title: Psychiatric Risk in Unstably Housed Sexual Minority Women: Relationship between Sexual and Racial Minority Status and Human Immunodeficiency Virus and Psychiatric Diagnoses.
abstract: Stress associated with minority statuses has been linked to mental health disorders. However, research conducted exclusively among impoverished women, a population known to be at risk for poor health owing to overlapping risks, is sparse. We sought to determine if homeless and unstably housed sexual minority (i.e., nonheterosexual) women were at greater psychiatric risk than their heterosexual counterparts. We also sought to determine if racial/ethnic minority and human immunodeficiency virus status contributed to psychiatric risks.
  
  
  
  Homeless/unstably housed women living in San Francisco between 2008 and 2010 were followed biannually over 3 years. Generalized estimating equation analysis identified significant correlates of any substance use, mood, or anxiety disorder, as well as the total number of psychiatric disorders.
  
  
  
  Among 300 women, 24% reported nonheterosexual identity at the first study visit. Consistent with minority stress theory, lesbian and bisexual identity were associated with higher levels of mental health comorbidity, and bisexual identity was related to greater rates of substance use disorders and mood disorders. Unique to this study, we found that identity assessed 1 or 2 years prior does not predict current substance disorders, but current identity does. In addition, women who were infected with the human immunodeficiency virus also had higher rates of mental health comorbidity and substance use disorders. Contrary to psychosocial stress theory, racial/ethnic minority status was associated with reduced odds of substance use disorder in this population. Recent homelessness was related to greater risk of anxiety disorder.
  
  
  
  Best research and health care practices should include the assessment of sexual orientation and housing status when addressing risks for mental health and substance disorders among low-income women.
authors.affiliation: Community Health Systems, School of Nursing, University of California, San Francisco, San Francisco, California. Electronic address: Annesa.flentje@ucsf.edu.
authors.forename: Annesa
authors.initials: A
authors.lastname: Flentje
authors.affiliation: Department of Psychiatry, School of Medicine, University of California, San Francisco, San Francisco, California.
authors.forename: Martha
authors.initials: M
authors.lastname: Shumway
authors.affiliation: Department of Liberal Arts, Saint Louis College of Pharmacy, St. Louis, Missouri.
authors.forename: Lauren H
authors.initials: LH
authors.lastname: Wong
authors.affiliation: Department of Medicine, School of Medicine, University of California, San Francisco, San Francisco, California.
authors.forename: Elise D
authors.initials: ED
authors.lastname: Riley
mesh_terms: D000328:Adult; D001008:Anxiety Disorders / Q000453:epidemiology; D015897:Comorbidity; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology; D006703:Ill-Housed Persons / Q000523:psychology*; D006798:Housing; D006801:Humans; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology*; D008603:Mental Health; D008875:Middle Aged; D008913:Minority Groups / Q000523:psychology* / Q000706:statistics & numerical data; D012495:San Francisco / Q000453:epidemiology; D000072339:Sexual and Gender Minorities / Q000523:psychology* / Q000706:statistics & numerical data; D019966:Substance-Related Disorders / Q000453:epidemiology; D055815:Young Adult