In spite of the system: A qualitatively-driven mixed methods analysis of the mental health services experiences of LGBTQ people living in poverty in Ontario, Canada.

Lesbian, gay, bisexual, trans, and/or queer (LGBTQ) people face barriers to accessing mental health care; however, we know little about service experiences of low income LGBTQ people. In this qualitatively-driven mixed methods study, over 700 women and/or trans people completed an internet survey, of whom 12 LGBTQ individuals living in poverty participated in interviews. Low income LGBTQ respondents saw more mental health professionals and had more unmet need for care than all other LGBTQ/income groups.

Depression and discrimination in the lives of women, transgender and gender liminal people in Ontario, Canada.

This article uses an intersectionality lens to explore how experiences of race, gender, sexuality, class and their intersections are associated with depression and unmet need for mental healthcare in a population of 704 women and transgender/gender liminal people from Ontario, Canada. A survey collecting demographic information, information about mental health and use of mental healthcare services, and data for the Everyday Discrimination Scale and the PHQ-9 Questionnaire for Depression was completed by 704 people via Internet or pen-and-paper between June 2011 and June 2012. Bivariate and regression analyses were conducted to assess group differences in depression and discrimination experiences, and predictors of depression and unmet need for mental healthcare services.

LGBT Identity, Untreated Depression, and Unmet Need for Mental Health Services by Sexual Minority Women and Trans-Identified People.

Background: Previous studies have found that transgender, lesbian, and bisexual people report poorer mental health relative to heterosexuals. However, available research provides little information about mental health service access among the highest need groups within these communities: bisexual women and transgender people. This study compared past year unmet need for mental health care and untreated depression between four groups: heterosexual cisgender (i.

Differential Effects of Cyproterone Acetate vs Spironolactone on Serum High-Density Lipoprotein and Prolactin Concentrations in the Hormonal Treatment of Transgender Women.

Introduction: Spironolactone and cyproterone acetate (CPA) are the two main antiandrogen medications used in feminizing hormone therapy in transgender women. Previous studies have suggested that these two agents might have opposite effects on high-density lipoprotein (HDL) level when used in this context, and limited data have suggested CPA increases prolactin more than spironolactone.

Aim: To compare the effects of spironolactone and CPA on HDL and prolactin serum concentrations in transgender women.

Progression From Perianal High-Grade Anal Intraepithelial Neoplasia to Anal Cancer in HIV-Positive Men Who Have Sex With Men.

Background: High-grade intraepithelial neoplasia is known to progress to invasive squamous-cell carcinoma of the anus. There are limited reports on the rate of progression from high-grade intraepithelial neoplasia to anal cancer in HIV-positive men who have sex with men.

Objectives: The purpose of this study was to describe in HIV-positive men who have sex with men with perianal high-grade intraepithelial neoplasia the rate of progression to anal cancer and the factors associated with that progression.

Mental health service use by recent immigrants from different world regions and by non-immigrants in Ontario, Canada: a cross-sectional study.

Background: Given that immigration has been linked to a variety of mental health stressors, understanding use of mental health services by immigrant groups is particularly important. However, very little research on immigrants' use of mental health service in the host country considers source country. Newcomers from different source countries may have distinct experiences that influence service need and use after arrival.

Rates of Anomalous Bupropion Prescriptions in Ontario, Canada.

Purpose: Reports of bupropion misuse have increased since it was first reported in 2002. The purpose of this study was to explore trends in bupropion prescribing suggestive of misuse or diversion in Ontario, Canada.

Methods: A serial cross-sectional study was conducted of Ontarians aged younger than 65 years who received prescriptions under Ontario's public drug program from April 1, 2000, to March 31, 2013.

Can naloxone prescription and overdose training for opioid users work in family practice? Perspectives of family physicians.

Objective: To explore family physicians' attitudes toward prescribing naloxone to at-risk opioid users, as well as to determine the opportunities and challenges for expanding naloxone access to patients in family practice settings.

Design: One-hour focus group session and SWOT (strengths, weaknesses, opportunities, and threats) analysis.

Setting: Workshop held at the 2012 Family Medicine Forum in Toronto, Ont.

Predictors of Opioid-Related Death During Methadone Therapy.

We aimed to examine pharmacologic, demographic and medical comorbidity risk factors for opioid-related mortality among patients currently receiving methadone for an opioid use disorder. We conducted a population-based, nested case-control study linking healthcare and coroner's records in Ontario, Canada, from January 31, 1994 to December 31, 2010. We included social assistance recipients receiving methadone for an opioid use disorder.

Examining the relationship between neighbourhood deprivation and mental health service use of immigrants in Ontario, Canada: a cross-sectional study.

Objective: While newcomers are often disproportionately concentrated in disadvantaged areas, little attention is given to the effects of immigrants' postimmigration context on their mental health and care use. Intersectionality theory suggests that understanding the full impact of disadvantage requires considering the effects of interacting factors. This study assessed the inter-relationship between recent immigration status, living in deprived areas and service use for non-psychotic mental health disorders.

Use of mental health care for nonpsychotic conditions by immigrants in different admission classes and by refugees in Ontario, Canada.

Background: Most Canadian newcomers are admitted in the economic, family, or refugee class, each of which has its own selection criteria and experiences. Evidence has shown various risks for mental health disorders across admission classes, but the respective service-use patterns for people in these classes are unknown. In this study, we compared service use for nonpsychotic mental health disorders by newcomers in various admission classes with that of long-term residents (i.

Sexual and gender minority peoples' recommendations for assisted human reproduction services.

Objective: To determine what recommendations lesbian, gay, bisexual, trans, and queer (LGBTQ) people have for provision of assisted human reproduction (AHR) services to their communities.

