Queer Asian Americans' intracommunity racism distress and mental health: Effects of social resources over time.

Over the past decades, public health research has started to examine the higher risk of mental health concerns among sexual minorities (e.g., lesbian, gay, or bisexual individuals) when compared with heterosexual individuals. Until more recently, most of this research has been coming from North America and focused on theories of stigma and minority stress in their attempt to explain these elevated rates of mental health problems. Minority stress theory posit stigma to be a root cause of the higher risk of mental health problems among sexual minorities and that stigma results in victimization, discrimination, internalized homonegativity, and identity concealment, which erodes mental health. Exposure to such minority stressors may differ across structural climates, based on population attitudes, discriminatory legislation, and unequal policies. In this way, such structural forms of stigma toward sexual minorities may foster increased exposure to minority stressors and elevated levels of mental health problems among sexual minorities. However, the evidence on these mechanisms remains limited as they have only recently become a topic of research. This workshop includes five empirical presentations from various structural contexts. It focuses on the elevated risk of mental health problems among sexual minorities across these settings, on identifying minority stressors in high-stigma countries, and on linking country-level structural stigma to experiences of minority stressors to explain poor mental health among sexual minorities. First, Michal Pitonak will present results from the first Czech population-based study showing higher rates of substance use, psychological distress, and low life satisfaction among sexual minorities compared to heterosexual individuals. Second, Giuseppina Lo Moro will present results from Italy showing a higher likelihood of depressive symptoms and mental health treatment among sexual minority medical students compared to their heterosexual peers. Next, Guillermo Martínez-Pérez will present findings on experiences of minority stress among Senegalese bisexual men and linkages to mental health. Finally, Arjan van der Star will extend these findings with data showing how the mental health effects of structural stigma and minority stress may be related to time both before and since migrating among migrant sexual minority men in the low-structural-stigma context of Sweden. Key messages Sexual minorities across the globe are at an increased risk for mental health problems and stigma-based minority stress experiences compared with heterosexual individuals. Structural forms of stigma, such as country-specific negative societal attitudes and discriminatory laws, may drive this elevated risk depending on length of exposure.

Differences exist between rural–urban migrants and urban–urban migrants in terms of human capital’s accumulation and pathways of social integration, yet few studies have systematically compared these distinctions. Based on the CMDS2017 survey data, this study constructed a comprehensive social integration index across four dimensions—economic integration, behavioral adaptation, identity recognition, and psychological assimilation—to analyze the influencing factors and decompose the disparities in social integration levels between the two groups from a human capital perspective. Using Oaxaca mean decomposition and Machado–Mata (MM) quantile decomposition, the results indicated that urban–urban migrants exhibited higher social integration levels than rural–urban migrants, with human capital significantly influencing integration outcomes. Better education, health status, longer migration duration, and more work experience positively enhanced migrants’ social integration. Human capital accounted for 38.35% of the social integration gap between the two groups, while coefficient differences were the primary driver of disparities. The returns to education diminish at higher integration levels, suggesting education played a stronger role for those with lower integration. The social integration gap between the two groups followed an inverted U-shaped trend, with smaller disparities at higher quantiles. As integration levels rose, characteristic differences declined continuously, indicating convergence toward homogeneity among high-integration migrants. These research findings indicated that the improvement in the social integration level of migrants still requires continuous investment in cultivating the human capital of migrants.

Patterns of alcohol consumption during pregnancy such as episodes of binge drinking may be as important as average levels of consumption in conferring risk for later childhood mental health and learning problems. However, it can be difficult to distinguish risk resulting from episodic or regular background levels of drinking. This large study investigates whether patterns of alcohol consumption are independently associated with child mental health and cognitive outcomes, whether there are gender differences in risk, and whether occasional episodes of higher levels of drinking carry any risk in the absence of regular daily drinking during pregnancy. This prospective, population-based study used data from the Avon Longitudinal Study of Parents and Children. We investigated the relationships between a binge pattern of alcohol use (consumption of > or =4 drinks in a day) in the second and third trimesters of pregnancy and childhood mental health problems at 47 and 81 months of age (n = 6355 and 5599, respectively). In a subgroup, we also investigated these relationships with child IQ at 49 months of age (n = 924). fter controlling for a range of prenatal and postnatal factors, any episodes of consuming > or =4 drinks in a day were independently associated with higher risks for mental health problems (especially hyperactivity/inattention) in girls at the age of 47 months and in both genders at 81 months. There was no association with IQ scores at 49 months after adjustment for confounders. The consumption of > or =4 drinks in a day continued to carry risk for mental health problems (especially hyperactivity/inattention) in the absence of regular daily drinking. The consumption of > or =4 drinks in a day on an occasional basis during pregnancy may increase risk for child mental health problems in the absence of moderate daily levels of drinking. The main risks seem to relate to hyperactivity and inattention problems.

