Bränström Richard
Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden.
Stress Research Institute, Stockholm University, Stockholm, Sweden.
J Epidemiol Community Health. 2017 May;71(5):446-452. doi: 10.1136/jech-2016-207943. Epub 2017 Jan 2.
Substantial mental health disparities between lesbian, gay and bisexual (LGB) individuals compared with heterosexuals have been identified. The aim was to examine potential sexual orientation-based disparities in mental health treatment in a prospectively analysed population-based sample in Sweden and to explore potential moderators and mediators.
30 730 individuals from the Stockholm Public Health Cohort were followed up with questionnaires and registry-based health record data on psychiatric healthcare visits and prescription drug use between 1 January 2011 and 31 December 2011.
In adjusted analyses, gay and lesbian individuals were more likely to receive treatment for anxiety disorders (adjusted ORs (AOR)=3.80; 95% CI 2.54 to 5.69) and to use antidepressant medication (AOR=2.13; 95% CI 1.62 to 2.79); and bisexuals were more likely to receive treatment for mood disorders (AOR=1.58; 95% CI 1.00 to 2.48), anxiety disorders (AOR=3.23; 95% CI 2.22 to 4.72) and substance use disorders (AOR=1.91; 95% CI 1.12 to 3.25), and to use antidepressant medication (AOR=1.91; 95% CI 1.12 to 3.25) when compared with heterosexuals. The largest mental health treatment disparities based on sexual orientation were found among bisexual women, gay men and younger lesbian women. More frequent experiences of victimisation/threat of violence and lack of social support could partially explain these disparities.
This study shows a substantially elevated risk of poor mental health among LGB individuals as compared with heterosexuals. Findings support several factors outlined in the minority stress theory in explaining the mechanisms behind these disparities.
已发现女同性恋、男同性恋和双性恋（LGB）个体与异性恋者之间存在显著的心理健康差异。目的是在瑞典一项基于人群的前瞻性分析样本中，研究心理健康治疗中潜在的基于性取向的差异，并探索潜在的调节因素和中介因素。
对来自斯德哥尔摩公共卫生队列的30730名个体进行随访，通过问卷调查以及基于登记处的健康记录数据，获取2011年1月1日至2011年12月31日期间的精神科医疗就诊情况和处方药使用情况。
在调整分析中，男同性恋和女同性恋个体更有可能接受焦虑症治疗（调整后的比值比（AOR）=3.80；95%置信区间2.54至5.69）并使用抗抑郁药物（AOR=2.13；95%置信区间1.62至2.79）；与异性恋者相比，双性恋者更有可能接受情绪障碍治疗（AOR=1.58；95%置信区间1.00至2.48）、焦虑症治疗（AOR=3.23；95%置信区间2.22至4.72）和物质使用障碍治疗（AOR=1.91；95%置信区间1.12至3.25），并使用抗抑郁药物（AOR=1.91；95%置信区间1.12至3.25）。基于性取向的最大心理健康治疗差异出现在双性恋女性、男同性恋和年轻女同性恋女性中。更频繁的受害/暴力威胁经历和缺乏社会支持可以部分解释这些差异。
本研究表明，与异性恋者相比，LGB个体心理健康状况不佳的风险显著升高。研究结果支持少数群体压力理论中概述的几个因素，这些因素解释了这些差异背后的机制。
