Center for the Study of Drugs, Alcohol, Smoking, and Health, School of Nursing (all authors), Addiction Center, Department of Psychiatry (Boyd), and Rogel Cancer Center, Institute for Social Research, and Institute for Healthcare Policy and Innovation (McCabe), University of Michigan, Ann Arbor.
Am J Psychiatry. 2020 Nov 1;177(11):1073-1081. doi: 10.1176/appi.ajp.2020.20010005. Epub 2020 Sep 11.
The authors examined psychiatric comorbidities associated with alcohol use disorders and tobacco use disorders among heterosexual, bisexual, and gay and lesbian men and women in the United States and whether stress-related factors were predictive of comorbidities.
The authors used data from the National Epidemiologic Survey on Alcohol and Related Conditions-III (2012-2013, N=36,309) to examine the co-occurrence of past-year alcohol or tobacco use disorder with past-year anxiety disorders, mood disorders, and posttraumatic stress disorder by sexual identity (heterosexual, bisexual, gay or lesbian) and sex. The authors also examined the association of stress-related factors and social support with the presence of comorbidities.
Comorbidities were more prevalent among women and sexual minorities, particularly bisexual women. More than half of bisexual (55%) and gay or lesbian (51%) individuals who met criteria for a past-year alcohol use disorder had a psychiatric comorbidity, while only one-third of heterosexual individuals who met criteria for a past-year alcohol use disorder did. Similar differences were found among those who met criteria for a past-year tobacco use disorder. Among sexual minorities, the frequency of sexual orientation discrimination (adjusted odds ratio range=1.08-1.10), number of stressful life events (adjusted odds ratio range=1.25-1.43), and number of adverse childhood experiences (adjusted odds ratio range=1.04-1.18) were significantly associated with greater odds of comorbidities. Greater social support was significantly inversely associated with tobacco use disorder comorbidities (adjusted odds ratio range=0.96-0.97).
This research suggests that integrated substance use and mental health prevention and treatment programs are needed, particularly for individuals who identify as sexual minorities. The increased stressors experienced by sexual minority individuals may be important drivers of these high levels of comorbidities.
本研究旨在调查美国异性恋、双性恋、同性恋和双性恋男女中与酒精使用障碍和烟草使用障碍相关的精神共病，并探讨应激相关因素是否对共病具有预测作用。
本研究使用了 2012-2013 年全国酒精相关状况流行病学调查-III（National Epidemiologic Survey on Alcohol and Related Conditions-III，NESARC-III）的数据，通过性取向（异性恋、双性恋、同性恋或双性恋）和性别，分析了过去一年中焦虑障碍、心境障碍和创伤后应激障碍与过去一年中酒精或烟草使用障碍共病的发生情况。此外，本研究还探讨了应激相关因素和社会支持与共病存在的关联。
共病在女性和性少数群体中更为常见，尤其是双性恋女性。超过一半符合过去一年酒精使用障碍标准的双性恋（55%）和同性恋或双性恋（51%）个体存在精神共病，而符合过去一年酒精使用障碍标准的异性恋个体中仅有三分之一存在精神共病。在符合过去一年烟草使用障碍标准的个体中也发现了类似的差异。在性少数群体中，性取向歧视的频率（调整后的优势比范围=1.08-1.10）、生活压力事件的数量（调整后的优势比范围=1.25-1.43）和不良童年经历的数量（调整后的优势比范围=1.04-1.18）与共病的发生风险显著相关。更多的社会支持与烟草使用障碍共病呈显著负相关（调整后的优势比范围=0.96-0.97）。
本研究表明，需要针对包括性少数群体在内的个体，开展综合性的物质使用和精神健康预防与治疗项目。性少数群体经历的更多应激源可能是导致这些高共病率的重要驱动因素。