The present study investigated school climate and family acceptance as two factors for reducing the minority stress that predicts sexual minority adolescents’ mental health broadly, and specifically in each environment. The current study investigated two analog mediational models examining the pathways of school climate and family acceptance on global life satisfaction (Model 1) and the subdomains of family and school satisfaction (Model 2), through minority stress. Based on reports from a sample of 293 sexual minority adolescents in the United States, results showed minority stress partially mediated the relationship between school climate and family acceptance on global life satisfaction (p < 0.001), sharing a direct effect with school climate (p = 0.006). School climate stood out as the stronger and more consistent predictor of global, family, and school satisfaction. These results suggest that addressing minority stress in schools through various levels of intervention could influence life satisfaction overall, in school, and at home by reducing minority stress. Limitations and potential implications for practice are discussed within a multitiered mental health service delivery framework in schools.

There are 376 million migrants, which account for more than 25% of the population in China according to the newest national demographic census, most of whom are from undeveloped areas to developed urban regions. Migrants’ social integration was one of the most important issues when the country aimed to build an inclusive society. As a form of human capital, the effect of migrants’ health status on social integration has rarely been explored until now, especially empirically. Previous studies have usually ignored health indicators when discussing the determinants of migrants’ social integration, and understanding the role of migrants’ physical health and mental health on their social integration is significant for efforts to ensure inclusive urbanization. For filling this research gap, the China Migrants Dynamic Survey dataset was used to uncover the role of migrants’ health status, including physical health and mental health, in their degree of social integration, and a further comparison of impact was conducted among rural–urban and urban–urban migrants. Through the empirical analysis, our results indicated the following. First, both better physical and mental health lead to higher social integration levels, and a one-point increase in physical and mental health improves the odds of good social integration by 33.27% and 5.98% for belonging and 66.05% and 6.35% for harmony, respectively. Second, health status is equally important for rural–urban and urban–urban migrants’ social integration, and the significant positive effect was consistent across groups, although some other impact factors may exhibit differences. Third, the effect of health status on social integration was moderated by social participation, which was more obvious for mental health than physical health. According to our findings, we discuss the measures to promote migrants’ health status and additional countermeasures to improve their social integration level.

Objectives The effects of a range of types of social integration and patterns of change in social integration over time were examined directly in relation to depressive symptoms in a large sample of the Korean population aged ≥45 years. Methods Data from the Korean Longitudinal Study of Aging (KLoSA) between 2006 and 2012 were assessed using longitudinal data analysis. We included 10242 research subjects at baseline (2006) and based the primary analysis on generalised linear mixed models to examine association between social integration and depressive symptom. Results The odds ratio (OR) for depressive symptoms in individuals at the lowest level of social integration was 1.539-fold higher (95% confidence interval (CI) 1.360-1.742) that that for those at highest level of social integration. Results of subgroup analysis according to gender revealed a similar trend. A five-class linear solution fit the data best; Class 1 (lowest constant social integration level, 10.5% of the sample) was significantly associated with the highest risk of depressive symptoms (OR 1.933, 95% CI 1.706-2.190). Conclusions The results of the present study provide a scientific basis for the specific association between the level of social integration and changes in social integration pattern with the risk of depressive symptoms in current practice. Therefore, interventions to provide emotional support for older adults via social integration may be important to protect against depressive symptoms. What is known about the topic? Although there has been considerable discussion about social integration among old adults, few studies related to effect of social integration on depression have been conducted. What does this paper add? The findings of the present study indicate that a high level of social integration is inversely related to depressive symptoms and is also associated with a substantial positive effect on depressive symptoms among individuals aged ≥45 years. What are the implications for practitioners? This paper provides evidence showing that it is useful to assess indicators of both social and emotional loneliness, which have been theorised to correspond to low social integration.

ABSTRACTThe evidence is now overwhelming that discrimination negatively impacts both the physical and mental health of minority groups. Members of multiple-minority groups, such as lesbian, gay, bisexual, transgender, queer people of color (LGBTQ-POC), are more likely to be exposed to experiences of stigmatization, discrimination, and fear of rejection. However, whether the stress of having these unfavorable experiences translates into increased risk for negative health outcomes is unanswered by the literature. Research to date attempts to address the relationship of stress as a minority and health outcomes through examining the role of microaggressions, exploring the concepts of risk and resilience, and most notably the creation of the minority stress model. The model analyzes the complex relationship between external (discrimination/prejudice) and internal (self-doubt/rumination) stressors that shape the experience of multiple-minority groups, which helps us understand the lived experiences of LGBTQ-POC. LGBTQ-POC are adversely affected by cumulative discrimination and social exclusion, including racism from the LGBTQ community, and homophobia and heterosexism within their racial/ethnic community. In this way, they are a multiply marginalized group, which has implications not only for their risk of mental illness, but also for their access to mental health care, and the quality of care they receive. Using the minority stress model as a frame of reference, we will discuss current approaches to capturing the toll that stress as an LGBTQ-POC has on mental health consequences.

