Publications by authors named "Lesley A Tarasoff"

25 Publications

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Guideline No. 416: Labour, Delivery, and Postpartum Care for People with Physical Disabilities.

J Obstet Gynaecol Can 2021 Feb 22. Epub 2021 Feb 22.

Calgary, AB.

Objective: To describe evidence-based practice for managing the labour, delivery, and postpartum care of people with physical disabilities in Canada.

Target Population: This guideline addresses the needs of people with physical disabilities, with a focus on conditions that affect strength and mobility, as well as those that affect neurological or musculoskeletal function or structure. Although aspects of this guideline may apply to people with solely intellectual, developmental, or sensory disabilities (e.g., hearing and vision loss), the needs of this population are beyond the scope of this guideline.

Outcomes: Safe and compassionate care for people with physical disabilities who are giving birth.

Benefits, Harms, And Costs: Implementation of this guideline will improve health care provider awareness of specific complications people with physical disabilities may experience during labour, delivery, and the postpartum period and therefore increase the likelihood of a safe birth.

Evidence: A literature review was conducted using MEDLINE (474), Embase (36), and the Cochrane Central Register of Controlled Trials (CENTRAL; 28) databases. The results have been filtered for English language, publication date of 2013 to present, observational studies, systematic reviews, meta-analyses, and guidelines and references in these publications were also reviewed.

Validation Methods: The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and weak recommendations).

Intended Audience: Maternal-fetal medicine specialists, obstetricians, family physicians, nurses, midwives, neurologists, physiatrists, and those who care for people with physical disabilities.

Recommendations:
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http://dx.doi.org/10.1016/j.jogc.2021.02.111DOI Listing
February 2021

Directive clinique n 416 : Soins pendant l'accouchement et la période post-partum chez les personnes ayant un handicap physique.

J Obstet Gynaecol Can 2021 Feb 20. Epub 2021 Feb 20.

Calgary, Alb.

Objectif: Décrire les pratiques fondées sur des données probantes en matière de prise en charge des soins pendant l'accouchement et la période post-partum chez les personnes ayant un handicap physique au Canada.

Population Cible: La présente directive clinique aborde les besoins des personnes ayant un handicap physique en mettant l'accent sur les problèmes de santé qui affectent la force et la mobilité, ainsi que sur ceux qui touchent les fonctions ou structures neurologiques ou musculosquelettiques. Bien que certains aspects de cette directive puissent s'appliquer aux personnes ayant une déficience intellectuelle, un trouble neurodéveloppemental ou un handicap sensoriel (p. ex., perte auditive ou visuelle) seulement, les besoins de cette population sortent du cadre de la présente directive. RéSULTATS: Prestation de soins sûrs et empathiques aux personnes parturientes ayant un handicap physique. BéNéFICES, RISQUES ET COûTS: La mise en œuvre de la présente directive permettra aux fournisseurs de soins de santé de mieux connaître les complications particulières que peuvent présenter les personnes ayant un handicap physique pendant l'accouchement et la période post-partum, ce qui augmentera la probabilité d'un accouchement sécuritaire. DONNéES PROBANTES: Une revue de la littérature a été effectuée à l'aide des bases de données MEDLINE (474), Embase(36) et le Cochrane Central Register of Controlled Trials (CENTRAL; 28). Les résultats ont été filtrés pour obtenir des études observationnelles, des revues systématiques, des méta-analyses et des directives publiées en anglais depuis 2013. Les références de ces articles ont également été passées en revue. MéTHODES DE VALIDATION: Les auteurs ont évalué la qualité des données probantes et la solidité des recommandations en utilisant la méthodologie GRADE (Grading of Recommendations Assessment, Development and Evaluation). Voir l'annexe A en ligne (tableau A1 pour les définitions et tableau A2 pour l'interprétation des recommandations fortes et faibles). PUBLIC VISé: Spécialistes en médecine fœto-maternelle, obstétriciens, médecins de famille, infirmières, sages-femmes, neurologues, physiatres et autres professionnels qui donnent des soins aux personnes ayant un handicap physique.
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http://dx.doi.org/10.1016/j.jogc.2021.02.112DOI Listing
February 2021

Association of Preexisting Disability With Severe Maternal Morbidity or Mortality in Ontario, Canada.

JAMA Netw Open 2021 02 1;4(2):e2034993. Epub 2021 Feb 1.

ICES, Toronto, Ontario, Canada.

Importance: Severe maternal morbidity and mortality are important indicators of maternal health. Pregnancy rates are increasing in women with disabilities, but their risk of severe maternal morbidity and mortality is unknown, despite their significant social and health disparities.

