Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, 1 Bowdoin Square, 7th Floor, Boston, MA, 02114, USA.
The Fenway Institute, Fenway Health, Boston, MA, USA.
J Behav Med. 2018 Aug;41(4):450-457. doi: 10.1007/s10865-018-9913-z. Epub 2018 Feb 6.
Sexual orientation related health disparities are well documented. Sexual minority men appear to be at risk for mental health problems due to the stress they experience in establishing and maintaining a minority sexual identity. These mental health issues may combine synergistically and lead to higher medical costs to society. We examine whether sexual minority specific syndemic indicators were associated with higher health care costs, health care utilization, or the risk of being HIV-infected. Health care consumers at a community health center (N = 1211) completed a brief screening questionnaire collected over 12 months. Self-reported data were linked with participants' clinical billing records. Adjusted logistic regression models identified that four syndemic indicators (suicidality, substance use, childhood sexual abuse, and intimate partner violence) were each significantly related to each other. Multiple syndemics significantly predicted higher medical care utilization and cost, and were associated with 2.5 times the risk of being HIV-infected (OR 2.49, 95% CI 1.45-4.25). Syndemic indicators did not significantly predict the number of mental health visits or costs per patient. These results confirm and extend earlier findings by relating syndemics to health services use and costs for sexual minority men.
性取向相关的健康差异有充分的记录。由于性少数群体男性在建立和维持少数性身份方面所经历的压力，他们似乎面临心理健康问题的风险。这些心理健康问题可能会协同作用，导致社会的医疗成本更高。我们研究了特定于性少数群体的综合征指标是否与更高的医疗保健费用、医疗保健利用或感染艾滋病毒的风险相关。在一个社区健康中心（N=1211）的医疗消费者完成了一个简短的筛查问卷，收集了 12 个月的数据。自我报告的数据与参与者的临床计费记录相关联。经过调整的逻辑回归模型表明，四个综合征指标（自杀意念、物质使用、儿童期性虐待和亲密伴侣暴力）彼此之间都有显著的关联。多种综合征显著预测了更高的医疗保健利用和成本，并且与感染艾滋病毒的风险增加 2.5 倍相关（OR 2.49，95% CI 1.45-4.25）。综合征指标并没有显著预测每位患者的心理健康就诊次数或费用。这些结果通过将综合征与性少数群体男性的卫生服务利用和成本联系起来，证实并扩展了早期的研究结果。
