Mental Health in Sexual, Gender, and Racial Minorities: A Q&A with Bowen Chung

Mental health disorders can impact anyone, but unfortunately, too often minority communities struggle even more. The LGBTQ community is almost three times more likely than others to experience a mental health condition, such as major depression or generalized anxiety disorder. Racial and ethnic minorities are also at higher risk, and studies have revealed these communities receive lower quality mental health care. So, what are the drivers behind these alarming statistics, and what can be done to mitigate them?

We had a conversation with Bowen Chung to learn more. Chung is the co-principal investigator for the Community and Patient Partnered Participatory Research Network and principal investigator for Resilience Against Depression Disparities, a PCORnet demonstration study that seeks to answer these questions and improve mental health care for underserved communities. PCORnet, the National Patient-Centered Clinical Research Network, is an ambitious initiative launched by PCORI with a mission to make research faster, less expensive, and more meaningful to people than it is to date.

Headshot of Bowen Chung
Bowen Chung, MD

PCORnet: In what ways are racial/ethnic, sexual, and gender minority groups uniquely impacted by mental health disorders, like depression and anxiety?

Chung: It’s no secret that being different than other people — whether it means your race, gender, or sexual orientation — is often a source of stress in our society. We all crave acceptance. Consider that until the 1970s, homosexuality was thought of as a mental health disorder that needed to be “fixed.” Only in the mid-80s was there a change toward the idea that self-acceptance is the bedrock of good mental health, so the research community is really late to the party on understanding the LGBTQ experience. Racial/ethnic, gender, and sexual minorities also often suffer from poor mental health outcomes due to multiple factors, including inaccessibility of high-quality mental health care services, cultural stigma surrounding mental health care, and discrimination.

PCORnet: How is the Resilience Against Depression Disparities study designed to help these minority communities?

Chung:  This project is studying whether offering a seven-session resiliency class improves the mood of lesbian, gay, bisexual, transgender, and queer adults in racial and ethnic minority communities over and above primary care depression quality improvement programs, which have been shown to improve outcomes for minorities more significantly than for non-minorities but are seldom available in safety-net systems. The resiliency classes are 90 to 120-minute sessions led by community health workers that teach skills like how to stop negative thoughts, communication tactics, and prioritizing pleasant activities to improve the mood. They offer a different option for those individuals who may be impacted by the stigma of the word “depression.” When we remove that stigma by focusing instead on mood improvement via positive thought patterns and activities, will we see better outcomes? That’s what this study aims to find out.

PCORnet: How does the infrastructure of PCORnet help further mental health research? What does it make possible that would otherwise not be possible?

Chung: PCORnet is indispensible to us in this study for two reasons. First, through PCORnet’s partner networks, we had access to PRIDEnet, which gave us a wealth of insights that improved our training. They helped us answer questions, like what is the best way to ask someone about his or her gender identity? PRIDEnet also sensitized us to the fact that lesbian, gay, bisexual, transgender, and queer individuals are really not one community; these groups are distinct, and they also comprise subgroups based on race, ethnicity, geographic location, socioeconomic status, age, and more.

The second reason PCORnet is indispensable is its infrastructure, which is allowing us to complete this study at incredible speed, reduced cost, and with the broad inclusion of people and families across the research spectrum. When we first scoped this study, we estimated it would cost $5 million and take eight years. We are doing it at $2.5 million in four. The power of uniting people, clinicians, health systems, and data for a common goal is real, and our study is proof.

The Resilience Against Depression Disparities Study is actively recruiting. For more information on how you can join, contact Bowen Chung at [email protected].

 

About PCORnet

PCORnet, the National Patient-Centered Clinical Research Network, is an innovative initiative of the Patient-Centered Outcomes Research Institute (PCORI). The goal of PCORnet is to improve the nation’s capacity to conduct clinical research by creating a large, highly representative network that directly involves patients in the development and execution of research. More information is available at www.pcornet.org.

About PCORI

The Patient-Centered Outcomes Research Institute (PCORI) is an independent nonprofit organization authorized by Congress in 2010. Its mission is to fund research that will provide patients, their caregivers, and clinicians with the evidence-based information needed to make better-informed healthcare decisions. PCORI is committed to continuously seeking input from a broad range of stakeholders to guide its work. More information is available at www.pcori.org.