Tuesday, March 31, 2009

Research Worth Reading

A report out of the UK gives some promising news, or is it depressing. I'm not sure.

The authors surveyed 1,328 shrinks of various sorts about how they would deal with a client whose main goal was to change from lesbian, gay, or bisexual into a heterosexual.
Only 55 (4%) said that they would help an LGB person try to become straight.

I don't know if it's promising that so few (UK) psychiatrists and therapists would help someone try to change their sexual orientation, or depressing that so many would.
It gets more depressing when you read on to discover that an additional 10% would try to refer the prospective client to someone else who would be willing to help them try to change.

This comes 52 years after the British Wolfenden Report concluded that "none of our medical witnesses were able ... to provide any reference in the medical literature to a complete change".

I think the most interesting part of the report, though, is the justifications that the shrinks who said they would try to help someone change their sexual orientation gave.
Although they reported a wide range of justifications, I want to focus on the idea of promoting patient autonomy. A quick sample of these follow:

“We have a responsibility to assist our patients with self-determination.”

“It is up to the person themselves to decide which direction to go in. I am just the sounding board for them to make their own decisions.”

“Client ultimately knows best and may have deep religious beliefs that influence them enormously.”

“(the) client is ‘the expert’ and I deal with their realities rather than mine.”

“People should be given the opportunity to choose to redirect their sexual feelings depending on their circumstances. For example the homosexual man I helped to become heterosexual came from a working class background where it was completely unacceptable to deviate from the norm. It was extremely important to him to be accepted by that community.”

The dilemma for me is that I'm a big proponent of autonomy and self-determination; that health care providers should spend more time helping people get where they want to go, and less time telling them where to go.
So, on the one hand, I agree with this (small minority) of shrinks that patient autonomy is a very strong ethic that should not be violated.

Any yet, I wonder how many of these shrinks would be such strong defenders of patient autonomy when presented with someone who wanted to become lesbian or gay? How many would assist someone who wanted to develop the ability to see through walls? Or who felt that their life would be so much better if they were just three inches taller?
Would these shrinks be such forceful advocates of patient autonomy when a person wants help to live as the gender they feel they are, not the body they were born into?

I believe the kindest thing to do would be to explain that the change they are trying to undertake is not possible, but perhaps it is better to humor someone's interest in trying to change their orientation long enough to develop a deeper therapeutic relationship that can begin to help them find more realistic ways to live in their bodies, in their minds, and in their communities in a more harmonious fashion.

Hmmm. Certainly has me confused about what the "right" thing to do is.

Annie Bartlett, Glenn Smith, Michael King. (2009). The response of mental health professionals to clients seeking help to change or redirect same-sex sexual orientation. BMC Psychiatry 9:11. http://www.biomedcentral.com/1471-244X/9/11

Report of the Committee on Homosexual Offences and Prostitution. (1957). Her Majesty's Stationary Office, London.

Thursday, March 12, 2009

What Explains the General Health Advantage of Gay Men in New York City?

In 2007, the New York City Community Health Survey asked men (and women) how they identified their sexual orientation, and also the standard question "Would you say that your health in general is: Excellent, Very Good, Good, Fair, or Poor?"
44 of 153 self-identified gay men (29%) said they were in excellent health, while 563 of 3,049 self-identified heterosexual men (18%) said they were in excellent health. So, gay men were almost twice as likely to report excellent health (odds ratio = 1.95, 95% confidence interval 1.36-2.79).

What gives? Well, aside from gay men being in better health, there might be a lot of other potential explanations. Like, what if men who identify as gay are just on average younger? Or less likely to live in poverty? Or less likely to be unemployed? All those things are strongly associated with one's subjective assessment of health.

So, I tried controlling for age, race/ethnicity, employment status, educational attainment, being foreign-born, and the ratio of the household's income to the poverty level set for a household of that composition (the poverty threshold for a household with two adults and three kids is a lot higher than the poverty threshold for someone living alone).

Of these, controlling for the ratio of income to poverty made the biggest difference. After controlling for the income:poverty ratio, self-identified gay men were 60% more likely to report excellent health (odds ratio 1.60, with a confidence range of 1.11-2.31).

Controlling for all of them simultaneously explained more of the gap, with gay men being almost half-again as likely as straight men to report excellent health (odds ratio 1.46, confidence range 0.99-2.16).

Still, all things equal, wouldn't you rather be gay in New York City?

Then, I decided to break it down by borough. Gay men in Manhattan were 67% more likely to report excellent health (odd ratio 1.67, confidence range 0.99-2.80), gay men in Brooklyn were 37% more likely to report excellent health (odds ratio 1.37, confidence range 0.58-3.23), and gay men in Queens were only 15% more likely to report excellent health (odds ratio 1.15, confidence range 0.40-3.28). There weren't enough men in this particular sample to say anything worthwhile about the Bronx or Staten Island.

Hmmm... looks like where you live as a gay man has a big influence on how you feel.

Sunday, March 1, 2009

Excellent Health among Polish MSM

In the Polish General Social Survey, they asked about the gender of sexual partners in 1994.
Extreme caution should be used interpreting these numbers, because I'm sure there are cultural and linguistic differences in how the questions are interpreted and answered between the US and Poland.
That and the numbers are fairly small. In general I try to avoid combining gay and bi, or MSM with MSMW, but in this case, the numbers were small enough that I wanted to get more stable estimates.

Only 2 of 31 men who said they had sex with at least one man since age 18 reported excellent health (6% {0%-15%}), while 48 of 322 men who said they never had sex with a man since age 18 reported excellent health (15% {11%-19%}).

I'm nervous about saying much of anything about this data, but it seems like the proportion of men reporting excellent health is lower than the US data, but I would attribute that to language differences until proven otherwise. However, within that context, it does appear that men who have had sex with men in Poland are less likely to report excellent health, perhaps speaking to the general attitudes towards homosexuality in Poland - although not having been to Poland I'm not in a position to say. Anyone with more relevant experience want to comment?

Also interesting is that 31 of 322 men said they had had sex with a man, a much higher percentage than we usually see in US telephone surveys. Should I interpret that to mean that more men have sex with men in Poland, that more are willing to admit it during a telephone survey, or that the question wording is confusing enough that a relatively large proportion gave answers incongruent with their experiences?

I got this data from ICPSR.

Measuring Well-Being

While looking for more data on the well-being of gay men relative to str8 men, I came across this initiative in Europe to measure national (and individual) well-being. I don't ordinarily put much stock in these quiz yourself things, but I think the questions they are asking are useful, and it was kind of fun to compare myself to the various European nations that participate.
Although I have Polish, Irish, Scottish, English & Norwegian heritage (and probably more), my own profile more closely resembles the Hungarians - anhedonic but satisfied. Maybe I should visit there, when I can afford to travel again.
And I score really high on autonomy, which is probably a main (non-material) component of why wealthier people generally have much better health than poorer people.