Lesley A. Tarasoff

Relation between place of residence and postpartum depression

Background: The relation between place of residence and risk of postpartum depression is uncertain. We evaluated the relation between place of residence and risk of postpartum depression in a population-based sample of Canadian women. Methods: Female postpartum respondents to the 2006 Canadian Maternity Experiences Survey (n = 6126) were classified as living in rural (< 1000 inhabitants or population density < 400/km2), semirural (nonrural but < 30 000 inhabitants), semiurban (30 000–499 999 inhabitants) or urban (≥ 500 000 inhabitants) areas. We further subdivided women living in rural areas based on the social and occupational connectivity of their community to larger urban centres. We compared the prevalence of postpartum depression (score of ≥ 13 on the Edinburgh Postnatal Depression Scale) across these groups and adjusted for the effect of known risk factors for postpartum depression. Results: The prevalence of postpartum depression was higher among women living in urban areas than among those living in rural, semirural or semiurban areas. The difference between semiurban and urban areas could not be fully explained by other measured risk factors for postpartum depression (adjusted odds ratio 0.60, 95% confidence interval 0.42–0.84). In rural areas, there was a nonsignificant gradient of risk: women with less connection to larger urban centres were at greater risk of postpartum depression than women in areas with greater connection. Interpretation: There are systematic differences in the distribution of risk factors for postpartum depression across geographic areas, resulting in an increased risk of depression among women living in large urban areas. Prevention programs directed at modifiable risk factors (e.g., social support) could specifically target women living in these areas to reduce the rates of postpartum depression.

Sexual and Gender Minority Peoples' Recommendations for Assisted Human Reproduction Services

OBJECTIVE To determine what recommendations lesbian, gay, bisexual, trans, and queer (LGBTQ) people have for provision of assisted human reproduction (AHR) services to their communities. METHODS Using a semi-structured guide, we interviewed a purposeful sample of 66 LGBTQ-identified individuals from across the province of Ontario who had used or had considered using AHR services since 2007. RESULTS Participants were predominantly cisgender (non-trans), white, same-sex partnered, urban women with relatively high levels of education and income. Participants made recommendations for changes to the following aspects of AHR service provision: (1) access to LGBTQ-relevant information, (2) adoption of patient-centred practices by AHR service providers, (3) training and education of service providers regarding LGBTQ issues and needs, (4) increased visibility of LGBTQ people in clinic environments, and (5) attention to service gaps of particular concern to LGBTQ people. CONCLUSION Many of the recommendations made by study participants show how patient-centred models may address inequities in service delivery for LGBTQ people and for other patients who may have particular AHR service needs. Our results suggest that service providers need education to enact these patient-centred practices and to deliver equitable care to LGBTQ patients.

Attitudes and Knowledge Among Obstetrician-Gynecologists Regarding Lesbian Patients and Their Health

OBJECTIVE The lesbian patient population is underserved. Almost no research has examined the knowledge and attitudes of obstetrician-gynecologists toward lesbian health. Our study sought to address this research gap. METHODS All 910 obstetrician-gynecologists licensed in Ontario, Canada, were mailed a true-false survey about lesbian health issues, the Homosexuality Attitudes Scale (HAS), and a demographic survey. RESULTS Of the 910 surveys, 271 were returned. The mean HAS score was 87.6 (standard deviation [SD] 11.5), indicating an overall positive attitude. The mean knowledge score was 76.0% (SD 9.5), indicating that respondents had adequate knowledge about lesbian health; 22% described their lesbian health knowledge-base as unaware. Most respondents reported lack of education on lesbian health in residency (81%) or medical school (78%). The majority reported a desire for formal education pertaining to lesbian health. There was no correlation between HAS and knowledge scores. CONCLUSIONS Although our results indicate overall adequate knowledge about lesbian health issues, important knowledge gaps were identified. Medical school and residency training curricula should include formal education about lesbian health issues, particularly because most obstetrician-gynecologists report a desire to receive this information.

Experiences of Women With Physical Disabilities During the Perinatal Period: A Review of the Literature and Recommendations to Improve Care

Although pregnancy and childbirth have significant identity and health implications for all women, perinatal research has focused primarily on nondisabled women. In this article, I provide a review of literature regarding the perinatal care experiences of women with physical disabilities. I found that many women with physical disabilities encounter attitudinal, informational, physical, and financial barriers during the perinatal period that contribute to poor care experiences and may subsequently affect health outcomes. In an effort to improve perinatal care experiences and outcomes, I offer recommendations to address the barriers identified in the literature, including increased disability content in medical school curricula.

Locating community among people with schizophrenia living in a diverse urban environment

ABSTRACT Increasing the community participation of people with severe mental illness is a primary goal of recovery-oriented services. Despite this emphasis, the construct of community remains understudied and poorly articulated. This study provides an in-depth examination of the experiences, beliefs, behaviors, and spaces that constitute community participation for a highly diverse group of people with schizophrenia who are urban dwellers. An in-depth, longitudinal qualitative design was employed with 30 individuals with schizophrenia residing in inner-city neighborhoods in Canada’s largest city. For these individuals, community participation is a dynamic process, shaped by illness and non-illness-associated social relationships and spaces, self-concept, and the resources accessible to the person. The complexity of factors that are associated with “community” for people with schizophrenia, with overlays of culture, poverty, victimization, and discrimination, calls for a critical examination of the community rhetoric employed in practice and policy contexts.

