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This rapid review provides an overview of recent literature on the nature of digital interventions for young people in terms of technologies used, substances and populations targeted, and theoretical or therapeutic models employed. A keyword search was conducted using MEDLINE and other databases for 2015-2021. Following a title/ and full-text screening of articles and consensus decision on study inclusion, data extraction proceeded using an extraction grid. Data synthesis relied on an adapted conceptual framework (Stockings et al., 2016) that involved a three-level treatment spectrum for youth substance use (prevention, early intervention, and treatment). The review identified 43 articles describing 39 digital interventions. Most were early interventions (n = 28), followed by prevention (n = 6) and treatment (n = 5). Of the five technologies identified, web-based interventions (n = 14) were most common. Digital interventions have mainly focused on alcohol use (n = 20), reflecting limited concern for other substance use and co-occurring use. Yet the rise in substance use and related harms during the Covid-19 pandemic highlights a critical need for more innovative substance use interventions. Technologies with more immersive and interactive features, such as VR and game-based interventions, call for further exploration. Only one intervention was culturally tailored and purposefully designed for gender minority youth, and another was geared to young men. As well, most interventions used a personalized or normative feedback approach, while a harm reduction approach guided only one intervention. The incorporation of culturally tailored interventions and harm reduction approaches may promote uptake and stronger engagement with digital interventions amongst youth.
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Hesitance toward COVID-19 vaccination has greatly decreased over the course of the pandemic in the U.S. However, some populations have lower vaccination rates than the general population. This study was conducted to identify correlates of being fully vaccinated (i.e., having received all doses required to be fully vaccinated) among college students using students' responses to the 2022 Spring American College Health Association-National College Health Assessment. The surveys were administered in March of 2022. The sample (n = 617) included 18-to-30-year-old students. Firth logistic regression models were performed that controlled for age, sex assigned at birth, and food security (at a 5% significance level). The model-assisted results indicated that being a member of sexual and gender minority communities, being a graduate student, and being concerned about someone close getting COVID-19 were positively associated with being fully vaccinated, while current use of any tobacco product and current use of e-cigarettes were negatively associated with being fully vaccinated (all p-values < 0.05). In addition, the percentage of fully vaccinated students was higher among transgender/gender non-binary students (95%) than among cisgender men and women (85-87%), and among sexual minority groups (93-97%) than among heterosexual/straight students (82%). Among the racial/ethnic groups considered, the percentage of fully vaccinated students was lowest among non-Hispanic Black/African American students (77%), but the racial/ethnic differences were not statistically significant (at 5% level). The study points to a critical need for development and implementation of tailored vaccination campaigns to help students from diverse communities, including tobacco users, make informed decisions and become fully vaccinated.
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Introduction: The differential effect of the Covid-19 pandemic on the mental health of the population around the globe is well documented. Social isolation, loss of job, financial crisis, and fear of infection due to the pandemic have widely affected people across countries, and the sexual and gender minority (SGM) group is no exception. However, the additional stressors like stigma, discrimination, rejection, non-acceptance, and violence associated with diverse sexual orientation complicated the situation for the SGM group in the context of the Covid-19 pandemic. Method: The present study conducted a systematic review of research (n = 16) investigating the impact of Covid-19 stress on the psychological health of SGM individuals. The review had two objectives: (a) to explore the effect of the stress associated with the pandemic on the psychological health of the SGM individuals; and (b) to identify potential stressors associated with the Covid-19 pandemic affecting the mental health of SGM individuals. Studies were selected following a PRISMA protocol and several inclusion criteria. Results: The review provided new insights into the mental health issues of the SGM individual in the Covid-19 context. The outcome of the review focused on five aspects: (a) depression and anxiety symptoms related to Covid-19 symptoms; (b) perceived social support and Covid-19 stress; (c) family support and psychological distress related to Covid-19; (d) Covid-19 stress and disordered eating, and (e) problem drinking and substance abuse associated with Covid-19 stress. Discussion: The present review indicated a negative association between Covid-19 stress and psychological distress among sexual and gender minority individuals. The findings have important implications for psychologists and social workers working with this population and policymakers around the globe.
