Vickie M. Mays

Mental Health Correlates of Perceived Discrimination Among Lesbian, Gay, and Bisexual Adults in the United States

OBJECTIVES Recent studies suggest that lesbians and gay men are at higher risk for stress-sensitive psychiatric disorders than are heterosexual persons. We examined the possible role of perceived discrimination in generating that risk. METHODS The National Survey of Midlife Development in the United States, a nationally representative sample of adults aged 25 to 74 years, surveyed individuals self-identifying as homosexual or bisexual (n = 73) or heterosexual (n = 2844) about their lifetime and day-to-day experiences with discrimination. Also assessed were 1-year prevalence of depressive, anxiety, and substance dependence disorders; current psychologic distress; and self-rated mental health. RESULTS Homosexual and bisexual individuals more frequently than heterosexual persons reported both lifetime and day-to-day experiences with discrimination. Approximately 42% attributed this to their sexual orientation, in whole or part. Perceived discrimination was positively associated with both harmful effects on quality of life and indicators of psychiatric morbidity in the total sample. Controlling for differences in discrimination experiences attenuated observed associations between psychiatric morbidity and sexual orientation. CONCLUSIONS Higher levels of discrimination may underlie recent observations of greater psychiatric morbidity risk among lesbian, gay, and bisexual individuals.

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.

Physical Health Complaints Among Lesbians, Gay Men, and Bisexual and Homosexually Experienced Heterosexual Individuals: Results from the California Quality of Life Survey

OBJECTIVES We examined evidence that minority sexual orientation is associated with more-frequent reports of physical health complaints. We also investigated the possible role of HIV infection among gay men and higher rates of psychological distress among lesbians, gay men, and bisexually and homosexually experienced heterosexual individuals in generating these health disparities. METHODS We used data from the California Quality of Life Survey (N=2272 adults) to examine associations between sexual orientation and self-reports about physical health status, common health conditions, disabilities, and psychological distress. RESULTS Prevalent HIV infection was reported by nearly 18% of gay, bisexual, and homosexually experienced heterosexual men. Gay men and bisexual and homosexually experienced heterosexual individuals had higher levels of psychological distress compared with exclusively heterosexual individuals. Self-reported physical health status varied by gender and by sexual orientation. CONCLUSIONS Lesbians and bisexual and homosexually experienced heterosexual women reported a greater variety of health conditions and limitations compared with exclusively heterosexual women; however, these differences mostly disappeared when distress levels were taken into account. Among men, differences in health complaints appeared to reflect the ongoing burden of HIV and other sexually transmitted diseases in the gay male community.

Estimates of alcohol use and clinical treatment needs among homosexually active men and women in the U.S. population.

Concerns about dysfunctional alcohol use among lesbians and gay men are longstanding. The authors examined alcohol use patterns and treatment utilization among adults interviewed in the 1996 National Household Survey on Drug Abuse. Sexually active respondents were classified into 2 groups: those with at least 1 same-gender sexual partner (n = 194) in the year prior to interview and those with only opposite-gender sexual partners (n = 9,714). The authors compared these 2 groups separately by gender. For men, normative alcohol use patterns or morbidity did not differ significantly between the 2 groups. However, homosexually active women reported using alcohol more frequently and in greater amounts and experienced greater alcohol-related morbidity than exclusively heterosexually active women. Findings suggest higher risk for alcohol-related problems among lesbians as compared with other women, perhaps because of a more common pattern of moderate alcohol consumption.

HIV Prevention Research: Are We Meeting the Needs of African American Men Who Have Sex with Men?

Two decades of HIV prevention efforts with men who have sex with men (MSM) have not eliminated the risk of new HIV infections in this vulnerable population. Indeed, current incidence rates in African American MSM are similar to those usually only seen in developing countries. A review of the existing literature suggests that the prevention research agenda for Black MSM could benefit from reframing conceptualization of risk as a function of individual properties to a broad consideration of social and interpersonal determinants. Studies that investigate dyadic and social-level influences on African American MSM’s relationships are needed. This includes research explicating the diversity existing within the categorizations of Black MSM with respect to perceived identity (gay, bisexual, “men on the down low,” “homo thugz”), constructions of masculinity, sexual scripts, sources of social support, and perceived norms and expectations. Recommendations are proposed for a research agenda focusing on linkages between interpersonal and social-structural determinants of HIV risk.

