Substance-related coping, HIV-related factors, and mental health among an HIV-positive sexual minority community sample.

HIV-positive status poses a unique set of social stressors, especially among lesbian, gay, and bisexual (LGB) persons. Among these difficulties are the internalization of HIV-related stigma and poor mental health. Unfortunately, substance use as a coping mechanism is also common, dependent on other demographic factors, among HIV-positive and LGB samples. The present study integrates these bodies of literature by examining main and interactive effects of HIV-related experiences (i.e., disclosure of HIV-positive status, fear of disclosure, HIV-related victimization, and internalized HIV-related stigma) and substance-related coping with discrimination as they impact mental health (i.e., stress, anxiety, depressive symptoms, and suicide and self-injury proneness). Participants were 216 HIV-positive LGB community members from an urban community medical clinic. Prominent results included: (1) robust negative effects of internalized HIV-related stigma on all mental health indicators when controlling for other HIV-related experiences and (2) a significant interaction in which substance-related coping significantly increases suicide proneness, only for those who have disclosed HIV-positive status to family or friends. Results are discussed with respect to theoretical perspectives of internalized stigma, implications for clinical work with LGB persons of HIV-positive status, and future research.

Health Disparities Between Older Lesbian, Gay, and Bisexual Adults and Heterosexual Adults in the Public Mental Health System.

OBJECTIVE: In this study, the authors examined disparities in general health, substance use, mental health conditions, and acute service use between lesbian, gay, and bisexual (LGB) adults (ages ≥50 years) and a matched sample of heterosexual adults. METHODS: Individuals whose electronic health record indicated their sexual orientation as gay, lesbian, or bisexual from the 2015 New York State Office of Mental Health Patient Characteristics Survey were matched with heterosexual individuals, resulting in N=1,659 individuals in each of the two groups. Differences in health status indicators and acute service use were compared in generalized estimating equation models. RESULTS: Compared with matched heterosexual men, older gay and bisexual men had more chronic general medical conditions and mental health issues; they also had fewer inpatient stays related to substance use disorders. Older lesbian and bisexual women had higher rates of tobacco use, alcohol use, and substance use disorders than heterosexual women; moreover, they reported more inpatient stays and emergency department visits related to substance use disorders. CONCLUSIONS: This study provides evidence of health disparities among sexual minority older adults within a public mental health system. The results suggest that health disparities persist into older adulthood and that new health concerns emerge with the aging of the sexual minority population. Targeted prevention and intervention programs are needed to effectively engage older LGB adults into treatment for general medical and mental illnesses as well as substance use disorders.

Love is heterosexual-by-default: Cultural heterosexism in default prototypes of romantic love.

Cultural heterosexist ideologies assume heterosexuality to be the default norm. Four studies investigated when concepts of romantic love are heterosexual-by-default (N = 685). In Studies 1-2, participants generated features of romantic love, in general (i.e., the default prototype) or among one of three sexual orientation-specific couples (lesbian, gay, or heterosexual). Heterosexual-identified participants' default prototypes were more similar to heterosexual than same-gender prototypes (Study 1). Lesbian- and gay-identified participants' default prototypes were more similar to both heterosexual and gay male than lesbian prototypes, whereas bisexual-identified participants' sexual orientation-specific prototypes were equivalently similar to the default (Study 2). However, heterosexual-identified participants rated presented features of love similarly across sexual orientation-specific conditions (Study 3). In a timed feature-verification task (Study 4), participants categorized fewer peripheral features of romantic love as relevant to same-gender than mixed-gender couples. Activating sexual orientation-specific representations affected subsequent default concepts of romantic love. We discuss implications for heterosexism theories and intervention.

Education Level and Cigarette Smoking: Diminished Returns of Lesbian, Gay and Bisexual Individuals.

Background: Education level is one of the strongest protective factors against high-risk behaviors such as cigarette smoking. Minorities' Diminished Returns (MDRs), however, suggest that the protective effects of education level tend to be weaker for racial and ethnic minority groups relative to non-Hispanic White people. Only two previous studies have shown that MDRs may also apply to lesbian, gay, and bisexual (LGB) individuals; however, these studies have focused on outcomes other than tobacco use. Aims: To compare LGB and non-LGB American adults for the effects of education level on cigarette-smoking status. Methods: Population Assessment of Tobacco and Health (PATH; 2013) entered 31,480 American adults who were either non-LGB (n = 29,303, 93.1%) or LGB (n = 2,177; 6.9%). The independent variable was education level. The dependent variable was current established cigarette smoking. Race, ethnicity, age, gender, poverty status, employment, and region were the covariates. LGB status was the moderator. Results: Overall, individuals with higher education level (odds ratio (OR) = 0.69) had lower odds of current established smoking. We found a significant interaction between LGB status and education level suggesting that the protective effect of education level on smoking status is systemically smaller for LGB people than non-LGB individuals (OR for interaction = 1.19). Conclusions: Similar to the patterns that are shown for racial and ethnic minorities, MDRs can be observed for the effects of education level among sexual minorities. In the United States, highly educated LGB adults remain at high risk of smoking cigarettes, a risk which is disproportionate to their education level. In other terms, high education level better helps non-LGB than LGB individuals to avoid cigarette smoking. The result is a relatively high burden of tobacco use in highly educated LGB individuals.

