Ellen Haller

Suicide and Suicide Risk in Lesbian, Gay, Bisexual, and Transgender Populations: Review and Recommendations

Despite strong indications of elevated risk of suicidal behavior in lesbian, gay, bisexual, and transgender people, limited attention has been given to research, interventions or suicide prevention programs targeting these populations. This article is a culmination of a three-year effort by an expert panel to address the need for better understanding of suicidal behavior and suicide risk in sexual minority populations, and stimulate the development of needed prevention strategies, interventions and policy changes. This article summarizes existing research findings, and makes recommendations for addressing knowledge gaps and applying current knowledge to relevant areas of suicide prevention practice.

Pharmacologic treatment for postpartum depression: a systematic review.

During the past decade, the medical community has expressed a growing concern over the high prevalence of postpartum depression and the tragic repercussions of untreated illness. However, many questions persist about the pathogenesis of postpartum depression, the natural course of the illness, and the safety and effectiveness of available treatments. To summarize the data on pharmacologic treatments for postpartum depression, we performed a systematic review of four major databases to identify original research published from 1960‐September 2009 that featured pharmacologic treatments for depression detected in women during the 12 months after delivery. Pharmacologic treatments included prescription drugs (antidepressants and hormones), herbal remedies, and dietary supplements. Case reports, studies examining the prevention of postpartum depression, and those including diagnosed episodes of depression preceding the postpartum period (i.e., antepartum onset) were excluded. Treatment randomization or the presence of a control group was not required for inclusion in this review. Fourteen investigations met inclusion criteria. Nine studies examined the effects of prescription antidepressants, two investigated hormones, and three featured omega‐3 fatty acid supplementation. Significant heterogeneity was evident in study design and prevented a pooled quantitative analysis of treatment effects. The power of most investigations was limited, and numerous confounding biases were evident. Therapeutic effects were documented for prescription antidepressants and hormone supplementation (estrogen derivatives). Tolerability of the interventions in depressed mothers and breastfed infants was not well described. The effectiveness of omega‐3 fatty acids was not evident in postpartum depression trials, although significant limitations in study methodology were apparent. Postpartum depression is a common and serious medical problem, but most cases go undetected and untreated. The need to identify safe, effective, and convenient treatments for postpartum depression is urgent, but the current state of the medical literature describing pharmacologic interventions is not impressive. Preliminary evidence documenting the effectiveness of serotonergic antidepressants and hormone supplementation should serve as an impetus for rigorous controlled investigations in the future.

Coping With A Patient’s Suicide: A Curriculum for Psychiatry Residency Training Programs

ObjectiveThe suicide of a patient is often experienced as a traumatic event by the clinician involved. Many articles have identified the need for education to guide clinicians through the aftermath of patient suicide; however, little has been published on development of such a curriculum, particularly for residents. This article describes one residency training program’s development of an organized curriculum on coping with patient suicide and evaluates the impact of a core aspect of the training on clinicians’ knowledge about and confidence with coping with patient suicide.MethodsThe training includes a biennial half-day workshop for all trainees plus an “as-needed curriculum” used after a completed suicide. A total of 42 clinicians (39 psychiatry residents and 3 psychiatry faculty) participated in a workshop on coping with patient suicide. Their attitudes and knowledge about the topic were assessed before and after the training.ResultsParticipation in the workshop was associated with large and statistically significant increases in knowledge and self-perceptions of competence in coping with patient suicide.ConclusionThe addition of a curriculum on coping with patient suicide has the potential to significantly enhance psychiatric residency training.

A Clinical Comparison of Lesbian and Heterosexual Women in a Psychiatric Outpatient Clinic

ABSTRACT Previous research has reported that when compared to heterosexual women, lesbians may use alcohol and illicit substances to a greater degree and may experience greater psychiatric symptomatology. This study sought to describe any differences in clinical diagnoses, familial histories, and substance usage between lesbian and heterosexual women in a psychiatric outpatient clinic. A chart review was conducted and a sample of 455 heterosexuals and 75 lesbians was obtained. Data, where available, included demographic information, clinical diagnoses, time in treatment, sexual orientation, past and present substance use, and familial substance abuse and psychiatric history. Lesbians were found to have greater past illicit substance use but less current use. No significant differences were found for alcohol use. Similarly, no significant differences in clinical diagnoses were found. Significant differences were found among families. Family members of lesbians had greater substance use and psychiatric histories. These findings both support and dispute some previous research and suggest areas for future researchers to explore.

Asians and Native Hawaiian or Other Pacific Islanders Midlife Lesbians' Health: A Pilot Study

SUMMARY The purpose of this pilot study was to determine actual and potential health issues of midlife lesbians who were Asian American, Native Hawaiian, or other Pacific Islanders (A-NHOPI). We explored the health status (body composition, “outness,” smoking, alcohol, and abuse) of 29 A-NHOPI lesbians; 34.5% were totally disclosed to family, co-workers, and health-care providers. They reported high rates of quitting smoking, and low rates of smoking and alcohol abuse. Childhood physical abuse was reported by 34.7% and childhood sexual abuse was reported by 28.6% of these women. Findings from this study will assist therapists with some of the issues affecting A-NHOPI midlife lesbians.

