Richard Bränström

Karolinska Institutet | KI · Department of Clinical Neuroscience, Division of Psychology

Background Sexual orientation differences in mental health service (MHS) use have been described before, but evidence from European settings is scarce, and little is known about unmet mental health needs (UMHN). This study examines sexual orientation differences in MHS use and UMHN and associated sociodemographic factors in a population-based sampl...

Despite the prominence of shame in stigma theories, its role in explaining population-level mental-health disparities between the stigmatized and nonstigmatized has not been investigated. We assessed shame explicitly (via self-report) and implicitly (via a behavioral task) in a prospective, representative cohort of sexual-minority and heterosexual...

Structural stigma’s role in lesbian, gay, and bisexual (LGB) people’s attainment of identity development milestones remains unknown. In a sample of 111,498 LGB people (ages 15 to 65+) living across 28 European countries, associations were investigated between structural stigma measured using an objective index of discriminatory country-level laws a...

Structural stigma toward sexual minority individuals, in the form of discriminatory laws and prejudicial population attitudes, varies widely across countries and is associated with psychosocial health outcomes. Yet, the association of changes in country-level structural stigma over time, as has recently characterized many European countries, with s...

Sexual minority individuals experience higher prevalence of major depression and more frequent depressive symptoms compared to heterosexual individuals. Although existing theories have suggested cognitive mechanisms that may explain these disparities, empirical tests are limited by a reliance on cross-sectional designs, self-reported measures, and...

Background According to the minority stress theory, stigma affects the health of marginalized populations. Previous stigma research has focused on the health effects of individual and interpersonal stigma, paying less attention to structural factors. Laws on legal gender recognition affect the lives of transgender individuals in unique ways. The fa...

Introduction: Structural stigma in the form of legal discrimination and population acceptance of same-sex relationships vary greatly across European countries. Previous cross-sectional research has linked such county variation in stigma with life-satisfaction among sexual minorities, but the consequences of the past decade's improvement in legal r...

Background Pregnancy and childbirth are significant events in many women’s lives, and the prevalence of depressive symptoms increases during this vulnerable period. Apart from well documented cognitive, affective, and somatic symptoms, stress and depression are associated with physiological changes, such as reduced heart-rate variability (HRV) and...

Despite its theorized role in lesbian, gay, and bisexual (LGB) people’s identity development, the role of structural stigma in the attainment of LGB-identity-related milestones remains unknown. In a sample of 111,186 LGB people living across 28 European countries, we investigated associations between an objective index of discriminatory country-lev...

Hypervigilance is often theoretically invoked as a psychological mechanism linking stigma to internalizing psychopathology among sexual minorities. Empirically, however, hypervigilance is rarely explicitly assessed but is instead commonly conflated with putatively related constructs, including sexual-orientation-related rejection sensitivity and ru...

Background Studies consistently show an increased risk of poor health among sexual minorities (i.e., those identifying as lesbian, gay, bisexual [LGB] or other non-heterosexuals individuals), as compared to those identifying as heterosexual. It is largely unknown whether the increased risk of mental and physical health problems among sexual minorit...

Objective: Lesbian, gay, bisexual, and queer (LGBQ)-affirmative cognitive behavioral therapy (CBT) focused on minority stress processes can address gay and bisexual men's transdiagnostic mental and behavioral health concerns. Identifying moderators of treatment outcomes may inform the mechanisms of LGBQ-affirmative CBT and subpopulations who may d...

Background Sexual minority men are at greater risk of depression and suicidality than heterosexuals. Stigma, the most frequently hypothesized risk factor for this disparity, operates across socioecological levels-structural (e.g., laws), interpersonal (e.g., discrimination), and individual (e.g., self-stigma). However, there is limited data on whet...

Background Structural stigma toward sexual minority individuals varies widely across countries and is associated with psychosocial health outcomes. Yet, the association of changes in country-level structural stigma over time, as has recently characterized many European countries, with such outcomes is largely unknown. The current study examined the...

Background: Epidemiologic studies point to multiple health inequities among sexual minority people, but few studies have examined mortality. Some causes of death are more preventable than others, and access to prevention is theorized to follow patterns of access to social and material resources. The objective of this study is to compare estimates o...

Hypervigilance is often theoretically invoked as a psychological mechanism linking stigma to internalizing psychopathology among sexual minority young adults. Empirically, however, hypervigilance is rarely explicitly assessed among sexual minorities but instead commonly conflated with putatively related constructs, such as sexual orientation-relate...

Objective Country-level structural stigma toward sexual minority individuals (i.e., discriminatory laws and policies and prejudicial attitudes) shows robust associations with sexual minority individuals’ mental health and individual-level stigma processes, such as identity concealment. Whether structural stigma is also associated with interpersonal...

