Background: While extensive research has been conducted on HIV stigma, few studies have examined ... more Background: While extensive research has been conducted on HIV stigma, few studies have examined HIV stigma across age groups. These studies have had small numbers of older adults and report divergent findings regarding aging and HIV stigma. Some suggest stigma is worse for older adults, while others show stigma diminishes with age. Methods: Cross-sectional data from the OHTN Cohort Study were selected based on adults aged 21+ years at their most recent interview (n=996). Total HIV stigma was assessed using the modified HIV Stigma scale (Berger, Ferrans, & Lashley, 2001). Age groups were measured in quintiles (21-39, 40-45, 45-49, 50-55, 56+). The youngest group was the reference category. The relationship between age and stigma was determined by hierarchical multiple regression. Covariates included socio-demographic (sexual orientation, gender, race, socioeconomic position, marital status), psychosocial (depression [CES-D], coping) and health-related (time since diagnosis, alcohol ...
Background. Previous reviews have demonstrated a higher risk of suicide attempts for lesbian, gay... more Background. Previous reviews have demonstrated a higher risk of suicide attempts for lesbian, gay, and bisexual (LGB) persons (sexual minorities), compared with heterosexual groups, but these were restricted to general population studies, thereby excluding individuals sampled through LGB community venues. Each sampling strategy, however, has particular methodological strengths and limitations. For instance, general population probability studies have defined sampling frames but are prone to information bias associated with underreporting of LGB identities. By contrast, LGB community surveys may support disclosure of sexuality but overrepresent individuals with strong LGB community attachment.
Objectives. To reassess the burden of suicide-related behavior among LGB adults, directly comparing estimates derived from population- versus LGB community–based samples.
Search methods. In 2014, we searched MEDLINE, EMBASE, PsycInfo, CINAHL, and Scopus databases for articles addressing suicide-related behavior (ideation, attempts) among sexual minorities.
Selection criteria. We selected quantitative studies of sexual minority adults conducted in nonclinical settings in the United States, Canada, Europe, Australia, and New Zealand.
Data collection and analysis. Random effects meta-analysis and meta-regression assessed for a difference in prevalence of suicide-related behavior by sample type, adjusted for study or sample-level variables, including context (year, country), methods (medium, response rate), and subgroup characteristics (age, gender, sexual minority construct). We examined residual heterogeneity by using Ï„2.
Main results. We pooled 30 cross-sectional studies, including 21 201 sexual minority adults, generating the following lifetime prevalence estimates of suicide attempts: 4% (95% confidence interval [CI] = 3%, 5%) for heterosexual respondents to population surveys, 11% (95% CI = 8%, 15%) for LGB respondents to population surveys, and 20% (95% CI = 18%, 22%) for LGB respondents to community surveys (Figure 1). The difference in LGB estimates by sample type persisted after we accounted for covariates with meta-regression. Sample type explained 33% of the between-study variability.
Author’s conclusions. Regardless of sample type examined, sexual minorities had a higher lifetime prevalence of suicide attempts than heterosexual persons; however, the magnitude of this disparity was contingent upon sample type. Community-based surveys of LGB people suggest that 20% of sexual minority adults have attempted suicide.
Public health implications. Accurate estimates of sexual minority health disparities are necessary for public health monitoring and research. Most data describing these disparities are derived from 2 sample types, which yield different estimates of the lifetime prevalence of suicide attempts. Additional studies should explore the differential effects of selection and information biases on the 2 predominant sampling approaches used to understand sexual minority health.
Although the deleterious effects of HIV stigma are well documented, less is known about how vario... more Although the deleterious effects of HIV stigma are well documented, less is known about how various types of stigma impact older adults living with HIV disease and what factors exacerbate or lessen the effects of HIV stigma. Using cross-sectional data from the OHTN cohort study (OCS), we undertook multiple linear regression to determine the predictors of overall HIV stigma, and enacted, anticipated, and internalized stigma subscales in a sample of OCS participants age 50 and over (n = 378). Being female, heterosexual, engaging in maladaptive coping, and having poor self-rated health were associated with greater overall stigma while being older, having greater mastery, increased emotional-informational social support, and a longer time since HIV diagnosis were associated with lower levels of stigma. The final model accounted for 31% of the variance in overall stigma. Differences in these findings by subscale and implications for practice are discussed.