Objective: To determine the risk of severe maternal morbidity or mortality among women with a physical, sensory, or intellectual/developmental disability compared with women without disabilities.

Design, Setting, And Participants: This population-based cohort study used linked health administrative data in Ontario, Canada, from 2003 to 2018. The cohort included all singleton births to women with preexisting physical, sensory, and intellectual/developmental disabilities as well as with 2 disabilities or more compared with women without a disability. Data analysis was conducted from September 2019 to September 2020.

Exposures: Disabilities were identified with published algorithms applied to diagnoses in 2 physician visits or more or at least 1 emergency department visit or hospitalization.

Main Outcomes And Measures: Severe maternal morbidity (a validated composite of 40 diagnostic and procedural indicators) or all-cause maternal mortality, arising between conception and 42 days post partum. Relative risks were adjusted for maternal age, parity, income quintile, rurality, chronic medical conditions, mental illness, and substance use disorders.

Results: The cohort comprised women with physical disabilities (144 972 women; mean [SD] age, 29.8 [5.6] years), sensory disabilities (45 259 women; mean [SD] age, 29.1 [6.0] years), intellectual/developmental disabilities (2227 women; mean [SD] age, 26.1 [6.4] years), and 2 or more disabilities (8883 women; mean [SD] age, 29.1 [6.1] years), and those without disabilities (1 601 363 women; mean [SD] age, 29.6 [5.4] years). The rate of severe maternal morbidity or death was 1.7% (27 242 women) in women without a disability. Compared with these women, the risk of severe maternal morbidity or death was higher in women with a physical disability (adjusted relative risk [aRR], 1.29; 95% CI, 1.25-1.34), a sensory disability (aRR, 1.14; 95% CI, 1.06-1.21), an intellectual/developmental disability (aRR, 1.57; 95% CI, 1.23-2.01), and 2 or more disabilities (aRR, 1.74; 95% CI, 1.55-1.95). Similar aRRs were observed for severe maternal morbidity or death arising in pregnancy, from birth to 42 days post partum, and from 43 to 365 days post partum. Women with disabilities were more likely than those without disabilities to experience multiple severe maternal morbidity indicators. The most prevalent indicators in all groups were intensive care unit admission, severe postpartum hemorrhage, puerperal sepsis, and severe preeclampsia.

Conclusions And Relevance: In this study, women with a preexisting disability were more likely to experience severe maternal morbidity or mortality. Preconception and perinatal care provisions should be considered among women with a disability to mitigate the risk of these rare but serious outcomes.
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http://dx.doi.org/10.1001/jamanetworkopen.2020.34993DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7871190PMC
February 2021

Health characteristics of reproductive-aged autistic women in Ontario: A population-based, cross-sectional study.

Autism 2021 Jan 19:1362361320982819. Epub 2021 Jan 19.

Centre for Addiction and Mental Health, Canada.

Lay Abstract: While an increasing number of girls and women are being identified with autism, we know little about reproductive-aged autistic women's health. This study used administrative data from Ontario, Canada, to compare the health of reproductive-aged autistic women with non-autistic women. Overall, reproductive-aged autistic women had poorer health compared with non-autistic women, including increased rates of material deprivation, chronic medical conditions, psychiatric conditions, history of assault, and use of potentially teratogenic medications (i.e. drugs that can be harmful to the development of an embryo or fetus). These findings suggest that there is a need for health interventions tailored to the needs of reproductive-aged autistic women.
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http://dx.doi.org/10.1177/1362361320982819DOI Listing
January 2021

Health of Newborns and Infants Born to Women With Disabilities: A Meta-analysis.

Pediatrics 2020 12 17;146(6). Epub 2020 Nov 17.

Department of Health and Society and

Context: Women with disabilities are at elevated risk for pregnancy, delivery, and postpartum complications. However, there has not been a synthesis of literature on the neonatal and infant health outcomes of their offspring.

Objective: We examined the association between maternal disability and risk for adverse neonatal and infant health outcomes.

Data Sources: Cumulative Index to Nursing and Allied Health Literature, Embase, Medline, and PsycINFO were searched from database inception to January 2020.

Study Selection: Studies were included if they reported original data on the association between maternal physical, sensory, or intellectual and/or developmental disabilities and neonatal or infant health outcomes; had a referent group of women with no disabilities; were peer-reviewed journal articles or theses; and were written in English.

Data Extraction: We used standardized instruments to extract data and assess study quality. DerSimonian and Laird random effects models were used for pooled analyses.

