Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada; Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.
Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada.
Womens Health Issues. 2017 Sep-Oct;27(5):592-599. doi: 10.1016/j.whi.2017.05.003. Epub 2017 Jun 20.
Stigma and discrimination contribute to elevated depression risks among sexual minority women (SMW) and gender minority (GM) people who identify as lesbian, bisexual, or queer. Syndemics theory posits that adverse psychosocial outcomes cluster to negatively impact health and mental health outcomes among sexual minorities. We tested whether a syndemic condition composed of low social support, low self-rated health, low self-esteem, and economic insecurity mediated the relationship between sexual stigma and depressive symptoms among SMW/GM.
We implemented a cross-sectional, Internet-based survey with SMW and GM in Toronto, Canada. We conducted structural equation modeling using maximum likelihood estimation to test a conceptual model of pathways between sexual stigma, syndemic factors, and depressive symptoms.
A total of 391 SMW/GM with a mean age of 30.9 (SD = 7.62) were included in the analysis. The model fit for a latent syndemics construct consisting of psychosocial variables (low social support, low self-rated health, low self-esteem, economic insecurity) was very good (χ = 6.022, df = 2, p = .049; comparative fit index = 0.973, Tucker-Lewis index = 0.918, root-mean square error of approximation = 0.072). In the simultaneous model, sexual stigma had a significant direct effect on depression. When the syndemic variable was added as a mediator, the direct path from sexual stigma to depression was no longer significant, suggesting mediation. The model fit the data well: χ2 = 33.50, df = 12, p = .001; comparative fit index = 0.951, Tucker-Lewis index = 0.915, root-mean square error of approximation = 0.068.
Our results highlight the salience of considering both sexual stigma and syndemic factors to explain mental health disparities experienced by SMW and GM. Addressing sexual stigma in the context of co-occurring psychosocial factors and economic insecurity will be key to achieving optimal health for SMW and GM.
污名和歧视导致性少数女性（SMW）和性别少数（GM）群体中的抑郁风险升高，这些群体认同女同性恋、双性恋或酷儿。综合征理论认为，不良的社会心理结果会聚集在一起，对性少数群体的健康和心理健康结果产生负面影响。我们测试了一种综合征状况，该状况由低社会支持、低自我报告健康、低自尊和经济不安全组成，这种状况是否在性污名与 SMW/GM 的抑郁症状之间起中介作用。
我们在加拿大多伦多对 SMW 和 GM 进行了一项横断面、基于互联网的调查。我们使用最大似然估计进行结构方程建模，以测试性污名、综合征因素和抑郁症状之间途径的概念模型。
共有 391 名 SMW/GM 参与了分析，平均年龄为 30.9（SD=7.62）。由社会心理变量（低社会支持、低自我报告健康、低自尊、经济不安全）组成的潜在综合征结构的模型拟合度非常好（χ=6.022，df=2，p=0.049；比较拟合指数=0.973，Tucker-Lewis 指数=0.918，均方根误差逼近值=0.072）。在同时模型中，性污名对抑郁有显著的直接影响。当综合征变量被添加为中介变量时，性污名与抑郁之间的直接路径不再显著，表明存在中介作用。该模型很好地拟合了数据：χ2=33.50，df=12，p=0.001；比较拟合指数=0.951，Tucker-Lewis 指数=0.915，均方根误差逼近值=0.068。
我们的结果强调了考虑性污名和综合征因素来解释 SMW 和 GM 所经历的心理健康差异的重要性。在共同存在的心理社会因素和经济不安全的背景下解决性污名问题，将是实现 SMW 和 GM 最佳健康的关键。
