Sexual Orientation, Adverse Childhood Experiences, and Comorbid DSM-5 Substance Use and Mental Health Disorders

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Overview

People in sexual minority groups are more likely than heterosexual individuals to experience adverse childhood experiences. Is trauma in childhood associated with increased mental health and substance use disorders in adulthood? Find survey data here.

Abstract

Objective: To assess the relationships between adverse childhood experiences (ACEs) and comorbid Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) substance use and mental health disorders across 5 sexual orientation subgroups: lesbian/gay, bisexual, unsure, discordant heterosexual (ie, heterosexual-identified with same-sex attraction or behavior), and concordant heterosexual.

Methods: Data were from the 2012−2013 National Epidemiologic Survey on Alcohol and Related Conditions-III, a cross-sectional, nationally representative survey of non-institutionalized US adults. Data were collected in households via structured diagnostic face-to-face interviews; the overall response rate was 60.1%. The sample included 36,309 US adults aged 18 years and older.

Results:  Sexual minorities (gay, lesbian, bisexual), especially bisexual women, reported the highest prevalence of ACEs and comorbid substance use and mental health disorders. Approximately 43.8% of bisexual women reported 4 or more ACEs, and 38.0% of bisexual women reported comorbid substance use and mental health disorders. Multivariable regression analyses indicated a curvilinear relationship between ACEs and comorbid substance use and mental health disorders, and sexual minorities consistently had a higher ACE mean than concordant heterosexual respondents. The majority of sexual minorities with high levels of ACEs had comorbid substance use and mental health disorders.

Conclusions: Sexual minorities are exposed to more ACEs than their heterosexual counterparts in the US. We found evidence that US sexual minorities are at higher risk of comorbid substance use and mental health disorders. These findings reinforce the importance of identifying exposure to ACEs and developing trauma-informed interventions to treat comorbidities in those exposed to multiple ACEs, especially sexual minorities.

To cite: McCabe SE, Hughes TL, West BT, et al. Sexual Orientation, Adverse Childhood Experiences, and Comorbid DSM-5 Substance Use and Mental Health Disorders. J Clin Psychiatry. 2020;81(6):20m13291.

To share: https://doi.org/10.4088/JCP.20m13291


Read the whole article at psychiatrist.com here:
Sexual Orientation, Adverse Childhood Experiences, and Comorbid DSM-5 Substance Use and Mental Health Disorders

© Copyright 2020 Physicians Postgraduate Press, Inc.

Target Audience

Psychiatrists

Learning Objectives

After completing this educational activity, you should be able to:

  • Screen patients with mental or substance use disorders for sexual minority status and adverse childhood experiences so that interventions can be tailored appropriately

Activity summary
Available credit: 
  • 1.00 AMA PRA Category 1 Credit™
  • 1.00 Participation
Activity opens: 
12/01/2020
Activity expires: 
12/31/2022
Cost:
$10.00
Rating: 
0

CME Background

Articles are selected for credit designation based on an assessment of the educational needs of CME participants, with the purpose of providing readers with a curriculum of CME articles on a variety of topics throughout each volume. Activities are planned using a process that links identified needs with desired results.

CME Objective

After studying this article, you should be able to:

  • Screen patients with mental or substance use disorders for sexual minority status and adverse childhood experiences so that interventions can be tailored appropriately

Statement of Need and Purpose

Clinicians treating patients in a sexual minority may be unaware of the high prevalence of adverse childhood experiences and comorbid substance use and mental health disorders in these patients. They need education about the associations among sexual minority status, adverse childhood experiences, and substance use and mental health disorders to help them evaluate for these disorders and guide patients to trauma-informed treatment plans.

Release, Expiration, and Review Dates

This educational activity was published in December 2020 and is eligible for AMA PRA Category 1 Credit™ through December 31, 2022. The latest review of this material was November 2020.

Disclosure of off-label usage

The authors have determined that, to the best of their knowledge, no investigational information about pharmaceutical agents or device therapies that is outside US Food and Drug Administration–approved labeling has been presented in this activity.

Author contributions

All authors take responsibility for the integrity of the data and accuracy of the data analysis. All authors have contributed, reviewed, and approved this manuscript.

Funding/support

The development of this article was supported by research grants R01AA025684 (principal investigator [PI]: Dr S. E. McCabe), R01CA203809 (PI: Dr S. E. McCabe), R01CA212517 (PI: Dr S. E. McCabe), R01DA031160 (PI: Dr S. E. McCabe), R01DA036541 (PI: Dr S. E. McCabe), and R01DA043696 (PI: Dr Boyd) from the National Institute on Alcohol Abuse and Alcoholism (NIAAA), National Cancer Institute (NCI), and National Institute on Drug Abuse (NIDA), and National Institutes of Health (NIH), Bethesda, Maryland.

