| 1. |
- Clark, Kristen D., et al.
(författare)
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COVID-19 News and Its Association With the Mental Health of Sexual and Gender Minority Adults : Cross-sectional Study
- 2022
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Ingår i: JMIR Public Health and Surveillance. - : JMIR Publications. - 2369-2960. ; 8:5
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Tidskriftsartikel (refereegranskat)abstract
- Background: Sexual and gender minority (SGM; people whose sexual orientation is not heterosexual or whose gender identity varies from what is traditionally associated with the sex assigned to them at birth) people experience high rates of trauma and substantial disparities in anxiety and posttraumatic stress disorder (PTSD). Exposure to traumatic stressors such as news related to COVID-19 may be associated with symptoms of anxiety and PTSD.Objective: This study aims to evaluate the relationship of COVID-19 news exposure with anxiety and PTSD symptoms in a sample of SGM adults in the United States.Methods: Data were collected between March 23 and August 2, 2020, from The PRIDE Study, a national longitudinal cohort study of SGM people. Regression analyses were used to analyze the relationship between self-reported news exposure and symptoms of anxiety using the Generalized Anxiety Disorder-7 and symptoms of COVID-19–related PTSD using the Impact of Events Scale-Revised.Results: Our sample included a total of 3079 SGM participants. Each unit increase in COVID-19–related news exposure was associated with greater anxiety symptoms (odds ratio 1.77, 95% CI 1.63-1.93; P<.001) and 1.93 greater odds of PTSD (95% CI 1.74-2.14; P<.001).Conclusions: Our study found that COVID-19 news exposure was positively associated with greater symptoms of anxiety and PTSD among SGM people. This supports previous literature in other populations where greater news exposure was associated with poorer mental health. Further research is needed to determine the direction of this relationship and to evaluate for differences among SGM subgroups with multiple marginalized identities.
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| 2. |
- Clark, Kristen D., Postdoctoral Fellow, et al.
(författare)
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Health Insurance Prevalence Among Gender Minority People : A Systematic Review and Meta-Analysis
- 2022
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Ingår i: Transgender Health. - : Mary Ann Liebert. - 2688-4887 .- 2380-193X. ; 7:4, s. 292-302
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: Gender minority (GM) (people whose gender does not align with the sex assigned at birth) people have historically been insured at lower rates than the general population. The purpose of this review is to (1) assess the prevalence of health insurance among GM adults in the United States, (2) examine prevalence by gender, and (3) examine trends in prevalence before and after implementation of the Affordable Care Act.Methods: Published articles from PubMed, EMBASE, and Web of Science databases before April 26th, 2019, were included. This review is registered on PROSPERO (CRD42019133627). Analysis was guided by a random-effects model to obtain a meta-prevalence estimate for all GM people and stratified by gender subgroup. Heterogeneity was assessed using a Q-test and I2 measure.Results: Of 55 included articles, a random pooled estimate showed that 75% GM people were insured (95% confidence interval [CI]: 0.71–0.79; p<0.001). Subgroup analysis by gender determined 70% of transgender women (95% CI: 0.64–0.76; p<0.001; I2=97.16%) and 80% of transgender men (95% CI: 0.77–0.83; p=0.01; I2=54.51%) were insured. Too few studies provided health insurance prevalence data for gender-expansive participants (GM people who do not identify as solely man or woman) to conduct analysis.Conclusion: The pooled prevalence of health insurance among GM people found in this review is considerably lower than the general population. Standardized collection of gender across research and health care will improve identification of vulnerable individuals who experience this barrier to preventative and acute care services.
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| 3. |
- Clark, Kristen D., et al.