Http Dx Doi Org 10 1080 09540121 2014 978734, Jan 30, 2015
The purpose of this study was to examine the independent influence of age on levels of HIV-relate... more The purpose of this study was to examine the independent influence of age on levels of HIV-related stigma experienced by adults living with HIV/AIDS. To accomplish this, cross-sectional data from the Ontario HIV Treatment Network Cohort Study were used to determine whether older age is associated with overall stigma among HIV-positive adults living in Ontario, Canada (n = 960). The relationship was also tested for enacted, anticipated, and internalized stigma. Covariates included sociodemographic (e.g., gender, sexual orientation, race) and psychosocial variables (e.g., depression). Modifying effects of covariates were also investigated. Those 55 and older have significantly lower overall and internalized stigma than adults under age 40, even when accounting for gender, sexual orientation, income, time since diagnosis, depression, maladaptive coping, and social support. Age does not predict enacted or Anticipated Stigma when accounting for the demographic and psychosocial variables. A significant interaction between depression and age suggests that stigma declines with age among those who are depressed but increases to age 50 and then decreases in older age groups among those who are not depressed. Age matters when it comes to understanding stigma among adults living with HIV/AIDS; however, the relationship between age and stigma is complex, varying according to stigma type and depression level.
ABSTRACT Purpose: Sexual minority youth (SMY) are considered a population at risk. Studies have i... more ABSTRACT Purpose: Sexual minority youth (SMY) are considered a population at risk. Studies have identified factors such as discrimination from peers and familial rejection (D'Augelli, Grossman, & Starks, 2008), to be associated with risks for low self-esteem (Elze, 2002) and depression (Bontempo & D'Augelli, 2002), yet little research has focused on the cumulative risks that could exacerbate such outcomes for multiethnic sexual minority youth (MSMY). Risk has been defined as an accumulation of stressors that increase the likelihood of negative developmental effects (Hughes, 2007). Studies have focused on the influence of individual risk factors, yet they rarely occur in isolation or are solely responsible for negative outcomes (Seifer, Sameroff & Baldwin, 1992). The quantity of experienced risk factors can be more influential than any particular risk (Goldman, 2010), despite the assumption of equal weight for risks that may be experienced disproportionally for some adolescents. Cumulative risk indexes (CRI) have been found to predict a multitude of negative developmental outcomes (Bean, Gil-Rivas, Greenberger & Chen, 2002) and capture the covariation of risk factors (Luthar, 1993). This paper will discuss the construction of the CRI and the advantages and disadvantages of using this type of risk analysis with MSMY. Methods: Data were collected from a counseling program for SMY (n=163) situated in a resource depleted urban environment. Based on ecological systems theory (Bronfenbrenner, 1989), and previous studies of SMY (Elze, 2003), risk factors were categorized into family, sociodemographic, personal health, and school risk variables. The CRI was constructed as follows: 1) Categorical measures of risk were dichotomized indicating the absence or presence of risk factors; 2) continuous responses were scored using a 75th percentile cut point (Gerrard & Butler, 2004), and 3) total scores were added to create a CRI. Self-esteem was assessed using the Self Esteem Scale (a=.77), (Rosenberg,1994). Utilizing multivariate structural equation modeling (SEM) with AMOS 18.0 software, this study explored the relationship of a latent variable of cumulative risk to self esteem. Results: The majority of participants identified as female (60%), Latina (55%), and bisexual (43%), with a mean age of 16. Family (86%) and sociodemographic (63%) risk domains were the most common. The mean CRI score was 9 (SD=3.4; range 1-13). SEM analysis produced good fit statistics x2 (12, p = > .853) = 12.21; CFI = .997; GFI =.995; and examination of the model path coefficients revealed that significant negative relationships were found between the CRI and the self-esteem of MSMY above and beyond particularly influential domains such as family risk. Conclusions and Implications: This study attempts to illuminate the role of cumulative risk factors for MSMY through the utilization of a CRI. This study extends our knowledge by providing evidence that individual risk factors may not be sufficient to fully explain outcomes. Specifically, it appears that greater cumulative risk negatively impacts the self-esteem of MSMY. A CRI based on an ecological systems approach will enhance the development of more effective interventions and policies that capture emerging needs of MSMY exposed to myriad risk factors.
