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1.  Are There Still Too Few Suicides to Generate Public Outrage? 
JAMA psychiatry  2016;73(10):1003-1004.
doi:10.1001/jamapsychiatry.2016.1736
PMCID: PMC5082695  PMID: 27706486
2.  Social Structure and Depression in TrevorSpace 
We discover patterns related to depression in the social graph of an online community of approximately 20,000 lesbian, gay, and bisexual, transgender, and questioning youth. With survey data on fewer than two hundred community members and the network graph of the entire community (which is completely anonymous except for the survey responses), we detected statistically significant correlations between a number of graph properties and those TrevorSpace users showing a higher likelihood of depression, according to the Patient Healthcare Questionnaire-9, a standard instrument for estimating depression. Our results suggest that those who are less depressed are more deeply integrated into the social fabric of TrevorSpace than those who are more depressed. Our techniques may apply to other hard-to-reach online communities, like gay men on Facebook, where obtaining detailed information about individuals is difficult or expensive, but obtaining the social graph is not.
doi:10.1145/2531602.2531704
PMCID: PMC5421990
LGBT youth; social network analysis; social media; H.5.m. Information Interfaces and Presentation (e.g. HCI): Group and Organization Interfaces
3.  The Mental Health of People Living with HIV in China, 1998–2014: A Systematic Review 
PLoS ONE  2016;11(4):e0153489.
Background
Understanding the mental health burdens faced by people living with HIV in China is instrumental in the development of successful targeted programs for psychological support and care.
Methods
Using multiple Chinese and English literature databases, we conducted a systematic review of observational research (cross-sectional, case-control, or cohort) published between 1998 and 2014 on the mental health of people living with HIV in China.
Results
We identified a total of 94 eligible articles. A broad range of instruments were used across studies. Depression was the most widely studied problem; the majority of studies reported prevalence greater than 60% across research settings, with indications of a higher prevalence among women than men. Rates of anxiety tended to be greater than 40%. Findings regarding the rates of suicidality, HIV-related neurocognitive disorders, and substance use were less and varied. Only one study investigated posttraumatic stress disorder and reported a prevalence of 46.2%. Conflicting results about health and treatment related factors of mental health were found across studies.
Conclusions
Despite limitations, this review confirmed that people living with HIV are vulnerable to mental health problems, and there is substantial need for mental health services among this population.
doi:10.1371/journal.pone.0153489
PMCID: PMC4833336  PMID: 27082749
4.  Are Informing Knowledge and Supportive Attitude Enough for Tobacco Control? A Latent Class Analysis of Cigarette Smoking Patterns among Medical Teachers in China 
Background: This study is one part of a five-year tobacco-control project in China, which aimed to gain insight into the smoking behavior, knowledge, and attitudes among medical teachers in China. Methods: In May 2010, a cross-sectional survey was conducted among medical teachers of Xiangya Medical School, Central South University, China. Results: A total number of 682 medical teachers completed the surveys. Latent class analysis indicated the sample of smoking patterns was best represented by three latent subgroups of smoking consumption severity levels. Most respondents were informed of smoking related knowledge, but lack of knowledge on smoking cessation. Most of them held a supportive attitude towards their responsibilities among tobacco control, as well as the social significance of smoking. However, both smoking related knowledge and attitude were not correlated with severity of smoking consumption among medical teachers. Conclusion: The smoking prevalence among medical teachers in China remains high. Programs on smoking cessation training are required. Future study should also develop targeted interventions for subgroups of smokers based on smoking consumption. Persistent and effective anti-tobacco efforts are needed to achieve the goals of creating smoke-free campuses and hospitals.
doi:10.3390/ijerph121012030
PMCID: PMC4626953  PMID: 26404331
smoking; smoking cessation; health knowledge; attitude; practice
5.  Health Inequalities Among Sexual Minority Adults 
Background
Improving the health of lesbian, gay, and bisexual (LGB) individuals is a Healthy People 2020 goal; however, the IOM highlighted the paucity of information currently available about LGB populations.
