Psychiatry and Family Medicine Residents' Likelihood of Prescribing HIV Pre-Exposure Prophylaxis (PrEP) to Patients with Mental Illness and HIV Vulnerability.

BACKGROUND: People living with mental illness (PLMI) experience disproportionately high incidence of and vulnerability to HIV. Pre-exposure prophylaxis (PrEP) is an effective and safe HIV prevention method, but data regarding prescription to PLMI are lacking. Psychiatrists may serve as important points of access for PrEP prescription for PLMI. METHODS: We conducted a vignette-based study of residents in psychiatry and family medicine (FM) to assess likelihood of prescribing PrEP and assumptions about the fictional patient. The patients' psychiatric diagnosis was varied (schizophrenia on LAI or oral antipsychotic, bipolar disorder, major depression) or a control condition without a psychiatric diagnosis. RESULTS: A total of 439 residents participated. We found high percentages of psychiatry (96.8%) and FM (97.4%) residents were aware of PrEP. High percentages of psychiatry (92.0-98.1%) and FM (80.8-100%) residents indicated that PrEP was indicated for all patient conditions. Family medicine residents were more likely to prescribe PrEP to all experimental conditions compared to psychiatry residents. There was no difference in likelihood of prescribing to the control condition without a psychiatric diagnosis. The belief that PrEP prescription was out of the scope of practice was greater among psychiatry residents. CONCLUSIONS: A majority of psychiatry residents responded that PrEP was indicated for an array of patients with psychiatric diagnoses. However, psychiatry residents were broadly less likely to prescribe PrEP to patients with these diagnoses. The high percentage of psychiatry residents who reported that PrEP was indicated for all patients suggests additional training is needed to facilitate PrEP prescription by psychiatrists.

Measurement invariance of the LGBT People of Color Microaggressions Scale among LGBTQ+ youth.

The LGBT People of Color Microaggressions Scale (LGBT-PCMS) is a widely used measure of intersectional microaggression experiences among sexual and gender minority people of color. Although it is widely used-and increasingly used in adolescent and young adult samples-it is unknown whether the LGBT-PCMS demonstrates similar measurement properties across subgroups of sexual and gender minority youth of color (SGMYOC). Among 4142 SGMYOC (ages 13-17) we found evidence for either partial or full scalar invariance (item loadings and intercepts were generally equal) across sexual orientation, race-ethnicity, and gender identity groups for all three subscales. Specific patterns of invariance and noninvariance across groups, as well as implications for the use of the LGBT-PCMS and its subscales among SGMYOC are discussed.

Entrapment and Defeat Scales: Factor Structure Assessment and Variation by Gender and Sexual Identity among Adults in the United Kingdom.

Entrapment and defeat are empirically-supported suicide risk factors. Their measurement is the subject of some debate, however. Also, limited work exists examining sexual and gender minority (SGM) differences in these suicide risk factors despite overall elevated rates of suicidal thoughts and behaviors (STBs) for SGM persons. The present study examined (1) entrapment and defeat differences by sexual orientation and gender identity, (2) factor structure and criterion validity of the Entrapment Scale (E-Scale) and the Defeat Scale (D-Scale), and (3) measurement invariance by sexual orientation (subsamples were too small for gender identity). A sample of 1,027 adults living in the United Kingdom completed a cross-sectional online questionnaire assessing mental health. Analysis of Variance and Kruskal-Wallis testing revealed: (1) all sexual minority (i.e., gay/lesbian, bisexual, and other SM) persons reported higher internal and external entrapment, defeat, and suicidal ideation compared to their heterosexual counterparts, and; (2) gender minority (i.e., transgender and gender diverse) persons reported higher internal and external entrapment, defeat, and suicidal ideation compared to cisgender persons. Supported by suicide theory, confirmatory factor analysis showed modest support for a two-factor E-Scale (internal and external), and a one-factor D-Scale. All entrapment and defeat scores displayed significant moderate positive correlations with suicidal ideation. E- and D-scale scores displayed high intercorrelation, tempering confidence in conclusions regarding the facture structure findings. Item threshold-level responding varied by sexual orientation for the D-Scale but not the E-Scale. Results are discussed with respect to suicide theory and measurement, public health, and clinical practice.

Sexual orientation and mental health in a US cohort of children: a longitudinal mediation study.

