Social Support as a Mediator of Anti-Bisexual Prejudice and Posttraumatic Stress Disorder Symptoms.

Among sexual minorities, bisexual individuals experience higher rates of victimization and symptoms of PTSD than their lesbian and gay peers as well as heterosexual individuals. Despite these disparities, little work has examined factors contributing to PTSD symptoms among bisexual adults. The current study examined the associations between bisexual-specific minority stress and PTSD symptoms in a sample of adults with bisexual orientation and tested social support as a potential mediator of this association. Participants were 488 adults (378 cisgender women, 49 cisgender men, 61 transgender individuals), ages 18 to 66 years, with bisexual orientation based on identity and/or attraction to multiple genders. Greater anti-bisexual prejudice was associated with greater PTSD symptoms (ß = 0.16) and lower social support (ß = -.16), while accounting for sociodemographics and sexual identity-based victimization. Social support was associated with lower PTSD symptoms (ß = -.25), while accounting for sociodemographics, sexual identity-based victimization, and anti-bisexual prejudice. Mediation analyses indicated that anti-bisexual prejudice was indirectly associated with greater PTSD symptoms through lower social support. Addressing bisexual-specific minority stress and its role in diminishing social support for bisexual individuals represents a critical component of trauma-informed research and intervention development in the bisexual community.

Associations between anti-bisexual minority stress and body esteem and emotional eating among bi+ individuals: The protective role of individual- and community-level factors.

Bisexual individuals experience prejudice specifically related to their bisexual identity, and these experiences may compound extant risk for disordered eating behaviors and body esteem concerns. However, little is known about how sexual minority stress related to bisexual orientation is associated with emotional eating and body esteem. The current study examined the associations between bisexual-specific minority stress and emotional eating and body esteem in a sample of bisexual plus (bi+) adults (including bisexual, pansexual, queer, and those with attractions to more than one gender regardless of identity), and tested the moderating effects of identity centrality, affirmation, and community connectedness as potential protective factors. This study leveraged data from an online survey of 498 adults (77.46% cisgender women; 79.7% White), ages 18 to 64 years (M = 28.5; SD = 9.59). Bisexual-specific minority stress was associated with more emotional eating (ß = 0.15, p = .013) and lower body esteem (ß = -0.16, p = .005), while controlling for sociodemographic characteristics, body mass index, and heterosexist minority stress. This finding remained the same when sensitivity analyses were conducted with participants who identified specifically as bisexual. Identity centrality and affirmation and community connectedness did not demonstrate moderating effects but they had main effects, such that they were positively associated with body esteem (ß = 0.16, p = .001; ß = 0.21, p < .001; ß = 0.13, p = .004, respectively). Results suggest that anti-bisexual minority stress has a unique association with bi+ individuals' emotional eating and body esteem, and identified potential individual- and community-level protective factors for body esteem. These findings inform future research and interventions for this understudied population.

Identity Abuse as a Tactic of Violence in LGBTQ Communities: Initial Validation of the Identity Abuse Measure.

Intimate partner violence (IPV; i.e., physical, sexual, or psychological abuse by a current or former partner) remains a public health concern with devastating personal and societal costs. Lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals are also vulnerable to a dimension of IPV called identity abuse (IA); that is, abuse tactics that leverage systemic oppression to harm an individual. Yet, we know little about its relative prevalence in subgroups of the LGBTQ community. This study developed and evaluated a measure of IA, and explored its prevalence in a sample of 734 sexual minority adults. The sample included women (53.1%), men (27.4%), and transgender or gender nonconforming "TGNC" (19.3%) participants. The majority of participants identified as queer or pansexual (38.7%), then gay (23.6%), lesbian (22.8%), and bisexual (13.6%). Participants completed an online survey that included measures of IA and physical, sexual, and psychological abuse. The IA items formed a unidimensional factor structure with strong internal consistency and construct validity. Nearly one fifth of the sample (16.8%) experienced past year IA and 40.1% reported adult IA. Women experienced greater exposure to IA in adulthood than men, and TGNC participants reported higher rates of IA in adulthood and in the last year compared to their cisgender counterparts. The odds of queer or bisexual participants reporting IA in adulthood were almost three times higher than gay participants, and two times higher than lesbian participants. Findings have implications for advancing assessment of partner abuse in the LGBTQ community, LGBTQ-competent clinical care, and training of practitioners.

