulates a vision for the robust, transdisciplinary incorporation of gender as a social, cultural, and structural variable into the NIH research agenda. The NIH vision for women's health is a world in which the influence of sex and/or gender are integrated into the health research enterprise. However, much of the NIH-supported research on gender and health has, to date, been limited to a small number of conditions (e.g., HIV, mental health, pregnancy) and locations (e.g., sub-Saharan Africa; India). Approaching the influences of gender on health with scientific rigor is critical to advancing health research that promotes health equity.

Gender Minority Stress and Resilience Measure: A Meta-Analysis of the Associations with Mental Health in Transgender and Gender Diverse Individuals.

Transgender and gender diverse (TGD) individuals are more likely to experience mental health difficulties than cisgender individuals due to unique stressors related to their stigmatized gender identity and/or expression. This meta-analysis examined the associations between gender minority stressors and resilience factors, as measured by the Gender Minority Stress and Resilience Measure (GMSR; Testa et al., 2015), and two types of mental health symptoms (i.e., depression and anxiety). A comprehensive literature search and study inclusion process following PRISMA guidelines identified 69 sources, representing 47 unique samples. Mean effect sizes revealed significant positive associations between all GMSR minority stress subscales and anxiety and depression symptoms (rs = .22 to .40) with larger correlations for proximal stressors compared to distal stressors. The GMSR resilience subscales were significantly negatively correlated with anxiety and depression symptoms (rs = -.07 to -.16). These findings highlight the robust relationship between gender minority stressors and mental health symptoms among TGD individuals and indicate a need for addressing these stressors both by reducing exposure to external stressors and by addressing the internalization of those stressors in clinical settings. The small effects for the resilience subscales suggest a need to examine additional resilience factors that may be more pertinent to mental health among TGD individuals.

Is there a disparity in medications for opioid use disorder based on race/ethnicity and gender? A systematic review and meta-analysis.

BACKGROUND: Access to medications for opioid use disorder (MOUD) among racial/ethnic minorities is a growing concern. OBJECTIVES: Inequalities in receiving MOUD among gender and racial/ethnic groups were examined in this systematic review. METHODS: Studies were retrieved by searching various databases and reference lists of reviews and selected full texts. Adjusted Odds Ratios (AORs) comparing MOUDs among racial/ethnic minorities to Whites were extracted or estimated from their findings. Meta-analysis was performed using STATA 17. RESULTS: After screening 2438 records, 19 studies were included in this review in two categories. The first category consists of 11 studies comparing receiving MOUD between different races/ethnicities and genders at the individual level. The meta-analysis regarding AORs comparing Blacks, Hispanics, Asians, Native Americans/Alaska-Natives, Hawaiians, and mixed-race patients with Whites were 0.56 (95 % CI: 0.45-0.68), 0.72 (95 % CI: 0.55-0.94), 0.85 (95 % CI: 0.72-0.99), 0.88 (95%CI: 0.73-1.04), 0.27 (95 % CI: 0.03-2.18), and 0.97 (95 % CI: 0.81-1.16), respectively. The AOR of receiving MOUD for all minorities compared to Whites was 0.70 (95 % CI: 0.61-0.80). Overall AOR comparing MOUD for females to males was 0.95 (95 % CI: 0.87-1.04). The second category of articles compared buprenorphine and methadone treatment among ethnic/racial minorities and Whites. CONCLUSIONS: Compared to Whites, Blacks, Hispanics, and Asians have limited access to MOUD. The findings suggest that methadone is the predominant medication for racial/ethnic minorities, while Whites and high-income communities receive buprenorphine more. It is crucial to re-design policies to bridge the gap in access to MOUD.

Impact of COVID-19 on the Mental Health of Healthcare Workers and Job Loss From a Gender Perspective in India: A Systematic Review and Meta-Analysis.