Purpose
To compare health indicators by gender and sexual orientation statuses.
Methods
Data are from Behavioral Risk Factor Surveillance System surveys conducted January–December of 2010 with population-based samples of non-institutionalized U.S. adults aged over 18 years (N=93,414) in ten states that asked about respondents’ sexual orientation (response rates=41.1%–65.6%). Analyses were stratified by gender and sexual orientation to compare indicators of mental health, physical health, risk behaviors, preventive health behaviors, screening tests, health care utilization, and medical diagnoses. Analyses were conducted in March 2013.
Results
Overall, 2.4% (95% CI=2.2, 2.7) of the sample identified as LGB. All sexual minority groups were more likely to be current smokers than their heterosexual peers. Compared with heterosexual women, lesbian women had over 30% decreased odds of having an annual routine physical exam, and bisexual women had over 2.5 times the odds of not seeking medical care owing to cost. Compared with heterosexual men, gay men were less likely to be overweight or obese, and bisexual men were twice as likely to report a lifetime asthma diagnosis.
Conclusions
This study represents one of the largest samples of LGB adults and finds important health inequalities, including that bisexual women bear particularly high burdens of health disparities. Further work is needed to identify causes of and intervention for these disparities.
doi:10.1016/j.amepre.2013.11.010
PMCID: PMC4102129  PMID: 24650836
6.  Suicide Contagion: A Systematic Review of Definitions and Research Utility 
PLoS ONE  2014;9(9):e108724.
Objectives
Despite the common use of contagion to analogize the spread of suicide, there is a lack of rigorous assessment of the underlying concept or theory supporting the use of this term. The present study aims to examine the varied definitions and potential utility of the term contagion in suicide-related research.
Methods
100 initial records and 240 reference records in English were identified as relevant with our research objectives, through systematic literature screening. We then conducted narrative syntheses of various definitions and assessed their potential value for generating new research.
Results
20.3% of the 340 records used contagion as equivalent to clustering (contagion-as-cluster); 68.5% used it to refer to various, often related mechanisms underlying the clustering phenomenon (contagion-as-mechanism); and 11.2% without clear definition. Under the category of contagion-as-mechanism, four mechanisms have been proposed to explain how suicide clusters occurred: transmission (contagion-as-transmission), imitation (contagion-as-imitation), contextual influence (contagion-as-context), and affiliation (contagion-as-affiliation). Contagion-as-cluster both confounds and constrains inquiry into suicide clustering by blending proposed mechanism with the phenomenon to be studied. Contagion-as-transmission is, in essence, a double or internally redundant metaphor. Contagion-as-affiliation and contagion-as-context involve mechanisms that are common mechanisms that often occur independently of apparent contagion, or may serve as a facilitating background. When used indiscriminately, these terms may create research blind spots. Contagion-as-imitation combines perspectives from psychology, sociology, and public health research and provides the greatest heuristic utility for examining whether and how suicide and suicidal behaviors may spread among persons at both individual and population levels.
Conclusion
Clarifying the concept of “suicide contagion” is an essential step for more thoroughly investigating its mechanisms. Developing a clearer understanding of the apparent spread of suicide-promoting influences can, in turn, offer insights necessary to build the scientific foundation for prevention and intervention strategies that can be applied at both individual and community levels.
doi:10.1371/journal.pone.0108724
PMCID: PMC4178222  PMID: 25259604
7.  Physical health indicators among lesbian, gay, and bisexual U.S. Veterans 
Annals of epidemiology  2013;23(7):448-451.
Purpose
To provide information about lesbian, gay and bisexual (LGB) veterans’ health status, diagnoses, and health screening behaviors compared with heterosexual veterans.
Methods
Data are from ten states’ 2010 Behavioral Risk Factor Surveillance System (BRFSS) surveys that contained sexual orientation data for veterans (n=11,665). Chi-square tests and multiple logistic regression were used to examine outcomes among LGB and heterosexual veterans.
