Sexual minority women (SMW; such as lesbian, bisexual, and mostly lesbian) exhibit excess cardiometabolic risk, yet factors that contribute to cardiometabolic risk in this population are poorly understood. Trauma exposure has been posited as a contributor to cardiometabolic risk in SMW.
Materials and Methods:
An analysis of data from Wave 3 of the Chicago Health and Life Experiences of Women Study was conducted. Multinomial logistic regression was used to examine correlates of trauma. Next, multiple logistic regression was used to examine the associations of different forms of trauma throughout the life course (childhood, adulthood, and lifetime), with psychosocial and behavioral risk factors and self-reported cardiometabolic risk (obesity, hypertension, and diabetes) in SMW adjusted for relevant covariates.
Results:
A total of 547 participants were included. Older age was associated with higher rates of childhood and adulthood trauma. SMW of color reported higher rates of childhood trauma than white participants. Higher education was associated with lower rates of adulthood trauma. All forms of trauma were associated with probable diagnosis of post-traumatic stress disorder and lower perceived social support. Adult trauma was associated with anxiety, whereas childhood and lifetime trauma were associated with higher odds of depression. No significant associations between forms of trauma and behavioral risk factors were noted, except that childhood trauma was associated with higher odds of past-3-month overeating. Logistic regression models examining the association of trauma and cardiometabolic risk revealed that childhood trauma was an independent risk factor for diabetes. Adulthood and lifetime trauma were significantly associated with obesity and hypertension.
Conclusions:
Trauma emerged as an independent risk factor for cardiometabolic risk in SMW. These findings suggest that clinicians should screen for trauma as a cardiovascular risk factor in SMW, with special attention to SMW most at risk.
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References
1.
Katz-WiseSL, HydeJS. Victimization experiences of lesbian, gay, and bisexual individuals: A meta-analysis. J Sex Res, 2012; 49:142–167.
2.
BalsamKF, RothblumED, BeauchaineTP. Victimization over the life span: A comparison of lesbian, gay, bisexual, and heterosexual siblings. J Consult Clin Psychol, 2005; 73:477–487.
3.
FriedmanMS, MarshalMP, GuadamuzTE, et al.A meta-analysis of disparities in childhood sexual abuse, parental physical abuse, and peer victimization among sexual minority and sexual nonminority individuals. Am J Public Health, 2011; 101:1481–1494.
4.
AustinSB, JunH-J, JacksonB, et al.Disparities in child abuse victimization in lesbian, bisexual, and heterosexual women in the Nurses' Health Study II. J Womens Health (Larchmt), 2008; 17:597–606.
5.
ZouC, AndersenJP. Comparing the rates of early childhood victimization across sexual orientations: Heterosexual, lesbian, gay, bisexual, and mostly heterosexual. PLoS One, 2015; 10:e0139198.
6.
MeyerIH. Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychol Bull, 2003; 129:674–697.
7.
HerekGM. Hate crimes and stigma-related experiences among sexual minority adults in the United States: Prevalence estimates from a national probability sample. J Interpers Violence, 2009; 24:54–74.
8.
LickDJ, DursoLE, JohnsonKL. Minority stress and physical health among sexual minorities. Perspect Psychol Sci, 2013; 8:521–548.
9.
BalsamKF, LehavotK, BeadnellB, CircoE. Childhood abuse and mental health indicators among ethnically diverse lesbian, gay, and bisexual adults. J Consult Clin Psychol, 2010; 78:459–468.
10.
HughesTL, JohnsonTP, SteffenAD, WilsnackSC, EverettB. Lifetime victimization, hazardous drinking, and depression among heterosexual and sexual minority women. LGBT Health, 2014; 1:192–203.
11.
HerekGM, GillisJR, CoganJC. Psychological sequelae of hate crime victimization among lesbian, gay, and bisexual adults. J Consult Clin Psychol, 1999; 67:945–951.
12.
SmithBC, ArmelieAP, BoartsJM, BrazilM, DelahantyDL. PTSD, depression, and substance use in relation to suicidality risk among traumatized minority lesbian, gay, and bisexual youth. Arch Suicide Res, 2016; 20:80–93.
13.