The rate of cases of HIV/AIDS in older people is increasing; indeed one out of every four people ... more The rate of cases of HIV/AIDS in older people is increasing; indeed one out of every four people with HIV/AIDS is over age 50. This study describes the correlates of HIV Voluntary Counseling and Testing (VCT) using structural equation modeling techniques for a sample of 135 middle-aged and middle-aged and older Latinas in South Florida. Over 60% of participants had been tested for HIV. Provider endorsement was found to be the strongest predictor of VCT (odds ratio [OR] = 6. 38), followed by having a clinic as a regular source of healthcare (OR = 3.88). Social work implications are provided.
Http Dx Doi Org 10 1080 01488376 2012 666936, 2012
ABSTRACT Social workers are expected to promote social justice for lesbian, gay, bisexual, and tr... more ABSTRACT Social workers are expected to promote social justice for lesbian, gay, bisexual, and transgender (LGBT) people, and social work programs and their faculty are expected to prepare students for competent and ethical practice with LGBT people and communities. Faculty's LGBT social attitudes can play a central role in developing students' competencies. Minimal attention has been given to the nature of faculty's LGBT social attitudes. This article presents the results of a national survey conducted in the United States with a random ...
Although LGBQ students experience blatant forms of heterosexism on college campuses, subtle manif... more Although LGBQ students experience blatant forms of heterosexism on college campuses, subtle manifestations, such as sexual orientation microaggressions are more common. Similar to overt heterosexism, sexual orientation microaggressions may threaten LGBQ students' academic development and psychological wellbeing. Limited research exists in this area, in part due to lack of a psychometrically sound instrument measuring the prevalence of LGBQ microaggressions on college campuses. To address this gap, we created and tested the LGBQ Microaggressions on College Campuses Scale. Two correlated subscales were generated: Interpersonal LGBQ Microaggressions and Environmental LGBQ Microaggressions. The results indicated that the subscales demonstrate strong reliability and validity.
Ethnicity and Inequalities in Health and Social Care, 2013
"This study sought to gain a better understanding of the general life experiences of lesbian... more "This study sought to gain a better understanding of the general life experiences of lesbian, gay, bisexual and transgender (LGBT) newcomer youth, situated within the broader context of their lives post-migration. The purpose of this paper is to explore the nature of various forms of oppression experienced by LGBT newcomers and offers recommendations for transforming services to better serve the complex needs of this marginalized population. "
The rate of cases of HIV/AIDS in older people is increasing; indeed one out of every four people ... more The rate of cases of HIV/AIDS in older people is increasing; indeed one out of every four people with HIV/AIDS is over age 50. This study describes the correlates of HIV Voluntary Counseling and Testing (VCT) using structural equation modeling techniques for a sample of 135 middle-aged and middle-aged and older Latinas in South Florida. Over 60% of participants had been tested for HIV. Provider endorsement was found to be the strongest predictor of VCT (odds ratio [OR] = 6. 38), followed by having a clinic as a regular source of healthcare (OR = 3.88). Social work implications are provided.
ABSTRACT Social workers are expected to promote social justice for lesbian, gay, bisexual, and tr... more ABSTRACT Social workers are expected to promote social justice for lesbian, gay, bisexual, and transgender (LGBT) people, and social work programs and their faculty are expected to prepare students for competent and ethical practice with LGBT people and communities. Faculty's LGBT social attitudes can play a central role in developing students' competencies. Minimal attention has been given to the nature of faculty's LGBT social attitudes. This article presents the results of a national survey conducted in the United States with a random ...
