Williams Charmaine C, Curling Deone, Steele Leah S, Gibson Margaret F, Daley Andrea, Green Datejie Cheko, Ross Lori E
Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada.
Women's Health in Women's Hands Community Health Centre, Toronto, Ontario, Canada.
Health Soc Care Community. 2017 May;25(3):1139-1150. doi: 10.1111/hsc.12414. Epub 2017 Jan 18.
This article uses an intersectionality lens to explore how experiences of race, gender, sexuality, class and their intersections are associated with depression and unmet need for mental healthcare in a population of 704 women and transgender/gender liminal people from Ontario, Canada. A survey collecting demographic information, information about mental health and use of mental healthcare services, and data for the Everyday Discrimination Scale and the PHQ-9 Questionnaire for Depression was completed by 704 people via Internet or pen-and-paper between June 2011 and June 2012. Bivariate and regression analyses were conducted to assess group differences in depression and discrimination experiences, and predictors of depression and unmet need for mental healthcare services. Analyses revealed that race, gender, class and sexuality all corresponded to significant differences in exposure to discrimination, experiences of depression and unmet needs for mental healthcare. Use of interaction terms to model intersecting identities and exclusion contributed to explained variance in both outcome variables. Everyday discrimination was the strongest predictor of both depression and unmet need for mental healthcare. The results suggest lower income and intersections of race with other marginalised identities are associated with more depression and unmet need for mental healthcare; however, discrimination is the factor that contributes the most to those vulnerabilities. Future research can build on intersectionality theory by foregrounding the role of structural inequities and discrimination in promoting poor mental health and barriers to healthcare.
本文运用交叉性视角，探讨种族、性别、性取向、阶级及其交叉体验如何与加拿大安大略省704名女性、跨性别者/性别界限模糊者的抑郁症及未满足的心理保健需求相关联。2011年6月至2012年6月期间，704人通过互联网或纸笔方式完成了一项调查，该调查收集了人口统计学信息、心理健康及心理保健服务使用情况的信息，以及日常歧视量表和PHQ - 9抑郁症问卷的数据。进行了双变量和回归分析，以评估抑郁症和歧视经历方面的群体差异，以及抑郁症和未满足的心理保健服务需求的预测因素。分析表明，种族、性别、阶级和性取向均与遭受歧视、抑郁经历以及未满足的心理保健需求方面的显著差异相对应。使用交互项来模拟交叉身份和排斥情况有助于解释两个结果变量的方差。日常歧视是抑郁症和未满足的心理保健需求的最强预测因素。结果表明，低收入以及种族与其他边缘化身份的交叉与更多的抑郁症和未满足的心理保健需求相关；然而，歧视是导致这些脆弱性的最大因素。未来的研究可以基于交叉性理论，突出结构不平等和歧视在促进心理健康不佳及医疗保健障碍方面的作用。