Self-Reported Mental and Physical Health Symptoms and Potentially Traumatic Events Among Lesbian, Gay, Bisexual, Transgender, and Queer Individuals: The Role of Shame.

OBJECTIVE: Lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals disproportionately face exposure to potentially traumatic events-adverse experiences that may have a traumatizing effect-and experience shame as a common consequence. Previous research demonstrates associations between shame and psychological and physical health issues among those with exposure to potentially traumatic events in general, with limited attention among LGBTQ individuals specifically. This study determined whether shame partially mediated the relationship between potentially traumatic events exposure and self-reported mental and physical health symptoms among LGBTQ individuals. METHOD: Participants were 218 self-identified LGBTQ individuals who reported experiencing at least one potentially traumatic event (e.g., childhood sexual abuse). Online surveys assessed the type and frequency of potentially traumatic events exposure, shame, self-reported mental health (depression symptoms, posttraumatic stress disorder symptoms, and substance use), and physical health symptoms (sexual risk behavior, somatic symptoms, and chronic health conditions). RESULTS: Greater potentially traumatic events exposure was associated with greater shame, and greater shame was associated with worse self-reported mental and physical health. Potentially traumatic events exposure had a direct effect on self-reported mental and physical health, and shame partially mediated this relationship. CONCLUSION: Shame represents an important and modifiable factor that relates to poor health and may be amenable to change through psychosocial interventions. Given the prevalence of negative self-attribution stemming from potentially traumatic events exposure, in addition to the internalization of stigma among this population, practitioners need to uncover interventions specifically targeting shame when working with LGBTQ individuals.

"PSYCH-PASS": the Development, Adaptation, and Implementation of a Psychiatric Handoff.

OBJECTIVE: The primary purpose of the study was to develop and implement a psychiatry mnemonic PSYCH-PASS for transitions of care in residency training programs. METHODS: The authors examined areas of improvement in the handoff system with residency training administration, service directors, and psychiatry residents to create PSYCH-PASS, a novel mnemonic that could be integrated in the electronic medical record (EMR). The components of PSYCH-PASS are Patient summary, Situational awareness, "whY" is the patient here, Comorbidities, Hemodynamics, Pharmacology/PRNs, Action list, Specifics, and Synthesis. The authors developed a 14 question pre- and post-survey with a 4-point Likert scale measuring five categories. RESULTS: Pre-survey and post-surveys completed by post-graduate year 2 and 3 residents at Montefiore Medical Center (n = 24) noted increased satisfaction, handoff efficiency, handoff efficiency, accessibility, accuracy, communication, awareness, and adherence to PSYCH-PASS, along with a decrease in frequency of errors. CONCLUSIONS: With promising results across a range of metrics indicating resident-reported positive impacts on patient care, further research on the implementation of PSYCH-PASS and its integration into EMR systems is merited. Future directions include gathering objective data from Epic and expansion of the initiative to other psychiatric services and institutions.

Perceived Discrimination, Coping Mechanisms, and Effects on Health in Bisexual and Other Non-Monosexual Adults.

Bisexual individuals experience unique discrimination related to their sexual orientation, which may increase their risk of adverse health outcomes. The study goal was to investigate how bisexual and other non-monosexual individuals experience discrimination, understand how they perceive discrimination to affect their health, and examine the ways in which they cope with discrimination by analyzing responses to open-ended survey questions. The sample included 442 bisexual and other non-monosexual adults, ages 18-68 years (M = 28.97, SD = 10.30), who either reported a bisexual identity or reported attractions to more than one gender. Gender identities included women (n = 347), men (n = 42), and transgender/non-binary individuals (n = 53); 29% of participants were currently located outside of the U.S. Participants completed an online survey, including three open-ended questions regarding their experiences with discrimination, how discrimination affects their health, and methods used to cope with discrimination. Themes related to perceived discrimination included: double discrimination of bisexuals and other non-monosexual individuals by heterosexuals, lesbian and gay individuals; bisexual invalidation and erasure; and sexual victimization. Themes related to the perceived effects of discrimination on health included: impact on mental health; impact on physical health; and effect of discrimination in healthcare. Themes related to coping with discrimination included: social support; resilience; and identity-specific media consumption. Findings demonstrate that bisexual and other non-monosexual individuals' experiences of discrimination can be additive, based on other marginalized facets of identity, including race/ethnicity, gender, and socioeconomic status. Our findings have implications for advancing bisexual health research from an intersectionality framework.

