Effects of Perceived Discrimination on Mental Health and Mental Health Services Utilization Among Gay, Lesbian, Bisexual and Transgender Persons

Center for Chronic Disease Outcomes Research, Veterans Affairs Medical Center, One Veterans Drive, Minneapolis, MN 55417, USA.
Journal of LGBT Health Research 02/2007; 3(4):1-14. DOI: 10.1080/15574090802226626
Source: PubMed


Previous research has found that lesbian, gay, bisexual and transgender (LGBT) individuals are at risk for a variety of mental health disorders. We examined the extent to which a recent experience of a major discriminatory event may contribute to poor mental health among LGBT persons.
Data were derived from a cross-sectional strata-cluster survey of adults in Hennepin County, Minnesota, who identified as LGBT (n=472) or heterosexual (n=7,412).
Compared to heterosexuals, LGBT individuals had poorer mental health (higher levels of psychological distress, greater likelihood of having a diagnosis of depression or anxiety, greater perceived mental health needs, and greater use of mental health services), more substance use (higher levels of binge drinking, greater likelihood of being a smoker and greater number of cigarettes smoked per day), and were more likely to report unmet mental healthcare needs. LGBT individuals were also more likely to report having experienced a major incident of discrimination over the past year than heterosexual individuals. Although perceived discrimination was associated with almost all of the indicators of mental health and utilization of mental health care that we examined, adjusting for discrimination did not significantly reduce mental health disparities between heterosexual and LGBT persons.
LGBT individuals experienced more major discrimination and reported worse mental health than heterosexuals, but discrimination did not account for this disparity. Future research should explore additional forms of discrimination and additional stressors associated with minority sexual orientation that may account for these disparities.

