Gender at the crossroads of mental health and climate change: A scoping review.

Longitudinal Assessment of Changes in Mental and Sexual Health Outcomes Due to COVID-19 Among Latinx SMM and TGW.

Meeting the UN Sustainable Development Goals for mental health: why greater prioritization and adequately tracking progress are critical.

Household food insecurity (FI) and water insecurity (WI) are prevalent public health issues that can co-occur. Few studies have concurrently assessed their associations with health outcomes, particularly among people living with HIV. We aimed to investigate the associations between FI and WI and how they relate to physical and mental health. Food-insecure adult smallholder farmers living with HIV in western Kenya were recruited to participate in a cluster-randomized controlled trial of a multisectoral agricultural and asset loan intervention. We used baseline data on experiences of FI (using the Household Food Insecurity Access Scale, range: 0-27) and WI (using a modified scale developed for this region, range: 0-51) in the prior month (n=716). Outcomes included probable depression (using the Hopkins Symptom Checklist), fatigue and diarrhea in the prior month, and overall mental and physical health (using the Medical Outcomes Study HIV Health Survey, range: 0-100). We first assessed Pearson correlations between FI, WI, and sociodemographic characteristics. We then developed 3 regressions for each health outcome (control variables and FI; control variables and WI; control variables, FI, and WI) and compared model fit indexes. Correlations between household FI, WI, and wealth were low, meaning they measure distinct constructs. FI and WI were associated with numerous physical and mental health outcomes; accounting for both resource insecurities typically provided the best model fit. For instance, when controlling for FI, each 10-point higher WI score was associated with a 6.42-point lower physical health score (P<0.001) and 2.92 times greater odds of probable depression (P<0.001). Assessing both FI and WI is important for correctly estimating their relation with health outcomes. Interventions that address food- and water-related issues among persons living with HIV concurrently will likely be more effective at improving health than those addressing a single resource insecurity. This trial was registered at clinicaltrials.gov as NCT02815579.

Policy Recommendations to Promote Integrated Mental Health Care for Children and Youth.

Introduction There are gaps in evidence regarding mental and sexual outcomes and associated interventions for women with Female Genital Mutilation/Cutting (FGM/C) living in Africa. Objective This study's objective was to collate evidence on mental and sexual health outcomes associated with female genital mutilation/cutting in Sub-Saharan Africa Methods The study employed a scoping review and narrative synthesis approach and conducted a systematic search of bibliographic databases and websites was performed using appropriate keywords and studies published in English from January 1, 2010 to March 25, 2022. 25 studies were retrieved and reported mental and sexual health complications associated with FGM/C. Results Most studies, n = 13 studies reported on sexual health outcomes including sexual pain, orgasm and sexual desire problems at sexual arousal and difficulties in lubrication. Mental health outcomes were reported in four studies including depression which was most prominent followed by somatisation and anxiety, Post Traumatic Stress Disorder (PTSD) and sleep disorder. Studies did not highlight combined mental and sexual health interventions. Conclusions The findings of this narrative synthesis reveal the need to prioritise provision of mental and sexual health care services for women with FGM/C. The study recommends strengthening of health systems in Africa through awareness building, training and capacity building of primary health and specialist health workers in offering mental and sexual health care to women with FGM/C. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Amref International University and Aga Khan University Hospital.

Background During pregnancy, women's mental and physical health, health behaviours, and experiences of maternity care can have significant implications for obstetric, maternal and child outcomes. These factors can be impacted by adverse life-events, such as the COVID-19 pandemic. Aim This study examined pregnant women's mental and physical health, health behaviours, and experiences of maternity care during the COVID-19 pandemic. Methods An international online survey was conducted in June and July 2020. Pregnant women self-reported levels of general stress, pregnancy-specific stress and COVID-19 related stress. Women also self-reported their mental and physical health, general health behaviours and COVID-19 related health behaviours. Maternity care experiences were reported using closed and open-ended questions. Descriptive statistics and thematic analyses were used for quantitative and qualitative data respectively. Results 573 pregnant women from 15 countries participated. Women reported high levels of pregnancy-specific and COVID-19-related stress, and low levels of mental and physical health, during the pandemic. Women reported distress related to restrictions implemented in their maternity care that limited in-person interactions with healthcare professionals and partner attendance at antenatal appointments. Lack of information on COVID-19 and pregnancy also led to uncertainty for women about pregnancy and birth. Encouragingly, pregnant women reported high levels of adherence to public health advice and healthy prenatal behaviours. Conclusions The COVID-19 pandemic is having significant adverse effects on the mental and physical health of pregnant women. Population level interventions targeting pregnancy- and pandemic-specific stress are needed to better support the mental and physical health of women during the on-going pandemic and minimise adverse outcomes for women and children. Key messages The COVID-19 pandemic is significantly adversely impact the mental and physical health of pregnant women, indicating need for population level interventions for prenatal mental and physical health. Restrictions in maternity care and uncertainty about COVID-19 impacts are key determinant of adverse prenatal physical and mental health outcomes.

