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Increased Risk Of Subjective Cognitive Decline In The LGBT Community

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New research reported at the Alzheimer’s Association International Conference 2019 in Los Angeles found higher rates of subjective cognitive decline among lesbian, gay, bisexual and/or transgender Americans compared to their cisgender heterosexual counterparts. In the study, subjective cognitive decline (SCD) was defined as self-reported confusion or memory problems that have been getting worse over the past year.

Another study presented at AAIC 2019 investigated the effectiveness of a first-of-its-kind Alzheimer’s intervention designed specifically to improve physical function and independence for LGBT older individuals with dementia and their caregivers. The study, conducted by researchers at the University of Washington, showed the importance of tailored interventions and strong community partnerships in designing care for LGBT individuals.

“Much too little is known about Alzheimer’s disease and dementia in the LGBT community. In fact, the first data on the prevalence of dementia among sexual and gender minorities was reported only last year at AAIC 2018,” said Maria C. Carrillo, PhD, Alzheimer’s Association chief science officer.

“As expanding research efforts continue to teach us more about the variability of Alzheimer’s and other dementias — for example by sex, race, genetics and exposure to environmental factors — the Alzheimer’s Association will fund, and encourage others to fund, more studies in LGBT and other diverse populations,” Carrillo added.

Increased Risk for Subjective Cognitive Decline Among Sexual and Gender Minorities

Few studies have investigated the symptoms and disease progression of Alzheimer’s and other dementias in the LGBT community. To examine these associations, Jason Flatt, PhD, MPH, assistant professor at the Institute for Health & Aging at the University of California, San Francisco, and colleagues analyzed data from the 2015 Behavioral Risk Factor Surveillance System (BRFSS), a large phone-based survey led by the Centers for Disease Control and Prevention.

The study analyzed data from 44,403 adults aged 45 and older across nine states in the U.S. (Georgia, Hawaii, Illinois, Minnesota, Nevada, Ohio, Virginia, West Virginia and Wisconsin) that participated in the 2015 BRFSS optional modules on the Healthy Brain Initiative, which included subjective cognitive decline and Sexual Orientation and Gender Identity. Roughly three percent of participants (1,253) identified as a sexual or gender minority (SGM). Subjective cognitive decline was defined as self-reported confusion or memory problems that have been getting worse over the past year.

The researchers found that more than 14% of SGM participants reported subjective cognitive decline, significantly higher (p<0.0001) than the 10% rate among cisgender heterosexual participants. Even after adjusting for factors such as income, age and race, SGM participants were 29% more likely to report subjective cognitive decline. More research is needed to understand why subjective cognitive decline may be higher in SGM individuals.

“Given that 1 in 7 adults who identified as a sexual or gender minority reported subjective cognitive decline, it is critical that more opportunities exist for people in these communities to receive regular evaluation for cognitive impairment and Alzheimer’s disease,” Flatt said. “There is also a need for greater education on Alzheimer’s risk, signs and symptoms, and training of health care providers to ensure inclusive and welcoming care for LGBTQ+ populations.”

“While we do not yet know for certain why sexual or gender minority individuals had higher subjective cognitive decline, we believe it may be due to higher rates of depression, inability to work, high stress, and a lack of regular access to healthcare,” Flatt added.

According to Flatt, less than half of SGM adults with SCD in the study talked to their health care provider about it. SGM adults with SCD were also more likely to report that they had to give up day-to-day activities (39% vs. 29%, p=0.003) and needed help with household tasks (44% vs. 35%, p=0.01) than cisgender heterosexual participants. Both groups were similar in terms of talking to their health care provider about their subjective cognitive decline.

First Study of an LGBT-Specific Alzheimer’s and Dementia Intervention

To advance research into Alzheimer’s in the LGBT community, Karen Fredriksen-Goldsen, PhD, professor and director of Healthy Generations Hartford Center of Excellence at the University of Washington, created the Aging with Pride: Innovations in Dementia Empowerment and Action (IDEA) study. A multisite study in Seattle, San Francisco, and Los Angeles, Aging with Pride: IDEA is the first federally-funded study dementia intervention specifically designed for LGBT older adults with dementia and their caregivers.

