Daily discrimination, church support, personal mastery, and psychological distress in black people in the United States.

OBJECTIVE: This study used the stress process model to test the mediating effects of personal mastery and moderating effects of church-based social support on the relationship between daily discrimination and psychological distress across three age groups of African American and Afro-Caribbean adults. METHODS: Using a national sample of 5008 African Americans and Afro-Caribbean adults from the National Survey of American Life Study, this study employs structural equation modeling to investigate the relationships between daily discrimination, personal mastery, church-based social support, and psychological distress. RESULTS: Daily discrimination was an independent predictor of psychological distress across all groups. Group- and age-specific comparisons revealed significant differences in the experience of daily discrimination and psychological distress. Mastery was a partial mediator of the relationship between discrimination and psychological distress among Afro-Caribbeans while church support was a significant moderator only among the young and older African Americans. IMPLICATIONS: Together, our study findings provide useful first steps towards developing interventions to reduce the adverse psychological impacts of daily discrimination on African Americans and Afro-Caribbeans. Intervention efforts such as individual psychotherapy aimed to improve Afro-Caribbean individuals' sense of mastery would be a partial solution to alleviating the adverse effects of discrimination on their psychological health.

A scoping review of brief alcohol interventions across young adult subpopulations.

OBJECTIVE: Brief alcohol interventions (BAIs) have historically centered on young adults attending 4-year predominantly white institutions. The purpose of this scoping review is to determine BAIs evaluated among young adults with one or more marginalized/understudied racial, ethnic, sexual, gender, and military/Veteran identities and/or who are embedded in an understudied context based on houselessness, attending a 2-year institution, or not attending college. A secondary objective is to explore definitions of the constructs young adult and brief to inform subsequent systematic reviews. METHOD: Sources had to be published in English between January 1, 1999 and December 31, 2019 and report the evaluation of an intervention ≤ 5 hr long, delivered over ≤ 4 weeks, among participants aged 18-30 years (or 16-30 in college contexts) within a specified marginalized/understudied subpopulation/context wherein alcohol use and/or consequences were a primary outcome. Systematic searches were conducted in APA PsycNet, the EBSCO Psychology and Behavioral Sciences Collection, PubMed, Sociological Abstracts, and Web of Science. Screening was independently performed by two coders who also extracted data. RESULTS: Of 4,825 identified records, 158 provided data; 86 described interventions fitting our definition of brief; of these, only 21 met criteria based on our definition of young adult, with nine meeting full inclusion criteria based on young adult subpopulation. CONCLUSIONS: Findings signify a need for additional research evaluating BAIs among young adult subpopulations and highlight the importance of carefully defining and reporting participant characteristics. Increased attention to sociocultural considerations and strengths relevant to the diverse contexts and intersecting identities of young adults may strengthen extant BAIs and equitably mitigate alcohol-related harm. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Sociodemographic, Health, and Caregiving Patterns of Aging Caregivers in Oregon: Gender Comparisons and the Role of Leisure Activities.

Recent studies have projected an increase in aging informal caregivers who are often dealing with their frailty. However, little is known about their health, caregiving factors, or coping resources that promote health. Informed by lifespan perspective and health behavior models, this study examined the gender differences in health and caregiving profiles of aging informal caregivers and investigated the association between leisure activity and unhealthy days. A sample of 565 informal caregivers (>50 years) was drawn from the Oregon version of the 2017 Behavioral Risk Factor Surveillance System. Descriptive analyses revealed that the caregivers were mainly women between 60 and 69, White non-Hispanic, married, college graduates, retired and healthinsured. Negative binomial regression showed that leisure activities were related to fewer odds of reporting unhealthy days for most comparison scenarios. Findings emphasize the importance of accounting for group differences and similarities in understanding health and caregiving factors among informal caregivers.

A qualitative analysis of transgender and gender nonconforming college students' experiences of gender-based discrimination and intersections with alcohol use.