Mental Health and Substance Use Disorders Among Latino and Asian American Lesbian, Gay, and Bisexual Adults

Growing evidence suggests that lesbian, gay, and bisexual adults may be at elevated risk for mental health and substance use disorders, possibly due to anti-gay stigma. Little of this work has examined putative excess morbidity among ethnic/racial minorities resulting from the experience of multiple sources of discrimination. The authors report findings from the National Latino and Asian American Survey (NLAAS), a national household probability psychiatric survey of 4,488 Latino and Asian American adults. Approximately 4.8% of persons interviewed identified as lesbian, gay, bisexual, and/or reported recent same-gender sexual experiences. Although few sexual orientation-related differences were observed, among men, gay/bisexual men were more likely than heterosexual men to report a recent suicide attempt. Among women, lesbian/bisexual women were more likely than heterosexual women to evidence positive 1-year and lifetime histories of depressive disorders. These findings suggest a small elevation in psychiatric morbidity risk among Latino and Asian American individuals with a minority sexual orientation. However, the level of morbidity among sexual orientation minorities in the NLAAS appears similar to or lower than that observed in population-based studies of lesbian, gay, and bisexual adults.

Reports of parental maltreatment during childhood in a United States population-based survey of homosexual, bisexual, and heterosexual adults

OBJECTIVE The study objective was to determine the nature and prevalence of childhood maltreatment experiences among lesbian, gay, and bisexual adults and to compare findings to those obtained from similar heterosexual adults. METHOD Data from the National Survey of Midlife Development in the United States (MIDUS), which measured both childhood experiences with parental emotional and physical maltreatment and adult sexual orientation, were used to compare childhood maltreatment experiences of 2,917 heterosexual, homosexual, and bisexual individuals, age 25-74 years, separately by gender. RESULTS Homosexual/bisexual men reported higher rates than heterosexual men of childhood emotional and any physical maltreatment (including major physical maltreatment) by their mother/maternal guardian and major physical maltreatment by their father/paternal guardian. In contrast, homosexual/bisexual women, as compared to heterosexual women, reported higher rates of major physical maltreatment by both their mother/maternal guardian and their father/ paternal guardian. Differences among individuals with differing sexual orientations were most pronounced for the more extreme forms of physical maltreatment. CONCLUSIONS Adult minority sexual orientation is a risk indicator for positive histories of experiencing parental maltreatment during childhood. While the reasons for this are beyond the scope of the current study, previous research suggests that childhood individual differences, including possibly gender atypicality, may be a causal factor.

Burden of psychiatric morbidity among lesbian, gay, and bisexual individuals in the California Quality of Life Survey.

In recent population-based surveys, minority sexual orientation has been identified as a potential risk indicator for psychiatric morbidity. However, methodological limitations in the studies to date have led to concerns that current estimates are biased due to inadequate measurement of sexual orientation and uncontrolled confounding from prevalent HIV infection. In the present study, the authors investigate associations between sexual orientation and mental health/substance use morbidity using information obtained from 2,272 individuals, including 652 sexual orientation minorities, age 18 to 72 years, interviewed in the California Quality of Life Survey. Results confirm that minority sexual orientation is a risk indicator for psychiatric morbidity. However, levels of increased risk vary within this subpopulation by both gender and patterns of sexual orientation expression. Among gay/bisexual men, much of this greater burden is related to concurrent HIV infection. Reducing excess mental health morbidity risk among sexual orientation minorities could result in possibly a 5% to 11% reduction in the burden of the disorders assessed here among the adult population. Sexual orientation represents an important, but relatively understudied, individual characteristic shaping risk for psychiatric morbidity.

Heterogeneity of Health Disparities Among African American, Hispanic, and Asian American Women: Unrecognized Influences of Sexual Orientation

OBJECTIVES This study compared health indicators among self-identified lesbians/bisexual women and heterosexual women residing in Los Angeles County. METHODS Respondents were English-speaking Hispanic, African American, and Asian American women. Health status, behavioral risks, access barriers, and indicators of health care were assessed. RESULTS Prevalence rates of chronic health conditions were similar among women in the 3 racial/ethnic groups. However, lesbians and bisexual women evidenced higher behavioral risks and lower rates of preventive care than heterosexual women. CONCLUSIONS Among racial/ethnic minority women, minority sexual orientation is associated with increased health risks. The effects of sexual minority status need to be considered in addressing health disparities affecting this population.

Perceived race-based discrimination, employment status, and job stress in a national sample of Black women: Implications for health outcomes.

Previous research has not systematically examined the relationship of perceived race-based discriminations to labor force participation or job related stresses-problems experienced by Black women. The present study investigated the relative contributions of perceived race-based discriminations and sociodemographic characteristics to employment status and job stress in a national probability sample (the National Survey of Black Americans; J. S. Jackson, 1991) of Black women in the United States. Logit and polychotomous logistic regression analyses revealed that Black womens current employment status was best explained by sociodemographic measures. In contrast, the combination of perceived discrimination and sociodemographics differentially affects patterns of employment status and perceived job stress in the work environment of Black women. Implications of these findings for the health of African American women are discussed.