The researchers had previously identified unique risk factors of LGBT older adults living with dementia through the first longitudinal study of this population (Aging with Pride: National Health, Aging, and Sexuality/Gender Study). Using longitudinal data with three time points (2014, 2015 and 2016), modifiable factors predicting physical functioning and quality of life (QOL) among LGBT older adults with dementia (n=646) were identified.

LGBT older adults living with dementia were significantly more likely to live alone (nearly 60%), not be partnered or married (65%), not have children (72%), and not have a caregiver (59%), when compared to older non-LGBT adults living with dementia. Previous experiences of discrimination and victimization (b=-0.19, p<.001) were negatively associated with QOL among LGBT older adults living with dementia. Socializing with friends or family (b=1.11, p<.05) was positively associated with QOL, and physical activity (b = 0.26, p<.001) were associated with better physical functioning.

As reported at AAIC 2019, Aging with Pride: IDEA includes a tailored approach in which trained coaches identify and modify challenging behaviors that are adversely affecting older adults living with dementia and their caregivers, either of whom are LGBT. The coaches delivered an individualized program of exercise, and behavioral and coping strategies designed to improve physical function, independence and QOL.

The exercise intervention is a low-impact physical exercise program including nine one-hour sessions over six weeks designed to improve physical functioning and maintain independence. The behavior and coping strategies include: techniques for working with LGBT-specific trauma, identity management and disclosure of their LGBT identities to providers and others, plus support engagement in the LGBT community and dementia services. Testing of the intervention is now underway and will be delivered to 225 pairs of LGBT older adults living with dementia and their caregivers.

“Given their lifetime experiences of victimization, discrimination and bias, many LGBT older adults forgo seeking needed medical care,” said Fredriksen Goldsen. “LGBT people living with dementia and their caregivers often have difficulty accessing information and support services, which can be especially challenging when memory loss and dementia enter the equation.”

Source: Press release

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Mental Health

Sex Addiction Or A Good Time: A Conversation With Sexpert Robert Weiss On Gay Male Sexuality

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Recently I attended the second annual Contemporary Relationships Conference held here in Austin.  The conference focused on topics specific to LGBTQ+ relationships and families; and this year the keynote speaker was Robert Weiss, LCSW, CSAT-Supervisor.  Weiss is an expert on addictions (he is the Senior Vice President of Clinical Development with Elements Behavioral Health) and technology.  His book, “Cruise Control: Understanding Sex Addiction in Gay Men” is already in its second edition.  Being a straight-friendly therapist, who works with clients around sexual functioning, I was ecstatic that Weiss agreed to sit down with me and speak about his work after his presentation.

When we sat down to talk about sex addiction and gay men, the first thing we acknowledged was how challenging it can be to talk about this topic because of stigma.  Many gay men have experiences of the world trying to make them feel shame for simply loving other men.  Laws, religion and families are only some of the sources of judgment.  Once a man develops pride and overcomes the irrationality of internalized shame, it can be difficult to have any discussions about healthy sexuality because those conversations echo of past judgement.

As a sex-positive person, I believe that sex can be healthy, good and fun in its many forms.  From monogamous to open, alone or in groups, vanilla to kink; do your own thing.  As long as it is consensual (animals and minors are unable to consent), non-coercive, and connecting (you to yourself or your partners).  So the first question Weiss and I explored is:

What is sexual addiction and what is a good time?

Weiss explained that he is also sex positive and that there are a number of indicators that distinguish sexual addiction from a healthy sexual appetite.  One factor is a person’s functioning.  Is the person able to have the life he wishes to have or is sex a hindrance to his goals?  For example, if a career-driven individual is consistently unable to accomplish duties at work because he is compulsively cruising Grindr then his functioning may be a concern.  Weiss went on to note that sexual addiction usually includes: shame, secrecy, hiding, self-hatred and denial.  Elements that are not typically a part of a healthy sexuality.  A man who struggles to keep commitments with friends because he gets caught up edging himself to porn in his free time will likely hide his behavior when talking to his friends about the reason for his absence.  Where healthy sexuality is about connecting to ourselves or our partners, sexual addiction is about escaping difficult feelings through obsessing about sex and acting on that obsession.  Successful treatment of sexual addiction is not about stopping sex or becoming a eunuch; according to Weiss the goal is sexual integrity.  That means feeling good about the sex we have with our partners and ourself with limited impediment of our professional and personal pursuits.

