Intragroup status, perceived discrimination and mental health among Japanese sexual and gender minorities

Improving the Experiences of Sexual and Gender Minority-Identifying Trainees in Gastroenterology and Hepatology

Effective Screening and Treatment to Reduce Suicide Risk Among Sexual and Gender Minority Youth.

To map existing sexual and gender minority (SGM) health research in Ireland, identify gaps in literature and outline priorities for future research and healthcare. SGM is an umbrella term that includes people who identify as lesbian, gay, bisexual, transgender, queer or intersex and is sometimes abbreviated as LGBTQI+. A scoping review of peer-reviewed studies published between 2014 and 2024. The review followed Joanna Briggs Institute (JBI) guidelines and PRISMA-ScR framework for scoping reviews. Articles were identified through systematic database searches and screened independently by reviewers. PubMed, PsycINFO, CINAHL and Embase were searched for articles published between January 2014 and April 2024. Sixty studies met inclusion criteria. The review highlighted a disproportionate focus on gay, bisexual and other men who have sex with men (gbMSM), particularly regarding HIV and sexual health. Mental health research revealed high levels of anxiety, depression and suicidality, largely attributed to minority stress and systemic discrimination. Transgender health studies documented barriers to accessing gender-affirming care and mental health services. Few studies explored experiences of sexual minority women, older SGM individuals or intersex people. Intersectional perspectives on race, disability and socio-economic status were notably absent. SGM health research in Ireland reflects significant progress in documenting disparities in mental and sexual health. However, there is a lack of representation for some groups. There is also limited attention to intersectionality. Systematic gaps in sexual orientation and gender identity (SOGI) data impede targeted policymaking and service delivery. Findings underscore the need for inclusive, culturally competent healthcare services, better integration of SGM health topics into nursing education, and community-centred interventions. Addressing structural barriers and improving provider competence can enhance equitable healthcare access for SGM populations. This review addresses the fragmented state of SGM health research in Ireland, highlighting gaps in representation and systemic issues. Authorship includes individuals from various sexual and gender minority communities.

Sexual and gender minorities (SGM) experience detriments across many physical and mental health outcomes compared with heterosexual and cisgender people. But little is known about health outcomes for those who are both gender minorities and sexual minorities. Motivated by theories of double disadvantage and leveraging advancements in data collection and measurement, we examine physical and mental health disparities across sexual and gender minority statuses: cisgender heterosexuals, gender minority heterosexuals, cisgender sexual minorities, and people who are both gender and sexual minorities. Using Gallup's National Health and Well-Being Index (N = 93,144) and the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System (N = 543,717), we estimate multivariable logistic regression models to examine how sexual and gender minority statuses are associated with poor/fair self-rated health, functional limitations, and diagnosed depression. Regression models adjusting for sociodemographic characteristics show marked physical and mental health disparities: people who are both gender and sexual minorities report greater odds of poor/fair self-rated health, functional limitations, and depression relative to cisgender heterosexuals and, in some cases, relative to gender minority heterosexuals and cisgender sexual minorities. Our results add to a growing body of research documenting the association between multiple disadvantaged statuses and health and provide novel information on SGM health disparities.

This study reviewed quantitative research on the health of sexual and gender minorities (SGMs) in Korea and aimed to propose a role for healthcare professionals in improving their health and access to medical care. We searched PubMed through February 29, 2024 for articles published since 2000, using terms related to SGMs and the keyword "Korea." This process yielded 33 quantitative studies on Korean SGMs. Of these, 17 focused on sexual minorities and 16 on gender minorities. The findings indicate that Korean SGMs experience many symptoms of depression and anxiety, as well as high rates of suicidal ideation, planning, and attempts. They also report diminished health-related quality of life. SGM individuals who have faced discrimination or pressure to change their sexual or gender identity face an elevated risk of mental health issues. To improve the health of Korean SGMs and improve their access to healthcare, we recommend several approaches. First, more research on the health of Korean SGMs is necessary. Second, education and training programs for health professionals are essential to promote their understanding of SGM health issues and their advocacy for SGM health. Third, strategies are required to develop and implement program interventions that improve SGM health, such as increasing the availability of gender-affirming care, which is known to benefit the health of transgender and gender-diverse individuals. Finally, healthcare professionals should actively advocate for SGM health and call for shifts in public perception and institutional change, grounded in a broad understanding of SGMs and their health needs.

