2.2.5 a prof ruth mc nair

1. The ALICE project –
alcohol, mental health and health service usage
Alcohol and
Lesbian/bisexual women:
Insights into
Culture and
Emotions
National Women’s Health Conference
May 2013 Alice in Wonderland
John Tenniel

2. Study team
Uni Melb
Turning Point
Ruth McNair
Kelsey Hegarty
Jodie Valpied
Gay and
Lesbian
Health Victoria
University of
Illinois at
Chicago
Tonda Hughes
Deakin Uni
Amy Pennay
Dan Lubman
Rhonda Brown Liam Leonard

3. Aims ALICE study
1. Explore relationships between hazardous
drinking, and depression and anxiety in LB
women
2. Investigate influence of cultural norms and
discrimination on drinking
3. Identify help-seeking patterns for hazardous
drinking and/or depression/anxiety
4. Develop training on LBW substance use for GP,
AOD and mental health sectors

4. ALICE Methods- ethnographic framework
Online survey n = 521
In-depth interviews n~30
Participant observation n~5

5. Recruitment of same-sex attracted women
>18yo, Australia-wide
48
19
9
10
6
5
1 1
Sources (%)
Facebook
Email
Websites
Other
Word of mouth
Mag/newspaper
Radio
Flyer

6. Survey respondent demographics n = 521
Age
mean 33.9 years old
range 18 to 73
Sexual orientation
lesbian 297 (57%)
bisexual 89 (17%)
queer 89 (17%)
other 19 (4%)
pansexual 10 (2%)
unsure 11 (2%)
heterosexual 6 (1%)
Gender identity
female 479 (92.0%)
gender queer 12 (2.3%)
trans male2fem 8 (1.5%)
trans fem2male 1 (0.2%)
other 18 (3.5%)
Relationship
with one person 52.8%
with >1 person 4.4%
Children
has children 100 (19.2%)
lives with “ 55 (10.6%)

7. Alcohol use, smoking and other drugs
Alcohol
%
Smoking
%
Illicit
drugs %
ALICE
Ever
98.8 65.9 71.3
ALICE
Past 12
months
93.7 31.7 32.5
Population
past 12
months*
77.5 16.3 22.7
Homosex/
Bi past 12
months**
n/a 32.9 35.7
Private Lives 2
Alcohol
12 mths
Smoking
12 mths
92% 16.1%
*Women in National
Household Drug Survey 2010
**all homosexual/bisexuals in
National Drug Survey 2010

8. Alcohol use and smoking (%)
Lesbian/gay Bisexual Queer/Pan Other
Alcohol ever 98.7 100 98 100
Alcohol past
12 months
91.6 97.8 92.9 100
AUDIT > 7
harmful
38.7 38.2 45.5 44.4
Difficult to
reduce/stop
14.8 14.6 15.0 25.0
Smoking past
12 months 29.3 25.8 45.0 38.8

9. Mental health
Anxiety diagnosed %
100%
80%
60%
40%
20%
0%
27.9 31.5
19.2 16.7
15.8 13.5 33.3 27.8
Never last 12 mths > 12 mths
Depression diagnosed %
100%
80%
60%
40%
20%
0%
19.9 20.2
28.3 27.8
34.3 39.3
28.3 30.6
Never Last 12 mths > 12 mths

10. Self harm and suicide - ever (%)
43.4
65.3
54.5
21.2
63.6
70.7
66.7
33.9
80
70
60
50
40
30
20
10
0
Self harm Life not worth
living >2wks
Suicidal
thoughts
Suicide
attempt
Lesbian/gay
Bisexual
Queer/pan
Other

11. Questions arising so far
• Are alcohol intake and mental health connected?
• If so, ? Direction of the effect
• Why are depression, anxiety, self harm, and
suicidality so prevalent?
• Discrimination experiences?
• Social marginalisation / lack social/family support?
• Are discrimination experiences influencing
alcohol use?

12. AUDIT scores vs. depression and anxiety
diagnoses and suicidality in the past year
45
40
35
30
25
20
15
10
5
0
Low Hazardous Harmful Dependent
Dx Anxiety
Dx Depression
Self harm
Life not worth living
Suicidal thought
Suicide attempt

13. Experienced discrimination regarding sexual
orientation/gender identity in past year (% yes)
50
45
40
35
30
25
20
15
10
5
0
159 women (30.5%) had experienced discrimination in the past year
29.3
19.1
48.5
19.4
Lesbian/gay Bisexual Queer/Pan Other

14. Alcohol intake (AUDIT score), and
discrimination – experiences and influence
50
45
40
35
30
25
20
15
10
5
0
25.7
39.3
44.8
26.8
Discrimination yes
Discrim effected alcohol
intake

15. Further questions arising?
Given the high levels of depression, anxiety, self
harm, suicidality and hazardous alcohol use
• Are women accessing health services?
• General practice
• Alcohol services
• Mental health services
• Are there any barriers to access related to sexual
orientation/gender identity?

16. General Practice use past 12 months
and disclosure
% Yes Lesbian Bisexual Pansexual Queer Unsure
Has a regular
GP
78.8 68.5 80.0 61.8 36.4
Used at least
once past 12
mth
94.3 94.4 90.0 92.1 100
Used re.
alcohol
6.1 6.7 10.0 3.4 0
Used re
mental health
12.8 7.9 30.0 21.3 0
GP aware of
sexual
orientation
69.4 36.0 20.0 68.5 18.2

17. Alcohol and mental health service use
at least once in the past 12 months
60
50
40
30
20
10
0
Used for
alcohol
Relucant to
use for
alcohol
Used for
mental
health
Reluctant to
use for MH
Lesbian/gay
Bisexual
Queer/Pan
Other

18. Range of barriers to service use for alcohol or
mental health issues
• lack of information about services available
• inability to access services
• not ready to seek advice or help
• previous services used were not helpful
• concerns about confidentiality
• concerns about being judged about alcohol/MH
• fear of discrimination based on SO/GI
• prior experiences of discrimination based on SO/GI

19. Barriers to service access - % ever
Barrier Services for
Alcohol issues
Services for
Mental health issues
Confidentiality 9.0 22.8
Fear about being judged 14.8 42.6
Fear of discrimination 7.6 24.4
Experience of
discrimination
5.7 12.5

20. Experiences of discrimination in health
services based on sexual orientation/ gender id
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
5.6
19.2
5.6
19.9 13.9
10.8
12.4
21.2
Lesbian/gay Bisexual Queer/Pan Other
Yes
Unsure
No

21. Take home messages - Convenience sample of
non-heterosexual women with
high levels of mental health disturbance
and suicidality
moderate
levels of
alcohol use,
smoking and
illicit drugs
discrimination
a key
association
with MH
disparities and
harmful
alcohol intake
service use is
high, but
barriers to use
also high,
especially for
mental health

22. Next steps for ALICE project
Complete and analyse interviews
Connections between MH, alcohol Health services perceptions
Complete and analyse observations
Cultural influences on alcohol use Mainstream versus LBQ
Develop health provider training – GP, AOD, MH
Health disparities for LBQ women Sensitising mainstream services