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AOD & MH indicators for Sydney LBQ women (SWASH survey)
- 1. SYDNEY MEDICAL SCHOOL Analysis of Alcohol and Other Drugs and Mental Health Indicators in the Sydney Women and Sexual Health (SWASH) survey (2006, 2008, 2010, 2012) ACON Snakes and Ladders: Comorbidity Education Sessions 2013 Dr Julie Mooney-Somers & Dr Rachel Deacon
- 2. What is SWASH? 1
- 3. Origin story…. › 1996 › Initiated by workers from ACON: Women Partners of Gay and Bisexual Men and the Gay and Lesbian Injecting Drug Use Project › Concern around women and HIV and particular worry about HIV spreading from gay men to ‘general community’ and women partners of bisexual men › Early in epidemic most HIV among women was via ‘heterosexual‘ transmission -> neither party need be heterosexual for this to occur › Assumption: lesbian women don’t have sex with men; behaviour = social identity › Actually: most LBQ women have history of sex with men; more likely to have sex with gay/bi men than other women; IDU higher in LBQ women; more likely to be sharing with gay/bi men › Lack of empirical evidence on which to base intervention work
- 4. Origin story… › Women engaged with the gay community -> Women having sex with gay and bi men › Estimate the HIV-related risk & identify need for future work › 1996 focus HIV-related risk behaviour › 1998 + hepatitis C › 2000 + lesbian sexual practices + safe sex behaviour (dental dams) + hepatitis A and B SWASH 1996, 1998, 2000
- 5. Broadening focus…. › Shifting focus on lesbian, bisexual women › Broadening range of health issues › Reflects the shift in ACON’s role and concerns › Each iteration of the survey has reflected a balance between the needs of the community – through consultation with ACON – and identified research prioritises based on review of the literature SWASH 2002 ->
- 6. Broadening focus…. › knowledge of sexually transmissible infections (STIs) › pap smears › testing for STIs and HIV + diagnosis › tobacco smoking › illicit drug use › alcohol consumption › self-report measures of physical health › self report mental health (K6) + accessing counselling + diagnosis › height and weight › regular GP + out to GP › satisfaction with last GP visit › domestic violence › anti-LGBTQ behaviour + seeking help + reporting to police › community engagement + community media use + community connection SWASH 2002 ->
- 7. SWASH sample › Women engaged with the LGBT communities in Sydney › Never claimed to be all lesbian, bisexual, queer, trans* or same-sex attracted women in Sydney / NSW / Australia › Data collection: 2 page self complete questionnaire › Recruitment by survey collectors at: - Mardi Gras Fair Day (consistent and core) - Mardi Gras social events (venues change each year) - Sexual health clinics/NSPs (early days)
- 8. SWASH now › Broader survey of the health of women in and around Sydney’s lesbian, gay, bisexual, transgender and queer (LGBTQ) and communities › Longest running and only regular survey of LBQ women’s health and wellbeing in Australia (probably the world) › Important and unique resource on LBQ women’s health and wellbeing › Self-funded partnership between a community-based NGO and its university partners (ie it is run largely by volunteers)
- 9. What does SWASH 2006 – 2012 sample look like? Has anything changed? 2
- 10. SWASH sample Recruitment by venue
- 11. SWASH sample Age distribution of sample
- 13. SWASH sample Sexual identity by age category
- 15. SWASH sample › Community connection: - 50% feel mostly or very connected to LGBTQ community - No overall change (9% increase among queer and other-identifying women) › Feel connected to community through: - ‘at home’ (66% very or mostly) - ‘LGBTQ venues’ (62%) - ‘partner’ (59%) - ‘online’ (30%) › Recent attendance at venues: - Trending down except for LGBTQ sports group Community connection