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    • "SM adults had higher levels/rates in studies with structured clinical interviews or medical chart: alcohol (Barnes, et al., 2014; Booth, et al., 2012; Chakraborty, et al., 2011; Cochran & Mays, 2009; Cochran, et al., 2003; Drabble, Midanik, & Trocki, 2005; Farmer, Jabson, Bucholz, & Bowen, 2013b; Fergusson, et al., 2005; Frisell, et al., 2010; Gilman, et al., 2001; Grella, et al., 2011; Hatzenbuehler, et al., 2009; Hughes, et al., 2010a; McCabe, Hughes, Bostwick, West, & Boyd, 2009; Midanik, Drabble, Trocki, & Sell, 2007; Sandfort, et al., 2001); drugs (Bolton & Sareen, 2011; Chakraborty, et al., 2011; Cochran & Mays, 2009; Cochran, et al., 2003; Fergusson, et al., 1999; Fergusson, et al., 2005; Gilman, et al., 2001; Grella, et al., 2011; Hatzenbuehler, et al., 2009; Hughes, et al., 2010a; McCabe, et al., 2009; Rath, et al., 2013; Sandfort, et al., 2001); with questionnaires for alcohol (Ericksen & Trocki, 1994; King & Nazareth, 2006; Lhomond, et al., 2014; Mattocks, et al., 2013; Said, et al., 2013), with single items for alcohol (Balsam, Beadnell, & Riggs, 2012; Blosnich, Bossarte, Silver, & Silenzio, 2013; Blosnich, Farmer, Lee, Silenzio, & Bowen, 2014a; Boehmer, Miao, Linkletter, & Clark, 2012; Bowring, Vella, Degenhardt, Hellard, & Lim, 2015; Burgard, Cochran, & Mays, 2005; Burgess, et al., 2007; Case et al., 2004; Cochran, Grella, & Mays, 2012; Diamant, Wold, Spritzer, & Gelberg, 2000; Dilley, Simmons, Boysun, Pizacani, & Stark, 2010; Drabble, et al., 2005; Ford & Jasinski, 2006; Fredriksen-Goldsen, Kim, Barkan, Muraco, & Hoy-Ellis, 2013; Gruskin & Gordon, 2006; Hughes, et al., 2010b; Julien, Jouvin, Jodoin, L'Archeveque, & Chartrand, 2008; Lhomond & Saurel-Cubizolles, 2006; Mercer et al., 2007; Pope, Ionescu-Pioggia, & Pope, 2001; Przedworski, McAlpine, Karaca-Mandic, & VanKim, 2014; Reczek, Liu, & Spiker, 2014; Reed, et al., 2010; Rhodes, McCoy, Wilkin, & Wolfson, 2009; Rothman, et al., 2012; Sandfort, Bakker, Schellevis, & Vanwesenbeeck, 2006; Schauer, et al., 2013; Steele, et al., 2009; Talley, Hughes, Aranda, Birkett, & Marshal, 2014) and drugs (Bowring, et al., 2015; Cochran, et al., 2012; Conron, Mimiaga, & Landers, 2010; Hughes, et al., 2010b; Julien, et al., 2008; Kerr, et al., 2015; Lhomond, et al., 2014; McCabe, Boyd, Hughes, & d'Arcy, 2003; McCabe, Hughes, Bostwick, & Boyd, 2005; McCabe, Hughes, Bostwick, Morales, & Boyd, 2012; Mercer, et al., 2007; Pope, et al., 2001; Reed, et al., 2010; Rhodes, et al., 2009; Ridner, Frost, & LaJoie, 2006; Rothman, et al., 2012; Skegg, et al., 2003; Ueno, 2010a) and with treatment/diagnosis by professionals, as reported by participants for drugs (Pelts & Albright, 2014). "
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    ABSTRACT: Many studies, reviews, and meta-analyses have reported elevated mental health problems for sexual minority (SM) individuals. This systematic review provides an update by including numerous recent studies, and explores whether SM individuals are at increased risk across selected mental health problems as per dimensions of sexual orientation (SO), genders, life-stages, geographic regions, and in higher quality studies. A systematic search in PubMed produced 199 studies appropriate for review. A clear majority of studies reported elevated risks for depression, anxiety, suicide attempts or suicides, and substance-related problems for SM men and women, as adolescents or adults from many geographic regions, and with varied SO dimensions (behaviour, attraction, identity), especially in more recent and higher quality studies. One notable exception is alcohol-related problems, where many studies reported zero or reversed effects, especially for SM men. All SM subgroups were at increased risk, but bisexual individuals were at highest risk in the majority of studies. Other subgroup and gender differences are more complex and are discussed. The review supports the long-standing mental health risk proposition for SM individuals, overall and as subgroups.
    International Review of Psychiatry 11/2015; DOI:10.3109/09540261.2015.1083949 · 1.80 Impact Factor
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    • "In the general population, several studies have demonstrated that LB women are more likely to report sexual and physical abuse in both childhood and adolescence,27–30 as well as higher levels of sexual assault in adulthood.28,31,32 Data from population-based studies also indicate that sexual minority status among women is associated with hazardous drinking,33–37 smoking,33,34,36,38 obesity,39,40 and mood and anxiety disorders, including PTSD.34,41–43 "
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    ABSTRACT: Relative to the general population, lesbian and bisexual (LB) women are overrepresented in the military and are significantly more likely to have a history of military service compared to all adult women. Due to institu-tional policies and stigma associated with a gay or lesbian identity, very little empirical research has been done on this group of women veterans. Available data suggest that compared to heterosexual women veter-ans, LB women veterans are likely to experience heightened levels of prejudice and discrimination, victimization, including greater incidence of rape, as well as adverse health and substance use disorders. They are also likely to encounter a host of unique issues when accessing health care, including fears of insensitive care and difficulty disclosing sexual orien-tation to Veterans Health Administration (VHA) pro-viders. Training of staff and providers, education efforts, outreach activities, and research on this subpopulation are critical to ensure equitable and high quality service delivery.
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    • "Greenwell, Mays, & Cochran, 2009), but lower rates of general health care among GLB groups than heterosexuals (Austin & Irwin, 2010; Buchmueller & Carpenter, 2010; Kerker, Mostashari, & Thorpe, 2006). Concerns about stigmatization and past experiences of discrimination are associated with lower non-mental health care utilization rates among civilian GLB individuals (Burgess , Tran, Lee, & van Ryn, 2007; Clark, Bonacore, Wright, Armstrong, & Rakowski, 2003; Kinsler, Wong, Sayles, Davis, & Cunningham, 2007; Malebranche, Peterson, Fullilove, & Stackhouse , 2004; Mayer et al., 2008), although research has also found that reporting a major incident of discrimination is associated with increased mental health care utilization for this group (Burgess et al., 2007). "
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    ABSTRACT: According to recent census reports, nearly a million veterans have a same-sex partner, yet little is known about them or their use of Veterans Health Care Administration (VHA) services. Gay, lesbian, and bisexual (GLB) veterans recruited from the community (N = 356) completed an on-line survey to assess their rates of VHA utilization and whether they experience specific barriers to accessing VHA services. Andersen's model of health care utilization was adapted to provide an analytic and conceptual framework. Overall, 45.5% reported lifetime VHA utilization and 28.7% reported past-year VHA utilization. Lifetime VHA health care utilization was predicted by positive service connection, positive screen for both posttraumatic stress disorder (PTSD) and depression, and history of at least one interpersonal trauma during military service related to respondent's GLB status. Past-year VHA health care utilization was predicted by female gender, positive service connection, positive screen for both PTSD and depression, lower physical functioning, a history of military interpersonal trauma related to GLB status, and no history of stressful experiences initiated by the military to investigate or punish GLB status. Rates of VHA utilization by GLB veterans in this sample are comparable to those reported by VHA Central Office for all veterans. Of those who utilized VHA services, 33% reported open communication about their sexual orientation with VHA providers. Twenty-five percent of all participants reported avoiding at least one VHA service because of concerns about stigma. Stigma and lack of communication between GLB veterans and their providers about sexual orientation are areas of concern for VHA. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
    Psychological Services 05/2013; 10(2):223-32. DOI:10.1037/a0031281 · 1.08 Impact Factor
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