RESUMO
Previous studies documenting sexual minority women's disproportionate risk for a range of medical, mental health, and substance use disorders have not provided a predictive framework for understanding their interrelations and outcomes. The present study aimed to address this gap by testing the syndemic effect of co-occurring psychosocial problems on 7-year health care costs and utilization among sexual minority women. The sample was comprised of sexual minority women (N = 341) who were seen at an urban LGBT-affirmative community health center. Medical and mental health care utilization and cost data were extracted from electronic medical records. Demographically adjusted regression models revealed that co-occurring psychosocial problems (i.e., childhood sexual abuse, partner violence, substance use, and mental health distress [history of suicide attempt]) were all strongly interrelated. The presence of these indicators had a syndemic (additive) effect on medical costs and utilization and mental health utilization over 7-year follow-up, but no effect on 7-year mental health costs. These results suggest that the presence and additive effect of these syndemic conditions may, in part, explain increased medical costs and utilization (and higher medical morbidity) among sexual minority women.
Assuntos
Bissexualidade/psicologia , Custos de Cuidados de Saúde/estatística & dados numéricos , Homossexualidade Feminina/psicologia , Grupos Minoritários/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Saúde da Mulher/economia , Adulto , Idoso , Bissexualidade/estatística & dados numéricos , Feminino , Homossexualidade Feminina/estatística & dados numéricos , Humanos , Pessoa de Meia-Idade , Fatores Socioeconômicos , Estados UnidosRESUMO
This report describes the evolution of a Boston community health center's multidisciplinary model of transgender healthcare, research, education, and dissemination of best practices. This process began with the development of a community-based approach to care that has been refined over almost 20 years where transgender patients have received tailored services through the Transgender Health Program. The program began as a response to unmet clinical needs and has grown through recognition that our local culturally responsive approach that links clinical care with biobehavioral and health services research, education, training, and advocacy promotes social justice and health equity for transgender people. Fenway Health's holistic public health efforts recognize the key role of gender affirmation in the care and well-being of transgender people worldwide.
Assuntos
Atenção à Saúde/organização & administração , Saúde Pública , Pessoas Transgênero , Adulto , Boston , Atenção à Saúde/estatística & dados numéricos , Feminino , Pesquisa sobre Serviços de Saúde , Humanos , Masculino , Modelos Organizacionais , Defesa do Paciente , Saúde Pública/métodosRESUMO
Research has documented significant relationships between sexual and gender minority stress and higher rates of suicidality (i.e. suicidal ideation and attempts) and substance use problems. We examined the potential mediating role of substance use problems on the relationship between sexual and gender minority stress (i.e. victimization based on lesbian, gay, bisexual, or transgender identity [LGBT]) and suicidality. A nonprobability sample of LGBT patients from a community health center (N = 1457) ranged in age from 19-70 years. Participants reported history of lifetime suicidal ideation and attempts, substance use problems, as well as experiences of LGBT-based verbal and physical attacks. Substance use problems were a significant partial mediator between LGBT-based victimization and suicidal ideation and between LGBT-based victimization and suicide attempts for sexual and gender minorities. Nuanced gender differences revealed that substance use problems did not significantly mediate the relationship between victimization and suicide attempts for sexual minority men. Substance use problems may be one insidious pathway that partially mediates the risk effects of sexual and gender minority stress on suicidality. Substances might be a temporary and deleterious coping resource in response to LGBT-based victimization, which have serious effects on suicidal ideation and behaviors.
Assuntos
Vítimas de Crime/estatística & dados numéricos , Grupos Minoritários/estatística & dados numéricos , Sexualidade/estatística & dados numéricos , Discriminação Social/psicologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Suicídio/estatística & dados numéricos , Adaptação Psicológica , Adulto , Idoso , Vítimas de Crime/psicologia , Estudos Transversais , Feminino , Disparidades nos Níveis de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Grupos Minoritários/psicologia , Análise de Regressão , Distribuição por Sexo , Sexualidade/psicologia , Identificação Social , Estresse Psicológico/epidemiologia , Estresse Psicológico/psicologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Pessoas Transgênero/psicologia , Pessoas Transgênero/estatística & dados numéricos , Adulto JovemRESUMO
OBJECTIVES: We examined relationships between social determinants of health and experiences of transgender-related discrimination reported by transgender people in Virginia. METHODS: In 2005 through 2006, 387 self-identified transgender people completed a statewide health needs assessment; 350 who completed eligibility questions were included in this examination of factors associated with experiences of discrimination in health care, employment, or housing. We fit multivariate logistic regression models using generalized estimating equations to adjust for survey modality (online vs paper). RESULTS: Of participants, 41% (n = 143) reported experiences of transgender-related discrimination. Factors associated with transgender-related discrimination were geographic context, gender (female-to male spectrum vs male-to-female spectrum), low socioeconomic status, being a racial/ethnic minority, not having health insurance, gender transition indicators (younger age at first transgender awareness), health care needed but unable to be obtained (hormone therapy and mental health services), history of violence (sexual and physical), substance use health behaviors (tobacco and alcohol), and interpersonal factors (family support and community connectedness). CONCLUSIONS: Findings suggest that transgender Virginians experience widespread discrimination in health care, employment, and housing. Multilevel interventions are needed for transgender populations, including legal protections and training for health care providers.