OBJECTIVE: Transgender and gender-nonconforming (TGNC) emerging adults (EAs) are a vulnerable population at risk for negative mental health and alcohol use outcomes often attributed to unique experiences of discrimination and transphobia, including in colleges/universities through institutionalized transphobia. There are no extant psychosocial interventions that focus on the experiences of EA TGNC undergraduate students. METHOD: The current study utilized a Community-Based Participatory Research framework and exploratory qualitative approach to better understand the unique experiences of this population (N = 16). Data are presented from an inductive thematic analysis of focus groups and interview transcripts that highlight TGNC experiences of gender-based stressors and substance use and provide feedback on a brief psychosocial intervention to prevent high-risk alcohol use among TGNC. RESULTS: Main themes were TGNC-specific experiences (e.g., pronoun misuse, invalidating interactions with faculty and staff), coping with gender-based discrimination and stressors (e.g., use of alcohol and other drugs), and resources and programs (e.g., lack of TGNC representation in leadership roles). Notable subthemes included the impact of intersecting gender, race, and class divisions, medical and mental health-care concerns, and qualities of interventions perceived as effective versus ineffective. CONCLUSIONS: This is one of the first studies to gather information related to the desires of EA TGNC undergraduate students on addressing high-risk alcohol use. Data provide considerations for developing psychosocial interventions to address negative mental health outcomes and risks associated with alcohol and other drug use among EA TGNC undergraduate students, such as creating safe interventions and utilizing a strengths-based approach to teaching coping skills. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The Link between Discrimination and Worst Point Suicidal Ideation among Sexual and Gender Minority Adults.

OBJECTIVE: Sexual and gender minority (SGM) adults often report a disproportionately high rate of suicidal ideation compared to their heterosexual and cisgender counterparts. The current study aimed to understand the relationship between discrimination for one's sexual orientation or gender identity and suicidal ideation. We hypothesized that discrimination would be associated with suicidal ideation at one's worst point through the indirect effects of hopelessness regarding thwarted belongingness and perceived burdensomeness. METHOD: A sample of 178 SGM adults (M age = 30.34, range 18-69; 76% white) completed an online questionnaire assessing minority-specific stressors and suicide-related thoughts and behaviors. RESULTS: A mediation model with bootstrapping indicated that greater discrimination was associated with more frequent suicidal ideation at one's worst point through the indirect effect of hopelessness regarding thwarted belongingness. CONCLUSIONS: The current study provides evidence that the pathway between discrimination and worst point suicidal ideation may be partially explained by the perception that one will never belong. These findings support the utility of an understudied Interpersonal Theory of Suicide hypothesis for research among SGM adults.

Posttraumatic Stress Symptoms and Emerging Adult Sexual Minority Men: Implications for Assessment and Treatment of Childhood Sexual Abuse.

Emerging adulthood (EA) is a developmental period marked by unique challenges that affect health including burgeoning occupational, relational, and financial stability; and increased risk taking in terms of sexual behavior(s) and substance use. Data were collected from 296 HIV-uninfected sexual minority men with childhood sexual abuse (CSA) histories. We analyzed baseline assessment data from a multisite randomized controlled trial that tested the efficaciousness of an experimental psychosocial treatment and examined vulnerabilities known to be linked with CSA. Our analyses compared EA sexual minority men, aged 18-29, with older sexual minority men (OSMM) on posttraumatic stress disorder (PTSD) and other mental health and substance use outcomes. We found higher odds of PTSD, odds ratio (OR) = 0.57, 95% CI [0.33, 0.96]; panic disorder or panic disorder with agoraphobia, OR = 0.36, 95% CI [0.16, 0.85]; and cocaine use, OR = 0.50, 95% CI [0.25, 0.97], among OSMM and higher odds of alcohol intoxication, OR = 5.60, 95% CI [3.20, 9.82]; cannabis use, OR = 3.09, 95% CI [1.83, 5.21]; and non-HIV sexually transmitted infections, OR = 3.03, 95% CI [1.29, 7.13], among the EA men. These results present a complex picture of health risks among sexual minority men in general and EA sexual minority men in particular. HIV seroconversion linked health risk behaviors, among sexual minority men, may be better addressed via increased attention to treating trauma and comorbid mental health and substance use problems using evidence-based psychosocial assessments and integrated treatment platforms that are tailored to this population.

