Unique and interactive effects of threat and deprivation on latent trait cortisol among emerging adults.

Though considerable work supports the Dimensional Model of Adversity and Psychopathology, prior research has not tested whether the dimensions-threat (e.g., abuse) and deprivation (e.g., neglect)-are uniquely related to salivary trait indicators of hypothalamic pituitary adrenal (HPA) axis activity. We examined the unique and interactive effects of threat and deprivation on latent trait cortisol (LTC)-and whether these effects were modified by co-occurring adversities. Emerging adults (n = 90; Mage = 19.36 years; 99.88% cisgender women) provided salivary cortisol samples four times a day (waking, 30 min and 45 min postwaking, bedtime) over three 3-day measurement waves over 13 weeks. Contextual life stress interviews assessed early adversity. Though the effects varied according to the conceptualization of early adversity, overall, threat-but not deprivation, nor other co-occurring adversities-was uniquely associated with the across-wave LTC. Specifically, the incidence and frequency of threat were each negatively related to the across-wave LTC. Threat severity was also associated with the across-wave LTC, but only among those with no deprivation. Finally, the effects of threat were modified by other co-occurring adversities. Findings suggest that threat has unique implications for individual differences in HPA axis activity among emerging adults, and that co-occurring adversities modify such effects.

Differences in clinical presentations of patients seeking care for treatment-resistant depression across sexual orientations and gender identities.

BACKGROUND: Sexual and/or gender minority (SGM) individuals experience higher rates and greater severity of depressive disorders than non-SGM persons. SGM individuals are more likely than non-SGM individuals to seek mental health treatment and to present to treatment with unique characteristics that should be accounted for when considering treatment recommendations. Patients seeking care for treatment-resistant depression (TRD) are offered a variety of evidence-based interventions ranging in modality and invasiveness (eg, psychotherapy and neuromodulation). METHODS: The current study used data from a TRD clinical research program to examine whether SGM (N = 52) and non-SGM (N = 202) patients differed in their clinical presentations and the treatment recommendations offered to them. RESULTS: We found that SGM patients were younger, had a more severe history of childhood trauma, and reported greater current suicidality than non-SGM patients. There were no significant differences in treatment recommendations between groups. CONCLUSIONS: This study adds to nascent literature investigating clinical characteristics of SGM populations seeking mental health care and provides foundational evidence for the unique treatment considerations necessary for SGM individuals seeking treatment for TRD. Research into whether treatment outcomes differ for SGM and non-SGM individuals with TRD is encouraged, given clinical differences in trauma history and suicidality.

The Roles of Discrimination and Aging Concerns in the Mental Health of Sexual Minority Older Adults.

Purpose: Sexual minority (SM) older adults report poorer mental health than their heterosexual peers. While all older adults can experience age discrimination and other aging concerns (e.g., functional decline), SM older adults also experience sexual orientation-related discrimination and aging concerns (e.g., that they will have to be less open about their sexual orientation to get support as they age). The goals of this study were to examine the roles of (1) sexual orientation and age discrimination and (2) sexual orientation-specific and general aging concerns in depression and anxiety among SM older adults. Methods: As part of a larger study, 477 SM older adults (aged ≥50 years) completed an online survey in September 2021. The majority were gay/lesbian (83%), cisgender men (40%) or cisgender women (34%), and non-Latinx White (39%) or Latinx (34%). Analyses controlled for age, sexual orientation, gender identity, and race/ethnicity. Results: Sexual orientation discrimination and age discrimination were positively associated with depression and anxiety. A significant interaction indicated that sexual orientation discrimination was positively associated with anxiety at low, moderate, and high levels of age discrimination, but the association was strongest at the low level. Sexual orientation-specific and general aging concerns were also positively associated with depression and anxiety. Significant interactions indicated that sexual orientation-specific aging concerns were associated with higher depression and anxiety at low and moderate, but not high, levels of general aging concerns. Conclusions: A range of factors contribute to mental health among SM older adults and there are complex relationships between general and sexual orientation-specific factors.

Psychiatric Diagnoses Among Transgender and Gender Diverse Patients Compared to Cisgender Patients.

