HOMOSEXUALITY and its health risks

As a health professional, It is my responsibility to discourage anything that is potentially damaging to one’s health regardless of political consequences or financial interests. That is the reason why I should find out the truth in a health issue and clear misconceptions to better advice patients.
I have so many gay friends, I find them sweet, caring and fun to be with. Most of them are talented with the arts and they know how to make me more lady like and how to improve my appearance. Yet, I noticed that they are prone to suicidal ideation with every relationship break-up and a close gay friend of mine even developed haemorrhoids and hepatitis. At first, I thought the haemorrhoids was just due to constipation, but then he told me that his boyfriend is doing anal sex with him. This is the time that I researched thoroughly about homosexuality and this is my conclusion: I fully endorse their artistic talents and genius in fashion and beauty but I don’t endorse what they are doing behind closed doors with their boyfriends for scientific reasons:
1. 1. It is a proven mental disorder – A diagnosis of gender identity disorder says the following: Gender identity disorder is a conflict between a person’s actual physical gender and the gender that person identifies himself or herself as. For example, a person identified as a boy may actually feel and act like a girl. The person experiences significant discomfort with the biological sex they were born. Please see this site of US National Library of Medicine and National Institutes of Health: http://www.nlm.nih.gov/medlineplus/ency/article/001527.htm
Take note: gay activists are planning to remove gender identity disorder from the current list of mental disorders. They were successful in influencing supposedly scientific and apolitical Psychologist and Psychiatrists in removing homosexuality from the list of mental disorders but many of the respected psychiatrists during that time denounced the decision and claimed that it was never based on scientific evidence.
Please see this books:
1. a. Bayer, Ronald (1981). Homosexuality and American Psychiatry. Basic Books, New York. ISBN0465030483 : 0465030483
2. b. Socarides, Charles W. (1992). Sexual politics and scientific logic: The Issue of Homosexuality. Association for Psychohistory. ASIN B0006RCH62.
3. c. Satinover, Jeffrey (1996). Homosexuality and the Politics of Truth. ISBN 0-8010-5625-x
4. d. Nicholas A. Cummings, Rogers H. Wright. (2005). Destructive Trends in Mental Health: The Well-Intentioned Path to Harm, ISBN 0415950864
Dr. Frank Spinelli a gay doctor himself is wondering why adult gays think and act like teenagers. http://www.advocate.com/Health_and_Fitness/Living_Well/Cruise_Control/
-Robert Spitzer http://en.wikipedia.org/wiki/Robert_Spitzer_%28psychiatrist%29 one of those instrumental in removing it from the list of mental disorder is now regretting it. Please see this video: http://www.youtube.com/watch?v=mjA_mSmxqOw and this http://www.youtube.com/watch?v=qBhW2q11qu8 .
2. There is no gay gene. http://www.mygenes.co.nz/download.htm
3. If someone is not in his proper mental functioning he is prone to do deviant practice. Deviant means differing from the norm. The Anus is anatomically designed only for exit and for feces. It is only one cell walled making it easier for bacteria and viruses to be transmitted once this wall was injured or broken. Natural lubrication is not produced during sodomy, therefore anal wall breakdown is common. Obviously, the mouth is designed for food particles, therefore sodomy and oral sex are deviant sexual practice. Sodomy was even considered a criminal activity until 2003 (http://en.wikipedia.org/wiki/Sodomy_laws_in_the_United_States). This deviant sexual acts are the defining characteristic of gay sex and puts someone at higher risks for so many lethal diseases.
1. a. Here is an article from the Gay and Lesbian Medical Association, Ten Things Gay Men Should discuss with Their Healthcare Provider (Download .pdf Version) http://www.glma.org/index.cfm?fuseaction=Page.viewPage&pageID=690
2. b. Diggs, Dr. John R., Jr.,(2002) “The Health Risks of Gay Sex.” Corporate Resource Council.
3. c. Cameron, Paul (1993). Medical Consequences of What Homosexuals do. Family Research Institute, Washington DC.
4. Gypsyamber D’Souza et al (2009) Oral Sexual Behaviors Associated with Prevalent Oral Human Papillomavirus Infection. Journal of Infectious Diseases. 199 (9): 1263-1269.doi: 10.1086/597755
5. e. A Kreiter et al, ( 2008) Penile Intraepithelial Neoplasia is frequent in HIV positive men with Anal Dysplasia. Journal of Investigative Dermatology Vol.128
4. Since gender identity disorder and homosexuality is ENCOURAGED by those who want to be politically correct even with scientific evidences about it being a disorder, the gay population continue to suffer and is suffering more and will continue if we don’t address the real issue that it is a disorder. Here are a list of studies about the prevalence of mental disorders in the gay population even in countries who approve same sex marriages: (please see table below)
5. Homosexuals themselves are not “ really” happy and they themselves seek out solutions that the Psychologists are denying them. Since APA (American Psychological and Psychiatric Association) declared they are “normal” and no longer treat them, they turn to Church ministries instead leading to the proliferation of ex-gay ministries.
http://en.wikipedia.org/wiki/Ex-gay_movement
http://en.wikipedia.org/wiki/User:Lionelt/List_of_ex-gay_organizations
InternationalPositive Alternatives to HomosexualityAsia Al-Tawbah, Musilm, Middle East Atzat Nefesh, Jewish, Middle East Bagong Pag-asa, Philippines Exodus Asia Pacific Liberty Christian Ministries, Australia Liberty League (Singapore), Singapore FIX DAB Pursuing Liberty Under Christ, Malaysia Rainbow 7 (Taiwan), Taiwan Europe ABEO, Northern Ireland Encourage Trust, Catholic, United Kingdom Exodus Europe Reichenberg Fellowship, non-denominational, German StraightWay Foundation, Muslim, United Kingdom True Freedom Trust, Christian, United Kingdom, North America Aesthetic Realism Foundation Courage International, Catholic Evergreen International, Latter Day Saint Exodus International Exodus Youth, young people Family Watch International Genesis Counseling Homosexuals Anonymous International Healing Foundation Jews Offering New Alternatives to Homosexuality (JONAH), Jewish Living Stones Ministries Love in Action National Association for Research and Therapy of Homosexuality NEA Ex-Gay Educators Caucus, teachers and students New Hope Ministries OneByOne, Presbyterian Parents and Friends of Ex-Gays and Gays People Can Change Powerful Change Ministry Group, African American Reality Resources Transformation Congregations, Methodist Witness Freedom Ministries, people of color South AmericaCamino de Salida, Ecuador Courage Latino, Catholic Elías S.O.S, Argentina Es Posible el Cambio, interdenominational Exodus Brasil Exodus Latino America RENACER, Mexico
http://www.narth.com/docs/cummings.pdf
http://www.cbn.com/cbnnews/healthscience/2009/August/Is-it-Possible-to-Change-Sexual-Orientation
http://www.drthrockmorton.com/APAneworleans.pdf
http://www.gaytostraight.org/home0.aspx
http://www.californiafamilycouncil.org/apareportonsexualorientation
http://www.peoplecanchange.com
http://couragerc.net/
http://www.couragephilippines.blogspot.com/
http://www.evergreeninternational.org
http://www.exodusinternational.orghttp://www.dijg.de/
http://www.ha-fs.org/
http://www.jonahweb.org
http://straightway.sinfree.net/
http://www.transformingcong.org
http://conservapedia.com/Ex-homosexuals
http://americansfortruth.com/
Arch Gen Psychiatry. 2001;58:85-91.
Same-Sex Sexual Behavior and Psychiatric Disorders
Findings From the Netherlands Mental Health Survey and Incidence Study (NEMESIS)
Theo G. M. Sandfort, PhD; Ron de Graaf, PhD; Rob V. Bijl, PhD; Paul Schnabel, PhD
ABSTRACT
Background It has been suggested that homosexuality isassociated with psychiatric morbidity. This study examined differencesbetween heterosexually and homosexually active subjects in 12-monthand lifetime prevalence of DSM-III-R mood, anxiety, and substanceuse disorders in a representative sample of the Dutch population(N = 7076; aged 18-64 years).
Methods Data were collected in face-to-face interviews,using the Composite International Diagnostic Interview. Classificationas heterosexual or homosexual was based on reported sexual behaviorin the preceding year. Five thousand nine hundred ninety-eight(84.8%) of the total sample could be classified: 2.8% of 2878men and 1.4% of 3120 women had had same-sex partners. Differences inprevalence rates were tested by logistic regression analyses,controlling for demographics.
Results Psychiatric disorders were more prevalent amonghomosexually active people compared with heterosexually activepeople. Homosexual men had a higher 12-month prevalence of mooddisorders (odds ratio [OR] = 2.93; 95% confidence interval [CI]= 1.54-5.57) and anxiety disorders (OR = 2.61; 95% CI = 1.44-4.74) thanheterosexual men. Homosexual women had a higher 12-month prevalenceof substance use disorders (OR = 4.05; 95% CI = 1.56-10.47)than heterosexual women. Lifetime prevalence rates reflect identicaldifferences, except for mood disorders, which were more frequentlyobserved in homosexual than in heterosexual women (OR = 2.41;95% CI = 1.26-4.63). The proportion of persons with 1 or morediagnoses differed only between homosexual and heterosexual women(lifetime OR = 2.61; 95% CI = 1.31-5.19). More homosexual thanheterosexual persons had 2 or more disorders during their lifetimes(homosexual men: OR = 2.70; 95% CI = 1.66-4.41; homosexual women:OR = 2.09; 95% CI = 1.07-4.09).
Conclusion The findings support the assumption that peoplewith same-sex sexual behavior are at greater risk for psychiatricdisorders.

© 2004 American Psychiatric Association
Am J Psychiatry. 2004 Feb;161(2):278-85.
Distress and Depression in Men Who Have Sex With Men: The Urban Men’s Health Study
Thomas C. Mills, M.D., M.P.H., Jay Paul, Ph.D., Ron Stall, Ph.D., M.P.H., Lance Pollack, Ph.D., Jesse Canchola, M.S., Y. Jason Chang, M.S., Judith T. Moskowitz, Ph.D., M.P.H., and Joseph A. Catania, Ph.D.
Abstract:
OBJECTIVE: This study estimates the prevalence of depressionand describes the correlates and independent associations ofdistress and depression among U.S. men who have sex with men.METHOD: A household-based probability sample of men who havesex with men (N=2,881) was interviewed between 1996 and 1998in four large American cities. With cutoff points of 15 and22 for the Center for Epidemiological Studies Depression Scale,individual correlates and predictors of distress and depressionwere examined, and multinomial logistic regression was performed.RESULTS: The 7-day prevalence of depression in men who havesex with men was 17.2%, higher than in adult U.S. men in general.Both distress and depression were associated with lack of adomestic partner; not identifying as gay, queer, or homosexual;experiencing multiple episodes of antigay violence in the previous5 years; and very high levels of community alienation. Distresswas also associated with being of other than Asian/Pacific Islanderethnicity and experiencing early antigay harassment. Depressionwas also associated with histories of attempted suicide, childabuse, and recent sexual dysfunction. Being HIV positive wascorrelated with distress and depression but not significantlywhen demographic characteristics, developmental history, substanceuse, sexual behavior, and current social context were controlledby logistic regression.
CONCLUSIONS: Rates of distress and depressionare high in men who have sex with men. These high rates haveimportant public health ramifications. The predictors of distressand depression suggest prevention efforts that might be effectivewhen aimed at men who have sex with men.