Characteristics and Correlates of Tobacco Use in a Community Sample of Sexual Minority Men and Women: Implications for Smoking Cessation Program Development.

PURPOSE: Tobacco use is the single most preventable cause of disease, death, and disability in the United States. Research suggests that sexual minorities have an increased risk for smoking and tobacco use. This study aimed to identify characteristics of patients affected by tobacco use disparities and examined demographic and substance use differences between tobacco users and nonusers in a sample of sexual minorities. METHODS: Patients at an urban community health center (specializing in the needs of sexual and gender minorities) were invited to complete a cross-sectional 25-item questionnaire. RESULTS: Of the 3068 questionnaire respondents, 1543 identified as gay, lesbian, or bisexual. Of these sexual minority respondents, most identified as White (84.4%), 67.3% identified as male and 32.7% as female, with a mean age of 37.7 (SD = 9.44). More than a quarter of sexual minority men (26.7%) and women (28.3%) reported current tobacco use. Among men, younger age (OR = 0.97, CI: 0.95-0.98, P < 0.001), less education (OR = 0.58, CI: 0.35-0.96, P < 0.01), heroin use (OR = 3.3, CI: 1.18-9.39, P < 0.05), and alcohol use (OR = 3.0, CI: 1.86-4.80, P < 0.001) were associated with increased odds of current tobacco use. Among women, younger age (OR = 0.97, CI: 0.95-0.99, P = 0.004), less education (OR = 0.45, CI: 0.22-0.91, P < 0.001), and alcohol use (OR = 3.78, CI: 1.87-7.65, P < 0.001) were associated with current tobacco use. CONCLUSION: Cessation programs placed within the context of co-occurring substance and alcohol use for young sexual minority tobacco users from lower socioeconomic backgrounds may be particularly effective.

Applying network analysis to psychological comorbidity and health behavior: Depression, PTSD, and sexual risk in sexual minority men with trauma histories.

OBJECTIVE: High rates of depression and posttraumatic stress disorder (PTSD) contribute to sexual risk, particularly in men who have sex with men (MSM) who have experienced childhood sexual abuse. The comorbidity between depression and PTSD and mechanisms by which they contribute to sexual risk in MSM remain unclear. This study sought to demonstrate the feasibility and utility of a network approach to (a) characterize symptom interconnections between depression and PTSD in MSM, (b) identify specific symptoms related to sexual risk behavior, and (c) compare symptom networks across groups at different levels of risk. METHOD: Cross-sectional baseline data were collected from 296 HIV-negative urban MSM as part of a multisite randomized intervention trial. Symptoms of depression and PTSD were self-reported along with sexual risk behavior. Analyses were performed in R using regularized partial correlation network modeling. RESULTS: Network analyses revealed complex associations between depression and PTSD symptoms and in relation to sexual risk behavior. While symptoms clustered within their respective disorders, depression and PTSD were connected at key symptom nodes (e.g., sleep, concentration). Specific symptoms (e.g., avoiding thoughts and feelings) were linked to sexual risk behavior. Network comparisons across risk groups suggested avoidant processes could be more readily activated in higher-risk individuals, whereas hyperarousal symptoms may be more salient and protective for lower-risk individuals. CONCLUSIONS: This study is one of the earliest network analyses of depression and PTSD, and first to extend this inquiry to health behavior. Symptom-level investigations may clarify mechanisms underlying psychological comorbidity and behavioral risk in MSM and refine targets for intervention/prevention. (PsycINFO Database Record

Psychological and behavioral moderators of the relationship between trauma severity and HIV transmission risk behavior among MSM with a history of childhood sexual abuse.