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BACKGROUND: Sexual and gender minorities (SGM) in the Southern United States face challenges in accessing sexual and gender affirming health care. Alternative care models, like inclusive mobile clinics, help mitigate barriers to care for SGM. There is limited data in the literature on the experience of medical referral processes for SGM individuals accessing services from mobile health clinics. AIMS AND OBJECTIVES: The purpose of this study is to describe the medical referral experiences of SGM clients and their providers at a mobile health clinic in the Southern United States. METHODS: We recruited English-speaking individuals who provided care or received care from the mobile health clinic in South Carolina between June 2019 and August 2020. Participants completed a brief demographic survey and a virtual in-depth, semi-structured individual interview. Data analysis was conducted using an iterative process to generate codes, categories, and themes. Data collection and analysis were terminated once thematic saturation was achieved. RESULTS: The findings from this study indicated that the mobile health clinic had an inconsistent referral process that was largely dependent on providers' knowledge. Furthermore, clients and providers expressed individual barriers to the referral process, such as financial barriers, and opportunities to improve the referral process, such as an opt-in follow-up from the mobile clinic and increased mobile clinic resources. CONCLUSION: The findings in this study underscore the importance of having mobile clinics create a structured referral process that all medical providers are familiar with, and the value of hiring patient navigators that can support and refer clients to care that goes beyond the mobile health clinic setting.
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Mobile Health Units , Sexual and Gender Minorities , Humans , South Carolina , Public Health , Gender Identity , Referral and ConsultationABSTRACT
Purpose: The purpose of this study was to utilize a systematic review and meta-analysis to assess the existing body of literature to understand the mental health impacts of the coronavirus disease-19 (COVID-19) pandemic among sexual and gender minority (SGM) people. Methods: The search strategy was developed by an experienced librarian and used five bibliographical databases, specifically PubMed, Embase, APA PsycINFO (EBSCO), Web of Science, and LGBTQ+ Source (EBSCO), for studies (published 2020 to June, 2021) examining the psychological impact of the COVID-19 pandemic among SGM people. Articles were screened by two reviewers. The quality of the articles was assessed using the National Institutes of Health quality assessment tool for observational studies. A double extraction method was used for data abstraction. Heterogeneity among studies was assessed by I2 statistic. The random-effects model was utilized to obtain the pooled prevalence. Publication bias was assessed by Funnel plot and Egger's linear regression test. Results: Of a total of 37 studies, 15 studies were included in the meta-analysis with 17,973 SGM participants. Sixteen studies were U.S. based, seven studies were multinational studies, and the remaining studies were from Portugal, Brazil, Chile, Taiwan, the United Kingdom, France, Italy, Canada, and several other countries. A majority of studies used psychometric valid tools for the cross-sectional surveys. The pooled prevalence of anxiety, depression, psychological distress, and suicidal ideation was 58.6%, 57.6%, 52.7%, and 28.8%, respectively. Conclusions: Findings of this study serve as evidence to develop appropriate interventions to promote psychological wellbeing among vulnerable population subgroups, such as SGM individuals.
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There is a dearth of research that examines COVID-19-related stress among multiply marginalised individuals who are in the developmental phase of emerging adulthood. This qualitative study investigated how the intersection of emerging adulthood, sexual and gender minority (SGM) identity, and migrant status were reflected in the experiences of SGM individuals (n = 37; ages 20-25 years old) who migrated to various parts of the United States in the last 5 years. Data were collected online using semi-structured interviews. Thematic analysis revealed that participants' developmental processes (e.g., identity exploration, building financial independence) were shaped by pandemic-related stressors, especially unemployment and financial instability. Participants who were able to maintain employment did so but at the risk of their health and safety. Findings also showed that participants experienced feelings of anxiety and depression due to social isolation, but online communication played an important role in combatting loneliness. Findings highlight the potential for trauma-informed and intersectional approaches to practice with SGM emerging adult migrants and expanded health services and temporary entitlement programs to mitigate the pandemic's effects on this population's psychosocial and financial well-being.
