Psychological Distress, Resilience, and Help-Seeking Experiences of LGBTIQA+ People in Rural Australia
Abstract
:1. Introduction
Literature Review
2. Materials and Methods
2.1. Survey
2.2. Interviews
2.3. Recruitment
2.4. Data Analysis
3. Results
3.1. Overall Results
3.2. Survey Results
3.2.1. Psychological Distress
3.2.2. Mental Health
3.2.3. Resilience
3.2.4. Help-Seeking Experiences
3.2.5. Barriers and Facilitators
3.3. Interview Results
3.3.1. Mental Health and Contributing Aspects
[I]t was many years before I met somebody else that identified similarly to me, which is really hard in terms of your … mental health because [when] there’s no one around like you, how do you work out that you don’t come from bloody Mars … ? … So that really impacts on your mental health and … suicidality…
3.3.2. Help-Seeking Experiences
3.3.3. Barriers and Facilitators
I feel just that living, living in rural areas, you either see one of the few people [MHP] who are close by, in which case your ability to get help is somewhat limited by the professional’s time. Or you go to a larger area where it’s limited by your ability to travel that distance [so access to services and care is compromised].
Outside of rural areas, I’ve found government services for mental health quite encouraging as a whole. But within them [in rural areas] … I’ve not really found much help … the harm, as always, comes from the interminable waiting.
… funds for mental health services are limited in [rural Tasmania]. And there is a lot of pressure on the people delivering these services to keep up with the demand… And sometimes that means [a person] misses out [on getting psychological care]. … that makes me a bit reluctant to go to these services for fear of not being able to get what I need…
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- National LGBTI Health Alliance. Snapshot of Mental Health and Suicide Prevention Statistics for LGBTI People; LGBTI Health: Pyrmont, Australia, 2020. [Google Scholar]
- Meyer, I.H. Prejudice, social distress, and mental health in lesbian, gay and bisexual populations: Conceptual issues and research evidence. Psychol. Bull. 2003, 129, 674–697. [Google Scholar] [CrossRef]
- Rosenstreich, G. LGBTI People: Mental Health & Suicide; Briefing Paper. Revised 2nd Edition; LGBTI Health: Pyrmont, Australia, 2013. [Google Scholar]
- Bariola, E.; Lyons, A.; Leonard, W.; Pitts, M.; Badcock, P.; Couch, M. Demographic and psychosocial factors associated with psychological distress and resilience among transgender individuals. Am. J. Public Health 2015, 105, 2108–2116. [Google Scholar] [CrossRef]
- Smith, B.W.; Dalen, J.; Wiggins, K.; Tooley, E.; Christopher, P.; Bernard, J. The Brief Resilience Scale: Assessing the ability to bounce back. Int. J. Behav. Med. 2008, 15, 194–200. [Google Scholar] [CrossRef]
- Kim-Cohen, J.; Turkewitz, R. Resilience and measured gene-environment interactions. Dev. Psychopathol. 2012, 24, 1297–1306. [Google Scholar] [CrossRef]
- Sippel, L.M.; Pietrzak, R.H.; Charney, D.S.; Mayes, L.C.; Southwick, S.M. How does social support enhance resilience in the trauma-exposed individual? Ecol. Soc. 2015, 20, 1–10. [Google Scholar] [CrossRef]
- Cochran, S.D.; Sullivan, J.G.; Mays, V.M. Prevalence of mental disorders, psychological distress, and mental health services use among lesbian, gay, and bisexual adults in the United States. J. Consult. Clin. Psychol. 2003, 71, 53–61. [Google Scholar] [CrossRef] [PubMed]
- Scott, M.; Cornelius-White, J. Mental health and social support experiences of transgender and gender nonconforming adults in rural America: A meta-synthesis. J. Gay Lesbian Ment. Health 2022. [Google Scholar] [CrossRef]
- Easpaig, B.N.G.; Reynish, T.; Hoang, H.; Bridgman, H.; Corvinus-Jones, S.L.; Auckland, S. A systematic review of the health and health care of rural sexual and gender minorities in the UK, USA, Canada, Australia and New Zealand. Rural Remote Health 2020, 22, 6999. [Google Scholar] [CrossRef]
- McNair, R.P.; Bush, R. Mental health help seeking patterns and associations among Australian same sex attracted women, trans and gender diverse people: A survey-based study. BMC Psychiatry 2016, 16, 209. [Google Scholar] [CrossRef]
- Platt, L.F.; Wolf, J.K.; Scheitle, C.P. Patterns of mental health care utilization among sexual orientation minority groups. J. Homosex. 2018, 65, 135–153. [Google Scholar] [CrossRef]
- McNair, R.P.; Bush, R. Rainbow Women and Help Seeking: Research Report; Beyondblue: Melbourne, VIC, Australia, 2015. [Google Scholar]
- Ahmed, S.; Shaw, K.; Tye, I.; Ho, V.; Edwards, L.; Kneebone, J. Primary Health Tasmania Needs Assessment: Health Intelligence Report, September 2017; The state of public health Tasmania, 2018; Primary Health Tasmania Department of Health: Hobart, TAS, Australia; Tasmanian Government: Hobart, TAS, Australia, 2018. [Google Scholar]
- Department of Health. 2018. The State of Public Health Tasmania 2018. Hobart: Tasmanian Government. Report to the Tasmanian Government on Suicide in Tasmania 2012–2018. 2021. Available online: https://www.health.tas.gov.au/publications/report-tasmanian-government-suicide-tasmania-2012-2018 (accessed on 15 April 2022).