Childhood sexual abuse (CSA) is associated with post-traumatic stress disorder (PTSD), which can be associated with condomless sex among men who have sex with men (MSM). However, the impact of moderating factors on the relationship between PTSD symptom severity and condomless sex is poorly understood. We examined whether PTSD symptom severity was associated with condomless sex among MSM with CSA histories, and whether substance dependence, self-esteem, and distress tolerance moderated that relationship (n = 288). Notably, no direct relationship between PTSD symptom severity and condomless sex was found. Adjusted models indicated that condomless sex was differentially impacted by PTSD symptom severity among those without substance dependence (ΔR2 = 0.03, p = 0.034) and, counterintuitively, those with high self-esteem (ΔR2 = 0.07, p = 0.005). PTSD symptom severity was associated with condomless sex across levels of distress tolerance. Findings indicate that substance use, self-esteem, and distress tolerance should be targeted in high-risk MSM with CSA even if they do not have PTSD.

Self-perceived vs. actual physical attractiveness: Associations with depression as a function of sexual orientation.

OBJECTIVE: A commonly held belief about physical attractiveness is that attractive individuals are psychologically healthier than less attractive individuals (i.e., the "beauty is good" stereotype). To date, the data on this stereotype and its relationship with depression is limited, with a paucity of literature comparing subjective and objective appearance evaluations and depressive symptoms. Additionally, there is no known research on this relationship among sexual minorities (i.e., gay and bisexual individuals), a highly vulnerable population. The primary aims of the study were to assess the prediction of depression symptoms by subjective and objective appearance evaluation, and secondary aims were to assess the interaction of subjective and objective appearance with sexual orientation. METHOD: Participants were 4882 American emerging adults (M age=22 years; 2253 males, 2629 females) taken from a U.S. nationally representative dataset (Add Health) RESULTS: Increased negative subjective appearance evaluation was associated with elevated rates of depressive symptoms (B=-.27, p<.001), while objective appearance evaluation was not significantly related to depressive symptoms. Sexual orientation significantly moderated the relationship between subjective appearance and depression (B=.19, p=.009), with a stronger positive association between negative appearance evaluation and depressive symptoms noted among sexual minority vs. heterosexual participants. LIMITATIONS: Limitations include cross-sectional design and self-report nature of questionnaires. CONCLUSIONS: Findings suggest that the 'beauty is good' stereotype may not be valid in regard to depressive symptoms, and that subjective appearance evaluation is a robust predictor of depression, particularly for sexual minority individuals.

Nonsuicidal self-injury in sexual minority college students: a test of theoretical integration.

BACKGROUND: Individuals identifying as a sexual minority report engaging in nonsuicidal self-injury (NSSI) at substantially higher rates compared to their heterosexual peers. Given that NSSI is a known risk factor for suicide, it is important to understand the processes unique to being a sexual minority that increases risk for NSSI so that adequate prevention efforts can be established. The current study integrated Minority Stress Theory and the Interpersonal Theory of Suicide to test a model of NSSI and suicide risk. METHODS: A total of 137 college students who identified as a sexual minority completed an anonymous on-line study assessing NSSI, suicidal thoughts/behaviors, and constructs of the minority stress and interpersonal theories. Two linear regressions using bootstrapping analyses were conducted to test our hypotheses. RESULTS: Minority stress was directly associated with NSSI and via perceived burdensomeness, explaining 27 % of the variance. NSSI was associated with increased risk for suicide thoughts/behaviors directly, and through acquired capability, explaining 45 % of the variance. CONCLUSIONS: These findings provide evidence that unique stressors individuals face as a result of their sexual minority status increases risk for self-harm by influencing cognitive and emotional processes such as burdensomeness and acquired capability. Implications for prevention, intervention, and future research are briefly discussed.

Optimizing adherence to preexposure and postexposure prophylaxis: the need for an integrated biobehavioral approach.

Preexposure prophylaxis (PrEP) and postexposure prophylaxis (PEP) has been shown to be effective in preventing transmission of human immunodeficiency virus (HIV). A dose-response relationship between adherence and HIV transmission is illustrated in the current PrEP literature, and adherence interventions for PrEP may be useful, although currently few effective programs have been developed and tested. There is a paucity of randomized controlled trials testing PEP adherence interventions, and further research is needed. We conclude by proposing the importance of tailoring adherence counseling to address psychosocial factors and mental health stressors that may negatively affect adherence.