Researching for LGBTQ Health

Women and Health

Research Papers

Women’s Sexual Orientation and Health: Results from a Canadian Population-Based Survey

The current study sought to determine whether health status and health risk behaviors of Canadian women varied based on sexual identity. This was a cross-sectional analysis of data from the Canadian Community Health Survey: cycle 2.1, a national population-based survey designed to gather health data on a representative sample of over 135,000 Canadians including 354 lesbian respondents, 424 bisexual women respondents, and 60,937 heterosexual women respondents. Sexual orientation was associated with disparities in health status and health risk behaviors for lesbian and bisexual women in Canada. Bisexual women were more likely than lesbians or heterosexual women to report poor or fair mental and physical health, mood or anxiety disorders, lifetime STD diagnosis, and, most markedly, life-time suicidality. Lesbians and bisexual women were also more likely to report daily smoking and risky drinking than heterosexual women. In sum, sexual orientation was associated with health status in Canada. Bisexual women, in particular, reported poorer health outcomes than lesbian or heterosexual women, indicating this group may be an appropriate target for specific health promotion interventions.

Perinatal Mental Health in Lesbian Mothers: A Review of Potential Risk and Protective Factors

Postpartum depression and other perinatal mental illnesses are common complications of childbirth. The majority of research on these conditions has been conducted in heterosexual women; however, increasing numbers of women are choosing to parent in the context of lesbian relationships. Although many of the fundamental aspects of the transition to parenthood are shared between lesbian and heterosexual mothers, lesbian mothers may differ from heterosexual parents on a number of variables that have been previously associated with perinatal mental health. Lesbian mothers may be more likely than their heterosexual peers to lack social support, particularly from their families of origin, and may be exposed to additional stress due to homophobic discrimination. However, the likelihood that lesbian pregnancies will be planned, together with the relatively equal division of child- care labour observed in lesbian couples, may offer protection from perinatal depression. The study of perinatal mental health in lesbian mothers is warranted, both to ensure that the mental health needs of this largely invisible population are being met, and to further illuminate the role of psychosocial stress in perinatal mental health in all women.

Perinatal depressive symptomatology among lesbian and bisexual women

Lesbian and bisexual women who were pregnant (N = 16), biological (N = 18) or non-biological (N = 15) parents completed the Edinburgh Postnatal Depression Scale (EPDS), and scores were compared to a previously published heterosexual sample. Lesbian and bisexual biological mothers had significantly higher EPDS scores than the previously published sample of heterosexual women. Results suggest that perinatal depression is not less common and may be more common among lesbian and bisexual women relative to heterosexual women. Additional, longitudinal studies are needed.

Correlates of mental health service use among lesbian, gay, and bisexual mothers and prospective mothers

Lesbian, gay, and bisexual women undertake parenting in a social context that may be associated with unique risk factors for perinatal depression. This cross-sectional study aimed to describe the mental health services used by women in the perinatal period and to identify potential correlates of mental health service use. Sixty-four women who were currently trying to conceive, pregnant, or the parent of a child less than one year of age were included. One-third of women reported some mental health service use within the past year; 30.6% of women reported a perceived unmet need for mental health services in the past year, with 40% of these women citing financial barriers as the reason for their unmet need. Women who were trying to get pregnant or who were less “out” were most likely to have had recent mental health service use. Women who had conceived by having sex with a man or who reported more than three episodes of discrimination were most likely to report unmet needs for mental health services. Providers may benefit from additional knowledge about the LBG social context that is relevant to perinatal health, and from identifying a strong referral network of skilled and affordable counsellors.

Regular health care use by lesbians: a path analysis of predictive factors

Lesbians have more health risks than other women but access preventive
medical care less frequently. To test the influence of: (i) provider inquiry about sexual orientation, (ii) perceived provider gay-positivity and (iii) patient disclosure of sexual orientation on regular health care use in a sample of Canadian lesbians. We analyzed survey data from 489 lesbian respondents. 78.5% [95% confidence interval (CI): 74.7–82.0] of women reported regular health service use; 75.8% (95% CI: 72.2–79.8) of women had disclosed their sexual orientation to their provider; and 24.4% (95% CI: 20.6–28.2) of women had been asked about their sexual orientation by their provider. Of those women whose physicians had inquired about their sexual orientation, 100% (95% CI: 97.5–100.0) had disclosed. In the final path analysis, perceived provider gay positivity and level of patient outness predicted disclosure, which, along with health status predicted regular health care use. All paths were significant at P < 0.05. Provider-related factors including perceived gay-positivity and inquiry about sexual orientation are strongly associated with disclosure of sexual orientation. Disclosure is associated with regular health care use. Minor changes to practice could improve access to health services for lesbians

Lesbian Health and the Assumption of Heterosexuality: An Organizational Perspective

This study used a qualitative research design to explore hospital policies and practices and the assumption of female heterosexuality. The assumption of heterosexuality is a product of discursive practices that normalize heterosexuality and individualize lesbian sexual identities. Literature indicates that the assumption of female heterosexuality is implicated in both the invisibility and marked visibility of lesbians as service users. This research adds to existing literature by shifting the focus of study from individual to organizational practices and, in so doing, seeks to uncover hidden truths, explore the functional power of language, and allow for the discovery of what we know and--equally as important--how we know.