IntroductionGay men experience a multiple burden of ill health in relation to sexual health, mental health and substance use and there is growing recognition that these could cluster assyndemichealth inequalities. Few studies (outside the USA) have addressed the co-occurrence of such negative health outcomes. We examine empirical evidence of syndemic health outcomes in an online cross-sectional survey of MSM.MethodsSelf-report data on sexual, mental and physical health outcomes from the SMMASH2 survey of 3373 MSM in Scotland, England, Wales, Northern Ireland and the Republic of Ireland in 2016 were used to derive a measure of syndemic ill health.ResultsOverall, 68.2% reported at least one sexual health outcome, 60.4% reported at least one mental health outcome, and 61.0% reported at least one physical health outcome. There was significant co-occurrence of outcomes, with 67.0% reporting multiple health outcomes; 42.0% reporting two, and 27.0% reporting all three. There was statistically significant clustering of the behaviours at all levels. When examining all three outcomes concurrently, all were clustered with greater prevalence than expected if the outcomes where independent (O/E Ratio=1.07; 95% Confidence Interval 1.004 –1.14).DiscussionClustering of poor sexual, mental and physical health provides evidence of syndemic health inequalities in communities of gay, bisexual and other MSM surveyed online (at levels significantly higher than the nationally estimated prevalence of 8.4%). Current health improvement efforts are often characterised by disjointed services, which should be reconfigured to ensure a holistic approach to addressing the complex, multi-faceted, interrelated issues affecting these communities.

Resilience has been depicted as a key characteristic in the promotion of mental health in the face of stress and adversity. Despite high levels of stress encountered in the autistic population, resilience studies remain scarce. Using data from an Australian longitudinal adult study, this study explored the inter-relationships between trait resilience, coping, and mental health in a sample of autistic adults (N=78). In particular, we examined the relationship between resilience and use of coping strategies, and the potential mediating role of coping strategies in the relationship between resilience and mental health outcomes. Our findings suggested that increased use of engagement coping (e.g., problem-solving, positive appraisal) and decreased use of disengagement coping (e.g., self-blame, being in denial) strategies were associated with higher levels of resilience. Further, mediation analysis results suggest that disengagement coping mediated the associations between resilience and all three mental health outcomes (i.e., depression, anxiety, and well-being), while engagement coping strategies mediated the relationship between resilience and well-being only. Our results illustrate that coping strategies may be an important mechanism in explaining the resilience-mental health relationship in autistic adults, highlighting the importance of considering stress-related constructs together (i.e., trait resilience and coping) when addressing support and intervention options for mental health difficulties in the autistic adult population. LAY SUMMARY: This research explored how resilience and coping strategies influence the mental health and well-being of autistic adults. We found that resilient autistic adults used more engagement coping strategies, less disengagement coping strategies, and reported better mental health and well-being. Considering stress-related factors together (i.e., resilience and coping) offers a novel perspective to mental health difficulties in autistic adults and may be a vital step in the development of support options in this population.

Research Priorities to Support Women Veterans' Reproductive Health and Health Care Within a Learning Health Care System.

&lt;p&gt;Objective: Compared to heterosexual men, gay and bisexual men (GBM) are at an increased risk of adverse mental and sexual health outcomes. The psychological mediation framework (PMF; Hatzenbuehler, 2009) posits that minority stress is associated with changes in cognitive, affective, and social psychological processes, thereby leading to negative mental health outcomes among sexual minority individuals. This study examined whether these psychological processes account for the relationship between minority stress and poor mental health among GBM and extended the PMF to examine the effects on sexual health outcomes. Method: HIV-negative GBM (N = 465) completed a battery of self-report questionnaires assessing minority stress; cognitive, affective, and social processes; and mental and sexual health outcomes. Structural equation modeling was used to examine study hypotheses. Results: Findings partially supported the PMF by demonstrating that affective and social factors had a significant indirect effect in the relationship between minority stress and mental health outcomes; however, cognitive factors were nonsignificant. A significant indirect effect was found for cognitive factors in the relationship between minority stress and sexual health outcomes, whereas affective and social factors were nonsignificant. Conclusion: By uncovering the mediators underlying the relationship between minority stress and poor health outcomes, these findings have important clinical implications in the development of future interventions aimed at reducing adverse stigma-related health outcomes among GBM. The differential pattern of findings in the mental and sexual health models suggests that different psychological processes may need to be targeted in the treatment of mental health versus sexual health problems. &lt;/p&gt;