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Despite significant social and legal progress, LGBTQ+ (lesbian, gay, bisexual, transgender, and other sexual and gender minority) populations continue to experience higher rates of mental health and substance use disorders than their heterosexual and cisgender counterparts. Effective LGBTQ+ affirmative mental health care is essential for addressing these disparities but is often limited and difficult to access. The shortage of LGBTQ+ affirmative mental health care providers results from the absence of required and accessible LGBTQ+-focused training and technical assistance opportunities for mental health care professionals. This study evaluates the implementation of our COVID-19 adapted, completely virtual, organization- and therapist-focused training program to improve the mental health workforce's cultural competence in working with the LGBTQ+ community: the Sexual and Gender Diversity Learning Community (SGDLC). Guided by an expanded RE-AIM model, we used administrator and therapist feedback to assess SGDLC implementation factors to understand how it may be best translated for scaled-up promotion and widespread adoption. Assessment of the initial reach, adoption, and implementation of the SGDLC indicated that it had strong feasibility; reports on satisfaction and relevance support the SGDLC's acceptability. Maintenance could not be fully assessed from the short study follow-up period. Still, administrators and therapists expressed an intent to continue their newfound practices, a desire for continued training and technical assistance in this area, but also concerns about finding additional opportunities for this education.
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To assess how the COVID-19 pandemic affected catch-up HPV vaccination among age-eligible adults (ages 18–45). The current study leverages a national, cross-sectional sample of US adults ages 18–45 years to assess the prevalence and determinants of COVID-19 pandemic-related disruptions to catch-up HPV vaccination in 2021. The sample was restricted to adults intending to receive the HPV vaccine. Multinomial logistic regression analysis was conducted to assess the probability of 1) pandemic-related HPV vaccination disruption and 2) uncertainty about pandemic-related HPV vaccination disruption. Report of ‘no pandemic-related HPV vaccination disruption' served as the reference category. Among adults intending to get the HPV vaccine (n = 1,683), 8.6 % reported pandemic-related HPV vaccination disruption, 14.7 % reported uncertainty about vaccination disruption, and 76.7 % reported no disruption. Factors associated with higher odds of pandemic-related vaccination disruption included non-English language preference (OR: 3.20;95 % CI: 1.99–5.13), being a parent/guardian (OR: 1.77;95 % CI: 1.18–2.66), having at least one healthcare visit in the past year (OR: 1.97;95 % CI: 1.10–3.53), being up-to-date on the tetanus vaccine (OR: 1.81;95 % CI: 1.19–2.75), and being a cancer survivor (OR: 2.57;95 % CI: 1.52–4.34). Catch-up HPV vaccination for age-eligible adults is a critical public health strategy for reducing HPV-related cancers. While a small percentage of adults reported pandemic-related disruptions to HPV vaccination, certain adults (e.g., individuals with a non-English language preference and cancer survivors) were more likely to report a disruption. Interventions may be needed that increase accessibility of catch-up HPV vaccination among populations with reduced healthcare access during the pandemic. © 2022 The Authors
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Purpose: Rates of suicidal ideation and attempts among adolescents, especially young sexual and gender minority (SGM) adolescents, have been on the rise over the last several years. The COVID-19 pandemic has only exacerbated risk factors for suicidality and introduced additional barriers to accessing needed medical care and other help-seeking resources. This study sought to estimate the prevalence of suicidal thoughts, plans, and attempts among young SGM adolescents residing in the South, a geographic region with high unmet health needs, greater multi-level experiences of discrimination, and a hostile policy landscape marked by numerous anti-LGBTQ bills and few protections on the basis of sexual and gender identity. Methods: Tailored social media advertising was used between July 2021 and April 2022 to recruit and enroll 384 SGM adolescents aged 13-17 years residing in eight southeastern states (Alabama, Florida, Georgia, Louisiana, Mississippi, North