Role of the sponsor

The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Disclaimer

The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIAAA, NCI, NIDA, NIH, or US Government.

Acknowledgments

The authors thank Curtiss Engstrom, BS, for his assistance with analysis of the data and developing the tables and figures for the manuscript. Kate Leary, BS, and Kathryn Lundquist, ABA, assisted with proofreading and formatting the manuscript. Mr Engstrom, Ms Leary, and Ms Lundquist are all affiliated with the University of Michigan and have no conflicts of interest to report.

Additional information

This manuscript was prepared using the limited access dataset National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III) obtained from the National Institute on Alcohol Abuse and Alcoholism (https://www.niaaa.nih.gov/).

Faculty Affiliation

Sean Esteban McCabe, PhD*
Center for the Study of Drugs, Alcohol, Smoking and Health, Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, Michigan; Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan; Institute for Research on Women and Gender, University of Michigan, Ann Arbor, Michigan; Center for Sexuality and Health Disparities, Department of Systems, Population and Leadership, University of Michigan School of Nursing, Ann Arbor, Michigan; and Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan; Department of Psychiatry, University of Michigan, Ann Arbor, Michigan

Tonda L. Hughes, PhD
School of Nursing and Department of Psychiatry, Columbia University, New York, New York

Brady T. West, PhD
Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan, and Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan

Rebecca J. Evans-Polce, PhD
Center for the Study of Drugs, Alcohol, Smoking and Health, Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, Michigan

Phil T. Veliz, PhD
Center for the Study of Drugs, Alcohol, Smoking and Health, Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, Michigan; Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan; and Institute for Research on Women and Gender, University of Michigan, Ann Arbor, Michigan

Kara Dickinson
Center for the Study of Drugs, Alcohol, Smoking and Health, Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, Michigan

Vita V. McCabe, MD, MHSA
Center for the Study of Drugs, Alcohol, Smoking and Health, Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, Michigan; Department of Psychiatry, University of Michigan, Ann Arbor, Michigan; and Department of Surgery, University of Michigan, Ann Arbor, Michigan

Carol J. Boyd, PhD
Center for the Study of Drugs, Alcohol, Smoking and Health, Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, Michigan; Institute for Research on Women and Gender, University of Michigan, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan; and Department of Psychiatry, University of Michigan, Ann Arbor, Michigan

*Corresponding author: Sean Esteban McCabe, PhD, Center for the Study of Drugs, Alcohol, Smoking and Health, University of Michigan School of Nursing, 400 North Ingalls St, Ann Arbor, MI 48109 (plius@umich.edu).

Financial Disclosure

All individuals in a position to influence the content of this activity were asked to complete a statement regarding all relevant personal financial relationships between themselves or their spouse/partner and any commercial interest. The CME Institute has resolved any conflicts of interest that were identified. In the past year, Marlene P. Freeman, MD, Editor in Chief of The Journal of Clinical Psychiatry, has received research funding from JayMac and Sage; has been a member of the advisory boards for Otsuka, Alkermes, and Sunovion; has been a member of the Independent Data Safety and Monitoring Committee for Janssen; has been a member of the Steering Committee for Educational Activities for Medscape; and, as a Massachusetts General Hospital (MGH) employee, works with the MGH National Pregnancy Registry, which is sponsored by Teva, Alkermes, Otsuka, Actavis, and Sunovion, and works with the MGH Clinical Trials Network and Institute, which receives research funding from multiple pharmaceutical companies and the National Institute of Mental Health. No member of the CME Institute staff reported any relevant personal financial relationships. Faculty financial disclosure appears at the end of the article.

Drs S. E. McCabeHughesWestEvans-PolceVelizDickinsonV. V. McCabe, and Boyd have no personal affiliations or financial relationships with any commercial interest to disclose relative to the article.

Accreditation Statement

The CME Institute of Physicians Postgraduate Press, Inc., is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

 

 

Credit Designation

The CME Institute of Physicians Postgraduate Press, Inc., designates this journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Note: The American Academy of Physician Assistants (AAPA) accepts certificates of participation for educational activities certified for AMA PRA Category 1 Credit™ from organizations accredited by ACCME or a recognized state medical society. Physician assistants may receive a maximum of 1.0 hour of Category I credit for completing this program.

Available Credit

  • 1.00 AMA PRA Category 1 Credit™
  • 1.00 Participation

Price

Cost:
$10.00
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