Results
More LGB veterans than heterosexual veterans reported current smoking, not seeking medical care due to cost, and activity limitations. Compared with heterosexual veterans, LGB veterans had greater odds of ever having an HIV test (OR=5.42; 95%CI: 3.28–8.96) but lower odds of diabetes diagnosis (0.55 (0.34–0.89).
Conclusions
Findings from this sample suggest patterns of health behaviors and outcomes among LGB veterans that are both unique from and similar to results from general samples of LGB persons. With the formal end of the “Don’t Ask, Don’t Tell” policy that discriminated against LGB people in the military, institutions such as the Department of Veterans Affairs (VA) are likely to see an increase in its current population of LGB veterans. The VA stands in a unique place to meet the health equity needs of this minority population.
doi:10.1016/j.annepidem.2013.04.009
PMCID: PMC3698572  PMID: 23688720
8.  Health Care Utilization and Health Indicators Among a National Sample of U.S. Veterans in Same-Sex Partnerships 
Military medicine  2013;178(2):207-212.
Objectives
To examine health indicators of same-sex partnered veterans as compared with their opposite-sex partnered veteran and nonveteran peers.
Methods
Same-sex partner status was derived by self-reported same-sex partnerships in data from the 2004 Behavioral Risk Factor Surveillance System. Outcome variables included health risk disparities associated with sexual minority status (e.g., frequent mental distress) and veteran status (e.g., firearm ownership). Stratified multiple logistic regression models were used to examine the association of same-sex partnered veteran status with health indicators.
Results
Same-sex partnered veterans had higher odds of being overweight and keeping firearms in the house compared with same-sex partnered nonveterans. Same-sex partnered veterans were less likely than opposite-sex partnered veterans to be overweight, and they were more than twice as likely to be current smokers when compared with opposite-sex partnered nonveterans.
Conclusions
Findings suggest both that some health disparities patterns identified by same-sex partnership status among the general population also exist among veteran populations, and that some unique distinctions may exist, particularly related to BMI and firearm ownership. Collection of information about sexual minority status within Department of Veterans Affairs data sources is needed to more accurately assess the health of this minority population.
PMCID: PMC3725588  PMID: 23495467
9.  Connecting the Invisible Dots: Network-Based Methods to Reach a Hidden Population at Risk for Suicide 
Social science & medicine (1982)  2009;69(3):469-474.
Young lesbian, gay, and bisexual (young LGB) individuals report higher rates of suicide ideation and attempts from their late teens through early twenties. Their high rate of Internet use suggests that online social networks offer a novel opportunity to reach them. This study explores online social networks as a venue for prevention research targeting young LGB. An automated data collection program was used to map the social connections between LGB self-identified individuals between 16 and 24 years old participating in an online social network. We then completed a descriptive analysis of the structural characteristics known to affect diffusion within such networks. Finally, we conducted Monte Carlo simulations of peer-driven diffusion of a hypothetical preventive intervention within the observed network under varying starting conditions. We mapped a network of 100,014 young LGB. The mean age was 20.4 years. The mean nodal degree was 137.5, representing an exponential degree distribution ranging from 1 through 4,309. Monte Carlo simulations revealed that a peer-driven preventive intervention ultimately reached final sample sizes of up to 18,409 individuals. The network’s structure is consistent with other social networks in terms of the underlying degree distribution. Such networks are typically formed dynamically through a process of preferential attachment. This implies that some individuals could be more important to target to facilitate the diffusion of interventions. However, in terms of determining the success of an intervention targeting this population, our simulation results suggest that varying the number of peers that can be recruited is more important than increasing the number of randomly-selected starting individuals. This has implications for intervention design. Given the potential to access this previously isolated population, this novel approach represents a promising new frontier in suicide prevention and other research areas.
doi:10.1016/j.socscimed.2009.05.029
PMCID: PMC2768574  PMID: 19540641
adolescent suicide; adult suicide; human sexuality; network analysis; Internet; algorithms; lesbian; gay; bisexual

Results 1-9 (9)