King Tania L, Shields Marissa, Shakespeare Tom, Milner Allison, Kavanagh Anne
Disability and Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Bouverie St, Carlton, 3010, Australia.
International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine, UK.
SSM Popul Health. 2019 Aug 2;9:100464. doi: 10.1016/j.ssmph.2019.100464. eCollection 2019 Dec.
Disability is a key social identity or social category that is associated with significant social disadvantage. For men, having a disability can be discordant with their masculine identity. Self-reliance is one component of masculinity that is known to be important to men with disabilities, however it is also known to be associated with adverse mental health outcomes in the broader adult male population. Intersectionality approaches offer a means of examining the way that the effect of self-reliance on mental health might vary between those with and without a disability. Among a sample of 12,052 men aged 18-55 years from the Ten-to-Men study, we used effect measure modification (EMM) to examine the way that self-reliance modifies the relationship between disability and depressive symptoms. Disability was assessed using the Washington Group Short Set of questions, which capture functional limitations. Results showed that men with disabilities who reported higher conformity to self-reliance norms had much worse mental health than non-disabled men with low conformity to self-reliance, as measured in terms of depressive symptoms (PRR: 9.40, 95%CI 7.88, 11.22, p-value<0.001). We found evidence of positive EMM of depressive symptoms by conformity to self-reliance on the additive scale (RERI: 2.84, 95%CI 1.26, 4.42, p-value<0.001). These results provide evidence that high conformity to self-reliance norms exerts a particularly damaging effect on the mental health of men with disabilities. Given that men with disabilities are more likely to rely on help and support from others, these results provide important insights for the delivery of services to men with disability.
残疾是一种关键的社会身份或社会类别，与严重的社会劣势相关联。对于男性而言，身患残疾可能与他们的男性身份不相符。自力更生是男性气质的一个组成部分，已知对残疾男性很重要，但在更广泛的成年男性群体中，它也与不良心理健康结果相关。交叉性方法提供了一种途径，用以研究自力更生对心理健康的影响在残疾人和非残疾人之间可能存在何种差异。在“十到男”研究中选取的12052名18至55岁男性样本中，我们使用效应量修正（EMM）来研究自力更生如何改变残疾与抑郁症状之间的关系。使用华盛顿小组简短问题集评估残疾情况，该问题集用于捕捉功能受限情况。结果显示，报告更高程度符合自力更生规范的残疾男性，其心理健康状况比不符合自力更生规范的非残疾男性差得多，以抑郁症状衡量（PRR：9.40，95%CI 7.88，11.22，p值<0.001）。我们发现，在相加尺度上，符合自力更生规范对抑郁症状存在正向效应量修正的证据（RERI：2.84，95%CI 1.26，4.42，p值<0.001）。这些结果表明，高度符合自力更生规范对残疾男性的心理健康产生特别有害的影响。鉴于残疾男性更有可能依赖他人的帮助和支持，这些结果为向残疾男性提供服务提供了重要见解。