- 16. Indictors: Alcohol and Other Drug use Mental Health 3
- 17. Alcohol Frequency of alcohol consumption
- 21. Other drugs Illicit drug use
- 22. Other drugs
- 23. Summary of change › Smoking: Small drop (2006 35% -> 2012 33%) › Smoking by age: 16-24 years 42% (2006 45%); 25-34 years 36% (2006 39%); 35-44 years 31% (2006 31%) › Everyday drinking: Down slightly › Recent binge drinking: No change; 50% reported doing so more than twice › Usual number of drinks: No change (59% 2+) › Illicit drugs: No change except benzos up; Any drug use 48% (steady) › Injecting: Continues downward trend (2006 10% -> 2012 7% ever) Alcohol, Tobacco, Other drugs
- 24. Self-reported mental health Table 46: Kessler 6 measure of psychological distress, by age group (2006, 2010, 2012) 16-24 years 25-34 years 35-44 years 45+ Not reported Total n (%) n (%) n (%) n (%) n (%) n (%) 2006 Low distress 96 (62.7) 266 (75.0) 195 (78.3) 137 (80.1) 4 (11.8) 698 (72.6) Medium distress 31 (20.3) 31 (8.7) 25 (10.0) 14 (8.2) 0 (0.00) 101 (10.5) High distress 20 (13.1) 21 (5.9) 3 (1.2) 9 (5.3) 0 (0.00) 53 (5.5) Not reported 6 (3.9) 37 (10.4) 26 (10.4) 11 (6.4) 30 (88.2) 110 (11.4) Total 153 (100) 355 (100) 249 (100) 171 (100) 34 (100) 962 (100) 2010 Low distress 124 (53.2) 215 (62.1) 165 (73.0) 114 (74.5) 2 (33.3) 620 (64.3) Medium distress 55 (23.6) 61 (17.6) 27 (11.9) 14 (9.2) 0 (0.00) 157 (16.3) High distress 28 (12.0) 29 (8.4) 12 (5.3) 4 (2.6) 0 (0.00) 73 (7.6) Not reported 26 (11.1) 41 (11.8) 22 (9.7) 21 (13.7) 4 (66.7) 114 (11.8) Total 233 (100) 346 (100) 226 (100) 153 (100) 6 (100) 964 (100) 2012 Low distress 82 (51.9) 214 (66.3) 143 (66.2) 90 (64.7) 4 (80.0) 533 (63.8) Medium distress 34 (21.5) 53 (16.4) 30 (13.9) 17 (12.8) 0 (0.0) 134 (16.1) High distress 26 (16.5) 24 (7.4) 19 (8.8) 7 (5.3) 0 (0.0) 76 (9.1) Not reported 16 (10.1) 32 (9.9) 24 (11.1) 19 (14.3) 1 (20.0) 92 (11.0) Total 158 (100) 323(100) 216(100) 133 (100) 5 (100) 835 (100) Note: cut off scores were Low = 0-7, Medium = 8-12, High = 13-24.(19)
- 25. Self-reported mental health Mental health by sexual identity
- 26. Self-reported mental health Mental health diagnosis by sexual identity
- 27. Summary of change › (Kessler 6): Proportion reporting low distress decreased (2006 73% -> 2012 64%) and proportion reporting high distress increased (2006 5.5% -> 2012 9%) *doubled* › High distress by age: 16% of 16-24 years (vs 13% in 2006) › High distress more likely in younger women, but over time the difference between younger and older is decreasing ?more distress generally › Recent access to conselling: Increase (2010 51% -> 2012 55%) › Recent mental health diagnosis: No change (34%) Mental health
- 28. Comorbidity 4
- 29. Tobacco › Smoking assoc with high psychological distress - High distress more likely among smokers (12%) than non-smokers (9%) - High distress lowest among ex-smokers (8%) – age? › Small difference among women diagnosed with mental health disorder in past 5 yrs: 40% smokers vs 30% non-smokers. › Small difference among women who accessed counselling in past 5 yrs: 33% smokers vs 38% non-smokers – age? › Women self-reporting excellent health more likely to be non-smokers (25%) than smokers (15%) – perception? Smoking
- 30. Alcohol › Binge drinking more often assoc with higher psychological distress - High distress more likely among women reporting 2+ binge drinking (11%) than never/1-2 times bingeing (8%) › More drinks on typical day assoc with more high psychological distress - High distress more likely among women reporting 2+ drinks on typical day (11%) than 1-2 drinks (7%) › Drinking more on a typical day not assoc with mental health diagnosis in past 5 yrs › Drinking more on a typical day assoc with not accessing counselling in past 5 yrs - 55% 2+ drinks on typical day vs 59% 1-2 drinks Alcohol
