Sexually Transmitted Disease (STD) Diagnoses and Mental Health Disparities Among Women Who Have Sex With Women Screened at an Urban Community Health Center, Boston, Mass., 2007
"A growing body of research documents mental health disparities among women who have sex with women (WSW) compared with women who have sex with men only (WSM)," the authors wrote. However, there is limited research on these indicators in conjunction with STDs and WSW sexual health.
From July to December 2007, a retrospective chart review was performed on all female patients (n=368) screened for STDs at an urban community health center in Boston. De-identified electronic medical record data (e.g., demographics, psychosocial, sexual health) were analyzed and linked to STD positivity. The analysis excluded women whose medical chart did not document sexual behavior (n=58). Sexual and psychosocial health indicators, including sexual preference, were examined via bivariate and multivariate logistic regression.
Of participants, 27 percent were WSW (17 percent WSW only and 10 percent WSW/M). Five percent of WSW were diagnosed with a new STD (HPV, anogenital warts, genital herpes, pelvic inflammatory disease) and 17 percent had a past history of STD diagnosis. In multivariable, demographics-adjusted models, WSW were disproportionately more likely to have medical records noting mental health and psychosocial issues, including: "a clinical diagnosis of depression, anxiety, and post-traumatic stress disorder, history of suicide attempts, and inpatient psychiatric/mental health treatment."
However, WSW were significantly less likely than WSM to engage in high-risk HIV/STD behavior. In a final multivariate model, same-sex behavior was not associated with a different likelihood of being diagnosed with an STD versus opposite-sex behavior. Compared to STD history-negative WSW, WSW diagnosed with an STD were at increased odds of having bipolar disorder and utilizing outpatient mental health counseling services; having attempted suicide; utilizing both inpatient and outpatient mental health treatment services; and having a history of injecting drugs.
"WSW with STDs may have presenting psychosocial problems," the authors concluded. "Further research is warranted to better understand the relationship between sexual behavior and health, as well as to guide the development of interventions to ameliorate health disparities among WSW, particularly in the psychosocial domain."