NeonatologyToday_2020_11_15_11 Color Blind: Shedding Light on the Mental Health of LGBTQ People of Color “ With the rise of the Black Lives Matter movement and threats against WUDQVJHQGHU�HPSOR\PHQW� rights and health SURWHFWLRQV�������KDV�EHHQ� PDUNHG�E\�VLJQL¿FDQW� social distress for communities of color and the LGBTQ community." ³��7KHLU�IXOO�VXSSRUW�±� including around mental health issues – can make D�KXJH�GL௺HUHQFH�IRU� IDPLOLHV���7KLV�LV�HVSHFLDOO\� true for communities of color and LGBTQ �/HVELDQ��*D\��%LVH[XDO�� Transgender, Questioning/ 4XHHU��KHDGHG�IDPLOLHV��� 43NEONATOLOGY TODAY�www.NeonatologyToday.net�November2020 .ULVWDQ� 6FRWW�� 0'�� 9LQFHQW� &�� 6PLWK�� 0'��03+ It is a frightening, isolating moment to be a new parent. And those supporting new parents right now – from medical providers and social workers to home visitors -- are FULWLFDO�IURQW�OLQH�ZRUNHUV��7KHLU�IXOO�VXSSRUW� – including around mental health issues – FDQ�PDNH�D�KXJH�GLႇHUHQFH�IRU� IDPLOLHV��� 7KLV�LV�HVSHFLDOO\�WUXH�IRU�FRPPXQLWLHV�RI� FRORU�DQG�/*%74��/HVELDQ��*D\��%LVH[XDO�� 7UDQVJHQGHU��4XHVWLRQLQJ�4XHHU��KHDGHG� families. With the rise of the Black Lives Matter movement and threats against transgen- der employment rights and health protec- WLRQV�������KDV�EHHQ�PDUNHG�E\�VLJQL¿FDQW� social distress for communities of color and WKH�/*%74�FRPPXQLW\��8QIRUWXQDWHO\��LW�LV� now well known that among the many con- sequences of social oppression, there are VLJQL¿FDQW�QHJDWLYH�HႇHFWV�RQ�WKH�PHQWDO� health of the oppressed populations. As healthcare providers in a time when more /*%74�LGHQWLI\LQJ�\RXWK�DUH�HQWHULQJ�SH- diatric practices, and the traditional Ameri- can family structure is changing with an LQFUHDVH� LQ� /*%74�KHDGHG� IDPLOLHV�� ZH� PXVW�UHÀHFW�RQ�WKH�KHDOWK�RI�WKLV�SRSXOD- tion, especially as it intersects with com- munities of color. As neonatal providers, it is vital that we also be aware these fami- lies will be carrying additional stresses, magnifying the already taxing experience RI�WKH�1,&8���7KLV�FDQ�OHDG�WR�VRPH�VNHSWL- cism related to medical practice and some heightened sensitivity to mistreatment. According to the National Institute of Men- tal Health (NIMH), mental illnesses are FRPPRQ��ZLWK�QHDUO\�RQH�LQ�¿YH�DGXOWV�LQ� America living with a serious mental ill- QHVV��$Q�HVWLPDWHG������PLOOLRQ�DGXOWV� LQ� WKH�8QLWHG�6WDWHV�KDG�DW�OHDVW�RQH�PDMRU� depressive episode. An estimated 31.1% of adults will experience an anxiety dis- order at some time in their lives. Notably, /*%74� SHRSOH� DUH� PRUH� WKDQ� WZLFH� DV� likely to face a mental health problem in their lifetime compared to their heterosex- ual counterparts(1)suicide and substance misuse in lesbian, gay and bisexual (LGB. 0RUH�VWULNLQJO\��/*%74�\RXWK�DUH�RYHU�WZR� times as likely to attempt suicide than their VWUDLJKW� SHHUV����� 7KH� PDMRULW\� RI� PHQWDO� LOOQHVV� GHYHORSV� E\� D� SHUVRQ¶V� PLG���V�� ZKLFK�FDQ�XOWLPDWHO\�KDYH�VLJQL¿FDQW�LPSOL- cations in areas such as work productivity in adulthood. (3,4) Unfortunately, studies VXJJHVW�WKDW�WKHUH�LV�D�VLJQL¿FDQWO\�KLJKHU� prevalence of mental health issues such as depression, anxiety, eating disorders, VHOI�LQMXU\��DQG�VXLFLGDOLW\�DPRQJ�/*%74� college and graduate students, who are in WKLV�DIRUHPHQWLRQHG�DJH�UDQJH��������D�PR- bile survey of randomly selected students �1 �������DW����8�6��FDPSXVHV��LQFOXGLQJ� ������JHQGHU�PLQRULW\�>*0@�VWXGHQWV���7KH� data