- Primary Health Tasmania. Mental Health Commissioning Intentions 2016–2017—Consultation Draft; Primary Health Tasmania: Hobart, TAS, Australia, 2016. [Google Scholar]
- Clarke, V.; Ellis, S.J.; Peel, E.; Riggs, D. Lesbian, Gay, Bisexual, Trans and Queer Psychology; Cambridge University Press: Melbourne, Australia, 2010. [Google Scholar]
- Sedgwick, E.K. Epistemology of the Closet; University of California Press: Los Angeles, CA, USA, 1990. [Google Scholar]
- van Anders, S.M. Beyond sexual orientation: Integrating gender/sex and diverse sexualities via Sexual Configurations Theory. Arch. Sex. Behav. 2015, 44, 1177–1213. [Google Scholar] [CrossRef]
- Fried, S.T.; Espinoza-Kim, A. Sexual health and sexual rights. In International Human Rights of Women; Reilly, N., Ed.; Springer Nature: Singapore, 2019; pp. 285–304. [Google Scholar]
- Hesse-Biber, S.; Rodriguez, D.; Frost, N. A qualitatively driven approach to multimethod and mixed methods research. In The Oxford Handbook of Multimethod and Mixed Methods Research Inquiry; Hesse-Biber, S.N., Johnson, B., Eds.; Oxford University Press: Oxford, UK, 2015. [Google Scholar] [CrossRef]
- Australian Bureau of Statistics. National Survey of Mental Health and Wellbeing: Summary of Results. Retrieved 15 April 2022; 2008. Available online: https://www.abs.gov.au/statistics/health/mental-health/national-survey-mental-health-and-wellbeing-summary-results/latest-release (accessed on 15 April 2022).
- Australian Psychological Society. Stress and Wellbeing: How Australians are Coping with Life. Retrieved 20 February 2021. 2015. Available online: https://www.psychology.org.au/getmedia/ae32e645-a4f0-4f7c-b3ce-dfd83237c281/stress-wellbeing-survey.pdf (accessed on 20 February 2021).
- Reynish, T.; Hoang, H.; Bridgman, H.; Easpaig, B.N.G. Towards barrier-free counselling for sexual/gender minorities and sex workers in rural Tasmania. In Proceedings of the 15th National Rural Health Conference, Hobart, TAS, Australia, 24–27 March 2019; National Rural Health Alliance: Canberra, ACT, Australia, 2019. [Google Scholar]
- Reynish, T.; Hoang, H.; Bridgman, H.; Easpaig, B.N.G. Barriers and enablers to sex workers’ uptake of mental healthcare: A systematic literature review. Sex. Res. Soc. Policy 2020, 18, 184–201. [Google Scholar] [CrossRef]
- Kessler, R.C.; Andrews, G.; Colpe, L.J.; Hiripi, E.; Mroczek, D.K.; Normand, S.-L.T.; Zaslavsky, A.M. Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychol. Med. 2002, 32, 959–976. [Google Scholar] [CrossRef]
- Australian Bureau of Statistics. Kessler Psychological Distress Scale-10 (K10). Retrieved 15 April 2022; 2019. Available online: https://www.abs.gov.au/ausstats/[email protected]/Lookup/by%20Subject/4363.0~2014-15~Main%20Features~Kessler%20Psychological%20Distress%20Scale-10%20(K10)~35#:~:text=The%20Kessler%20Psychological%20Distress%20Scale%2D10%20(K10)%20is%20a,US%20National%20Health%20Interview%20Survey (accessed on 15 April 2022).
