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.

"Getting the Staff to Understand It:" Leadership Perspectives on Peer Specialists Before and After the Implementation of a Peer-Delivered Healthy Lifestyle Intervention.

Over the past two decades, there has been increased recognition of the effectiveness of peer delivered services, with prior research highlighting the benefits for both recipients of peer services and peer providers. Despite this, peer specialists report challenges to their work such as experiencing stigma associated with their role and difficulty integrating into a non-peer dominated workforce. The study sought to explore the perceptions of agency leadership from three supportive housing agencies regarding peer specialists and peer-delivered services within their organization before and after a peer-led intervention to promote healthy lifestyles for people with SMI. Semi-structured qualitative interviews were conducted with agency leadership and analyzed using a content analysis approach. Findings from this study contribute to the literature on the peer specialist workforce by identifying factors (e.g., agency's prior experience employing peer specialists) and potential strategies (e.g., exposure to peer services) impact the level of workplace integration of peer specialists.

Alcohol use, behavioral and mental health help-seeking, and treatment satisfaction among sexual minority women.

BACKGROUND: Sexual minority women (SMW) report higher rates of heavy episodic drinking (HED) and adverse alcohol-related outcomes, including poor mental health, than heterosexual women. These disparities indicate a greater need for behavioral and mental health treatment for SMW. This study examined associations among alcohol outcomes, behavioral and mental health help-seeking, and treatment satisfaction among SMW by age, sexual identity, race/ethnicity, and income. METHODS: Participants included a community sample of 695 SMW (Mage  = 40.0, SD = 14.1; 74.1% lesbian, 25.9% bisexual; 37.6% White, 35.8% Black, 23.2% Latinx; 26.3% annual income $14,999 or less). We used bivariate analyses to characterize the sample's demographic characteristics and multivariable logistic regression analyses to examine associations among variables. RESULTS: SMW subgroups based on age, race/ethnicity, and annual income differed in alcohol outcomes (i.e., HED, DSM-IV alcohol dependence, alcohol-related problem consequences, alcohol problem recognition, and motivation to reduce drinking); help-seeking; and treatment satisfaction. SMW who engaged in help-seeking for alcohol-related concerns were more likely than those who did not to meet criteria for DSM-IV alcohol dependence (adjusted odds ratio [aOR] = 7.13; 95% CI = 2.77; 18.36), endorse alcohol-related problem consequences (aOR = 11.44; 95% CI = 3.88; 33.71), recognize problematic drinking (aOR = 14.56; 95% CI = 3.37; 62.97), and report motivation to reduce drinking (aOR = 5.26; 95% CI = 1.74; 15.88). SMW's alcohol outcomes did not differ based on their satisfaction with treatment or with providers. CONCLUSIONS: This study's findings confirm SMW's elevated risk for HED and other alcohol-related outcomes and underscore the importance of identity-affirmative and accessible behavioral and mental health treatment for young, Black, and low-income SMW. Clinicians and intervention scientists should develop or enhance existing brief behavioral and mental health treatments for SMW engaging in HED who may not recognize that their drinking is problematic or who are not motivated to reduce drinking.

"We Die 25 Years Sooner:" Addressing Physical Health Among Persons with Serious Mental Illness in Supportive Housing.

People diagnosed with serious mental illness (SMI) experience significant health disparities, including high rates of premature mortality. Supportive housing may serve as a critical service setting for addressing physical health, but comprehensive health-related services within these programs remain an exception. This study sought to identify barriers, and potential solutions, to addressing the physical health needs of people with SMI within supportive housing. Semi-structured interviews and focus groups were conducted with multiple stakeholders (clients, peer specialists, non-peer staff, leadership) across three supportive housing agencies. There was general consensus regarding multiple barriers at the individual, organizational, policy/system, and community levels. Nevertheless, stakeholders also identified strategies in domains such as staffing, organizational culture, partnerships, communication, and infrastructure for addressing barriers. These findings can inform planning for implementation of health initiatives within supportive housing while also highlighting the need for broader community, systems, and policy change.Trial Registration Number: NCT02175641.