Background: While extensive research has been conducted on HIV stigma, few studies have examined ... more Background: While extensive research has been conducted on HIV stigma, few studies have examined HIV stigma across age groups. These studies have had small numbers of older adults and report divergent findings regarding aging and HIV stigma. Some suggest stigma is worse for older adults, while others show stigma diminishes with age. Methods: Cross-sectional data from the OHTN Cohort Study were selected based on adults aged 21+ years at their most recent interview (n=996). Total HIV stigma was assessed using the modified HIV Stigma scale (Berger, Ferrans, & Lashley, 2001). Age groups were measured in quintiles (21-39, 40-45, 45-49, 50-55, 56+). The youngest group was the reference category. The relationship between age and stigma was determined by hierarchical multiple regression. Covariates included socio-demographic (sexual orientation, gender, race, socioeconomic position, marital status), psychosocial (depression [CES-D], coping) and health-related (time since diagnosis, alcohol ...
Background. Previous reviews have demonstrated a higher risk of suicide attempts for lesbian, gay... more Background. Previous reviews have demonstrated a higher risk of suicide attempts for lesbian, gay, and bisexual (LGB) persons (sexual minorities), compared with heterosexual groups, but these were restricted to general population studies, thereby excluding individuals sampled through LGB community venues. Each sampling strategy, however, has particular methodological strengths and limitations. For instance, general population probability studies have defined sampling frames but are prone to information bias associated with underreporting of LGB identities. By contrast, LGB community surveys may support disclosure of sexuality but overrepresent individuals with strong LGB community attachment.
Objectives. To reassess the burden of suicide-related behavior among LGB adults, directly comparing estimates derived from population- versus LGB community–based samples.
Search methods. In 2014, we searched MEDLINE, EMBASE, PsycInfo, CINAHL, and Scopus databases for articles addressing suicide-related behavior (ideation, attempts) among sexual minorities.
Selection criteria. We selected quantitative studies of sexual minority adults conducted in nonclinical settings in the United States, Canada, Europe, Australia, and New Zealand.
Data collection and analysis. Random effects meta-analysis and meta-regression assessed for a difference in prevalence of suicide-related behavior by sample type, adjusted for study or sample-level variables, including context (year, country), methods (medium, response rate), and subgroup characteristics (age, gender, sexual minority construct). We examined residual heterogeneity by using Ï„2.
Main results. We pooled 30 cross-sectional studies, including 21 201 sexual minority adults, generating the following lifetime prevalence estimates of suicide attempts: 4% (95% confidence interval [CI] = 3%, 5%) for heterosexual respondents to population surveys, 11% (95% CI = 8%, 15%) for LGB respondents to population surveys, and 20% (95% CI = 18%, 22%) for LGB respondents to community surveys (Figure 1). The difference in LGB estimates by sample type persisted after we accounted for covariates with meta-regression. Sample type explained 33% of the between-study variability.
Author’s conclusions. Regardless of sample type examined, sexual minorities had a higher lifetime prevalence of suicide attempts than heterosexual persons; however, the magnitude of this disparity was contingent upon sample type. Community-based surveys of LGB people suggest that 20% of sexual minority adults have attempted suicide.
Public health implications. Accurate estimates of sexual minority health disparities are necessary for public health monitoring and research. Most data describing these disparities are derived from 2 sample types, which yield different estimates of the lifetime prevalence of suicide attempts. Additional studies should explore the differential effects of selection and information biases on the 2 predominant sampling approaches used to understand sexual minority health.
Although the deleterious effects of HIV stigma are well documented, less is known about how vario... more Although the deleterious effects of HIV stigma are well documented, less is known about how various types of stigma impact older adults living with HIV disease and what factors exacerbate or lessen the effects of HIV stigma. Using cross-sectional data from the OHTN cohort study (OCS), we undertook multiple linear regression to determine the predictors of overall HIV stigma, and enacted, anticipated, and internalized stigma subscales in a sample of OCS participants age 50 and over (n = 378). Being female, heterosexual, engaging in maladaptive coping, and having poor self-rated health were associated with greater overall stigma while being older, having greater mastery, increased emotional-informational social support, and a longer time since HIV diagnosis were associated with lower levels of stigma. The final model accounted for 31% of the variance in overall stigma. Differences in these findings by subscale and implications for practice are discussed.
