Psychiatrist and data scientist use ‘big data’ for minority populations

If health services researchers do not ask questions about distinct subpopulations, those populations will be invisible.

“It is unacceptable that minority segments of the population known to receive disparate care remain hidden in health care data and health surveys. ”—Adrienne Grzenda, MD, Ph.D.

This is one of the important lessons of a study published last year in the journal LGBT health by psychiatrist Adrienne Grzenda, MD, Ph.D., former APA health services researcher and current consultant in bioinformatics and big data in the APA Research Division.

Grzenda’s study showed a dramatic increase in mental distress among those belonging to sexual and gender minorities associated with the election of Donald Trump in 2016.

The finding has implications for how political, social and cultural currents can sometimes have a direct impact on mental health and distress – a finding which has been echoed by major news outlets, notably USA today and news from the television network.

But Grzenda believes the study also demonstrated the importance of asking the right questions and including in surveys previously neglected populations – in this case, people from sexual and gender minorities. Grzenda’s co-authors were Haiyong Xu, Ph.D., Jeanne Miranda, Ph.D., and Susan Ettner, Ph.D., all from the University of California, Los Angeles (UCLA).

“It wasn’t until recently that major health surveys like the CDC’s Behavioral Risk Factor Surveillance System [BRFSS] even started asking questions about sexual orientation and gender identity, ”Grzenda told Psychiatric News. “I’m gratifying that one of the things this study has highlighted is the importance of representation in data. It is unacceptable that minority segments of the population known to receive disparate care remain hidden in health care and health survey data. “

She began the research that culminated in the August 2021 study during her two years as the APA’s inaugural Health Services Research Fellow while in her third and fourth years of university. residency at UCLA. She is now a faculty member at UCLA’s David Geffen School of Medicine and UCLA-Olive View Medical Center. The two-year scholarship started in 2017.

Grzenda brought a remarkable curriculum vitae to this survey: she earned her MD and PhD. (in biochemistry and molecular biology, epigenomics student) from the Mayo Clinic and an MSc in bioinformatics and computational biology from the University of Minnesota. She completed her residency in the research stream at UCLA-Semel Institute and is certified in Psychiatry and Clinical Informatics.

She has applied this tremendous background to studying the mental health of LGBT populations. “When I applied for the APA scholarship, my proposal was to investigate the mental health of gender minorities using under-explored data types, such as insurance claims and social media data. , for example, by examining suicide accounts of transgender and non-binary individuals in social media posts, ”said Grzenda.

“We know that there is a gap in mental health services for LGBT populations and that the lifetime suicide attempt rate among transgender and non-binary people has persisted at around 40%,” he said. she declared. “How to better capture information on mental health and distress of gender minorities to provide better service?” “

In the study, she and her colleagues used cross-sectional data from the 17 states that administered the sexual orientation and gender identity module in the 2015 and 2018 BRFSS surveys. The sample included 268,851 adult respondents: 12,006 adults from sexual and gender minorities and 256,845 cisgender and heterosexual adults.

The primary outcome measure was physical distress, mental distress, limited activity and / or fair or poor general health for 14 days or more in the previous month.

Grzenda noted that as the election approaches, Trump and his running mate Mike Pence have spoken prominently about the overthrow of some of the LGBT protections adopted during Obama’s presidency. After the election, she and her colleagues noted in the study, 129 bills were proposed during the 2017 legislative season in 30 states, targeting protections for LGBT and gender minorities ranging from housing to healthcare. adoption health.

“Our hypothesis was that we should be able to use this large representative sample [the BRFSS] to empirically test whether there was an increase in LGBT mental distress over the election, ”she said.

She pointed out that a poll asking people if the election caused distress would elicit a lot of biased responses. But the BRFSS is a “cold” telephone survey that includes general questions about health and mental health.

Merely comparing pre-election and post-election changes in mental distress could be misleading, as factors other than election could be responsible. Grzenda and her colleagues therefore used a quasi-experimental approach known as “difference in differences” to calculate the impact of an event (in this case, the election of Donald Trump in 2016).

By comparing the changes in outcome (mental distress) in a “treatment” group affected by the event to a “control” group, unaffected by the event, the design better controls invisible confounders.

“That way the difference in the differences allows you to make causal inferences,” she explained. Data analysis also controlled for socio-demographic variables, health care coverage and chronic disease.

They found that the LGBT population as a whole experienced a statistically significant increase in frequent mental distress compared to that of the cisgender and heterosexual sample, but the minority sex group (transgender and non-binary) experienced a significant increase in mental distress. dramatic increase.

Compared to the cisgender and heterosexual population, the cisgender and lesbian and gay populations experienced an increase in primary endpoint of 1.5%, a relative increase of 11.6% from 2015, although this was not statistically significant. Cisgender and bisexual and other respondents experienced a 4.8% point increase compared to the cisgender and heterosexual population, an increase of 27.6% from 2015.

However, the transgender or gender nonconforming population has seen a 14.8% increase over the cisgender and heterosexual population, a surprising relative increase of 117.5% from 2015.

“Previous studies indicate that persons belonging to a gender minority and bisexual are often more vulnerable to mental health and health problems,” wrote Grzenda and her colleagues. “The existing disparities can then sensitize these subgroups to the effects of acute or worsened stress. The overwhelming majority of anti-LGBT laws proposed during the period under review specifically targeted the rights of persons belonging to gender minorities. … The effect on subgroups may then be dose dependent, with increases in mental distress being proportional to the extent to which the individual perceives the impact.

The study was presented in USA today and on NBC News. It has also drawn criticism from conservative media such as Breitbart News.

Today, Grzenda uses her expertise in data science to help the research division of the APA explore how large sets of demographic data can be used to improve the mental health of individuals and communities.

“Big data is the next evolution in health services research,” she said. “How can we take advantage of the ever-proliferating health data with machine learning and other artificial intelligence techniques to improve patient outcomes? “■

“Impact of the 2016 election on the quality of life of adults belonging to sexual and gender minorities: an analysis of the differences” is published here.

Sean N. Ayres