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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

Study Shows Link Between Conversion Therapy and Transgender Suicide Attempts

Findings from researchers at The Fenway Institute, Massachusetts General Hospital (Harvard Medical School), and McLean Hospital (Harvard Medical School) support recommendations that gender identity conversion efforts at any age are harmful.

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A new study published today in JAMA Psychiatry found that exposure to attempts by professionals to change a person’s gender identity from transgender to cisgender is associated with a range of adverse mental health outcomes, including suicide attempts. The study was authored by researchers at The Fenway Institute, Massachusetts General Hospital (Harvard Medical School), and McLean Hospital (Harvard Medical School) and is believed to be the first to show an association between exposure to gender identity conversion efforts and adverse mental health outcomes among transgender adults in the United States. The study also builds on previous work published last month by the same researchers documenting the widespread prevalence (13.5%) among the U.S. transgender population of having experienced gender identity conversion efforts by therapists, counselors, and religious advisors.

“The rate of previous suicide attempts among transgender people in the United States is extremely high, with 41 percent reporting that they have had that experience, ” said Dr. Alex Keuroghlian, senior author of the study who directs the National LGBT Health Education Center at The Fenway Institute and the Massachusetts General Hospital Psychiatry Gender Identity Program. “What this new study shows is that transgender people who are exposed to conversion efforts anytime in their lives have more than double the odds of attempting suicide compared with those who have never experienced efforts by professionals to convert their gender identity from transgender to cisgender.”

Findings from the study titled “Association Between Recalled Exposure to Gender Identity Conversion Efforts and Suicide Attempts” support recommendations by the American Psychiatric Association, the American Medical Association, the American Academy of Child and Adolescent Psychiatry, and the American Academy of Pediatrics advising mental health care providers that gender identity conversion efforts at any age are harmful.

Lifetime exposure to gender identity conversion efforts was associated with a broad range of adverse mental health outcomes, including suicidal ideation in the previous 12 months and severe psychological distress in the previous month. Additionally, associations with adverse mental health outcomes held true whether the person conducting the conversion efforts was a secular therapist or a religious advisor.

“One of the most alarming findings from this study was the association between exposure to gender identity conversion efforts during childhood and a four-fold increased odds of lifetime suicide attempts,” said Dr. Jack Turban, resident physician in psychiatry at The Massachusetts General Hospital and McLean Hospital and lead author of the study. “This is important because some experts continue to advocate for gender identity conversion efforts for young children. We hope our findings contribute to ongoing legislative efforts to ban gender identity conversion efforts.”

The study uses data from the 2015 U.S. Transgender Survey conducted by the National Center for Transgender Equality and includes responses from over 27,000 transgender people in the U.S. Its publication comes one month after The American Journal of Public Health published “Psychological Attempts to Change a Person’s Gender Identity From Transgender to Cisgender: Estimated Prevalence Across US States, 2015” showing that nearly 200,000 transgender people representing every U.S. state have been exposed to gender identity conversion efforts.

Source: Press release

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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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