Richard Bränström

Older people are at increased risk for mental health issues and involuntary loneliness. Belonging to a sexual or gender minority is also found to increase these risks. However, there is a lack of knowledge about mental health, social isolation and involuntary loneliness among LGBT+ people (lesbian, gay, bisexual, transgender and other sexual and gender minority identities) in later life.The overall research aim of this project is to investigate mental health, social isolation, and involuntary loneliness among LGBT+ people 65 years or older in Sweden, using both quantitative and qualitative approaches. A second aim is to, in collaboration with the target group and community-based, social and health care stakeholders, identify ways to tailor initiatives to those older LGBT+ people who are found to be most at risk.The aims are addressed through four studies. Study 1 uses already collected data from a population-based survey study to analyze gender identity and sexual orientation disparities in mental wellbeing among older people in Sweden. Study 2 is a survey study directed to the 65+ LGBT+ population to investigate how structural and experiential factors (e.g., openness about LGBT+ identity and stigma-based stress) affect mental health, social isolation and involuntary loneliness in this group. Study 3 is a qualitative interview study with older LGBT+ people who reported loneliness and social isolation, to explore their experiences of relationships, belonging, and community, and facilitators and challenges in strengthening social support networks. Study 4 is a qualitative interview study with community-based, social and healthcare stakeholders to identify ways to tailor initiatives to those older LGBT+ people who are found to be most at risk. An advisory group with representatives from the target group, LGBT+ organizations, and care and policy stakeholders, will be involved throughout the research. This interdisciplinary project is theoretically informed by gerontology, psychology, healthcare science, gender and queer theory. Research results are intended to contribute empirically and theoretically to these fields. Results will be disseminated academically and in contexts where results can inform practice and policy with support from the advisory group. Furthermore, results are intended to form a basis for developing initiatives towards preventing mental health issues, isolation and involuntary loneliness among older LGBT+ people.

Research area and aims Eating disorders (EDs) are common and cause significant morbidity and mortality. Due to stigma, only 25% seek help and only 50% fully recover after receiving treatments. Large-scale prevention is urgently needed to reduce the emergence and burden of EDs at a population level. However, current prevention programs do not meet requirements for efficient and economically attractive large-scale implementation. The main aim of this project is to investigate the efficacy and cost-effectiveness of a scalable, brief, and interactive prevention program based on reinforcement of protective factors against EDs using a randomized controlled design. A focus on protective factors disrupts the processes by which risk factors increase the probability for EDs to emerge and minimizes the risks for stigmatization. Research questions: How effective is an internet-based prevention program, that reinforces protective factors against EDs, in reducing the onset of EDs 6, 12, and 24 months post-intervention?Does the intervention reduce the incidence of EDs through enhancement of specifically targeted protective factors (mediators)?Is prevention of EDs based on reinforcement of protective factors cost-effective?How sustainable are virtual communities for maintenance of future recruitment and prevention on a large scale? Secondary questions concern gender differences in enrollment and compliance, potential moderators of outcome, participation in booster sessions, and potential risk for stigma. Data and MethodParticipants (15-20 years old, n=644, based on power analysis) will be recruited online and randomized to prevention or a credible placebo. The intervention will be selective (target those with significant body dissatisfaction), delivered in a scalable format (Internet-based), brief (45 minutes/week for four weeks), and with interactive components of the program moderated by artificial intelligence for future scalability. Assessments will be done using the gold standard within the field of EDs.  Plan for project realisationThe proposed project is an extension of our previous work, including the largest controlled trial of prevention of EDs in Sweden. Recruitment, intervention, and assessments will be done using established methods. The costs are necessary for running a large randomized controlled trial. RelevanceA brief, scalable and efficacious prevention program is the pre-requisite for reducing the emergence and burden of EDs on public health level.

Despite significant changes in legislation and attitudes towards homosexuality in Sweden during the past decades, national health surveys show that gay, lesbian, and bisexual (LGB) individuals show substantially higher rates of adverse mental and physical health outcomes than heterosexuals. The reasons for these substantial health disparities are largely unknown.This study aims to compare health metrics between LGB respondents and heterosexuals. Three large Swedish population-based data sources will be used: the Stockholm Public Health Cohort, the LifeGene cohort, and a sample from the Swedish Twin Registry encompassing twins born in Sweden 1959-1985. With regression modelling, we will examine if potential differences in health outcomes among sexual orientation groups correspond to differences in various health determinants. Specifically, we propose that LGB respondents will report (a) more prejudice events or minority stressors (i.e., victimization, discrimination, perceived stress), (b) higher biological markers of cardiovascular, metabolic, and respiratory diseases risk, and (c) familial (shared environmental and genetic) risk of disease, which will account for sexual orientation-related health disparities.No study has ever examined these three explanatory factors (social, biological, and familial) simultaneously within population-based data to identify the leading causes of sexual orientation disparities in health. Major strengths of the current study include the three large cohorts with sexual orientation data in combination with the physiological and biological measures, self-report data on social stressors and lifestyle, the co-twin control design, and the high-quality registry data on health outcomes available in Sweden.The study team has extensive expertise in research concerning stigma and social/contextual and biological determinants of sexual orientation health disparities, and has a productive history of collaboration.