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Open Access Publications from the University of California

Scholarly Works (5 results)

  • Article
  • Peer Reviewed
UC Berkeley Previously Published Works (2020)
Sexual minority populations experience disproportionately high rates of depression and anxiety relative to their heterosexual counterparts. Unfortunately, both sexual minority clients and their therapists experience difficulties in therapy. After conducting a review of the extant literature focused on approaches to treating depression and anxiety among sexual minority individuals in psychotherapy, this manuscript aims to: (1) Propose a taxonomy of existing practice models for treating sexual minority clients for depression and anxiety (protocol-based approaches, principles-based approaches, and relationship-based approaches); (2) Describe the current research findings of the evaluations of these practice models; (3) Offer recommendations for research and practice.
    Cover page: Clinical interventions with sexual minority clients: Review, critique, and future directions
    • Thesis
    • Peer Reviewed
    UC Berkeley Electronic Theses and Dissertations (2019)

    INTRODUCTION: Sexual minority (e.g., lesbian, bisexual) women experience depression and alcohol use disorder at approximately twice the rates of heterosexual women. Though stigma serves as a common explanation for these disparities, less is known about the mechanisms through which stigma may contribute to these disparities. Past research has found that the strategies that individuals use to regulate their emotions in response to experiences of stigma may influence their depression symptoms and alcohol use symptoms. Among general samples, alcohol use and suppression have been linked to increased risk for depression symptoms whereas seeking social support following a stigma-related stressor has been linked to reduced risk for depression symptoms. A limited body of past research has found constructs similar to suppression and social support to be associated with greater or fewer alcohol use symptoms, respectively, at the same level of alcohol use.

    The current dissertation proposes and validates a model to test whether greater levels of alcohol use, greater levels of suppression, and lower levels of social support explain 1) sexual minority women’s disproportionally high rates of depression symptoms/alcohol use symptoms and 2) the relationship between stigma-related stressors and depression symptoms/alcohol use symptoms for sexual minority women. (a) A greater number of stigma-related stressors are hypothesized to be associated with higher levels of suppression, higher levels of alcohol use, and lower levels of social support, (b) which are hypothesized to be associated with a greater number of depression symptoms. (c) Higher levels of alcohol use are hypothesized to be associated with a greater number of alcohol use symptoms; (d) higher levels of suppression are hypothesized to weaken this relationship, whereas higher levels of social support are hypothesized to strengthen this relationship.

    METHODS: A national sample of 1,773 sexual minority women participated in an online survey in 2017 through the PRIDE Study. Respondents self-reported demographic information, number of experiences of stigma, levels of alcohol use, suppression, and social support, and number of depression and alcohol use symptoms. Structural equation modeling was used to test hypotheses a to d (detailed above). Chi-square, RMSEA, CFI, and TLI were all employed to assess model fit.

    RESULTS: (a) As hypothesized, a greater number of stigma-related stressors was associated with lower levels of social support (standardized coefficient estimate, β = -0.185; p < 0.001), but contrary to hypothesis, the number of stigma-related stressors was not significantly associated with levels alcohol use or suppression. (b) As hypothesized, lower levels of social support (β = -0.210; p < 0.001), higher levels of alcohol use (β = 0.105; p < 0.001), higher levels of suppression (β = 0.169; p < 0.001), and greater number of stigma-related stressors (β = 0.220; p < 0.001) were all significantly associated with a greater number of depression symptoms. (c). As hypothesized, higher levels of alcohol use (β = 0.790; p < 0.001) were significantly associated with a greater number of alcohol use symptoms, but contrary to hypothesis, greater numbers of stigma-related stressors did not predict a greater number of alcohol use symptoms. (d) Contrary to hypothesis, there was no evidence that relationship between alcohol use and alcohol use symptoms was strengthened by higher levels of suppression or weakened by higher levels of social support. All fit statistics exceeded established standards.

    DISCUSSION: Stigma-related stressors were found to be associated with depression symptoms, but not alcohol use symptoms, among sexual minority women. Stigma-related stressors may cause sexual minority women to deplete their social support resources, potentially increasing risk for depression symptoms; this mechanism does not appear to drive alcohol use symptoms. This finding suggests that cultivating social support networks that are responsive to experiences of stigma may be an important component of depression treatments for sexual minority women. Though the cross-sectional design of this study limits the potential for causal inference, this study makes an important contribution to the literature by utilizing a largescale, national sample of sexual minority women to evaluate potential mechanisms driving both depression symptoms and alcohol use symptoms among this vulnerable population. Future research should use longitudinal methods to improve potential for causal inference. Future research should also identify mechanisms common to depression symptoms and alcohol use symptoms to facilitate the development of interventions for co-occurring depression and alcohol use disorders for this vulnerable population.

