What Do LGBTQ+ Medical Students Experience and Need in Medical School? A Multicenter Qualitative Study in Thailand.

PURPOSE: This study evaluated the experiences and needs of lesbian, gay, bisexual, transgender, queer, and other sexual and gender minorities (LGBTQ+) attending medical schools in Thailand. METHOD: Medical students from 4 medical schools in Thailand were recruited in 2022. LGBTQ+ participants were selected via purposive sampling and invited for semistructured interviews. Verbatim transcripts were analyzed using reflexive thematic analysis. RESULTS: Interviews were conducted with 39 students identifying as lesbian, gay, bisexual, transgender, queer, questioning, nonbinary, asexual, or androgynous, with a mean age of 21. The experiences of these LGBTQ+ individuals in medical school had 4 themes: (1) normalization of LGBTQ+ identity among friends, or not openly identifying as LGBTQ+ (because it was viewed as unnecessary), facilitated everyday life; (2) fear of negative judgments from being LGBTQ+ by attending physicians and patients; (3) authenticity to sexual or gender identity provided relief; and (4) personal histories of discrimination affected self-disclosure and social dynamics. Overall, approximately 17% of reported stressors were directly associated with participants' LGBTQ+ identity. The identified needs within medical schools comprised 2 themes: (1) treat each other with equal respect (with 3 subthemes: nonjudgmental attitudes supported by effective discrimination reporting systems; more LGBTQ+-related education and extracurricular activities; and activities driven by voluntariness without gender-based selection); and (2) abolishment or amendment of regulations that strictly enforce gender binaries. These amendments could include implementing flexible dress codes, establishing gender-neutral restrooms and dormitories, and introducing gender-neutral titles. Transgendered participants reported experiencing the most significant disparities due to binary regulations and infrastructures. CONCLUSIONS: LGBTQ+ medical students in Thailand reported fear of negative perceptions by attending physicians and patients. Exposing everyone, particularly attending physicians, to examples of unintentional discrimination is recommended. There is also a need to promote LGBTQ+-related education and extracurricular activities and to ensure activities and regulations are not gender-divided.

Perceived attitudes toward LGBTQ + physicians among individuals with psychiatric illness in the religiously diverse Southern Region of Thailand: a multihospital-based survey.

OBJECTIVES: This study purposed to analyze perceived attitudes toward LGBTQ + physicians and related factors among individuals with psychiatric illnesses in southern Thailand. MATERIALS AND METHODS: From May to July 2023, a cross-sectional study was conducted at four psychiatric outpatient clinics in Southern Thailand. The questionnaires utilized were: 1) a demographic information questionnaire, 2) a questionnaire regarding attitudes toward LGBTQ + physicians, 3) a questionnaire evaluating individuals' attitudes toward LGBTQ + physicians while receiving medical attention, and 4) a patient-doctor relationship questionnaire. All data were analyzed using descriptive statistics, and the factors associated with perceived attitudes toward LGBTQ + physicians were analyzed using the Wilcoxon rank sum test, the Kruskal-Wallis test, and linear regressions. The analyses were conducted using the R Foundation for Statistical Computing software, version 4.3.1. Statistical significance was defined as a p-value of less than 0.05. RESULTS: Among our 542 participants, the mean age was 36.3 ± 14.1 years. The majority were female (64.6%), Buddhist (62.4%), and diagnosed with depression (46.3%). Approximately three-quarters showed a good doctor-patient relationship (74.0%). The median (IQR) score of the perceived attitudes toward LGBTQ + physicians was 75 (66, 88). Predominantly, the LGBTQ + physicians were perceived as normal (76.3%) and being a viable part of society (88.7%). Moreover, our participants disagreed with the view that being an LGBTQ + physician was a sin (70.6%) or immoral (68.2%). They felt comfortable during history taking (79.0%), physical examination not involving private parts of the body (72.5%), and management for both medical (78.4%) and psychiatric conditions (81.4%) at the hands of LGBTQ + physicians. However, they reported feeling uncomfortable during history taking involving private matters (6.3%) and the physical examination of private parts (16.4%). Older age, absence of LGBTQ + close relatives/friends, and being a Muslim were associated with lower scores of perceived attitudes toward LGBTQ + physicians. Conversely, a higher level of education and a reported mismatch between the patient's sex and gender were associated with higher scores. CONCLUSIONS: Most participants reported positive perceived attitudes toward LGBTQ + physicians. However, some age groups and adherents of Islam showed lower perceived attitude scores and reported feeling uncomfortable receiving medical treatment from LGBTQ + physicians. On the one hand, LGBTQ + physicians have cause to be concerned about this point; on the other hand, finding appropriate approaches to promote positive attitudes toward LGBTQ + physicians among these groups of people remains a necessity.

Sexual Behaviors Among Lesbian, Gay, Bisexual, Transgender, and Other Sexual and Gender Diverse Medical Students: A National Study of Thai Medical Schools.

