Journal of Urban Health

, Volume 92, Issue 6, pp 1092–1104 | Cite as

The Predictive Syndemic Effect of Multiple Psychosocial Problems on Health Care Costs and Utilization among Sexual Minority Women

  • Sarah E. Valentine
  • Steven Elsesser
  • Chris Grasso
  • Steven A. Safren
  • Judith B. Bradford
  • Ethan Mereish
  • Conall O’CleirighEmail author


Previous studies documenting sexual minority women’s disproportionate risk for a range of medical, mental health, and substance use disorders have not provided a predictive framework for understanding their interrelations and outcomes. The present study aimed to address this gap by testing the syndemic effect of co-occurring psychosocial problems on 7-year health care costs and utilization among sexual minority women. The sample was comprised of sexual minority women (N = 341) who were seen at an urban LGBT-affirmative community health center. Medical and mental health care utilization and cost data were extracted from electronic medical records. Demographically adjusted regression models revealed that co-occurring psychosocial problems (i.e., childhood sexual abuse, partner violence, substance use, and mental health distress [history of suicide attempt]) were all strongly interrelated. The presence of these indicators had a syndemic (additive) effect on medical costs and utilization and mental health utilization over 7-year follow-up, but no effect on 7-year mental health costs. These results suggest that the presence and additive effect of these syndemic conditions may, in part, explain increased medical costs and utilization (and higher medical morbidity) among sexual minority women.


Lesbian Bisexual Mental health Health care costs Health care utilization Sexual minority 



Dr. Conall O'Cleirigh's time on this manuscript was supported in part by a National Institute of Mental Health grant R01 MH095624 (PI: O'Cleirigh).


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Copyright information

© The New York Academy of Medicine 2015

Authors and Affiliations

  • Sarah E. Valentine
    • 1
    • 2
  • Steven Elsesser
    • 3
  • Chris Grasso
    • 3
  • Steven A. Safren
    • 1
    • 2
    • 3
  • Judith B. Bradford
    • 3
  • Ethan Mereish
    • 4
  • Conall O’Cleirigh
    • 1
    • 2
    • 3
    Email author
  1. 1.Department of PsychiatryMassachusetts General HospitalBostonUSA
  2. 2.Harvard Medical SchoolBostonUSA
  3. 3.The Fenway Institute, Fenway HealthBostonUSA
  4. 4.Department of Behavioral and Social SciencesBrown UniversityProvidenceUSA

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