Work in the health and social care sector is stressful, and work-related stress increases the risk of depression, anxiety, burnout, and sleep disorders. Although interventions to reduce stress and burnout at workplaces have been developed and studied, most studies have lacked the effectiveness to improve the situation. Thus, more knowledge on interventions and analysis of their mechanisms is needed to reduce the risk of more adverse mental health problems (MHP). We conducted a scoping review to identify the relevant literature on individual and organizational interventions to improve mental health in health and social care workplaces. Data were gathered on target groups, intervention types and their effectiveness, and the outcomes of the interventions. We summarized this data thematically. The final review consisted of 76 studies. Mental health interventions primarily focused on health care workers rather than social care professionals. The interventions were mostly directed at individual workers, ignoring organizational-level interventions. They used a great variety of outcomes and questionnaires, and the questionnaires that measured the outcomes were used ambiguously. In most cases, the reported effectiveness of the studied interventions was incoherent, and many of the interventions had both statistically significant and non-significant effects. Evidence that interventions reduce the risk of work-related MHP is scarce. High-quality randomized controlled trials of interventions to promote mental health with more coherently formed outcomes are needed, especially on the organizational level. More interventions to improve social care professionals’ mental health are also needed.

While heterosexist family undermining has been demonstrated to be a developmental risk factor in the life of persons with same-gender orientation, the issue of protective family factors is both controversial and relatively neglected. In this study of Israeli gay males (N = 114), we focused on the interrelations of family support, family acceptance and family knowledge of gay orientation, and gay male identity formation, and their effects on mental health and self-esteem. A path model was proposed based on the hypotheses that family support, family acceptance, family knowledge, and gay identity formation have an impact on psychological adjustment, and that family support has an effect on gay identity formation that is mediated by family acceptance. The assessment of gay identity formation was based on an established stage model that was streamlined for cross-cultural practice by defining three basic processes of same-gender identity formation: self-definition, self-acceptance, and disclosure (Elizur & Mintzer, 2001). The testing of our conceptual path model demonstrated an excellent fit with the data. An alternative model that hypothesized effects of gay male identity on family acceptance and family knowledge did not fit the data. Interpreting these results, we propose that the main effect of family support/acceptance on gay identity is related to the process of disclosure, and that both general family support and family acceptance of same-gender orientation play a significant role in the psychological adjustment of gay men.

Public health has expanded health disparities research to include the importance of mental health. Minority stress theory provides a framework for contextualizing these disparities. Queer people of color (QPOC), who are studied far less often than other marginalized groups, face unique distal and proximal stressors as a consequence of their social location. Historically, the healthcare system has served as a conduit for these stressors, with bias and discrimination occurring at interpersonal and structural levels. The Patient Protection and Affordable Care Act (ACA) served to lessen the stressful impact of the healthcare system, specifically by improving access to mental health services for people of color and queer people. The authors utilize a minority stress framework to present information about the separate mental health access gains for people of color and LGBT people and hypothesize about how these gains affect QPOC. This study then uses these gains to frame a discussion about the positive impact of the ACA and discusses the disproportionate impact that repeal of such policy gains could have on the well‐being of QPOC.

Risk for adult mental health problems associated with child sexual, physical, or emotional abuse and multiple types of child abuse was examined. Logistic regression analyses were used to test study hypotheses in a population-based sample of women (N = 3,936). As expected, child sexual, physical, and emotional abuse were independently associated with increased risk for mental health problems. History of multiple types of child abuse was also associated with elevated risk for mental health problems. In particular, exposure to all three types of child abuse was linked to a 23-fold increase in risk for probable posttraumatic stress disorder (PTSD). Findings underscore relations between child emotional abuse and adult mental health problems and highlight the need for mental health services for survivors of multiple types of child abuse.

Social integration is fundamental to health and well-being. However, few studies have explored how neighborhood contexts pattern types and levels of social integration that individuals experience. We examined how neighborhood poverty structures two dimensions of social integration: integration with neighbors and social integration more generally. Using data from the United States Third National Health and Nutrition Examination Survey, we linked study participants to percent poverty in their neighborhood of residence (N=16,040). Social integration was assessed using a modified Social Network Index and neighborhood integration based on yearly visits with neighbors. We fit multivariate logistic regression models that accounted for the complex survey design. Living in high poverty neighborhoods was associated with lower social integration but higher visits with neighbors. Neighborhood poverty distinctly patterns social integration, demonstrating that contexts shape the extent and quality of social relationships.

