Joanna Semlyen

A systematic review of mental disorder, suicide, and deliberate self harm in lesbian, gay and bisexual people

BackgroundLesbian, gay and bisexual (LGB) people may be at higher risk of mental disorders than heterosexual people.MethodWe conducted a systematic review and meta-analysis of the prevalence of mental disorder, substance misuse, suicide, suicidal ideation and deliberate self harm in LGB people. We searched Medline, Embase, PsycInfo, Cinahl, the Cochrane Library Database, the Web of Knowledge, the Applied Social Sciences Index and Abstracts, the International Bibliography of the Social Sciences, Sociological Abstracts, the Campbell Collaboration and grey literature databases for articles published January 1966 to April 2005. We also used Google and Google Scholar and contacted authors where necessary. We searched all terms related to homosexual, lesbian and bisexual people and all terms related to mental disorders, suicide, and deliberate self harm. We included papers on population based studies which contained concurrent heterosexual comparison groups and valid definition of sexual orientation and mental health outcomes.ResultsOf 13706 papers identified, 476 were initially selected and 28 (25 studies) met inclusion criteria. Only one study met all our four quality criteria and seven met three of these criteria. Data was extracted on 214,344 heterosexual and 11,971 non heterosexual people. Meta-analyses revealed a two fold excess in suicide attempts in lesbian, gay and bisexual people [pooled risk ratio for lifetime risk 2.47 (CI 1.87, 3.28)]. The risk for depression and anxiety disorders (over a period of 12 months or a lifetime) on meta-analyses were at least 1.5 times higher in lesbian, gay and bisexual people (RR range 1.54–2.58) and alcohol and other substance dependence over 12 months was also 1.5 times higher (RR range 1.51–4.00). Results were similar in both sexes but meta analyses revealed that lesbian and bisexual women were particularly at risk of substance dependence (alcohol 12 months: RR 4.00, CI 2.85, 5.61; drug dependence: RR 3.50, CI 1.87, 6.53; any substance use disorder RR 3.42, CI 1.97–5.92), while lifetime prevalence of suicide attempt was especially high in gay and bisexual men (RR 4.28, CI 2.32, 7.88).ConclusionLGB people are at higher risk of mental disorder, suicidal ideation, substance misuse, and deliberate self harm than heterosexual people.

Spasticity in multiple sclerosis

The objective of this article is to establish the prevalence of spasticity in a random selection of people with multiple sclerosis (MS) in the city of Newcastle upon Tyne in the Northeast of England. A secondary aim was to assess the adequacy of current pharmacological intervention for spasticity and assess the relationship between spasticity and overall disability. The study design was a simple comparison that examined differences in functional independence in 2 random groups of people with MS subdivided by the presence of clinically significant spasticity. A total of 68 adults with a diagnosis of clinically definite MS were included in the study. Their level of functional independence was assessed using the Newcastle Independence Assessment Form (NIAF), the Functional Independence Measure (FIM), and the Kurtzke Extended Disability Status Scale (EDSS). Spasticity was assessed using the Modified Ashworth Scale. A subjective analysis was made of the appropriateness of oral antispastic medication by a rehabilitation physician. Thirty-two people (47%) had clinically significant spasticity (Modified Ashworth Score of 2, 3, or 4). Seventy-eight percent of the population were receiving some oral antispastic medication, but 50% were deemed to require some drug adjustment or additional treatment. Individuals with spasticity were found to have significantly higher levels of disability than those who had no spasticity or clinically insignificant spasticity. This study has confirmed that spasticity is highly prevalent in the MS population and is significantly associated with a reduced level of functional independence. Treatment of spasticity is suboptimal in a large proportion of the population, and the need for further information and education to health professionals and to people with MS is highlighted.

