Selten Jean-Paul, Alrashed Hussam, Oh Hans, Blokland Gabriëlla A M
Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine, and Life Sciences, Mental Health and Neuroscience Research Institute, Maastricht University, Maastricht, The Netherlands.
Faculty of Life Sciences & Medicine, King's College London, London, UK.
Psychol Med. 2024 Sep 25;54(13):1-10. doi: 10.1017/S0033291724002253.
The social defeat hypothesis posits that low status and repeated humiliation increase the risk for psychotic disorders (PDs) and psychotic experiences (PEs). The purpose of this paper was to provide a systematic review of studies on risk of PDs and PEs among lesbian, gay, or bisexual (LGB) people and a quantitative synthesis of any difference in risk. PubMed, PsycINFO, Embase, and Web of Science were searched from database inception until January 30, 2024. Two independent reviewers assessed the eligibility and quality of studies, extracted effect sizes, and noted the results of mediation analyses. Using a random effects model we computed pooled odds ratios (ORs). Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. The search identified seven studies of PDs and six of PEs. As for PDs, the unadjusted (2.13; 95% confidence interval 0.72-6.34) and covariate-adjusted pooled OR (2.24; 1.72-3.53) were not significantly increased for LGB individuals. After exclusion of a study of limited quality, both the unadjusted pooled OR (2.77; 1.21-6.32) and the covariate-adjusted pooled OR (2.67; 1.53-4.66) were significantly increased. The pooled ORs were increased for PEs: unadjusted, pooled OR = 1.97 (1.47-2.63), covariate-adjusted, pooled OR = 1.85 (1.50-2.28). Studies of PE that examined the mediating role of several variables reported that the contribution of drug abuse was small compared to that of psychosocial stressors. The results of a study in adolescents suggested a protective effect of parental support. These findings suggest an increased psychosis risk for LGB people and support the social defeat hypothesis.
社会挫败假说认为，低社会地位和反复遭受羞辱会增加患精神障碍（PDs）和出现精神病性体验（PEs）的风险。本文旨在对关于女同性恋、男同性恋或双性恋（LGB）人群中患PDs和PEs风险的研究进行系统综述，并对风险差异进行定量综合分析。检索了PubMed、PsycINFO、Embase和Web of Science数据库，检索时间从数据库建立至2024年1月30日。两名独立评审员评估了研究的 eligibility 和质量，提取效应量，并记录中介分析结果。我们使用随机效应模型计算合并优势比（ORs）。遵循系统综述和Meta分析的首选报告项目指南。检索到七项关于PDs的研究和六项关于PEs的研究。对于PDs，LGB个体的未调整合并OR（2.13；95%置信区间0.72 - 6.34）和协变量调整后的合并OR（2.24；1.72 - 3.53）没有显著增加。排除一项质量有限的研究后，未调整的合并OR（2.77；1.21 - 6.32）和协变量调整后的合并OR（2.67；1.53 - 4.66）均显著增加。PEs的合并OR增加：未调整时，合并OR = 1.97（1.47 - 2.63），协变量调整后，合并OR = 1.85（1.50 - 2.28）。研究PEs中介作用的几项变量的研究报告称，与心理社会应激源相比，药物滥用的作用较小。一项针对青少年的研究结果表明父母支持具有保护作用。这些发现表明LGB人群患精神病的风险增加，并支持社会挫败假说。