(författare)
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Healthcare Mistreatment, State-Level Policy Protections, and Healthcare Avoidance Among Gender Minority People
- 2022
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Ingår i: Sexuality Research & Social Policy. - : Springer Nature. - 1868-9884 .- 1553-6610. ; 19:4, s. 1717-1730
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Tidskriftsartikel (refereegranskat)abstract
- IntroductionThis study examined whether past experiences of mistreatment in healthcare were associated with greater healthcare avoidance due to anticipated mistreatment among gender minority (GM) people. We evaluated whether state-level healthcare policy protections moderated this relationship.MethodsData from the 2018 Annual Questionnaire of The PRIDE Study, a national longitudinal study on sexual and gender minority people’s health, were used in these analyses. Logistic regression modeling tested relationships between lifetime healthcare mistreatment due to gender identity or expression and past-year healthcare avoidance due to anticipated mistreatment among GM participants. Interactions between lifetime healthcare mistreatment and state-level healthcare policy protections and their relationship with past-year healthcare avoidance were tested.ResultsParticipants reporting any lifetime healthcare mistreatment had greater odds of past-year healthcare avoidance due to anticipated mistreatment among gender expansive people (n = 1290, OR = 4.71 [CI]: 3.57–6.20), transfeminine people (n = 263, OR = 10.32 [CI]: 4.72–22.59), and transmasculine people (n = 471, OR = 3.90 [CI]: 2.50–6.13). Presence of state-level healthcare policy protections did not moderate this relationship in any study groups.ConclusionsFor GM people, reporting lifetime healthcare mistreatment was associated with healthcare avoidance due to anticipated mistreatment. State-level healthcare policy protections were not a moderating factor in this relationship. Efforts to evaluate the implementation and enforcement of state-level policies are needed. Continued efforts to understand instances of and to diminish healthcare mistreatment of GM people are recommended.
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| 4. |
- Clark, Kristen D., et al.
(författare)
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State-Level Policy Environments, Discrimination, and Victimization among Sexual and Gender Minority People
- 2022
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Ingår i: International Journal of Environmental Research and Public Health. - : MDPI. - 1661-7827 .- 1660-4601. ; 19:16
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Tidskriftsartikel (refereegranskat)abstract
- Legislation has been passed in some states to reduce discrimination and victimization toward sexual and gender minority people (SGM; people who are not solely heterosexual and/or whose gender identity is not equal to what is socially associated with sex assigned at birth). The purpose of these analyses is to test whether state-level policy environments are associated with past-year discrimination and victimization among SGM people. Cross-sectional data from The Population Research in Identity and Disparities for Equality (PRIDE) Study annual questionnaire (collected 2018–2019), a national study of the health of SGM adults in the USA, were used for these analyses. Measures included related to discrimination, victimization, and demographic characteristics. State-level policy environments were measured using data from the Movement Advancement Project. Logistic regression analyses evaluated state-level policy environment scores and past-year discrimination and victimization among gender identity categories. In this sample, 7044 people (gender minority n = 2530) were included. Cisgender sexual minority (odds ratio [OR] = 1.007, p = 0.041) and the gender expansive subgroup of gender minority people (OR = 1.010, p = 0.047) in states with more protective policy environments had greater odds of discrimination. The gender expansive subgroup was found to have greater odds of victimization in states with more protective policy environments (OR = 1.003, p < 0.05). There was no relationship between state-level policy environments and victimization among any other study groups. SGM people may experience increased risk for discrimination and victimization despite legislative protections, posing continued risks for poor health outcomes and marginalization. Evaluation of factors (e.g., implementation strategies, systems of accountability) that influence the effectiveness of state-level polices on the reported experiences of discrimination and victimization among SGM people is needed.
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| 5. |
- Clark, Kristen D., Postdoctoral Fellow, et al.
