Top

Published in:

Open Access 01-06-2018 | PSYCHIATRIC EPIDEMIOLOGY

Sexual orientation differences in outpatient psychiatric treatment and antidepressant usage: evidence from a population-based study of siblings

Authors: Richard Bränström, Mark L. Hatzenbuehler, Petter Tinghög, John E. Pachankis

Published in: European Journal of Epidemiology | Issue 6/2018

Abstract

In the past two decades, population-based health surveys have begun including measures of sexual orientation, permitting estimates of sexual orientation disparities in psychiatric morbidity and differences in treatment utilization. The present study takes advantage of the high-quality, comprehensive nationwide health registry data available in Sweden to examine whether psychiatric outpatient treatment for various diagnoses and antidepressant medication usage are greater in sexual minority individuals compared to their siblings. A longitudinal cohort study design was used with a representative random population-based sample in Stockholm, Sweden. Registry-based health record data on all specialized outpatient health care visits and prescription drug use was linked to a sample of 1154 sexual minority individuals from the Stockholm Public Health Cohort and their siblings. The main outcomes were treatment due to psychiatric diagnoses retrieved from nationwide registry-based health records. In analyses accounting for dependency between siblings, gay men/lesbians had a greater likelihood of being treated for mood disorder [adjusted odds ratio (AOR) 1.77; 99% confidence intervals (CI) 1.00, 3.16] and being prescribed antidepressants (AOR 1.51; 99% CI 1.10, 2.07) compared to their siblings. Further, bisexual individuals had a greater likelihood of any outpatient psychiatric treatment (AOR 1.69; 99% CI 1.17, 2.45) and being prescribed antidepressants (AOR 1.48; 99% CI 1.07, 2.05) as well as a greater likelihood of being treated for a mood disorder (AOR 1.98; 99% CI 1.33, 2.95) compared to their siblings. No difference in anxiety or substance use disorder treatment was found between any sexual minority subgroup and their siblings. The potential role of familial confounding in psychiatric disorder treatment was not supported for more than half of the outcomes that were examined. Results suggest that sexual minority individuals are significantly more likely to be treated for certain psychiatric disorders compared to their siblings. Future research is needed to understand mechanisms other than familial factors that might cause the substantial treatment differences based on sexual orientation reported here.

Available only for authorised users

Cochran SD, Mays VM. Relation between psychiatric syndromes and behaviorally defined sexual orientation in a sample of the US population. Am J Epidemiol. 2000;151(5):516–23.CrossRefPubMedPubMedCentral

Cochran SD, Mays VM, Sullivan JG. Prevalence of mental disorders, psychological distress, and mental health services use among lesbian, gay, and bisexual adults in the United States. J Consult Clin Psychol. 2003;71(1):53–61.CrossRefPubMedPubMedCentral

Fergusson DM, Horwood LJ, Beautrais AL. Is sexual orientation related to mental health problems and suicidality in young people? Arch Gen Psychiatry. 1999;56(10):876–80.CrossRefPubMed

Sandfort TG, Bakker F, Schellevis FG, Vanwesenbeeck I. Sexual orientation and mental and physical health status: findings from a Dutch population survey. Am J Public Health. 2006;96(6):1119–25. https://doi.org/10.2105/ajph.2004.058891.CrossRefPubMedPubMedCentral

Ploderl M, Tremblay P. Mental health of sexual minorities. A systematic review. Int Rev Psychiatry. 2015;27(5):367–85. https://doi.org/10.3109/09540261.2015.1083949.CrossRefPubMed

Hughes TL. Lesbians and mental health: preliminary results from the Chicago women’s health survey. J Gay Lesbian Med Assoc. 1997;1(3):137–48.

Sorensen L, Roberts SJ. Lesbian uses of and satisfaction with mental health services: results from Boston lesbian health project. J Homosex. 1997;33(1):35–49.CrossRefPubMed

Bradford J, Ryan C, Rothblum ED. National lesbian health care survey: implications for mental health care. J Consult Clin Psychol. 1994;62(2):228.CrossRefPubMed

Cleary PD, Jette AM. The validity of self-reported physician utilization measures. Med Care. 1984;22(9):796–803.CrossRefPubMed

10.