&lt;p&gt;Objective: Compared to heterosexual men, gay and bisexual men (GBM) are at an increased risk of adverse mental and sexual health outcomes. The psychological mediation framework (PMF; Hatzenbuehler, 2009) posits that minority stress is associated with changes in cognitive, affective, and social psychological processes, thereby leading to negative mental health outcomes among sexual minority individuals. This study examined whether these psychological processes account for the relationship between minority stress and poor mental health among GBM and extended the PMF to examine the effects on sexual health outcomes. Method: HIV-negative GBM (N = 465) completed a battery of self-report questionnaires assessing minority stress; cognitive, affective, and social processes; and mental and sexual health outcomes. Structural equation modeling was used to examine study hypotheses. Results: Findings partially supported the PMF by demonstrating that affective and social factors had a significant indirect effect in the relationship between minority stress and mental health outcomes; however, cognitive factors were nonsignificant. A significant indirect effect was found for cognitive factors in the relationship between minority stress and sexual health outcomes, whereas affective and social factors were nonsignificant. Conclusion: By uncovering the mediators underlying the relationship between minority stress and poor health outcomes, these findings have important clinical implications in the development of future interventions aimed at reducing adverse stigma-related health outcomes among GBM. The differential pattern of findings in the mental and sexual health models suggests that different psychological processes may need to be targeted in the treatment of mental health versus sexual health problems. &lt;/p&gt;

Mental and sexual health outcomes associated with FGM/C in Africa: a systematic narrative synthesis

Transgender and gender nonbinary (TGNB) individuals were recently designated a health disparity population by the U.S. National Institutes of Health. We examined the effect of gender-related discrimination and resilience factors on the mental health of a community sample diverse in gender identity, age, and race/ethnicity. We report on the baseline data of a longitudinal study of transgender identity development across the lifespan with 330 TGNB individuals recruited through venue-based recruitment in three major metropolitan areas in the U.S. Mean age of participants was 34.4years (SD= 13.7). Structured interviews collected self-report data on sociodemographics, gender-related discrimination, mental health, and resilience. We used hierarchical regression to examine the association between gender-related discrimination and psychological distress (BSI-18) and tested the moderating effect of family support, transgender community connectedness, gender literacy, and transgender activism on this relationship. In adjusted analyses, gender-related discrimination was positively associated with psychological distress. Family support was negatively associated with psychological distress. Contrary to our expectations, gender literacy and transgender activism were positively associated with psychological distress, while no significant relationship was found for transgender community connectedness. Family support, transgender community connectedness, gender literacy, and transgender activism did not moderate the effect of gender-related discrimination on psychological distress. Future mental health interventions should consider leveraging family support among TGNB individuals. Longitudinal studies are needed to better understand the role of gender literacy and activism with respect to mental health and development of identity and resilience among TGNB people.

Background: A vast amount of research has demonstrated the numerous adverse health risks of short sleep duration and poor sleep health among the general population, and increasing studies have been conducted among lesbian, gay, and bisexual individuals. However, although poor sleep health is disproportionately experienced by sexual and gender minority populations, little research has examined sleep quality and associated factors among transgender and gender nonbinary (TGNB) individuals. This study qualitatively explored the relationship that factors such as gender identity, mental health, and substance use have with sleep health among a sample of TGNB individuals in New York City.Methods: Forty in-depth interviews were conducted among an ethnically diverse sample who identified as transgender male, transgender female, and gender nonbinary from July to August 2017. All interviews were transcribed, coded, and thematically analyzed for domains affecting overall sleep, including mental health, gender identity, and various coping mechanisms to improve overall sleep.Results: TGNB interview participants frequently described one or more problems with sleeping. Some (15%) participants suggested that mental health issues caused them to have difficulty falling asleep, but that psychiatric medication was effective in reducing mental health issues and allowing them to sleep. An even larger number (35%) told us that their gender identity negatively impacted their sleep. Specifically, participants described that the presence of breasts, breast binding, stress and anxiety about their identity, and concerns about hormonal therapy and gender-affirming surgery were all reported as contributing to sleep problems. Given these sleep challenges, it is not surprising that most (60%) participants used various strategies to cope with and manage their sleep problems, including prescription and over-the-counter sleep medications (33%) and marijuana (18%).Conclusions: Our findings document that sleep health is frequently an issue for TGNB individuals, and they also offer insight into the various ways that TGNB individuals attempt to cope with these sleep problems. Sleep health promotion interventions should be developed for TGNB people, which would promote positive mental health, reduce the risk of pharmaceutical adverse events, and help alleviate psychosocial stress in this target population.

Mental Health Impacts of Climate Change for Birthing People and the Provider's Role.