BackgroundSome physicians lack knowledge and awareness about health issues specific to sexual and gender minority (SGM) individuals. To help improve this, hospitals have implemented policies that mandate non-discrimination and training to promote sexual and gender minority health. There is limited evidence about how such policies relate to physicians’ knowledge, attitudes, and gender and sexual minority affirmative practices.MethodA random sample of 1000 physicians was recruited from a complete list of physicians affiliated with one of two university Hospitals located in Tennessee and 180 physicians completed the survey concerning attitudes and knowledge about SGM individuals. Physicians were affiliated with either Hospital A that had not implemented policies for non-discrimination and training, or Hospital B that did.ResultsPhysicians held different attitudes about SGM patients than non-patients. Physicians affiliated with Hospital A held more negative attitudes about SGM individuals who were non-patients than physicians affiliated with Hospital B. There were no differences between the two hospitals in physicians’ attitudes and knowledge about SGM patients.ConclusionPolicies that mandate non-discrimination and training as they currently exist may not improve physicians’ attitudes and knowledge about SGM individuals. Additional research is needed to understand how these policies and trainings relate to physicians’ SGM affirmative practices.

Sexual and gender minority (SGM) populations are vulnerable to health disparities, including worse mental health when compared with cisgender, heterosexual populations. This is in part due to the stigma and discrimination they experience. In this study, we used a novel approach to examine structural-level stigma by determining which categories of statewide law and policy protections for SGM people were associated with mental health outcomes among SGM adults. This was a cross-sectional study using law and policy data compiled by the Human Rights Campaign health data and collected through the Behavioral Risk Factor Surveillance System survey in the United States between January and December of 2019. We applied the weighted quantile sum regression to generate the Protection Alignment Index (PAI) from the 10 SGM categories of laws and policies and evaluated the influence of the PAI on the number of days of poor mental health and a diagnosis of depression. SGM people living in states with a higher SGM PAI, indicating greater protections, had significantly fewer poor mental health days. When the PAI increased one interquartile range (IQR≈0.75), the log of expected poor mental health days significantly decreased −0.04 days (95% CI = −0.08, −0.01;p-value = 0.012). Additionally, the odds of depression was 22% lower (OR = 0.78; 95% CI = 0.62, 0.98;p-value = .033) when the SGM PAI increased one IQR (≈0.77). Findings from this study indicate that whether laws and policies discriminate against or protect SGM people impacts the levels of structural stigma and ultimately mental health. Advocating for more protective laws and policies may be a way to help improve the mental health of SGM populations.

LGBT HealthVol. 7, No. 3 Call for PapersFree AccessCall for Papers: Addressing Critical Gaps in Sexual and Gender Minority Health ResearchPublished Online:7 Apr 2020https://doi.org/10.1089/lgbt.2020.29005.cfpAboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail LGBT Health is the premier peer-reviewed journal dedicated to promoting optimal health and health care for all sexual and gender minority (SGM) persons worldwide. The Journal focuses specifically on health while maintaining sufficient breadth to address policy, legislative, educational, and training issues relevant to health care provision and health outcomes. The Journal aims to advance an intersectional understanding of the health needs particular to each SGM population and to improve access to and delivery of affirming clinically and culturally competent health care.We are seeking novel, high-quality original research articles and systematic reviews and meta-analyses that address gaps in critical areas of SGM health research, including the following: Best clinical practices for conditions of particular relevance to one or more SGM populationsHealth impacts of gender-affirming care including, but not limited to, gender-affirming endocrine and surgical careOptimal primary care for SGM individualsHealth benefits of sexual orientation and gender identity disclosure and data collectionMinority stress, mental health, and health risk behaviorsTailored prevention and treatment interventions for substance abuseCancer screening and prevention in SGM populationsPhysical health and chronic conditions disparitiesHealth equity and social determinants of healthImpact of LGBT policies and services on health and wellbeingIntersections of race, ethnicity, nativity, gender, and sexual orientation in healthHealth care discrimination, health care access, and health outcomes among SGM populationsAlzheimer's disease and other dementias among older SGM adultsHealth care needs of incarcerated and formerly incarcerated SGM individualsPriority will be given to articles that advance research in these areas and have implications for reducing health disparities and improving clinical practice, access to care, and health outcomes. We welcome articles that address SGM health in the U.S. and all other regions of the world.All additional information for submission can be found in our Instructions for Authors.Our mission statement, publications to date, and instructions for authors can be found on our website. We look forward to your submissions.SUBMIT TODAYFiguresReferencesRelatedDetails Volume 7Issue 3Apr 2020 InformationCopyright 2020, Mary Ann Liebert, Inc., publishersTo cite this article:Call for Papers: Addressing Critical Gaps in Sexual and Gender Minority Health Research.LGBT Health.Apr 2020.123-123.http://doi.org/10.1089/lgbt.2020.29005.cfpPublished in Volume: 7 Issue 3: April 7, 2020PDF download