for mental health prevalence among racial minority populations varies; howev- HU��VRPH�VWXGLHV�VXJJHVW�D�VLJQL¿FDQW�EXU- den of mental health problems among ra- cial/ethnic minority students in addition to OLPLWHG�XVH�RI�PHQWDO�KHDOWK�VHUYLFHV������� 7KH� GLVSURSRUWLRQDWH� SUHVHQFH� RI� PHQWDO� KHDOWK�SUREOHPV�IRU�WKH�/*%74�FRPPXQL- ty and communities of color is explained by the theory of minority stress. (9) It outlines KRZ�WKH�VWLJPD��SUHMXGLFH�DQG�GLVFULPLQD- WLRQ� DVVRFLDWHG� ZLWK� D� SHUVRQ¶V� PLQRULW\� status (i.e., race, sexuality, gender) cre- ates a negative social environment that UHVXOWV� LQ� PHQWDO� KHDOWK� SUREOHPV�� 0DMRU� discriminatory events like observing or ex- SHULHQFLQJ�GLႇHUHQWLDO� WUHDWPHQW�E\�PHGL- cal providers that often go unmentioned WR�VWDႇ�DUH�FHUWDLQO\�FRQWULEXWRUV�WR�PLQRU- ity stress. Furthermore, microaggressions like providing inadvertently exclusionary handouts that say “mother” and “father” to a same-sex couple in the NICU certainly add to this stress. (10) Intersectionality describes how social iden- tities and social inequality based on race and sexual orientation are interdependent, not mutually exclusive. (11) As such, the ZD\�LQ�ZKLFK�/*%74�SHRSOH�RI�FRORU�H[- perience the world is unique as they hold PXOWLSOH� LGHQWLWLHV� RI� PDUJLQDOL]DWLRQ�� )RU� LQVWDQFH�� /*%74� SHRSOH� RI� FRORU� PD\� ERWK�H[SHULHQFH�UDFLVP�ZLWKLQ�WKH�/*%74� community and homophobia within their respective racial/ethnic minority communi- WLHV��7KH�HQG�UHVXOW�LV�WKDW�PDQ\�RI�WKHVH� The National Perinatal Association (NPA) is an interdisciplinary organiza- tion that strives to be a leading voice for perinatal care in the United States. Our diverse membership is comprised of healthcare providers, parents & caregiv- ers, educators, and service providers, all driven by their desire to give voice to and support babies and families at risk across the country. Members of the NPA write a regular peer-reviewed column in Neonatology Today. Peer Reviewed Readers can also follow NEONATOLOGY TODAY via our Twitter Feed @NEOTODAY 44NEONATOLOGY TODAY�www.NeonatologyToday.net�November 2020 IDPLOLHV�GRQ¶W�IHHO�ZHOFRPHG�RU�LQFOXGHG�E\�HLWKHU�WKH�UDFLDO�HWKQLF� PLQRULW\�RU�/*%74�FRPPXQLW\�� �5HFRJQL]LQJ�WKH�FRPSRXQGLQJ� HႇHFW�RI�WKH�PXOWLSOH�PLQRULW\�VWUHVVRUV��WKH�SUHYDOHQFH�RI�PHQWDO� KHDOWK�SUREOHPV�LQ�/*%74�FRPPXQLWLHV�RI�FXOWXUH�PD\�QRW�EH� captured by studies that investigate the association of mental health with race and sexuality independently. /*%74� SHRSOH� RI� FRORU� UHSUHVHQW� DQ� XQGHUVHUYHG� DQG� XQGHU� researched population, especially in the area of mental health. Considering the potential consequences of the intersectionality RI�UDFH�DQG�/*%74�VWDWXV��WKH�PHQWDO�KHDOWK�SUHYDOHQFH�RI�WKLV� population may not mirror that of the larger population. One online VXUYH\�RI�����SDUWLFLSDQWV�VXJJHVWV�DQ�DGGLWLYH�HႇHFW�RI�PXOWLSOH� IRUPV�RI�GLVFULPLQDWLRQ�RQ�WKH�PHQWDO�KHDOWK�RI�/*%74�SHRSOH�RI� color. (12)sexual orientation, and gender identity has been linked to many negative psychological and physical health outcomes LQ�SUHYLRXV�UHVHDUFK��LQFOXGLQJ�LQFUHDVHG�VXLFLGDO�LGHDWLRQ��7ZR� KXQGUHG�OHVELDQ��JD\��ELVH[XDO��WUDQVJHQGHU��DQG�TXHHU��/*%74�� However, few studies have investigated this issue or had a large HQRXJK�VDPSOH�VL]H�WR�HOXFLGDWH�VLJQL¿FDQFH��� As healthcare providers, we must investigate the etiologies and consequences of this inequity in