Results: Thirty-one studies, representing 20 distinct cohorts, met our inclusion criteria. Meta-analyses revealed that newborns of women with physical, sensory, and intellectual and/or developmental disabilities were at elevated risk for low birth weight and preterm birth, with smaller numbers of studies revealing elevated risk for other adverse neonatal and infant outcomes.

Limitations: Most studies had moderate ( = 9) or weak quality ( = 17), with lack of control for confounding a common limitation.

Conclusions: In future work, researchers should explore the roles of tailored preconception and perinatal care, along with family-centered pediatric care particularly in the newborn period, in mitigating adverse outcomes among offspring of women with disabilities.
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http://dx.doi.org/10.1542/peds.2020-1635DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7786829PMC
December 2020

Preconception Health Characteristics of Women with Disabilities in Ontario: A Population-Based, Cross-Sectional Study.

J Womens Health (Larchmt) 2020 12 14;29(12):1564-1575. Epub 2020 Jul 14.

Interdisciplinary Centre for Health & Society, University of Toronto Scarborough, Scarborough, Canada.

: There is growing recognition that preconception health, defined as the health of all reproductive-age individuals, impacts reproductive and perinatal outcomes. Although women with disabilities are becoming pregnant at increasing rates, little is known about their preconception health. Our objective was to describe the preconception health characteristics of women with physical, sensory, and intellectual/developmental disabilities and compare these characteristics with women without disabilities. : We conducted a population-based cross-sectional study of 15- to 44-year-old women with physical ( = 253,184), sensory ( = 93,170), intellectual/developmental ( = 8,986), and multiple disabilities ( = 29,868), and women without these disabilities ( = 2,307,822) using Ontario health administrative data (2017-2018). We described preconception health variables related to social determinants of health, physical health status, psychosocial well-being, history of assault, medication use, and continuity of primary care and compared women with and without disabilities in crude and age-standardized analyses, with standardized differences >0.10 indicating clinically meaningful results. : Women with physical, sensory, intellectual/developmental, and multiple disabilities had poorer preconception health than women without disabilities. Disparities were pronounced for physical health status, psychosocial well-being, use of potentially teratogenic medications, and history of assault. Of all groups, women with intellectual/developmental disabilities had the greatest disparities. : Further research is needed to identify contributors to poor preconception health among women with disabilities and to develop tailored preconception health interventions to meet their unique needs and experiences.
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http://dx.doi.org/10.1089/jwh.2019.8273DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7757535PMC
December 2020

Rates of recognized pregnancy in women with disabilities in Ontario, Canada.

Am J Obstet Gynecol 2020 02 2;222(2):189-192. Epub 2019 Nov 2.

ICES, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.

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http://dx.doi.org/10.1016/j.ajog.2019.10.096DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7261363PMC
February 2020

Parenting Interventions for Mothers With Problematic Substance Use: A Systematic Review of Research and Community Practice.

Child Maltreat 2020 08 14;25(3):247-262. Epub 2019 Oct 14.

Canadian Institute for Substance Use Research, University of Victoria, British Columbia, Canada.

Women with problematic substance use are frequently referred to interventions to promote positive parenting. Parenting interventions that attend to the unique risks faced by this population may enhance engagement and outcomes. While reviews of extant parenting interventions in the research literature have been undertaken, no studies have examined parenting interventions being implemented in community practice and the extent to which these are informed by current research. We systematically compared parenting interventions offered in 12 maternal substance use treatment programs in one Canadian province with those described in the research literature ( = 21). Few parenting interventions were replicated, either within or across the two samples. However, parenting interventions within both samples were largely similar in their objectives. Across both research and community samples, approximately half of the interventions were developed or adapted for a problematic substance use population. Parenting knowledge, psychosocial risk, and maternal emotional regulation were most commonly addressed. Risks pertaining to the impact of drug craving and substance-related changes in neurobiology associted with parenting were less commonly addressed. Findings highlight current strengths and limitations of parenting interventions within research and community settings, with recommendations offered for future research and knowledge translation.
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http://dx.doi.org/10.1177/1077559519873047DOI Listing
August 2020

Maternal disability and risk for pregnancy, delivery, and postpartum complications: a systematic review and meta-analysis.

Am J Obstet Gynecol 2020 01 12;222(1):27.e1-27.e32. Epub 2019 Jul 12.

Interdisciplinary Centre for Health and Society, University of Toronto Scarborough, Scarborough, Toronto, Canada; Dalla Lana School of Public Health, Toronto, Canada; Department of Psychiatry, Toronto, Canada; University of Toronto, and Women's College Research Institute, Women's College Hospital, Toronto, Canada. Electronic address:

Background: Women with disabilities are increasingly becoming pregnant, and growing evidence suggests maternal disability may be associated with increased risk for perinatal complications.

