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Comparison of Treatment Outcomes Between Lesbian, Gay, Bisexual and Heterosexual Individuals Receiving a Primary Care Psychological Intervention

Published online by Cambridge University Press:  05 October 2017

Katharine A. Rimes ,
Matthew Broadbent ,
Rachel Holden ,
Qazi Rahman ,
David Hambrook ,
Stephani L. Hatch  and
Janet Wingrove
Katharine A. Rimes*
Affiliation:
King's College London, Institute of Psychiatry, Psychology & Neuroscience, London SE5 8AF
Matthew Broadbent
Affiliation:
South London and Maudsley NHS Foundation Trust, London SE5 8AZ
Rachel Holden
Affiliation:
King's College London, Institute of Psychiatry, Psychology & Neuroscience, London SE5 8AF
Qazi Rahman
Affiliation:
King's College London, Institute of Psychiatry, Psychology & Neuroscience, London SE5 8AF
David Hambrook
Affiliation:
South London and Maudsley NHS Foundation Trust, London SE5 8AZ
Stephani L. Hatch
Affiliation:
King's College London, Institute of Psychiatry, Psychology & Neuroscience, London SE5 8AF
Janet Wingrove
Affiliation:
South London and Maudsley NHS Foundation Trust, London SE5 8AZ
*
Correspondence to Katharine A. Rimes, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF. E-mail: Katharine.Rimes@kcl.ac.uk
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Abstract

Background: Lesbian, gay and bisexual individuals experience more anxiety and depression than heterosexual people. Little is known about their comparative treatment response to psychological interventions. Aims: To compare sociodemographic/clinical characteristics and treatment outcomes across sexual orientation groups, for adults receiving primary care psychological interventions from Improving Access to Psychological Therapies (IAPT) services in London, adjusting for possible confounders. Method: Data from 188 lesbian women, 222 bisexual women, 6637 heterosexual women, 645 gay men, 75 bisexual men and 3024 heterosexual men were analysed from pre-treatment and last treatment sessions. Males and females were analysed separately. Results: Before treatment, lesbian and bisexual women were more likely to report clinical levels of impairment (Work and Social Adjustment Scale) than heterosexual women; there were no significant differences in depression (PHQ-9) or anxiety (GAD-7). Bisexual men were more likely to meet depression caseness than gay men but less likely to meet anxiety caseness than gay or heterosexual men. Compared with heterosexual women, lesbian and bisexual individuals showed smaller reductions in depression and impairment, controlling for age, ethnicity, employment, baseline symptoms, number of sessions and intervention type. Bisexual women experienced significantly smaller reductions in anxiety than heterosexual women and were less likely to show recovery or reliable recovery. There were no significant differences in treatment outcomes between gay, bisexual and heterosexual men. Conclusions: Reasons for poorer outcomes in lesbian and bisexual women require investigation, for example lifetime trauma or stigma/discrimination regarding gender or sexual orientation in everyday life or within therapy services.

Keywords

sexual orientationgendertreatment effectivenesstherapy
Type
Research Article
Information
Behavioural and Cognitive Psychotherapy , Volume 46 , Issue 3 , May 2018 , pp. 332 - 349
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2017 