Carolina, South Carolina, and Tennessee). Study staff used multiple authentication procedures to verify the uniqueness and validity of each enrollment. Respondents completed an online cross-sectional survey that assessed prior suicidality (thoughts, plans, attempts). Respondents were provided a number of help-seeking resources at the conclusion of the survey. The mean respondent age was 16.1 years (SD = 1.0), and respondents were primarily female (45.6%, n=175), bisexual (38.0%, n=146), and non-Hispanic White (52.6%, n=202). We used unadjusted and adjusted logistic regression analyses to identify sociodemographic, health, and relationship correlates of prior suicidal ideation and attempts. Results: Overall, 70.6% (n=271) of SGM adolescents reported ever having serious suicidal thoughts. Of these respondents, 74.9% (n=203) had planned and 43.9% (n=119) had attempted suicide. Adjusted analyses showed that the likelihood of prior suicidal ideation was higher among respondents who identified as Hispanic (AOR: 2.7;95% CI: 1.1, 7.0), non-Hispanic Multiracial (AOR: 4.1;95% CI: 1.2, 13.9), and non-Hispanic White (AOR: 3.0;95% CI: 1.4, 6.3) as compared to non-Hispanic Black, and was twice as high among respondents 17 years of age (AOR: 2.3;95% CI: 1.1, 5.0) compared to those 15 years of age. Having a diagnosed disability (AOR: 3.4;95% CI: 1.9, 6.1) and poor parental relationship quality (AOR: 2.3;95% CI: 1.2, 4.1) were also associated with an increased likelihood of prior suicidal ideation. The likelihood of prior attempted suicide was significantly greater among SGM adolescents who reported poor parental relationship quality (AOR: 2.0;95% CI: 1.1, 3.6), a diagnosed disability (AOR: 2.1;95% CI: 1.1, 4.0), and a chronic health condition (AOR: 2.5;95% CI: 1.4, 4.7). Conclusions: The prevalence of lifetime suicidality was quite high among SGM adolescents in the South, even higher than estimates reported by national studies among similarly aged adolescents. The findings suggest the immediate need for tailored efforts to prevent and address suicidality among SGM adolescents, especially given the compounding effects of the COVID-19 pandemic on adolescents' health. The findings also suggest the need to intervene with the parents of SGM adolescents or increase acceptance and connectedness in other close relationships. Sources of Support: This study was funded by the Centers for Disease Control and Prevention's National Center for Injury Prevention and Control (K01CE003226).
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Objective: To understand how students are coping one year after campuses were closed due to the COVID-19 pandemic. Participants: Students at a large state university in Midwestern USA. Method: Sequential mixed method study. A photo-survey of students' experiences was conducted as part of an ethnographic study of "college life." Student researchers and faculty collaboratively analyzed photos and accompanying text for coping strategies. Association of coping strategies with respondents' characteristics was assessed with inferential statistics. Results: Most respondents alluded to the negative mental toll of the pandemic and predominantly utilized emotion-focused coping strategies. Non-binary students and students who lived off but close to campus appeared to have fewer coping strategies than their peers. Conclusion: The experiences of diverse student sub-populations differ. Photos give researchers a unique vista into students' experiences. Students - as co-researchers - can help campuses understand the stresses associated with their college experiences and how they are coping.
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Emerging adulthood is a critical period of development as individuals explore their identities and embark on developmental trajectories. Emerging adulthood may be an especially important period for sexual and gender minority (SGM) individuals as they explore, learn, and seek out communities related to their sexuality and gender identity. College is a unique setting in which SGM students may have access to physical and mental healthcare, secure food and housing, and affirming spaces and community related to their identity. However, the COVID-19 pandemic has interrupted or ended many of the services and resources provided by colleges and universities, potentially exacerbating challenges faced by sexual and gender minority students. This article provides recommendations for colleges and universities to improve access to and mitigate potentially negative outcomes among SGM students during and in the wake of the COVID-19 pandemic.