RobertsAL, AustinSB, CorlissHL, VandermorrisAK, KoenenKC. Pervasive trauma exposure among US sexual orientation minority adults and risk of posttraumatic stress disorder. Am J Public Health, 2010; 100:2433–2441.
14.
MatthewsAK, ChoYI, HughesTL, WilsnackSC, ArandaF, JohnsonT. The effects of sexual orientation on the relationship between victimization experiences and smoking status among US women. Nicotine Tob Res, 2018; 20:332–339.
15.
LehavotK, SimoniJM. Victimization, smoking and chronic physical health problems among sexual minority women. Ann Behav Med, 2014; 42:269–276.
16.
HughesT, McCabeSE, WilsnackSC, WestBT, BoydCJ. Victimization and substance use disorders in a national sample of heterosexual and sexual minority women and men. Addiction, 2010; 105:2130–2140.
17.
AaronDJ, HughesTL. Association of childhood sexual abuse with obesity in a community sample of lesbians. Obesity (Silver Spring), 2007; 15:1023–1028.
18.
SmithHA, MarkovicN, DanielsonME, et al.Sexual abuse, sexual orientation, and obesity in women. J Womens Health (Larchmt), 2010; 19:1525–1532.
19.
Katz-WiseSL, JunH-J, CorlissHL, JacksonB, HainesJ, AustinSB. Child abuse as a predictor of gendered sexual orientation disparities in body mass index trajectories among U.S. youth from the Growing Up Today Study. J Adolesc Health, 2014; 54:730–738.
20.
Institute of Medicine. The health of lesbian, gay, bisexual, and transgender people: Building a foundation for better understanding. Washington D.C.: Institute of Medicine, 2011.
21.
CaceresBA, BrodyA, LuscombeRE, et al.A systematic review of cardiovascular disease in sexual minorities. Am J Public Health, 2017; 107:e13–e21.
22.
KinskyS, StallR, HawkM, MarkovicN. Risk of the metabolic syndrome in sexual minority women: Results from the ESTHER Study. J Womens Health (Larchmt), 2016; 25:784–790.
23.
CaceresBA, BrodyAA, HalkitisPN, DorsenC, YuG, ChyunDA. Cardiovascular disease risk in sexual minority women (18–59 years old): Findings from the National Health and Nutrition Examination Survey (2001–2012). Womens Health Issues, 2018; 28:333–341.
24.
BenjaminEJ, BlahaMJ, ChiuveSE, et al.Heart disease and stroke statistics-2017 update: A report from the American Heart Association. Circulation, 2017; 135:e146–e603.
25.
MoscaL, Barrett-ConnorE, Kass WengerN. Sex/gender differences in cardiovascular disease prevention: What a difference a decade makes. Circulation, 2011; 124:2145–2154.
26.
XueY-T, TanQ, LiP, et al.Investigating the role of acute mental stress on endothelial dysfunction: A systematic review and meta-analysis. Clin Res Cardiol, 2015; 104:310–319.
27.
RosengrenA, HawkenS, ÔunpuuS, et al.Association of psychosocial risk factors with risk of acute myocardial infarction in 11 119 cases and 13 648 controls from 52 countries (the INTERHEART study): Case-control. Lancet, 2004; 364:953–962.
28.
JoodK, RedforsP, RosengrenA, BlomstrandC, JernC. Self-perceived psychological stress and ischemic stroke: A case-control study. BMC Med, 2009; 7:53.
29.
LowCA, ThurstonRC, MatthewsKA. Psychosocial factors in the development of heart disease in women: Current research and future directions. Psychosom Med, 2010; 72:842–854.
30.
MandelliL, PetrelliC, SerrettiA. The role of specific early trauma in adult depression: A meta-analysis of published literature. Childhood trauma and adult depression. Eur Psychiatry, 2015; 30:665–680.
31.
BlackMC, BasileKC, BreidingMJ, et al.The National Intimate Partner and Sexual Violence Survey (NISVS): 2010 Summary Report. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 2011.
32.
HemmingssonE, JohanssonK, ReynisdottirS. Effects of childhood abuse on adult obesity: A systematic review and meta-analysis. Obes Rev, 2014; 15:882–893.