Http Dx Doi Org 10 1080 09540121 2014 978734, Jan 30, 2015
The purpose of this study was to examine the independent influence of age on levels of HIV-relate... more The purpose of this study was to examine the independent influence of age on levels of HIV-related stigma experienced by adults living with HIV/AIDS. To accomplish this, cross-sectional data from the Ontario HIV Treatment Network Cohort Study were used to determine whether older age is associated with overall stigma among HIV-positive adults living in Ontario, Canada (n = 960). The relationship was also tested for enacted, anticipated, and internalized stigma. Covariates included sociodemographic (e.g., gender, sexual orientation, race) and psychosocial variables (e.g., depression). Modifying effects of covariates were also investigated. Those 55 and older have significantly lower overall and internalized stigma than adults under age 40, even when accounting for gender, sexual orientation, income, time since diagnosis, depression, maladaptive coping, and social support. Age does not predict enacted or Anticipated Stigma when accounting for the demographic and psychosocial variables. A significant interaction between depression and age suggests that stigma declines with age among those who are depressed but increases to age 50 and then decreases in older age groups among those who are not depressed. Age matters when it comes to understanding stigma among adults living with HIV/AIDS; however, the relationship between age and stigma is complex, varying according to stigma type and depression level.
ABSTRACT Purpose: Sexual minority youth (SMY) are considered a population at risk. Studies have i... more ABSTRACT Purpose: Sexual minority youth (SMY) are considered a population at risk. Studies have identified factors such as discrimination from peers and familial rejection (D'Augelli, Grossman, & Starks, 2008), to be associated with risks for low self-esteem (Elze, 2002) and depression (Bontempo & D'Augelli, 2002), yet little research has focused on the cumulative risks that could exacerbate such outcomes for multiethnic sexual minority youth (MSMY). Risk has been defined as an accumulation of stressors that increase the likelihood of negative developmental effects (Hughes, 2007). Studies have focused on the influence of individual risk factors, yet they rarely occur in isolation or are solely responsible for negative outcomes (Seifer, Sameroff & Baldwin, 1992). The quantity of experienced risk factors can be more influential than any particular risk (Goldman, 2010), despite the assumption of equal weight for risks that may be experienced disproportionally for some adolescents. Cumulative risk indexes (CRI) have been found to predict a multitude of negative developmental outcomes (Bean, Gil-Rivas, Greenberger & Chen, 2002) and capture the covariation of risk factors (Luthar, 1993). This paper will discuss the construction of the CRI and the advantages and disadvantages of using this type of risk analysis with MSMY. Methods: Data were collected from a counseling program for SMY (n=163) situated in a resource depleted urban environment. Based on ecological systems theory (Bronfenbrenner, 1989), and previous studies of SMY (Elze, 2003), risk factors were categorized into family, sociodemographic, personal health, and school risk variables. The CRI was constructed as follows: 1) Categorical measures of risk were dichotomized indicating the absence or presence of risk factors; 2) continuous responses were scored using a 75th percentile cut point (Gerrard & Butler, 2004), and 3) total scores were added to create a CRI. Self-esteem was assessed using the Self Esteem Scale (a=.77), (Rosenberg,1994). Utilizing multivariate structural equation modeling (SEM) with AMOS 18.0 software, this study explored the relationship of a latent variable of cumulative risk to self esteem. Results: The majority of participants identified as female (60%), Latina (55%), and bisexual (43%), with a mean age of 16. Family (86%) and sociodemographic (63%) risk domains were the most common. The mean CRI score was 9 (SD=3.4; range 1-13). SEM analysis produced good fit statistics x2 (12, p = > .853) = 12.21; CFI = .997; GFI =.995; and examination of the model path coefficients revealed that significant negative relationships were found between the CRI and the self-esteem of MSMY above and beyond particularly influential domains such as family risk. Conclusions and Implications: This study attempts to illuminate the role of cumulative risk factors for MSMY through the utilization of a CRI. This study extends our knowledge by providing evidence that individual risk factors may not be sufficient to fully explain outcomes. Specifically, it appears that greater cumulative risk negatively impacts the self-esteem of MSMY. A CRI based on an ecological systems approach will enhance the development of more effective interventions and policies that capture emerging needs of MSMY exposed to myriad risk factors.