Psychometric validation of the identity abuse scale among LGBTQ individuals.

Identity abuse (IA) comprises a set of abuse tactics that exploit discriminatory systems including homophobia, biphobia, and transphobia (Tesch & Berkerian, 2015). This study examined the factorial validity of the IA Scale (Woulfe & Goodman, 2018) with a large independent sample of lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals. Participants included 1,049 LGBTQ-identified participants (Mage  = 27.3, 71.9% White, 52.6% cisgender women, and 18.7% as other nonheterosexual identity in their sexual orientation), recruited through listservs. Participants completed an online survey measuring past-year and adult exposure to identity, physical, and psychological abuse. Confirmatory factor analysis indicated that the measurement model had good fit to the data, and strong factor loadings were found across the seven items, confirming a unidimensional factor structure. Findings demonstrate the IA Scale's validity and reliability, supporting its use to assess the frequency of IA tactics experienced within intimate partnerships among LGBTQ individuals.

We're Here and We're Queer: Sexual Orientation and Sexual Fluidity Differences Between Bisexual and Queer Women.

Theorists and researchers have noted an overlap between bisexually-identified and queer-identified individuals. Whereas early definitions of bisexuality may have been predominantly binary (i.e., attracted to women and men), in recent years there has been a move toward a more "queer" understanding of bisexuality (e.g., attraction to more than one gender beyond female and male). The purpose of this study was to examine similarities and differences between bisexually-identified and queer-identified adult women, ages 18-66 years, on sociodemographic characteristic, two dimensions of sexual orientation (sexual behaviors and attractions), fluidity in attractions and sexual orientation identity, and identity centrality and affirmation in an online sample (N = 489), which was mostly from the United States (73.5%). Our results indicated that bisexual and queer women were similar in terms of sociodemographic characteristics, with the exception of education; queer women were more educated than bisexual women. Queer women were also more likely than bisexual women to report variability in their sexual behaviors and attractions and more fluidity in their sexual orientation identity. Additionally, queer women reported higher levels of identity centrality and affirmation than bisexual women. Considerations for sexual minority women's health research are discussed.

Bisexual-Specific Minority Stressors, Psychological Distress, and Suicidality in Bisexual Individuals: the Mediating Role of Loneliness.

Bisexual individuals are at higher risk for poor mental health outcomes compared to heterosexual as well as lesbian and gay individuals and experience minority stressors, such as discrimination, from both heterosexual and sexual minority communities. However, there is little research examining the negative effects of bisexual-specific minority stressors on bisexual individuals' mental health as well as psychological factors that might help explain minority stressors' deleterious effects. This research examined the effects of distal minority stressors (i.e., anti-bisexual experiences from both heterosexual as well as lesbian and gay people) and proximal stressors (i.e., internalized heterosexism and sexual orientation concealment) on psychological distress and suicidality among bisexual adults (N = 503). Building on the relational framing of the minority stress model, we also tested one relational factor (i.e., loneliness) as a mediator of the associations between distal and proximal minority stressors and poor mental health (i.e., psychological distress and suicidality). Structural equation modeling analyses were used to test the mediating effects of loneliness on the associations between minority stressors and psychological distress and suicidality. Although distal and proximal minority stressors were not associated with each other, loneliness mediated the effects of distal and proximal minority stressors on psychological distress and suicidality. The results of this study underscore the importance of targeting bisexual-specific minority stressors as well as loneliness in preventive interventions to improve the mental health of bisexual individuals.

Associations of Bisexual-Specific Minority Stress and Health Among Cisgender and Transgender Adults with Bisexual Orientation.

Among sexual minorities, bisexuals are at the greatest risk for poor health due in part to prejudice and stigma. This research examined associations of bisexual-specific minority stress and health among cisgender (non-transgender) and transgender adults with bisexual orientation. Participants were 488 adults (378 cisgender women, 49 cisgender men, 61 transgender individuals), age 18 to 66 years, with bisexual orientation based on identity and/or attractions to multiple genders. Participants completed an online survey. Hierarchical linear regression analyses were conducted with sexual minority stress and bisexual-specific minority stress as the predictors and physical health, measured by the 36-Item Short Form Survey (SF-36), as the outcome. Models controlled for demographic variables. Moderation analyses were conducted to test for gender differences. Greater bisexual-specific minority stress significantly predicted poorer overall physical health (ß = -0.16), greater pain (ß = -0.16), and poorer general health (ß = -0.25) above and beyond the effects of sexual minority stress. Gender moderated the association between bisexual-specific minority stress and health, such that bisexual-specific minority stress predicted overall physical health and role limitations for transgender individuals but not for cisgender women. Addressing bisexual-specific minority stress is necessary to improve the health and well-being of bisexual individuals.

