Valentine Sarah E, Elsesser Steven, Grasso Chris, Safren Steven A, Bradford Judith B, Mereish Ethan, O'Cleirigh Conall
Department of Psychiatry, Massachusetts General Hospital, 1 Bowdoin Square, 7th Floor, Boston, MA, 02114, USA.
Harvard Medical School, Boston, MA, USA.
J Urban Health. 2015 Dec;92(6):1092-104. doi: 10.1007/s11524-015-9989-5.
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.
以往的研究记录了性少数群体女性在一系列医疗、心理健康和物质使用障碍方面面临的不成比例的风险，但尚未提供一个预测框架来理解这些风险之间的相互关系和结果。本研究旨在通过测试同时出现的心理社会问题对性少数群体女性7年医疗保健成本和利用率的综合征效应来填补这一空白。样本包括在城市一家支持LGBT的社区健康中心就诊的性少数群体女性（N = 341）。医疗和心理健康服务的利用情况及成本数据从电子病历中提取。经人口统计学调整的回归模型显示，同时出现的心理社会问题（即童年期性虐待、伴侣暴力、物质使用和心理健康困扰[自杀未遂史]）之间都密切相关。在7年的随访中，这些指标的存在对医疗成本、利用率以及心理健康服务利用率具有综合征（累加）效应，但对7年心理健康成本没有影响。这些结果表明，这些综合征状况的存在及其累加效应可能在一定程度上解释了性少数群体女性医疗成本和利用率增加（以及更高的医疗发病率）的原因。