In his book, “Cruise Control: Understanding Sex Addiction in Gay Men” Weiss noted technology’s role in increasing the number of sex addicts. Prior to the internet there where a number of steps and risks involved in obtaining pornography.  A person would have to drive to sex shops where he would risk being seen and need to have money to purchase or rent materials.  Over time, pornography and dating sites (including apps) became more easily accessible (thank you smartphones) at little to no cost, while offering users anonymity.  This has increased number of people struggling with sexual addiction.  Weiss told me during our interview that we’d see an increase in cocaine addiction if one day every medicine cabinet in America magically had free cocaine in it.  Since technology has lead to more sexual addiction, I wondered:

How technology might help those in recovery from sex addiction?

Weiss noted how technology has made it easier for people to connect with each other, as well as resources to manage sexual addiction.  Folks in recovery from sexual addiction are able to maintain a consistent core support group via technology (such as Skype) no matter where their lives might take them. Recovery in rural areas is easy when a person doesn’t have to drive two hours to a larger city to attend a Sex Addicts Anonymous meeting.

As we finished up our chat I was interested in any new work that might be interesting.  Weiss recommended keeping an eye out for a book from his colleague, Lauren Costine, PhD called “Urge To Merge.”  He also noted that folks should check out the Global Pride Summit which is free online.

My hope is that people are able to have fulfilling sex, in any of its many wonderful forms.  If you think that you might be struggling with developing a healthy sex life consider talking with a therapist.  When guilt, shame and judgement are removed from exploration, you might just find the kind of sex for which you’ve been searching.

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Study: Transgender Youth at High Risk for Negative Mental Health Outcomes

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A new study released by The Fenway Institute based on data from the Sidney Borum Jr. Health Center in Boston, Massachusetts shows what a handful of local and regional studies on transgender youth have long suggested: Transgender youth have disparately negative mental health outcomes compared to non-transgender youth.

The study examined data from the electronic health records of 180 transgender patients age 12-29 years matched with non-transgender patients who were seen for healthcare at the Sidney Borum Jr. Health Center. Compared with non-transgender youth, transgender youth had an elevated probability of being diagnosed with depression (50.6% vs. 20.6%); suffering from anxiety (26.7% vs. 10%); attempting suicide (17.2% vs. 6.1%); and engaging in self-harming activities without lethal intent (16.7% vs. 4.4%).

Among transgender patients, there were 106 female-to-male youth and 74 male-to-female youth, and there were no statistically significant differences in negative mental health outcomes between female-to-male and male-to-female youth.

The findings are detailed in Mental health of transgender youth in care at an adolescent urban community health center: A matched retrospective cohort study, which was published January 6, 2015 in the Journal of Adolescent Health.

“To date, there are limited comparative mental health data available in transgender adolescents and young adults to document health inequities by gender minority status. This research points to the need for gender-affirming mental health services and interventions to support transgender youth,” said Sari Reisner, ScD, Research Scientist at The Fenway Institute and Postdoctoral Research Fellow in the Department of Epidemiology at Harvard School of Public Health, and the lead author of the report. “It is clear that clinicians serving transgender youth should routinely screen for mental health concerns.”

Findings from the study also point to the need to integrate gender-inclusive measures into electronic health records, including assigned sex at birth and current gender identity at patient registration. Including these questions facilitates clinic-based epidemiological research as well as quality improvement efforts to ensure high-quality, gender-affirming care.

