在身份和歧视经历的交叉点上，妇女和男子的精神健康和物质使用：交叉性框架的见解。
Mental health and substance use among women and men at the intersections of identities and experiences of discrimination: insights from the intersectionality framework.
机构信息
Department of Behavioral Sciences and Health Education, Rollins School of Public Health, 1518 Clifton Rd NE, Atlanta, GA, 30322, USA.
Winship Cancer Institute, 1365 Clifton Rd, Atlanta, CA, 30322, USA.
出版信息
BMC Public Health. 2019 Jan 23;19(1):108. doi: 10.1186/s12889-019-6430-0.
BACKGROUND
Intersectionality theory focuses on how one's human experiences are constituted by mutually reinforcing interactions between different aspects of one's identities, such as race, class, gender, and sexual orientation. In this study, we asked: 1) Do associations between intersecting identities (race and sexual orientation) and mental health (depressive symptoms) and substance use (alcohol, tobacco, and marijuana) differ between men and women? and 2) How do single or intersecting self-reports of perceived racial and/or sexual orientation discrimination influence mental health and substance use outcomes for men and women? We compared results of assessing identities versus experiences of discrimination.
METHODS
Multivariable regressions were conducted on cross-sectional data from 2315 Black and White college students. Predictors included measures of sociodemographic characteristics and experiences of discrimination. Outcomes included past 2-week depressive symptoms (PHQ-9), past 30-day alcohol use, past 30-day tobacco use, and past 30-day marijuana use.
RESULTS
Intersecting identities and experience of discrimination had different associations with outcomes. Among women, self-reporting both forms of discrimination was associated with higher depressive symptoms and substance use. For example, compared to women experiencing no discrimination, women experiencing both forms of discrimination had higher depressive symptoms (B = 3.63, CI = [2.22-5.03]), alcohol use (B = 1.65, CI = [0.56-2.73]), tobacco use (OR = 3.45, CI = [1.97-6.05]), and marijuana use (OR = 3.38, CI = [1.80-6.31]). However, compared to White heterosexual women, White sexual minority women had higher risks for all outcomes (B = 3.16 and CI = [2.03-4.29] for depressive symptoms, B = 1.45 and CI = [0.58-2.32] for alcohol use, OR = 2.21 and CI = [1.32-3.70] for tobacco use, and OR = 3.01 and CI = [1.77-5.12] for marijuana use); while Black sexual minority women had higher tobacco (OR = 2.64, CI = [1.39-5.02]) and marijuana use (OR = 2.81, CI = [1.33-5.92]) only. Compared to White heterosexual men, White sexual minority men had higher depressive symptoms (B = 1.90, CI = [0.52-3.28]) and marijuana use (OR = 2.37, CI = [1.24-4.49]).
CONCLUSIONS
Our results highlight the deleterious impacts of racial discrimination and sexual orientation discrimination on health, in particular for women. Future studies should distinguish between and jointly assess intersecting social positions (e.g., identities) and processes (e.g., interpersonal experience of discrimination or forms of structural oppression).
背景
交叉性理论关注的是一个人的人类经验是如何通过相互加强的方式构成的，这些方式包括一个人的身份的不同方面之间的相互作用，例如种族、阶级、性别和性取向。在这项研究中，我们提出了以下两个问题：1）在男性和女性中，交叉身份（种族和性取向）与心理健康（抑郁症状）和物质使用（酒精、烟草和大麻）之间的关联是否存在差异？2）对于男性和女性来说，单一或交叉的感知种族和/或性取向歧视报告如何影响心理健康和物质使用结果？我们比较了评估身份与评估歧视经历的结果。
方法
对来自 2315 名黑人和白人大学生的横断面数据进行多变量回归分析。预测因子包括社会人口统计学特征和歧视经历的测量。结果包括过去 2 周的抑郁症状（PHQ-9）、过去 30 天的酒精使用、过去 30 天的烟草使用和过去 30 天的大麻使用。
结果
交叉身份和歧视经历与结果有不同的关联。在女性中，报告两种形式的歧视与更高的抑郁症状和物质使用有关。例如，与没有经历任何歧视的女性相比，同时经历两种形式歧视的女性抑郁症状更严重（B=3.63，CI=[2.22-5.03]），酒精使用（B=1.65，CI=[0.56-2.73]），烟草使用（OR=3.45，CI=[1.97-6.05]），和大麻使用（OR=3.38，CI=[1.80-6.31]）。然而，与白人异性恋女性相比，白人性少数女性在所有结果上的风险更高（抑郁症状的 B=3.16，CI=[2.03-4.29]，酒精使用的 B=1.45，CI=[0.58-2.32]，烟草使用的 OR=2.21，CI=[1.32-3.70]，大麻使用的 OR=3.01，CI=[1.77-5.12]）；而黑人性少数女性仅在烟草（OR=2.64，CI=[1.39-5.02]）和大麻（OR=2.81，CI=[1.33-5.92]）使用方面风险更高。与白人异性恋男性相比，白人性少数男性的抑郁症状（B=1.90，CI=[0.52-3.28]）和大麻使用（OR=2.37，CI=[1.24-4.49]）更高。
结论
我们的研究结果强调了种族歧视和性取向歧视对健康的有害影响，特别是对女性而言。未来的研究应区分和共同评估交叉的社会地位（如身份）和过程（如人际经历的歧视或形式的结构性压迫）。
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