BMC Psychiatry. 2008 Aug 18;8:70. Review.
4. Systematic review of mental disorder, suicide, and deliberate self harm in lesbian, gay and bisexual people.
King M, Semlyen J, Tai SS, Killaspy H, Osborn D, Popelyuk D, Nazareth I.
Source: Department of Mental Health Sciences, Royal Free and University College Medical School, Hampstead Campus, University College London, London, NW3 2PF, UK. m.king@medsch.ucl.ac.uk
Abstract
BACKGROUND: Lesbian, gay and bisexual (LGB) people may be at higher risk of mental disorders than heterosexual people.
METHOD: We conducted a systematic review and meta-analysis of the prevalence of mental disorder, substance misuse, suicide, suicidal ideation and deliberate self harm in LGB people. We searched Medline, Embase, PsycInfo, Cinahl, the Cochrane Library Database, the Web of Knowledge, the Applied Social Sciences Index and Abstracts, the International Bibliography of the Social Sciences, Sociological Abstracts, the Campbell Collaboration and grey literature databases for articles published January 1966 to April 2005. We also used Google and Google Scholar and contacted authors where necessary. We searched all terms related to homosexual, lesbian and bisexual people and all terms related to mental disorders, suicide, and deliberate self harm. We included papers on population based studies which contained concurrent heterosexual comparison groups and valid definition of sexual orientation and mental health outcomes.
RESULTS: Of 13706 papers identified, 476 were initially selected and 28 (25 studies) met inclusion criteria. Only one study met all our four quality criteria and seven met three of these criteria. Data was extracted on 214,344 heterosexual and 11,971 non heterosexual people. Meta-analyses revealed a two fold excess in suicide attempts in lesbian, gay and bisexual people [pooled risk ratio for lifetime risk 2.47 (CI 1.87, 3.28)]. The risk for depression and anxiety disorders (over a period of 12 months or a lifetime) on meta-analyses were at least 1.5 times higher in lesbian, gay and bisexual people (RR range 1.54-2.58) and alcohol and other substance dependence over 12 months was also 1.5 times higher (RR range 1.51-4.00). Results were similar in both sexes but meta analyses revealed that lesbian and bisexual women were particularly at risk of substance dependence (alcohol 12 months: RR 4.00, CI 2.85, 5.61; drug dependence: RR 3.50, CI 1.87, 6.53; any substance use disorder RR 3.42, CI 1.97-5.92), while lifetime prevalence of suicide attempt was especially high in gay and bisexual men (RR 4.28, CI 2.32, 7.88).
CONCLUSION: LGB people are at higher risk of mental disorder, suicidal ideation, substance misuse, and deliberate self harm than heterosexual people.
J Consult Clin Psychol. 2007 Oct;75(5):785-94.
5. Mental health and substance use disorders among Latino and Asian American lesbian, gay, and bisexual adults.
Cochran SD, Mays VM, Alegria M, Ortega AN, Takeuchi D.

Source
Department of Epidemiology, University of California, Los Angeles, CA 90095-1772, USA. cochran@ucla.edu
Abstract
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.

Soc Psychiatry Psychiatr Epidemiol. 2007 May;42(5):414-20. Epub 2007 Apr 21.
6. High prevalence of mental disorders and comorbidity in the Geneva Gay Men’s Health Study.
Wang J, Häusermann M, Ajdacic-Gross V, Aggleton P, Weiss MG.
Source
Institute for Social and Preventive Medicine, Hirschengraben 84, Zurich, Switzerland. jwang@ifspm.uzh.ch
Abstract
BACKGROUND:
Several large surveys have suggested high prevalence of psychiatric disorders among gay men and other men who have sex with men.
METHODS:
In 2002, a comprehensive health survey was conducted among 571 gay men in Geneva, Switzerland, using probability-based time-space sampling. The Composite International Diagnostic Interview Short-Form (CIDI-SF) was used to assess 12-month prevalence of major depression, specific phobia, social phobia, alcohol dependence, and drug dependence.
RESULTS:
Nearly half (43.7%, 95% CI=39.0-48.4) of the sample fulfilled the criteria for at least one of the five DSM-IV disorders: 19.2% had major depression, 21.9% had specific and/or social phobia, and 16.7% had an alcohol and/or drug dependence disorder in the past 12 months. Over one quarter of the cases were comorbid with another kind of disorder, and 35.7% of cases consulted a health care professional in the past 12 months for mental health. Like cases, screen-positives for mood and/or anxiety disorders (24.7%) also reported significantly greater disability and lower quality of life.
CONCLUSIONS:
Nearly two-thirds of this community sample of gay men was affected by psychiatric morbidity with new evidence for comorbidity, subthreshold disorders, and low levels of awareness of psychiatric disorders and their treatment. This population needs to be a priority in psychiatric epidemiology and mental public health.
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J Abnorm Psychol. 2009 Aug;118(3):647-58.
7. Burden of psychiatric morbidity among lesbian, gay, and bisexual individuals in the California Quality of Life Survey.
Cochran SD, Mays VM.
Source
Department of Epidemiology, School of Public Health, University of California, Los Angeles, California 90095-1772, USA. cochran@ucla.edu
Abstract
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.

8. Subst Use Misuse. 2003 Sep-Nov;38(11-13):1739-58.
Lesbians’ drinking patterns: beyond the data.
Hughes TL.
Source
Public Health, Mental Health, and Administrative Nursing, College of Nursing, University of Illinois at Chicago, Chicago, Illinois 60612, USA. thughes@uic.edu
Abstract
Early studies report very high rates of “alcohol abuse” and alcoholism among lesbians. However, serious methodological problems, including nonrepresentative samples that were often recruited in lesbian or gay lesbian bars, limit the validity of findings from these studies. In this article, I briefly review the literature on lesbians’ use of alcohol and present findings from a recent study conducted in Chicago (USA). This study recruited a race- and age-diverse sample of lesbians and a demographically matched group of heterosexual women. Rates of “heavy” alcohol use and alcohol-use-related problems among lesbians were much lower in this study than in early studies. However, lesbians were more likely than their heterosexual counterparts to be in recovery and to have been in treatment for alcohol-use-related problems. Further, high rates of childhood sexual abuse, depression, and suicidal ideation reported by lesbians suggest that at least some groups may be at heightened risk for “heavy” drinking and drinking-related problems. Nevertheless, results of this and other studies suggest that reports of heavy drinking and drinking-related problems among lesbians may have been inflated in earlier studies, or that heavy drinking and drinking-related problems may have declined among lesbians.

Addiction. 2009 Aug;104(8):1333-45. Epub 2009 May 12.
9. Sexual orientation, substance use behaviors and substance dependence in the United States.
McCabe SE, Hughes TL, Bostwick WB, West BT, Boyd CJ.
Source: Substance Abuse Research Center, Institute for Research on Women and Gender, University of Michigan, Ann Arbor, MI 48105-2194, USA.
Abstract
AIMS: To assess past-year prevalence rates of substance use behaviors and substance dependence across three major dimensions of sexual orientation (identity, attraction and behavior) in a large national sample of adult women and men in the United States.
DESIGN: Data were collected from structured diagnostic face-to-face interviews using the Alcohol Use Disorder and Associated Disabilities Interview Schedule DSM-IV version IV (AUDADIS-IV).
SETTING: Prevalence estimates were based on data collected from the 2004-2005 (wave 2) National Epidemiologic Survey on Alcohol and Related Conditions (NESARC).
PARTICIPANTS: A large national sample of 34 653 adults aged 20 years and older: 52% female, 71% white, 12% Hispanic, 11% African American, 4% Asian and 2% Native American.
FINDINGS: Approximately 2% of the population self-identified as lesbian, gay or bisexual; 4% reported at least one life-time same-sex sexual partner and 6% reported same-sex sexual attraction. Although non-heterosexual orientation was generally associated with a higher risk of substance use and substance dependence, the majority of sexual minority respondents did not report substance use or meet criteria for DSM-IV substance dependence. There was considerable variation in substance use outcomes across sexual orientation dimensions; these variations were more pronounced among women than among men.
CONCLUSIONS: Results support previous research findings of heightened risk of substance use and substance dependence among some sexual minority groups and point to the need for research that examines the reasons for such differences. Results also highlight important gender differences and question previous findings indicating uniformly higher risk for substance dependence among sexual minorities. Risks appear to vary based on gender and how sexual orientation is defined. Findings have implications for more effective prevention and intervention efforts that target subgroups at greatest risk.
Am J Public Health. 2001 Jun;91(6):933-9.
11. Risk of psychiatric disorders among individuals reporting same-sex sexual partners in the National Comorbidity Survey.
Gilman SE, Cochran SD, Mays VM, Hughes M, Ostrow D, Kessler RC.
Source
Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave, Boston, MA 02115, USA.
Abstract
OBJECTIVES:
This study examined the risk of psychiatric disorders among individuals with same-sex sexual partners.
METHODS:
Data are from the National Comorbidity Survey, a nationally representative household survey. Respondents were asked the number of women and men with whom they had sexual intercourse in the past 5 years. Psychiatric disorders according to Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition (DSM-III-R) criteria were assessed with a modified version of the Composite International Diagnostic Interview.
RESULTS:
A total of 2.1% of men and 1.5% of women reported 1 or more same-sex sexual partners in the past 5 years. These respondents had higher 12-month prevalences of anxiety, mood, and substance use disorders and of suicidal thoughts and plans than did respondents with opposite-sex partners only. Decomposition showed that the elevated same-sex 12-month prevalences were largely due to higher lifetime prevalences. Ages at onset and persistence of disorders did not differ between the same-sex and opposite-sex subsamples.
CONCLUSIONS:
Homosexual orientation, defined as having same-sex sexual partners, is associated with a general elevation of risk for anxiety, mood, and substance use disorders and for suicidal thoughts and plans. Further research is needed to replicate and explore the causal mechanisms underlying this association.
Am J Public Health. 2000 Apr;90(4):573-8.
12. Lifetime prevalence of suicide symptoms and affective disorders among men reporting same-sex sexual partners: results from NHANES III.
Cochran SD, Mays VM.
Source
Department of Epidemiology, UCLA School of Public Health 90095-1772, USA. cochran@ucla.edu
Abstract
OBJECTIVES:
This study examined lifetime prevalence of suicide symptoms and affective disorders among men reporting a history of same-sex sexual partners.
METHODS:
In the third National Health and Nutrition Examination Survey, men aged 17 to 39 years were assessed for lifetime history of affective disorders and sexual behavior patterns. The study classified this subset of men into 3 groups: those reporting same-sex sexual partners, those reporting only female sexual partners, and those reporting no sexual partners. Groups were compared for histories of suicide symptoms and affective disorders.
RESULTS:
A total of 2.2% (95% confidence interval [CI] = 1.3%, 3.1%) of men reported same-sex sexual partners. These men evidenced greater lifetime prevalence rates of suicide symptoms than men reporting only female partners. However, homosexually/bisexually experienced men were no more likely than exclusively heterosexual men to meet criteria for lifetime diagnosis of other affective disorders.
CONCLUSIONS:
These data provide further evidence of an increased risk for suicide symptoms among homosexually experienced men. Results also hint at a small, increased risk of recurrent depression among gay men, with symptom onset occurring, on average, during early adolescence.
R01-AI38216/AI/NIAID NIH HHS/United States
Sex Res Social Policy. 2010 Sep;7(3):176-200. Epub 2010 Mar 3.
13. Demographic, Psychological, and Social Characteristics of Self-Identified Lesbian, Gay, and Bisexual Adults in a US Probability Sample.
Herek GM, Norton AT, Allen TJ, Sims CL.
Source
Psychology Department, University of California, One Shields Avenue, Davis, CA 95616-8686 USA.
Abstract
Using data from a US national probability sample of self-identified lesbian, gay, and bisexual adults (N = 662), this article reports population parameter estimates for a variety of demographic, psychological, and social variables. Special emphasis is given to information with relevance to public policy and law. Compared with the US adult population, respondents were younger, more highly educated, and less likely to be non-Hispanic White, but differences were observed between gender and sexual orientation groups on all of these variables. Overall, respondents tended to be politically liberal, not highly religious, and supportive of marriage equality for same-sex couples. Women were more likely than men to be in a committed relationship. Virtually all coupled gay men and lesbians had a same-sex partner, whereas the vast majority of coupled bisexuals were in a heterosexual relationship. Compared with bisexuals, gay men and lesbians reported stronger commitment to a sexual-minority identity, greater community identification and involvement, and more extensive disclosure of their sexual orientation to others. Most respondents reported experiencing little or no choice about their sexual orientation. The importance of distinguishing among lesbians, gay men, bisexual women, and bisexual men in behavioral and social research is discussed.