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BACKGROUND: Efficacious mental health interventions for sexual and gender minority youth have had limited reach, given their delivery as time-intensive, in-person sessions. Internet-based interventions may facilitate reach to sexual and gender minority youth; however, there is little research examining their efficacy. OBJECTIVE: This study aims to describe the results of a pilot randomized controlled trial of imi, a web application designed to improve mental health by supporting lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority identity affirmation, coping self-efficacy, and coping skill practice. METHODS: Sexual and gender minority youth (N=270) aged 13 to 19 (mean 16.5, SD 1.5) years and living in the United States were recruited through Instagram advertisements. Approximately 78% (210/270) of the sample identified as racial or ethnic minorities. Participants were randomized in a 1:1 fashion to the full imi intervention web application (treatment; 135/270, 50%) or a resource page-only version of the imi site (control; 135/270, 50%). The imi application covered four topical areas: gender identity; lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority identity; stress and coping; and internalized homophobia and transphobia. Participants explored these areas by engaging with informational resources, exercises, and peer stories at a self-guided pace. Both arms were assessed via web-based surveys at baseline and 4-week follow-up for intervention satisfaction, stress appraisals (ie, challenge, threat, and resource), coping skills (ie, instrumental support, positive reframing, and planning), and mental health symptoms among other outcomes. Main intent-to-treat analyses compared the arms at week 4, controlling for baseline values on each outcome. RESULTS: Survey retention was 90.4% (244/270) at week 4. Participants in the treatment arm reported greater satisfaction with the intervention than participants in the control arm (t241=-2.98; P=.003). The treatment arm showed significantly greater improvement in challenge appraisals (ie, belief in one's coping abilities) than the control (Cohen d=0.26; P=.008). There were no differences between the arms for threat (d=0.10; P=.37) or resource (d=0.15; P=.14) appraisals. The treatment arm showed greater increases in coping skills than the control arm (instrumental support: d=0.24, P=.005; positive reframing: d=0.27, P=.02; planning: d=0.26, P=.02). Mental health symptoms improved across both the treatment and control arms; however, there were no differences between arms. Within the treatment arm, higher engagement with imi (≥5 sessions, >10 minutes, or >10 pages) predicted greater improvement in stress appraisals (all P values <.05). CONCLUSIONS: The results provide initial evidence that asynchronous psychosocial interventions delivered via a web application to sexual and gender minority youth can support their ability to cope with minority stress. Further research is needed to examine the long-term effects of the imi application. TRIAL REGISTRATION: ClinicalTrials.gov NCT05061966; https://clinicaltrials.gov/ct2/show/NCT05061966.
Subject(s)
Gender Identity , Sexual and Gender Minorities , Adaptation, Psychological , Adolescent , Female , Humans , Male , Pilot Projects , Sexual Behavior/psychology , United StatesABSTRACT
Sexual and gender minority (SGM) people face pre-existing inequalities that may have been exacerbated by the Coronavirus-19 (COVID-19) pandemic. Canadian sexual minorities are twice as likely to live alone compared to heterosexual people and are more vulnerable to anxiety, depression, self-harm, and substance abuse. Despite these vulnerabilities, several studies suggest that social support and community solidarity can mitigate the effect of stress on SGM mental health. Using a cross-sectional online survey, our team examined SGM and cisgender heterosexual mental health and social support during the first four months of the COVID-19 crisis in Quebec, Canada. A total of 2900 adults (n = 304 SGM people, n = 2596 cisgender heterosexual people) completed questionnaires measuring perceived social support, perceived stress, depressive symptoms, anxiety symptoms, and loneliness. A series of one-way ANOVAs revealed that SGM people presented worse health outcomes than cisgender heterosexual people on all questionnaires (p < .001). Post hoc analyses also showed that some particularly marginalised SGM sub-groups, including bisexual and asexual people, showed the worst health outcomes. Moderation analyses later revealed that social support moderated the relationship between perceived stress and depressive symptoms among both SGM and cisgender heterosexual people - but this effect was four times stronger among SGM people (ΔR2 = .041;p < .001) than among cisgender heterosexual people (ΔR2 = .010;p < .001). These results suggest fostering social connectedness among SGM people may be especially beneficial in buffering against distress in the face of a crisis. To better understand how SGM mental health is evolving during this pandemic, our team is currently conducting a follow-up longitudinal study examining mental health, trauma, coping strategies and resilience among SGM and cisgender heterosexual adults before and after vaccination efforts started in Canada (to date, N = 6083). Preliminary results from time 1 (July 2020) and 2 (Fall 2021) are being treated and will also be presented.