Hennessy KD, Reed SK. Validating self-reports of mental health service use in a chronic population. J Nerv Ment Dis. 1992;180(6):399–400.CrossRefPubMed

11.

Kashner T, Suppes T, Rush A, Altshuler K. Measuring use of outpatient care among mentally ill individuals: a comparison of self reports and provider records. Eval Program Plan. 1999;22(1):31–40.CrossRef

12.

Kessler RC, Wittchen HU, Abelson JM, et al. Methodological studies of the composite international diagnostic interview (CIDI) in the US national comorbidity survey (NCS). Int J Methods Psychiatr Res. 1998;7(1):33–55.CrossRef

13.

Rhodes AE, Lin E, Mustard CA. Self-reported use of mental health services versus administrative records: should we care? Int J Methods Psychiatr Res. 2002;11(3):125–33.CrossRefPubMed

14.

King M, Semlyen J, Tai SS, et al. A systematic review of mental disorder, suicide, and deliberate self harm in lesbian, gay and bisexual people. BMC Psychiatry. 2008;8(1):70.CrossRefPubMedPubMedCentral

15.

Schor E, Starfield B, Stidley C, Hankin J. Family health: utilization and effects of family membership. Med Care. 1987;25(7):616–26.CrossRefPubMed

16.

Cardol M, Groenewegen P, De Bakker D, Spreeuwenberg P, Van Dijk L, Van den Bosch W. Shared help seeking behaviour within families: a retrospective cohort study. BMJ. 2005;330(7496):882.CrossRefPubMedPubMedCentral

17.

Cardol M, Groenewegen PP, Spreeuwenberg P, Van Dijk L, Van Den Bosch WJ, De Bakker DH. Why does it run in families? Explaining family similarity in help-seeking behaviour by shared circumstances, socialisation and selection. Soc Sci Med. 2006;63(4):920–32.CrossRefPubMed

18.

Rothblum ED, Factor R. Lesbians and their sisters as a control group: demographic and mental health factors. Psychol Sci. 2001;12(1):63–9.CrossRefPubMed

19.

Balsam KF, Beauchaine TP, Mickey RM, Rothblum ED. Mental health of lesbian, gay, bisexual, and heterosexual siblings: effects of gender, sexual orientation, and family. J Abnorm Psychol. 2005;114(3):471.CrossRefPubMed

20.

Rosario M, Reisner SL, Corliss HL, Wypij D, Calzo J, Austin SB. Sexual-orientation disparities in substance use in emerging adults: a function of stress and attachment paradigms. Psychol Addict Behav. 2014;28(3):790.CrossRefPubMedPubMedCentral

21.

Svensson AC, Fredlund P, Laflamme L, et al. Cohort profile: the Stockholm public health cohort. Int J Epidemiol. 2013;42(5):1263–72. https://doi.org/10.1093/ije/dys126.CrossRefPubMed

22.

Hatzenbuehler ML, Bränström R, Pachankis JE. Societal-level explanations for reductions in sexual orientation mental health disparities: results from a ten-year, population-based study in Sweden. Stigma and Health. 2017;3(1):16–26.CrossRef

23.

Sexual Minority Assessment Research Team (SMART). Best practices for asking questions about sexual orientation on surveys. California: The Williams Institute; 2009.

24.

Sell RL, Wells JA, Wypij D. The prevalence of homosexual behavior and attraction in the United States, the United Kingdom and France: results of national population-based samples. Arch Sex Behav. 1995;24(3):235–48.CrossRefPubMed

25.

Ekbom A. The Swedish multi-generation register. In: Dillner J, editor. Methods in biobanking. Totowa, NJ: Humana Press; 2011. p. 215–20.CrossRef

26.

WHO. International statistical classification of diseases and related health problems, tenth revision (ICD-10). Geneva: WHO; 1993.

27.