Objective: A systematic review and meta-analysis were undertaken to examine the association between maternal disabilities and risk for perinatal complications.

Study Design: Medline, CINAHL, EMBASE, and PsycINFO were searched from inception to July 2018 for full-text publications in English on pregnancy, delivery, and postpartum complications in women with any disability and those with physical, sensory, and intellectual and developmental disabilities specifically. Searches were limited to quantitative studies with a comparison group of women without disabilities. Reviewers used standardized instruments to extract data from and assess the quality of included studies. Pooled odds ratios and 95% confidence intervals were generated using DerSimonian and Laird random effects models for outcomes with data available from ≥3 studies.

Results: The review included 23 studies, representing 8,514,356 women in 19 cohorts. Women with sensory (pooled unadjusted odds ratio, 2.85, 95% confidence interval, 0.79-10.31) and intellectual and developmental disabilities (pooled unadjusted odds ratio, 1.10, 95% confidence interval, 0.76-1.58) had elevated but not statistically significant risk for gestational diabetes. Women with any disability (pooled unadjusted odds ratio, 1.45, 95% confidence interval, 1.16-1.82) and intellectual and developmental disabilities (pooled unadjusted odds ratio, 1.77, 95% confidence interval, 1.21-2.60) had increased risk for hypertensive disorders of pregnancy; risk was elevated but not statistically significant for women with sensory disabilities (pooled unadjusted odds ratio, 2.84, 95% confidence interval, 0.85-9.43). Women with any (pooled unadjusted odds ratio, 1.31, 95% confidence interval, 1.02-1.68), physical (pooled unadjusted odds ratio, 1.60, 95% confidence interval, 1.21-2.13), and intellectual and developmental disabilities (pooled unadjusted odds ratio, 1.29, 95% confidence interval, 1.02-1.63) had increased risk for cesarean delivery; risk among women with sensory disabilities was elevated but not statistically significant (pooled unadjusted odds ratio, 1.28, 95% confidence interval, 0.84-1.93). There was heterogeneity in all analyses, and 13 studies had weak-quality ratings, with lack of control for confounding being the most common limitation.

Conclusion: Evidence that maternal disability is associated with increased risk for perinatal complications demonstrates that more high-quality research is needed to examine the reasons for this risk and to determine what interventions could be implemented to support women with disabilities during the perinatal period.
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http://dx.doi.org/10.1016/j.ajog.2019.07.015DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6937395PMC
January 2020

A call to recognize the value in disability.

CMAJ 2019 04;191(16):E453

Postdoctoral research fellow, University of Toronto Scarborough, Scarborough, Ont.

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http://dx.doi.org/10.1503/cmaj.71763DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6476722PMC
April 2019

Differences in Rape Acknowledgment and Mental Health Outcomes Across Transgender, Nonbinary, and Cisgender Bisexual Youth.

J Interpers Violence 2019 Feb 15:886260519829763. Epub 2019 Feb 15.

6 Mount Holyoke College, South Hadley, MA, USA.

The purpose of this study was to document the rates of rape acknowledgment (labeling rape as rape rather than using a minimizing label) and the corresponding mental health correlates using the minority stress framework in a unique and vulnerable sample: racially diverse sexual and gender minority young adults. Participants were 245 young adults who identified their sexual orientation as under the bisexual umbrella. A total of 159 of these participants (65.2%) identified their gender identity as nonbinary. All participants completed a series of online questionnaires regarding their sexual victimization history, mental health outcomes (depression, anxiety, and posttraumatic stress disorder [PTSD]), and constructs relevant to minority stress theory (level of outness, internalized bisexual negativity, connection to LGBTQ [lesbian, gay, bisexual, transgender, questioning] community). Rape acknowledgment was significantly greater among gender nonbinary participants (79.9%) than among trans and cisgender male participants (17.9%). Lack of rape acknowledgment was associated with increased anxiety, depression, and PTSD. Outness was significantly associated with greater rape acknowledgment. Despite the highly increased vulnerability for sexual violence among sexual and gender minorities, very little is understood about the mechanisms of this increased vulnerability or their unique needs for recovery. The results of this study strongly suggest the importance of a minority stress framework for understanding this increased vulnerability and for designing sexual violence prevention and recovery interventions for sexual and gender minority populations.
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http://dx.doi.org/10.1177/0886260519829763DOI Listing
February 2019

Bisexual Stigma, Sexual Violence, and Sexual Health Among Bisexual and Other Plurisexual Women: A Cross-Sectional Survey Study.

J Sex Res 2019 Nov-Dec;56(9):1115-1127. Epub 2019 Jan 11.