"Being There" vs "Being Direct:" Perspectives of Persons with Serious Mental Illness on Receiving Support with Physical Health from Peer and Non-Peer Providers.

Individuals with serious mental illness (SMI) face significant health disparities and multiple barriers to engaging in health behavior change. To reduce these health disparities, it is necessary to enhance the support individuals with SMI receive through the collaboration of different healthcare providers. This study explored how people with SMI living in supportive housing perceived receiving support from peer and non-peer providers for their physical health. Qualitative interviews were conducted with 28 participants receiving a peer-led healthy lifestyle intervention in the context of a randomized trial in supportive housing agencies. Interviews explored participants' experiences working with the healthy lifestyle peer specialist and a non-peer provider who assisted them with health. Interviews were audio recorded, transcribed, and analyzed using strategies rooted in grounded theory. Participants viewed their relationships with peer and non-peer providers positively, but described differences in the approach to practice, power dynamics present, and how they identified with each provider. Participants described peers as process-oriented while non-peer staff as task-oriented, focusing on accomplishing concrete objectives. Each provider sought to boost participants' motivation, but peers built hope by emphasizing the possibility of change, while non-peer providers emphasized the consequences of inaction. Participants related to peer staff through shared experiences, while identifying the importance of having a shared treatment goal with their non-peer provider. Overall, participants appreciated the unique roles of both peer and non-peer staff in supporting their health. Study findings have implications for integrating the use of peer-based health interventions to improve the health of people with SMI.

"What We Have in Common": A Qualitative Analysis of Shared Experience in Peer-Delivered Services.

"Shared experience" has been described as a key element of peer-delivered services, but it is not well-understood how it is used in practice, particularly among peer specialists working in more conventional mental health agencies. In-depth qualitative interviews were conducted with eight peer specialists and two supervisors working in a Peer Wellness Program within a Housing First agency to explore peer specialists' approach to service delivery, with a focus on the role of shared experience. Peer specialists rarely reported explicitly sharing experiences related to mental health with clients, but described how it was nevertheless ever-present through the unique ways it shaped features of their practice (e.g., empathy, patience, consistency, listening, unstructured time, and a client-centered approach). In contrast, explicit discussion of shared experiences related to other life domains, such as culture, physical health, and significant life events, were frequently relied upon to support and build rapport with clients.

"We're All in this Together": Peer-specialist Contributions to a Healthy Lifestyle Intervention for People with Serious Mental Illness.

This qualitative study explored peer specialists' contributions to a healthy lifestyle intervention for obese/overweight individuals with serious mental illness (SMI) living in supportive housing. Intervention participants, peer specialists, and supervisors were interviewed and a grounded model emerged from the data identifying essential interpersonal attributes of the peer specialist-participant relationship. Peer specialists' disclosure of their own experiences making health behaviors changes was critical for building participants' motivation and ability to try lifestyle changes. Findings can inform peer specialist training and practice standards and facilitate the expansion of peer-delivered interventions to improve the physical health of people with SMI.

Parent-teacher agreement on children's problems in 21 societies.

Parent-teacher cross-informant agreement, although usually modest, may provide important clinical information. Using data for 27,962 children from 21 societies, we asked the following: (a) Do parents report more problems than teachers, and does this vary by society, age, gender, or type of problem? (b) Does parent-teacher agreement vary across different problem scales or across societies? (c) How well do parents and teachers in different societies agree on problem item ratings? (d) How much do parent-teacher dyads in different societies vary in within-dyad agreement on problem items? (e) How well do parents and teachers in 21 societies agree on whether the child's problem level exceeds a deviance threshold? We used five methods to test agreement for Child Behavior Checklist (CBCL) and Teacher's Report Form (TRF) ratings. CBCL scores were higher than TRF scores on most scales, but the informant differences varied in magnitude across the societies studied. Cross-informant correlations for problem scale scores varied moderately across societies studied and were significantly higher for Externalizing than Internalizing problems. Parents and teachers tended to rate the same items as low, medium, or high, but within-dyad item agreement varied widely in every society studied. In all societies studied, both parental noncorroboration of teacher-reported deviance and teacher noncorroboration of parent-reported deviance were common. Our findings underscore the importance of obtaining information from parents and teachers when evaluating and treating children, highlight the need to use multiple methods of quantifying cross-informant agreement, and provide comprehensive baselines for patterns of parent-teacher agreement across 21 societies.

