Differences by sexual orientation in treatment outcome and satisfaction with treatment among inpatients of a German psychiatric clinic.
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ABSTRACT:
SUBMITTER: Ploderl M
PROVIDER: S-EPMC8782353 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description: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 Sweden to examine whether psychiatric outpatient treatment for various diagnoses and antidepressant medication usage are greater in sexual minority individuals compared to their siblings. A longitudinal cohort study design was used with a representative random population-based sample in Stockholm, Sweden. Registry-based health record data on all specialized outpatient health care visits and prescription drug use was linked to a sample of 1154 sexual minority individuals from the Stockholm Public Health Cohort and their siblings. The main outcomes were treatment due to psychiatric diagnoses retrieved from nationwide registry-based health records. In analyses accounting for dependency between siblings, gay men/lesbians had a greater likelihood of being treated for mood disorder [adjusted odds ratio (AOR) 1.77; 99% confidence intervals (CI) 1.00, 3.16] and being prescribed antidepressants (AOR 1.51; 99% CI 1.10, 2.07) compared to their siblings. Further, bisexual individuals had a greater likelihood of any outpatient psychiatric treatment (AOR 1.69; 99% CI 1.17, 2.45) and being prescribed antidepressants (AOR 1.48; 99% CI 1.07, 2.05) as well as a greater likelihood of being treated for a mood disorder (AOR 1.98; 99% CI 1.33, 2.95) compared to their siblings. No difference in anxiety or substance use disorder treatment was found between any sexual minority subgroup and their siblings. The potential role of familial confounding in psychiatric disorder treatment was not supported for more than half of the outcomes that were examined. Results suggest that sexual minority individuals are significantly more likely to be treated for certain psychiatric disorders compared to their siblings. Future research is needed to understand mechanisms other than familial factors that might cause the substantial treatment differences based on sexual orientation reported here.
| S-EPMC5995973 | biostudies-literature
Project description:Introduction Unlike the extensively examined early maladaptive schemas, positive schemas have rarely been examined in psychiatric patients. This study aimed to investigate the relationships between anxiety, depression, life satisfaction, resilience, and positive schemas in psychiatric inpatients with generalized anxiety disorder or major depressive disorder and explore their associations. A sample of 140 psychiatric inpatients with anxiety and depression, aged between 18 and 72 years (Mage = 35.62, SD = 13.87) participated in this study. Methods A majority were women (n = 98, 70.0%). The analyses examined resilience and anxiety/depression as mediators between positive schema and life satisfaction. Results Based on statistical analyses, resilience and anxiety/depression were parallel rather than serial mediators between positive schemas and life satisfaction. These results confirmed the positive association between positive schemas and life satisfaction, and identified mechanisms between them: directly associated and indirectly associated through the parallel mediations of resilience and anxiety/depression. Discussion The findings of this study suggest that higher levels of positive schemas in psychiatric inpatients are associated with greater life satisfaction directly and through the mediation of reduced psychopathological emotions and increased resilience. Longitudinal studies are needed to explore the associations between positive schemas and negative and positive outcomes and the mechanisms underlying these associations in clinical populations.
| S-EPMC9798195 | biostudies-literature
Project description:Study questionIs there a difference in fertility between heterosexual women and lesbians undergoing sperm donation?Summary answerWomen undergoing treatment with donated sperm are equally fertile regardless of sexual orientation.What is known alreadyLesbians have an increased prevalence of smoking, obesity, sexually transmitted diseases and, possibly, polycystic ovary syndrome, all factors known to affect fertility. Previous studies on sperm donation inseminations (D-IUI) show conflicting results regarding pregnancy outcome.Study design, size, durationThis is a national study of 171 lesbians and 124 heterosexual women undergoing sperm donation both as D-IUI (lesbian n = 438, heterosexual n = 298) and as embryo transfers (ET) after IVF with donated sperm (lesbians n = 225, heterosexuals n = 230) during 2005-2010.Participants/materials, setting, methodsAll clinics in Sweden offering sperm donation recruited patients. Differences in patients' medical history, treatment results and number of treatments to live birth were analyzed using independent samples t-test, Pearson's ?(2) test or Fisher's exact probability test.Main results and the role of chance71.8% of heterosexuals and 69.0% of lesbians had a child after treatment. The mean number of treatments was 4.2 for heterosexual women and 3.9 for lesbians. The total live birth rate, regardless of treatment type, was 19.7% for heterosexuals and 19.5% for lesbians. For D-IUI, the live birth rate was 12.8% for heterosexuals and 16.0% for lesbians and the live birth rate for all IVF embryo transfers (fresh and thawed cycles) was 28.7% for heterosexuals and 26.2% for lesbians. There were no differences in live birth rate between the groups for each of the different types of insemination stimulations (natural cycle; clomiphene citrate; FSH; clomiphene citrate and FSH combined). Nor was there a difference in live birth rate between the groups for either fresh or thawed embryo transfer. There was no difference between the proportions of women in either group or the number of treatments needed to achieve a live birth. Heterosexuals had a higher prevalence of smokers (9.2%), uterine polyps (7.2%) or previous children (11.3%) than lesbians (smokers 2.8%, P = 0.03; polyps 1.8%, P = 0.03; child 2.5%, P = 0.003).Limitations, reasons for cautionThis study is limited to women living in stable relationships undergoing treatment with donated sperm in a clinical setting and may not apply to single women or those undergoing home inseminations.Wider implications of the findingsThese results may influence healthcare policy decisions as well as increase the quality of clinical care and medical knowledge of healthcare professionals. The data also have important implications for individuals regarding screening, infertility diagnostic procedures and treatment types offered to heterosexuals and lesbians seeking pregnancy through sperm donation.Study funding/competing interest(s)Funding was granted by the Stiftelsen Familjeplaneringsfonden i Uppsala; the Swedish Research Council for Health, Working Life and Welfare; and the Marianne and Marcus Wallenberg Foundation. The authors report no conflicts of interest.