J LGBT Health Res. 2007;3(3):1-10.
14. Sexual orientation and sexual behavior: results from the Massachusetts Behavioral Risk Factor Surveillance System, 2002-2006.
Keyes SM, Rothman EF, Zhang Z.
Source
Health Survey Program, Massachusetts Department of Public Health, Boston, MA 02108, USA. susan.keyes@state.ma.us
Abstract
Few population-based surveys in the United States include sexual orientation as a demographic variable. As a result, estimating the proportion of the U.S. population that is gay, lesbian, or bisexual (GLB) is a substantial challenge. Prior estimates vary widely, from 1-21%. In 2001, questions on sexual orientation and sexual behavior were added to the Massachusetts Behavioral Risk Factor Surveillance System (MA BRFSS) and have been asked continually since that time. The purpose of this study was to determine the prevalence of adults in Massachusetts identifying as GLB and providing a demographic description of this group. The study also examined the correlation of reported sexual behavior and sexual identity within this group. Overall, 1.9% of Massachusetts adults identified as gay or lesbian and 1.0% of Massachusetts adults identified as bisexual. Of those identifying as gay or lesbian, 95.4% reported sexual behavior concordant with this identification, and 99.4% of respondents identifying as heterosexual reported behavior concordant with heterosexual sexual orientation. Among those reporting a GLB sexual orientation, men were more likely than women to identify as gay, and women were more likely than men to identify as bisexual. Younger adults (18-25 years old) were more likely than people in other age groups to identify as bisexual. Respondents with 4 or more years of education were more likely to identify as gay or lesbian than those in all other education categories. The addition of sexual orientation to population-based surveys will allow for research on the health of GLB adults and provide critical information for those charged with the creation of public policy regarding sexual orientation.

J Acquir Immune Defic Syndr. 2010 Dec 15;55 Suppl 2:S74-7.
15. Mental health and HIV risk in men who have sex with men.
Safren SA, Reisner SL, Herrick A, Mimiaga MJ, Stall RD.
Source
Massachusetts General Hospital/Harvard Medical School, Boston, MA 02114, USA. ssafren@partners.org
Abstract
Evidence-based HIV prevention interventions with men who have sex with men (MSM) in the United States have moderate effect sizes in reducing HIV sexual risk behavior. Mental health and psychosocial problems, which both disproportionately affect MSM populations and are implicated in HIV transmission risk behaviors, also likely interfere with the uptake of HIV behavioral interventions. Moreover, given that mental health and psychosocial problems such as depression, substance use, and violence frequently co-occur for many MSM (eg, as syndemic conditions), what is probably needed are combination prevention efforts, or prevention “cocktails,” similar to treatment “cocktails,” that address the psychological and behavioral mechanisms that interact to produce elevated risk for HIV. Such interventions should incorporate a holistic framework to address the sexual health and overall well being of MSM. Addressing co-occurring psychosocial risk factors is apt to improve effect sizes of current HIV prevention interventions and allow for more effective uptake by MSM.

Am J Public Health. 2003 Jun;93(6):939-42.
16. Association of co-occurring psychosocial health problems and increased vulnerability to HIV/AIDS among urban men who have sex with men.
Stall R, Mills TC, Williamson J, Hart T, Greenwood G, Paul J, Pollack L, Binson D, Osmond D, Catania JA.
Source
Prevention Research Branch, Division of HIV/AIDS Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. rstall@cdc.gov
Abstract
OBJECTIVES:
We measured the extent to which a set of psychosocial health problems have an additive effect on increasing HIV risk among men who have sex with men (MSM).
METHODS:
We conducted a cross-sectional household probability telephone sample of MSM in Chicago, Los Angeles, New York, and San Francisco.
RESULTS:
Psychosocial health problems are highly intercorrelated among urban MSM. Greater numbers of health problems are significantly and positively associated with high-risk sexual behavior and HIV infection.
CONCLUSIONS:
AIDS prevention among MSM has overwhelmingly focused on sexual risk alone. Other health problems among MSM not only are important in their own right, but also may interact to increase HIV risk. HIV prevention might become more effective by addressing the broader health concerns of MSM while also focusing on sexual risks.

Dis Colon Rectum. 2011 Mar;54(3):352-9.
17. The psychological impact of being screened for anal cancer in HIV-infected men who have sex with men.
Tinmouth J, Raboud J, Ali M, Malloch L, Su D, Sano M, Lytwyn A, Rourke SB, Rabeneck L, Salit I.
Source: Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. jill.tinmouth@sunnybrook.ca
Abstract
BACKGROUND: Anal cancer screening may be considered in HIV-infected men who have sex with men because they are at increased risk. Cancer screening can provoke anxiety, which may lead to poorer screening compliance.
OBJECTIVE: This study aimed to measure the psychological consequences of anal cancer screening in HIV-infected men who have sex with men.
DESIGN: This investigation is a prospective cohort study.
SETTING: This study was conducted in primary and tertiary care HIV clinics in Toronto, Canada.
PATIENTS: One hundred four HIV-infected men who have sex with men were studied.
MAIN OUTCOME MEASURES: : Psychological impact was measured at 4 time points (before screening, after screening, after receiving results, and before follow-up) using the Impact of Events Scale, the Illness Intrusiveness Ratings Scale, and the Psychological Consequences Questionnaire.
RESULTS: Median age was 44, 77% were receiving antiretroviral therapy, and 11% had high-grade anal dysplasia (anal intraepithelial neoplasia 2/3). Fifteen to 32% of the patients reported high levels of negative psychological consequences across the 4 time points; the highest levels occurred at time 2. Higher HIV symptom count and baseline level of negative impact were significantly associated with higher Impact of Events scores, whereas younger age and a higher baseline level of negative impact were significantly associated with higher scores with use of the Illness Intrusiveness Ratings Scale.
CONCLUSIONS: Anal cancer screening is not associated with greater adverse psychological impact in most HIV-infected men who have sex with men. Younger patients, those with more HIV-related symptoms and greater baseline psychological distress, are at risk for increased psychological distress during screening.

Am J Mens Health. 2008 Dec;2(4):314-21. Epub 2008 Jan 23.
18. The relationship of depressive symptoms, self-esteem, and sexual behaviors in a predominantly Hispanic sample of men who have sex with men.
De Santis JP, Colin JM, Provencio Vasquez E, McCain GC.
Source
University of Miami School of Nursing and Health Studies, Coral Gables, FL 33146, USA. jdesantis@miami.edu
Abstract
Despite public health campaigns and safer sex messages, many men who have sex with men (MSM) continue to participate in high-risk sexual behaviors, which may make them vulnerable to HIV infection and sexually transmitted infections. The purpose of this study was to determine the relationship of depressive symptoms, self-esteem, and sexual behaviors in a predominantly Hispanic sample of MSM. This correlational study sampled 205 MSM (M = 37 years of age, SD = +/-8) representing the diverse ethnic composition of South Florida. This sample consisted of ethnic minorities (79%) with a large number of foreign-born men (69%). Participants completed measures of depressive symptoms, self-esteem, and sexual behaviors. Results indicated that higher levels of depressive symptoms and higher levels of self-esteem had a statistically significant relationship to lower levels of safer sexual behaviors. Lower income, lower educational level, and preference for Spanish language were associated with higher levels of depressive symptoms; lower income was associated with lower levels of self-esteem; and foreign birth and a preference for Spanish language were associated with lower levels of safer sex behaviors. Higher levels of depressive symptoms and higher levels of self-esteem were associated with high-risk sexual behaviors in this sample of MSM. Further research needs to be directed at culturally specific mental health and HIV prevention strategies for these vulnerable MSM.
J Homosex. 2011 Jan;58(1):97-116.
19. Mental health among Israeli homosexual adolescents and young adults.
Shenkman G, Shmotkin D.
Source
Department of Psychology, Tel Aviv University, Tel Aviv, Israel. gevashen@post.tau.ac.il
Abstract
This study examines the mental health status of Israeli homosexuals in adolescence and early adulthood in comparison to heterosexual controls. We compared 219 homosexuals (136 gay men and 83 lesbian women) with 219 individually matched heterosexuals on indices of depression and subjective well being. In line with the study hypothesis, the results indicated that the homosexual participants reported more depressive symptoms and more negative affect than matched heterosexuals. However, the homosexuals were also found to report a higher level of positive affect. This study suggests that co-activated systems of negative and positive emotions facilitate adaptation among young homosexuals.

Rev Epidemiol Sante Publique. 2009 Dec;57(6):437-50.
20. Sexual orientation and mental health: a review
[Article in French]
Lhomond B, Saurel-Cubizolles MJ.
Source
CNRS, ENS LSH, laboratoire Triangle, université de Lyon, 15, parvis René-Descartes, 69342 Lyon cedex 07, France. brigitte.lhomond@ens-lsh.fr
Abstract
BACKGROUND:
The aim of this paper is to review available knowledge on sexual orientation and mental health, especially for women.
METHODS:
Papers published in English or French, between 1997 and 2007, were selected in PubMed using the following keywords “homosexuality/sexual orientation and mental health/depression/suicide”. To be retained, papers had to contain findings from quantitative surveys comparing homosexual and heterosexual adults. In all, this review analyses 22 papers including two that are based on the same survey.
RESULTS:
This review found a general pattern of poorer mental health for homosexuals and even more so for bisexuals compared to heterosexuals. Results are especially consistent regarding elevated risk of suicide attempts.