Assuntos
Nível de Saúde , Discriminação Social , Pessoas Transgênero , Adulto , Intervalos de Confiança , Estudos Transversais , Feminino , Comportamentos Relacionados com a Saúde , Acessibilidade aos Serviços de Saúde , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Avaliação das Necessidades , Razão de Chances , Discriminação Social/estatística & dados numéricos , Virginia , Adulto JovemRESUMO
This study examined disparities in lifetime substance misuse by sexual orientation among 2,653 patients engaged in care at an urban community health center in Boston, MA, as well as the potential mediating roles of childhood abuse Assuntos
Sobreviventes Adultos de Maus-Tratos Infantis/psicologia
, Disparidades nos Níveis de Saúde
, Comportamento Sexual/psicologia
, Parceiros Sexuais/psicologia
, Maus-Tratos Conjugais/psicologia
, Transtornos Relacionados ao Uso de Substâncias/psicologia
, Adolescente
, Adulto
, Idoso
, Centros Comunitários de Saúde
, Feminino
, Humanos
, Masculino
, Pessoa de Meia-Idade
, População Urbana
RESUMO
OBJECTIVES: We sought to determine whether health care use and expenditures among gay and bisexual men were reduced following the enactment of same-sex marriage laws in Massachusetts in 2003. METHODS: We used quasi-experimental, prospective data from 1211 sexual minority male patients in a community-based health center in Massachusetts. RESULTS: In the 12 months after the legalization of same-sex marriage, sexual minority men had a statistically significant decrease in medical care visits (mean = 5.00 vs mean = 4.67; P = .05; Cohen's d = 0.17), mental health care visits (mean = 24.72 vs mean = 22.20; P = .03; Cohen's d = 0.35), and mental health care costs (mean = $2442.28 vs mean = $2137.38; P = .01; Cohen's d = 0.41), compared with the 12 months before the law change. These effects were not modified by partnership status, indicating that the health effect of same-sex marriage laws was similar for partnered and nonpartnered men. CONCLUSIONS: Policies that confer protections to same-sex couples may be effective in reducing health care use and costs among sexual minority men.
Assuntos
Centros Comunitários de Saúde/economia , Centros Comunitários de Saúde/estatística & dados numéricos , Homossexualidade Masculina/estatística & dados numéricos , Casamento/legislação & jurisprudência , Adulto , Fatores Etários , Idoso , Bissexualidade/estatística & dados numéricos , Homossexualidade Masculina/etnologia , Humanos , Masculino , Casamento/etnologia , Massachusetts , Serviços de Saúde Mental/economia , Serviços de Saúde Mental/estatística & dados numéricos , Pessoa de Meia-Idade , Políticas , Estudos Prospectivos , Fatores SocioeconômicosRESUMO
We describe the emergence of lesbian, gay, bisexual, and transgender (LGBT) health as a key area of study and practice for clinicians and public health professionals. We discuss the specific needs of LGBT populations on the basis of the most recent epidemiological and clinical investigations, methods for defining and measuring LGBT populations, and the barriers they face in obtaining appropriate care and services. We then discuss how clinicians and public health professionals can improve research methods, clinical outcomes, and service delivery for lesbian, gay, bisexual, and transgender people.
Assuntos
Atenção à Saúde/normas , Acessibilidade aos Serviços de Saúde , Necessidades e Demandas de Serviços de Saúde , Grupos Minoritários/estatística & dados numéricos , Sexualidade , Humanos , Estados UnidosRESUMO
The birth of a child with an intersex condition is often an emotionally stressful event for parents. Preparation and ongoing support systems could be beneficial to both parents and children and would alleviate some of the shame and isolation associated with intersex conditions. To assess the extent to which psychological support is available, a short e-mail survey on this topic was sent to the directors of 50 pediatric endocrinology fellowship training programs (PEFTPs), who are most likely to evaluate and treat intersex children and their parents. Of the 29 PEFTPs that responded, 69% offer psychological support and 58% have a mental health specialist on staff. However, only 19% of patients or families receive emotional support during diagnosis and only 15% receive support after diagnosis. We found two barriers that prevent patients and families from receiving psychological help from their intersex care team. First, there is a lack of training for mental health professionals regarding the needs of intersex patients and families. Second, some families refuse help even though it is offered. This study reveals that further research is needed to overcome these two barriers regarding mental health treatment of intersex patients and families.
Assuntos
Transtornos do Desenvolvimento Sexual , Endocrinologia/educação , Saúde Mental , Pediatria/educação , Apoio Social , Transtornos do Desenvolvimento Sexual/psicologia , Transtornos do Desenvolvimento Sexual/terapia , Feminino , Humanos , Recém-Nascido , MasculinoRESUMO
This supplemental issue of the Journal of Homosexuality presents research that explores a variety of health care issues encountered by lesbian, gay, bisexual, transgender and intersex (LGBTI) population groups in the United States over the 10-year period from 1993 to 2002. Topics include access to health care, utilization of care, training of medical and mental health providers, and the appropriate preparation of clinical offices and waiting areas. Authors used a variety of community-based public health research methods, including participant and provider surveys and retrospective chart reviews of patients, to develop this body of research, providing a recent-historical perspective on the complex health care and health-related needs of sexual and gender minorities. Particularly for transgender and intersex populations, the state of research describing their health care needs is in its infancy, and much remains to be done to design effective medical and mental health programs and interventions.