- Drauker, C.B.; Martsolf, D.S.; Poole, C. Developing distress protocols for research on sensitive topics. Arch. Psychiatr. Nurs. 2009, 23, 343–350. [Google Scholar] [CrossRef] [PubMed]
- Guest, G.; Namey, E.; Chen, M. A simple method to assess and report thematic saturation in qualitative research. PLoS ONE 2020, 15, e0232076. [Google Scholar] [CrossRef] [PubMed]
- Joffe, H. Thematic analysis. In Qualitative Methods in Mental Health and Psychotherapy: A Guide for Students and Practitioners; Harper, D., Thompson, A.R., Eds.; John Wiley and Sons, Ltd.: Chichester, UK, 2011; pp. 209–223. [Google Scholar]
- Terry, G.; Hayfield, N.; Clarke, V.; Braun, V. Thematic analysis. In The SAGE Handbook of Qualitative Research in Psychology; Willig, C., Rogers, W.S., Eds.; SAGE Publications Ltd.: London, UK, 2017; pp. 17–36. [Google Scholar]
- Guest, G.; MacQueen, K.M.; Namey, E.E. Applied Thematic Analysis; SAGE Publications Inc.: Thousand Oaks, CA, USA, 2012. [Google Scholar]
- Nowell, L.S.; Norris, J.M.; White, D.E.; Moules, N.J. Thematic analysis: Striving to meet the trustworthiness criteria. Int. J. Qual. Methods 2017, 16, 1–13. [Google Scholar] [CrossRef]
- Slade, T.; Grove, R.; Burgess, P. Kessler Psychological Distress Scale: Normative data from the 2007 Australian National Survey of Mental Health and Wellbeing. Aust. N. Z. J. Psychiatry 2011, 45, 308–316. [Google Scholar] [CrossRef] [PubMed]
- Hill, A.O.; Bourne, A.; McNair, R.; Carman, M.; Lyons, A. Private Lives 3: The Health and Wellbeing of LGBTIQ People in Australia; ARCSHS Monograph Series No. 122; La Trobe University: Bundoora, VIC, Australia, 2020. [Google Scholar]
- Cochran, S.D.; Mays, V.M. Burden of psychiatric morbidity among lesbian, gay, and bisexual individuals in the California quality of life survey. J. Abnorm. Psychol. 2009, 118, 647–658. [Google Scholar] [CrossRef]
- Romanelli, M.; Hudson, K.D. Individual and systemic barriers to health care: Perspectives of lesbian, gay, bisexual, and transgender adults. Am. J. Orthopsychiatry 2017, 87, 714–728. [Google Scholar] [CrossRef]
- Ufomata, E.; Eckstrand, K.L.; Hasley, P.; Jeong, K.; Rubio, D.; Spagnoletti, C. Comprehensive Internal Medicine Residency Curriculum on Primary Care of Patients Who Identify as LGBT. LGBT Health 2018, 5, 375–380. [Google Scholar] [CrossRef]
- Moll, J.; Krieger, P.; Heron, S.L.; Joyce, C.; Moreno-Walton, L. Attitudes, behavior, and comfort of emergency medicine residents in caring for LGBT patients: What do we know? AEM Educ. Train. 2019, 3, 129–135. [Google Scholar] [CrossRef] [PubMed]
- Stroumsa, D.; Shires, D.A.; Richardson, C.R.; Jaffee, K.D.; Woodford, M.R. Transphobia rather than education predicts provider knowledge of transgender health care. Med. Educ. 2019, 53, 398–407. [Google Scholar] [CrossRef] [PubMed]
- QLIFE. Rural and Regional: A QLIFE Guide for Health Professionals; QLIFE: Queensland, Australia, 2016. [Google Scholar]
- Wesselmann, E.D.; Cardoso, F.D.; Slater, S.; Williams, K.D. To be looked at as though air: Civil attention matters. Psychol. Sci. 2012, 23, 166–168. [Google Scholar] [CrossRef] [PubMed]
Characteristic | Survey (N = 66) No. (%) | Interview (N = 30) No. (%) | Total (N = 96) No. (%) |
---|---|---|---|
Gender | |||
Cisgender woman | 35 (53.0) | 16 (53.3) | 51 (53.1) |
Cisgender man | 9 (13.6) | 7 (23.2) | 16 (16.7) |
Nonbinary | 10 (15.2) | 2 (6.7) | 12 (12.5) |
Trans woman | 5 (7.6) | 2 (6.7) | 7 (7.3) |
Trans man | 6 (9.1) | --- | 6 (6.3) |
Additional genders | 1 (1.5) | 3 (10.0) | 3 (3.1) |
Intersex status | |||
Yes | 2 (3.0) | --- | 2 (2.1) |
Unsure/Prefer not to say | 1 (1.5) | 1 (3.3) | 2 (2.1) |