The relationship between depressive symptoms and perceptions of available social support, social conflict, and subjective social integration were examined as part of a psychosocial study of Puerto Rican, African American, and non‐Hispanic White women living with HIV/AIDS (N= 146) in New York City. Lower levels of subjective social integration and higher levels of social conflict were associated with more depressive symptoms. Perceived availability of social support was not significantly associated with depression in comparison with these other forms of support. No evidence was found for a stress‐buffering or a stress‐amplification effect. Significant ethnic differences in levels of social integration and social conflict also were noted. Results suggest that intervention efforts should go beyond addressing support to further address the conflict and lack, of integration experienced.

Studies among civilian populations have consistently shown that when compared with men, women have significantly higher prevalence rates of depression and anxiety disorders, including post-traumatic stress disorder (PTSD). Studies of general military populations in garrison have paralleled findings from civilian studies. Research on the gender differences associated with military deployment, such as Vietnam, Persian Gulf War, or peacekeeping operations, has found inconsistent results. These studies are not representative of current extended combat deployments in Iraq or Afghanistan, war zones that lack traditional front lines and in which women are serving in roles that put them at greater risk than in the past. Although women are excluded from serving in direct combat specialties, such as infantry or armour, and are therefore not at the same risk as male soldiers, they do serve in a variety of support positions where they travel outside military bases, work alongside combat soldiers, come under direct fire and may become casualties. These positions include military police, transportation, intelligence, pilots, medics, mechanics, civil affairs and other roles. Among the 3004 US fatalities from Iraq reported through 31 December 2006, 66 (2.2%) were women; among 127 UK fatalities, 3 (2.4%) were women. About two-thirds of these deaths involved hostile fire. In contrast, only one woman was reported to have died by hostile fire in Vietnam and five in the Persian Gulf War. An important unanswered question is whether there are gender differences in the risk of PTSD and other mental health problems among men and women exposed to similar levels of combat. The article by Dr Rona and colleagues is notable for being one of the first studies of gender differences in mental health concerns associated with deployment to the Iraq combat theatre. This study paves the way for future efforts to understand gender differences in the mental health impact of operations in Iraq and Afghanistan. The article reports a number of different findings among veterans of two wars and era controls that includes a trend analysis of changes in the health of UK military veterans between 1997 and 2005 in addition to the gender comparisons. The trend analysis is difficult to interpret due to the crosssectional design, lack of uniformity in the survey instruments (especially for the alcohol measure), demographic differences between the samples, differences in the prevalence of combat experiences and markedly different time frames for surveying following the return from deployment. Within the context of this larger effort, however, there are important comparisons of the prevalence of mental health concerns by gender for each cross-sectional deployed sample. Among the deployed Iraq War study group in the Rona et al. study, 26.7% of women compared with 19.8% of men reported high levels of psychological distress on the General Health Questionnaire (GHQ), a measure made up of questions pertaining mostly to depression. However, this difference in prevalence between men and women is considerably smaller than the differences found in most studies of civilian and non-deployed military populations. In terms of post-traumatic stress symptoms among Iraq War veterans, most notable was the lack of gender differences, which contrasts with the marked gender differences reported in many studies on PTSD in both civilian and military populations. In the study by Rona et al., 8.4% of women and 7.1% of men met the criteria for post-traumatic stress reaction and a smaller percentage met full criteria for PTSD. This finding suggests that combat deployment to Iraq is not associated with a higher risk of mental health problems among female compared with male service members, at least during the time frame that was measured, relatively proximal to homecoming. Some additional evidence from the United States supports the findings by Rona and colleagues regarding the minimal gender differences in mental health outcomes. All US troops receive a brief mental health assessment for depressive symptoms, posttraumatic stress symptoms, and concerns about family and relationship functioning when they return from deployment. Among the first 222 620 Army and Marine service members (10.6% of whom were women) who completed this assessment after returning from Iraq, 24% of the women reported some sort of mental health concern compared with 19% of the men, prevalences remarkably similar to the GHQ measures seen among UK–Iraq War service members. A more detailed survey was conducted among a sample of 2064 US soldiers (including 288 females) from infantry and combat support units during the middle of a year-long deployment to Iraq or Kuwait (August–October 2004). Among this sample, 13% of the male soldiers and 12% of the female y To accompany the article by Rona RJ, Fear NT, Hull L, Wessely S. ‘‘Women in novel occupational roles: mental health trends in the UK armed forces.’’

Minority stress, social integration, and the mental health needs of LGBTQ asylum seekers in North America