Health Outcomes of Sexual Minority Women Who Have Experienced Adverse Childhood Experiences: A Scoping Review.

Sexual minority women (SMW; e.g., lesbian, bisexual) report higher rates of almost every negative physical health (e.g., asthma, arthritis, cardiovascular disease), mental health (e.g., depression, anxiety), and substance use outcome compared to heterosexual women. Adverse Childhood Experiences (ACEs) have been identified as risk factors for negative health outcomes. Despite this, no study to date has synthesized existing literature examining ACEs and health outcomes among SMW. This gap is important because SMW are significantly more likely than heterosexual women to report every type of ACE and a higher total number of ACEs. Therefore, using a scoping review methodology, we sought to expand understanding of the relationship between ACEs and health outcomes among SMW. Using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for. Scoping Reviews protocol, we searched five databases: Web of Science, PsycInfo, CINAHL, PubMed, and Embase for studies published between January 2000 and June 2021 that examined mental health, physical health, and/or substance use risk factors and outcomes among adult cisgender SMW who report ACEs. Our search yielded 840 unique results. Studies were screened independently by two authors to determine eligibility, and 42 met full inclusion criteria. Our findings provide strong evidence that ACEs are an important risk factor for multiple negative mental health and substance use outcomes among SMW. However, findings were mixed with respect to some health risk behaviors and physical health outcomes among SMW, highlighting the need for future research to clarify these relationships.

Childhood sexual abuse, adult sexual assault, revictimization, and coping among sexual minority women.

BACKGROUND: Compared with heterosexual women, sexual minority women experience higher rates and greater severity of sexual victimization. Little is known about how childhood sexual abuse (CSA), adult sexual assault (ASA), and revictimization impact coping in this population. Few studies have examined the effects of recency, developmental stage, and revictimization on coping. OBJECTIVE: To improve psychosocial outcomes following sexual victimization, it is important to understand whether different patterns of exposure differentially impact coping over time. To do so, we investigated associations between CSA, ASA, and revictimization (both CSA and ASA) and adult sexual minority women's coping strategies. PARTICIPANTS AND SETTING: Data are from a longitudinal community-based sample of 513 sexual minority women of diverse ages and races/ethnicities. METHODS: Participants reported CSA (

"Being here, you could actually be yourself": Trans and gender expansive youth's experiences of affirmation within LGBTQ+ community-based organizations.

Across the United States, polarizing politics have contributed to the increased stigmatization of transgender (trans) and gender expansive (TGE) youth, reinforcing health inequities for this population. Although lesbian, gay, bisexual, transgender, queer, and/or questioning (LGBTQ+) youth centers have often served as places of refuge for young people across the gender spectrum, literature has yet to show how practices and strategies used in these settings promote TGE affirmation. This qualitative study explores youth and staff experiences within these settings; identifies the services, policies, and environments needed to support TGE community members; and ultimately calls for the expansion of the limited research on TGE experience and affirmation across such spaces. Using data collected in a larger study on affirming practices for LGBTQ+ youth, this article presents findings from in-depth, semistructured focus groups and interviews with TGE (n = 12) youth and staff (n = 12) across four LGBTQ+ community-based organizations in two large urban centers. Study findings show these organizations provide TGE affirmation through language, programming, and atmospheres of openness to identity exploration. Essential to these offerings are organizational policy mandates, such as correct pronoun usage and TGE-specific programming. Youth often juxtapose their experiences of affirmation within LGBTQ+ spaces with experiences of invalidation from the cisheteronormative cultures within their school or home environments. Implications for future practice and research include administering ongoing training on TGE-affirming language and developing comprehensive accountability measures (e.g., TGE-inclusive community guidelines). Institutions with these systems in place are well-equipped to contribute to the fight for trans liberation. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