The rate of cases of HIV/AIDS in older people is increasing; indeed one out of every four people ... more The rate of cases of HIV/AIDS in older people is increasing; indeed one out of every four people with HIV/AIDS is over age 50. This study describes the correlates of HIV Voluntary Counseling and Testing (VCT) using structural equation modeling techniques for a sample of 135 middle-aged and middle-aged and older Latinas in South Florida. Over 60% of participants had been tested for HIV. Provider endorsement was found to be the strongest predictor of VCT (odds ratio [OR] = 6. 38), followed by having a clinic as a regular source of healthcare (OR = 3.88). Social work implications are provided.
Http Dx Doi Org 10 1080 01488376 2012 666936, 2012
ABSTRACT Social workers are expected to promote social justice for lesbian, gay, bisexual, and tr... more ABSTRACT Social workers are expected to promote social justice for lesbian, gay, bisexual, and transgender (LGBT) people, and social work programs and their faculty are expected to prepare students for competent and ethical practice with LGBT people and communities. Faculty's LGBT social attitudes can play a central role in developing students' competencies. Minimal attention has been given to the nature of faculty's LGBT social attitudes. This article presents the results of a national survey conducted in the United States with a random ...
Although LGBQ students experience blatant forms of heterosexism on college campuses, subtle manif... more Although LGBQ students experience blatant forms of heterosexism on college campuses, subtle manifestations, such as sexual orientation microaggressions are more common. Similar to overt heterosexism, sexual orientation microaggressions may threaten LGBQ students' academic development and psychological wellbeing. Limited research exists in this area, in part due to lack of a psychometrically sound instrument measuring the prevalence of LGBQ microaggressions on college campuses. To address this gap, we created and tested the LGBQ Microaggressions on College Campuses Scale. Two correlated subscales were generated: Interpersonal LGBQ Microaggressions and Environmental LGBQ Microaggressions. The results indicated that the subscales demonstrate strong reliability and validity.
Ethnicity and Inequalities in Health and Social Care, 2013
"This study sought to gain a better understanding of the general life experiences of lesbian... more "This study sought to gain a better understanding of the general life experiences of lesbian, gay, bisexual and transgender (LGBT) newcomer youth, situated within the broader context of their lives post-migration. The purpose of this paper is to explore the nature of various forms of oppression experienced by LGBT newcomers and offers recommendations for transforming services to better serve the complex needs of this marginalized population. "
The rate of cases of HIV/AIDS in older people is increasing; indeed one out of every four people ... more The rate of cases of HIV/AIDS in older people is increasing; indeed one out of every four people with HIV/AIDS is over age 50. This study describes the correlates of HIV Voluntary Counseling and Testing (VCT) using structural equation modeling techniques for a sample of 135 middle-aged and middle-aged and older Latinas in South Florida. Over 60% of participants had been tested for HIV. Provider endorsement was found to be the strongest predictor of VCT (odds ratio [OR] = 6. 38), followed by having a clinic as a regular source of healthcare (OR = 3.88). Social work implications are provided.
ABSTRACT Social workers are expected to promote social justice for lesbian, gay, bisexual, and tr... more ABSTRACT Social workers are expected to promote social justice for lesbian, gay, bisexual, and transgender (LGBT) people, and social work programs and their faculty are expected to prepare students for competent and ethical practice with LGBT people and communities. Faculty's LGBT social attitudes can play a central role in developing students' competencies. Minimal attention has been given to the nature of faculty's LGBT social attitudes. This article presents the results of a national survey conducted in the United States with a random ...