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Individuals testing positive for BRCA1/2 genetic mutations, or hereditary breast and ovarian cancer mutations, are 33-55% more likely than women without these mutations to develop breast and/or ovarian cancers before the age of 70. While research involving these genetic mutations continues to emerge, there remains unanswered questions regarding prophylactic experiences and subsequent impacts on mental health within subgroups of BRCA1/2-positive women. The purpose of this analysis was to explore the impact of BRCA1/2 mutations, prophylactic surgeries, and surveillance regimens within the scope of everyday life within a sample of BRCA1/2 positive women from medically-underserved backgrounds living in the United States (US). A sample of 211 US adult women who have tested positive for BRCA1/2 mutations within the past 5 years and who identify with one or more medically-underserved populations (racial, ethnic, or sexual minority, person with a physical disability, chronically-ill, those in poverty, immigrant populations) elucidated compelling qualitative data. A total of 169 (80.1%) women completed open-ended questions at the end of the online survey. Thematic analysis was utilized to identify themes and subthemes concerning mental health, sources of stress, and methods of stress relief. The focus of the current analysis is on the sources of stress identified by the respondents. Fourteen subthemes were identified. The four most common stressors were concerns about post-treatment recovery (19% of respondents), recurrence of a new cancer (15%), medical unknown of having a genetic mutation that increases the risk of cancer (14%), and having to schedule and plan for continual surveillance (12%). The next five subthemes ranged from 7-9% and include waiting for medical results, personal finances and covering medical expenses, impact of the COVID-19 pandemic, pre-operative anxiety, and worrying about insurance coverage. Our findings support previous research on cancer stressors for women while adding important qualitative elements for a richer understanding. Furthermore, since much of the research on the lived experiences of BRCA1/2 has been on highly-educated, non-Hispanic white women, few studies have focused entirely on medically-underserved populations, which was the entirety of our sample. This work adds an important intersectional lens in which to better understand the experiences of living with a BRCA1/2 mutation.
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Background During the COVID-10 pandemic, governments worldwide were faced with priority setting challenges as the resource needs outpaced the available resources. Explicit criteria and ethical principles are recommended since they improve the consistency, transparency and the fairness of the priority setting and resource allocation processes. Objectives To identify the criteria and the degree to which COVID-19 pandemic plans included explicit criteria, including equity considerations. Methods We retrieved and reviewed COVID-19 pandemic plans from a sample of 86 countries from the six WHO regions. We ed information, on criteria and equity considerations, from each of the retrieved reports. We conducted comparative analysis of the criteria that were ed between regions and the priority setting criteria discussed in the literature. Results Only 32% (n=28) of the sampled countries identified explicit criteria and guiding principles in their pandemic plans. The most common criteria identified included: disease burden, severity, health sector capacity (in low income countries) and justice or equity. Several plans explicitly identified equity as a criterion, while other plans identified varied groups of vulnerable populations which should be prioritized including: those at risk for severe disease, risk of infection or risk of spreading the disease;immigrants/refugees, sexual minorities. Discussion and Conclusion The limited number of countries that included explicit PS criteria and equity considerations in their pandemic plans, highlight a need for PS researchers and policy makers to collaborate on how to meaningfully integrate these aspects into their pandemic plans. However, the documentation of the criteria is just an initial step. There is a need for studies that empirically examine the criteria which were actually implemented during the response phase of the pandemic.
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The burden of the pandemic is more pronounced among vulnerable and marginalized groups in the society, who, in the context of complex disadvantages, do not have the means to cope with the multifaceted disruptions in the labour market, food and health system, and their social networks. The pandemic and different measures taken by the Ethiopian government including State of Emergency (SOE) and strategies to contain COVID-19 affect all citizens in general and LGB in particular. This mixed methods study seeks to assess the impact of COVID-19 and the wide socio-economic and political upheaval associated with the State of Emergency Proclamation on the lives of LGBs in Ethiopia. The research combines phone surveys involving 200 LGB and qualitative interviews with 12 LGB. Most of the participants reported experiencing drastic changes in their lives since the advent of COVID-19. The most reported as well as the worst experiences include unemployment/ reduced income and food/housing insecurity;fear of COVID-19 infection or death;inability to continue normal daily life, social and intimate relationship;and change in living arrangement. A small proportion of participants also mentioned violence. The study confirmed the precarious situation of sexual minorities in times of crisis. The ongoing war since Nov.2020 and resulting insecurity have led to disruption and destruction of the economy, social and health services;and deterioration of peace and security with significant bearing on marginalized groups. Long standing and entrenched stigma and widely held notions of heteronormativity have relegated LGB in Ethiopia to the margins of society. The pandemic and subsequent SOE and internet interruptions have pushed LGB into further physical, social, and economic vulnerabilities and marginalization. Within the LGB group, the impact varies across individuals based on their socioeconomic and health standing. The situation calls for concerted policy measures to address economic, social, and health determinants.
