Disproportionate exposure to early-life adversity and sexual orientation disparities in psychiatric morbidity.
Disproportionate exposure to early-life adversity and sexual orientation disparities in psychiatric morbidity.
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DOI：
10.1016/j.chiabu.2012.07.004
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发表时间：
2012-09
影响因子：
4.8
通讯作者：
Conron KJ
中科院分区：
文献类型：
--
作者：
McLaughlin KA;Hatzenbuehler ML;Xuan Z;Conron KJ
与异性恋者相比，女同性恋者、男同性恋者和双性恋者(LGB)人群的精神障碍发生率更高，而且这些差异在生命过程中很早就出现了。我们研究了早年受害和逆境--包括身体和性虐待、无家可归和亲密伴侣暴力--在解释青少年和年轻人心理健康中的性取向差异方面的作用。数据来自全国青少年健康纵向研究第三波(2001-2002)，这是一项具有全国代表性的青少年调查。参与者包括男/女同性恋(n=227)、双性恋(n=245)和异性恋(n=13,490)青年，年龄在18-27岁之间。我们考察了儿童遭受身体或性虐待、无家可归或被照顾者逐出家门，以及按性取向实施身体和性亲密伴侣暴力的流行率的差异。接下来，我们检查了这些暴露与精神病理学症状的关系，包括自杀念头和企图、抑郁症、酗酒、非法药物使用、烟草使用、酒精滥用和药物滥用。最后，我们确定，暴露在受害和逆境中是否解释了性取向和精神病理学之间的联系。在所有结果中，男/女同性恋者和双性恋者的精神病理水平都高于异性恋者。与异性恋者相比，男/女同性恋者遭受虐待儿童和住房困境的几率更高，而双性恋者遭受虐待儿童、住房困境和亲密伴侣暴力的几率更高。与异性恋者相比，更多地暴露在这些逆境中可以解释LGB青少年相对过量的自杀、抑郁、吸烟以及酒精和药物滥用症状的10%-20%。儿童和青春期的受害和逆境经历显著地中介了同性恋和双性恋取向与自杀、抑郁症状、烟草使用和酗酒的联系。早年家庭和恋爱关系中的受害情况在一定程度上解释了各种心理健康和药物使用结果中的性取向差异，突出了旨在减少这些差异的预防性干预措施的新目标。
Lesbian, gay, and bisexual (LGB) populations exhibit elevated rates of psychiatric disorders compared to heterosexuals, and these disparities emerge early in the life course. We examined the role of exposure to early-life victimization and adversity—including physical and sexual abuse, homelessness, and intimate partner violence—in explaining sexual orientation disparities in mental health among adolescents and young adults. Data were drawn from the National Longitudinal Study of Adolescent Health, Wave 3 (2001–2002), a nationally representative survey of adolescents. Participants included gay/lesbian (n=227), bisexual (n=245), and heterosexual (n=13,490) youths, ages 18–27. We examined differences in the prevalence of exposure to child physical or sexual abuse, homelessness or expulsion from one’s home by caregivers, and physical and sexual intimate partner violence according to sexual orientation. Next we examined the associations of these exposures with symptoms of psychopathology including suicidal ideation and attempts, depression, binge drinking, illicit drug use, tobacco use, alcohol abuse, and drug abuse. Finally, we determined whether exposure to victimization and adversity explained the association between sexual orientation and psychopathology. Gay/lesbian and bisexual respondents had higher levels of psychopathology than heterosexuals across all outcomes. Gay/lesbian respondents had higher odds of exposure to child abuse and housing adversity, and bisexual respondents had higher odds of exposure to child abuse, housing adversity, and intimate partner violence, than heterosexuals. Greater exposure to these adversities explained between 10–20% of the relative excess of suicidality, depression, tobacco use, and symptoms of alcohol and drug abuse among LGB youths compared to heterosexuals. Exposure to victimization and adversity experiences in childhood and adolescence significantly mediated the association of both gay/lesbian and bisexual orientation with suicidality, depressive symptoms, tobacco use, and alcohol abuse. Exposure to victimization in early-life family and romantic relationships explains, in part, sexual orientation disparities in a wide range of mental health and substance use outcomes, highlighting novel targets for preventive interventions aimed at reducing these disparities.
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