Traumatic brain injury: Efficacy of multidisciplinary rehabilitation

OBJECTIVE To establish efficacy of a coordinated multidisciplinary rehabilitation service for severe head injury, provided at Hunters Moor Regional Rehabilitation Centre. DESIGN A quasi-experimental design to compare treatment effects between two groups. The first group received a coordinated, multidisciplinary regional rehabilitation service; the other, a single discipline approach provided by local, district hospitals. Follow-up was for 2 years postinjury. PATIENTS OR OTHER PARTICIPANTS Fifty-six consecutive severe head injury admissions, with an identified main caregiver, referred for rehabilitation within 4 weeks of their injury. MAIN OUTCOME MEASURES The Barthel index, the Functional Independence Measure (FIM), and the Newcastle Independence Assessment Form (NIAF), a newly developed, real-life, comprehensive measure. In addition, caregivers completed the General Health Questionnaire. RESULTS The group that received coordinated multidisciplinary rehabilitation not only demonstrated significant gains throughout the study period but also maintained treatment effect after input ended. Furthermore, caregivers of this group had significantly reduced levels of distress. The comparison group, despite initial lower injury severity and shorter hospital stay, did not demonstrate equivalent gains or any posttreatment effect. CONCLUSIONS The results show the efficacy of a comprehensive, specialist multidisciplinary regional service. There are significant implications for service provision for people with severe traumatic head injury.

Sexual orientation identity in relation to smoking history and alcohol use at age 18/19: cross-sectional associations from the Longitudinal Study of Young People in England (LSYPE)

Objectives Information about the health behaviours of minority groups is essential for addressing health inequalities. We evaluated the association among lesbian, gay or bisexual (LGB) sexual orientation identity and smoking and alcohol use in young people in England. Design Data drawn from wave 6 of the Longitudinal Study of Young People in England (LSYPE). Setting Self-completion questionnaires during home visits, face-to-face interviews and web-based questionnaires. Participants Data from 7698 participants (3762 men) with information on sexual orientation identity and health behaviours at age 18/19. Outcome measures Cigarette smoking history, alcohol drinking frequency and risky single occasion drinking (RSOD). Results LGB identity was reported by 3.1% of participants (55 gay, 33 lesbian, 35 bisexual male, 111 bisexual female), 3.5% when adjusting for the survey design. Adjusting for a range of covariates, identification as lesbian/gay was found to be associated with smoking (OR=2.23, 95% CI 1.42 to 3.51), alcohol drinking >2 days/week (OR=1.99, 95% CI 1.25 to 3.17) and RSOD (OR=1.80, 95% CI 1.13 to 2.86) more than weekly. Bisexual identity was associated with smoking history (OR=1.84, 95% CI 1.30 to 2.61) but not alcohol drinking >2 days/week (OR=1.20, 95% CI 0.79 to 1.81) or RSOD (OR=1.04, 95% CI 0.71 to 2.86). Conclusions In a sample of more than 7600 young people aged 18/19 years in England, lesbian/gay identity is associated with cigarette smoking, drinking alcohol frequency and RSOD. Bisexual identity is associated with smoking but not RSOD or frequent alcohol drinking.

The establishment of a community multiple sclerosis team.

This paper describes the introduction of a community multiple sclerosis team (CMST) in the city of Newcastle upon Tyne in the North of England. Historically, a service for people with MS had existed in Newcastle upon Tyne since the early 1990s, when the local branch of the Multiple Sclerosis Society funded a community physiotherapist. In 1995 a successful bid was made to Newcastle District Health Authority for the establishment of a multidisciplinary community multiple sclerosis team. One hundred and ten thousand pounds (

The further validation and precision of the NIAF-R

165 000) per annum was made available, which was further supplemented by continuation of a grant of £10 000 (

The cancer care experiences of gay, lesbian and bisexual patients: A secondary analysis of data from the UK Cancer Patient Experience Survey

