Depressive distress among homosexually active African American men and women.

OBJECTIVE: Although early surveys of psychological adjustment among gay men and lesbians suggest only minor and not clinically relevant differences from heterosexual populations, concerns about psychiatric morbidity associated with HIV infection have renewed interest in the prevalence of psychological distress in this population, particularly among gay men. These later studies have focused primarily on white men. However, research indicates higher crude prevalence rates of psychological distress in community-drawn samples of African American subjects than in white subjects and also higher rates in women than in men. The authors examined rates of depressive distress and suicidal thoughts among homosexually active African American men and women who might be especially at risk for psychiatric morbidity due to multiple stigmatized social statuses. METHOD: Two nationally recruited groups of homosexually active African Americans (829 men and 603 women) completed self-administered questionnaires, including the Center for Epidemiologic Studies Depression Scale. RESULTS: Homosexually active black women were as distressed as HIV-infected gay black men. Men with symptomatic HIV disease were significantly more distressed than men who were HIV infected but asymptomatic, HIV-antibody negative, or whose HIV status was unknown. Both men and women reported distress levels in excess of those previously reported in studies of blacks or primarily white gay men. CONCLUSIONS: Further research is needed to identify specific predictors of life stressors and lack of social support among homosexually active African Americans who appear to be at higher risk for depressive distress.

Maintenance lithium treatment: side effects and compliance.

Fifty-one bipolar patients receiving maintenance lithium treatment were evaluated for the presence of side effects, their degree of distress, and the association of these side effects with compliance. Cognitive side effects and weight gain were the most disturbing to patients, whereas thirst and polyuria were the most common. Self-reported noncompliance correlated most highly with coordination (r = .38, p less than .01) and cognition (r = .30, p less than .05) side effects. Current depressed mood also showed a strong correlation with side effect scores, especially those for cognitive disturbances. However, the correlations between noncompliance and coordination and cognitive side effects were just as strong when the effects of depressed mood were partialled out. These findings indicate the link between noncompliance and lithium-induced central nervous side effects and suggest that related treatment issues must be addressed to ensure maximum clinical response.

Estimates of alcohol use and clinical treatment needs among homosexually active men and women in the U.S. population.

Concerns about dysfunctional alcohol use among lesbians and gay men are longstanding. The authors examined alcohol use patterns and treatment utilization among adults interviewed in the 1996 National Household Survey on Drug Abuse. Sexually active respondents were classified into 2 groups: those with at least 1 same-gender sexual partner (n = 194) in the year prior to interview and those with only opposite-gender sexual partners (n = 9,714). The authors compared these 2 groups separately by gender. For men, normative alcohol use patterns or morbidity did not differ significantly between the 2 groups. However, homosexually active women reported using alcohol more frequently and in greater amounts and experienced greater alcohol-related morbidity than exclusively heterosexually active women. Findings suggest higher risk for alcohol-related problems among lesbians as compared with other women, perhaps because of a more common pattern of moderate alcohol consumption.

Optimal scaling of HIV-related sexual risk behaviors in ethnically diverse homosexually active men.

As HIV-related behavioral research moves increasingly in the direction of seeking to determine predictors of high-risk sexual behavior, more efficient methods of specifying patterns are needed. Two statistical techniques, homogeneity analysis and latent class analysis, useful in scaling binary multivariate data profiles are presented. Both were used to analyze reported sexual behavior patterns in two samples of homosexually active men, one sample of 343 primarily White gay men attending an HIV workshop and one sample of 837 African American gay men recruited nationally. Results support the existence of a single, nonlinear, latent dimension underlying male homosexual behaviors consistent with HIV-related risk taking. Both statistical methods provide an efficient means to optimally scale sexual behavior patterns, a critical outcome variable in HIV-related research.

Perceptions of stressful life events and depression: a test of attributional models.

A brief review of tests of the attributional model of depression suggests that there is only weak or inconsistent support for the predicted causal ascriptions by depressed persons for negative events. Moreover, in very few studies have researchers actually tested the causal predictions of the model. Finally, because many of the studies were conducted with normal college students, the generality of the model as applied to different populations needs to be investigated. We addressed three questions: (a) the validity of the hypothesized independent and direction relation between each of the dimensions of internality, stability, controllability, intentionality, and globality and depression; (b) the causal relation between attributions and depression in a 2-month prospective study; and (c) evaluation of the model on two disparate samples: normal college students and elderly depressed outpatients ascribing causes for their personally stressful events. Causal modeling statistical procedures were applied to both the question of concurrent relations and causal relations between cognitions and depression. The results suggest minimal support for the attributional model: The dimensions were not each independently and directly associated with depression in the manner predicted by Abramson, Seligman, and Teasdale (1978), and the model that best fit the data was generally congruent for both the normal and clinical samples. In terms of direction of causality, the data were more consistent in indicating that depression causes cognitions than in indicating the reverse.

