Rosner Bastian, Neicun Jessica, Yang Justin Christopher, Roman-Urrestarazu Andres
Department of Anaesthesia/Intensive Care/Emergency Medicine/Pain Medicine, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany; Institute of Public Health, University of Cambridge, Forvie Site, Cambridge, United Kingdom.
Department of International Health, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.
J Psychiatr Res. 2021 Mar;135:107-118. doi: 10.1016/j.jpsychires.2020.12.023. Epub 2020 Dec 17.
Sexual minorities (SM) have specific substance use patterns and show elevated rates of substance use and substance use disorders. We investigated the potential association between substance use - including chemsex drug use - among SM adults in the United States (US) and social inequality, with an additional focus on disparities in unmet need for mental health treatment.
A secondary cross-sectional data analysis was performed using National Survey on Drug Use and Health (NSDUH) data from 2015 to 2017 and including 126,463 individuals with 8241 identifying as SM. Multivariable logistic regression models were implemented to quantify disparities in substance use, to calculate the effect of sociodemographic variables on substance use, and to examine associations with socioeconomic vulnerability.
SM showed higher odds of past-year substance use and lifetime chemsex drug use. All SM except for bisexual men exhibited higher odds of past-month binge drinking relative to heterosexuals. Bisexual women had higher odds for use of all analysed substances relative to heterosexual women. Being older and being a woman were shown to be protective factors. Urbanity, being uninsured, and unmet need for mental health treatment were associated with significantly higher odds of substance use, chemsex drug use and binge drinking. A link was established between drug use and health indicators, with higher odds of drug use for lower health ratings. SM experienced significantly higher levels of socioeconomic vulnerability. Higher vulnerability indices were associated with increased odds for drug use.
This study is among the first nationally representative samples that analysed the link between sociodemographic factors and unmet need for mental health treatment and substance use in SM. It emphasises the multifactorial aetiology of substance use exposure, highlights the underlying mechanisms for substance use among SM while underscoring disparities among them. Approaches tailored to SM subgroups may be needed to address comorbidities and negative health outcomes of substance use in the long-term. However, critical gaps in the literature remain and large-scale studies inclusive of SM individuals are needed to present causal links.
Gillings Fellowship SYOG054 to ARU.
性少数群体（SM）有特定的物质使用模式，且物质使用及物质使用障碍的发生率较高。我们调查了美国成年性少数群体中物质使用（包括使用催情药）与社会不平等之间的潜在关联，并特别关注心理健康治疗需求未得到满足方面的差异。
利用2015年至2017年全国药物使用和健康调查（NSDUH）的数据进行二次横断面数据分析，纳入126,463人，其中8241人被认定为性少数群体。采用多变量逻辑回归模型来量化物质使用方面的差异，计算社会人口学变量对物质使用的影响，并检验与社会经济脆弱性的关联。
性少数群体过去一年物质使用及终身使用催情药的几率更高。除双性恋男性外，所有性少数群体过去一个月暴饮的几率相对于异性恋者更高。相对于异性恋女性，双性恋女性使用所有分析物质的几率更高。年龄较大和女性是保护因素。城市化、未参保以及心理健康治疗需求未得到满足与物质使用、使用催情药和暴饮的几率显著更高相关。在药物使用与健康指标之间建立了联系，健康评级较低者药物使用几率更高。性少数群体经历的社会经济脆弱性水平显著更高。较高的脆弱性指数与药物使用几率增加相关。
本研究是首批在全国具有代表性的样本中分析社会人口学因素与性少数群体心理健康治疗需求未得到满足及物质使用之间联系的研究之一。它强调了物质使用暴露的多因素病因，突出了性少数群体中物质使用的潜在机制，同时强调了他们之间的差异。可能需要针对不同性少数群体亚组的方法来长期解决物质使用的合并症和负面健康结果。然而，文献中仍存在关键空白，需要开展纳入性少数群体个体的大规模研究来呈现因果关系。
ARU获得吉利斯奖学金SYOG054。