the burden of mental health for WKH�/*%74�FRPPXQLW\�RI�FRORU�DQG�GHYHORS�LQWHUYHQWLRQV�WR�PLWL- JDWH�WKH�HႇHFWV�RI�WKLV�GLVSDULW\�ZLWKLQ�RXU�SUDFWLFHV�DQG�XOWLPDWHO\� within our health care system. Furthermore, as neonatal provid- HUV��ZH�PXVW�UHFRJQL]H�WKH�EXUGHQ�RI�PHQWDO�KHDOWK�LVVXHV�LP- SDFWLQJ�RXU� IDPLOLHV� IURP�/*%74�FRPPXQLWLHV�RI�FRORU�DQG�EH� proactive about assessing needs and providing essential support. References: 1. Semlyen J, King M, Varney J, Hagger-Johnson G. Sexual orientation and symptoms of common mental disorder or low wellbeing: Combined meta-analysis of 12 UK popu- lation health surveys. BMC Psychiatry. 2016;16(1):1-9. doi:10.1186/s12888-016-0767-z 2. Goldbach JT, Rhoades H, Green D, Fulginiti A, Marshal 03��,V�7KHUH�D�1HHG�IRU�/*%7�6SHFL¿F�6XLFLGH�&ULVLV�6HU- vices? Crisis. 2019;40(3):203-208. doi:10.1027/0227-5910/ a000542 3. Kessler RC, Amminger GP, Aguilar-Gaxiola S, Alonso J, Lee S, Ustün TB. Age of onset of mental disorders: a review of recent literature. Curr Opin Psychiatry. 2007;20(4):359-364. doi:10.1097/YCO.0b013e32816ebc8c 4. Wang PS, Simon GE, Avorn J, Mcculloch J, Petukhova MZ, Kessler RC. and Care Management for Depressed Work- ers and Impact on Clinical. Jama. 2007;298(12):1401-1411. doi:10.1001/jama.298.12.1401 5. Lipson SK, Raifman J, Abelson S, Reisner SL. Gender Mi- nority Mental Health in the U.S.: Results of a National Sur- vey on College Campuses. Am J Prev Med. 2019;57(3):293- 301. doi:10.1016/j.amepre.2019.04.025 6. Horwitz AG, Berona J, Busby DR, et al. Variation in Suicide Risk among Subgroups of Sexual and Gender Minority Col- lege Students. Suicide Life-Threatening Behav. Published online 2020. doi:10.1111/sltb.12637 7. Lipson SK, Kern A, Eisenberg D, Breland-Noble AM. Men- tal Health Disparities Among College Students of Color. J Adolesc Heal. 2018;63(3):348-356. doi:10.1016/j.jado- health.2018.04.014 8. Busby DR, Horwitz AG, Zheng K, et al. Suicide risk among gender and sexual minority college students: The roles of victimization, discrimination, connectedness, and identity D௻UPDWLRQ��-�3V\FKLDWU�5HV�����������-XO\���������������� doi:10.1016/j.jpsychires.2019.11.013 9. 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 10. Smith V, Litt J, Wylie M. Further Insights and Suggestions to Support the Lesbian, Gay, Bisexual, Transgender, and Queer/Questioning (LGBTQ)-Headed Family in the NICU. Neonatol Today. 2019;14(11):38-40. 11. Crenshaw K. Mapping the Margins: Intersectionality, Iden- tity Politics, and Violence against Women of Color. Stanford Law Rev. 1991;43(6):1241. doi:10.2307/1229039 12. Sutter M, Perrin PB. Discrimination, Mental Health, and Sui- cidal Ideation Among LGBTQ People of Color. J Couns Psy- chol. 2016;63(1):98-105. doi:10.1037/cou0000126 &RQÀLFW�RI�,QWHUHVW�'LVFORVXUHV��7KH�RWKHU�DXWKRUV�KDYH�QR�FRQ- ÀLFWV�RI�LQWHUHVW�WR�GLVFORVH� Disclosure: The National Perinatal Association www.nationalperina- tal.org is a 501c3 organization that provides education and advo- FDF\�DURXQG�LVVXHV�D௺HFWLQJ�WKH�KHDOWK�RI�PRWKHUV��EDELHV��DQG� families. NT &RUUHVSRQGLQJ�$XWKRU Kristan Scott, MD, Boston Combined Residency Program, Department of Pediatrics, Boston Medical Center, 801 Albany St, Boston, MA 02119. E-mail: kristan.scott@childerns.harvard.edu Vincent C. Smith, M.D. M.P.H. Boston Medical Center 801 Albany Street Room 2009 Boston, MA 02119 Vincent.smith@bmc.org (617) 414-3989 (T) (617) 414-3833 (F)