Methods: Using a semi-structured guide, we interviewed a purposeful sample of 66 LGBTQ-identified individuals from across the province of Ontario who had used or had considered using AHR services since 2007.

Results: Participants were predominantly cisgender (non-trans), white, same-sex partnered, urban women with relatively high levels of education and income.

Inclusion of persons with mental illness in patient-centred medical homes: cross-sectional findings from Ontario, Canada.

Background: In Ontario, Canada, the patient-centred medical home is a model of primary care delivery that includes 3 model types of interest for this study: enhanced fee-for-service, blended capitation, and team-based blended capitation. All 3 models involve rostering of patients and have similar practice requirements but differ in method of physician reimbursement, with the blended capitation models incorporating adjustments for age and sex, but not case mix, of rostered patients. We evaluated the extent to which persons with mental illness were included in physicians' total practices (as rostered and non-rostered patients) and were included on physicians' rosters across types of medical homes in Ontario.

Assessment and Diagnosis of Musculoskeletal Shoulder Disorders over the Internet.

Shoulder disorders are common, debilitating, and represent a considerable burden on society. As primary contact practitioners, physiotherapists play a large role in the management and rehabilitation of people with these conditions. For those living outside of urban areas, however, access to physiotherapy can be limited.

Validity and reliability of the assessment and diagnosis of musculoskeletal elbow disorders using telerehabilitation.

We examined the validity and reliability of a physiotherapy examination of the elbow, using telerehabilitation. The patho-anatomical diagnoses, systems diagnosis and physical examination findings of face-to-face physiotherapy examinations were compared with telerehabilitation examinations. Ten participants attended a single session, during which they were interviewed, a face-to-face physical examination was performed and a remote physical examination was conducted, guided by an examiner at a different location via a telerehabilitation system.

Rural residence and risk for perinatal depression: a Canadian pilot study.

Few studies have examined whether rural residence is associated with increased or decreased risk for postpartum depression (PPD). To address this research gap, this pilot study examined rates of depressive symptoms and perceived social support among women living in rural (population <10,000), semi-rural (population 10,000-20,000), and urban (downtown Toronto, population approximately 2.5 million) areas.

Challenges and mental health experiences of lesbian and bisexual women who are trying to conceive.

To date, there is little evidence to inform social work practice with lesbian and bisexual women who are trying to conceive (TTC). The authors report a preliminary examination of the mental health experiences of lesbian and bisexual women who are TTC, through a comparison with lesbian and bisexual women in the postpartum period (PP). Thirty-three lesbian and bisexual women (TTC, n = 15; PP, n = 18) completed standardized questionnaires assessing symptoms of depression and anxiety as well as relationship satisfaction and perceived social support.

Men's sexual orientation and health in Canada.

Objectives: Previous large-scale population studies have reported that gay and bisexual men may be at increased risk for health disparities. This study was conducted to determine whether health status and health risk behaviours of Canadian men vary based on sexual orientation identity.

Methods: Utilizing the Canadian Community Health Survey data (Cycle 2.

The gatekeeper system and disparities in use of psychiatric care by neighbourhood education level: results of a nine-year cohort study in toronto.

Background: In Ontario, psychiatric care is fully covered by provincial health insurance without co-payments or deductibles. The provincial fee schedule supports a "gatekeeper" system for psychiatric care by paying psychiatrists more for consultations with patients who have a physician referral. In this context, we sought to explore socio-economic differences in patterns of mental health service delivery.

Women's sexual orientation and health: results from a Canadian population-based survey.

The current study sought to determine whether health status and health risk behaviors of Canadian women varied based on sexual identity. This was a cross-sectional analysis of data from the Canadian Community Health Survey: cycle 2.1, a national population-based survey designed to gather health data on a representative sample of over 135,000 Canadians including 354 lesbian respondents, 424 bisexual women respondents, and 60,937 heterosexual women respondents.

Correlates of mental health service use among lesbian, gay, and bisexual mothers and prospective mothers.

Lesbian, gay, and bisexual women undertake parenting in a social context that may be associated with unique risk factors for perinatal depression. This cross-sectional study aimed to describe the mental health services used by women in the perinatal period and to identify potential correlates of mental health service use. Sixty-four women who were currently trying to conceive, pregnant, or the parent of a child less than one year of age were included.

Education level, income level and mental health services use in Canada: associations and policy implications.

Background: Investigations of socio-economic gradients in mental health services use in Canada have used different measures of socio-economic status and have shown conflicting results. We explored the relationships between education level, income level and mental health services use among people with a mental illness using data from the Canadian Community Health Survey: Cycle 1.2.

Socioeconomic status and self-reported barriers to mental health service use.

Objective: Socially disadvantaged individuals are at high risk for having their mental health service needs unmet. We explored the relations among education level, income level, and self-reported barriers to mental health service use for individuals with a mental illness, using data from the Canadian Community Health Survey: Mental Health and Well-Being (CCHS 1.2).

Service use and gaps in services for lesbian and bisexual women during donor insemination, pregnancy, and the postpartum period.

Objective: Increasing numbers of lesbian and bisexual women are choosing to have children. This qualitative study investigated the degree to which a sample of Canadian lesbian and bisexual women were satisfied with the health and social services that they received during the process of trying to conceive, during pregnancy, and during the early postpartum weeks and months.

Methods: Three focus groups were conducted: (1) women who were themselves, or whose partners were, in the process of trying to conceive (n = 6); (2) biological parents of young children (n = 7); and (3) women who were non-biological parents of young children or whose partners were currently pregnant (n = 10).