BACKGROUND: Sexual minorities, including children, are at increased risk for adverse mental health outcomes compared to their heterosexual peers, but longitudinal studies are needed to determine the factors that explain the associations between sexual minority identification and adverse mental health outcomes during this developmental period. We examined longitudinal associations between sexual orientation and mental health over 2 years in a US cohort of children (aged 9-10 at baseline) and two explanatory factors (increased social problems such as getting teased and decreased perceived school safety). We hypothesized that beginning to identify as gay/bisexual and consistently identifying as gay/bisexual would be associated with increases in internalizing (e.g. depression, anxiety) and externalizing (e.g. aggression) problems compared to consistently identifying as heterosexual, and these associations would be partially explained by increased social problems and decreased perceived school safety. METHODS: We used data from Waves 1-3 of the Adolescent Brain Cognitive Development study. The analytic sample included 5,574 children (46.0% female; 55.1% non-Hispanic White). RESULTS: Beginning to identify as gay/bisexual was associated with increased internalizing/externalizing problems, and consistently identifying as gay/bisexual was associated with increased internalizing problems, compared to consistently identifying as heterosexual. For those who consistently identified as gay/bisexual, increased disparities in internalizing problems were partially explained by increased social problems and decreased perceived school safety, and increased disparities in externalizing problems were partially explained by increased social problems. CONCLUSIONS: These findings suggest the health disparities affecting sexual minority children include both internalizing and externalizing problems, and social problems and feeling unsafe at school may be contributing factors.

Emotion regulation and OCD among sexual minority people: Identifying treatment targets.

Sexual minority individuals experience higher rates of psychopathology, such that sexual minority people are nine times more likely to receive a diagnosis or treatment for obsessive-compulsive disorder (OCD) compared to heterosexual people. Poor emotion regulation capacity is a risk factor for OCD, but little is known about sexual orientation differences in dimensions of emotion regulation and how dimensions of emotion regulation relate to OCD severity among sexual minority people. The aims of the current study include 1) comparing sexual minority to heterosexual people on OCD severity and emotion regulation capacity upon admission to treatment for OCD, and 2) examining emotion regulation in relation to OCD severity among sexual minority people. Participants (N = 470) were adults in partial hospital/residential treatment with an average stay of 59.7 days (SD = 25.3), including 22 % sexual minority people. Sexual minority people reported a lower emotion regulation capacity. Among the largest three subgroups (heterosexual, bi+, and gay/lesbian), bi+ individuals reported a lower emotion regulation capacity compared to heterosexual but not gay/lesbian people. Results suggest there are sexual orientation differences in emotion regulation capacity, and that bi+ people have the most difficulty with ER. There is a need for OCD treatment to directly target emotion regulation strategies and be affirming of sexual minority identities.

Does Outness Function the Same for All Sexual Minority Youth? Testing Its Associations With Different Aspects of Well-Being in a Sample of Youth With Diverse Sexual Identities.

While research generally supports that greater outness about one's sexual identity is associated with improved well-being, emerging evidence suggests that outness may have negative consequences for bisexual individuals. Yet, few studies have examined sexual identity as a moderator of the associations between outness and well-being, especially among youth. As such, the role of outness in the mental health of diverse sexual minority youth (including pansexual, queer, questioning, and asexual youth) remains unclear. Thus, we examined how the associations between outness and well-being differed as a function of sexual identity in a sample of sexual minority youth. Using data from the LGBTQ National Teen Study (N = 11,225), we tested sexual identity as a moderator of the associations between outness and well-being (depression and self-esteem). In the full sample, greater outness was significantly associated with lower depression and higher self-esteem. However, these associations were significantly different for gay/lesbian versus questioning youth. Greater outness was associated with lower depression and higher self-esteem for gay/lesbian youth yet was associated with higher depression and was not associated with self-esteem for questioning youth. The association between outness and self-esteem was also significantly different for gay/lesbian versus bisexual youth. Greater outness was associated with higher self-esteem for both groups, but the association was stronger for gay/lesbian youth. These findings suggest that outness may have benefits for gay/lesbian and bisexual youth, yet it may have negative consequences for questioning youth. These findings can inform efforts to promote positive sexual identity development and wellbeing of sexual minority youth.

