Social stressors and mental health Social stressors contribute to increased rates of mental health issues, suicide, substance abuse, obesity, and victimization in this population. Chronic stress resulting from stigma, discrimination, and prejudice in the social environment has been referred to as minority stress and is a topic of interest in sexual minority individuals. 35 One frequently used framework for understanding the factors involved in the health disparities experienced by members of the LGBTQ community is the minority stress model. 37 Meyer 37 identifies the processes of minority stress, as related to LGBTQ populations, as having distal to proximal factors. These factors include experiencing external objective stressors, expecting such events to take place and the vigilance this expectation entails, and internalizing negative attitudes. Individual response to stressors varies as do stress- relieving factors. Many minority groups respond with group solidarity, which serves to support the morale and protect individuals from adverse stressors. 37 When a person does not have access to group-level resources, it can lead to increased stress and alienation. Mental health issues are prevalent among LGBTQ people of all ages. Much of the risk for mental health conditions is thought to result from discrimination, bullying, violence, and loss of support. LGB identified youth were more than eight times more likely to have attempted suicide if their family rejected them than LGB peers with low or no level of family rejection.38 LGB individuals have a two-to-six-time higher lifetime risk of suicide and/or depression. 39 A 2015 US study on transgender individuals found that 81.7% contemplated suicide and 40.4% had attempted suicide at some point. 39 In addition to risk factors common to the non-transgender public, elevated risks of suicidal thoughts and attempts were more likely among transgender people who report heavy substance use, have poor general health, have a disability, or have experienced recent homelessness or an arrest. 39 In addition to stress and mental health issues, people who identify as LGBTQ are at risk for misuse of tobacco, alcohol, and other substances. In 2016, the Centers for Disease Control and Prevention (CDC) reported that 20.5% of LGB adults smoked compared to 15.3% of heterosexual adults. 40 This report means that about one LGB adult in five is a person who smokes. While limited information exists on transgender tobacco use, it is reported to be higher Medical risk factors Although cardiovascular deaths have declined since 2010 in the US, there remain significant differences in cardiovascular death rates based on race, sex, and income. 48,49 Caceres and colleagues 50 found that sexual minority persons experienced a higher prevalence of elevated cardiovascular (CVD) risk because of largely modifiable conditions than their heterosexual peers. For women, these risks included tobacco, alcohol, and illicit drug use, mental health issues, and elevated body mass index. For men, the risks were tobacco use, illicit drug use, and poor
than among the general population. 40 Although actual substance abuse rates are unknown, the Substance Abuse and Mental Health Services Administration (SAMHSA) reports rates of 20% to 30% vs. 9% for the general population. 41 In 2019, 7.6 million LGB adults > 18 had a mental health or substance use disorder. That figure is a 20.5% increase from 2018. 42 Although, historically, intimate partner violence has not been widely recognized or reported among the LGBTQ population, studies show that it is experienced as frequently or more frequently by LBGTQ individuals compared to those who identify as cis-gender. 43 Clinicians should include gender- neutral screening tools, such as the Partner Violence Screen, and be prepared with appropriate resources for positive screening results. 6 Violence against transgender people, especially transgender women of color, continues to occur in the United States. People who identify as transgender are 2.2 times more likely to experience physical IPV and 2.5 times more likely to experience sexual IPV compared to those who identify as cisgender. 44 Social stigmatization and other factors may lead to an under-reporting of acts of violence committed against transgender people. 44 Findings from several studies illustrate the seriousness of criminal and interpersonal violence in transgender communities: ● The Human Rights Campaign began tracking fatal violence against transgender people in 2013. In 2020, 44 transgender or gender non-conforming people were killed. In November of 2021, 47 fatalities had already been recorded. 45 ● In 2016, the National Coalition of Anti-Violence Programs received information on 1,036 incidents of hate violence from 12 antiviolence organizations across the United States. The information showed 21% self-identified as transgender women and 5% as transgender men. 46 Despite the known risk, 13 states do not have hate crime laws that cover sexual orientation or gender identity, and four states and three US territories do not have hate crime laws at all. In addition, only 12 states require hate crime training for law enforcement that includes crimes based on sexual orientation or gender identity. 47 Moreover, 20 states and five territories do not require hate crime data collection, 47 suggesting that the true crime numbers are higher. mental health. 50 Repeat exposure to interpersonal stress (discrimination, family rejection, expectation of stigma), general stress (financial, life adversity, childhood trauma), and the potential for additional physical stress from hormone or antiretroviral treatments, combined with risks of tobacco, illicit drugs, excess alcohol, and elevated BMI, are believed to increase CVD risk. These findings were based on subjective data rather than physical markers and show the need for further research. According to Caceres and colleagues, 49 cardiovascular health research in
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Book Code: CT24CME
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