Department of Sociology and Social Anthropology, Dalhousie University.

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http://dx.doi.org/10.1080/00224499.2018.1563042DOI Listing
September 2020

Integrated treatment programs for pregnant and parenting women with problematic substance use: Service descriptions and client perceptions of care.

J Subst Abuse Treat 2018 07 18;90:9-18. Epub 2018 Apr 18.

Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell Street, Toronto M5S 3M1, ON, Canada; Canadian Institute for Substance Use Research, University of Victoria, 2300 McKenzie Avenue, Victoria V8W 2Y2, BC, Canada.

Integrated treatment programs comprehensively address the unique and varied needs of pregnant and parenting women with problematic substance use. Despite the growth of these programs and evidence supporting their effectiveness, a clear picture of services that comprise integrated treatment is lacking. To address this gap in knowledge, we explored the services provided by 12 integrated treatment programs in one Canadian province. We found that integrated programs routinely provided substance use and mental health services, yet there was marked variability in other supportive services that address other central needs of women, such as prenatal and primary care, therapeutic childcare, housing and transportation support. Using survey data, we further examined client perceptions of care within integrated treatment programs (N = 106) compared to standard treatment programs (N = 207), and thematically analyzed qualitative feedback provided by integrated program clients to gain insight into how services may or may not be promoting positive perceptions of care. We found that integrated treatment program clients perceive their care more positively than clients in standard treatment programs and services provided impact on these perceptions. Implications for treatment development and research are discussed.
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http://dx.doi.org/10.1016/j.jsat.2018.04.008DOI Listing
July 2018

Integrated treatment programs for pregnant and parenting women with problematic substance use: Service descriptions and client perceptions of care.

J Subst Abuse Treat 2018 07 18;90:9-18. Epub 2018 Apr 18.

Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Russell Street, Toronto M5S 3M1, ON, Canada; Canadian Institute for Substance Use Research, University of Victoria, 2300 McKenzie Avenue, Victoria V8W 2Y2, BC, Canada.

Integrated treatment programs comprehensively address the unique and varied needs of pregnant and parenting women with problematic substance use. Despite the growth of these programs and evidence supporting their effectiveness, a clear picture of services that comprise integrated treatment is lacking. To address this gap in knowledge, we explored the services provided by 12 integrated treatment programs in one Canadian province. We found that integrated programs routinely provided substance use and mental health services, yet there was marked variability in other supportive services that address other central needs of women, such as prenatal and primary care, therapeutic childcare, housing and transportation support. Using survey data, we further examined client perceptions of care within integrated treatment programs (N = 106) compared to standard treatment programs (N = 207), and thematically analyzed qualitative feedback provided by integrated program clients to gain insight into how services may or may not be promoting positive perceptions of care. We found that integrated treatment program clients perceive their care more positively than clients in standard treatment programs and services provided impact on these perceptions. Implications for treatment development and research are discussed.
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http://dx.doi.org/10.1016/j.jsat.2018.04.008DOI Listing
July 2018

Perceptions of partner support among pregnant plurisexual women: A qualitative study.

Sex Relation Ther 2018 15;33(1-2):59-78. Epub 2018 Jan 15.

Western University - Department of Psychology, London, Canada,

Although partner support is an established determinant of mental health, we know little about bisexual and other plurisexual people's experiences of support from their partners. Further, very limited research has examined how bisexual or plurisexual people experience partner support during pregnancy, a significant life stage for many couples. This paper draws from semi-structured interviews with 29 plurisexual women partnered with different-gender (i.e., cisgender male or transgender) partners to examine women's perceptions of partner support during pregnancy. While participants reported many of the same partner support issues and dynamics that have been described in research with monosexual childbearing women, their experiences as plurisexual women were unique in two regards: a) unconditional acceptance from partners was connected to the partner's support for their plurisexual identities/histories; and b) social integration support often included shared integration into social networks related to their plurisexual experiences, including sexual networks. These findings offer important implications for sexual and relationship therapists, who can play an important role in helping to foster these plurisexual-specific forms of partner support, and in so doing, improve outcomes for women during this significant life stage.
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http://dx.doi.org/10.1080/14681994.2017.1419562DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6419966PMC
January 2018

Prevalence of Depression and Anxiety Among Bisexual People Compared to Gay, Lesbian, and Heterosexual Individuals:A Systematic Review and Meta-Analysis.

J Sex Res 2018 May -Jun;55(4-5):435-456. Epub 2017 Nov 3.

a Dalla Lana School of Public Health , University of Toronto.