The COVID-19 pandemic caused significant stress and anxiety among the general population and healthcare workers (HCWs) worldwide. India is one of the countries severely impacted by the pandemic. This review explores the gender perspective of mental health conditions among HCWs and job loss during the pandemic in India. Electronic databases (PubMed, Scopus, and Web of Science) were searched for articles published till March 2021. Studies that reported the prevalence of depression, anxiety, stress, and worry among HCWs in India during the pandemic and job loss in both males and females due to COVID-19 were included. We used a random-effects model to estimate pooled prevalence rates with 95% CIs. We assessed heterogeneity using the I2 statistic. The meta-analysis included 11 studies; the pooled prevalence of depression, anxiety, stress, and worry among HCWs was 34.9% (95%CI 27.33, 42.47), 35.4% (95%CI 24.46, 46.33), 32.9% (95%CI 25.43, 40.37), and 42.87% (95%CI 25.83, 59.91), respectively. The pooled prevalence of job loss due to COVID-19 was 16.6% (95%CI 8.34, 19.66). We employed meta-regression and Egger's regression for publication bias. The meta-analysis findings suggest that the prevalence of depression, anxiety, stress, and worry among HCWs in India during COVID-19 was high. Furthermore, job loss due to COVID-19 has also been prevalent in India. These findings emphasize the need for mental health support for HCWs and those who have lost their jobs during the pandemic. It is essential to prioritize mental health and job creation policies in India to support individuals affected by COVID-19.

Measures of Health Care Providers' Knowledge, Clinical Skills, or Prejudice Toward Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexual, and Other Sexual and Gender Minority Populations: A Scoping Review.

Purpose: Assessing health care providers' knowledge, clinical skills, and prejudice toward lesbian, gay, bisexual, transgender, queer, intersex, asexual, and other sexual and gender minority populations (LGBTQIA+) can help identify areas for improvement in health care provider training. The aim of this study was to map the range of studies that report measures of health care providers' knowledge, clinical skills, or prejudice toward LGBTQIA+ populations. Methods: A scoping review adopting the Joanna Briggs Institute methodology was conducted. Electronic database searches were conducted in CINAHL via EBSCO Host, Epistemonikos, LILACS via Virtual Health Library Regional Portal, PubMed, Scopus, and Web of Sciences. The samples of other reviews were screened. Studies that validated, translated, and/or cross-culturally adapted measures of the knowledge, clinical skills, and prejudice of health care providers and students toward LGBTQIA+ individuals were selected. Scholars were consulted to ensure that no relevant studies were missing. Data were extracted by two independent reviewers and presented in tabular form along with narrative summaries. Results: This scoping review identified 27 measures that have been validated, translated, and/or adapted with health care providers or students as the target population, distributed across 33 studies. Conclusions: Psychometric studies involving LGBTQIA+ patients and health care professionals have increased in recent years, with North American countries being the most frequent location. However, a growing number of studies are being conducted in Latin American countries such as Brazil and Colombia.

Health disparities in one of the world's most progressive countries: a scoping review of mental health and substance use among sexual and gender minority people in the Netherlands.

BACKGROUND: Evidence from many parts of the world shows that sexual and gender minority (SGM) people have poorer health than their cisgender heterosexual counterparts. Minority stressors, particularly stigma and discrimination, have been identified as major contributors to sexual orientation- and gender identity-related health disparities, particularly negative mental health and behavioral health outcomes. To better understand factors that contribute to these disparities, we conducted a scoping review of SGM mental health and substance use research in the Netherlands-a country with a long-standing reputation as a pioneer in SGM equality. METHODS: Using Joanna Briggs Institute guidelines and the PRISMA-ScR protocol, we searched seven databases to identify studies published between 2010 and 2022 that focused on substance use and/or mental health of SGM youth and adults in the Netherlands. RESULTS: Although there was some evidence that SGM people in the Netherlands report fewer substance use and mental health concerns than those in less progressive countries, with very few exceptions studies found poorer outcomes among SGM participants than cisgender, heterosexual participants. However, this observation must be considered cautiously given major gaps in the literature. For example, only one study focused exclusively on adult sexual minority women, two focused on older SGM adults, and very little attention was given to nonbinary individuals. Most studies used non-probability samples that were quite homogenous. Many studies, especially those with youth, assessed sexual orientation based on sexual attraction; some studies of adults operationalized SGM status as having a same-sex partner. Importantly, we found no studies that directly assessed associations between structural-level stigma and health outcomes. Studies were mostly focused at the individual level and on health problems; very little attention was given to strengths or resilience. CONCLUSIONS: Findings of persistent health disparities-despite the relatively long history of SGM supportive policies in the Netherlands-highlight the need for more research and greater attention to population groups that have been underrepresented. Such research would not only provide guidance on strategies to improve the health of SGM people in the Netherlands, but also in other countries that are seeking to reduce health inequities. Addressing SGM health disparities in the Netherlands and elsewhere is complex and requires a multifaceted approach that addresses individual, interpersonal and structural factors.