Background According to the minority stress theory, stigma affects the health of marginalized populations. Previous stigma research has focused on the health effects of individual and interpersonal stigma, paying less attention to structural factors. Laws on legal gender recognition affect the lives of transgender individuals in unique ways. The fa...

Purpose: We assessed sexual orientation-related patterns in the 1-year longitudinal course (i.e., onset, remittance, persistence) and severity of suicidality. Method: Data were obtained from a prospective, population-based cohort representing nearly 2.4 million Swedish young adults. Results: A higher proportion of sexual minorities remitted (1...

An increasing number of studies show a substantial increased risk of stress-sensitive mental health problems among sexual minority individuals compared with heterosexual individuals. However, existing data regarding the age patterning of this disparity in sparse and sometimes inconsistent. We therefore examined the age patterning of the sexual orie...

Background: Pregnancy and childbirth are significant events in many women’s lives, and the prevalence of depressive symptoms increases during this vulnerable period. Apart from well documented cognitive, affective, and somatic symptoms, depression is associated with physiological changes, such as reduced heart-rate variability (HRV) and activation...

Objective: Effective Skills to Empower Effective Men (ESTEEM) represents the first intervention to address the psychological pathways through which minority stress undermines young sexual minority men's (SMM's) mental and sexual health using transdiagnostic cognitive-behavioral therapy. This study compared the efficacy of ESTEEM against two existi...

Introduction: Numerous studies have reported a high prevalence of suicidality among transgender individuals. Yet few studies have reported results from population-based samples, leaving open questions about the generalizability of existing findings. Factors proposed to explain transgender individuals' elevated risk of suicidality derive from sever...

In recent years, public health research has increasingly focused on identifying various risk factors purportedly leading to poor social, mental, and physical health among sexual and gender minorities (SGM). There is however, still a great paucity of research focusing on facilitators, barriers, and characteristics that may help inform the creation a...

Sexual minority men are at greater risk of depression and suicidality than heterosexuals. Stigma, the most frequently hypothesized risk factor for this disparity, operates across socioecological levels-structural (e.g., laws), interpersonal (e.g., discrimination), and individual (e.g., self-stigma). Although the literature on stigma and mental heal...

Are we affected by growing up in either female or male environment? This study examined whether girls’ and boys’ academic strengths at age 16 in verbal/language school subjects, relative to technical/numerical subjects, and cognitive demands of a chosen occupation at age 35 are influenced by having same- or opposite-sex siblings. Using representati...

Social stressors stemming from within the gay community might render gay and bisexual men vulnerable to mental health problems. The 20-item intraminority Gay Community Stress Scale (GCSS) is a reliable measure of gay community stress, but the scale’s length limits its widespread use in sexual minority mental health research. Using three independent...

Purpose Discriminatory laws, policies, and population attitudes, surrounding transgender people vary greatly across countries, from equal protection under the law and full acceptance to lack of legal recognition and open bias. The consequences of this substantial between-country variation on transgender people’s health and well-being is poorly unde...

Objective Maternal stress and depression in pregnancy and early parenting are associated with decreased maternal sensitivity and infant social-emotional development impairments. This randomized controlled trial explored if a Mindfulness-Based Childbirth and Parenting Program (MBCP) is more beneficial than a Lamaze program for infant’s social-emotio...

Background Increasing evidence suggests that structural stigma (e.g. discriminatory laws, policies and population attitudes) can give rise to minority stress reactions (i.e. rejection sensitivity, internalized homophobia and identity concealment) to compromise sexual minorities’ mental health. Yet, many sexual minorities encounter divergent structu...

Background Displaced Syrians face psychiatric morbidity often resulting from displacement-related stressors (eg, resource scarcity). Both men who have sex with men (MSM) and transgender women among the displaced Syrians are particularly vulnerable to mental health challenges given that they also often face stigma-related stressors (eg, discriminati...

Objectives The aim of the present study was to investigate long-term effects of Mindfulness-Based Childbirth and Parenting (MBCP) during pregnancy on women’s perceived stress and depressive symptoms during the first year postpartum.Methods Women (n = 193) who were pregnant with their first child and at risk for perinatal depression were randomized...

Country-level structural stigma, defined as prejudiced population attitudes and discriminatory legislation and policies, has been suggested to compromise the wellbeing of sexual minority adults. This study explores whether and how structural stigma might be associated with sexual minorities' school-based and adulthood experiences of victimization a...