Over the past decade, evidence has accumulated to suggest that bisexual people experience higher rates of poor mental health outcomes compared to both heterosexual and gay/lesbian individuals. However, no previous meta-analyses have been conducted to establish the magnitude of these disparities. To address this research gap, we conducted a systematic review and meta-analysis of studies that reported bisexual-specific data on standardized measures of depression or anxiety. Of the 1,074 full-text articles reviewed, 1,023 were ineligible, predominantly because they did not report separate data for bisexual people (n = 562 studies). Ultimately, 52 eligible studies could be pooled in the analysis. Results indicate that across both outcomes, there is a consistent pattern of lowest rates of depression and anxiety among heterosexual people, while bisexual people exhibit higher or equivalent rates in comparison to lesbian/gay people. On the basis of empirical and theoretical literature, we propose three interrelated contributors to these disparities: experiences of sexual orientation-based discrimination, bisexual invisibility/erasure, and lack of bisexual-affirmative support. Implications for interventions to improve the health and well-being of bisexual people are proposed.
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http://dx.doi.org/10.1080/00224499.2017.1387755DOI Listing
November 2019

"We don't know. We've never had anybody like you before": Barriers to perinatal care for women with physical disabilities.

Disabil Health J 2017 07 5;10(3):426-433. Epub 2017 Apr 5.

Dalla Lana School of Public Health, University of Toronto, 6th Floor - 155 College Street, Toronto, Ontario M5T 3M7, Canada. Electronic address:

Background: While more women with physical disabilities are becoming mothers, many encounter barriers to perinatal care and experience poor outcomes. Little is known about the perinatal care experiences and outcomes of women with physical disabilities in Canada.

Objective: This qualitative study sought to understand the perinatal care experiences and outcomes of women with physical disabilities in one Canadian province, with an emphasis on identifying barriers to care.

Methods: In-depth interviews were conducted with 13 women with physical disabilities who had given birth in the last 5 years. Follow-up interviews were conducted with 10 of the 13 participants. All interviews were audio-recorded and transcribed verbatim. Data analysis was informed by a constructivist grounded theory approach.

Results: Based on analysis of participants' interviews, five themes regarding barriers to care were identified: (1) Inaccessible care settings, (2) Negative attitudes, (3) Lack of knowledge and experience, (4) Lack of communication and collaboration among providers, and (5) Misunderstandings of disability and disability-related needs.

Conclusions: Study findings reveal that the perinatal care system is not set up with women with physical disabilities in mind and that barriers to perinatal care may contribute to poor outcomes. More research and training are needed to address barriers to perinatal care for women with physical disabilities. Collaboration among perinatal and disability-related providers and meaningful inclusion of women with physical disabilities in educational initiatives and care plans are vital to improve care experiences and outcomes.
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http://dx.doi.org/10.1016/j.dhjo.2017.03.017DOI Listing
July 2017

Understanding perceptions of community participation in persons with severe mental illness: A mixed-methods approach.

Can J Public Health 2017 03 1;107(6):e568-e574. Epub 2017 Mar 1.

Department of Geography and Planning, University of Toronto, Toronto, ON; Centre for Addiction and Mental Health, Toronto, ON.

Objectives: This study aims to measure community participation in persons with severe mental illness (SMI) in Toronto, Ontario and outlines a methodological approach for understanding the dimensions of community participation.

Methods: A mixed methods approach was used to define activity spaces through participatory mapping and a qualitative survey interview for participants (N = 31), selected through a stratified purposeful sampling strategy. Five neighbourhoods in Toronto were sampled in an attempt to obtain an ethnically diverse sample. Participants were interviewed over the study period and asked to draw maps indicating places that constituted their community. A qualitative interview was also administered to understand participants' perceptions of their communities. Point locations from the mapping exercise were used to measure and construct activity spaces using a mean circle approach; outlying locations were simultaneously recorded. Observed spatial patterns were then analyzed alongside the findings of the qualitative interviews.

Results: There were no observed relationships between the number of locations reported by participants and the resultant activity space or outlier count. There were no quantitative relationships between activity space size and perceptions of community by participants. However, qualitative data revealed that a number of underlying factors (mental health status and associated stigma; relationships with friends and family; cultural background; income; and neighbourhood safety) influenced participants' activity spaces.

Conclusions: These results highlight the ways that community participation is influenced by an interplay of determinants, all of which have implications for service delivery and population-level interventions. They also point to the importance of mixed methods approaches in spatial analysis.
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http://dx.doi.org/10.17269/cjph.107.5519DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6972451PMC
March 2017

Pregnant plurisexual women's sexual and relationship histories across the lifespan: A qualitative study.