Disclosure, minority stress, and mental health among bisexual, pansexual, and queer (bi+) adults: The roles of primary sexual identity and multiple sexual identity label use.

Bisexual people are at increased risk for anxiety and depression compared to heterosexual and gay/lesbian people, but little is known about people who use other labels to describe attractions to more than one gender (e.g., pansexual, queer; collectively "bi+"). In addition, some people use more than one label to describe their sexual orientation, but research has yet to examine whether using one versus multiple labels is associated with identity-related experiences or mental health. To address these gaps, we explored potential differences in disclosure, minority stress, and mental health among bi+ adults based on primary sexual identity and multiple label use. As part of a larger project, 669 bi+ adults completed an online survey. Primary sexual identities included bisexual (53.2%), pansexual (26.3%), and queer (20.5%), and 55.2% used multiple labels. Compared to bisexual participants, pansexual participants reported higher disclosure, discrimination from heterosexual people, and depression. Pansexual participants also reported higher anxiety and lower internalized binegativity, but these associations became non-significant after adjusting for demographics. Queer participants reported higher disclosure, discrimination from heterosexual people, and anxiety, but only the difference in disclosure remained significant in adjusting analyses. Finally, participants who used multiple labels reported higher disclosure and discrimination from heterosexual and gay/lesbian people, but only the difference in discrimination from gay/lesbian people remained significant in adjusted analyses. Findings highlight the heterogeneity of bi+ individuals and the importance of considering bisexual, pansexual, and queer individuals as unique groups as well as considering whether bi+ individuals use one or multiple sexual identity labels.

The Role of Partner Gender in Bisexual Men's Stigma-Related Experiences and Mental Health: Results From a Probability-Based Sample in the United States.

Bisexual men are disproportionately affected by negative mental health outcomes compared to heterosexual and gay men. These disparities are related to the unique stressors that they experience, and emerging evidence suggests that their experiences of these stressors can be different depending on the gender of their partner. However, previous studies have largely focused on bisexual women and little is known about the role of partner gender in bisexual men's experiences and mental health. We examined the associations between relationship type and outness, stigma-related experiences, and mental health using data from Wave 1 of the National Study of Stigma and Sexual Health, a probability-based sample of 502 gay and bisexual men in the U.S. Analyses focused on the subset of 128 men who identified as bisexual (44.53% in relationships with women, 14.84% in relationships with men, 40.63% not in relationships). Bisexual men in relationships with men reported being more out than those in relationships with women and those who were not in relationships; furthermore, bisexual men in relationships with men reported more discrimination and family stress than those in relationships with women. Bisexual men who were not in relationships reported more anticipated and internalized stigma than those in relationships with men; additionally, bisexual men who were not in relationships reported more anticipated stigma and depression than those in relationships with women. Partner gender plays a role in bisexual men's stigma-related experiences and mental health, and efforts to improve bisexual men's health should attend to sexual orientation, relationship status, and partner gender.

Associations between Drinking Contexts, Minority Stress, and Problematic Alcohol Use among Sexual Minority Individuals Assigned Female at Birth.

Sexual minority individuals assigned female at birth (SM-AFAB) are at increased risk for problematic alcohol use compared to heterosexual women. Despite evidence that drinking locations and companions play an important role in problematic alcohol use among heterosexuals, few studies have examined these social contexts of alcohol use among SM-AFAB. To address this gap, the current study examined two aspects of social contexts in which SM-AFAB drink (locations and companions). We utilized two waves of data (six-months between waves) from an analytic sample of 392 SM-AFAB ages 17-33 from a larger longitudinal study. The goals were: (1) to identify classes of SM-AFAB based on the contexts in which they drank; (2) to examine the associations between drinking contexts, minority stressors, and problematic alcohol use; and (3) to examine changes in drinking contexts over time. Using latent class analysis, we identified four classes based on drinking locations and companions (private settings, social settings, social and private settings, multiple settings). These classes did not differ in minority stress. Drinking in multiple settings was associated with more problematic alcohol use within the same timepoint and these differences were maintained six months later. However, drinking in multiple settings did not predict subsequent changes in problematic alcohol use when problematic alcohol use at the prior wave was controlled for. Based on these findings, SM-AFAB who drink in multiple settings may be an important subpopulation for interventions to target. Interventions could focus on teaching SM-AFAB strategies to limit alcohol consumption and/or minimize alcohol-related consequences.