Reducing structural drivers of intimate partner violence (IPV), including gender inequity in education, employment, and health, surrounding women worldwide represents a clear public health priority. Within countries, some women are at disproportionate risk of IPV compared to other women, including sexual minority women, immigrant women, and women i...

Background Increasing evidence suggests that structural stigma (e.g., discriminatory laws, policies, and population attitudes) can give rise to minority stress reactions (i.e., rejection sensitivity, internalized homophobia, and identity concealment) to compromise sexual minorities' mental health. Yet, many sexual minorities encounter divergent str...

Identity concealment affects all sexual minority individuals, with potentially complex mental health implications. Concealing a sexual minority identity can simultaneously generate the stress of hiding, protect against the stress of discrimination, and keep one apart from sexual minority communities and their norms and supports. Not surprisingly, e...

Gay and bisexual men might face unique, status-based competitive pressures given that their social and sexual relationships often occur with other men, who are known to compete for social and sexual gain. In a multistage study, we delineated intraminority gay community stress theory-that status-focused elements of the gay community challenge the me...

Purpose Despite increasing legal protections and supportive attitudes toward sexual minorities (e.g., those who identify as lesbian, gay, and bisexual [LGB]) in recent decades, suicidality remains more common among this population than among heterosexuals. While barriers to societal integration—or a lack of meaning, purpose, and belonging as derive...

Background The national climate surrounding sexual minorities (i.e., those self-identifying as lesbian, gay, or bisexual [LGB]) varies greatly worldwide. Recent Cross-European studies have shown that country-level structural stigma is a strong determinant of sexual minority individuals health risk behaviors and mental health. The consequences of th...

Background Despite increasing legal protections and supportive attitudes toward sexual minorities (e.g., those who identify as lesbian, gay, and bisexual [LGB]) in recent decades, suicidality remains more common among this population than among heterosexuals. While barriers to societal integration have been widely theorized as determinants of suici...

Background Sexual minorities (e.g., lesbian, gay, and bisexual individuals) are at higher risk for depression than heterosexual individuals. Lack of openness about one’s sexual orientation is a suggested source of these disparities, but it has been linked to both positive and negative mental health. Few population-based studies have explored the as...

Background Despite professional recommendations to consider gender-affirming hormonal and surgical interventions for transgender individuals with gender dysphoria, the long-term effect of such interventions on mental health is largely unknown. This study aims to ascertain the prevalence of mood and anxiety disorder healthcare visits and antidepress...

Objective: Despite professional recommendations to consider gender-affirming hormone and surgical interventions for transgender individuals experiencing gender incongruence, the long-term effect of such interventions on mental health is largely unknown. The aim of this study was to ascertain the prevalence of mood and anxiety disorder health care...

Objectives: The aim of this study was to test the efficacy of a Mindfulness-Based Childbirth and Parenting Program (MBCP) in reducing pregnant women's perceived stress and preventing perinatal depression compared to an active control condition. Method: First time pregnant women (n = 197) at risk of perinatal depression were randomized to MBCP or...

Because sexual orientation concealment can exact deep mental and physical health costs and dampen the public visibility necessary for advancing equal rights, estimating the proportion of the global sexual minority population that conceals its sexual orientation represents a matter of public health and policy concern. Yet a historic lack of cross-na...

The time has arrived for the health of sexual and gender minority (i.e. lesbian, gay, bisexual, and transgender) Europeans to be assessed. It has become increasingly clear that this likely-sizeable proportion of the European population experiences frequent discrimination, harassment and victimization; often conceals its identity and behavior from f...

Sexual minorities (e.g., lesbian, gay, and bisexual individuals) are at higher risk for depression than heterosexual individuals. Lack of openness about one's sexual orientation is a suggested source of these disparities, but it has been linked to both positive and negative mental health. Few population-based studies have explored the association b...

In the past two decades, population-based health surveys have begun including measures of sexual orientation, permitting estimates of sexual orientation disparities in psychiatric morbidity and differences in treatment utilization. The present study takes advantage of the high-quality, comprehensive nationwide health registry data available in Swed...

Objective: Although structural stigma (i.e., discriminatory laws, policies, and community attitudes) toward sexual minorities predicts adverse health and wellbeing, this association has typically only been examined within a single country and potential mechanisms remain unknown. Consequently, we examined the association between structural stigma a...

Purpose: Although strong evidence documents the elevated prevalence of both substance use and mental health problems among sexual minorities (i.e., gay, lesbian, and bisexuals), relatively less research has examined whether risk of the co-occurrence of these factors is elevated among sexual minorities compared to heterosexuals. The object of this...