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Purpose: Sexual and gender minority (SGM) people are at increased risk for psychological distress compared with cisgender heterosexual people. Specific SGM subgroups include lesbian, gay, bisexual, gender diverse, and asexual people who each experience unique psychosocial challenges that can result in different mental health outcomes. The coronavirus disease 2019 (COVID-19) pandemic may have further exacerbated mental health disparities among these groups. The aim of this study was to compare lesbian, gay, bisexual, gender diverse, asexual, and cisgender heterosexual people's mental health and social support during the first 4 months of the COVID-19 crisis. Methods: This study used a cross-sectional online survey from March 26th, 2020 to July 7th, 2020 in Québec, Canada. A total of 2908 individuals (n = 304 SGM people, n = 2604 cisgender heterosexual people) completed questionnaires measuring perceived social support, perceived stress, symptoms of depression and anxiety, as well as loneliness. Results: SGM people presented worse health outcomes than cisgender heterosexual people on all questionnaires (p < 0.001). Post hoc analyses showed that particularly marginalized SGM subgroups, including bisexual and asexual people, reported the poorest mental health. Moderation analyses revealed that the buffering effect of social support on depressive symptoms was four times stronger among SGM people (ΔR2 = 0.041; p < 0.001) than among cisgender heterosexual people (ΔR2 = 0.010; p < 0.001). Conclusion: This study suggests that fostering social connectedness among SGM people may be especially beneficial in buffering against distress in the face of a crisis.
Subject(s)
COVID-19 , Sexual and Gender Minorities , Cross-Sectional Studies , Female , Humans , Mental Health , Quebec/epidemiology , Social SupportABSTRACT
Introduction MSM are disproportionately affected by health inequalities which may be exacerbated by COVID-19 and pandemic- related restrictions. We examine uptake of the COVID- 19 vaccine in MSM and assess factors associated with vaccination status. Methods An online cross-sectional survey of MSM recruited via social media and dating applications for 3 weeks in November/December 2021. Questions included those on vaccine offer and uptake (1 dose/2 doses/2 doses+booster). Logistic regression assessed factors associated with reporting full vaccination status (≥2 doses) by sociodemographic characteristics, HIV status, self-reported COVID history, and mental health indicators. Results Of 1,039 participants, 98.2% (n=1,020) reported everhaving been offered a COVID vaccine, of which 98.0% (1,000/1,020) reported ≥1 dose and 96.5% (985/1020) full vaccination status. In multivariate models, full vaccination status was associated with: age (aOR:1.04, 95%CI:1.01-1.06 per increasing year), gender (aOR: 0.26, 95%CI:0.09-0.72, gender minority vs cis male), degree-level education (aOR: 2.11,95% CI:1.12-3.98), employment since lockdown (aOR: 2.07,95% CI:1.08-3.94), single relationship status (aOR: 0.50,95% CI:0.25-1.00), self-reported COVID-19 history (aOR: 0.47, 95%CI:0.25-0.88), HPV vaccination history (aOR: 3.32, 95% CI:1.43-7.75), and self-reported low life-worth (aOR: 0.29, 95%CI:0.15-0.54). Conclusion This large community survey suggests COVID-19 vaccine uptake and coverage is high in MSM and exceeds general population vaccination estimates. However, inequalities appear to exist in some groups, including younger age-groups, gender minorities, and those with poorer mental health less likely to report full vaccination. Efforts are needed to limit COVID-related exacerbation of health inequalities in these groups who already experience a greater burden of poor health relative to other MSM.