Differences in clinical presentations of patients seeking care for treatment-resistant depression across sexual orientations and gender identities.

BACKGROUND: Sexual and/or gender minority (SGM) individuals experience higher rates and greater severity of depressive disorders than non-SGM persons. SGM individuals are more likely than non-SGM individuals to seek mental health treatment and to present to treatment with unique characteristics that should be accounted for when considering treatment recommendations. Patients seeking care for treatment-resistant depression (TRD) are offered a variety of evidence-based interventions ranging in modality and invasiveness (eg, psychotherapy and neuromodulation). METHODS: The current study used data from a TRD clinical research program to examine whether SGM (N = 52) and non-SGM (N = 202) patients differed in their clinical presentations and the treatment recommendations offered to them. RESULTS: We found that SGM patients were younger, had a more severe history of childhood trauma, and reported greater current suicidality than non-SGM patients. There were no significant differences in treatment recommendations between groups. CONCLUSIONS: This study adds to nascent literature investigating clinical characteristics of SGM populations seeking mental health care and provides foundational evidence for the unique treatment considerations necessary for SGM individuals seeking treatment for TRD. Research into whether treatment outcomes differ for SGM and non-SGM individuals with TRD is encouraged, given clinical differences in trauma history and suicidality.

Sexual and Gender Minority Differences in Likelihood of Being a Caregiver and Levels of Caregiver Strain in a Sample of Older Adults.

Over the next two decades, the number of caregivers is expected to climb dramatically alongside a rise in older adults, particularly sexual and gender minority (SGM) older adults, yet little research has assessed differences between SGM and non-SGM care partners. Data for these analyses come from the Columbus Healthy Aging Project (N = 79). This study was designed to assess several domains of health among adults aged ≥50 years in Columbus, Ohio, US. Multivariable regression models were used to examine the likelihood of being a care partner, the SGM identity of the primary care recipient, and caregiver strain. In our sample, 227 (28.6%) participants self-identified as care partners for at least one individual. Compared to heterosexuals, gay/lesbian (aOR = 8.38; 95% CI: 5.29, 13.29) participants were more likely to be care partners but did not experience elevated caregiver strain. Bisexual individuals (aIRR = 1.70, 95% CI: 1.11, 2.61) reported greater caregiver strain, while those identifying as a different sexual identity reported lower caregiver strain (aIRR = 0.46, 95% CI: 0.23, 0.96). In turn, caregiver strain was reduced significantly when the care recipient identified as a member of the SGM community (aIRR = 0.67: 95% CI: 0.55, 0.80). These results suggest that SGM care partners may be at risk of unique stressors which may contribute to extant health disparities.

Differences in infection and prevention of HIV and other sexually transmitted infections among older adults in Columbus, Ohio.

INTRODUCTION: In the United States, rates of sexually transmitted infections (STIs) have increased year after year for the past six consecutive years. Even so, the majority of research has focused on younger populations with little work examining infections and prevention methods among older adults. METHODS: Data come from the Columbus Health Aging Project (N = 794). This study was designed to assess several domains of health among adults aged 50 years and older in Columbus, Ohio with a particular focus on addressing disparities based on sexual and gender identity. Multivariable logistic regression models were used to examine the association between sociodemographic factors and risk of STI acquisition, HIV diagnosis, and several common prevention methods, adjusting for known confounders. RESULTS: Key results suggest that cisgender women, intersex individuals, and transgender women are less likely to use condoms relative to cisgender men. Meanwhile, white individuals were least likely to use condoms while bisexual individuals were most likely. Transgender women and those living with family/roommates were most likely to use PrEP/PEP relative to cisgender men and those living with a spouse or partner. Cisgender women, compared to cisgender men, were most likely to report not using any prevention method. CONCLUSION: This study highlights the need for better research among older adults in order to ascertain how interventions may be targeted to specific populations. Future research should aim to educate individuals differently based on their specific needs rather than treating older adults as a homogenous population or ignoring their sexually active nature entirely.

Use of the Heterosexist Harassment, Rejection, and Discrimination Scale With Different Sexual Orientation, Gender, and Racial/Ethnic Groups: An Examination of Measurement Invariance.