Arch Sex Behav. 2006 Jun;35(3):253-62. Epub 2006 Jun 24.
21. Suicidality and sexual orientation: differences between men and women in a general population-based sample from the Netherlands.
de Graaf R, Sandfort TG, ten Have M.
Source
Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands. rgraaf@trimbos.nl
Abstract
Homosexuality has been shown to be associated with suicidality and mental disorders. It is unclear whether homosexuality is related to suicidality, independently of mental disorders. This study assessed differences in lifetime symptoms of suicidality (death ideation, death wishes, suicide contemplation, and deliberate self-harm) between homosexual and heterosexual men and women, controlling for lifetime psychiatric morbidity. Interaction effects of age and the role of perceived discrimination were also examined. Data were collected on a representative sample of the Dutch population aged 18-64 years. Classification as heterosexual or homosexual was based upon reported sexual behavior in the preceding year. Of those sexually active, 2.8% of 2,878 men and 1.4% of 3,120 women had had same-sex partners. Homosexual men differed from their heterosexual counterparts on all four suicide symptoms (OR ranging from 2.58 to 10.23, with higher ORs for more severe symptoms), and on the sum total of the four symptoms; homosexual women only differed from heterosexual women on suicide contemplation (OR=2.12). Controlling for psychiatric morbidity decreased the ORs, but among men all associations were still significant; the significance for suicide contemplation among women disappeared. Younger homosexuals were not at lower risk for suicidality than older homosexuals in comparison with their heterosexual counterparts. Among homosexual men, perceived discrimination was associated with suicidality. This study suggests that even in a country with a comparatively tolerant climate regarding homosexuality, homosexual men were at much higher risk for suicidality than heterosexual men. This relationship could not only be attributed to their higher psychiatric morbidity. In women, there was no such clear relationship.

J Psychiatr Ment Health Nurs. 2004 Aug;11(4):428-34.
22. Ignoring the evidence dictating the practice: sexual orientation, suicidality and the dichotomy of the mental health nurse.
McAndrew S, Warne T.
Source
School of Health Care, University of Leeds, LS2 9UT, UK. s.l.mcandrew@leeds.ac.uk
Abstract
International epidemiological studies demonstrate that gay and bisexual males are four times more likely to report a serious suicide attempt than their heterosexual counterparts. Data on completed suicides, usually derived from mortality statistics misrepresent the rate of suicides among homosexual populations. However, an increasing number of studies comparing representative samples of gay, lesbian and bisexual youths with heterosexual controls demonstrate increased rates of mental health problems and subsequent suicide among the homosexual population. Homosexual orientation must therefore be considered a risk factor for mental distress and as such should be a focus for any contemporary public health agenda. One of the difficulties of addressing the problem through a public health agenda is the juxtaposition proffered by our political and social environment. The Diagnostic and Statistical Manual of Mental Disorder ceased to define homosexuality as pathological in 1973 replacing it with a new ‘illness’ of ‘gender identity disorder’. Until recently in England, Section 28 of the Local Government Act (1988), forbidding the promotion of homosexuality, further reinforced negativity towards this group of people. This compounded the negative mental health consequences for those developing a gay sexual orientation in a climate of heterosexism. Current health care policy in England concerns itself with the rising number of suicides among young people but fails to acknowledge the importance of the research findings relating to gay people by integrating them into the development of mental health policy. This paper reviews the literature relating to homosexual people and suicidality, and addresses the seriousness of a policy rhetoric which results from ignoring the evidence while dictating mental health nursing practice.

J Homosex. 2009;56(2):121-46.
23. Intimate partner violence among sexual minorities in Japan: exploring perceptions and experiences.
DiStefano AS.
Source
Department of Health Science, California State University, Fullerton, California 92834-6870, USA. adistefano@fullerton.edu
Abstract
Using qualitative interviews (n = 39) and participant observation (n = 54), this study documents perceptions and experiences of violence between lesbian, gay, bisexual, transgender, and intersex intimate partners in Japan, thereby providing exploratory, formative data on a previously unexamined issue. Results indicate that intimate partner violence (IPV) is experienced physically, sexually, and psychologically in all sexual minority groups. Participants perceived the violence to be: a) very similar to heterosexual IPV against women; b) more likely perpetrated and experienced by lesbians, bisexual women, and transgender persons compared to gay and bisexual men and intersex persons; c) the cause of several negative physical and mental health outcomes; and d) largely unrecognized in both sexual minority communities and broader Japanese society.

Arch Gen Psychiatry. 1999 Oct;56(10):876-80.
24. Is sexual orientation related to mental health problems and suicidality in young people?
Fergusson DM, Horwood LJ, Beautrais AL.
Source
Christchurch Health and Development Study, Christchurch School of Medicine, New Zealand. david.fergusson@chmeds.ac.nz
Abstract
BACKGROUND:
This study examines the extent to which gay, lesbian, and bisexual young people are at increased risk of psychiatric disorder and suicidal behaviors using data gathered on a New Zealand birth cohort studied to age 21 years.
METHODS:
Data were gathered during the course of the Christchurch Health and Development Study, a 21-year longitudinal study of a birth cohort of 1265 children born in Christchurch, New Zealand. At 21 years of age, 1007 sample members were questioned about their sexual orientation and relationships with same-sex partners since the age of 16 years. Twenty-eight subjects (2.8%) were classified as being of gay, lesbian, or bisexual sexual orientation. Over the period from age 14 to 21 years, data were gathered on a range of psychiatric disorders that included major depression, generalized anxiety disorder, conduct disorder, and substance use disorders. Data were also gathered on suicidal ideation and suicide attempts.
RESULTS:
Gay, lesbian, and bisexual young people were at increased risks of major depression (odds ratio [OR], 4.0; 95% confidence interval [CI], 1.8-9.3), generalized anxiety disorder (OR, 2.8; 95% CI, 1.2-6.5), conduct disorder (OR, 3.8; 95% CI, 1.7-8.7), nicotine dependence (OR, 5.0; 95%, CI, 2.3-10.9), other substance abuse and/or dependence (OR, 1.9; 95% CI, 0.9-4.2), multiple disorders (OR, 5.9; 95% CI, 2.4-14.8), suicidal ideation (OR, 5.4; 95% CI, 2.4-12.2), and suicide attempts (OR, 6.2; 95% CI, 2.7-14.3).
CONCLUSIONS:
Findings support recent evidence suggesting that gay, lesbian, and bisexual young people are at increased risk of mental health problems, with these associations being particularly evident for measures of suicidal behavior and multiple disorder.

Arch Gen Psychiatry. 1999 Oct;56(10):867-74.
25. Sexual orientation and suicidality: a co-twin control study in adult men.
Herrell R, Goldberg J, True WR, Ramakrishnan V, Lyons M, Eisen S, Tsuang MT.
Source
Division of Epidemiology-Biostatistics, School of Public Health, University of Illinois at Chicago, 60615, USA.
Abstract
BACKGROUND:
Several recent studies have found a higher lifetime prevalence of suicide attempts in homosexual males compared with heterosexual control subjects or population rates. These studies used either convenience samples, most without controls, or population-based samples in which confounding factors such as depression and substance abuse were not measured.
METHODS:
This study used twins from the population-based Vietnam Era Twin Registry, Hines, Ill. An analytic sample of 103 middle-aged male-male twin pairs from the registry was identified in which one member of the pair reported male sex partners after age 18 years while the other did not. Four lifetime symptoms of suicidality as measured by the Diagnostic Interview Schedule were analyzed: thoughts about death, wanting to die, thoughts about committing suicide, and attempted suicide. A composite measure of reporting at least one suicidality symptom was also assessed.
RESULTS:
Same-gender sexual orientation is significantly associated with each of the suicidality measures. Unadjusted matched-pair odds ratios follow: 2.4 (95% confidence interval [CI], 1.2 – 4.6) for thoughts about death; 4.4 (95% CI, 1.7 – 11.6) for wanted to die; 4.1 (95% CI, 2.1 – 8.2) for suicidal ideation; 6.5 (95% CI, 1.5 – 28.8) for attempted suicide; and 5.1 (95% CI, 2.4 – 10.9) for any of the suicidal symptoms. After adjustment for substance abuse and depressive symptoms (other than suicidality), all of the suicidality measures remain significantly associated with same-gender sexual orientation except for wanting to die (odds ratio, 2.5 [95% CI, 0.7 – 8.81).
CONCLUSIONS:
The substantially increased lifetime risk of suicidal behaviors in homosexual men is unlikely to be due solely to substance abuse or other psychiatric comorbidity. While the underlying causes of the suicidal behaviors remain unclear, future research needs to address the inadequacies in the measurement of both sexual orientation and suicidality in population-based samples.
J Am Acad Child Adolesc Psychiatry. 2010 Feb;49(2):104-13.
26. Suicidal ideation and attempt among adolescents reporting “unsure” sexual identity or heterosexual identity plus same-sex attraction or behavior: forgotten groups?
Zhao Y, Montoro R, Igartua K, Thombs BD.
Source : aMcGill University bJewish General Hospital cMcGill University Sexual Identity Centre of the McGill University Health Centre, Montréal, Québec.
Abstract
OBJECTIVE: To compare risk of suicide ideation and attempts in adolescents with 1) gay, lesbian, or bisexual (GLB) identity, 2) “unsure” identity, or 3) heterosexual identity with same-sex attraction/fantasy or behavior, to heterosexual identity without same-sex attraction/fantasy or behavior.
METHOD: A total of 1,856 students 14 years of age and older from 14 public and private high schools in Montréal, Québec, were surveyed anonymously. The survey included items assessing sexual orientation, health risk behaviors, and suicidal ideation and attempts. Multiple logistic regression models were used to assess risk factors for suicidal ideation and attempts.
RESULTS: In all, 58 (3.1%) adolescents self-identified as GLB, 59 (3.2%) as unsure, and 115 (6.2%) as heterosexual with same-sex attraction/fantasy or behavior. Compared with heterosexually identified youth without same-sex attraction/fantasy or behavior (N = 1,624; 87.5%), in multivariable analyses, 12-month suicidal ideation was significantly higher for both GLB (odds ratio [OR] = 2.31, 95% confidence interval [CI] = 1.22-4.37) and unsure youth (OR = 2.64, 95% CI = 1.38-5.08). Twelve-month suicide attempts were significantly elevated for GLB youth (OR = 2.23, 95% CI = 1.15-4.35) and high, although not statistically significant, for unsure youth (OR = 1.61, 95% CI = 0.77-3.36). Heterosexual identity with same-sex attraction/fantasy or behavior was not significantly associated with increased suicidal ideation (OR = 1.26, 95% CI = 0.76-2.08) or attempts (OR = 1.03, 95% CI = 0.55-1.91) in multivariable analyses.
CONCLUSION:
Compared with heterosexual youth without same-sex attraction/fantasy or behavior, adolescents with GLB and unsure identities were at greater risk of suicidality. However, youth who reported same-sex attraction or behavior but a heterosexual identity were not at elevated risk.
Crisis. 2000;21(3):111-7.
27. Elevated rates of suicidal behavior in gay, lesbian, and bisexual youth.
Bagley C, Tremblay P.
Source
Department of Social Work Studies, University of Southampton, UK. cb5@socsci.soton.ac.uk
Abstract
Both clinical and epidemiological literature point to elevated rates of suicidal behaviors in gay, lesbian, and bisexual youth (GLBY). Recent North American and New Zealand studies of large populations (especially the US Youth Risk Behavior Surveys from several states) indicate that gay, lesbian, and bisexual adolescents (males in particular) can have rates of serious suicide attempts at least four times those of apparently heterosexual youth. There are various reasons why this figure is likely to be an underestimate. Reasons for these elevated rates of suicidal behavior include a climate of homophobic persecution in schools, and sometimes in family and community–values and actions that stigmatize homosexuality and that the youth who has not yet “come out” has to endure in silence.
Suicide Life Threat Behav. 2005 Dec;35(6):646-60.
28. Predicting the suicide attempts of lesbian, gay, and bisexual youth.
D’Augelli AR, Grossman AH, Salter NP, Vasey JJ, Starks MT, Sinclair KO.
Source
College of Health & Human Development, The Pennsylvania State University, 105 White Building, University Park, PA 16802-3903, USA. ard@psu.edu
Abstract
In this study predictors of serious suicide attempts among lesbian, gay, and bisexual (LGB) youth were examined. Three groups were compared: youth who reported no attempts, youth who reported attempts unrelated to their sexual orientation, and youth whose attempts were considered related to their sexual orientation. About one third of respondents reported at least one suicide attempt; however, only half of the attempts were judged serious based on potential lethality. About half of all attempts were related to youths’ sexual orientation. Factors that differentiated youth reporting suicide attempts and those not reporting attempts were greater childhood parental psychological abuse and more childhood gender-atypical behavior. Gay-related suicide attempts were associated with identifiability as LGB, especially by parents. Early openness about sexual orientation, being considered gender atypical in childhood by parents, and parental efforts to discourage gender atypical behavior were associated with gay-related suicide attempts, especially for males. Assessment of past parental psychological abuse, parental reactions to childhood gender atypical behavior, youths’ openness about sexual orientation with family members, and lifetime gay-related verbal abuse can assist in the prediction of suicide attempts in this population.