Bringing a Network-Oriented Approach to Domestic Violence Services: A Focus Group Exploration of Promising Practices.

Despite powerful evidence that informal social support contributes to survivors' safety and well-being, mainstream domestic violence (DV) programs have not developed comprehensive models for helping isolated survivors re-engage with these networks. Although many advocates use network-oriented strategies informally, they often do so without resources, funding, or training. This qualitative focus group study explored advocates' use and perceptions of network-oriented strategies. Advocates working in a range of DV programs across one state described the importance of network-oriented work and articulated its five dimensions, including helping survivors build their capacity to form healthy relationships, identify helpful and harmful network members, re-engage with existing networks, develop new relationships, and respond more effectively to network members.

Survivor-Defined Practice in Domestic Violence Work: Measure Development and Preliminary Evidence of Link to Empowerment.

Survivor-defined practice, characterized by an emphasis on client choice, partnership, and sensitivity to the unique needs, contexts, and coping strategies of individual survivors, is an aspirational goal of the domestic violence (DV) movement, assumed to be a key contributor to empowerment and other positive outcomes among survivors. Despite its central role in DV program philosophy, training, and practice, however, our ability to assess its presence and its presumed link to well-being has been hampered by the absence of a way to measure it from survivors' perspectives. As part of a larger university-community collaboration, this study had two aims: (a) to develop a measure of survivor-defined practice from the perspective of participants, and (b) to assess its relationship to safety-related empowerment after controlling for other contributors to survivor well-being (e.g., financial stability and social support). Results supported the reliability and validity of the Survivor-Defined Practice Scale (SDPS), a nine-item measure that assesses participants' perception of the degree to which their advocates help them achieve goals they set for themselves, facilitate a spirit of partnership, and show sensitivity to their individual needs and styles. The items combined to form one factor indicating that the three theoretical aspects of survivor-defined practice may be different manifestations of one underlying construct. Results also support the hypothesized link between survivor-defined practice and safety-related empowerment. The SDPS offers DV programs a mechanism for process evaluation that is rigorous and rooted in the feminist empowerment philosophy that so many programs espouse.

Emerging adults' lived experience of formative family stress: the family's lasting influence.

In this article, we use a phenomenology framework to explore emerging adults' formative experiences of family stress. Fourteen college students participated in a qualitative interview about their experience of family stress. We analyzed the interviews using the empirical phenomenological psychology method. Participants described a variety of family stressors, including parental conflict and divorce, physical or mental illness, and emotional or sexual abuse by a family member. Two general types of parallel processes were essential to the experience of family stress for participants. First, the family stressor was experienced in shifts and progressions reflecting the young person's attempts to manage the stressor, and second, these shifts and progressions were interdependent with deeply personal psychological meanings of self, sociality, physical and emotional expression, agency, place, space, project, and discourse. We describe each of these parallel processes and their subprocesses, and conclude with implications for mental health practice and research.

Multisector partnerships in population health improvement.

Many new initiatives for population health improvement feature partnerships of leaders and organizations across multiple sectors of society. The purpose of this article is to review 1) the rationale for such partnerships as an important, if not essential, tool for population health improvement; 2) key organizational and contextual factors that appear to be associated with effective multisector partnerships; and 3) the limited evidence regarding the effect of such partnerships on population health outcomes. We conclude that systems thinking - accounting for the collective effect of many actors and actions - is essential to organizing and sustaining efforts to improve population health, and to evaluating them. More research is needed to understand how and why multisector partnerships are formed and sustained and the conditions under which multisector partnerships are necessary or more effective than other strategies for population health improvement. Research on and evaluation of multisector partnerships also need to incorporate more standard measures of partnership contexts, characteristics, and strategies and adopt longitudinal and prospective designs to accelerate social learning in this area. Finally, studies of multisector partnerships must be alert to the value of such initiatives to individuals and communities apart from any direct and measurable impact on population health.