Hatzenbuehler ML, McLaughlin KA, Keyes KM, Hasin DS. The impact of institutional discrimination on psychiatric disorders in lesbian, gay, and bisexual populations: a prospective study. Am J Public Health. 2010;100(3):452–9. https://doi.org/10.2105/ajph.2009.168815.CrossRefPubMedPubMedCentral

28.

Mays VM, Cochran SD. Mental health correlates of perceived discrimination among lesbian, gay, and bisexual adults in the United States. Am J Public Health. 2001;91(11):1869–76.CrossRefPubMedPubMedCentral

29.

Meyer IH, Schwartz S, Frost DM. Social patterning of stress and coping: does disadvantaged social statuses confer more stress and fewer coping resources? Soc Sci Med. 2008;67(3):368–79. https://doi.org/10.1016/j.socscimed.2008.03.012.CrossRefPubMedPubMedCentral

30.

Cochran SD, Björkenstam C, Mays VM. Sexual orientation differences in functional limitations, disability, and mental health services use: results from the 2013–2014 national health interview survey. J Consult Clin Psychol. 2017;85(12):1111.CrossRefPubMed

31.

Cochran SD. Emerging issues in research on lesbians’ and gay men’s mental health: does sexual orientation really matter? Am Psychol. 2001;56(11):931.CrossRefPubMed

32.

Donahue K, Långström N, Lundström S, Lichtenstein P, Forsman M. Familial factors, victimization, and psychological health among sexual minority adolescents in Sweden. Am J Public Health. 2017;107(2):322–8.CrossRefPubMed

33.

Frisell T, Lichtenstein P, Rahman Q, Langstrom N. Psychiatric morbidity associated with same-sex sexual behaviour: influence of minority stress and familial factors. Psychol Med. 2010;40(2):315–24. https://doi.org/10.1017/s0033291709005996.CrossRefPubMed

34.

Zietsch BP, Verweij KJ, Bailey JM, Wright MJ, Martin NG. Sexual orientation and psychiatric vulnerability: a twin study of neuroticism and psychoticism. Arch Sex Behav. 2011;40(1):133–42. https://doi.org/10.1007/s10508-009-9508-4.CrossRefPubMed

35.

Kapur S, Phillips AG, Insel TR. Why has it taken so long for biological psychiatry to develop clinical tests and what to do about it? Mol Psychiatry. 2012;17(12):1174–9.CrossRefPubMed

36.

Eubanks-Carter C, Goldfried MR. The impact of client sexual orientation and gender on clinical judgments and diagnosis of borderline personality disorder. J Clin Psychol. 2006;62(6):751–70.CrossRefPubMed

37.

Plomin R. Commentary: why are children in the same family so different? Non-shared environment three decades later. Int J Epidemiol. 2011;40(3):582–92.CrossRefPubMedPubMedCentral

Title: Sexual orientation differences in outpatient psychiatric treatment and antidepressant usage: evidence from a population-based study of siblings
Authors: Richard Bränström
Mark L. Hatzenbuehler
Petter Tinghög
John E. Pachankis
Publication date: 01-06-2018
Publisher: Springer Netherlands
Published in: European Journal of Epidemiology / Issue 6/2018
Print ISSN: 0393-2990
Electronic ISSN: 1573-7284
DOI: https://doi.org/10.1007/s10654-018-0411-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Sexual orientation differences in outpatient psychiatric treatment and antidepressant usage: evidence from a population-based study of siblings

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 6/2018

Low concentrations of 25-hydroxyvitamin D and long-term prognosis of COPD: a prospective cohort study

Hypothesis-free screening of large administrative databases for unsuspected drug-outcome associations

Hypothetical interventions to prevent stroke: an application of the parametric g-formula to a healthy middle-aged population

Performing studies using the UK Clinical Practice Research Datalink: to link or not to link?

The heart of the matter: years-saved from cardiovascular and cancer deaths in an elite athlete cohort with over a century of follow-up

Tobacco smoking and the risk of sudden cardiac death: a systematic review and meta-analysis of prospective studies