J Bisex 2017 11;17(3):257-276. Epub 2017 Aug 11.

Department of Psychology and Education, Mount Holyoke College, 205 Reese Psychology and Education Building, South Hadley, Massachusetts, United States 01075, (413) 538-2052,

Plurisexual women (that is, those with the potential for attraction to more than one gender) experience unique issues associated with forming and maintaining intimate relationships. In particular, plurisexual women, unlike monosexual women, navigate choices and decisions related to the gender of their partners throughout their lifetime, and may experience a variety of social pressures and constraints that influence these decisions. However, previous research on women's sexual and relationship trajectories has largely focused on adolescence and young adulthood, and therefore we know little about the experiences of plurisexual women at other life stages. The aim of this study was to profile the lifetime sexual and relationship trajectories of 29 plurisexual, different-gender partnered women as described during pregnancy. We identified three primary types of trajectories: women who predominantly partnered with men, women who partnered with men and women about equally, and women who predominantly partnered with women, and found that various contextual factors, including heterosexism and monosexism, constrained women's opportunities for partnering with women. Implications for social and clinical interventions are discussed.
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http://dx.doi.org/10.1080/15299716.2017.1344177DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6433383PMC
August 2017

Positive Identity Experiences of Young Bisexual and Other Nonmonosexual People: A Qualitative Inquiry.

J Homosex 2017 31;64(8):1014-1032. Epub 2016 Oct 31.

b Dalla Lana School of Public Health, University of Toronto , Toronto , Ontario , Canada.

The majority of LGBTQ psychological research focuses on dysfunction. The exclusion of strengths-based perspectives in LGBTQ psychology limits the understanding of LGBTQ mental health. In this article we report experiences that young bisexual and other nonmonosexual people perceive as affirming of their sexual identity. A 28-day, daily diary study was used to investigate whether bisexual-identified participants encountered positive experiences related to their sexual identity, and which type of experiences they perceived to be positive. Using a constructivist grounded theory approach, participants' experiences were organized according to a social ecological model. Experiences were reported at the intrapersonal, interpersonal, and institutional levels, but most positive sexual identity experiences occurred at the interpersonal level. Implications for positive health outcome research and the integration of positive psychology with LGBTQ psychology are discussed, as well as study limitations.
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http://dx.doi.org/10.1080/00918369.2016.1236592DOI Listing
May 2017

Using interactive theatre to help fertility providers better understand sexual and gender minority patients.

Med Humanit 2014 Dec 8;40(2):135-41. Epub 2014 Jul 8.

Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada Social and Epidemiological Research Department, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.

Objective: To determine the effectiveness of interactive theatre as a knowledge translation and exchange (KTE) method to educate assisted human reproduction (AHR) service providers about lesbian, gay, bisexual, trans and queer (LGBTQ) patients.

Design: We transformed data from the 'Creating Our Families' study, a qualitative, community-based study of LGBTQ peoples' experiences accessing AHR services, into a script for an interactive theatre workshop for AHR service providers. Based on forum theatre principles, our workshop included five scenes illustrating LGBTQ people interacting with service providers, followed by audience interventions to these scenes. Before and after the workshop, service providers completed surveys to assess their knowledge and comfort concerning LGBTQ patients, as well as the modality of the interactive theatre workshop as a KTE strategy. Wilcoxon signed-rank tests were used to determine changes in preworkshop and postworkshop knowledge and comfort scores.

Results: Thirty AHR service providers attended the workshop. Twenty-three service providers (76.7%) fully completed the preworkshop and postworkshop evaluation forms. Service providers' knowledge scores significantly improved after the workshop, while their comfort scores minimally decreased. Most agreed that the interactive workshop was an effective KTE method.

Conclusions: In comparison with traditional forms of KTE, interactive theatre may be particularly effective in engaging service providers and addressing their attitudes towards marginalised patient populations. Although the evaluation results of our interactive workshop were mostly positive, the long-term impact of the workshop is unknown. Long-term evaluations are needed to determine the effectiveness of arts-based KTE efforts. Other considerations for developing effective arts-based KTE strategies include adequate funding, institutional support, attention to power dynamics and thoughtful collaboration with forum theatre experts.
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http://dx.doi.org/10.1136/medhum-2014-010516DOI Listing
December 2014

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

J Obstet Gynaecol Can 2014 Feb;36(2):146-153

St. Michael's Hospital, Toronto ON; Department of Family and Community Medicine, University of Toronto, Toronto ON.

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. Participants made recommendations for changes to the following aspects of AHR service provision: (1) access to LGBTQ-relevant information, (2) adoption of patient-centred practices by AHR service providers, (3) training and education of service providers regarding LGBTQ issues and needs, (4) increased visibility of LGBTQ people in clinic environments, and (5) attention to service gaps of particular concern to LGBTQ people.