Educational Attainment and Subjective Health and Well-Being; Diminished Returns of Lesbian, Gay, and Bisexual Individuals.

Background: Educational attainment is one of the strongest determinants of subjective health and well-being. Minorities' Diminished Returns, however, suggests that such an effect may be smaller for the members of racial/ethnic minorities such as Blacks and Hispanics relative to non-Hispanic Whites. Only one study has previously shown that minorities' diminished returns may also apply to lesbian, gay, and bisexual (LGB) individuals; however, that study has focused on other outcomes (i.e., obesity). Aims: To compare LGB and non-LGB American adults for the effects of educational attainment on subjective health and well-being. Methods: This cross-sectional study used baseline data of 31,480 adults in the Population Assessment of Tobacco and Health (PATH, 2013), a nationally representative study in the United States. The independent variable was educational attainment. The dependent variable was subjective health and well-being, measured using four items. Race, ethnicity, age, gender, poverty status, and employment were the covariates. LGB status was the moderator. Results: Overall, individuals with higher educational attainment had better subjective health and well-being. We found a significant interaction between LGB status and educational attainment which was suggestive of that the boosting effect of high educational attainment on better subjective health and well-being was systemically smaller for LGB than non-LGB individuals. Conclusions: In the United States, highly educated LGB adults experience poor subjective health and well-being, a status that is disproportionate to their educational attainment.

Psychometric Properties of the Lesbian, Gay, and Bisexual Identity Scale-Turkish (LGBIS-TR).

The aim of the current study was to examine the psychometric properties of the Lesbian, Gay, and Bisexual Identity Scale (LGBIS; Mohr & Kendra, 2011) in a Turkish sample. Three hundred and ten LGB individuals participated and completed the Turkish version of the LGBIS (LGBIS-TR) along with the Satisfaction with Life, Positive and Negative Affect, and Self-Compassion Scales. Confirmatory factor analysis results yielded a good-fit for eight subscales of the LGBIS-TR. We also obtained satisfactory criterion validity and internal consistency reliability. Based on this initial study, the LGBIS-TR appears to be a psychometrically sound instrument to gauge LGB individuals' identity experiences in Turkey. We discuss the results along with previous findings and limitations of the study, and we provide implications for further research and practice.

Disparities in health and disability among older adults in same-sex cohabiting relationships.

OBJECTIVE: The present study compared indicators of impaired health and disability between older adults in same-sex cohabiting relationships and their peers in opposite-sex cohabiting relationships. METHOD: Data were obtained on men (n = 698) and women (n = 630) aged 50 years and older and in self-reported same-sex relationships from the National Health Interview Survey. Multiple regression analyses were conducted to estimate differences in physical health, mental health, and disability status. RESULTS: Compared with their peers in married opposite-sex relationships, older men in same-sex relationships exhibited greater odds of psychological distress, and older women in same-sex relationships experienced elevated odds of poor/fair health, needing help with activities of daily living and instrumental activities of daily living, functional limitations, and psychological distress. DISCUSSION: This study adds to the limited information on health and disability among older lesbian, gay, and bisexual adults. As this population grows, gerontologists must develop a better understanding of the unique issues and challenges facing them and their families.

An Exploratory Study of Student Service Members/Veterans' Mental Health Characteristics by Sexual Orientation.

OBJECTIVE: Explore the mental health differences of student veterans by sexual orientation. PARTICIPANTS: Student service members/veterans (N = 702) from the Fall 2011 National College Health Assessment. METHODS: Descriptive statistics and 2-sample proportion and mean tests were used to compare mental health characteristics. RESULTS: Student veterans who identify as lesbian, gay, bisexual, or unsure had higher levels of mental health symptoms and treatment. CONCLUSIONS: Results suggest a need for continued examination of student service members/veterans as related to disparities in mental health by sexual orientation.

Minority Stress and Physical Health Among Sexual Minorities.

Lesbian, gay, and bisexual (LGB) individuals suffer serious mental health disparities relative to their heterosexual peers, and researchers have linked these disparities to difficult social experiences (e.g., antigay victimization) and internalized biases (e.g., internalized homophobia) that arouse stress. A recent and growing body of evidence suggests that LGB individuals also suffer physical health disparities relative to heterosexuals, ranging from poor general health status to increased risk for cancer and heightened diagnoses of cardiovascular disease, asthma, diabetes, and other chronic conditions. Despite recent advances in this literature, the causes of LGB physical health problems remain relatively opaque. In this article, we review empirical findings related to LGB physical health disparities and argue that such disparities are related to the experience of minority stress-that is, stress caused by experiences with antigay stigma. In light of this minority stress model, we highlight gaps in the current literature and outline five research steps necessary for developing a comprehensive knowledge of the social determinants of LGB physical health.