33.
SteneLE, JacobsenGW, DybG, TverdalA, ScheiB. Intimate partner violence and cardiovascular risk in women: A population-based cohort study. J Womens Health (Larchmt), 2013; 22:250–258.
34.
MasonSM, WrightRJ, HibertEN, SpiegelmanD, FormanJP, Rich-EdwardsJW. Intimate partner violence and incidence of hypertension in women. Ann Epidemiol, 2012; 22:562–567.
35.
HuangH, YanP, ShanZ, et al.Adverse childhood experiences and risk of type 2 diabetes: A systematic review and meta-analysis. Metabolism, 2015; 64:1408–1418.
36.
KatzDA, SprangG, CookeC. The cost of chronic stress in childhood: Understanding and applying the concept of allostatic load. Psychodyn Psychiatry, 2012; 40:469–480.
37.
FuSS, McFallM, SaxonAJ, et al.Post-traumatic stress disorder and smoking: A systematic review. Nicotine Tob Res, 2007; 9:1071–1084.
38.
GalloLC, RoeschSC, FortmannAL, et al.Associations of chronic stress burden, perceived stress, and traumatic stress with cardiovascular disease prevalence and risk factors in the Hispanic Community Health Study/Study of Latinos Sociocultural Ancillary Study. Psychosom Med, 2015; 76:468–475.
39.
SchwandtML, HeiligM, HommerDW, GeorgeDT, RamchandaniVA. Childhood trauma exposure and alcohol dependence severity in adulthood: Mediation by emotional abuse severity and neuroticism. Alcohol Clin Exp Res, 2013; 37:984–992.
40.
RamosZ, FortunaLR, PorcheM V., et al.Posttraumatic stress symptoms and their relationship to drug and alcohol use in an international sample of Latino immigrants. J Immigr Minor Health, 2017; 19:552–561.
41.
HallerM, ChassinL. Risk pathways among traumatic stress, posttraumatic stress disorder symptoms, and alcohol and drug problems: A test of four hypotheses. Psychol Addict Behav, 2014; 28:841–851.
42.
PalmisanoGL, InnamoratiM, VanderlindenJ. Life adverse experiences in relation with obesity and binge eating disorder: A systematic review. J Behav Addict, 2016; 5:11–31.
43.
CasliniM, BartoliF, CrocamoC, DakanalisA, ClericiM, CarràG. Disentangling the association between child abuse and eating disorders. Psychosom Med, 2016; 78:79–90.
44.
Rich-EdwardsJW, MasonS, RexrodeK, et al.Physical and sexual abuse in childhood as predictors of early-onset cardiovascular events in women. Circulation, 2012; 126:920–927.
45.
FriedmanEM, MontezJK, SheehanCM, GuenewaldTL, SeemanTE. Childhood adversities and adult cardiometabolic health: Does the quantity, timing, and type of adversity matter?. J Aging Health, 2015; 27:1311–1338.
46.
GilbertLK, BreidingMJ, MerrickMT, et al.Childhood adversity and adult chronic disease: An update from ten states and the District of Columbia, 2010. Am J Prev Med, 2015; 48:345–349.
47.
ScottKM, Von KorffM, AngermeyerMC, et al.Association of childhood adversities and early-onset mental disorders with adult-onset chronic physical conditions. Arch Gen Psychiatry, 2011; 68:838–844.
48.
DedertEA, CalhounPS, WatkinsLL, SherwoodA, BeckhamJC. Posttraumatic stress disorder, cardiovascular, and metabolic disease: A review of the evidence. Ann Behav Med, 2010; 39:61–78.
49.
SugliaSF, KoenenKC, Boynton-JarrettR, et al.Childhood and adolescent adversity and cardiometabolic outcomes: A scientific statement from the American Heart Association. Circulation, 2018; 137:e15–e28.
50.
SugliaSF, ClarkCJ, Boynton-JarrettR, KressinNR, KoenenKC. Child maltreatment and hypertension in young adulthood. BMC Public Health, 2014; 14:1149.
51.
HughesTL, WilsnackSC, SzalachaLA, et al.Age and racial/ethnic differences in drinking and drinking-related problems in a community sample of lesbians. J Stud Alcohol, 2006; 67:579–590.
