History of the UMD-PRC  

The University of Maryland Prevention Research Center (UMD-PRC) was founded with a CDC cooperative agreement from 2009-2014.  Its focus was the role of jurisdictional and other boundaries in fracturing coordinated efforts for addressing an HIV epidemic.  The UMD-PRC was involved in state HIV prevention planning, inter-jurisdiction and inter-organization prevention programs, and research that was disseminated through training programs and publications. 

Since its initial CDC supported founding, the UMD-PRC has continued addressing HIV prevention and has become more focused on related LGBTQ+ mental health and health care challenges.  Its major partners in addressing these challenges have continued to be government health departments and community organizations.  HIV, substance use and related concerns continue to be topics of importance for the UMD-PRC given their relationship with LGBTQ+ mental health disparities.  Hence, this new CDC cooperative agreement beginning in the Fall of 2019 and extending through 2024 is a timely facilitator for improving the UMD-PRC’s ability to address its mission of improving mental health and health care for LGBTQ+ persons.

A team of highly qualified and engaged researchers at the University of Maryland School of Public Health, along with researchers from many other schools and programs across the University of Maryland, College Park campus, is driving the UMD-PRC effort.  The researchers work closely with a broad array of community advisors from many different stakeholder groups to plan and implement all research, training, and service activities.  A growing coalition of LGBTQ+, mental health, and health care organizations, in connection with other Prevention Research Centers from across the country, serves as the advice and outreach network to facilitate the local, state and national impact of the UMD-PRC.

Description of Health Disparities Addressed 

In 2015, Congress passed the 21st Century Cures Act, stating that the NIH must “encourage efforts to improve research related to the health of sexual and gender minority populations.” In October of 2016, the National Institute of Minority Health and Health Disparities designated LGBT people as a health disparity population.

LGBT people demonstrate vexing mental, behavioral and physical health disparities relative to their heterosexual and cisgender (i.e., non-transgender) peers. LGB people, for example, are 1.5 to 3.5 times as likely as heterosexuals to meet the criteria for a past-year mood, anxiety or alcohol use disorder and are 3 times as likely to experience psychiatric comorbidity.1-3 A recent meta-synthesis found that 55% of transgender people report lifetime suicidal ideation.4 

Healthy People 2020 calls for national action to reduce LGBT population health disparities including inadequate health care, suicide, homelessness, cancer, bully victimization, STI/HIV, obesity, mental health concerns and the use of tobacco, alcohol, and other drugs. One key strategy to address these disparities is through improved mental health services and better integration of mental health and other health care services.

Problem of Importance: Culturally Competent Mental Health Care for Reducing Health Disparities

Healthy People 2020 requests more research and services directed toward LGBT people due to health disparities evidenced by this population. Mental health and health care are related to many LGBT health concerns. Chronic stress related to stigma, marginalization and discrimination is a major contributing factor to LGBT-related health disparities.5-7 Not surprisingly, LGBT people, as a population, have higher rates of mental health problems than cisgender, heterosexual persons and have a greater need for mental health services.

Unfortunately, LGBT persons have reported concerns and dissatisfaction with their mental health care experiences due to lack of clinician understanding, acceptance and sensitivity.8-11 LGBT racial/ethnic minorities may have the highest unmet need for mental health care.12 

Mental health care clinicians themselves have also described limited opportunity, resources and support for training regarding LGBT-specific concerns.13 The need for mental health professional continuing education regarding LGBT persons’ is exacerbated by the quickly evolving societal attitudes, government policies, empirical research and community and scientific language regarding LGBT persons.14

We Thank Our LGBTQ+ Research Supporters 

University Health Center http://health.umd.edu/

LGBT Equity Center at UMD https://lgbt.umd.edu/

University of Maryland Office of Diversity & Inclusion https://www.diversity.umd.edu/

Center for Healthy Families  https://sph.umd.edu/department/fmsc/center-healthy-families-0

UMD-SPH Center for Health Equity http://sph.umd.edu/center/che/

Human Right Campaign https://www.hrc.org/

The Forum for Dignity Initiatives - FDI Pakistan. https://www.fdipakistan.org/

Dostana Male Health Society- DMHS Pakistan

Citations

  1. Bostwick WB, Boyd CJ, Hughes TL, McCabe SE. Dimensions of Sexual Orientation and the Prevalence of Mood and Anxiety Disorders in the United States. American Journal of Public Health. 2010;100(3):468-475. doi:10.2105/AJPH.2008.152942
  2. Goldberg S, Strutz KL, Herring AA, Halpern CT. Risk of Substance Abuse and Dependence Among Young Adult Sexual Minority Groups Using a Multidimensional Measure of Sexual Orientation. Public Health Reports. 2013;128(3):144-152.
  3. Hatzenbuehler ML, Keyes KM, Hasin DS. State-level policies and psychiatric morbidity in lesbian, gay, and bisexual populations. American Journal of Public Health. 2009;99(12):2275–2281.
  4. Adams N, Hitomi M, Moody C. Varied Reports of Adult Transgender Suicidality: Synthesizing and Describing the Peer-Reviewed and Gray Literature. Transgender Health. 2017;2(1):60-75. doi:10.1089/trgh.2016.0036
  5. Heckman CJ, Darlow S, Manne SL, Kashy DA, Munshi T. Correspondence and correlates of couples’ skin cancer screening. JAMA Dermatol. 2013;149(7):825-830. doi:10.1001/jamadermatol.2013.515
  6. Valdiserri RO, Holtgrave DR, Poteat TC, Beyrer C. Unraveling Health Disparities Among Sexual and Gender Minorities: A Commentary on the Persistent Impact of Stigma. Journal of Homosexuality. January 2018:1-19. doi:10.1080/00918369.2017.1422944
  7. Meyer IH. Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychol Bull. 2003;129(5):674-697. doi:10.1037/0033-2909.129.5.674
  8. Pepping CA, Lyons A, Morris EMJ. Affirmative LGBT psychotherapy: Outcomes of a therapist training protocol. Psychotherapy. 2018;55(1):52-62. doi:10.1037/pst0000149
  9. Willging CE, Salvador M, Kano M. Brief Reports: Unequal Treatment: Mental Health Care for Sexual and Gender Minority Groups in a Rural State. Psychiatric Services. 2006;57(6):867-870. doi:10.1176/ps.2006.57.6.867
  10. Spengler ES, Miller DJ, Spengler PM. Microaggressions: Clinical errors with sexual minority clients. Psychotherapy. 2016;53(3):360-366. doi:10.1037/pst0000073
  11. Holt NR, Hope DA, Mocarski R, Woodruff N. First impressions online: The inclusion of transgender and gender nonconforming identities and services in mental healthcare providers’ online materials in the USA. International Journal of Transgenderism. 2018;0(0):1-14. doi:10.1080/15532739.2018.1428842
  12. Jeong YM, Veldhuis CB, Aranda F, Hughes TL. Racial/ethnic differences in unmet needs for mental health and substance use treatment in a community-based sample of sexual minority women. Journal of Clinical Nursing. 2016;25(23-24):3557-3569. doi:10.1111/jocn.13477
  13. Rutherford K, McIntyre J, Daley A, Ross LE. Development of expertise in mental health service provision for lesbian, gay, bisexual and transgender communities. Med Educ. 2012;46(9):903-913. doi:10.1111/j.1365-2923.2012.04272.x
  14. Boroughs MS, Andres Bedoya C, O’Cleirigh C, Safren SA. Toward Defining, Measuring, and Evaluating LGBT Cultural Competence for Psychologists. Clin Psychol (New York). 2015;22(2):151-171. doi:10.1111/cpsp.12098