- 31. Other drugs › Drug use assoc with high psychological distress - 63% of women reporting high distress reported recent drug use (vs 37% no drug use) - High psychological distress women more likely to report using benzos (25% vs 14% for low distress) › Drug use assoc with mental health diagnosis › 56% reporting diagnosis in last 5 years reported drug use (vs 47% no diagnosis) › Drug use assoc with accessing counselling in past 5 yrs - 55% reporting counselling reported drug use (vs 47% no counselling) › Drug use assoc with binge drinking: - 58% of women reporting drug use reported 2+ binge drinking (vs 33% no drug use) › Drug use assoc with smoking: - 45% of women reporting drug use were smokers (vs 22% no drug use) Other drug use
- 32. What should the research priorities be for LBQ women? How can we generate relevant and useful knowledge? 5
- 33. CONTACTS Acknowledgments › SWASH owes a deep debt of gratitude to ACON for continued practical and financial support. This research could not have happened without their commitment, enthusiasm and contacts. We thank all the women who completed the questionnaire. Contacts › Dr Julie Mooney-Somers, Centre for Values, Ethics and the Law in Medicine (VELiM), University of Sydney, julie.MooneySomers@sydney.edu.au › Dr Rachel Deacon, Discipline of Addiction Medicine, University of Sydney, Rachel.Deacon@sydney.edu.au › All previous SWASH reports and publications can be found at: http://www.acon.org.au/research/news/sydney-women-and-sexual-health
Editor's Notes
- 35mins of talking
- 2012 – only 18% ever completed before
- The age range was 16-76 years, with a median age of 32 (2006 range was 16-68 years, median age 33; 2008 range was 16-69 years, median age 31; 2010 range was 17-81, median age 31). Figure 1 compares the proportion of respondents in 5-year age categories over the three surveys. The category with the largest number of respondents has consistently been the 25-34 years age group
- In 2012 we kept the response option ‘queer’ - added in 2010 - in the question ‘Do you think of yourself primarily as: Lesbian/dyke/homosexual/gay, Bisexual, Heterosexual/straight, Other (please specify)?’. We did this to reflect the significant proportion of women in previous years who ticked ‘other’ and wrote ‘queer’. This change likely accounts for the drop in the number of women selecting ‘other’ in 2012 and 2010, compared to 2008 (Table 3). However, to allow easy comparison we have collapsed ‘queer’ and ‘other’ in further analyses.
- Age and sexual identity have been correlated in each SWASH survey since it began in 1996. Younger women were more likely than older women to identify as bisexual, queer or other and less likely to identify as lesbian (Figure 2). Sexual identity: all age groups have more bisexual-identifying women (2006 9% .-> 2012 13%) and more queer and other-identifying women (2006 5% -> 2012 18%) and fewer lesbian-identifying women (2006 86% -> 2012 68%) Proportion of women identifying as lesbian increases with age BUT appears that over time fewer women overall identifying as lesbian/gay
- all but 2.4% of respondents indicated at least some attraction to women, though only 28% indicated exclusively same-sex attraction.As Table 5 shows, not everyone felt sexual attraction exclusively or even mostly to women, even in this sample of women who were in contact with and recruited through LGBTQ community venues and functions, and 77% of whom had been sexually active with a woman in the preceding six months (and 95% in their lives). As would be expected, lesbian-identified women were most likely to say they were attracted only or mostly to females (96%), followed by queer or other women (65%), and then bisexual women (28%).