52.
MartinK, JohnsonTP, HughesTL. Using respondent driven sampling to recruit sexual minority women. Surv Pract. 2015; 8:273.
53.
HughesTL, SzalachaLA, JohnsonTP, KinnisonKE, WilsnackSC, ChoY. Sexual victimization and hazardous drinking among heterosexual and sexual minority women. Addict Behav, 2010; 35:1152–1156.
54.
AndersenJP, HughesTL, ZouC, WilsnackSC. Lifetime victimization and physical health outcomes among lesbian and heterosexual women. PLoS One, 2014; 9:e101939.
55.
WyattGE. The sexual abuse of Afro-American and White-American women in childhood. Child Abuse Negl, 1985; 9:507–519.
56.
KohoutFJ, BerkmanLF, EvansDA, Cornoni-HuntleyJ. Two shorter forms of the CES-D (Center for Epidemiological Studies Depression) depression symptoms index. J Aging Health, 1993; 5:179–193.
57.
BreslauN, PetersonEL, KesslerRC, SchultzLR. Short screening scale for DSM-IV posttraumatic stress disorder. Am J Psychiatry, 1999; 156:908–911.
58.
ZimetGD, PowellSS, FarleyGK, WerkmanS, BerkoffKA. Psychometric characteristics of the Multidimensional Scale of Perceived Social Support. J Pers Assess, 1990; 55:610–617.
59.
ZimetGD, DahlemNW, ZimetSG, FarleyGK. The Multidimensional Scale of Perceived Social Support. J Pers Assess, 1988; 52:30–41.
60.
National Institute on Alcohol Abuse and Alcoholism. Drinking levels defined. 2017. Available at: https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/moderate-binge-drinking Accessed December11, 2017.
61.
Centers for Disease Control and Prevention. Defining adult overweight and obesity. 2016. Available at: https://www.cdc.gov/obesity/adult/defining.html Accessed December28, 2017.
62.
HavranekEP, MujahidMS, BarrDA, et al.Social determinants of risk and outcomes for cardiovascular disease. Circulation, 2015; 132:873–898.
63.
BenjaminEJ, ViraniSS, CallawayCW, et al.Heart disease and stroke statistics-2018 update: A report from the American Heart Association. Circulation, 2018; 137:e67–e492.
64.
WoodSM, SchottW, MarshalMP, AkersAY. Disparities in body mass index trajectories from adolescence to early adulthood for sexual minority women. J Adolesc Health, 2017; 61:722–728.
65.
MatthewsAK, RileyBB, EverettB, HughesTL, ArandaF, JohnsonT. A longitudinal study of the correlates of persistent smoking among sexual minority women. Nicotine Tob Res, 2014; 16:1199–1206.
66.
GilmoreAK, KooKH, Nguyen HV, GranatoHF, HughesTL, KaysenD. Sexual assault, drinking norms, and drinking behavior among a national sample of lesbian and bisexual women. Addict Behav, 2014; 39:630–636.
67.
RhewIC, StappenbeckCA, Bedard-GilliganM, HughesT, KaysenD. Effects of sexual assault on alcohol use and consequences among young adult sexual minority women. J Consult Clin Psychol, 2017; 85:424–433.
68.
DrabbleL, TrockiKF, HughesTL, KorchaRA, LownAE. Sexual orientation differences in the relationship between victimization and hazardous drinking among women in the National Alcohol Survey. Psychol Addict Behav, 2013; 27:639–648.
69.
HrubyA, HuFB. The epidemiology of obesity: A big picture. Pharmacoeconomics, 2015; 33:673–689.
70.
SinghGM, DanaeiG, FarzadfarF, et al.The age-specific quantitative effects of metabolic risk factors on cardiovascular diseases and diabetes: A pooled analysis. PLoS One, 2013; 8:e65174.
71.
EckelN, MeidtnerK, Kalle-UhlmannT, StefanN, SchulzeMB. Metabolically healthy obesity and cardiovascular events: A systematic review and meta-analysis. Eur J Prev Cardiol, 2015; 23:956–966.
72.