(författare)
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Stressors in health care and their association to symptoms experienced by gender diverse people
- 2023
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Ingår i: Public Health. - : Elsevier. - 0033-3506 .- 1476-5616. ; 217, s. 81-88
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Tidskriftsartikel (refereegranskat)abstract
- ObjectivesMany individuals whose gender does not align with the sex they were assigned at birth (gender diverse [GD] people) report stressful health care encounters. We examined the relationship of these stressors to symptoms of emotional distress and impaired physical functioning among GD people.Study designThis study was conducted using a cross-sectional design with data from the 2015 United States Transgender Survey.MethodsComposite metrics of health care stressors and physical impairments were developed, and the Kessler Psychological Distress Scale (K-6) provided a measure of emotional distress. Linear and logistic regression were used to analyze the aims.ResultsA total of 22,705 participants from diverse gender identity subgroups were included. Participants who experienced at least one stressor in health care during the past 12 months had more symptoms of emotional distress (β = 0.14, P < .001) and 85% greater odds of having a physical impairment (odds ratio = 1.85, P < .001). Transgender men exposed to stressors were more likely than transgender women to experience emotional distress and have a physical impairment, with other gender identity subgroups reporting less distress. Black participants exposed to stressful encounters reported more symptoms of emotional distress than White participants.ConclusionsThe results suggest that stressful encounters in health care are associated with symptoms of emotional distress and greater odds of physical impairment for GD people, with transgender men and Black individuals being at greatest risk of emotional distress. The findings indicate the need for assessment of factors that contribute to discriminatory or biased health care for GD people, education of health care workers, and support for GD people to reduce their risk of stressor-related symptoms.
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| 6. |
- Clark, Kristen D., Postdoctoral Fellow, et al.
(författare)
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Supporting sexual and gender minority health : Research priorities from mental health professionals
- 2020
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Ingår i: Journal of Gay & Lesbian Mental Health. - : Routledge. - 1935-9705 .- 1935-9713. ; 24:2, s. 205-221
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Tidskriftsartikel (refereegranskat)abstract
- Sexual and gender minority (SGM) people experience significant disparities in mental health and substances use disorders. This study reached out to mental health professionals (MHPs) who treat SGM people to determine mental health priorities for research that would better inform their clinical practice. MHPs were surveyed and asked to rate items based on a likert-type scale. Open-ended questions were also queried and analyzed qualitatively. Five items had the highest mean scores: “stressors related to SGM status,” “lifestyle factors that support emotional resilience and wellbeing,” “depression,” “intimate relationships,” and “suicide.” Intersecting identities and sexual relationships emerged as qualitative themes.
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| 7. |
- Clark, Kristen, Postdoctoral Fellow, et al.
(författare)
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Societal stigma and mistreatment in healthcare among gender minority people : a cross-sectional study
- 2023
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Ingår i: International Journal for Equity in Health. - : BMC. - 1475-9276. ; 22:1
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Tidskriftsartikel (refereegranskat)abstract
- Background Gender minority (GM; individuals whose gender is not aligned with that traditionally associated with the sex that was assigned to them at birth) people have widely reported mistreatment in healthcare settings. Mistreatment is enacted by individuals within society who hold stigmatizing beliefs. However, the relationship between healthcare mistreatment and societal stigma (i.e., the degree to which society disapproves of GM people) is unclear and not measured consistently.Methods We analyzed data from 2,031 GM participants in The Population Research in Identity and Disparities for Equality (PRIDE) Study's 2019 Annual Questionnaire to determine whether societal stigma was associated with participants' past-year reports of mistreatment (defined as denial of healthcare services and/or lower quality care) in medical or mental healthcare settings. We created a proxy measure of societal stigma by incorporating variables validated in existing literature. Participants reported whether they had experienced mistreatment in medical and mental health settings independently.Results Healthcare denial and/or lower quality care during the past year was reported by 18.8% of our sample for medical settings and 12.5% for mental health settings. We found no associations between the societal stigma variables and past-year reports of healthcare denial and/or lower quality care in medical or mental healthcare settings.Conclusions Although a high proportion of GM people reported past-year healthcare mistreatment in both medical and mental health settings, mistreatment had no relationship with societal stigma. Factors other than societal stigma may be more important predictors of healthcare mistreatment, such as healthcare workers' knowledge of and attitudes toward GM people. However, other measures of societal stigma, or different types of mistreatment, may show stronger associations. Identifying key factors that contribute to mistreatment can serve as targets for intervention in communities and healthcare settings.
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