What We Lose When We "Don't Say Gay": Generational Shifts in Sexual Identity and Gender.

At a time when anti-LGBTQ+ legislation is on the rise in more than a dozen states across the United States, social work providers and researchers must be acutely aware of the ways in which their practice may unintentionally invalidate the identities of LGBTQ+ youth. Concurrently, language used in the LGBTQ+ youth community to describe both sexual identity and gender has moved away from monosexual and binary labels toward nonmonosexual and nonbinary descriptions. The adoption of such language, in practice and in research, is a simple step toward combatting invalidation in the social work field. This commentary explores the expansion of identity labels through the lens of a study conducted across four leading LGBTQ+ agencies in New York and New Jersey with youth and staff. Authors review data that demonstrate the evolution of labels and argue that adopting these terms in practice and research will have fruitful and affirming effects on access to care, treatment attrition, and the design and quality of research in and for the LGBTQ+ community. This shift in language must be comprehensively addressed to ensure that practice and research continue to adopt and advocate for ways to affirm LGBTQ+ people, particularly given the recent onslaught of anti-LGBTQ+ legislation.

Mental health and substance use among sexual minority women who report childhood sexual abuse: A systematic literature review.

OBJECTIVE: A growing body of literature provides evidence that sexual minority women (SMW; e.g., lesbian, bisexual) are at greater risk of negative mental health and substance use outcomes than are heterosexual women. While minority stress may partially explain these disparities, it does not fully account for them. Therefore, it is necessary to identify how other risk factors (i.e., childhood sexual abuse [CSA]) contribute to SMW's increased risk of negative mental health and substance use outcomes. METHOD: We conducted a systematic literature review to identify and synthesize the state of knowledge about CSA and mental health and substance use outcomes among SMW. Two independent reviewers screened 347 articles identified in searches of five databases (Web of Science, PsycInfo, CINAHL, PubMed, and Embase). Eligible articles were peer-reviewed, reported quantitative or mixed methods results focused on mental health or substance use outcomes among adult SMW with a history of CSA. RESULTS: Twenty-four papers were included in the review. Findings clearly show that SMW report higher rates of CSA than heterosexual women. Findings also suggest that CSA may mediate the relationship between minority sexual identity and some negative outcomes. CONCLUSIONS: Future studies should include minority stress factors, a broader range of mental health outcomes (apart from substance use and suicide), and more nuanced measures of CSA. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Using the matrixed multiple case study methodology to understand site differences in the outcomes of a Hybrid Type 1 trial of a peer-led healthy lifestyle intervention for people with serious mental illness.

Site differences in implementation trial outcomes are common but often not examined. In a Hybrid Type 1 trial examining the effectiveness-implementation of a peer-led group life-style balance (PGLB) intervention for people with serious mental illness (SMI) in three supportive housing agencies, we found that PGLB recipients' physical health outcomes differed by study sites. The matrixed multiple case study methodology was used to explore how implementation outcomes and changes in context of usual care (UC) services contributed to these site differences. Two implementation outcomes (i.e. PGLB fidelity ratings and intervention recipients' acceptability of PGLB and UC) and changes in healthcare services integration at the study sites were examined. ANOVAs were used to examine site differences in fidelity ratings and client satisfaction. Directed content analysis was used to analyze leadership interviews to identify changes in the context of UC services. Site 3 showed a trend approaching significance (P = .05) towards higher fidelity ratings. High levels of satisfaction with PGLB were reported at all sites. Significant differences in PGLB recipients' satisfaction with UC were found, with Site 3 reporting the lowest levels of satisfaction. Agency leaders reported an increase in prioritizing client's health throughout the trial with sites differing in how these priorities were put into action. Differences in PGLB recipients' satisfaction with UC, and changes in healthcare service integration seemed to have contributed to the site differences in our trial. The matrixed multiple case study methodology is a useful approach to identify implementation outcomes contributing to the heterogeneity of multisite implementation trial results.