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References

Austin, S. B., Jun, H.-J., Jackson, B., Spiegelman, D., Rich-Edwards, J., Corliss, H. L. and Wright, R. J. (2008). Disparities in child abuse victimization in lesbian, bisexual, and heterosexual women in the Nurses' Health Study II. Journal of Women's Health, 17, 597–606. https://doi.org/10.1089/jwh.2007.0450Google Scholar
Barker, M. (2015). Depression and/or oppression? Bisexuality and mental health. Journal of Bisexuality, 15, 369–384. doi: 10.1080/15299716.2014.995853Google Scholar
British Psychological Society (2012). Guidelines and Literature Review for Psychologists Working Therapeutically with Sexual and Gender Minority Clients. London: British Psychological Society. Available at: http://www.bps.org.uk/sites/default/files/images/rep_92.pdfGoogle Scholar
Chakraborty, A., McManus, S., Bhugra, T. S., Bebbington, P. and King, M. (2011). Mental health of the non-heterosexual population of England. British Journal of Psychiatry, 198, 143–148. doi: 10.1192/bjp.bp.110.082271CrossRefGoogle ScholarPubMed
Community and Mental Health Team, Health and Social Care Information Centre. (2017). Psychological Therapies: Annual report on the use of IAPT services England, 2015–16. Available at: http://content.digital.nhs.uk/catalogue/PUB22110/psyc-ther-ann-rep-2015-16_v2.pdfGoogle Scholar
Dodge, B., Herbenick, D., Friedman, M. R., Schick, V., Fu, T.-C. J., Bostwick, W., Bartelt, E., Munoz-Laboy, M., Pletta, D., Reece, M. and Sandfort, T. G. M. (2016). Attitudes toward bisexual men and women among a nationally representative probability sample of adults in the United States. PLOS ONE, 11, e0164430. doi: 10.1371/journal.pone.0164430Google Scholar
Elliott, M. N., Kanouse, D. E., Burkhart, Q., Abel, G. A., Lyratzopoulos, G., Beckett, M. K., Schuster, M. A. and Roland, R. (2015). Sexual minorities in England have poorer health and worse health care experiences: a national survey. Journal of General and International Medicine, 30, 9–16. doi: 10.1007/s11606-014-2905-yGoogle Scholar
Guasp, A. and Taylor, J. (2012) Experiences of healthcare: Stonewall Health Briefing. Available at: https://www.stonewall.org.uk/resources/experiences-healthcare-%E2%80%93-stonewall-health-briefing-2012Google Scholar
Gyani, A., Shafran, R., Layard, R. and Clark, D. (2013). Enhancing recovery rates: Lessons from year one of IAPT. Behaviour Research Therapy, 51, 597–606. doi: 10.1016/j.brat.2013.06.004Google Scholar
Hatch, S. L., Gazard, B., Williams, D. R., Frissa, S., Goodwin, L., SELCoH Study Team and Hotopf, M. (2016). Discrimination and common mental disorder among migrant and ethnic groups: findings from a South East London Community sample. Social Psychiatry and Psychiatric Epidemiology, 51, 689–107. doi:10.1007/s00127-016-1191-xGoogle Scholar
Hatzenbuehler, M. L. (2009). How does sexual minority stigma ‘get under the skin’? A psychological mediation framework. Psychological Bulletin, 135, 707–730. doi: 10.1037/a0016441Google Scholar
Hatzenbuehler, M. L., Keyes, K. M. and McLaughlin, K. A. (2011). The protective effects of social/contextual factors on psychiatric morbidity in LGB populations. International Journal of Epidemiology, 40, 1071–1080. doi: 10.1093/ije/dyr019CrossRefGoogle ScholarPubMed
Heck, N. C., Mirabito, L. A., LeMaire, K., Livingston, N. A. and Flentje, A. (2016). Omitted data in randomized controlled trials for anxiety and depression: a systematic review of the inclusion of sexual orientation and gender identity. Journal of Consulting and Clinical Psychology, 85, 72–76. doi: http://dx.doi.org/10.1037/ccp0000123CrossRefGoogle ScholarPubMed
Hepgul, N., King, S., Amarasinghe, M., Breen, G., Grant, N., Grey, N., Hotopf, M., Moran, P., Pariante, C. M., Tylee, A., Wingrove, J., Young, A. H. and Cleare, A. J. (2016). Clinical characteristics of patients assessed within an Improving Access to Psychological Therapies (IAPT) service: results from a naturalistic cohort study (Predicting Outcome Following Psychological Therapy; PROMPT). BMC Psychiatry, 16, 52. doi: 10.1186/s12888-016-0736-6CrossRefGoogle ScholarPubMed
Hsieh, N. (2014). Explaining the mental health disparity by sexual orientation: the importance of social resources. Society and Mental Health, 4, 129–146. doi: 10.1177/2156869314524959Google Scholar
Jacobson, N. S. and Truax, P. (1991). Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 12–19.Google Scholar