Suicide Life Threat Behav. 2001 Fall;31(3):250-64.
29. Suicidality patterns and sexual orientation-related factors among lesbian, gay, and bisexual youths.
D’Augelli AR, Hershberger SL, Pilkington NW.
Source
Department of Human Development and Family Studies, Pennsylvania State University, University Park 16802, USA. ard@psu.edu
Abstract
Three hundred fifty lesbian, gay, and bisexual youths aged 14 to 21 years were questioned about suicidal thoughts and behaviors, families’ reactions to youths’ sexual orientation, and suicidality among relatives and friends. Results confirmed an association between sexual orientation and suicidality. Nearly half (42%) had sometimes or often thought of suicide; one third (33%) reported at least one suicide attempt. Many related suicidal ideation and suicide attempts to their sexual orientation. Most attempts followed awareness of same-sex feelings and preceded disclosure of sexual orientation to others. One quarter said a family member had made a suicide attempt, and nearly three quarters said a close friend had attempted suicide.
J Health Soc Behav. 2010 Dec;51(4):391-407.
30. Mental health differences between young adults with and without same-sex contact: A simultaneous examination of underlying mechanisms.
Ueno K.
Source
Florida State University, Tallahassee, 32306-2270, USA. kueno@fsu.edu
Abstract
Previous research has documented that sexual minorities are more likely than heterosexual people to experience mental health problems, but little is known about how these disparities emerge. Analysis of data from Miami-Dade County, Florida, shows that young adults reporting same-sex contact have higher levels of depressive symptoms and drug use than those without such contact, but that different processes explain the disparities in the two outcomes. A substantial portion of the gap in depressive symptoms is explained by sexual minorities’ higher levels of stress exposure and their lower levels of family support and psychological resources. The gap in drug use is not explained by these processes, but is partially explained by self-exploratory attitudes and permissiveness of drug use in social networks. This study highlights the importance of using multiple outcome measures in research that examines mechanisms underlying mental health disparities across social groups.

J Youth Adolesc. 2010 Oct;39(10):1189-98. Epub 2010 Apr 10.
31. Sexual orientation, parental support, and health during the transition to young adulthood.
Needham BL, Austin EL.
Source
Department of Sociology and Social Work, University of Alabama at Birmingham, HHB 460K, 1530 3rd Ave. S., Birmingham, AL 35294-1152, USA. bneedham@uab.edu
Abstract
Some recent studies suggest that sexual minorities may have worse health-related outcomes during adolescence because they report lower levels of family connectedness, a key protective resource. Using data from wave 3 of the National Longitudinal Study of Adolescent Health (n = 11,153; 50.6% female; mean age = 21.8 years), this study extends prior research on adolescents to young adults. We examine whether lesbian, gay, and bisexual (LGB) young adults report lower levels of parental support than their heterosexual peers and whether differences in parental support help explain why LGB young adults tend to have worse health-related outcomes. We find that lesbian and bisexual women report lower levels of parental support than heterosexual women and that gay men report lower levels of parental support than bisexual and heterosexual men. Compared to heterosexual women, lesbian and bisexual women have higher odds of suicidal thoughts and recent drug use; bisexual women also have higher odds of elevated depressive symptomatology and heavy drinking. Gay men have higher odds of suicidal thoughts than heterosexual men. With the exception of heavy drinking, parental support either partially or fully mediates each of the observed associations. Even though the transition from adolescence to young adulthood is characterized by increased independence from parents, parental support remains an important correlate of health-related outcomes during this stage of life. Sexual minorities report lower levels of parental support during young adulthood, which helps explain why they have worse health-related outcomes. Interventions designed to strengthen relationships between LGB young adults and their parents could lead to a reduction in health disparities related to sexual orientation.

Int J Sex Health. 2010 Apr 1;22(2):91-102.
32. Mental Health Needs of Sexual Minorities in Jamaica.
White YR, Barnaby L, Swaby A, Sandfort T.
Source
Faculty of Medical Sciences, University of the West Indies, Mona, Kingston 7, Jamaica.
Abstract
This study examined the prevalence of Axis I disorders and associated risk factors in a sample of sexual minority men and women in Jamaica, a country that is widely known for its high societal rejection of homosexuality. Poor relationships with family, negative or abusive experiences related to one’s sexual orientation, and greater openness about one’s sexual orientation were independent risk factors for Axis I disorders. Prevention of mental disorders in sexual minorities in Jamaica should focus on rebuilding family support and promoting social acceptance of sexual minorities.

Am J Public Health. 2010 Dec;100(12):2426-32. Epub 2010 Oct 21.
33. Mental health disorders, psychological distress, and suicidality in a diverse sample of lesbian, gay, bisexual, and transgender youths.
Mustanski BS, Garofalo R, Emerson EM.
Source
IMPACT Department of Psychiatry, University of Illinois, Chicago, IL 60608, USA. bmustanski@psych.uic.edu
Abstract
OBJECTIVES:
We examined associations of race/ethnicity, gender, and sexual orientation with mental disorders among lesbian, gay, bisexual, and transgender (LGBT) youths.
METHODS:
We assessed mental disorders by administering a structured diagnostic interview to a community sample of 246 LGBT youths aged 16 to 20 years. Participants also completed the Brief Symptom Inventory 18 (BSI 18).
RESULTS:
One third of participants met criteria for any mental disorder, 17% for conduct disorder, 15% for major depression, and 9% for posttraumatic stress disorder. Anorexia and bulimia were rare. Lifetime suicide attempts were frequent (31%) but less so in the prior 12 months (7%). Few racial/ethnic and gender differences were statistically significant. Bisexually identified youths had lower prevalences of every diagnosis. The BSI 18 had high negative predictive power (90%) and low positive predictive power (25%) for major depression.
CONCLUSIONS:
LGBT youths had higher prevalences of mental disorder diagnoses than youths in national samples, but were similar to representative samples of urban, racial/ethnic minority youths. Suicide behaviors were similar to those among representative youth samples in the same geographic area. Questionnaires measuring psychological distress may overestimate depression prevalence among this population.

J Consult Clin Psychol. 2010 Aug;78(4):459-68.
34. Childhood abuse and mental health indicators among ethnically diverse lesbian, gay, and bisexual adults.
Balsam KF, Lehavot K, Beadnell B, Circo E.
Source
School of Social Work, University of Washington, Seattle, WA 98195, USA. kbalsam@uw.edu
Abstract
OBJECTIVE:
Prior research has established that lesbian, gay, and bisexual (LGB) people experience higher rates of childhood abuse than heterosexuals. However, there has been little research on the mental health impact of these experiences or how race/ethnicity might influence prevalence and mental health impact of childhood abuse in this population. The study’s objective was to examine the relationships between race/ethnicity, childhood abuse, and mental health indicators in a national sample of LGB adults.
METHOD:
Participants were recruited via the Internet through snowball and targeted sampling methods. Six hundred and sixty-nine LGB adults, 21% of whom were people of color, participated in an online survey. Participants completed the Childhood Trauma Questionnaire-Short Form, the Center for Epidemiologic Studies Depression Scale, the Patient Health Questionnaire Generalized Anxiety Disorder Scale, the Posttraumatic Stress Disorder (PTSD) Checklist-Civilian Version, and the Perceived Stress Scale-Short Form.
RESULTS:
Latina/o and Asian American participants reported the highest levels of physical abuse (p < .01), and Latina/o and African American participants reported the highest levels of sexual abuse (p < .01). Childhood emotional abuse was the strongest predictor of psychopathology symptoms for all participants (ps < .01). Relative to White participants, emotional abuse showed a stronger relationship with PTSD and anxiety symptoms for African American participants (ps < .01), and physical abuse showed a stronger relationship with PTSD and anxiety symptoms for Latina/o participants (ps < .05).
CONCLUSIONS:
Race/ethnicity may be an important factor when examining childhood abuse and mental health correlates among LGB populations.

Am J Public Health. 2010 Sep;100(9):1696-700. Epub 2010 Jul 15.
35. School environment and the mental health of sexual minority youths: a study among Dutch young adolescents.
Sandfort TG, Bos HM, Collier KL, Metselaar M.
Source
HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, 1051 Riverside Dr, PI Unit 15, New York, NY 10032, USA. tgs2001@columbia.edu
Abstract
OBJECTIVES:
We examined whether structural elements of the school environment, in particular cultural pluralism and consistency and clarity of school rules and expectations of students, could mitigate the risk for mental health problems among young sexual minority adolescents.
METHODS:
Data were collected in 2008 by means of a computer-based questionnaire completed at school by 513 young Dutch adolescents (12-15 years old) during regular class times. Eleven percent of these students, who were enrolled in 8 different schools, reported having at least some feelings of same-sex attraction.
RESULTS:
Adolescents with same-sex attractions in schools where rules and expectations were experienced as less consistent and clear reported significantly more mental health problems than their peers with no same-sex attractions in the same schools. Such differences were absent in schools where rules and expectations were experienced as more consistent and clear. There were no such effects of cultural pluralism.
CONCLUSIONS:
Our results suggest that schools with consistent and clear rules and expectations mitigate the risk for mental health problems among students with same-sex attractions and underscore the importance of structural measures for the health of sexual minority youth.
Am J Psychiatry. 1970 Aug;127(2):147-54.
36. Psychiatric Disorders and Disability in the Female Homosexual
MARCEL T. SAGHIR M.D.1, ELI ROBINS M.D.2, BONNIE WALBRAN 3, , and KATHYE A. GENTRY 4
1 Fellow in the department of epidemiology and medical statistics, London School of Hygiene and the social psychiatry research unit, Maudsley Hospital, London, England
2 Wallace Renard Professor of Psychiatry and head of the department, department of psychiatry, Washington University School of Medicine, 4940 Audubon Ave., St. Louis, Mo. 63110, psychiatrist-in-chief, Barnes and Renard Hospitals
3 Research assistant in social psychiatry, department of psychiatry, Washington University School of Medicine, 4940 Audubon Ave., St. Louis, Mo. 63110
4 Research assistant in sociology in psychiatry, department of psychiatry, Washington University School of Medicine, 4940 Audubon Ave., St. Louis, Mo. 63110
A study of 57 homosexual women and 43 single heterosexual controlsrevealed slightly more clinically significant changes and disabilityin the lives of the homosexual women as compared with the heterosexualwomen. The chief differences were in the increased prevalenceof alcoholism and of attempted suicide. Despite these difficulties,the homosexual women were able to achieve, adapt, and be productivecitizens.