15 000) per annum from the local Multiple Sclerosis Society. The team was fully operational by spring 1997. The team consists of a full-time physiotherapist/team leader, rehabilitation assistant and administrator and three part-time professionals – a medically qualified counsellor, clinical neuropsychologist and rehabilitation physician. Additionally, a full-time occupational therapist and social worker have been appointed by the local social services department but paid for from the health budget. A nurse was not appointed to the team as there was an existing MS nurse who was attached to the local neurology department and was developing close links with the team. However, after the completion of this evaluation a part-time nurse has now been appointed to the team with particular expertise in continence management as well as sexual and relationship counselling. It should be emphasized that the team fosters an interdisciplinary mechanism of working with an emphasis on collaboration between professionals and clients in order to give the person with MS and their carers close involvement in the decision-making process. This client-centred approach has the effect of blurring the boundaries of professional roles. The team developed the administrative base in the local Disabled Living Centre, which is run by a charity. This centre has a fully equipped exhibition of disability equipment and is the base for a disability information service. The team is closely associated with Hunters Moor Regional Neurorehabilitation Centre, which is the specialist rehabilitation centre for the population of the North of England. The team is supported by an advisory panel consisting of representatives from the local community, general practitioners, neurologists, social services, the MS Society and the funding health authority. A research grant was obtained from the Department of Health in the UK in order to employ a full-time researcher (R.W.M.) for a two year period to describe and evaluate the impact of the team.

The Newcastle Independence Assessment Form—Research:Development of an Alternative Functional Measure

It is essential that any tool which is measuring outcome following head injury is sensitive to change over time. The Newcastle Independence Assessment Form-Research (NIAF-R) has been developed to be appropriate and applicable both in the acute situation and in the long-term. This paper illustrates the NIAF-Rs level of sensitivity to change over time from eight weeks through to one year post-injury. There were no ceiling effects demonstrated at follow-up. Such effects can be a problem with other comparable measures. In addition, the results of further concurrent validation with the Barthel index, are reported. The NIAF-R scoring is refined through the development of an Adjusted Severity Indicator for more stringent analysis of level of independence. Scoring can now provide data in 55 individual areas of function for each subject or alternatively give an overall measure of severity of functional independence. Finally, this paper demonstrates the ability of the NIAF-R to predict outcome at follow-up.

The Predictive Validity of the Newcastle Independence Assessment Form Research (NIAF-R):Further Development of an Alternative Measure

Understanding the effects of population diversity on cancer-related experiences is a priority in oncology care. Previous research demonstrates inequalities arising from variation in age, gender and ethnicity. Inequalities and sexual orientation remain underexplored. Here, we report, for the first time in the UK, a quantitative secondary analysis of the 2013 UK National Cancer Patient Experience Survey which contains 70 questions on specific aspects of care, and six on overall care experiences. 68,737 individuals responded, of whom 0.8% identified as lesbian, gay or bisexual. Controlling for age, gender and concurrent mental health comorbidity, logistic regression models applying post-estimate probability Wald tests explored response differences between heterosexual, bisexual and lesbian/gay respondents. Significant differences were found for 16 questions relating to: (1) a lack of patient-centred care and involvement in decision-making, (2) a need for health professional training and revision of information resources to negate the effects of heteronormativity and (3) evidence of substantial social isolation through cancer. These findings suggest a pattern of inequality, with less positive cancer experiences reported by lesbian, gay and (especially) bisexual respondents. Poor patient-professional communication and heteronormativity in the healthcare setting potentially explain many of the differences found. Social isolation is problematic for this group and warrants further exploration.

Intersectional identities and dilemmas in interactions with healthcare professionals: an interpretative phenomenological analysis of British Muslim gay men

The Newcastle Independence Assessment Form—Research (NIAF-R) is a 55-item global measure of the functional independence of people with neurologic disability. It has been designed to establish outcome over time—throughout recovery and at long- term follow-up. This paper recounts the development of this scale and demonstrates its expediency, acknowledging the presence of other less suitable or less user-friendly extended ADL and global functional assessment measures. Interrater agreement was demonstrated throughout the developmental stages of the NIAF-R. The majority of kappa ratings were greater than 0.6 in a comparison .between the NIAF-R and the Functional Independence Measure (FIM). Values at this level are agreed to be a sub stantial result. Recommendations for future analyses include validation studies at longer term follow-up and with a wider range of neurologic disabilities, an increased sample size to increase statistical power, and further testing to establish NIAF-R as a clinical tool.