A healthy lifestyle intervention delivered by people with lived experience of serious mental illness (SMI) led to improved health outcomes among participants living with SMI in three supportive housing agencies, but these outcomes differed by study sites. This study aimed to identify which factors influenced these site differences in study outcomes by examining if the intervention was delivered as intended, intervention recipients' satisfaction with the intervention and the pre-existing health care services delivered at each study site, and what changes occurred in health care services offered at each of the supportive housing agencies throughout the study. The intervention was found to have high levels of satisfaction across all three agencies but the agency which had the best outcomes also had the highest levels of intervention delivery adherence and the lowest levels of intervention recipients' satisfaction with existing health care services. Additionally, during the study period, the same agency described minimal changes in their existing health care services while the other two agencies were found to have made more significant changes integrating health care services to their day-to-day operations. As a result, findings from this study emphasize the importance of understanding the context in which interventions are delivered in routine practice settings to ensure their overall success.

Intimate Partner Violence Among Sexual Minority Women: A Scoping Review.

Intimate partner violence (IPV) is prevalent among sexual minority women (SMW). However, compared to IPV research with heterosexual women and other LGBTQ+ population groups, SMW are understudied. We conducted a scoping review to examine the current state of knowledge about IPV among SMW, and to identify gaps and directions for future research. A search of Medline, Embase, CINAHL, and PsycINFO databases returned 1,807 papers published between January 2000 and December 2021. After independent reviewers screened these papers for relevance, 99 were included in the final review. Papers were included if they used quantitative methods and reported IPV data on adult SMW separately from other groups. Findings confirmed high rates of IPV among SMW and highlighted groups with particular vulnerabilities, including non-monosexual women and SMW of color. Risk factors for IPV in this population include prior trauma and victimization, psychological and emotional concerns, substance use, and minority stressors. Outcomes include poor mental and physical health. Findings related to the effects of minority stressors on IPV and comparisons across sexual minority groups were inconsistent. Future research should focus on IPV perpetration; mechanisms underlying risk for IPV, including structural-level risk factors; and understanding differences among SMW subgroups.

Learning, doing and sticking with it: A qualitative study on achieving clinically significant reduction in cardiovascular disease risk in a healthy lifestyle intervention for people with serious mental illness.

People with serious mental illness (SMI; e.g. schizophrenia) have mortality rates two to three times higher than the general population, largely due to a higher prevalence of cardiovascular disease (CVD). Healthy lifestyle interventions can improve the health of people with SMI, but information about why these interventions work for some and not others is scarce. Our study aims to qualitatively explore differences in these two groups' overall experiences and application of the intervention. Data were drawn from a randomised effectiveness trial of a peer-led healthy lifestyle intervention. Qualitative data from interviews and focus groups with 21 participants were linked to their 12-month outcome data. Grounded theory was used to compare the experiences of participants who achieved clinically significant CVD risk reduction (i.e. clinically significant weight loss or clinically significant improvements in cardiorespiratory fitness) versus those who did not. Three qualitative themes: learning, change, sticking with it - differentiated participants who achieved CVD risk reduction and those that did not. Participants achieving CVD risk reduction described learning and applying specific knowledge and skills related to a healthy lifestyle when making health decisions, made healthy concrete changes to diet and physical activity, and stuck with those changes. Participants not achieving clinically significant CVD risk reduction reported surface-level learning about healthy lifestyle practices, difficulty sticking with healthy changes, and were more likely to report ambiguous or no changes. Our findings suggest that healthy lifestyle interventions for people with SMI should provide experiential in-vivo learning experiences while periodically assessing participants' understanding and then tailoring the intervention to their needs. It is important to build self-efficacy for health behaviour changes by creating early perceptions of success, which was found to enhance motivation and sustain behaviour change. Helping people with SMI develop and strengthen their support systems will also be an important factor for building and sustaining health behaviour changes.