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Papers by David Brennan
Objectives. To reassess the burden of suicide-related behavior among LGB adults, directly comparing estimates derived from population- versus LGB community–based samples.
Search methods. In 2014, we searched MEDLINE, EMBASE, PsycInfo, CINAHL, and Scopus databases for articles addressing suicide-related behavior (ideation, attempts) among sexual minorities.
Selection criteria. We selected quantitative studies of sexual minority adults conducted in nonclinical settings in the United States, Canada, Europe, Australia, and New Zealand.
Data collection and analysis. Random effects meta-analysis and meta-regression assessed for a difference in prevalence of suicide-related behavior by sample type, adjusted for study or sample-level variables, including context (year, country), methods (medium, response rate), and subgroup characteristics (age, gender, sexual minority construct). We examined residual heterogeneity by using Ï„2.
Main results. We pooled 30 cross-sectional studies, including 21 201 sexual minority adults, generating the following lifetime prevalence estimates of suicide attempts: 4% (95% confidence interval [CI] = 3%, 5%) for heterosexual respondents to population surveys, 11% (95% CI = 8%, 15%) for LGB respondents to population surveys, and 20% (95% CI = 18%, 22%) for LGB respondents to community surveys (Figure 1). The difference in LGB estimates by sample type persisted after we accounted for covariates with meta-regression. Sample type explained 33% of the between-study variability.
Author’s conclusions. Regardless of sample type examined, sexual minorities had a higher lifetime prevalence of suicide attempts than heterosexual persons; however, the magnitude of this disparity was contingent upon sample type. Community-based surveys of LGB people suggest that 20% of sexual minority adults have attempted suicide.
Public health implications. Accurate estimates of sexual minority health disparities are necessary for public health monitoring and research. Most data describing these disparities are derived from 2 sample types, which yield different estimates of the lifetime prevalence of suicide attempts. Additional studies should explore the differential effects of selection and information biases on the 2 predominant sampling approaches used to understand sexual minority health.
Read More: http://ajph.aphapublications.org/doi/full/10.2105/AJPH.2016.303088
Objectives. To reassess the burden of suicide-related behavior among LGB adults, directly comparing estimates derived from population- versus LGB community–based samples.
Search methods. In 2014, we searched MEDLINE, EMBASE, PsycInfo, CINAHL, and Scopus databases for articles addressing suicide-related behavior (ideation, attempts) among sexual minorities.
Selection criteria. We selected quantitative studies of sexual minority adults conducted in nonclinical settings in the United States, Canada, Europe, Australia, and New Zealand.
Data collection and analysis. Random effects meta-analysis and meta-regression assessed for a difference in prevalence of suicide-related behavior by sample type, adjusted for study or sample-level variables, including context (year, country), methods (medium, response rate), and subgroup characteristics (age, gender, sexual minority construct). We examined residual heterogeneity by using Ï„2.
Main results. We pooled 30 cross-sectional studies, including 21 201 sexual minority adults, generating the following lifetime prevalence estimates of suicide attempts: 4% (95% confidence interval [CI] = 3%, 5%) for heterosexual respondents to population surveys, 11% (95% CI = 8%, 15%) for LGB respondents to population surveys, and 20% (95% CI = 18%, 22%) for LGB respondents to community surveys (Figure 1). The difference in LGB estimates by sample type persisted after we accounted for covariates with meta-regression. Sample type explained 33% of the between-study variability.
Author’s conclusions. Regardless of sample type examined, sexual minorities had a higher lifetime prevalence of suicide attempts than heterosexual persons; however, the magnitude of this disparity was contingent upon sample type. Community-based surveys of LGB people suggest that 20% of sexual minority adults have attempted suicide.
Public health implications. Accurate estimates of sexual minority health disparities are necessary for public health monitoring and research. Most data describing these disparities are derived from 2 sample types, which yield different estimates of the lifetime prevalence of suicide attempts. Additional studies should explore the differential effects of selection and information biases on the 2 predominant sampling approaches used to understand sexual minority health.
Read More: http://ajph.aphapublications.org/doi/full/10.2105/AJPH.2016.303088