| S-EPMC3949497 | biostudies-literature
Project description: Not available
| S-EPMC9483721 | biostudies-literature
Project description:OBJECTIVES:We examined sexual orientation-related differences in various pregnancy outcomes (e.g., teen pregnancy, abortion) across the lifespan. METHODS:We collected data from 124,710 participants in three U.S. longitudinal cohort studies, the Nurses' Health Study 2 and 3 and Growing Up Today Study 1, followed from 1989 to 2017. Multivariate regression was used to calculate differences of each outcome-ever had pregnancy, teen pregnancy, ever had abortion, and age at first birth-by sexual orientation groups (e.g., heterosexual, mostly heterosexual, bisexual, lesbian), adjusting for potential confounders of age and race/ethnicity. RESULTS:All sexual minority groups-except lesbians-were generally more likely than heterosexual peers to have a pregnancy, a teen pregnancy, and an abortion. For example, Growing Up Today Study 1 bisexual participants were three times as likely as heterosexuals to have had an abortion (risk ratio, 3.21; 95% confident interval, 1.94-5.34). Lesbian women in all of the cohorts were approximately half as likely to have a pregnancy compared with heterosexual women. Few sexual orientation group differences were detected in age at first birth. CONCLUSIONS:The increased risk of unintended pregnancy among sexual minority women likely reflects structural barriers to sexual and reproductive health services. It is critical that sex education programs become inclusive of sexual minority individuals and medical education train health care providers to care for this population. Health care providers should not make harmful heteronormative assumptions about pregnant patients and providers must learn to take sexual histories as well as offer contraceptive counseling to all patients who want to prevent a pregnancy regardless of sexual orientation.
| S-EPMC7071993 | biostudies-literature
Project description:Previous neuroimaging studies demonstrated sex and also sexual orientation related structural and functional differences in the human brain. Genetic information and effects of sex hormones are assumed to contribute to the male/female differentiation of the brain, and similar effects could play a role in processes influencing human's sexual orientation. However, questions about the origin and development of a person's sexual orientation remain unanswered, and research on sexual orientation related neurobiological characteristics is still very limited. To contribute to a better understanding of the neurobiology of sexual orientation, we used magnetic resonance imaging (MRI) in order to compare regional cortical thickness (Cth) and subcortical volumes of homosexual men (hoM), heterosexual men (heM) and heterosexual women (heW). hoM (and heW) had thinner cortices primarily in visual areas and smaller thalamus volumes than heM, in which hoM and heW did not differ. Our results support previous studies, which suggest cerebral differences between hoM and heM in regions, where sex differences have been reported, which are frequently proposed to underlie biological mechanisms. Thus, our results contribute to a better understanding of the neurobiology of sexual orientation.
| S-EPMC4257718 | biostudies-literature
Project description:IntroductionSubjective cognitive decline is a self-reported measure of worsening memory and day-to-day decision making. Cognitive decline may impair an individual's ability to complete instrumental activities of daily living (IADL) such as preparing meals or taking medication, ultimately limiting one's ability to live independently. People with IADL impairments typically rely on informal care from spouses or children. Interpersonal and structural discrimination towards sexual minority (SM, including lesbian, gay, bisexual, and other queer identified) populations may contribute to disparities in cognitive decline and informal care outcomes.ObjectiveEstimate differences in prevalence, severity, and receipt of social support for subjective cognitive decline stratified by sex and SM status.MethodsCross-sectional study design using a probability sample (n = 172,047) from the Behavioral Risk Factor Surveillance System 2015-2019. Prevalence estimates and multivariable Poisson regression models were used to compare outcomes by sex and sexual identity.ResultsCompared to heterosexual peers, SM men and women were more likely to experience cognitive decline (15% of SM men, 11% of heterosexual men, 17% of SM women, 11% of heterosexual women). In adjusted models, SM women were 22% more likely (95%CI:3%-44%, p < .05) to report IADL impairments due to cognitive decline but were 17% less likely (95%CI:1%-31%, p < .05) to receive any social support with IADL impairments compared to heterosexual women. In adjusted models, SM men were 25% more likely (95%CI: 0%-56%, p < .05) to report IADL impairments due to cognitive decline but reported no significant difference in receiving social support with IADL impairments compared to heterosexual men.DiscussionWe identified significant unmet need for social supports for IADL impairments, with highest unmet need among SM women. Comprehensive strategies such as LGBTQ + affirming assisted living and home and community-based services are needed to ensure equity in receipt of long-term supports and services for SM populations.