Psychiatr. Serv. 2011;62:404-410. © 2011 American Psychiatric Association
37. Effects of Sexual Orientation and Gender on Perceived Need for Treatment by Persons With and Without Mental Disorders
Christine E. Grella, Ph.D., Susan D. Cochran, Ph.D., M.S., Lisa Greenwell, Ph.D. and Vickie M. Mays, Ph.D., M.S.P.H.
Dr. Grella is affiliated with Integrated Substance Abuse Programs, Dr. Cochran is with the Department of Epidemiology, School of Public Health, and Dr. Mays is with the Department of Psychology, all at the University of California, Los Angeles (UCLA).
When this work was done Dr. Greenwell was with Integrated Substance Abuse Programs, UCLA. She is now with RMC Research Corporation in Portland, Oregon.

Send correspondence to Dr. Grella at Integrated Substance Abuse Programs, UCLA, 1640 S. Sepulveda Blvd., Suite 200, Los Angeles, CA 90025 (e-mail: grella@ucla.edu).

Objective: Research has shown that sexual minority groups have higher prevalencerates of psychiatric disorders (both mental and substance usedisorders) and that they may seek treatment at higher ratesthan heterosexuals. However, relationships between treatmentneed and treatment use are not well understood. This study examinedthe relationship of sexual orientation and gender to perceivedneed for treatment and treatment use among individuals withand without mental or substance use disorders.

Methods: Data were obtained from a probability sample of California residentsthat oversampled for persons from sexual minority groups (unweightedN=2,079). Bivariate analyses compared perceived treatment needand treatment use among groups defined by sexual orientation,gender, and presence of a mood, anxiety, or substance use disorder.Logistic regression models that controlled for sociodemographicfactors were used to predict no use of treatment among thosewho perceived a need for it (unmet need), testing the interactiveeffects of gender, disorder, and sexual orientation.

Results: Women from sexual minority groups had about half the odds ofunmet treatment need as heterosexual women, but no interactionwas found for men between sexual minority status and unmet need.Among individuals without any of the disorders assessed, menand women from sexual minority groups had lower odds of unmetneed for treatment than heterosexual men and women.

Conclusions: Sexual orientation and gender differentially influenced treatmentutilization, particularly among those who did not have a diagnoseddisorder but perceived a need for treatment. Diagnostic criteriaappear to be less relevant to understanding treatment use insexual minority populations. (Psychiatric Services 62:404–410,2011)

Int J Epidemiol 2011;0:dyr019v1-dyr019.
38. The protective effects of social/contextual factors on psychiatric morbidity in LGB populations
Hatzenbuehler et al.
Abstract
Background Lesbian, gay and bisexual (LGB) populations evidence higher rates of psychiatric disorders than heterosexuals, but most LGB individuals do not have mental-health problems. The present study examined risk modifiers at the social/contextual level that may protect LGB individuals from the development of psychiatric disorders.
Methods Data are drawn from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (N  = 34 653), a nationally representative study of non-institutionalized US adults. Risk variables included social isolation and economic adversity. High state-level concentration of same-sex couples, obtained from the US Census, was examined as a protective factor.
Results The past-year prevalence of major depression and generalized anxiety disorder was lower among LGB respondents living in states with higher concentrations of same-sex couples, compared with LGB respondents in states with lower concentrations. Additionally, the increased risk for mood and anxiety disorders among LGB individuals exposed to economic adversity and social isolation was evident only in states with low concentrations of same-sex couples. These interactions between the risk and protective factors were not found among heterosexuals, suggesting specificity of the effects to LGB individuals. Results were not attenuated after controlling for socio-demographic factors, state-level income inequality, state-level policies targeting LGBs and state-level attitudes towards LGB-relevant issues.
Conclusions These results provide evidence for the protective effect of social/contextual influences on the prevalence of psychiatric disorders in LGB individuals. Measures of the social environment should be incorporated into future research on the mental health of LGB populations.
Br. J. Psychiatry 2011;198:143-148. © 2011 The Royal College of Psychiatrists
39. Mental health of the non-heterosexual population of England
Chakraborty et al.

Department of Mental Health Sciences, University College London, London
Background
There has been little research into the prevalence of mentalhealth problems in lesbian, gay and bisexual (LGB) people inthe UK with most work conducted in the USA.
Aims
To relate the prevalence of mental disorder, self-harm and suicideattempts to sexual orientation in England, and to test whetherpsychiatric problems were associated with discrimination ongrounds of sexuality.
Method
The Adult Psychiatric Morbidity Survey 2007 (n = 7403) was representativeof the population living in private UK households. Standardisedquestions provided demographic information. Neurotic symptoms,common mental disorders, probable psychosis, suicidality, alcoholand drug dependence and service utilisation were assessed.In addition, detailed information was obtained about aspectsof sexual identity and perceived discrimination on these grounds.
Results
Self-reported identification as non-heterosexual (determinedby both orientation and sexual partnership, separately) wasassociated with unhappiness, neurotic disorders overall, depressiveepisodes, generalised anxiety disorder, obsessive–compulsivedisorder, phobic disorder, probable psychosis, suicidal thoughtsand acts, self-harm and alcohol and drug dependence. Mentalhealth-related general practitioner consultations and communitycare service use over the previous year were also elevated.In the non-heterosexual group, discrimination on the groundsof sexual orientation predicted certain neurotic disorder outcomes,even after adjustment for potentially confounding demographicvariables.
Conclusions
This study corroborates international findings that people ofnon-heterosexual orientation report elevated levels of mentalhealth problems and service usage, and it lends further supportto the suggestion that perceived discrimination may act asa social stressor in the genesis of mental health problemsin this population.
November 2010, Vol 100, No. 11 | American Journal of Public Health 2255-2261
© 2010 American Public Health Association DOI: 10.2105/AJPH.2009.177329
40. Disparities in Health-Related Quality of Life: A Comparison of Lesbians and Bisexual Women
Fredriksen-Goldsen et al.
Objectives. We investigated the association of health-relatedquality of life (HRQOL) with sexual orientation among lesbiansand bisexual women and compared the predictors of HRQOL betweenthe 2 groups.
Methods. We used multivariate logistic regression to analyzeWashington State Behavioral Risk Factor Surveillance Systempopulation-based data (2003 to 2007) in a sample of 1496 lesbiansand bisexual women and examined determinants of HRQOL amonglesbians and bisexual women.
Results. For lesbians and bisexual women, frequent mental distressand poor general health were associated with poverty and lackof exercise; poor general health was associated with obesityand mental distress. Bisexual women showed a higher likelihoodof frequent mental distress and poor general health than didlesbians. The odds of mental distress were higher for bisexualwomen living in urban areas as compared with nonurban areas.Lesbians had an elevated risk of poor general health and mentaldistress during midlife.
Conclusions. Despite the standard practice of collapsing sexualminority women into a single group, lesbian and bisexual womenin this study emerge as distinct groups that merit specificattention. Bisexual women are at elevated risk for poor HRQOL.

Arch Pediatr Adolesc Med 2008;162:1071-1078.
42. Sexual Orientation Disparities in Longitudinal Alcohol Use Patterns Among Adolescents
Corliss et al.

Objective To compare sexual orientation group differencesin the longitudinal development of alcohol use behaviors duringadolescence.
Design Community-based prospective cohort study.
Setting Self-reported questionnaires.
Participants A total of 13 450 Growing Up Today Studyparticipants (79.7% of the original cohort) aged 9 to 14 yearsat baseline in 1996 were followed up for more than 7 years.
Main Exposure Self-reported sexual orientation classifiedas heterosexual, mostly heterosexual, bisexual, or gay/lesbian.
Main Outcome Measures Age at alcohol use initiation, anypast-month drinking, number of alcoholic drinks usually consumed,and number of binge drinking episodes in the past year.
Results Compared with heterosexual participants, youthreporting any minority sexual orientation reported having initiatedalcohol use at younger ages. Greater risk of alcohol use wasconsistently observed for mostly heterosexual males and femalesand for bisexual females, whereas gay and bisexual males andlesbians reported elevated levels of alcohol use on only someindicators. Gender was an important modifier of alcohol userisk; mostly heterosexual and bisexual females exhibited thehighest relative risk. Younger age at alcohol use initiationamong participants with minority sexual orientations significantlycontributed to their elevated risk of binge drinking.
Conclusions Our findings suggest that disparities in alcoholuse among youth with a minority sexual orientation emerge inearly adolescence and persist into young adulthood. Health careproviders should be aware that adolescents with a minority sexualorientation are at greater risk of alcohol use.

Author Affiliations: Division of Adolescent and Young Adult Medicine (Drs Corliss and Austin) and Department of Cardiology (Dr Wypij), Children’s Hospital Boston, Boston, Massachusetts; Department of Psychology, The City University of New York–The City College and Graduate Center, New York, New York (Dr Rosario); Channing Laboratory, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School (Ms Fisher), Boston; and Departments of Biostatistics (Dr Wypij) and Society, Human Development, and Health (Dr Austin), Harvard School of Public Health, Boston.

AJPH 2008;98:1004-1006.
43. Lifetime Prevalence of Mental Disorders and Suicide Attempts in Diverse Lesbian, Gay, and Bisexual Populations

Ilan H. Meyer, PhD, Jessica Dietrich, MPH and Sharon Schwartz, PhD
Past studies have reported little about variability in mentaldisorders among lesbians, gay men, and bisexual individuals.We assessed the prevalence of psychiatric disorders in 388 lesbian,gay, and bisexual Black, Latino, and White individuals. Blacklesbians, gay men, and bisexual individuals had lower prevalenceof all disorders than did Latino and White individuals; youngercohorts had fewer mood disorders than did older cohorts; bisexualpersons had more substance use disorders than did gay men andlesbians; and Latino respondents attempted suicide more oftenthan did White respondents.

Am J Mens Health 2007;1:60-72.
44. An Integrated Model of Gay Men’s Depressive Symptoms
Josephson and Whiffen
Abstract
A model of depressive symptoms in gay men is tested that links gender-related personality traits (agency and unmitigated communion) to peer harassment, self-discrepancies in agency, and cold-submissive interpersonal behavior, all of which were reported in previous research to contribute to depression. A sample of 510 gay men was recruited through the Internet. The integrated model was tested using half of the sample and validated with the other half. Significant zero order correlations between the gender-related personality traits and depressive symptoms were mediated by unassured-submissive behavior and self-discrepancies in agency. Recalled peer harassment was linked directly with depressive symptoms and indirectly through unassured-submissive interpersonal behavior.