Objective: This study aims to investigate sexual behaviors among gender diverse (LGBT and other sexual/gender minorities) and nongender-diverse medical students. Methods: In 2021 academic year, medical students from five Thai medical schools completed questionnaires identifying demographic data, psychosexual factors, sexual experiences, and risks. Results: Among 1,322 students, 32.1% were gender-diverse students who had lower age at first sexual intercourse and more experiences in solitary and partnered sexual activity. Conclusions: Use of hookup applications was more frequent among gay and bisexual males. Risky sexual behaviors were significantly higher among bisexual females. Gender-diverse medical students showed higher involvement in sexual activities. Future studies should be addressing sexual health in Thai medical education.

The association between physical activity and prevalence of anxiety and depression in medical students during COVID-19 pandemic: A cross-sectional study.

BACKGROUND: The COVID-19 pandemic has affected medical students both physically and mentally. Medical students have had to take online classes, which may have decreased their physical activity (PA) and increased their risk of mental health. This research aimed to explore the association between mental health problems and PA levels. MATERIALS AND METHODS: A cross-sectional study was conducted on 1st-6thyear medical students, at a university in Southern Thailand; from September to October 2021. The participants completed online questionnaires; including, demographic data, Global Physical Activity, PHQ-9 and the GAD-7 questionnaire. The association between PA levels and mental health was assessed using ordinal logistic regression. RESULTS: Among 325 medical students, 42.8% were males and 51.1% were clinical medical students. The prevalence of moderate to severe depression and anxiety was 31% and 12.9%. In total, 49.7% of participants had low PA levels. Pre-clinical students had a higher risk of depression (OR 2.11 p-value 0.001) and anxiety (OR 2.20 p-value 0.045) than clinical students. We also found that moderate or high PA levels were not a significant factor with mental health status (p-value of depression 0.447, 0.823 and p-value of anxiety 0.362, p-value 0.574, respectively). CONCLUSION: There were a lot of medical students with moderate to severe depression and anxiety, and about half of those had low PA levels; especially, pre-clinical students that learned online study activities. There was no significant association between PA levels and mental health status. However, the faculty should reconsiderate their medical student to increase physical activities and redesign the curriculum to support their students during these challenging times.

Stress and associated factors with received and needed support in medical students during COVID-19 pandemic: a multicenter study.

PURPOSE: The coronavirus disease 2019 (COVID-19) pandemic is a global health crisis that has impacted daily life due to the policies created to contain the outbreak. Recent studies showed that medical students, a high-stress population, experienced deteriorated mental well-being during the pandemic. The aim of the present study was to assess stress and the need for support among Thai medical students during the COVID-19 pandemic, as a multicenter study. METHODS: The present study was a cross-sectional questionnaire-based study which collected data from second through sixth year medical students. Data was collected during the pandemic from multiple medical schools spanning all six regions of Thailand. Questionnaires included: demographic data; the Thai version of the Perceived Stress Scale-10 (T-PSS-10) assessing stress level and the sources of stress; and the received supports from medical schools, the satisfaction with the supports, and the further necessary needs. RESULTS: There were 1,395 medical students who responded to the questionnaires. Mean T-PSS-10 score was 17.8. Most of the sources of stress were related to the changing of teaching and evaluation system. Students residing in larger medical schools were significantly more satisfied with received support and tended to gain greater support than those in medium and small sized schools. Stress-relieving activities arrangement was considered the most sought after additional support by students. CONCLUSION: Medical student stress levels were higher during the pandemic compared to pre-pandemic levels. Stress relieving activities, availability and access to mental health resources, and other strategies to reduce stress among medical students are urgently needed.

Association between Social Support and Frailty among Older People with Depressive Disorders.

OBJECTIVES: This study aimed at examining the association between social support and frailty status, specifically amongst older people with depressive disorders. METHODS: It was conducted in older people, aged 65 and over, with depressive disorders at the Psychiatry Outpatient Unit of Songklanagarind Hospital, Thailand. The main independent variable, level of social support, was assessed using the Inventory of Social Support Behaviors (ISSB) - Thai. The main dependent variable, frailty status, was assessed via the adapted Fried Frailty Phenotype. Bivariate and ordinal regression analyses were conducted to examine the relationships between variables. RESULTS: In our study sample, 32% of the 147 participants were considered frail, 51% pre-frail, and 17% robust. From the ordinal regression analysis, four variables - social support score, current depressive symptoms, level of education, and key family caregivers - were statistically significantly associated with frailty status. The odds of having pre-frailty and frailty were statistically significantly reduced by a factor of 0.99, or around 1.0 percent, for each 1-point increment of the social support scale (Ordinal OR 0.99, 95% CI = 0.97-0.99, p-value = 0.015). CONCLUSIONS: Social support interventions should be designed to influence multiple items of the social support scale at the same time, which might, therefore, have a substantial effect on frailty status among the older population. CLINICAL IMPLICATIONS: We recommend a regular practice that focuses not only on biological (i.e., prescribing medications) and psychological aspects (i.e., providing psychotherapy) but also on the social dimension of older people living with frailty and depressive disorders.