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Background/aims: The COVID-19 pandemic has resulted in global mass bereavement;in the UK alone there have been 140,000 deaths to date, with a disproportionate impact on Black, Asian or minoritized ethnic (BME) communities. Voluntary and community sector (VCS) bereavement services including hospices play an important role in bereavement support. We aimed to determine services' perspectives on access to their support. Methods: Cross-sectional online survey of VCS bereavement services in the UK, open March-May 2021, disseminated via national organisations, associations and networks and social media. Results: 147 organisations participated;53% served specific counties or smaller regions;16% were UK-wide. 36% were hospice or palliative care services, 15% national bereavement charities or NGOs;12% local bereavement charities. 67.3% reported there were groups with unmet needs not accessing their services before the pandemic;most frequently reported were people from BME communities (49%), sexual minority groups (26.5%), deprived communities (24.5%) and men (23.8%). 50% of services reported that, in the year before COVID-19, <5% of clients were from BME communities;25% did not collect this data and 25% reported >5% BME clients. Compared with before the pandemic, 3.4% of services were seeing more people from BME groups, 52% were seeing the same proportion, 6.1% were seeing fewer and 38% didn't know/didn't collect this data. Conclusions: For over two thirds of VCS bereavement services in the UK, there are known inequities in who accesses support, with people from BME groups most likely to be recognised as needing support but not Paediatric Palliative Care Commissioners (n=2) Gender Female:Male 2:0 accessing services. During the pandemic, the proportion of BME clients did not increase, despite these communities being disproportionately affected by COVID-19. More attention needs to be paid to assessing and meeting unmet needs for formal bereavement support among disadvantaged groups and routinely collecting client data to help determine and ensure equity. (Table Presented).
ABSTRACT
Background: The current scarcity of research surrounding sexual minorities has yielded an incomplete picture of their health needs, especially during the COVID-19 pandemic. The Household Pulse Survey (HPS) was launched in April of 2020 to efficiently understand the impact of the coronavirus pandemic on households and was recently expanded to include questions related to sexual orientation and gender identity (SOGI). Aim: In this study, we examined the mental health of sexual minorities (gay/lesbian and bisexual) in the United States compared with heterosexual peers during the COVID-19 pandemic. Methods: This study used data from 357,939 heterosexual adults, 13,293 gay/lesbian adults, and 12,856 bisexual adults aged 18 years and older surveyed in waves 34-39 from the HPS. We compared anxiety and depression (calculated using the PHQ-2 and GAD-2), as well as access to and utilization of mental health treatment between sexual minority and heterosexual adults using multivariable logistic regression models controlling for sociodemographic characteristics. Results: After adjusting for sociodemographic characteristics, gay men had higher odds of experiencing both anxiety (OR=1.798, p<0.001) and depression (OR=1.603, p<0.001) than heterosexual men. Bisexual men experienced similar disparities of a greater magnitude for anxiety (OR=2.453, p<0.001) and depression (OR=2.309, p<0.001). Lesbian women also had higher odds of experiencing anxiety (OR=1.762, p<0.001) and depression (OR=1.740, p<0.001) than heterosexual women. Bisexual women experienced similar disparities of a greater magnitude for both anxiety (OR=2.084, p<0.001) and depression (OR=2.386, p<0.001). These disparities are not restricted to the prevalence of anxiety and depression but are instead also reflected in health access measures. Unmet mental health care needs displayed similar disparities: gay (OR=2.482, p<0.001) and bisexual (OR=2.644, p<0.001) men had higher odds of reporting this outcome than heterosexual men. Similarly, lesbian (OR=2.009, p<0.001) and bisexual (OR=2.092, p<0.001) women had higher odds of reporting unmet mental health care needs than heterosexual women. Discussion and Limitations: Although we used weighting to generate nationally representative estimate, important limitations include possible selection bias (owing to low survey response rate). Causal associations cannot be assumed given the repeated cross-section design and because sexual minority respondents may be different from heterosexual respondents in ways not accounted for. Implications for Health Care Provision and Use: Practitioners and public health leaders should be mindful of sexual minority vulnerabilities when developing targeted treatment plans, public health campaigns, and interventions to combat the mental health effects of the COVID-19 pandemic. Implications for Health Policies: These results establish that sexual minorities are extremely vulnerable in the area of mental health during the COVID-19 pandemic and that they are experiencing disproportionate gaps in access to care. Policymakers must consider the access gaps faced by this population when designing policies to combat the mental health effects of the COVID-19. Implications for Further Research: The health of gender minorities during the COVID-19 pandemic is a crucial and understudied topic. Additionally, further research can explore what this novel data source can tell us about other factors that may be contributing to sexual minority mental health disparities during the COVID-19 pandemic, including employment differences, housing disparities, and food insecurity.