AJPH 2006;96:1119-1125.
45. Sexual Orientation and Mental and Physical Health Status: Findings From a Dutch Population Survey
Theo G.M. Sandfort, PhD, Floor Bakker, PhD, François G. Schellevis, MD, PhD and Ine Vanwesenbeeck, PhD
Abstract:
Objectives. We sought to determine whether sexual orientationis related to mental and physical health and health behaviorsin the general population.
Methods. Data was derived from a health interview survey thatwas part of the second Dutch National Survey of General Practice,carried out in 2001 among an all-age random sample of the population.Of the 19685 persons invited to participate, 65% took part inthe survey. Sexual orientation was assessed in persons aged18 years and older and reported by 98.2% of 9684 participants.The respondents’ characteristics are comparable with thoseof the Dutch general population.
Results. Gay/lesbian participants reported more acute mentalhealth symptoms than heterosexual people and their general mentalhealth also was poorer. Gay/lesbian people more frequently reportedacute physical symptoms and chronic conditions than heterosexualpeople. Differences in smoking, alcohol use, and drug use wereless prominent.
Conclusions. We found that sexual orientation was associatedwith mental as well as physical health. The causal processesresponsible for these differences by sexual orientation needfurther exploration.

AJPH 2003;93:939-942.
47. Association of Co-Occurring Psychosocial Health Problems and Increased Vulnerability to HIV/AIDS Among Urban Men Who Have Sex With Men
Stall R, Mills TC, Williamson J, Hart T, Greenwood G, Paul J, Pollack L, Binson D, Osmond D, Catania JA.
Source
Prevention Research Branch, Division of HIV/AIDS Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. rstall@cdc.gov
Abstract
OBJECTIVES:
We measured the extent to which a set of psychosocial health problems have an additive effect on increasing HIV risk among men who have sex with men (MSM).
METHODS:
We conducted a cross-sectional household probability telephone sample of MSM in Chicago, Los Angeles, New York, and San Francisco.
RESULTS:
Psychosocial health problems are highly intercorrelated among urban MSM. Greater numbers of health problems are significantly and positively associated with high-risk sexual behavior and HIV infection.
CONCLUSIONS:
AIDS prevention among MSM has overwhelmingly focused on sexual risk alone. Other health problems among MSM not only are important in their own right, but also may interact to increase HIV risk. HIV prevention might become more effective by addressing the broader health concerns of MSM while also focusing on sexual risks.

Br J Psychiatry. 2002 Aug;181:153-7.
48. Sexual molestation of males: associations with psychological disturbance
King M, Coxell A, Mezey G.
Source
Department of Psychiatry and Behavioural Sciences, Royal Free and University College Medical School, London, UK. m.king@rfc.ucl.ac.uk
Abstract
BACKGROUND:
There are no epidemiological data in Europe on associations between sexual molestation in males and psychological disturbance.
AIMS:
To investigate whether sexual molestation in males is a significant predictor of psychological disturbance.
METHOD:
We recruited men attending general practice and genitourinary medicine services. Participants took part in a computerised interview about sexual molestation as children or adults. We ranked reported sexual experiences into three categories of decreasing severity. Each category was treated as an independent predictor in a multivariate analysis predicting different types of psychological disturbance.
RESULTS:
Men who reported child sexual abuse were more likely to report any type of psychological disturbance. Men who reported sexual molestation in adulthood were 1.7 (1.0-2.8) times more likely to have experienced a psychological disorder, but self-harm was the single most likely problem to occur (odds ratio=2.6, range=1.3-5.2). Men reporting ‘consenting’ sexual experiences when aged under 16 years also were more likely to report acts of self-harm (odds ratio=1.7, range=0-2.8).
CONCLUSIONS:
Sexual abuse as a child or adult is associated with later psychological problems. All forms of sexual molestation were predictive of deliberate self-harming behaviour in men.
Br. J. Psychiatry 2002;180:423-427.
49. Sexual orientation and mental health: results from a community survey of young and middle-aged adults
Jorm AF, Korten AE, Rodgers B, Jacomb PA, Christensen H.
Source
Centre for Mental Health Research, Australian National University, Canberra 0200, Australia. Anthony.Jorm@anu.edu.au
Abstract
BACKGROUND:
Community surveys have reported a higher rate of mental health problems in combined groups of homosexual and bisexual participants, but have not separated these two groups.
AIMS:
To assess separately the mental health of homosexual and bisexual groups compared with heterosexuals.
METHOD:
A community survey of 4824 adults was carried out in Canberra, Australia. Measures covered anxiety, depression, suicidality, alcohol misuse, positive and negative affect and a range of risk factors for poorer mental health.
RESULTS:
The bisexual group was highest on measures of anxiety, depression and negative affect, with the homosexual group falling between the other two groups. Both the bisexual and homosexual groups were high on suicidality. Bisexuals also had more current adverse life events, greater childhood adversity, less positive support from family, more negative support from friends and a higher frequency of financial problems. Homosexuals reported greater childhood adversity and less positive support from family.
CONCLUSIONS:
The bisexual group had the worst mental health, although homosexual participants also tended to report more distress.

Arch Gen Psychiatry 2001;58:721-728.
50. Psychiatric Disorders and Drug Use Among Human Immunodeficiency Virus-Infected Adults in the United States
Bing EG, Burnam MA, Longshore D, Fleishman JA, Sherbourne CD, London AS, Turner BJ, Eggan F, Beckman R, Vitiello B, Morton SC, Orlando M, Bozzette SA, Ortiz-Barron L, Shapiro M.
Source
Center for AIDS Research, Charles R. Drew University of Medicine & Science, 1651 E 120th St, Los Angeles, CA 90059, USA. erbing@cdrewu.edu
Abstract
BACKGROUND:
There have been no previous nationally representative estimates of the prevalence of mental disorders and drug use among adults receiving care for human immunodeficiency virus (HIV) disease in the United States. It is also not known which clinical and sociodemographic factors are associated with these disorders.
SUBJECTS AND METHODS:
We enrolled a nationally representative probability sample of 2864 adults receiving care for HIV in the United States in 1996. Participants were administered a brief structured psychiatric instrument that screened for psychiatric disorders (major depression, dysthymia, generalized anxiety disorders, and panic attacks) and drug use during the previous 12 months. Sociodemographic and clinical factors associated with screening positive for any psychiatric disorder and drug dependence were examined in multivariate logistic regression analyses.
RESULTS:
Nearly half of the sample screened positive for a psychiatric disorder, nearly 40% reported using an illicit drug other than marijuana, and more than 12% screened positive for drug dependence during the previous 12 months. Factors independently associated with screening positive for a psychiatric disorder included number of HIV-related symptoms, illicit drug use, drug dependence, heavy alcohol use, and being unemployed or disabled. Factors independently associated with screening positive for drug dependence included having many HIV-related symptoms, being younger, being heterosexual, having frequent heavy alcohol use, and screening positive for a psychiatric disorder.
CONCLUSIONS:
Many people infected with HIV may also have psychiatric and/or drug dependence disorders. Clinicians may need to actively identify those at risk and work with policymakers to ensure the availability of appropriate care for these treatable disorders.

Am J Public Health. 2010 Dec;100(12):2433-41. Epub 2010 Apr 15.
51. Pervasive trauma exposure among US sexual orientation minority adults and risk of posttraumatic stress disorder.
Roberts AL, Austin SB, Corliss HL, Vandermorris AK, Koenen KC.
Source
Department of Society, Human Development, and Health, School of Public Health, Harvard University, Boston, MA 02115, USA. kkoenen@hsph.harvard.edu
Abstract
OBJECTIVES:
We assessed sexual orientation disparities in exposure to violence and other potentially traumatic events and onset of posttraumatic stress disorder (PTSD) in a representative US sample.
METHODS:
We used data from 34 653 noninstitutionalized adult US residents from the 2004 to 2005 wave of the National Epidemiologic Survey on Alcohol and Related Conditions.
RESULTS:
Lesbians and gay men, bisexuals, and heterosexuals who reported any same-sex sexual partners over their lifetime had greater risk of childhood maltreatment, interpersonal violence, trauma to a close friend or relative, and unexpected death of someone close than did heterosexuals with no same-sex attractions or partners. Risk of onset of PTSD was higher among lesbians and gays (adjusted odds ratio [AOR] = 2.03; 95% confidence interval [CI] = 1.34, 3.06), bisexuals (AOR = 2.13; 95% CI = 1.38, 3.29), and heterosexuals with any same-sex partners (AOR = 2.06; 95% CI = 1.54, 2.74) than it was among the heterosexual reference group. This higher risk was largely accounted for by sexual orientation minorities’ greater exposure to violence, exposure to more potentially traumatic events, and earlier age of trauma exposure.
CONCLUSIONS:
Profound sexual orientation disparities exist in risk of PTSD and in violence exposure, beginning in childhood. Our findings suggest there is an urgent need for public health interventions aimed at preventing violence against individuals with minority sexual orientations and providing follow-up care to cope with the sequelae of violent victimization.

J Epidemiol Community Health. 2006 Nov;60(11):962-7.
52. Attempted suicide, psychological health and exposure to harassment among Japanese homosexual, bisexual or other men questioning their sexual orientation recruited via the internet.
Hidaka Y, Operario D.
Source
Department of Global Health and Socio-epidemiology, Kyoto University School of Public Health, Kyoto-Shi, Kyoto, Japan. yass@kta.att.ne.jp
Abstract
OBJECTIVE:
To investigate the rates of attempted suicide and its association with psychological distress, experiences of bullying and verbal harassment, and demographic characteristics among Japanese homosexual, bisexual or other men questioning their sexual orientation.
DESIGN:
A cross-sectional design using Japanese participants recruited through the internet.
RESULTS:
Of the 1025 respondents, 154 (15%) of the men reported a history of attempted suicide, 716 (70%) showed high levels of anxiety and 133 (13%) showed high levels of depression. 851 (83%) experienced school bullying and 615 (60%) were verbally harassed because of being perceived by others as homosexual. Independent correlates of attempted suicide were psychological distress, history of being verbally harassed, history of sex with a woman, history of meeting a male through the internet, disclosing sexual orientation to six or more friends and not having a university degree.
CONCLUSIONS:
Mental health services and prevention programmes are needed to deal with the psychological consequences of social stigma for Japanese men who are homosexual, bisexual or questioning their sexual orientation.

J Pediatr Psychol. 2010 Feb 1. [Epub ahead of print]
53. Cigarette Smoking as a Coping Strategy: Negative Implications for Subsequent Psychological Distress Among Lesbian, Gay, and Bisexual Youths.
Rosario M, Schrimshaw EW, Hunter J.
Source
Department of Psychology, The City University of New York – City College and Graduate Center, Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, and HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute.
Abstract
OBJECTIVE:
The heightened risk of cigarette smoking found among lesbian, gay, and bisexual (LGB) youths may be because smoking serves as a coping strategy used to adapt to the greater stress experienced by LGB youths. The current report examines whether smoking moderates the relation between stress and subsequent psychological distress, and whether alternative coping resources (i.e., social support) moderate the relation between smoking and subsequent distress.
METHOD:
An ethnically diverse sample of 156 LGB youths was followed longitudinally for 1 year.
RESULTS:
Significant interactions demonstrated that smoking amplified the association between stress and subsequent anxious distress, depressive distress, and conduct problems. Both friend and family support buffered the association between smoking and subsequent distress.
CONCLUSIONS:
Smoking has negative implications for the distress of LGB youths, especially those reporting high levels of stress or few supports. Interventions and supportive services for LGB youths should incorporate smoking cessation to maximally alleviate distress.