Homophobia: Therapeutic and Training Considerations for Psychiatry

A ubiquitous aspect of contemporary society, homophobia has important intrapsychic consequences. This overview examines therapeutic considerations for psychiatrists and other clinicians working with patients whose identifiable sexual orientation (whether bisexual, lesbian, “queer,” or gay) is enough homoerotic to be the target of homophobia in latency, adolescence, and young or older adulthood. It explores the relationship between perceived or introjected homophobia, self-destructive behavior, and psychological symptoms. Treatment of patients for whom the homoerotic is part of sexual identity can be improved by educating psychiatrists throughout their training and practice about sexual identity formation, the “coming out” process, the internalization of homophobia, and the integration of sexuality with identity in homoerotically identified patients. Recommendations are made for the individualized, empathic treatment of identified homoerotic patients. The impact of homophobia on the psychiatrist and the psychiatrist in training is also discussed.

The psychiatric assessment and brief intervention program: Partnering with primary care providers

Objective To present the structure and outcomes to date for the Psychiatric Assessment and Brief Intervention (PABI), a pilot program developed at University of California, San Francisco, to improve access of primary care patients to mental health services. PABI offers diagnostic evaluations and brief (up to 3 months) evidence-based treatment, including pharmacologic management and psychotherapy, to medical patients 18 years of age and older. Core PABI features are ensuring prompt access, actively partnering with patients and referring providers, and coordinating seamless transitions of care. Methods Demographic and clinical variables and outcome indicators were collected for all patients seen in PABI from October 2015 to June 2017. Descriptive statistics and mixed-effects linear models were used to analyze the data. Results During the study period, 139 patients (54% women, mean [SD] age of 48.2 [17.5] years) with a mean of 2 DSM-5 psychiatric diagnoses each (range, 1-5) were seen. Mean time to access was 8 days, with a mean length of stay in the program of 11 weeks. Compared to baseline, final behavioral health measure scores showed significant improvement: the mean Patient Health Questionnaire-9 score decreased by 5.9 points (95% CI, 4.6-7.2), and the mean 7-item Generalized Anxiety Disorder scale score was 4.4 points lower (95% CI, 3.2-5.6; both P values < .0001). Conclusions This brief psychiatric treatment program provides prompt access to quality mental health care for patients with medical comorbidities. Results to date suggest that this program leads to significantly improved clinical outcomes. Further research is needed to determine its long-term sustainability and generalizability.

Development and Implementation of a Residency Area-of-Distinction in Lesbian, Gay, Bisexual, and Transgender Mental Health

The term “sexual minorities” refers to a broad and diverse community of individuals who do not conform to normative standards for sexual orientation, gender identity, or sexual practice; these individuals are often grouped under the term LGBT (lesbian, gay, bisexual, or transgender). Numerous studies have found that LGBT individuals demonstrate unique patterns of mental health issues, including increased rates of suicidal behavior, substance use disorders, and mood and anxiety disorders compared with non-LGBT peers [1]. Stigma, victimization, exclusion, and perceived discrimination are thought to contribute to the increased rates of mental health conditions among LGBT populations [2], and, in turn, perceived discrimination may reduce help-seeking behavior among these individuals [3]. Therefore, there is a pressing need to train future psychiatrists to recognize and address mental health issues in their LGBT patients, while creating a welcoming environment for them. The current state of adult psychiatry residency LGBTspecific training is not well documented. The Accreditation Council for Graduate Medical Education (ACGME) Program Requirements in Psychiatry specify that residents should gain competence in medical knowledge and professionalism related to “sexual orientation” [4]. However, the ACGME does not delineate how training programs are to achieve those goals. A recent survey of program directors and trainees within 19 adult and child-psychiatry New York City-based training programs revealed that 42.4% of respondents reported no coverage of LGBT-specific topics, though 89.9% of trainees and 62.5% of program directors expressed interest in hearing from guest speakers about such issues [5]. Here, we describe the development and early implementation of an LGBT “area-of-distinction” (AoD) within an adult psychiatry residency program. We anticipate that this narrative (and supplemental material, available upon request) will serve as a resource for training program leaders who are considering ways to integrate LGBT-specific education into their curricula.

Marriage Plans Interrupted and Then Fulfilled: The Impact on a Family

In this paper, originally a presentation, the author discusses creating a family and raising a son with another couple as four co-parents. The couples had wedding plans when their son was young but were forced to postpone their union as California law changed. The author reviews her familys odyssey of marriage plans interrupted and then fulfilled and the impact of the resultant legal complexities on her son.