Psychosocial Syndemic Risks Surrounding Physical Health Conditions Among Sexual and Gender Minority Individuals

Abstract

Purpose: The high prevalence of physical health conditions among sexual and gender minority (SGM) individuals could be explained, in part, by SGM individuals' disparate exposure to interconnected psychosocial syndemic risks, including substance use, depression, posttraumatic stress disorder, intimate partner violence, and sexual assault. We utilized a syndemic framework to understand the overlapping and potentially synergistic association between psychosocial syndemic risks and physical health conditions among SGM adults. Methods: A sample of 298 self-identified SGM adults (M age = 28.03, SD = 9.86; 47.0% racial/ethnic minority, 41.6% transgender or gender nonconforming) completed an online survey from May 2016 through May 2017. Results: Three (1.0%) participants reported no syndemic risks, 19 (6.4%) reported one, 52 (17.4%) reported two, 85 (28.5%) reported three, 89 (29.9%) reported four, and 50 (16.8%) reported all five syndemic risks. The number of psychosocial syndemic risks was positively associated with the number of physical health conditions and synergistically (i.e., more than additively) increased the overall health burden on SGM individuals. Conclusion: We found evidence for psychosocial syndemic risks as predictors of SGM individuals' physical health. This study is novel in providing evidence for syndemics surrounding a comprehensive set of physical health outcomes among individuals identifying along a full spectrum of SGM identities. The study controlled for HIV to examine syndemic conditions surrounding physical health outcomes beyond this well-established syndemically determined condition. Comprehensive intervention and policy efforts that address co-occurring psychosocial risks for physical health conditions are needed to reduce health disparities affecting SGM populations.

A Scoping Review Investigating Relationships between Depression, Anxiety, and the PrEP Care Continuum in the United States

“…In addition, two studies found that depression alone was not associated with PrEP use, although it was when depression was part of syndemic conditions [ 37 , 60 ]. The salience of syndemic risks and health conditions among SGM has been highlighted previously, with prior research showing that SGM individuals are disproportionately impacted by intersecting psychosocial risks (e.g., substance use, depression, trauma) that together create challenging dynamics for physical health [ 86 , 87 , 88 ]. Current findings echo previous calls for novel assessment and intervention strategies that target multiple co-occurring risks among SGM populations [ 86 ].…”

“…The salience of syndemic risks and health conditions among SGM has been highlighted previously, with prior research showing that SGM individuals are disproportionately impacted by intersecting psychosocial risks (e.g., substance use, depression, trauma) that together create challenging dynamics for physical health [ 86 , 87 , 88 ]. Current findings echo previous calls for novel assessment and intervention strategies that target multiple co-occurring risks among SGM populations [ 86 ]. In other words, clinicians and PrEP providers should be careful to not consider depression in isolation when discussing/recommending PrEP—but rather, should pay close attention to a constellation of risks (e.g., depressive symptoms, substance use, social isolation) that, taken together, may create significant barriers to PrEP initiation and adherence.…”

The health status of transgender and gender nonbinary adults in the United States

“…Findings from this study elicit the health effects stemming from such lived experiences, particularly for transgender adults who are also identify as a sexual minority person. Often, researchers examining the health of lesbian, gay, bisexual, and transgender (LGBT) individuals group all LGBT people together, compare LGB-to T-identified participants, or do not use measures to identify their transgender participants [65][66][67][68][69][70][71].…”

Sex Hormone Suppression and Physical Activity: Possible Implications for Transgender Individuals

“…21 In addition, estrogens have long been considered to be cardioprotective, 22 and reducing estrogen levels in women may lead to decreased bone and cardiovascular health. 23 Because of these unique health needs, a variety of interventions have emerged to help improve transgender health, [24][25][26][27] but an intervention yet to receive adequate attention is increased physical activity. It is possible that some health concerns observed in transgender individuals may be mitigated with increased physical activity.…”