{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T00:10:59Z","timestamp":1791850259951,"version":"4.3.4"},"reference-count":37,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2023,9,13]],"date-time":"2023-09-13T00:00:00Z","timestamp":1694563200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Psycho-Oncology"],"published-print":{"date-parts":[[2023,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Lesbian, Gay, Bisexual, Transgender, Queer, and all other sexual and gender minority (LGBTQ+) populations made up 7.1% of the US population in 2021. LGBTQ+ cancer survivors face a variety of economic and mental health disparities; however, the determinants of poor mental health among LGBTQ+ cancer survivors are understudied.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This analysis utilized the OUT National Survey which consists of <jats:italic>N<\/jats:italic>\u00a0=\u00a02233 LGBTQ+ cancer survivors (complete cases). Multivariable negative binomial and logit regression models were used to generate predicted values, predicted probabilities, and average marginal effects (AME) to assess the association between COVID\u201019 related employment loss and mentally unhealthy days (MUDs) and frequent mental distress among LGBTQ+ cancer survivors. Predicted values and marginal effects were generated with interaction terms (demographics interacted with employment loss) to explore the heterogeneity of the effect of employment loss among LGBTQ+ sub\u2010populations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In bivariate analyses employment loss was associated with a higher number of MUDs (10.3, SD\u00a0=\u00a09.9 vs. 8.4, SD\u00a0=\u00a09.6; <jats:italic>p<\/jats:italic>\u2010value&lt;0.001) and frequent mental distress (34% vs. 26%; <jats:italic>p<\/jats:italic>\u2010value\u00a0=\u00a00.001). AME from a multivariable negative binomial model revealed that employment loss was associated with 1.42 more MUDs (95%CI: 0.33\u20132.86). Demographic factors such as some sexual orientations, cis\u2010female and non\u2010binary gender, younger age, and a current cancer diagnosis were also associated with significant expected increases in the number of MUDs. When\u00a0assessing the heterogeneity of the effect of employment loss some sub\u2010populations experienced changes in the number of MUDs that pushed them over\u00a0the threshold of frequent mental distress while others did not. Furthermore, identifying with multiple sexual orientations (AME: 0.19, 95%CI: 0.11\u20130.27), cis\u2010female and non\u2010binary genders (AME: 0.07, 95%CI: 0.2\u20130.12; AME:\u00a00.18, 95%CI: 0.07\u20130.28), American Indian and Alaska Native race (AME: 0.17, 95%CI: 0.03\u20130.31), and a current cancer diagnosis (AME: 0.14, 95%CI: 0.09\u20130.19) were associated with an increase in the probability of experiencing frequent mental distress.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>COVID\u201019 related employment loss negatively impacted the mental health of LGBTQ+ cancer survivors. LGBTQ+ specific supportive services as well as equity\u2010based employment and income interventions are needed.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pon.6210","type":"journal-article","created":{"date-parts":[[2023,9,14]],"date-time":"2023-09-14T04:13:22Z","timestamp":1694664802000},"page":"1586-1597","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["The impact of employment loss on mentally unhealthy days among LGBTQ+ cancer survivors during the COVID\u201019 pandemic: Findings from the OUT National Survey"],"prefix":"10.1002","volume":"32","author":[{"given":"Austin R.","family":"Waters","sequence":"first","affiliation":[{"name":"Department of Health Policy and Management Gillings School of Global Public Health University of North Carolina Chapel Hill  Chapel Hill North Carolina USA"},{"name":"Lineberger Comprehensive Cancer Center University of North Carolina Chapel Hill  Chapel Hill North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reece","family":"Lyerly","sequence":"additional","affiliation":[{"name":"National LGBT Cancer Network  Providence Rhode Island USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N. F. N.","family":"Scout","sequence":"additional","affiliation":[{"name":"National LGBT Cancer Network  Providence Rhode Island USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2503-2191","authenticated-orcid":false,"given":"Erin E.","family":"Kent","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management Gillings School of Global Public Health University of North Carolina Chapel Hill  Chapel Hill North Carolina USA"},{"name":"Lineberger Comprehensive Cancer Center University of North Carolina Chapel Hill  Chapel Hill North Carolina USA"},{"name":"Cecil G. Sheps Health Services Research Center University of North Carolina Chapel Hill  Chapel Hill North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,9,13]]},"reference":[{"key":"e_1_2_11_2_1","volume-title":"LGBT Identification in U.S. Ticks up to 7.1%","author":"Jones JM","year":"2022"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00127\u2010021\u201002119\u20104"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1080\/13548506.2013.780129"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21288"},{"key":"e_1_2_11_6_1","article-title":"Health care expenditures and financial burden: a comparison of adults in same\u2010sex couples and different\u2010sex couples","author":"Gavulic KA","year":"2021","journal-title":"Med Care Res Rev"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.soncn.2021.151227"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1089\/lgbt.2018.0204"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11920\u2010016\u20100697\u2010y"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1089\/lgbt.2014.0075"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2022.832635"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1200\/jop.2017.027136"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.29808"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.33190"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.2217\/fon\u20102020\u20100547"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1037\/ort0000030"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1037\/0033\u20102909.129.5.674"},{"key":"e_1_2_11_18_1","volume-title":"Methods on the Margins? 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