The Heterosexist Harassment, Rejection, and Discrimination Scale (HHRDS) is one of the most commonly used measures of sexual orientation-related discrimination, but little is known about its psychometric properties across different sexual orientations, gender, and racial/ethnic groups. A three-factor model was initially obtained, but most studies treat the HHRDS unidimensionally. Therefore, we tested whether the HHRDS exhibited measurement invariance across sexual orientation, gender, and racial/ethnic groups among 792 sexual minority young adults (aged 18-29) who participated in an online study. Across models, the three-factor solution fit better than the one-factor solution. All models achieved configural invariance and most achieved metric invariance; none of the considered models achieved scalar invariance (1-3 items were not equivalent across groups, depending on the comparison). Findings suggest that the HHRDS generally functions equivalently across sexual orientation, gender, and racial/ethnic groups, but some caution in interpreting scores is warranted.

Testing the interpersonal theory of suicide in a sample of sexual minority young adults: Attention to within-group differences.

INTRODUCTION: This study investigated demographic differences in interpersonal theory of suicide factors and their associations with suicide attempts among sexual minority young adults. METHODS: 784 sexual minority young adults ages 18-29 (42.7% cisgender men, 42.2% cisgender women, 15.1% transgender/gender diverse; 62.2% non-Hispanic White; 50.5% gay/lesbian, 49.5% bisexual+) completed an online survey assessing lifetime suicide attempts and interpersonal theory of suicide factors. RESULTS: Demographic differences included (1) greater perceived burdensomeness among transgender/gender diverse participants compared to other gender groups; (2) greater acquired capability for suicide and suicide attempts among cisgender men compared to cisgender women; (3) greater acquired capability for suicide among bisexual+ compared to gay/lesbian participants; and (4) a lower number of suicide attempts among Asian/Asian American sexual minority participants compared to most other sexual minority participants. All interpersonal theory of suicide factors were significantly associated with a higher number of suicide attempts, though only perceived burdensomeness and acquired capability for suicide remained significant when examining all three simultaneously. No two- or three-way interactions between interpersonal theory of suicide factors were significant. CONCLUSION: The interpersonal theory of suicide may be useful for understanding suicide attempts in this population, with perceived burdensomeness and acquired capability being particularly relevant to consider.

Effects of knowledge and implicit biases on pharmacy students' decision-making regarding pre-exposure prophylaxis for HIV prevention: A vignette-based experimental study.

INTRODUCTION: Men who have sex with men (MSM), especially Black MSM, are disproportionately affected by HIV and experience disparate prescription of pre-exposure prophylaxis (PrEP) for HIV prevention compared to White MSM. While pharmacists are essential in efforts to scale-up PrEP, little is known about the role of knowledge and implicit biases in pharmacy students' decision-making regarding PrEP, which may elucidate mechanisms for improving PrEP access and addressing disparities. METHODS: A nationwide, cross-sectional study of pharmacy students in the United States was conducted. A fictional White or Black MSM seeking PrEP was presented. Participants completed measures of PrEP/HIV knowledge, implicit racism and heterosexism, assumptions about the patient's behavior (condomless sex, extra-relational sex, adherence to PrEP), and confidence providing PrEP-related care. RESULTS: A total of 194 pharmacy students completed the study. Compared to the White patient, the Black patient was assumed to be less adherent to PrEP if prescribed. In contrast, assumptions of sexual risk behaviors if prescribed PrEP and confidence providing PrEP-related care did not differ. Additionally, implicit racism was associated with lower confidence providing PrEP-related care, whereas PrEP/HIV knowledge, implicit sexual orientation bias, and assumed sexual risk behaviors if prescribed PrEP were not associated with confidence. CONCLUSIONS: Pharmacists are essential in efforts to scale-up PrEP prescription, making pharmacy education about PrEP for HIV prevention critical. These findings suggest that implicit bias awareness training is needed. This training may reduce the influence of implicit racial bias on confidence providing PrEP-related care and improve knowledge of HIV and PrEP.

Aspects of positive identity buffer the longitudinal associations between discrimination and suicidal ideation among bi+ young adults.

