Mental health among LGBTQ+ communities in the context of COVID-19

Rates of anxiety, depression, and suicidality have long been known to be elevated among LGBTQ+ communities and it was expected that the COVID-19 pandemic would deepen systemic injustices and inequities in mental health outcomes. However, it remains difficult to document inequities as surveillance systems do not typically capture LGBTQ+-inclusive data necessary to study the impact of COVID-19 on LGBTQ+ population health. This chapter reports on two studies designed to address this gap. The COVID-19 Impacts Study (CIS) documented the early mental health and social impacts of COVID-19 among sexual and gender minority adults, as well as adults with HIV, during the first round of shut-downs and initial economic disruptions. Subsequently, the Youth and Young Adults COVID-19 Study (YYA) measured the impacts of COVID-19 on the mental health outcomes, testing/vaccination behaviors, and stigmatization experiences of LGBTQ+ and BIPOC (Black, Indigenous, People of Color) young people. Several recommendations are discussed-including mandated collection of data on sexual orientation and gender identity in all surveillance systems, policy solutions to better address access and cost barriers, and deep and meaningful engagement that empowers communities. © 2023 The authors.

Assessing widening disparities in hba1c and systolic blood pressure re-testing during the COVID-19 pandemic in LGBTQ+ focused federally qualified health centers in Chicago

Introduction: The COVID-19 pandemic caused disruptions in the health services delivery, especially among vulnerable populations. We assessed if the pandemic widened disparities in care for cardiometabolic conditions in a LGBTQ+-focused federally qualified health system in Chicago. Hypothesis: Disparities in monitoring cardiometabolic conditions present in 2019 worsened in 2020. Methods: We analyzed electronic health records from Howard Brown Health. We assessed HbA1c re-testing and control (≤9%) in 2019 and 2020 among people with diabetes (DM) and ≥1 HbA1c test in the prior year (2018 for 2019, 2019 for 2020) (n2019=818, n2020=1033). A similar assessment was done for hypertension (HTN) with systolic blood pressure (SBP) (n2019=2813, n2020=3660). Comparisons per demographic group per year were done using logistic regression adjusting for socio-demographic variables. Results: Re-testing rates declined from 2019 to 2020 for both HbA1c and SBP overall and across all groups. Adjusted analysis showed gay people with DM had higher rates of HbA1c re-testing than people of other sexual orientations in 2019 and experienced a significantly lower re-testing rate decline in 2020. Adjusted analysis for SBP showed that white (vs Hispanic) and straight (vs gay) people with HTN had lower SBP re-testing rates in 2019 and 2020. Rates of controlled SBP (<140mmHg), but not HbA1c (≤9%), declined from 2019 to 2020. Adjusted analyses showed that straight (vs gay) patients had lower controlled HbA1c and SBP rates. Cis males (vs trans males) had lower controlled SBP and white (vs Asian/other) had lower controlled HbA1c. These disparities did not worsen in 2020. Conclusion: The pandemic had mixed impacts on cardiometabolic service disparities in a large LGBTQ+-focused health system. Disparities by sexual orientation for HbA1c widened during the pandemic. Similar worsening was not found for systolic blood pressure, nor for other demographic groups.