| S-EPMC11320599 | biostudies-literature
Project description:Purpose: Prior studies have identified health care providers' lack of cultural competency as a major barrier to care among sexual minority individuals. However, little is known about disparities in experience with culturally competent care by sexual orientation at the population level. This study assessed experiences with culturally competent care and satisfaction with care across sexual orientation groups in the United States. Methods: We analyzed nationally representative data from the 2017 National Health Interview Survey (n = 21,620) with ordinal logit regression models and compared six aspects of health care experiences across sexual orientation groups. These were: preferences for and frequencies of seeing health care providers who understand or share their culture; perceived experiences of being treated with respect by providers and providers asking about their beliefs and opinions; access to easily understood health information from providers; and satisfaction with received care. Results: Relative to heterosexual men, gay men were more likely to consider it important for providers to understand or share their culture (odds ratio [OR] = 1.4, p < 0.05) and to have providers who ask for their opinions or beliefs about care (OR = 1.5, p < 0.01). Relative to heterosexual women, bisexual- and something else-identified women were less likely to report being treated with respect (ORs = 0.4-0.6, p's < 0.01) and satisfaction with care (ORs = 0.5-0.6, p's < 0.05). No statistical differences in health care experiences were found between other sexual minority groups and their heterosexual counterparts. Conclusions: Access to culturally competent care and satisfaction with care varied by sexual orientation and gender. Clinical practices should address the unique health care barriers faced by bisexual- and something else-identified women.
| S-EPMC8060893 | biostudies-literature
Project description:INTRODUCTION:Sexual and gender minority (SGM) young adults have higher smoking prevalence than their non-SGM peers. Less is known about differences in smoking characteristics within the SGM community. METHODS:Participants were SGM young adult smokers age 18-25 (N?=?165, M age?=?21.8) enrolled in a clinical trial of the Put It Out Project, a Facebook smoking cessation intervention for SGM young adults. Analyses tested differences between 1) sexual orientation groups, and 2) gender identity groups, on the following smoking characteristics: cigarettes/day, daily smoker (yes/no), social smoker (yes/no), years of smoking, number of close friends who smoke (out of 5), age of initiation, age began smoking regularly, time to first cigarette (30?min or less/>30?min), lifetime quit attempts, past-year quit attempts, and stage of change for quitting smoking (precontemplation, contemplation, preparation). RESULTS:Participants were 56% bi/pansexual, 18% gay, 18% lesbian, 8% other (e.g., asexual, queer). The gender identity of the sample was 52% cisgender, 18% transgender, 30% gender non-binary. Lesbian women began smoking at an older age (M?=?18.0, SD?=?2.0) than "other" sexual orientation participants (M?=?15.7, SD?=?2.2), p?<?.05. Transgender participants smoked the most cigarettes per day (M?=?11.3, SD?=?6.7), followed by cisgender (M?=?8.1, SD?=?5.6), then non-binary (M?=?5.7, SD?=?3.5) participants (p?<?.001; pairwise comparisons p's?<?0.05). No other constructs differed by sexual orientation or gender. CONCLUSIONS:Smoking characteristics were mostly similar across subgroups of young adult SGM smokers; however, transgender individuals were heavier smokers.
| S-EPMC6545125 | biostudies-literature
Project description:IntroductionSexual orientation‒related disparities in alcohol use disorder are well-established. Yet, the degree to which sexual orientation differences in alcohol use disorder vary across the life course is poorly understood. There is also a limited understanding of how exposure to minority stressors and their relationship with alcohol use disorder vary as a function of age.MethodsUsing nationally representative data collected in 2012-2013, authors used sex-stratified time-varying effect models to estimate age-specific prevalence rates of alcohol use disorder among heterosexual and sexual minority adults aged 18-60 years (N=28,090). Among sexual minority adults (n=1,050), authors also assessed age-specific associations between exposure to lesbian, gay, and bisexual‒related discrimination and alcohol use disorder. Analyses were conducted in 2019.ResultsGay and bisexual male participants aged 18-45 years demonstrated the highest prevalence rates of alcohol use disorder (e.g., >45% at age 25 years), whereas lesbian, gay, and bisexual female participants were most likely to meet the criteria for alcohol use disorder between ages 45 and 55 years. Sexual minority adults who experienced discrimination in the past year had greater odds of alcohol use disorder between ages 23 and 34 years and again from ages 42 to 53 years; the association between discrimination and alcohol use disorder was strongest among sexual minority men.ConclusionsSexual orientation-related disparities in alcohol use disorder are dynamic across the life course and point to critical times for screening and intervention. Developmental perspectives of sexual minority health inequities demand focused research attention as findings will help to identify strategies for promoting sexual minority health at distinct points in the life course.
| S-EPMC7483372 | biostudies-literature