Background: Research on the syndemic health threats facing sexual minority men suggests that the elevated risk of HIV among this population co-occurs with other psychosocial health disparities. This study aimed to conduct a population-based examination of clinically assessed syndemic predictors of HIV infection among gay and bisexual, compared wit...

Purpose To explore future diagnosis-specific sickness absence and disability pension among women with breast cancer compared with women without breast cancer. Also, to examine associations with disease-related and sociodemographic factors among those with breast cancer. Methods Longitudinal register data on 3,547 women living in Sweden (age 20 to...

Background: Substantial mental health disparities between lesbian, gay and bisexual (LGB) individuals compared with heterosexuals have been identified. The aim was to examine potential sexual orientation-based disparities in mental health treatment in a prospectively analysed population-based sample in Sweden and to explore potential moderators an...

Health disparities related to stigmatized characteristics, including sexual orientation, have been well-documented. However, it is largely unknown whether temporal declines in stigma at a structural level contribute to concomitant reductions in health disparities between stigmatized and nonstigmatized groups. The objective of this study was to (a)...

Background Interventions based on meditation and mindfulness techniques have been shown to reduce stress and increase psychological well-being in a wide variety of populations. Self-administrated Internet-based mindfulness training programs have the potential to be a convenient, cost-effective, easily disseminated, and accessible alternative to gro...

Objectives: To determine whether fundamental cause theory (which posits that, in societal conditions of unequal power and resources, members of higher-status groups experience better health than members of lower-status groups because of their disproportionate access to health-protective factors) might be relevant in explaining health disparities r...

Objectives: Dispositional optimism is viewed as a key personality resource for resiliency and has been linked to adjustment among women with breast cancer. The aim was to examine (a) the psychometric proprieties of Life Orientation Test-Revised (LOT-R), (b) the potential independence and co-occurrence of positive and negative dimensions of future...

Reduction of health disparities is a fundamental goal of public health research and practice. During the past several years, public health policy and research have begun to address the substantial health disparities that exist between sexual minority [lesbian, gay and bisexual (LGB)] and gender minority [transgender (T)], as compared with heterosex...

Recent studies have identified substantial health disparities between lesbian, gay, and bisexual (LGB) individuals compared to heterosexuals. However, possible variation in sexual orientation health disparities by age and according to gender remains largely unexplored. To examine physical health disparities between LGB and heterosexual individuals...

Background: Awareness of health disparities based on sexual orientation has increased in the past decades, and many official public health agencies throughout Europe call for programs addressing the specific needs of lesbian, gay and bisexual (LGB) individuals. However, the acceptance of LGB individuals varies significantly in different countries,...

The primary aim of this study was to examine the associations between different types of coping and psychological well-being and physical health among women with breast cancer. A second aim was to explore the potential moderating influences of situational and measurement factors on the associations between coping and psychological well-being and ph...

Background Improving the health of vulnerable minorities is an important public health goal. Research has shown that lesbian, gay and bisexuals (LGB) in general have poorer mental and physical health than heterosexuals. Swedish studies regarding factors influencing these health disparities are lacking. We need a better understanding of the mechan...

Emerging evidence indicates that individuals reporting more positive affect are healthier and live longer. The aim of this study was to examine if positive states of mind moderates the effect of perceived stress on psychological functioning and perceived health. A cross-sectional sample, n = 382, responded to questions regarding perceived stress, d...

Physicians' work with sickness certifications is an understudied field. The aims of this study were to gain knowledge of experiences concerning the sickness certification process among physicians working at oncology clinics. In 2008, all physicians working in Sweden (n = 36 898) were sent a questionnaire concerning sick-listing practices. All respo...

Background Physicians’ work with sickness certifications is an understudied field. Physicians’ experience of sickness certifying for longer periods than necessary has been previous reported. However, the extent and frequency of such sickness certification is largely unknown. The aims of this study were: a) to explore the frequency of sickness certi...

Objective: To explore frequencies and experiences with problems in sickness certification consultations among gynecologists and obstetricians in two different years. Design: Cross-sectional surveys on two occasions; in 2004 and 2008. Setting: Gynecological, obstetric and maternal health care. Sample: Physicians working in gynecology, obstetr...

Mindfulness meditation as an intervention to promote stress reduction has become increasingly studied and implemented over the last decade and consistently shows promising beneficial effects on psychological well-being. The development of mindfulness is integrated in several structured training programs and therapies such as mindfulness-based stres...

Objective: The aims of this study were to examine the effects of a mindfulness-based stress reduction (MBSR) training intervention among cancer patients on levels of salivary cortisol, and further to explore if changes in psychological variables mediate intervention effects on cortisol. Methods: Patients with a previous cancer diagnosis (n = 71)...