Pandya Anand
Anand Pandya, MD: Associate Professor of Clinical Medicine, Department of Psychiatry and Behavioral Neurosciences, UCLA School of Medicine, Los Angeles, CA.
J Psychiatr Pract. 2014 May;20(3):225-7. doi: 10.1097/01.pra.0000450322.06612.a1.
This column reviews the evolution of lesbian, gay, bisexual, and transgender (LGBT) mental health advocacy in relation to modern mental health advocacy efforts. In addition to developments in organized psychiatry (e.g., American Psychiatric Association's LGBT caucus), grassroots LGBT community initiatives are playing an important role (e.g., Trevor Project providing crisis intervention/suicide prevention services to LGBT youth, face-to-face mental health services in LGBT community centers). Studies have found that LGBT individuals are at increased risk for mental health problems (e.g., depression, anxiety, substance misuse, suicidal ideation, self-harm). Mental health advocacy in the LGBT community has been slowed by the long-standing association of the concept of homosexuality with psychopathology in mainstream psychiatry (e.g., homosexuality was only removed from the DSM in 1973, ego dystonic homosexuality still appears in the ICD-10). However, positive developments in LGBT mental health advocacy have been fostered by the proposed minority stress model (i.e., that elevated risk of mental illness in LGBT individuals is a consequence of a hostile stressful environment). A particularly encouraging initiative is the It Gets Better Project, in which thousands of videos, some by prominent individuals, have been posted online to send a message of hope to LGBT youth facing harassment and low self-esteem.
本专栏回顾了女同性恋、男同性恋、双性恋和跨性别者（LGBT）心理健康倡导工作相对于现代心理健康倡导努力的发展历程。除了有组织的精神病学领域的发展（例如美国精神病学协会的LGBT核心小组），LGBT社区的基层倡议也发挥着重要作用（例如特雷弗项目为LGBT青年提供危机干预/自杀预防服务，LGBT社区中心提供面对面的心理健康服务）。研究发现，LGBT个体出现心理健康问题（如抑郁、焦虑、药物滥用、自杀意念、自我伤害）的风险增加。LGBT社区的心理健康倡导工作因主流精神病学中长期将同性恋概念与精神病理学联系在一起而受到阻碍（例如同性恋直到1973年才从《精神疾病诊断与统计手册》中删除，自我不协调同性恋仍出现在《国际疾病分类第10版》中）。然而，少数群体压力模型（即LGBT个体患精神疾病风险升高是敌对压力环境的结果）促进了LGBT心理健康倡导工作的积极发展。一个特别鼓舞人心的倡议是“情况会好转”项目，该项目中有数千个视频（有些是由知名人士发布的）被上传到网上，向面临骚扰和自卑的LGBT青年传递希望的信息。