RileyEH, WrightRJ, JunHJ, HibertEN, Rich-EdwardsJW. Hypertension in adult survivors of child abuse: Observations from the Nurses' Health Study II. J Epidemiol Community Health, 2010; 64:413–418.
73.
Rich-EdwardsJW, SpiegelmanD, Lividoti HibertEN, et al.Abuse in childhood and adolescence as a predictor of type 2 diabetes in adult women. Am J Prev Med, 2010; 39:529–536.
74.
RobertsA, GilmanS, BreslauJ, BreslauN, KoenenK. Race/ethnic differences in exposure to traumatic events, development of post-traumatic stress disorder, and treatment-seeking for post-traumatic stress disorder in the United States. Psychol Med, 2011; 41:71–83.
75.
LefebvreR, FallonB, Wert MVan, FilippelliJ. Examining the relationship between economic hardship and child maltreatment using data from the Ontario Incidence Study of Reported Child Abuse and Neglect-2013 (OIS-2013). Behav Sci (Basel), 2017; 7.
76.
HalfonN, LarsonK, SonJ, LuM, BethellC. Income inequality and the differential effect of adverse childhood experiences in US children. Acad Pediatr, 2017; 17:S70–S78.
77.
CopelandWE, ShanahanL, HinesleyJ, et al.Association of childhood trauma exposure With adult psychiatric disorders and functional outcomes. JAMA Netw Open, 2018; 1:e184493.
78.
WilsnackSC, KristjansonAF, HughesTL, BensonPW. Characteristics of childhood sexual abuse in lesbians and heterosexual women. Child Abuse Negl, 2012; 36:260–265.
79.
CaceresBA, BrodyA, ChyunD. Recommendations for cardiovascular disease research with lesbian, gay and bisexual adults. J Clin Nurs, 2016; 25:3728–3742.
80.
SumnerJA, KubzanskyLD, Elkind MSV, et al.Trauma exposure and posttraumatic stress disorder symptoms predict onset of cardiovascular events in women. Circulation, 2015; 132:251–259.
81.
GilsanzP, WinningA, KoenenKC, et al.Post-traumatic stress disorder symptom duration and remission in relation to cardiovascular disease risk among a large cohort of women. Psychol Med, 2017; 47:1370–1378.
82.
RobertsAL, RosarioM, CorlissHL, KoenenKC, AustinSB. Elevated risk of posttraumatic stress in sexual minority youths: Mediation by childhood abuse and gender nonconformity. Am J Public Health, 2012; 102:1587–1593.
83.
SumnerJA, KubzanskyLD, RobertsAL, et al.Post-traumatic stress disorder symptoms and risk of hypertension over 22 years in a large cohort of younger and middle-aged women. Psychol Med, 2016; 46:3105–3116.
84.
Office of the National Coordinator for Health Information Technology. ONC fact sheet: 2015 edition Health Information Technology (Health IT) certification criteria, base electronic health record (EHR) definition, and ONC health IT certification program modifications final rule. 2015. Available at: https://www.healthit.gov/sites/default/files/factsheet_draft_2015-10-06.pdf Accessed December1, 2018.
85.
CahillS, SingalR, GrassoC, et al.Do ask, do tell: High levels of acceptability by patients of routine collection of sexual orientation and gender identity data in four diverse American community health centers. PLoS One, 2014; 9:e107104.
86.
MasonSM, AyourN, CanneyS, EisenbergME, Neumark-SztainerD. Intimate partner violence and 5-year weight change in young women: A longitudinal study. J Womens Health (Larchmt), 2017; 26:677–682.
87.
Fredriksen-GoldsenKI, KimH-J, BarkanSE, BalsamKF, MincerSL. Disparities in health-related quality of life: A comparison of lesbians and bisexual women. Am J Public Health, 2010; 100:2255–2261.
88.
KohAS. Use of preventive health behaviors by lesbian, bisexual, and heterosexual women: questionnaire survey. West J Med, 2000; 172:379–384.
89.
QureshiRI, ZhaP, KimS, et al.Health care needs and care utilization among lesbian, gay, bisexual, and transgender populations in New Jersey. J Homosex, 2018; 65:167–180.
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