Understanding Factors Associated with Suicidality Among Transgender and Gender-Diverse Identified Youth.

Purpose: Individuals who identify as transgender and gender-diverse (TGD) experience heightened rates of mental health challenges compared with cisgender people (including both heterosexual and lesbian, gay, and bisexual individuals). Furthermore, adolescence has been identified as a critical period for intervention as the majority of suicide attempts occur during this time period. However, no study to date has synthesized prior literature to understand the correlates of suicidal behavior among TGD youth, which is an essential step needed to inform intervention development and reduce suicidal behaviors in this community. Methods: Three databases were searched following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses method to assess eligibility for study inclusion. Five studies met full inclusion criteria. Results: Analyses revealed a consistent relationship across studies between suicidal behaviors and symptoms of depression, gender-based victimization, and bullying, and lack of parental support. Conclusions: Consistent with minority stress theory, this systematic review demonstrates that identification as TGD is associated with increased environmental stressors, highlighting the importance of considering both individual and contextual factors in the development of mental health interventions for TGD youth. Given the significance of findings related to the association between both depression and gender-based victimization and suicidal behavior, it is critical to advocate for the destigmatization of noncisgender identities through policy-level change.

Participant Experiences With a Peer-Led Healthy Lifestyle Intervention for People With Serious Mental Illness.

OBJECTIVE: This study explored the experiences of individuals with serious mental illness who were predominantly Black, were living in supportive housing, and participated in the Peer-Led Group Lifestyle Balance (PGLB) intervention. The authors examined how participants engaged in the process of behavior change and applied intervention concepts. METHODS: Focus groups and interviews with 63 participants explored their motivation for engaging with PGLB, challenges to behavior change, and how they integrated intervention strategies into their lives. Interviews were transcribed and analyzed with grounded theory. RESULTS: A grounded model summarized the description of the cycle of behavior change and provided insight into participants' decision-making processes. Challenges to engaging in healthy lifestyle change were related to participants' general medical health, time constraints, lack of knowledge, difficulties breaking old habits and changing self-perceptions, mood state, and the social-physical environment. Participants applied many intervention strategies, such as addressing problematic social cues, contexts, and food associations; planning ahead; starting with smaller changes; portion control; food substitution; mindful eating; and integrating changes into their daily lives. They reported various behavior changes with respect to eating and physical activity and more limited shifts in self-monitoring. CONCLUSIONS: Improving the health of people with serious mental illness will require expanding their access to healthy lifestyle interventions in community-based settings. The findings suggest that future interventions should expand support for self-monitoring, meal planning, tailored physical activity, and advocacy. Such interventions should also enhance participants' understanding of the corresponding impact of changes on weight loss and emphasize subjective wellness outcomes to maintain motivation.

Strategies and Lessons Learned for Supporting and Supervising Peer Specialists.

As peer-delivered services are increasingly embedded within behavioral health organizations, a need has arisen to identify practices that facilitate supervision and support of peer providers. The authors present supervision strategies and lessons learned that emerged during a large pragmatic trial in three supportive housing agencies that examined a peer-delivered healthy lifestyle intervention for people with serious mental illness. Strategies included access to multiple supervisors, formal and informal support, acknowledgment of lack of role clarity, ongoing role negotiation, a collaborative approach to troubleshooting challenges, explicit emphasis on peer specialists' value, and linking peer specialists to opportunities for mutual support and professional development.