Sexual and gender minorities (SGMs) are known to experience mental health disparities. Outing, the non-consensual disclosure of one's sexual orientation or gender identity, has been suggested to exacerbate these issues. This study aimed to investigate the mental health status, outing experiences and their associations among SGMs in Japan. This cross-sectional study used data from 'the Japan COVID-19 and Society Internet Survey' conducted in September-October 2022, analyzing SGMs aged 18-79. Outing experiences were assessed across family, friends and school/workplace. Mental health was measured using the Kessler 6-Item Psychological Distress Scale (K6) and self-reported suicidal ideation within the past year. Modified Poisson regression was used to estimate prevalence ratios for mental health outcomes associated with outing experiences and the outing ranges within communities while adjusting for sociodemographic factors. Of the 2596 SGM participants analyzed, 50.8% exhibited moderate-to-high K6 scores and 9.3% reported experiencing outings, with transgender and gender non-binary individuals being the most affected. Outing experience was significantly associated with moderate-to-high K6 scores (adjusted prevalence ratios [aPR], 1.43; 95% confidence interval [CI], 1.33-1.55), high K6 scores (aPR, 1.36; 95% CI, 1.10-1.68) and suicidal ideation within the past year (aPR, 1.39; 95% CI, 1.17-1.66). Additionally, experiencing outings within broader communities showed a dose-dependent association with higher levels of mental distress (aPR of moderate-to-high K6 for one to three communities: 1.31, 1.52 and 1.58, respectively). Outings can be a significant minority stressor among SGMs in Japan, contributing to elevated psychological distress and suicidal ideation.

Integrating skin of color and sexual and gender minority content into dermatology residency curricula: A prospective program initiative

Austria has long lacked comprehensive data on the health and well-being of sexual and gender minorities (SGMs). The 2022 LGBTIQ+ Health Report addresses this gap by presenting a comprehensive overview of the health status of SGMs in Austria. To contextualize SGM health issues, a review of the literature, health surveys, and action plans across Europe was conducted in the initial project phase. Then a questionnaire was developed in collaboration with an expert group for quantitative data collection. A total of 1,047 individuals participated in the survey; analyses of the quantitative data were enriched by insights from ten qualitative interviews. Detailed findings cover SGMs’ health status and experiences of discrimination as well as access to healthcare and health-promoting factors. Participants rated their health status lower than the average in Austria. A high number reported encountering discrimination in healthcare, especially among intersex and trans participants. While approximately half of the respondents were satisfied with healthcare provision, around 16% expressed dissatisfaction. Finally, a significant proportion of participants reported having foregone healthcare services at least once despite having health issues. Our work underscores the importance of recognizing the diverse needs of distinct groups within the SGM spectrum. It is crucial to avoid oversimplification by grouping them into a single SGM category as this obscures the unique challenges and inequalities faced by each subgroup. The rapid evolution of terms adds complexity to this work. Moreover, attention should be directed towards intersectionality within these groups as some are hard to reach with an online survey. Navigating the seas of public health innovation, our exploration of SGM health in Austria reveals not only the challenges but also the imperative for inclusive and tailored healthcare strategies.Key messages• The 2022 LGBTIQ+ Health Report Austria reveils SGM health realities: lower health status, discrimination, and unmet healthcare needs, urging targeted interventions.• Acknowledging diverse SGM groups and evolving terminologies, our study underscores the need for nuanced, intersectional healthcare approaches.