Prevalence of Depression and Anxiety Among Bisexual People Compared to Gay, Lesbian, and Heterosexual Individuals:A Systematic Review and Meta-Analysis

Over the past decade, evidence has accumulated to suggest that bisexual people experience higher rates of poor mental health outcomes compared to both heterosexual and gay/lesbian individuals. However, no previous meta-analyses have been conducted to establish the magnitude of these disparities. To address this research gap, we conducted a systematic review and meta-analysis of studies that reported bisexual-specific data on standardized measures of depression or anxiety. Of the 1,074 full-text articles reviewed, 1,023 were ineligible, predominantly because they did not report separate data for bisexual people (n = 562 studies). Ultimately, 52 eligible studies could be pooled in the analysis. Results indicate that across both outcomes, there is a consistent pattern of lowest rates of depression and anxiety among heterosexual people, while bisexual people exhibit higher or equivalent rates in comparison to lesbian/gay people. On the basis of empirical and theoretical literature, we propose three interrelated contributors to these disparities: experiences of sexual orientation-based discrimination, bisexual invisibility/erasure, and lack of bisexual-affirmative support. Implications for interventions to improve the health and well-being of bisexual people are proposed.

Positive Identity Experiences of Young Bisexual and Other Nonmonosexual People: A Qualitative Inquiry

ABSTRACT The majority of LGBTQ psychological research focuses on dysfunction. The exclusion of strengths-based perspectives in LGBTQ psychology limits the understanding of LGBTQ mental health. In this article we report experiences that young bisexual and other nonmonosexual people perceive as affirming of their sexual identity. A 28-day, daily diary study was used to investigate whether bisexual-identified participants encountered positive experiences related to their sexual identity, and which type of experiences they perceived to be positive. Using a constructivist grounded theory approach, participants’ experiences were organized according to a social ecological model. Experiences were reported at the intrapersonal, interpersonal, and institutional levels, but most positive sexual identity experiences occurred at the interpersonal level. Implications for positive health outcome research and the integration of positive psychology with LGBTQ psychology are discussed, as well as study limitations.

Predisposing, reinforcing, and enabling factors of trans-positive clinical behavior change: A summary of the literature

ABSTRACT Transgender, transsexual, and other gender minority (trans) populations experience numerous health disparities in comparison to cisgender (non-trans) groups. Many trans and gender nonconforming people report interactions with health care providers who lack knowledge about the clients specific health care needs and in some cases discrimination from health care providers, which leads to health care avoidance behaviors and poor health outcomes. Trans-positive health care interventions are necessary in order to improve health care access and outcomes for this marginalized group. In this paper we (a) synthesize literature in the areas of trans-positive care and clinical behavior change according to predisposing, reinforcing, and enabling factors, factors to be addressed as a part of the Precede-Proceed model, a model to develop and evaluate behavior change interventions, and (b) discuss future directions for research and program development with the goal of improving access to competent and quality health care for trans populations.

Using interactive theatre to help fertility providers better understand sexual and gender minority patients

Objective To determine the effectiveness of interactive theatre as a knowledge translation and exchange (KTE) method to educate assisted human reproduction (AHR) service providers about lesbian, gay, bisexual, trans and queer (LGBTQ) patients. Design We transformed data from the ‘Creating Our Families’ study, a qualitative, community-based study of LGBTQ peoples’ experiences accessing AHR services, into a script for an interactive theatre workshop for AHR service providers. Based on forum theatre principles, our workshop included five scenes illustrating LGBTQ people interacting with service providers, followed by audience interventions to these scenes. Before and after the workshop, service providers completed surveys to assess their knowledge and comfort concerning LGBTQ patients, as well as the modality of the interactive theatre workshop as a KTE strategy. Wilcoxon signed-rank tests were used to determine changes in preworkshop and postworkshop knowledge and comfort scores. Results Thirty AHR service providers attended the workshop. Twenty-three service providers (76.7%) fully completed the preworkshop and postworkshop evaluation forms. Service providers’ knowledge scores significantly improved after the workshop, while their comfort scores minimally decreased. Most agreed that the interactive workshop was an effective KTE method. Conclusions In comparison with traditional forms of KTE, interactive theatre may be particularly effective in engaging service providers and addressing their attitudes towards marginalised patient populations. Although the evaluation results of our interactive workshop were mostly positive, the long-term impact of the workshop is unknown. Long-term evaluations are needed to determine the effectiveness of arts-based KTE efforts. Other considerations for developing effective arts-based KTE strategies include adequate funding, institutional support, attention to power dynamics and thoughtful collaboration with forum theatre experts.

Community participation within the context of recovery: multiple perspectives on South Asians with schizophrenia

ABSTRACT Community participation is a key component of recovery for people with schizophrenia however, little is known about this process for persons of South Asian origin. This study explores the community participation and recovery amongst South Asians with schizophrenia living in Toronto, Canada. Seven people of South Asian origin with a diagnosis of psychosis or schizophrenia participated in a longitudinal qualitative study, with interviews taking place at three time points over 10 months. Nineteen service providers and community members were also interviewed in an effort to capture multi-level perspectives of persons of South Asian origin. Using a grounded theory approach we identified five major themes: (i) forces of collectivist community; (ii) religious and supernatural conceptualizations of schizophrenia; (iii) cultivating identity and belonging; (iv) points of exclusion; and (v) points of inclusion. The multi-level analysis provided insight into the many systems and structures that influence the recovery process, impacting identity, self-concept, and use of social space. Provider efforts to encourage community participation and recovery for persons of South Asian origin with schizophrenia should take into account individual identity and community of origin factors. Social and identity capital theories provide a mechanism to promote the social inclusion of individuals with schizophrenia.