      Cover page: Understanding Co-Occurring Depression Symptoms and Alcohol Use Symptoms among Sexual Minority Women
      • Article
      • Peer Reviewed
      UC Berkeley Previously Published Works (2018)
      Sexual minority youth experience substantially higher rates of family victimization than their heterosexual peers. No systematic review has yet identified the predictors and consequences in this vulnerable population of childhood abuse, exposure to sibling abuse and domestic violence, and sibling aggression. This systematic review aims to (a) describe differences in these family victimization rates by sexual orientation, gender, and race/ethnicity; (b) identify potential sexual minority and non-sexual minority-specific risk factors; and (c) identify physical, mental, and behavioral health and extrafamilial victimization correlates. The systematic review, which followed PRISMA guidelines, yielded 32 articles that met study inclusion criteria. Rates of childhood physical, sexual, and emotional abuse were consistently higher for sexual minority youth than for their heterosexual peers. Bisexual youth appear to be at greater risk for physical abuse than their gay and lesbian peers. Younger age at sexual minority milestones (first awareness, disclosure, and same-sex sexual contact) and higher levels of sexual minority-specific (sexuality disclosure, gender non-conformity) and non-sexual minority-specific (delinquent behaviors, parental drinking) risk factors were associated with higher rates of family victimization. Sexual minorities who experienced some form of childhood abuse reported more frequent physical (higher rates of HIV, higher BMIs, lower levels of perceived health), mental (higher rates of depression, PTSD symptoms, experiential avoidance, internalized homophobia), and behavioral (higher rates of suicidality, substance misuse, earlier sexual debut, unprotected anal sex) health problems relative to heterosexual or non-abused sexual minority peers. Sexual minority females who experienced childhood physical or sexual abuse were at greater risk than abused sexual minority males for sexual assault later in life. We conclude this systematic review with recommendations for future research, including the necessity for longitudinal research that utilizes a poly-victimization conceptual framework to identify the developmental pathways connecting risk factors, different types of family victimization, and health and extrafamilial victimization consequences.
        Cover page: A Systematic Review of Family Victimization Experiences Among Sexual Minority Youth
        • Article
        UC San Francisco Previously Published Works (2023)
        Sexual and gender minority (SGM) people experience health disparities due to minority stress. We investigated the applicability of AWARENESS, a 10-session cognitive-behavioral intervention, to intersectional minority stress. We assessed the impact of the intervention format (group vs. individual sessions) and modality (in-person vs. telehealth). AWARENESS was piloted among SGM women in individual sessions and SGM people in a group format. Session progress notes, feedback surveys, and semi-structured feedback interviews were analyzed. Twelve participants began the intervention. Eight participants provided feedback (n=5 in the women’s pilot, n=3 in the group pilot). Participants reported learning new skills and applying the intervention in their daily lives. In both pilots, participants applied the intervention psychoeducation and skills to multiple identities and characteristics. Feedback emphasized the importance of integrating an intersectional perspective consistently and directly throughout the intervention. Although the group and telehealth formats provided useful opportunities for connection and support, future iterations of AWARENESS may need to approach enrollment of participants with a personalized approach to determine which format or modality will be most beneficial. This study suggests that AWARENESS is feasible for intersectional minority stress. We outline future intervention modifications to improve participant engagement and address intersectional minority stressors.
          Cover page: Adapting AWARENESS: Examining sexual and gender minority participant experiences with a novel cognitive-behavioral intervention to address intersectional minority stress
          • Article
          • Peer Reviewed
          UCLA Previously Published Works (2021)
          Mutual help groups are a ubiquitous component of the substance abuse treatment system in the United States, showing demonstrated effectiveness as a treatment adjunct; so, it is paramount to understand whether they are as appealing to, and as effective for, racial or ethnic minority groups as they are for Whites. Nonetheless, no known comprehensive reviews have examined whether there are racial/ethnic disparities in mutual help group participation. Accordingly, this study comprehensively reviewed the U.S. literature on racial/ethnic disparities in mutual help participation among adults and adolescents with substance use disorder treatment need. The study identified 19 articles comparing mutual help participation across specific racial/ethnic minority groups and Whites, including eight national epidemiological studies and 11 treatment/community studies. Most compared Latinx and/or Black adults to White adults, and all but two analyzed 12-step participation, with others examining self-help attendance. Across studies, racial/ethnic comparisons yielded mostly null (N = 17) and mixed (N = 9) effects, though some findings were consistent with a racial/ethnic disparity (N = 6) or minority advantage (N = 3). Findings were weakly suggestive of disparities for Latinx populations (especially immigrants, women, and adolescents) as well as for Black women and adolescents. Overall, data were sparse, inconsistent, and dated, highlighting the need for additional studies in this area.
            Cover page: Racial/Ethnic Disparities in Mutual Help Group Participation for Substance Use Problems.
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