ABSTRACTBackground: Sexual and gender minority (SGM) individuals experience high rates of harassment and discrimination when seeking healthcare, which contributes to substantial healthcare disparities. Improving physician training about gender identity, sexual orientation, and the healthcare needs of SGM patients has been identified as a critical strategy for mitigating these disparities. In 2014, the Association of American Medical Colleges (AAMC) published medical education competencies to guide undergraduate medical education on SGM topics.Objective: Conduct pilot study to investigate medical student comfort and competence about SGM health competencies outlined by the AAMC and evaluate curricular coverage of SGM topics.Design: Six-hundred and fifty-eight students at New England allopathic medical schools (response rate 21.2%) completed an anonymous, online survey evaluating self-reported comfort and competence regarding SGM health competencies, and coverage of SGM health in the medical curriculum.Results: 92.7% of students felt somewhat or very comfortable treating sexual minorities; 68.4% felt comfortable treating gender minorities. Most respondents felt not competent or somewhat not competent with medical treatment of gender minority patients (76.7%) and patients with a difference of sex development (81%). At seven schools, more than 50% of students indicated that the curriculum neither adequately covers SGM-specific topics nor adequately prepares students to serve SGM patients.Conclusions: The prevalence of self-reported comfort is greater than that of self-reported competence serving SGM patients in a convenience sample of New England allopathic medical students. The majority of participants reported insufficient curricular preparation to achieve the competencies necessary to care for SGM patients. This multi-institution pilot study provides preliminary evidence that further curriculum development may be needed to enable medical students to achieve core competencies in SGM health, as defined by AAMC. Further mixed methods research is necessary to substantiate and expand upon the findings of this pilot study. This pilot study also demonstrates the importance of creating specific evaluation tools to assess medical student achievement of competencies established by the AAMC.

Sexual and gender minority (SGM) groups have been historically underrepresented in neurologic research, and their brain health disparities are unknown. We aim to evaluate whether SGM persons are at higher risk of adverse brain health outcomes compared with cisgender straight (non-SGM) individuals. We conducted a cross-sectional study in the All of Us Research Program, a US population-based study, including all participants with information on gender identity and sexual orientation. We used baseline questionnaires to identify sexual minority (lesbian, gay, bisexual, diverse sexual orientation; nonstraight sexual orientation) and gender minority (gender diverse and transgender; gender identity different from sex assigned at birth) participants. The primary outcome was a composite of stroke, dementia, and late-life depression, assessed using electronic health record data and self-report. Secondarily, we evaluated each disease separately. Furthermore, we evaluated all subgroups of gender and sexual minorities stratified by sex assigned at birth. We used multivariable logistic regression (adjusted for age, sex assigned at birth, race/ethnicity, cardiovascular risk factors, other relevant comorbidities, and neighborhood deprivation index) to assess the relationship between SGM groups and the outcomes. Of 413,457 US adults enrolled between May 31, 2017, and June 30, 2022, we included 393,041 participants with available information on sexual orientation and gender identity (mean age 51 [SD 17] years), of whom 39,632 (10%) belonged to SGM groups. Of them, 38,528 (97%) belonged to a sexual minority and 4,431 (11%) to a gender minority. Compared with non-SGM, SGM persons had 15% higher odds of the brain health composite outcome (odds ratio [OR] 1.15, 95% CI 1.08-1.22). In secondary analyses, these results persisted across sexual and gender minorities separately (all 95% CIs > 1). Assessing individual diseases, all SGM groups had higher odds of dementia (SGM vs non-SGM: OR 1.14, 95% CI 1.00-1.29) and late-life depression (SGM vs non-SGM: OR 1.27, 95% CI 1.17-1.38) and transgender women had higher odds of stroke (OR 1.68, 95% CI 1.04-2.70). In a large US population study, SGM persons had higher odds of adverse brain health outcomes. Further research should explore structural causes of inequity to advance inclusive and diverse neurologic care.

