Salway Travis, Delgado-Ron Jorge Andrés, Rich Ashleigh J, Dharma Christoffer, Baams Laura, Fish Jessica
Faculty of Health Sciences, Simon Fraser University, Blusson Hall, Room 11300-8888 University Drive, Burnaby, BC, V5A 1S6, Canada.
Centre for Gender and Sexual Health Equity, 1190 Hornby St. (11th floor), Vancouver, BC, V6Z 2K5, Canada.
SSM Popul Health. 2024 Jul 3;27:101697. doi: 10.1016/j.ssmph.2024.101697. eCollection 2024 Sep.
Sexual minority populations experience a higher burden of mental health and substance use/misuse conditions than heterosexual comparators-a health inequality that has predominantly been attributed to forms of minority stress experienced by the former group. Sexual minority-affirming legislative and policy advances, as well as improvements in social attitudes toward sexual minorities in recent decades, should presumably reduce experiences of minority stress, thereby attenuating these disparities. We conducted temporal trend analyses of annual prevalence of anxiety, depression, poor self-rated mental health, and cigarette smoking, stratified by sexual orientation and gender/sex subgroups using the Canadian Community Health Survey, 2003-2020. Descriptive analyses were used to display temporal trends; joinpoint regression was used to identify significant changes in prevalence data during 2003-2020; and prevalence ratios were estimated by year to detect any reduction in disparities. The prevalence of self-rated mental health and mood and anxiety disorders increased, whereas the prevalence of smoking decreased, between 2003 and 2020, among both sexual minority and heterosexual people in Canada. We observed a significant inflection point in 2009 in the self-rated mental health trend among bisexual women, where rates of poor mental health initially decreased from 2003 but then increased drastically from 2009 to 2020. Significant inflection points in current smoking trends were observed in 2012 among bisexual and heterosexual women and in 2013 among heterosexual men; in all three groups, both segments demonstrated decreasing trends, however, the slope of the trend became more pronounced in the latter period. Consistent with other North American studies, we found that relative differences between sexual minority and heterosexual groups for all four outcomes remained the same or increased during this 18-year period. Findings highlight the need to better understand mechanisms bolstering sexual orientation health disparities.
与异性恋者相比，性少数群体承受着更高的心理健康负担以及物质使用/滥用问题，这种健康不平等主要归因于前一组人所经历的各种形式的少数群体压力。近几十年来，支持性少数群体的立法和政策取得进展，以及社会对性少数群体态度的改善，理应会减少少数群体压力的经历，从而缩小这些差距。我们利用2003 - 2020年加拿大社区健康调查，按性取向和性别/性亚组对焦虑、抑郁、自我评估心理健康状况不佳和吸烟的年度患病率进行了时间趋势分析。描述性分析用于展示时间趋势；连接点回归用于确定2003 - 2020年期间患病率数据的显著变化；并逐年估计患病率比值以检测差距是否有所缩小。2003年至2020年期间，加拿大性少数群体和异性恋者中，自我评估心理健康以及情绪和焦虑障碍的患病率上升，而吸烟率下降。我们观察到双性恋女性的自我评估心理健康趋势在2009年出现了一个显著的转折点，心理健康状况不佳的比率最初从2003年开始下降，但随后在2009年至2020年期间急剧上升。在2012年观察到双性恋和异性恋女性当前吸烟趋势的显著转折点，在2013年观察到异性恋男性的显著转折点；在所有这三组中，两个阶段均呈现下降趋势，然而，后期趋势的斜率变得更加明显。与其他北美研究一致，我们发现，在这18年期间，性少数群体和异性恋群体在所有四个结果方面的相对差异保持不变或有所增加。研究结果凸显了更好地理解加剧性取向健康差距的机制的必要性。