OBJECTIVE: Prior research has demonstrated that discrimination is associated with suicidal ideation among bi + individuals, but little is known about resilience factors (both general and bi + specific) that may buffer these associations. This prospective study examined the main and interactive effects of antibisexual discrimination and resilience factors, including general resilience and positive bi + identity factors (community, authenticity, and intimacy), in predicting suicidal ideation at 1- and 2-month follow-up. METHOD: Participants were bi + young adults (N = 396; ages 18-29; 42.7% cisgender men, 42.2% cisgender women, 15.2% transgender/gender diverse individuals; 37.9% racial and ethnic minority individuals) who completed measures of antibisexual discrimination (Brief Antibisexual Experiences Scale), positive bi + identity (Lesbian, Gay, and Bisexual Positive Identity Measure), general resilience (Brief Resilience Scale), and suicidal ideation (Beck Scale for Suicide Ideation) at baseline, and suicidal ideation again at 1- and 2-month follow-up. RESULTS: Greater antibisexual discrimination was significantly associated with increases in suicidal ideation at 1-month follow-up at low levels of community, authenticity, and intimacy, and increases in suicidal ideation at 2-month follow-up at low levels of authenticity. In addition, at high levels of authenticity, greater antibisexual discrimination was significantly associated with decreases in suicidal ideation at 1-month follow-up. In contrast, general resilience did not moderate the associations between antibisexual discrimination and suicidal ideation at 1- or 2-month follow-up. CONCLUSIONS: Results suggest that promoting positive aspects of bi + identity (community, authenticity, and intimacy), but not general resilience, may help attenuate the effects of antibisexual discrimination on suicidal ideation over time. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Knowledge of human papillomavirus vaccination: A multi-institution, cross-sectional study of allopathic and osteopathic medical students.

Human papillomavirus (HPV) vaccination is a well-established and successful tool for preventing HPV-related cancers. However, vaccine uptake remains low, influenced by patient hesitancy around safety concerns and little opportunity to discuss the vaccine with trusted healthcare providers. We conducted a national, cross-sectional study of allopathic and osteopathic medical students regarding knowledge of HPV vaccination guidelines March-April 2021. Analysis sought to identify gaps in knowledge as well as demographic and academic correlates of knowledge. A total of 718 students participated (response rate = 50.8%). While 92.8% of participants identified the connection between HPV and cervical cancer, lower percentages associated HPV with vaginal/vulvar (67.7%), anal (63.3%), and penile (53.9%) cancers. Low percentages of participants correctly identified age of HPV vaccine eligibility (33.3%) and how many doses are needed for full protection (48.1%). This study identifies specific knowledge gaps in medical students' training on HPV-related cancers and HPV vaccination guidelines. Through addressing these gaps, we may improve HPV vaccine uptake and decrease the incidence of HPV-related cancers.

PrEP use and stigma among a sample of older adults in Columbus, Ohio.

INTRODUCTION: Despite older adults (age ≥50 years) continuing to account for 1 in 6 new HIV diagnoses, the majority of research has focused on young adults. Assessing PrEP use and stigma among this understudied population is key to achieving the U.S.'s goals of Ending the HIV Epidemic, a federal initiative focusing on reducing new HIV infections by at least 90% by 2030. METHODS: Data for this analysis came from the Columbus Health Aging Project (N = 794). This study was designed to assess several domains of health among adults aged 50 years and older in Columbus, Ohio. Multiple logistic and linear regression models were used to examine the associations between sociodemographic factors and past 6-month PrEP use, PrEP stigma, and concurrent use of PrEP and other prevention methods, adjusting for known confounders. RESULTS: Overall, 93 (11.7%) participants reported past 6-month PrEP use. Transgender women (aOR = 6.90; 95% CI: 2.19, 21.72), cisgender gay men (aOR = 5.58; 95% CI: 2.49, 12.50), cisgender lesbians (aOR = 2.24; 95% CI: 1.05, 4.80), and those living with family members or roommates (aOR = 6.59; 95% CI: 3.49, 12.45) were each more likely to report past 6-month PrEP use relative to cisgender women, heterosexuals, and those living with a spouse/partner, respectively. Relative to cisgender women, PrEP-related stigma was lower among transgender women (ß = -5.05; 95% CI: -8.44, -1.66) and higher among cisgender men (ß = 1.96; 95% CI: 0.46, 3.46). CONCLUSION: Future research should aim to continue developing a firm understanding of PrEP use and stigma among older adults to reduce HIV risk among this population and to understand unique needs of sub-populations of older adults.