- The majority of respondents reported spending time with a partner (59%) and attending community events (55%) were very or mostly important sources of community connection. Socialising online was reported as important by surprisingly low proportion, with nearly as many people reporting online socialising was not important or not applicable (24%) as reported it was very or mostly important (30%)
- The majority of women (84%) in the 2012 survey reported drinking alcohol. Table 34 illustrates the distribution of drinking frequency.
- The National Health and Medical Research Council (NHMRC) recommends that adults drink no more than two standard drinks on any single day to reduce the lifetime risk of alcohol-related disease or injury.(15) More than half of women - 59% of drinkers - exceeded this recommendation (Table 35). This compares to 11% of women in the general population. (14) This level of drinking in our sample decreased with age; 75% of 16-24 year old drinkers reported consuming more than 2 standard drinks on a typical day compared to 35% of women drinkers aged over 45 years. The NHMRC recommends that adults drink no more than four standard drinks on a single occasion to reduce the risk of alcohol-related injury on that occasion.(15) One in five women - 23% of drinkers - exceeded this advice (Table 35). This is lower than women in the general population (30% in the preceding 12 months). (14)
- However, 2.3 times as many LBQ women drank at these risky levels daily or weekly (21% of drinkers), compared to women in the general population (9%) (Table 36).(14) Again, risky drinking was associated with age; 59% of 16-24 year old drinkers reported binge drinking more than twice in the preceding six months compared to 26% of women aged over 45 years (p<0.001).
- A third of women (33%) said they were current tobacco smokers (Table 32), 22% of women (or 66% of current smokers) were daily smokers. These are high rates of smoking compared with the general population, especially considering that this is a highly educated urban sample. For comparison, in the 2010 National Drug Strategy Household Survey (NDSHS) of the general population,(14) 16% of women 18 or older were current smokers (vs 33% SWASH), with 14% of women daily smokers (vs 22% SWASH). In the NDSHS sample, gay women and men (not reported by gender) were twice as likely to smoke and among smokers were twice as likely to report smoking daily, compared to the heterosexual women and men in the sample.(14) In SWASH, tobacco use was twice as likely in the youngest age group compared to the oldest age group (42% of 16-24 year olds vs. 22% of women over 45 years) (Table 32). The closest comparison in the NDSHS is 20-29 year old women, of whom 22% were smokers.(14)
- In the preceding six months, 48% of respondents had used any illicit drug including cannabis (32%), ecstasy (23%), and cocaine (17%) (Table 37). Use of speed, crystal meth and ecstasy has dropped significantly since 2006 (p<0.001 for each), while cocaine use has significantly increased (p<0.001). These trends echo the 2010 NDSHS.(14) In response to the question ‘Have you ever injected drugs?’ 7% of women indicated that they had ever done so (2006: 10%; 2008: 10%; 2010: 8%; 2012: 7%).
- Rates of use of illicit drug use were several times higher among our respondents than rates reported in the general community by the NDSHS (Table 38). Gay women and men (statistics not reported by gender) in the NDSHS had the highest rate of recent drug use (36%) among all subpopulation groups.(14)
- In 2006, 2010 and 2012 we used the Kessler 6 to measure non-specific psychological distress (e.g. feeling nervous, hopeless, restless, worthless) in the preceding four weeks.(18) Distress was most common in younger women; 17% of 16-24 year olds reported high distress compared to 5% of women aged 45 years and older (p<0.015; Table 46), and has increased since the last survey (12%) A similar relationship between psychological distress and age is likely to contribute to the findings that bisexual women (13%) and queer and other (14%) identifying women were twice as likely to report high distress compared to lesbian (7%) women (Table 47).
- From 2010, we asked women if they had ever accessed counselling or psychological services (Table 48). Over half the sample (55%) had accessed such services in the preceding five years; two thirds (67%) had ever accessed such services. Nearly three quarters (71%) of queer and other identifying women had accessed services in the preceding five years.
- We also asked women if they had ever been diagnosed with depression, anxiety disorder or other mental health disorder. Forty six per cent of women in our sample reported that they had ever received a mental health diagnosis (34% in the preceding five years) (Table 49).