J Sex Res. 2011 Jan;48(1):3-15.
54. Different patterns of sexual identity development over time: implications for the psychological adjustment of lesbian, gay, and bisexual youths.
Rosario M, Schrimshaw EW, Hunter J.
Source
Department of Psychology, City University of New York-City College and Graduate Center, New York, NY 10031, USA. mrosario@gc.cuny.edu
Abstract
Despite research documenting variability in the sexual identity development of lesbian, gay, and bisexual (LGB) youths, it remains unclear whether different developmental patterns have implications for the psychological adjustment of LGB youths. This report longitudinally examines whether different patterns of LGB identity formation and integration are associated with indicators of psychological adjustment among an ethnically diverse sample of 156 LGB youths (ages 14-21) in New York City. Although differences in the timing of identity formation were not associated with psychological adjustment, greater identity integration was related to less depressive and anxious symptoms, fewer conduct problems, and higher self-esteem both cross-sectionally and longitudinally. Individual changes in identity integration over time were associated with all four aspects of psychological adjustment, even after controlling for rival hypotheses concerning family and friend support, gay-related stress, negative social relationships, and other covariates. These findings suggest that difficulties in developing an integrated LGB identity may have negative implications for the psychological adjustment of LGB youths and that efforts to reduce distress among LGB youths should address the youths’ identity integration.

Am J Public Health. 2010 Mar;100(3):496-502. Epub 2010 Jan 14.
55. Perceived determinants of mental health for bisexual people: a qualitative examination.
Ross LE, Dobinson C, Eady A.
Source
Social Equity & Health Research Section, Centre for Addiction & Mental Health, Toronto, Ontario, Canada M5S 2G8. l.ross@utoronto.ca
Abstract
OBJECTIVES:
We examined the determinants of mental health, as perceived by bisexual people, in order to begin understanding the disparities in the rates of mental health problems reported by bisexual people versus those reported by heterosexual people, and, in many studies, gay men and lesbians.
METHODS:
Our community-based participatory action research project comprised focus groups and semistructured interviews with 55 bisexual people across the province of Ontario, Canada.
RESULTS:
Perceived determinants of emotional well-being identified by participants could be classified as macrolevel (social structure), mesolevel (interpersonal), or microlevel (individual). In the context of this framework, monosexism and biphobia were perceived to exert a broad-reaching impact on participants’ mental health.
CONCLUSIONS:
Like other marginalized populations, bisexual people perceive experiences of discrimination as important determinants of mental health problems. Additional research is required to examine the relationships between these perceived determinants of emotional well-being and specific mental health outcomes and to guide interventions, advocacy, and support for bisexual people.

Am J Public Health. 2010 Mar;100(3):468-75. Epub 2009 Aug 20.
56. Dimensions of sexual orientation and the prevalence of mood and anxiety disorders in the United States.
Bostwick WB, Boyd CJ, Hughes TL, McCabe SE.
Source
Adler School of Professional Psychology, Chicago, IL, USA. wbostwick@niu.edu
Abstract
OBJECTIVES:
We used data from a nationally representative sample to examine the associations among 3 dimensions of sexual orientation (identity, attraction, and behavior), lifetime and past-year mood and anxiety disorders, and sex.
METHODS:
We analyzed data from wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions.
RESULTS:
Mental health outcomes differed by sex, dimension of sexual orientation, and sexual minority group. Whereas a lesbian, gay, or bisexual identity was associated with higher odds of any mood or anxiety disorder for both men and women, women reporting only same-sex sexual partners in their lifetime had the lowest rates of most disorders. Higher odds of any lifetime mood or anxiety disorder were more consistent and pronounced among sexual minority men than among sexual minority women. Finally, bisexual behavior conferred the highest odds of any mood or anxiety disorder for both males and females.
CONCLUSIONS:
Findings point to mental health disparities among some, but not all, sexual minority groups and emphasize the importance of including multiple measures of sexual orientation in population-based health studies.

Qual Health Res. 2008 Oct;18(10):1429-41. Epub 2008 Aug 8.
57. Suicidality and self-harm among sexual minorities in Japan.
DiStefano AS.
Source
Department of Health Science, California State University, Fullerton, California, USA.
Abstract
In this study, I used ethnographic methods to examine suicidality and nonsuicidal self-harm among gay, lesbian, bisexual, and transgender persons in Japan. Participants (N = 84) indicated that suicidality and self-harm are serious problems among sexual minorities and tend to be driven by (a) a homophobic/transphobic environment and the negative consequences of sexual minorities either disclosing their true selves or remaining hidden and silent within such an environment; (b) various antecedents to poor mental health; and (c) factors not directly related to being a sexual minority, particularly unemployment and debt in the context of a protracted national economic decline in Japan prior to the study period of 2003–2004. Participants also perceived a potentially higher risk for suicidality and self-harm among sexual minority adolescents and persons in their early 20s; those who work in the entertainment, bar, or sex industries; and survivors of violence perpetrated by intimate partners or family members.
Sex Health. 2011 Feb;8(1):123-4.
Survey investigating homosexual behaviour among adult males used to estimate the prevalence of HIV and AIDS among men who have sex with men in Japan.
Ichikawa S, Kaneko N, Koerner J, Shiono S, Shingae A, Ito T.
Source
Nagoya City University, School of Nursing, Department of Communicable Disease Epidemiology and Control, 1 Kawasumi Mizuho-cho Mizuho-ku, Nagoya 467-8601, Japan.
Abstract
Background: This study investigated the prevalence of male homosexual behaviour among adult men and of HIV and AIDS among men who have sex with men (MSM) and non-MSM in Japan. Methods: An anonymous self-administered postal questionnaire, and national HIV and AIDS notifications. Results: Same-sex sexual experience was reported by 2.0% of respondents. The prevalence of HIV and AIDS was 0.8818% among MSM and 0.0130% among non-MSM, indicating that HIV and AIDS are 68 times more prevalent among MSM. Conclusion: Our findings underestimate homosexual and HIV prevalence due to several methodological limitations. The high prevalence of HIV and AIDS among MSM in comparison with non-MSM indicates the urgent need to prioritise funding and programs targeting MSM in Japan.
PMID:
21371395
[PubMed – in process]
Nippon Rinsho. 2010 Mar;68(3):546-50.
[The HIV/AIDS epidemic among MSM and gay NGO activities in Japan].
[Article in Japanese]
Ichikawa S.
Source
Graduate School of Nursing, Nagoya City University.
Abstract
The increase of the number of reports of the person with HIV and the patient with AIDS continues focusing on the Japanese MSM in 1996 and afterwards. Gay community centers have been set up to provide information about HIV/STI for gay community in Tokyo, Osaka Nagoya, and Fukuoka. The percentage of respondents undertaking HIV tests in the previous year was increasing. From now, it is important to support the activities of gay NGOs.
Psychiatry Res. 2008 Jan 15;157(1-3):315-8. Epub 2007 Oct 23.
Clinical characteristics of patients with gender identity disorder at a Japanese gender identity disorder clinic.
Okabe N, Sato T, Matsumoto Y, Ido Y, Terada S, Kuroda S.
Source
Department of Neuropsychiatry, Okayama University, Okayama, Japan.
Abstract
The aim of this study was to examine the clinical characteristics of patients with gender identity disorder (GID) at a GID clinic in Japan. A total of 603 consecutive patients were evaluated at the GID clinic using clinical information and results of physical and neurological examinations. Using DSM-IV criteria, 579 patients (96.0%) were diagnosed with GID. Four patients were excluded for transvestic fetishism, eight for homosexuality, five for schizophrenia, three for personality disorders, and four for other psychiatric disorders. Among the GID patients, 349 (60.3%) were the female-to-male (FTM) type, and 230 (39.7%) were the male-to-female (MTF) type. Almost all FTM-type GID patients started to feel discomfort with their sex before puberty and were sexually attracted to females. The proportion of FTM patients who had experienced marriage as a female was very low, and very few had children. Therefore, FTM-type GID patients seem to be highly homogeneous. On the other hand, various patterns of age at onset and sexual attraction existed among MTF patients. Among the MTF-type GID patients, 28.3% had married as males and 18.7% had sired children. Thus, MTF-type GID patients seem to be more heterogeneous.
PMID:
17959255
[PubMed – indexed for MEDLINE]
BMC Public Health. 2006 Sep 26;6:239.
Substance use and sexual behaviours of Japanese men who have sex with men: a nationwide internet survey conducted in Japan.
Hidaka Y, Ichikawa S, Koyano J, Urao M, Yasuo T, Kimura H, Ono-Kihara M, Kihara M.
Source
Department of Global Health and Socio-epidemiology, Kyoto University School of Public Health Yoshidakonoe-cho, Sakyo-ku, Kyoto 606-8501, Japan. yass@kta.att.ne.jp
Abstract
BACKGROUND:
Japanese men who have sex with men (MSM), especially those living in large metropolitan areas such as Tokyo and Osaka, are facing a growing HIV/AIDS epidemic. Although the Internet is used as a new venue for meeting sex partners, it can also serve as a useful research tool for investigating the risk behaviours of Japanese MSM. This Internet survey explored the extent of substance use and its association with sexual risk behaviours among Japanese MSM.
METHODS:
Between 28 February 2003 and 16 May 2003 MSM were recruited through 57 Japanese gay-oriented Web sites, gay magazines, and Internet mailing lists. Participants completed a structured questionnaire anonymously through the Internet.
RESULTS:
In total, 2,062 Japanese MSM completed the questionnaire. The average age of participants was 29.0 years and 70.5% identified as gay, 20.8% as bisexual, and 8.7% as other. Overall, 34.5% reported never using a substance, 45% reported ever using one type of substance (lifetime reported single substance users), and 19.6% had used more than 1 type of substance (lifetime reported multiple substance users) in their lifetimes. The substances most commonly used were amyl nitrite (63.2%), 5-methoxy-N, N-diisopropyltryptamine (5MEO-DIPT) (9.3%), and marijuana (5.7%). In the multivariate analysis, unprotected anal intercourse, having had 6 or more sexual partners, visiting a sex club/gay venue in the previous 6 months, a lower education level, and being 30 to 39 years of age were associated with both lifetime single and lifetime multiple substance use. Lifetime reported multiple substance use was also correlated with having a casual sex partner, having symptoms of depression, being diagnosed as HIV-positive, and greater HIV/AIDS-related knowledge.
CONCLUSION:
This is the first Internet-based research focused on the sexual and substance use behaviours of MSM in Asia. Our findings suggest a compelling need for prevention interventions to reduce HIV risk-related substance use behaviours among Japanese MSM. The results also suggest that the Internet is potentially a useful tool for collecting behavioural data and promoting prevention interventions among this population

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