Emerging issues in research on lesbians' and gay men's mental health: does sexual orientation really matter?

Theoretical writings and research suggest that the onset, course, treatment, and prevention of mental disorders among lesbians and gay men differ in important ways from those of other individuals. Recent improvements in studies of sexual orientation and mental health morbidity have enabled researchers to find some elevated risk for stress-sensitive disorders that is generally attributed to the harmful effects of antihomosexual bias. Lesbians and gay men who seek mental health services must find culturally competent care within systems that may not fully address their concerns. The affirmative therapies offer a model for intervention, but their efficacy and effectiveness need to be empirically documented. Although methodological obstacles are substantial, failure to consider research questions in this domain overlooks the welfare of individuals who may represent a sizable minority of those accessing mental health services annually.

Women and AIDS-related concerns. Roles for psychologists in helping the worried well.

Acquired Immunodeficiency Syndrome (AIDS) has important implications for the practice of psychology. As the epidemic continues, the role of behavior change and psychosocial factors in the spread and transmission of Human Immunodeficiency Virus (HIV) infections assumes increasing significance. Psychologists, as behavior change experts, have a special and challenging role to play in educating the public, particularly women, about AIDS. This article examines AIDS- and HIV-related concerns in women with a focus on the personal dilemmas for the practicing psychologist, problems in health behavior advocacy, and methods and pitfalls in modifying sexual behaviors.

Issues in psychotherapy with lesbians and gay men. A survey of psychologists.

In 1984, a task force of the American Psychological Association (APA) Committee on Lesbian and Gay Concerns was charged with investigating bias in psychotherapy with lesbians and gay men. The task force surveyed a large and diverse sample of psychologists to elicit information about specific instances of respondent-defined biased and sensitive psychotherapy practice. Open-ended responses were used to separately identify major themes of biased and sensitive practice and to illustrate each with concrete examples. Results suggest that psychologists vary widely in their adherence to a standard of unbiased practice with gay men and lesbians. To bring individual practice into accord with APA policy will require continued and expanded efforts to educate practitioners about sexual orientation.

Sexual risk reduction behaviors among young heterosexual adults.

Although young, sexually-active heterosexuals have always been at risk for contracting sexually transmitted diseases, the recent appearance of Acquired Immunodeficiency Syndrome (AIDS) has increased the possible peril of sexual experimentation. Currently, behaviors to reduce the risk of contracting AIDS are being widely advocated. The present study examines predictors of self-reported risk reduction behaviors in a sample of 188 young, sexually-active heterosexuals. Three factors (perceptions of personal vulnerability, sexual behaviour history, and homophobia) were hypothesized to predict levels of worry about contracting a sexually transmitted disease. Worry, in turn, was hypothesized to predict behavior change. Structural equation modeling provided support for these predictions, but found somewhat different patterns for women and men. For both sexes, higher levels of worry were a significant predictor of risk reduction behavior implementation. For women only, more extensive sexual behavior histories significantly predicted levels of worry. In contrast, for men only, perceptions of personal vulnerability and homophobia were significant predictors of worry. Results suggest that gender plays an important role in understanding cognitive predictors of sexual risk reduction behaviors.

Acquired immunodeficiency syndrome and black Americans: special psychosocial issues.

Approximately 25 percent of persons diagnosed with acquired immunodeficiency syndrome (AIDS) have been black. This paper examines three areas of concern when focusing on AIDS in the black population: differences from whites in patterns of transmission of the infection, cultural factors that may affect health education efforts, and ethnically relevant issues in the provision of medical care to black persons with AIDS. Recognition of these differences is important in developing appropriate AIDS-related services for the black population. First, the epidemiologic pattern of infection in the black population differs from whites. Although they represent only 12 percent of the American population, blacks make up nearly one-quarter of reported AIDS cases. Currently, it is estimated that between 1 and 1.4 percent of the black population may be infected with the human T-lymphotropic virus/lymphadenopathy-associated virus (HTLV-III/LAV), a rate estimated to be three times that of whites. In addition, epidemiologic patterns of viral transmission in the black community suggest a greater incursion into the heterosexual population. Second, educational interventions designed to slow the rate of infection need to be sensitive to cultural and behavioral differences between blacks and whites who are at increased risk for acquiring or transmitting an HTLV-III/LAV infection. These include possible differences in perceptions of being at risk and actual risk behaviors. Third, in caring for black AIDS patients there are psychological, sociocultural, and medical care issues that are relevant. Research findings specific to health care for blacks are reviewed with particular reference to concerns that might arise in the treatment of black persons with AIDS. Recommendations for research and health education efforts in the black community are presented.