Sexual orientation b | |||
Bisexual | 20 (30.8) | 7 (23.3) | 27 (28.4) |
Lesbian | 13 (20.0) | 3 (10.0) | 16 (16.8) |
Gay | 8 (12.3) | 2 (6.7) | 10 (10.5) |
Pansexual | 7 (10.8) | 3 (10.0) | 10 (10.5) |
Queer | 7 (10.8) | 3 (10.0) | 10 (10.5) |
Asexual | 6 (9.2) | 1 (3.3) | 7 (7.4) |
Additional sexualities | 4 (6.2) | 11 (36.7) | 15 (15.8) |
Kink/BDSM | |||
Kink oriented | 33 (50.0) | 6 (20.0) | 39 (40.6) |
Kink curious | --- | 1 (3.3) | 1 (1.0) |
Educational attainment c | |||
Not university educated | 35 (53.0) | 8 (47.0) | 43 (51.8) |
University educated | 31 (47.0) | 9 (53.0) | 40 (48.2) |
Employment status b | |||
Employed | 33 (50.0) | 22 (75.9) | 55 (57.9) |
Not employed | 33 (50.0) | 7 (24.1) | 40 (42.1) |
Relationship status a | |||
Single | 34 (51.5) | 9 (40.9) | 43 (48.9) |
In a relationship | 28 (42.4) | 7 (31.8) | 35 (39.8) |
Polyamorous | 4 (6.1) | 4 (18.2) | 8 (9.1) |
Open relationship | --- | 2 (9.1) | 2 (2.3) |
Sex work experience | |||
Current or former | 4 (5.1) | 6 (18.2) | 10 (10.4) |
Australian Statistical Geography Standard (ASGA) remoteness class a | |||
Inner regional (RA2) | 28 (48.3) | 17 (56.7) | 45 (51.1) |
Outer regional (RA3) | 28 (48.3) | 12 (40.0) | 40 (45.5) |
Remote (RA4) | 2 (3.4) | 1 (3.3) | 3 (3.4) |
Survey Question | N | n | Normal BRS Score (%) | r | p |
---|---|---|---|---|---|
I have good social support from a significant other, family, friends, community or peers | 51 | 28 | 54.9 | 0.277 * | 0.026 |
I am proud of being sex, sexually, or gender diverse | 34 | 33 | 63.6 | 0.299 * | 0.016 |
Sex, sexual, or gender diversity has become more accepted over the past 5 years | 65 | 60 | 56.7 | 0.314 * | 0.011 |
BDSM/kink improves my mental health | 20 | 19 | 73.4 | 0.579 ** | 0.001 |
I am proud of my kink orientation | 16 | 14 | 63.4 | 0.447 * | 0.010 |
My involvement in a BDSM/kink community has a positive impact on my mental health | 17 | 15 | 75.0 | 0.620 ** | 0.000 |
Cis Woman (n = 35) | Cis Man (n = 9) | Trans Woman (n = 5) | Trans Man (n = 7) | Non- Binary (n = 10) | Total % | |
---|---|---|---|---|---|---|
External aspects | ||||||
MHP said diversity a ‘phase’ | 3 (8.6) | 1 (11.1) | 1 (20.0) | 1 (14.3) | 4 (40.0) | 15.2 |
Proximity | ||||||
MHP too far from home | 5 (14.3) | 1 (11.1) | 0 (0.0) | 4 (57.1) | 4 (40.0) | 21.2 |
Access | ||||||
Lack of MHP in my town | 5 (14.3) | 4 (44.4) | 2 (40.0) | 4 (57.1) | 5 (50.0) | 30.3 |
Limited operating hours | 7 (20.0) | 3 (33.3) | 2 (40.0) | 4 (57.1) | 5 (50.0) | 31.8 |
Lack of public transport | 4 (11.4) | 1 (11.1) | 0 (0.0) | 5 (71.4) | 4 (40.0) | 21.2 |
Interal aspect | ||||||
No trust for MHP | 6 (17.1) | 2 (22.2) | 2 (40.0) | 3 (42.9) | 6 (60.0) | 28.8 |
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Reynish, T.; Hoang, H.; Bridgman, H.; Nic Giolla Easpaig, B. Psychological Distress, Resilience, and Help-Seeking Experiences of LGBTIQA+ People in Rural Australia. Int. J. Environ. Res. Public Health 2023, 20, 2842. https://doi.org/10.3390/ijerph20042842
Reynish T, Hoang H, Bridgman H, Nic Giolla Easpaig B. Psychological Distress, Resilience, and Help-Seeking Experiences of LGBTIQA+ People in Rural Australia. International Journal of Environmental Research and Public Health. 2023; 20(4):2842. https://doi.org/10.3390/ijerph20042842
Chicago/Turabian StyleReynish, Tamara, Ha Hoang, Heather Bridgman, and Bróna Nic Giolla Easpaig. 2023. "Psychological Distress, Resilience, and Help-Seeking Experiences of LGBTIQA+ People in Rural Australia" International Journal of Environmental Research and Public Health 20, no. 4: 2842. https://doi.org/10.3390/ijerph20042842