Recognizing the unique health needs of sexual and gender minorities (i.e., lesbian, gay, bisexual, transgender, queer/questioning individuals) is critical to providing competent and comprehensive healthcare. To assess resident knowledge of healthcare issues uniquely affecting sexual and gender minorities as well as the role of online case-based didactics to measure and improve knowledge in the diagnosis and treatment of these patients. A multicenter online education intervention from December 2016 to April 2018. The study population consisted of 833 PGY1-3 residents at 120 internal medicine residency programs in the USA who completed 1018 tests. A 1-h online module addressing sexual and gender minority (SGM) health. The test evaluated each resident in four categories: (1) terminology relevant to SGM patients; (2) health disparities and preventive care issues affecting SGM patients; (3) substance use and mental health issues unique to SGM patients; and (4) common sexually transmitted illnesses affecting SGM populations. Participants completed a pre-test assessing SGM health knowledge. A didactic module reviewing diagnosis and management of these diseases was then completed, followed by a post-test. Among 1018 resident respondents, there was no difference between post-graduate year pre-test performance (PGY-1 52%, PGY-2 50%, PGY-3 51%; p = 0.532) or post-test performance (PGY-1 80%, PGY-2 82%, PGY-3 82%; p = 0.285). Pre-test and post-test performance of an online didactic module was the same across test categories and patient populations for PGY-1 vs. PGY-2 vs. PGY-3. Residents demonstrated an improvement between pre- and post-test knowledge. Baseline knowledge of health issues of sexual and gender minorities, as assessed by pre-test performance, did not change during residency training. An online didactic module introduced trainees to critical issues regarding the care of these vulnerable populations until such curricula are required in training. Health disparities in LGBTQ communities may improve with improved physician training on clinical care of LGBTQ patients and families.

BackgroundPeople identifying as sexual and gender minorities (SGM) may have higher risk for subjective cognitive decline and Alzheimer’s disease, although the risk for Parkinson’s disease dementia (PDD) has not been investigated. Male sex is associated with a higher risk for PDD, it is unclear whether SGM status impacts the risk.MethodsData were obtained from Fox Insight on April 5th, 2023. The analysis included people (1) with adult‐onset Parkinson’s, (2) responding to questions on sex assigned at birth, gender identity, sexual orientation, (3) with at least one available Penn Parkinson’s Daily Activities Questionnaire‐15 (PDAQ‐15), (4) without dementia at baseline, based on the first PDAQ‐15 (>43). Groups consisted of people identifying as (1) SGM with female sex assigned at birth (SGM‐F, n = 75); (2) cisgender, heterosexual women (CHW, n = 2,046); (3) SGM with male sex assigned at birth (SGM‐M, n = 84); (4) cisgender, heterosexual men (CHM, n = 2,056). Sex assigned at birth and SGM status effects on dementia likelihood during follow‐up were assessed with generalized linear mixed models.ResultsOut of 159 people identifying as SGM, eight (5.0%) identified as gender minorities, 144 (90.6%) identified as sexual minorities, seven (4.4%) identified as both gender and sexual minorities. At baseline, people with female sex had better PDAQ‐15 scores than people with male sex assigned at birth; SGM‐M had the lowest scores. SGM‐M had a higher dementia likelihood compared to people not identifying as SGM. After adjusting for age, education, employment status, income, perceived discrimination level, age at Parkinson’s diagnosis, baseline PDAQ‐15 scores, that differed across groups at baseline, dementia likelihood was lower for CHW compared to people with male sex assigned at birth.ConclusionsFor PDD, SGM‐M can be at a higher risk than CHM; people with female sex can have a lower risk than people with male sex assigned at birth. Socioeconomic disadvantages can alter the sex effect on PDD risk, by putting SGM‐M at a higher risk and females at a similar risk level compared to people with male sex assigned at birth, as shown in unadjusted models. Socioeconomic disadvantages should be acknowledged and addressed to support the well‐being of SGM with Parkinson’s.