Background: Sexual and gender minority persons (ie, those reporting sexual orientation other than heterosexual and gender identity other than cisgender, respectively) experience high rates of various forms of psychopathology. However, discussions of sexual minority populations are often focused on aspects of mental health associated with sexual orientation, with relatively less emphasis placed on transgender and gender diverse (TGD) individuals' mental health. No prior studies have compared psychiatric diagnoses between TGD and cisgender patients presenting for psychiatric treatment in a systematic way using semistructured diagnostic interviews assessing a broad range of disorders.Methods: Between April 2014 and January 2021, we administered semistructured diagnostic interviews for DSM-IV disorders to 2,212 psychiatric patients, 69 of whom reported TGD identity (ie, gender identity other than cisgender such as transgender, genderqueer, or nonbinary identity). The patients completed a demographic questionnaire on which they indicated their assigned sex at birth and their current gender identity.Results: TGD patients had on average more diagnoses than cisgender patients (3.54 ± 1.88 vs 3.04 ± 1.72, t = 2.37, P = .02). After controlling for age, TGD patients were significantly more likely to be diagnosed with posttraumatic stress disorder and borderline personality disorder than cisgender patients (P < .05).Conclusions: To the best of our knowledge, this is the first study of psychiatric patients using semistructured diagnostic interviews to compare the frequency of psychiatric disorders between cisgender and TGD patients. These results bear implications for creating gender-inclusive treatment facilities. Psychiatry programs interested in qualifying as Safe Zones and treating TGD patients should have or develop expertise in treating posttraumatic stress disorder and borderline personality disorder.

An examination of attitudes toward bisexual people at the intersections of gender and race/ethnicity.

People report more negative attitudes toward bisexual than gay/lesbian individuals, but little is known about attitudes at the intersections of gender and race/ethnicity. We examined whether attitudes toward bisexual people differed depending on: 1) target gender identity (man, woman), gender modality (cisgender, transgender), and race/ethnicity (White, Black, Hispanic); and 2) participant gender identity (man, woman) and race/ethnicity (White, person of color). As part of a cross-sectional survey, 552 participants rated their feelings toward 12 bisexual targets who varied in gender identity/modality and race/ethnicity. A repeated-measures ANOVA indicated that participants rated bisexual men more negatively than women, transgender individuals more negatively than cisgender individuals, and Black/Hispanic individuals more negatively than White individuals. However, differences based on target gender identity and race/ethnicity were only observed for cisgender targets, and most effects were only observed for male participants. Efforts to improve attitudes toward bisexual people must account for heterogeneity based on target/participant characteristics.

The Clinical Characteristics of Patients With Borderline Personality Disorder in Different Treatment Settings.

The present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) Project compares patients with borderline personality disorder (BPD) in an outpatient practice (n = 390) and a partial hospital setting (n = 358) on diagnostic comorbidities, symptoms experienced, suicidality, and occupational impairment. The patients in the partial program were diagnosed with significantly more psychiatric disorders and were more frequently diagnosed with dysthymia, generalized anxiety disorder, alcohol and substance use disorders, adjustment disorders, and posttraumatic stress disorder. Those at the partial hospital had significantly higher levels of suicidal ideation than those in the outpatient practice. The samples did not differ on utilization of disability or suicide attempts. Treatment setting may have implications in the recognition of the disorder in clinical practice, the development and support of etiological theories, identification of core deficits, and evaluation of psychosocial morbidity associated with BPD.

Patient satisfaction with partial hospital telehealth treatment during the COVID-19 pandemic: Comparison to in-person treatment.

Most research evaluating telehealth psychiatric treatment has been conducted in outpatient settings. There is a lack of research assessing the efficacy of telehealth treatment in more acute, intensive treatment settings such as a partial hospital. In the face of the COVID-19 pandemic, much of ambulatory behavioral health treatment has transitioned to a telehealth, or virtual, format. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we compared patient satisfaction of partial hospital services delivered via telehealth to in-person treatment provided to patients treated prior to the COVID-19 outbreak. The sample included 240 patients who were treated virtually from May, 2020 to October, 2020, and a comparison group of 240 patients who were treated in the in-person partial program a year earlier. Patients completed self-administered measures of patient satisfaction after the initial evaluation and at the end of treatment. For both the in-person and telehealth methods of delivering partial hospital level of care, patients were highly satisfied with the initial diagnostic evaluation and were optimistic at admission that treatment would be helpful. At the completion of treatment, both groups were highly satisfied with all components of the treatment program and almost all would recommend treatment to a friend or family member. Thus, patient satisfaction was as high with telehealth partial hospital treatment as with in-person treatment.