“Here in the Bible Belt, It’s Predominantly Negative”: Sexual Identity Stigma in the American South, 50 Years After Stonewall

Lesbian, gay, bisexual, and pansexual (LGB+) individuals have disproportionate rates of mental illness. Minority stress and sexual identity stigma are posited as the primary social determinants of LGB+ mental health disparities. Discussions in the literature have questioned the impact of sexual identity stigma in a world increasingly accepting of sexual minorities. Additionally, the LGB+ population in the United States South is often overlooked in American research. This article details a qualitative study exploring experiences related to sexual identity stigma among adults who identify as LGB+ in the United States South. Semi-structured interviews with 16 individuals were analyzed using content analysis. Six thematic categories of stigma emerged from participants’ experiences: (a) navigating an LGB+ identity, (b) social acceptability of an LGB+ identity, (c) expectation of LGB+ stigma, (d) interpersonal discrimination and harassment, (e) structural stigma, and (f) relationship with the lesbian, gay, bisexual, transgender, and queer (LGBTQ) community. Findings suggest that sexual identity stigma remains a common experience among these Southern United States participants. Further, thematic categories and subcategories primarily aligned with extant theory with one exception: Intracommunity stigma, a form of stigma emanating from the LGBTQ community, emerged as a stigma type not currently accounted for in theoretical foundations underpinning mental health disparities in this population.

COVIDsmart Study: Evaluation of Statewide Mental Health Disparities in Digital Research. (Preprint)

BACKGROUND As digital health research is becoming a critical element of population health during the COVID-19 pandemic, efforts to recognize and integrate the digital research needs of individuals at risk for mental health disparities have lagged. This could result in poor community health outcomes and increased mental health disparities. OBJECTIVE We evaluated the digital COVIDsmart study for inclusiveness of populations at risk for mental health disparities. Additionally, we identified demographic and clinical characteristics of participants with higher rates of anxiety and/or depression during COVID-19, and potential emerging mental health disparities in the context of COVID-19 METHODS Using multiple recruitment strategies, a total of 782 participants were enrolled in the Virginia COVIDsmart prospective study. A HIPAA compliant digital platform was used to collect data on demographics, COVID-19 clinical parameters, health perceptions, mental and physical health, resilience, vaccination status, education/work functioning, social/family functioning, and economic impact. We assessed differences in frequencies of individuals at risk for mental health disparities and in demographic/clinical characteristics of participants with anxiety and/or depression. RESULTS The majority of participants enrolled in the COVIDsmart study were White (628/771, 81.5%), female (577/734, 78.6%), with at least a Master’s degree (483/771, 62.6%), an annual household income of at least $100,000 (389/771, 51%), living in non-rural areas (758/771, 98%), with health insurance (718/728, 98.6%), and between ages 36 and 65 years (471/736, 64%). Although anxiety and/or depression rates were high for all groups, significant differences were found among age groups (P<.001), gender (P<.001), annual household income (P=.014), and comorbid cancer and neurological disorders (P<.05). CONCLUSIONS Digital research methods may provide opportunities to rapidly study the numerous health impacts of COVID-19, which are currently not fully understood. However, digital health research inclusiveness remains challenging. COVIDsmart study did not achieve expected representation of individuals at risk for mental health disparities. Nevertheless, we found substantial anxiety and/or depression across all demographic and clinical groups. Areas of potential emerging mental health disparities in digital research may include low resiliency, low health literacy, and being a woman between 18 and 35 years. Further research is necessary to understand participation barriers and emerging mental health disparities during COVID-19, which impact digital research practices.

Training LEADers to Accelerate Global Mental Health Disparities Research (LEAD) Program: A Research Training Program Protocol

Background: There is a critical need to address mental health needs across the globe, especially in low and middle-income countries where mental health disparities are pervasive, including among children. The global mental health disparities suggest an imperative for culturally and contextually-congruent mental health services models that expand upon the existing services and interventions for these groups. Rigorous research is a key tool in providing the scientific evidence to inform public policy and practice efforts to effectively address these needs. Yet, there is a limited number of researchers, especially those from diverse backgrounds, who study these issues. In this paper, we describe the “TrainingLEADers to Accelerate Global Mental Health Disparities Research” (LEAD) program, a research training program funded by the National Institute on Minority Health and Health Disparities and focused on global mental health disparities research for early career researchers from under-represented minority groups.Methods: The LEAD program is designed as a two-phase training program for advanced pre-doctoral students, postdoctoral fellows, and junior faculty from diverse backgrounds in the U.S., including groups underrepresented in biomedical, behavioral, clinical and social sciences research, interested in global mental health disparities research. Trainees are matched with mentors and participate in an intensive 12-week program.Discussion: The LEAD program seeks to provide a robust platform for the development, implementation and expansion of evidence-based culturally and contextually-congruent interventions and services models addressing global mental health disparities across the life cycle, especially in low-resource communities in the global context. By producing a sustainable network of well-trained investigators from underrepresented backgrounds, LEAD will potentially contribute to the shared lessons and efforts relevant to addressing global mental health disparities and improving care for vulnerable populations in low-resource settings.

Creating a Culture of Mental Health in Filipino Immigrant Communities through Community Partnerships

One out of five children in the United States has a mental, emotional, or behavioral health diagnosis. Behavioral health issues cost America $247 billion per year and those with mental health disorders have poorer health and shorter lives. Evidence-based parenting interventions provided in childhood have proven to be effective in helping parents to prevent disruptive, oppositional and defiant behaviors, anxiety and depressive symptoms, tobacco, alcohol, and drug misuse, aggression, delinquency, and violence. Yet, few parents participate in such programs, especially hard-to-reach, underserved minority and immigrant populations. The Robert Wood Johnson Foundation has identified a culture of health action framework that mobilizes individuals, communities, and organizations in order to examine ways to improve systems of prevention, invest in building the evidence base for such systems, and provide evidence-based information to decision makers. The overarching goal of this effort was to create a culture of mental health among Filipinos, a large, yet understudied immigrant community that is affected by alarming mental health disparities, including high rates of adolescent suicide ideation and attempts. Our impact project focused on increasing the reach of the Incredible Years® because maximizing the participation of high-risk, hard-to-engage populations may be one of the most important ways to increase the population-level impact of evidence-based parenting programs. If the approach succeeded with Filipinos, comparable strategies could be used to effectively reach other underserved populations in the U.S., many of whom are reluctant to seek behavioral health services. In this chapter we discuss 1) the state of the literature on the topic of Filipino adolescent mental health disparities; 2) our wicked problem and the impact project aimed at ameliorating this issue; 3) how our team formed and implemented our impact project; 4) outcomes and results of our efforts; 5) challenges we faced and how they were overcome; 6) the leadership and health equity skills that were most helpful in addressing our problem; and 7) a toolkit that could assist other communities addressing youth mental health and prevention of suicide and depression.

Sexual Minority Mental Health

Sexual minority clients are more likely to experience emotional disorders and other psychiatric conditions than the general population. This health disparity is not attributable to an individual's sexual minority identity, but rather, the social milieu that produces a unique set of stigma-related stressors. Therefore, mental health disparities affecting sexual minority communities are best understood through a minority stress framework. This chapter outlines mental health disparities affecting sexual minority communities, tailored evidence-based treatments, and clinical considerations for working with sexual minority clients. We hope this chapter can offer pragmatic guidance on how best to tailor intervention approaches given the unique needs and lived experiences of this population.