King, M. (2015). Attitudes of therapists and other health professionals towards their LGB patients. International Review of Psychiatry, 27, 396–404. doi: 10.3109/09540261.2015.1094033CrossRefGoogle ScholarPubMed
King, M., Semlyen, J., Tai, S. S., Killaspy, H., Osborn, D., Popelyuk, D. and Nazareth, I. (2008). A systematic review of mental disorder, suicide, and deliberate self harm in lesbian, gay and bisexual people. BMC Psychiatry, 8, 70. doi: 10.1186/1471-244X-8-70Google Scholar
King, M., Semlyen, S., Killaspy, H., Nazareth, I. and Osborn, D. (2007). A Systematic Review of Research on Counselling and Psychotherapy for Lesbian, Gay, Bisexual and Transgender People. Lutterworth: British Association for Counselling and Psychotherapy.Google Scholar
Kroenke, K., Spitzer, R. L. and Williams, J. B. (2001). The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine, 16, 606–613.Google Scholar
Kroenke, K., Spitzer, R. L., Williams, J. B., Monahan, P. O. and Lowe, B. (2007). Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Annals of Internal Medicine, 146, 317–325.Google Scholar
Lowe, B., Kroenke, K., Herzog, W. and Grafe, K. (2004). Measuring depression outcome with a brief self-report instrument: sensitivity to change of the Patient Health Questionnaire (PHQ-9). Journal of Affective Disorders, 81, 61–66. doi: 10.1016/s0165-0327(03)00198-8Google Scholar
Memorandum of Understanding on Conversion Therapy in the UK (2015). Available at: https://www.psychotherapy.org.uk/wp-content/uploads/2016/09/Memorandum-of-understanding-on-conversion-therapy.pdfGoogle Scholar
Mundt, J. C., Marks, I. M., Shear, K. and Greist, J. H. (2002). The Work and Social Adjustment scale; a simple measure of impairment in functioning. British Journal of Psychiatry, 180, 461–464. doi: 10.1192/bjp.180.5.461Google Scholar
Mustanski, B., Birkett, M., Greene, G., Hatzenbuehler, M. L. and Newcomb, M. E. (2014). Envisaging an America without sexual orientation inequities in adolescence health. American Journal of Public Health, 104, 218–225. doi: 10.2105/AJPH.2013.301625Google Scholar
Nanni, V., Uher, R. and Danese, A. (2012). Childhood maltreatment predicts unfavourable course of illness and treatment outcome in depression: a meta-analysis. American Journal of Psychiatry, 169, 141–151. doi: 10.1176/appi.ajp.2011.11020335Google Scholar
Pachankis, J. E., Hatzenbuehler, M. L., Rendina, H. J., Safren, S. A. and Parsons, J. T. (2015). LGB-affirmative cognitive-behaviour therapy for young adult gay and bisexual men: a randomized controlled trial of a transdiagnostic minority stress approach. Journal of Consulting and Clinical Psychology, 83, 875–889. doi: 10.1037/ccp0000037Google Scholar
Ploderl, M. and Tremblay, P. (2015). Mental health of sexual minorities. A systematic review. International Review of Psychiatry, 27, 367–385. doi: 10.3109/09540261.2015.1083949Google Scholar
Robinson, M. and Ross, L. E. (2013). Gender and sexual minorities: intersecting inequalities and health. Ethnicity and Inequalities in Health and Social Care, 6, 91–96. doi: 10.1108/EIHSC-01-2014-0003Google Scholar
Semlyen, J., King, M., Varney, J. and Hagger-Johnson, G. (2016). Sexual orientation and symptoms of common mental disorder or low wellbeing: combined meta-analysis of 12 UK population health surveys. BMC Psychiatry, 16, 67. doi: 10.1186/s12888-016-0767-zCrossRefGoogle ScholarPubMed
Spitzer, R. L., Kroenke, K., Williams, J. B. and Lowe, B. (2006). A brief measure for assessing generalized anxiety disorder: the GAD-7. Archives of Internal Medicine, 166, 1092–1097. doi: 10.1001/archinte.166.10.1092Google Scholar
Stewart, R., Soremekun, M., Perera, G., Broadbent, M., Callard, F., Denis, M., Hotopf, M., Thornicroft, G. and Lovestone, S. (2009). The South London and Maudsley NHS Foundation Trust Biomedical Research Centre (SLAM BRC) case register: development and descriptive data. BMC Psychiatry, 9, 51.Google Scholar
Walker, J. L., Carey, P. D., Mohr, N., Stein, D. J. and Seedat, S. (2004). Gender differences in the prevalence of childhood sexual abuse and in the development of pediatric PTSD. Archives of Women's Mental Health, 7, 111–121. doi: 10.1007/s00737-003-0039-zGoogle Scholar
Woodhead, C., Gazard, B., Hotopf, M., Rahman, Q., Rimes, K. A. and Hatch, S. L. (2016). Mental health among UK inner city non-heterosexuals: the role of risk factors, protective factors and place. Epidemiology and Psychiatric Sciences, 25, 450–461. doi: 10.1017/S2045796015000645Google Scholar
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