Being Recognized, Accepted, and Affirmed: Self-Disclosure of Lesbian/Queer Sexuality Within Psychiatric and Mental Health Service Settings

This article explores the relationship between self-disclosure of lesbian/queer (LQ) sexuality and well-being and recovery as described by women who either identify as consumer/survivors of psychiatric and mental health services and/or who work as mental health service providers within hospital- and community-based psychiatric and mental health service settings. I explore the relationship between self-disclosure and well-being and recovery by examining three points that frame women's ideas and experiences of self-disclosure including: (a) The negation and dismissal of lesbian/queer sexuality as an identity, (b) the closing off or compartmentalizing of concerns by lesbian/queer women, and (c) sexuality as a potential source of stress and/or support for lesbian/queer women.

Are lesbians really women who have sex with women (WSW)? Methodological concerns in health research on sexual minority women

Varying measures of sexual orientation are used in women's health research. As they incorporate different dimensions, definitions, and categorical groupings, the comparability of results obtained across studies using different measures remains unknown. We examined the comparability of results using data from the U.S. 2002 National Survey of Family Growth (n = 6,356). Women were classified according to sexual orientation identity, sex of sex partners in the past year, and sex of sex partners over the lifetime. Associations with six health outcomes were compared across sexual orientation schemes. Associations differed in magnitude and statistical significance, even producing conflicting results. Our analyses resulted in a series of methodological recommendations for research on sexual minority women. Data on both behavioral and identity measures should be gathered in health research; identity groups should not be combined for analysis; and researchers should carefully consider which classification scheme(s) to use based on the theoretical basis for the study and the implications for informing interventions.

Beyond assumptions of negligible risk: Sexually transmitted diseases and women who have sex with women

This study evaluated the association of female–female sexual behavior with sexually transmitted diseases (STDs). Female participants (n = 286) were recruited from the Twin Cities Gay/Lesbian/Bisexual/Transgender Pride Festival. Logistic regression was used to examine the association between female–female sexual behavior and STDs. Women in all partner history groups, including 13% of women with only female partners, reported a history of STD. Increased sexual exposures with women predicted an increase in the likelihood of STDs after known risk factors had been controlled. Neither number of female partners nor number of exposures was associated with obtaining regular STD testing. The risk of STDs through female–female sexual exposure is not negligible. Nevertheless, patterns of STD testing do not reflect this risk.

Attitudes and knowledge among Obstetrician-Gynecologists regarding lesbian patients and their health

OBJECTIVE: The lesbian patient population is underserved. Almost no research has examined the knowledge and attitudes of obstetrician-gynecologists toward lesbian health. Our study sought to address this research gap.

METHODS: All 910 obstetrician-gynecologists licensed in Ontario, Canada, were mailed a true-false survey about lesbian health issues, the Homosexuality Attitudes Scale (HAS), and a demographic survey.

RESULTS: Of the 910 surveys, 271 were returned. The mean HAS score was 87.6 (standard deviation [SD] 11.5), indicating an overall positive attitude. The mean knowledge score was 76.0% (SD 9.5), indicating that respondents had adequate knowledge about lesbian health; 22% described their lesbian health knowledge-base as unaware. Most respondents reported lack of education on lesbian health in residency (81%) or medical school (78%). The majority reported a desire for formal education pertaining to lesbian health. There was no correlation between HAS and knowledge scores.

CONCLUSIONS: Although our results indicate overall adequate knowledge about lesbian health issues, important knowledge gaps were identified. Medical school and residency training curricula should include formal education about lesbian health issues, particularly because most obstetrician-gynecologists report a desire to receive this information.

Culture and postpartum mood problems: similarities and differences in the experiences of first and second generation immigrant women

Purpose: Few studies have examined the role of culture in a woman’s experience of postpartum mood problems (PPMP). This study explored differences and similarities in experiences of PPMP between first- and second-generation Canadian women. Design: In this exploratory qualitative study, we interviewed nine first-generation and eight second-generation women who were clients of the Women’s Health Centre at St. Joseph’s Health Centre in Toronto, Canada. Using semi-structured interviews, we explored how women perceived and experienced PPMP. Findings: Four themes reflected cultural issues: PPMP stigma, relationship with parents/in-laws, internalization of society’s expectations of motherhood, and identity issues/relationship with self. Discussion and Conclusion: The results of this study contribute to a limited literature on possible contributing factors to PPMP and can inform development of resources for delivering culturally appropriate mental health care for women dealing with PPMP.

Relation between place of residence and postpartum depression

Background: The relation between place of residence and risk of postpartum depression is uncertain. We evaluated the relation between place of residence and risk of postpartum depression in a population-based sample of Canadian women.

Methods: Female postpartum respondents to the 2006 Canadian Maternity Experiences Survey (n = 6126) were classified as living in rural (< 1000 inhabitants or population density < 400/km2), semirural (nonrural but < 30 000 inhabitants), semiurban (30 000–499 999 inhabitants) or urban (≥ 500 000 inhabitants) areas. We further subdivided women living in rural areas based on the social and occupational connectivity of their community to larger urban centres. We compared the prevalence of postpartum depression (score of ≥ 13 on the Edinburgh Postnatal Depression Scale) across these groups and adjusted for the effect of known risk factors for postpartum depression.

Results: The prevalence of postpartum depression was higher among women living in urban areas than among those living in rural, semirural or semiurban areas. The difference between semiurban and urban areas could not be fully explained by other measured risk factors for postpartum depression (adjusted odds ratio 0.60, 95% confidence interval 0.42–0.84). In rural areas, there was a nonsignificant gradient of risk: women with less connection to larger urban centres were at greater risk of postpartum depression than women in areas with greater connection.

Interpretation: There are systematic differences in the distribution of risk factors for postpartum depression across geographic areas, resulting in an increased risk of depression among women living in large urban areas. Prevention programs directed at modifiable risk factors (e.g., social support) could specifically target women living in these areas to reduce the rates of postpartum depression.

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