Although the Sidney Borum, Jr. Health Center devotes a good part of its resources to the care of transgender youth, it is still a primary care clinic for adolescents and emerging adults. Therefore, this study shows that expanded care for transgender youth can be provided in the context of overall pediatric care: integration of behavioral health, psychiatry, and pediatric primary care – a medical home approach – can more than adequately support the medical and behavioral health needs of transgender youth and provide a locus of care for reduction of psychiatric outcomes described by the study.

The full report is available online.

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Tips For Finding A Therapist

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Choosing a therapist can be a challenging task. Austin therapist, Adam Maurer, LMFT-Associate, LPC-Intern, offers some insights into the process of finding a therapist that meets your needs.

I have a confession to make. Even as I consider typing the words my body cringes at the thought of admitting this. It sounds like career suicide, but the truth of the matter is that for some people, I would be a rotten therapist.

I mean, I would just stink it up: and it’s not that I’m inept or anything like that. My university made sure to give me a certificate commemorating my 4.0 GPA so that I might prove to others that I know about therapy. This overachieving student cannot be a sensational therapist for everyone who wants help because I, and every other mental health professional, am limited by my scope of competency and my therapeutic modality.

Therapy is similar to medicine in this way. There are doctors who focus on specific diseases, demographics or parts of the human body. All doctors can check a patient’s vital signs, no problem. But, a pediatric surgeon may not be the first choice to perform heart surgery on a 65-year old woman because the surgeon lacks expertise in geriatric medicine.

Graduate schools train therapists how to develop empathy, listen without judgement and work with issues that are common to the human experience. Therapists develop their scope of competency through: practicums, workshops, reading, supervision, training, lectures, and work experiences. For a person seeking therapy, it can be difficult to figure out which therapists may be best suited to help for a particular issue. So, here are some tips for finding a therapist.

[gdlr_process min_height=”160px” type=”vertical” ]

[gdlr_tab icon=”icon-question” title=”Identify The Issues” ]Consider what issues are encouraging you to enter therapy and try to prioritize them; then search for therapists who specialize in your top issues.[/gdlr_tab]

[gdlr_tab icon=”icon-search” title=”Do Your Research” ]Most therapists have a website and they offer a free phone consultation or short visit. Before you talk, look over the therapist’s website to gain a sense of who the person is and how the therapist works; then write down any questions you may have.[/gdlr_tab]

[gdlr_tab icon=”icon-comments-alt” title=”Ask Questions” ]Some helpful questions to ask when you call might be about: current trainings they have attended, their therapeutic modality, what a typical client for the therapist is like, books and articles they have been reading or have written, and colleagues they network with currently. This will aid you in developing an idea of how helpful they might be in working with your concerns.[/gdlr_tab]

[gdlr_tab icon=”icon-group” title=”Get A Referral” ]If a potential therapist you like is unable to see you, ask them to refer you to other mental health professionals who may be of service.[/gdlr_tab]

[/gdlr_process]

It is also important to understand the difference between an LGBTQ-friendly therapist and a therapist who specializes in LGBTQ issues. An LGBTQ-friendly therapist will not try to pray away your gay. You can talk freely, knowing that you are accepted. An LGBTQ-friendly therapists may not be familiar with the language we use, or they may not understand phenomenons specific to our community. If the main concerns that are prompting you to seek counseling do not appear to be related to your membership in the the LGBTQ community, then a LGBTQ-friendly therapist may be a great fit. Especially if the therapist specializes in an area that is contributing to your distress.

Therapists who specialize in working with the LGBTQ community help their clients consider how heterosexism may be impacting their current issues. In my work I make sure I inquire about family support, levels of outness and other factors that might be contributing to current troubles. There are therapists who identify as allies to the community and specialize in LGBTQ issues. Allies usually have compelling reasons for focusing their work to helping our community. If you are hesitant to work with an ally, consider asking why the therapist chose to work with the LGBTQ community.

A specialization is not about experiencing a certain issue, but about intimate knowledge on the subject. Therapists who specialize in LGBTQ issues tend to be more aware of resources that may be helpful to their LGBTQ clients. Any therapist you decide to work with will be an investment of your time, money and energy. Be wise and make sure you take time to find therapists who are best suited to work with you and your top concerns.

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