Delivering patient-centered care requires an understanding of the psychosocial and behavioral determinants of health. The article by Gonzales et al1 in this issue of JAMA Internal Medicine demonstrates that one such determinant, sexual orientation, has an influential effect on several aspects of health. Psychological distress was more common among gay men, bisexual men, and bisexual women than heterosexuals. There was more cigarette smoking and greater alcohol use among lesbians, gay men, and bisexuals than heterosexuals. Although this study is not the first to note these differences among lesbians, gay men, and bisexuals, it is the first to capture the disparity in a population-based sample rather than a convenience or clinic-based sample.
As Gonzales et al1 note, the higher psychological distress and use of unhealthy substances likely reflect the experience of being in a stigmatized minority population. There is reason to anticipate that with the growing acceptance of sexual minority populations, as evidenced by the rapid increase in the establishment of same-sex marriage in the United States and other counties, these disparities will decrease.
Health care professionals can help by creating environments that are inclusive and supportive of sexual minority patients. As with discussion of other personal issues, such as religious beliefs or sexual function, the important thing is to ask open-ended questions that do not prejudge responses. For example, asking a new patient whether he or she has sex with men, women, or both indicates openness and acceptance. Whatever the answer, following up by asking if the patient has a special partner shows interest and willingness to discuss intimate issues. In caring for people who have experienced bias and discrimination, support is a very potent medicine.
Conflict of Interest Disclosures: None reported.
Katz MH. Health Care for Lesbian, Gay, and Bisexual People Comes Out of the Closet. JAMA Intern Med. 2016;176(9):1352. doi:10.1001/jamainternmed.2016.3828