Barnes David M, Hatzenbuehler Mark L, Hamilton Ava D, Keyes Katherine M
Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, 10032, USA,
Soc Psychiatry Psychiatr Epidemiol. 2014 Sep;49(9):1447-54. doi: 10.1007/s00127-014-0849-5. Epub 2014 Feb 26.
Mental health disparities between sexual minorities and heterosexuals remain inadequately understood, especially across levels of educational attainment. The purpose of the present study was to test whether education modifies the association between sexual orientation and mental disorder.
We compared the odds of past 12-month and lifetime psychiatric disorder prevalence (any Axis-I, any mood, any anxiety, any substance use, and comorbidity) between lesbian, gay, and bisexual (LGB) and heterosexual individuals by educational attainment (those with and without a bachelor's degree), adjusting for covariates, and tested for interaction between sexual orientation and educational attainment. Data are drawn from the National Epidemiologic Survey on Alcohol and Related Conditions, a nationally representative survey of non-institutionalized US adults (N = 34,653; 577 LGB).
Sexual orientation disparities in mental health are smaller among those with a college education. Specifically, the disparity in those with versus those without a bachelor's degree was attenuated by 100 % for any current mood disorder, 82 % for any current Axis-I disorder, 76 % for any current anxiety disorder, and 67 % for both any current substance use disorder and any current comorbidity. Further, the interaction between sexual orientation and education was statistically significant for any current Axis-I disorder, any current mood disorder, and any current anxiety disorder. Our findings for lifetime outcomes were similar.
The attenuated mental health disparity at higher education levels underscores the particular risk for disorder among LGBs with less education. Future studies should consider selection versus causal factors to explain the attenuated disparity we found at higher education levels.
性少数群体与异性恋者之间的心理健康差异仍未得到充分理解，尤其是在不同教育程度层面。本研究的目的是检验教育程度是否会改变性取向与精神障碍之间的关联。
我们根据教育程度（有和没有本科学位的人），比较女同性恋、男同性恋和双性恋（LGB）个体与异性恋个体在过去12个月和一生中患精神障碍的几率（任何轴I障碍、任何情绪障碍、任何焦虑障碍、任何物质使用障碍及共病情况），并对协变量进行调整，同时检验性取向与教育程度之间的交互作用。数据来自全国酒精及相关状况流行病学调查，这是一项对美国非机构化成年人具有全国代表性的调查（N = 34,653；577名LGB者）。
受过大学教育的人群中，心理健康方面的性取向差异较小。具体而言，对于任何当前情绪障碍，有本科学位者与无本科学位者之间的差异减少了100%；对于任何当前轴I障碍，减少了82%；对于任何当前焦虑障碍，减少了76%；对于任何当前物质使用障碍和任何当前共病情况，均减少了67%。此外，性取向与教育程度之间的交互作用对于任何当前轴I障碍、任何当前情绪障碍和任何当前焦虑障碍均具有统计学意义。我们关于终生结果的研究发现与此相似。
高等教育水平中心理健康差异的减弱凸显了受教育程度较低的LGB者患精神障碍的特殊风险。未来的研究应考虑选择因素与因果因素，以解释我们在高等教育水平中发现的差异减弱现象。