Conclusion: Many of the recommendations made by study participants show how patient-centred models may address inequities in service delivery for LGBTQ people and for other patients who may have particular AHR service needs. Our results suggest that service providers need education to enact these patient-centred practices and to deliver equitable care to LGBTQ patients.
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http://dx.doi.org/10.1016/S1701-2163(15)30661-7DOI Listing
February 2014

Experiences of women with physical disabilities during the perinatal period: a review of the literature and recommendations to improve care.

Health Care Women Int 2015 2;36(1):88-107. Epub 2013 Sep 2.

a Dalla Lana School of Public Health, University of Toronto; and Centre for Addiction & Mental Health , Toronto , Ontario , Canada.

Although pregnancy and childbirth have significant identity and health implications for all women, perinatal research has focused primarily on nondisabled women. In this article, I provide a review of literature regarding the perinatal care experiences of women with physical disabilities. I found that many women with physical disabilities encounter attitudinal, informational, physical, and financial barriers during the perinatal period that contribute to poor care experiences and may subsequently affect health outcomes. In an effort to improve perinatal care experiences and outcomes, I offer recommendations to address the barriers identified in the literature, including increased disability content in medical school curricula.
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http://dx.doi.org/10.1080/07399332.2013.815756DOI Listing
April 2015

Relation between place of residence and postpartum depression.

CMAJ 2013 Sep 6;185(13):1129-35. Epub 2013 Aug 6.

Background: The relation between place of residence and risk of postpartum depression is uncertain. We evaluated the relation between place of residence and risk of postpartum depression in a population-based sample of Canadian women.

Methods: Female postpartum respondents to the 2006 Canadian Maternity Experiences Survey (n=6126) were classified as living in rural (<1000 inhabitants or population density<400/km2), semirural (nonrural but <30,000 inhabitants), semiurban (30 000-499 999 inhabitants) or urban (≥500,000 inhabitants) areas. We further subdivided women living in rural areas based on the social and occupational connectivity of their community to larger urban centres. We compared the prevalence of postpartum depression (score of ≥13 on the Edinburgh Postnatal Depression Scale) across these groups and adjusted for the effect of known risk factors for postpartum depression.

Results: The prevalence of postpartum depression was higher among women living in urban areas than among those living in rural, semirural or semiurban areas. The difference between semiurban and urban areas could not be fully explained by other measured risk factors for postpartum depression (adjusted odds ratio 0.60, 95% confidence interval 0.42-0.84). In rural areas, there was a nonsignificant gradient of risk: women with less connection to larger urban centres were at greater risk of postpartum depression than women in areas with greater connection.

Interpretation: There are systematic differences in the distribution of risk factors for postpartum depression across geographic areas, resulting in an increased risk of depression among women living in large urban areas. Prevention programs directed at modifiable risk factors (e.g., social support) could specifically target women living in these areas to reduce the rates of postpartum depression.
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http://dx.doi.org/10.1503/cmaj.122028DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3778469PMC
September 2013

Attitudes and knowledge among obstetrician-gynecologists regarding lesbian patients and their health.

J Womens Health (Larchmt) 2013 Jan;22(1):85-93

Hôpital Régional Chaleur, Vitalité Health Networks, Bathurst, New Brunswick, Canada.

Objective: The lesbian patient population is underserved. Almost no research has examined the knowledge and attitudes of obstetrician-gynecologists toward lesbian health. Our study sought to address this research gap.

Methods: All 910 obstetrician-gynecologists licensed in Ontario, Canada, were mailed a true-false survey about lesbian health issues, the Homosexuality Attitudes Scale (HAS), and a demographic survey.

Results: Of the 910 surveys, 271 were returned. The mean HAS score was 87.6 (standard deviation [SD] 11.5), indicating an overall positive attitude. The mean knowledge score was 76.0% (SD 9.5), indicating that respondents had adequate knowledge about lesbian health; 22% described their lesbian health knowledge-base as unaware. Most respondents reported lack of education on lesbian health in residency (81%) or medical school (78%). The majority reported a desire for formal education pertaining to lesbian health. There was no correlation between HAS and knowledge scores.

Conclusions: Although our results indicate overall adequate knowledge about lesbian health issues, important knowledge gaps were identified. Medical school and residency training curricula should include formal education about lesbian health issues, particularly because most obstetrician-gynecologists report a desire to receive this information.
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http://dx.doi.org/10.1089/jwh.2012.3718DOI Listing
January 2013