Differences in Health Care Access, Utilization, and Experiences Among LGBTQ+ Subgroups in the Southern United States.

Lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) individuals experience health inequities and barriers to accessing appropriate, affirming care. Little is known about differing health care experiences within the LGBTQ+ population, particularly among individuals living in underserved areas. This study explored health care experiences and utilization among LGBTQ+ subgroups: lesbian and gay cisgender individuals (n = 258), bisexual+ cisgender individuals (n = 71), and transgender and gender-diverse individuals (n = 80). Participants were recruited from a geographic region in South Carolina and Georgia and completed an online survey regarding negative health care experiences, barriers to care, and utilization of different health care venues and services. Results revealed significant differences between LGBTQ+ subgroups, with transgender and gender-diverse participants reporting more discriminatory experiences and greater barriers to care. Bisexual+ cisgender individuals also experienced some disparities compared with lesbian and gay cisgender individuals. Most participants endorsed a need for more competent providers. Findings and recommendations are considered within the context of the Southeastern United States for addressing access and utilization disparities among LGBTQ+ communities.

The Effects of Polyvictimization on Mental and Physical Health Outcomes in an LGBTQ Sample.

Lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) individuals are at elevated risk for violent victimization and often experience increased health disparities compared to their non-LGBTQ counterparts. The present study examined associations between polyvictimization and mental and physical health in an LGBTQ sample. Participants included 385 LGBTQ individuals involved in a larger health-needs assessment of LGBTQ individuals living in the southeastern United States. The sample primarily identified as gay/lesbian (63.4%), cisgender (78.7%), and White (66.5%), and the mean participant age was 34.82 years (SD = 13.45). A latent class analysis (LCA) was conducted on seven items assessing different types of violence exposure. The LCA identified a three-class model, with classes characterized by low trauma exposure (71.4%), nondiscriminatory violence (15.1%), and high trauma exposure (13.5%). Differences in demographic characteristics, perceptions of mental and physical health, and diagnoses of specific health conditions were assessed across classes. The high-trauma class reported poorer perceived physical and mental health compared to the other two classes, with mean differences in past-month poor health days ranging from 11.38 to 17.37. There were no differences between the classes regarding specific physical health conditions; however, the high-trauma and nondiscriminatory violence classes had significantly higher rates of anxiety, depression, drug abuse, and suicidality than the low-trauma class, ORs = 2.39-23.83. The present findings suggest that polyvictimization is an important risk factor for poor health among LGBTQ individuals. These results have implications for addressing health disparities among the broader LGBTQ community.

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.

A scoping review of institutional policies and recommendations for trans inpatient mental health care.

WHAT IS KNOWN ON THE SUBJECT?: International guidelines for trans-and-gender-non-conforming (TGNC) exists in outpatient settings. Compared to cisgender and heterosexual people, TGNC individuals are at a higher risk of mental health difficulties and have higher rates of inpatient mental health treatment. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: An international scoping review identifying the lack of guidelines existing for TGNC individuals in inpatient mental health settings. Compared to psychiatrists and psychologists, mental health nursing has the most contact with patients admitted for inpatient psychiatric treatment. The study identifies unaddressed needs in gender affirming policies and outlines preliminary policy recommendations to assist mental health staff in improving TGNC patient quality of care within the United States. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Reforming existing guidelines or creating new guidelines based on the identified themes and gaps to improve the well-being and treatment outcomes of TGNC individuals in inpatient psychiatric settings within the United States. ABSTRACT: INTRODUCTION: Access to culturally sensitive care is critical for addressing known mental health disparities among trans-and gender-non-conforming (TGNC) individuals. Although there has been a proliferation of TGNC healthcare guidelines from accrediting bodies, policies have failed to address the needs of TGNC patients in inpatient psychiatric settings. AIM: To identify unaddressed needs in policies and policy recommendations for the care of TGNC patients to inform recommendations for change. METHOD: A scoping review protocol was developed following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 850 articles were reduced to seven relevant articles with six themes identified via thematic analysis. RESULTS: Six themes were identified: lack of consistency in preferred and pronoun use, lack of communication among providers, lack of training in TGNC healthcare, personal bias, lack of formal policies, and housing segregation by sex rather than gender. DISCUSSION: The creation of new guidelines or bolstering of existing guidelines to specifically address identified themes and gaps may improve the well-being and treatment outcomes of TGNC individuals in inpatient psychiatric settings. IMPLICATIONS FOR PRACTICE: To provide a foundation for future studies to integrate these identified gaps and inform the future development of comprehensive formal policies that generalize TGNC care in inpatient settings.

Investigating the Joint Effect of Allostatic Load among Lesbian, Gay, and Bisexual Adults with Risk of Cancer Mortality.

Sexual minorities (SM) have higher chronic physiologic stress as indicated by allostatic load (AL), which may be explained in part by consistent experiences of discriminatory practices. This is one of the first studies to examine the joint effects of SM status and AL on the association with long-term risk for cancer death. Retrospective analyses were conducted on 12,470 participants using National Health and Nutrition Examination Survey (NHANES) from years 2001 through 2010 linked with the National Death Index through December 31, 2019. Cox proportional hazards models estimated adjusted hazard ratios (aHRs) of cancer deaths between groups of SM (those reporting as gay, lesbian, bisexual, or having same-sex sexual partners) status and AL. SM adults living with high AL (n = 326) had a 2-fold increased risk of cancer death (aHR: 2.55, 95% CI: 1.40-4.65) when compared to straight/heterosexual adults living with low AL (n = 6674). Among those living with high AL, SM (n = 326) had a 2-fold increased risk of cancer death (aHR: 2.26, 95% CI: 1.33-3.84) when compared to straight/heterosexual adults with high AL (n = 4957). SM with high AL have an increased risk of cancer mortality. These findings highlight important implications for promoting a focused agenda on cancer prevention with strategies that reduce chronic stress for SM adults.

Gender Minority Stress and Health Perceptions Among Transgender Individuals in a Small Metropolitan Southeastern Region of the United States.

Purpose: Transgender individuals continue to face wide-ranging health disparities, which may be due in part to unique and chronic gender identity-related stressors. The present study assessed the relationships between barriers to health care, proximal minority stress related to perceived community safety, and overall health perceptions of transgender individuals living in a small metropolitan region of the Southern United States. Methods: Participants included 66 transgender individuals who took part in a larger lesbian, gay, bisexual, transgender, and queer (LGBTQ) community needs assessment study. Participants completed measures of barriers to health care, inclusive of medical access barriers, psychosocial needs barriers, and personal resource barriers, perceptions of LGBTQ safety within the region, and overall perceptions of health. Results: Results revealed that psychosocial needs barriers, personal needs barriers, and perceived lack of community safety were correlated with poorer self-perceptions of overall health, with psychosocial needs barriers and perceived lack of community safety independently predictive of poor health perceptions. Conclusions: The study demonstrates the need for greater health resources and access to care, as well as improved community conditions for transgender individuals, particularly those in less populated, Southern regions of the United States, to improve health quality and ultimately reduce community health disparities.