Demography and Ageing Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.
Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.
BMJ Open. 2018 May 24;8(5):e020829. doi: 10.1136/bmjopen-2017-020829.
To examine the association between disability exclusion and psychological distress.
Cross-sectional study.
Population-based study of individuals living in households across Australia.
Respondents were persons aged 15 and over living with a disability.
Reporting an experience of discrimination or avoidance behaviour due to a respondent's disability. High or very high levels of psychological distress measured using the Kessler K10 instrument.
Using the Survey of Disability, Ageing and Carers, we calculated the prevalence of persons with a disability experiencing psychological distress, disaggregated by experiences of disability exclusion, including discrimination and avoidance. Logistic regression models were fitted to examine the association between disability exclusion and psychological distress, once extensive controls and adjustments for survey design and presence of psychosocial disabilities were considered.
About 62% of persons citing an experience of disability discrimination were in psychological distress, compared with 27% of those citing no discrimination. Furthermore, 53% of those who actively avoided social, familial or economic activities because of their disability experienced psychological distress, compared with 19% of those who did not avoid these situations. After controlling for demographic characteristics and disabling conditions, reporting an experience of disability discrimination or disability avoidance increased the odds of psychological distress by 2.2 (95% CI 1.74 to 2.26) and 2.6 (95% CI 2.28 to 2.97) times, respectively. Those who experienced both avoidance and discrimination were 3.7 (95% CI 2.95 to 4.72) times more likely to be in psychological distress than those experiencing neither. Avoidance and discrimination in healthcare settings were also found to be strongly associated with experiencing psychological distress.
Given new policy initiatives to improve disability care, coupled with the increasing speed of population ageing, the onus is on governments and its citizenry to address disability exclusion to offset potential mental health impacts.
研究残疾排斥与心理困扰之间的关联。
横断面研究。
澳大利亚各地家庭中生活的人群的基于人群的研究。
被调查者为年龄在 15 岁及以上且有残疾的人。
报告因残疾而遭受歧视或回避行为的经历。使用 Kessler K10 量表测量高度或非常高度的心理困扰。
使用残疾、老龄化和护理者调查，我们计算了经历心理困扰的残疾人士的患病率，并按经历残疾排斥（包括歧视和回避）进行了分类。在考虑了调查设计和存在心理社会残疾的广泛控制和调整后，使用逻辑回归模型来检验残疾排斥与心理困扰之间的关联。
约 62%的报告残疾歧视经历的人处于心理困扰中，而报告没有歧视的人的比例为 27%。此外，53%的人因为残疾而积极避免社交、家庭或经济活动，而这些活动中不回避的人的比例为 19%。在控制人口特征和残疾状况后，报告残疾歧视或残疾回避经历使心理困扰的可能性增加了 2.2 倍（95%CI 1.74 至 2.26）和 2.6 倍（95%CI 2.28 至 2.97）。同时经历回避和歧视的人比没有经历这两种情况的人更容易出现心理困扰，其可能性是后者的 3.7 倍（95%CI 2.95 至 4.72）。在医疗保健环境中经历回避和歧视也与经历心理困扰密切相关。
鉴于新的改善残疾护理的政策举措，再加上人口老龄化速度的加快，政府及其公民有责任解决残疾排斥问题，以减轻潜在的心理健康影响。