Exploring a model of symbolic social communication: the case of 'magic' johnson.

We propose a model of symbolic social communication to explain the process whereby sociocultural identity mediates relationships among receivers, sources and messages to shape message effects. This exploratory study examines how two at-risk groups of African American men responded to various HIV prevention messages delivered by celebrity and professional sources. We interviewed 47 men from a homeless shelter and 50 male college students. Members of both groups were likely to select Johnson as the best person to deliver HIV prevention messages among a list of African American celebrity and professional sources. Results suggest the symbolic meanings embedded in celebrities and message topics are important and enduring influences on message effects. The images and ideas that a source represents are transferred to the advocated behavior, attitude or knowledge change and thus shape how messages are interpreted and received. Further understanding of how culture influences the effects of persuasive messages is critical for the improvement of health-communication campaigns.

Loneliness and psychological distress.

Research on relationships between loneliness and psychological symptoms has generally shown significant positive associations across a wide spectrum of psychopathologies. However, such results may be artificial, to some extent, given the high intercorrelations of typical psychopathology measures. In the current study, we examined associations between psychological symptoms, assessed by the Symptom Check List-90 (SCL-90; Derogatis, Lipman, & Covi, 1973) and loneliness, as measured by the UCLA-R Loneliness Scale (Russell, Peplau, & Cutrona, 1980), in college students. Using partial correlations to control for the confounding influence of generalized distress, relationships between loneliness and individual dimensions of distress were examined. Results indicate a significant association between loneliness and interpersonal sensitivity (low self-esteem) and depression. Other dimensions of distress were not significantly related to loneliness. In addition, no sex differences in patterns of association were observed. Results support the notion that self-blame and self-devaluation are strong correlates of loneliness.

Value orientations in the intimate relationships of gay men.

A questionnaire study investigated the intimate relationships of 128 gay men. Most men said their current relationship was extremely close and personally satisfying. An analysis of their values concerning these relationships identified two distinct dimensions: dyadic attachment and personal autonomy. Relationship values appeared to be part of more general patterns of conservatism versus liberalness in men's attitudes. The importance men gave to attachment values was consistently related to features of their relationships, including love and intimacy, future expectations, sexual behavior and exclusivity, and reactions to breakups. In contrast, autonomy values appeared to have little impact on intimate relationships. Results are discussed in terms of men's sex-role socialization.

The impact of perceived discrimination on the intimate relationships of black lesbians.

This paper explores the effects of perceived racial/ethnic and sexual orientation discrimination on African-American lesbians' relationships with friends, lovers, family, and community support systems. Data for this exploratory study were gathered from a series of semi-structured ethnographic interviews with self-identified Black lesbians. Results suggested that those who had been in relationships with White lesbians reported more frequent experiences of discrimination that influenced their later decision to seek a Black lesbian partner for their next love relationship. Reactions toward lesbian community events ranged from avoidance to determined participation in response to feelings of alienation and racism. Also, Black lesbians perceived the African-American community to be conservative in their views on homosexuality. Nevertheless, for half of the women their interest in participation in the African-American community overshadowed their concerns about negative reactions to their homosexuality. Data from this exploratory study isolated questions that need further empirically based exploration in order to understand how race/ethnicity, culture, and sexual orientation influence the development, maintenance, and dissolution of intimate relationships in the lives of African-American lesbians.

Disclosure of sexual preference to physicians by black lesbian and bisexual women.

Physicians' ability to diagnose and treat health care problems, particularly those with a psychosocial component, is facilitated by accurate information concerning the life-styles of their patients. White lesbians have been shown to be generally reluctant to disclose sexual orientation to their physicians, but little, if anything, is known about black lesbians. Black women, self-identified as bisexuals (N = 65) and lesbians (N = 529), were asked whether they had disclosed their homosexual behavior to their physicians. In the sample, only a third of the women had. Previous sexual experiences, both heterosexual and homosexual, were also queried to illuminate patterns of gynecologic health risk factors. Nearly all of the women reported previous heterosexual experiences.

Attitudinal correlates of lithium compliance in bipolar affective disorders.

Lithium noncompliance is a significant barrier to effective treatment of manic-depressive disorders, yet the reasons for it are not well established. This questionnaire study of 48 lithium outpatients evaluated the utility of Ajzen and Fishbein's Theory of Reasoned Action in explicating the relationships among lithium-related beliefs and attitudes, normative beliefs, behavioral intentions, and self-reported compliance with the treatment regimen. Results support the usefulness of this model, with some modification, in conceptualizing patients' compliance behaviors. Findings underscore the importance of the patient-physician relationship in lithium compliance.