title: The Predictive Syndemic Effect of Multiple Psychosocial Problems on Health Care Costs and Utilization among Sexual Minority Women.
abstract: Previous studies documenting sexual minority women's disproportionate risk for a range of medical, mental health, and substance use disorders have not provided a predictive framework for understanding their interrelations and outcomes. The present study aimed to address this gap by testing the syndemic effect of co-occurring psychosocial problems on 7-year health care costs and utilization among sexual minority women. The sample was comprised of sexual minority women (N = 341) who were seen at an urban LGBT-affirmative community health center. Medical and mental health care utilization and cost data were extracted from electronic medical records. Demographically adjusted regression models revealed that co-occurring psychosocial problems (i.e., childhood sexual abuse, partner violence, substance use, and mental health distress [history of suicide attempt]) were all strongly interrelated. The presence of these indicators had a syndemic (additive) effect on medical costs and utilization and mental health utilization over 7-year follow-up, but no effect on 7-year mental health costs. These results suggest that the presence and additive effect of these syndemic conditions may, in part, explain increased medical costs and utilization (and higher medical morbidity) among sexual minority women.
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital, 1 Bowdoin Square, 7th Floor, Boston, MA, 02114, USA.|Harvard Medical School, Boston, MA, USA.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Valentine
authors.affiliation: The Fenway Institute, Fenway Health, Boston, MA, USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Elsesser
authors.affiliation: The Fenway Institute, Fenway Health, Boston, MA, USA.
authors.forename: Chris
authors.initials: C
authors.lastname: Grasso
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital, 1 Bowdoin Square, 7th Floor, Boston, MA, 02114, USA.|Harvard Medical School, Boston, MA, USA.|The Fenway Institute, Fenway Health, Boston, MA, USA.
authors.forename: Steven A
authors.initials: SA
authors.lastname: Safren
authors.affiliation: The Fenway Institute, Fenway Health, Boston, MA, USA.
authors.forename: Judith B
authors.initials: JB
authors.lastname: Bradford
authors.affiliation: Department of Behavioral and Social Sciences, Brown University, Providence, RI, USA.
authors.forename: Ethan
authors.initials: E
authors.lastname: Mereish
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital, 1 Bowdoin Square, 7th Floor, Boston, MA, 02114, USA. cocleirigh@mgh.harvard.edu.|Harvard Medical School, Boston, MA, USA. cocleirigh@mgh.harvard.edu.|The Fenway Institute, Fenway Health, Boston, MA, USA. cocleirigh@mgh.harvard.edu.
authors.forename: Conall
authors.initials: C
authors.lastname: O'Cleirigh
mesh_terms: D000328:Adult; D000368:Aged; D001727:Bisexuality / Q000523:psychology* / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D018452:Homosexuality, Female / Q000523:psychology* / Q000706:statistics & numerical data; D006801:Humans; D008875:Middle Aged; D008913:Minority Groups / Q000706:statistics & numerical data*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D014481:United States; D016387:Women's Health / Q000191:economics*
keywords: Bisexual; Health care costs; Health care utilization; Lesbian; Mental health; Sexual minority