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标题：Responses to Discrimination and Psychiatric Disorders Among Black, Hispanic, Female, and Lesbian, Gay, and Bisexual Individuals
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作者：Katie A. McLaughlin ; Mark L. Hatzenbuehler ; Katherine M. Keyes 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2010
卷号：100
期号：8
页码：1477-1484
DOI：10.2105/AJPH.2009.181586
语种：English
出版社：American Public Health Association
摘要：Objectives. We examined associations between perceived discrimination due to race/ethnicity, sexual orientation, or gender; responses to discrimination experiences; and psychiatric disorders. Methods. The sample included respondents in the 2004–2005 National Epidemiologic Survey on Alcohol and Related Conditions (n = 34 653). We analyzed the associations between self-reported past-year discrimination and past-year psychiatric disorders as assessed with structured diagnostic interviews among Black (n = 6587); Hispanic (n = 6359); lesbian, gay, and bisexual (LGB; n = 577); and female (n = 20 089) respondents. Results. Black respondents reported the highest levels of past-year discrimination, followed by LGB, Hispanic, and female respondents. Across groups, discrimination was associated with 12-month mood (odds ratio [ORs] = 2.1–3.1), anxiety (ORs = 1.8–3.3), and substance use (ORs = 1.6–3.5) disorders. Respondents who reported not accepting discrimination and not discussing it with others had higher odds of psychiatric disorders (ORs = 2.9–3.9) than did those who did not accept discrimination but did discuss it with others. Black respondents and women who accepted discrimination and did not talk about it with others had elevated rates of mood and anxiety disorders, respectively. Conclusions. Psychiatric disorders are more prevalent among individuals reporting past-year discrimination experiences. Certain responses to discrimination, particularly not disclosing it, are associated with psychiatric morbidity. The role of discrimination as a health determinant has increasingly become a focus of scholarly inquiry. Accumulating evidence points to the deleterious consequences of discrimination experiences on health.^{1 – 6} The damaging effects of discrimination on mental health, in particular, are increasingly evident.^{6 – 9} Experiences of discrimination, whether based on race/ethnicity, sexual orientation, or gender, have been linked to elevations in psychological distress and symptoms of psychopathology.^{1 , 8 , 10 – 13} Although the relation between discrimination and psychiatric disorders has been studied less frequently, significant associations with major depression,^{9 , 13} generalized anxiety disorder (GAD),⁹ early initiation of substance abuse,¹⁴ and a composite index of psychiatric morbidity¹⁵ have been reported. This research provides empirical documentation of the role of discrimination in shaping the distribution of adverse mental health outcomes at a population level, but numerous questions regarding these associations remain. Despite widespread exposure to discrimination, most members of stigmatized groups do not ultimately develop psychiatric disorders, which suggests the presence of factors that buffer some individuals against the negative mental health consequences of discrimination. How an individual responds to and copes with discrimination is one factor that may help to identify those most vulnerable to the development of psychiatric disorders after exposure to discrimination. Although several studies have examined coping strategies that members of stigmatized groups use in response to status-based discrimination,^{16 , 17} few studies have considered the impact of these strategies on psychiatric disorders. Previous research has reported associations between responses to discrimination and blood pressure,^{3 , 5} self-esteem, and psychological distress,^{6 , 16} which suggest that such responses may have implications for psychiatric morbidity. Two dimensions of discrimination responses relevant to health outcomes are acceptance and disclosure. Previous research has suggested that these responses interact in complex ways. Among individuals who accept discrimination, disclosing the experience is associated with elevated blood pressure among Black men, whereas not disclosing the experience predicts higher blood pressure among Black women.³ Aside from that study, however, the extent to which responses to discrimination and their associations with health outcomes vary across stigmatized groups has rarely been examined empirically. Given the heterogeneity across groups in experiences of discrimination,^{18 – 20} it is likely that members of stigmatized groups have developed divergent social norms or beliefs regarding appropriate responses to discriminatory actions. Consequently, it remains unclear (1) whether members of different stigmatized groups respond differently to discrimination, and (2) wct 6 whether these variations in responses translate into differential vulnerability to psychiatric disorders when discrimination is experienced. Such information may help to more effectively target preventive interventions, an important public health priority given group-based disparities in psychiatric morbidity.²¹ In the present study, we addressed these gaps in the literature by examining whether psychiatric disorders were associated with perceived discrimination due to race/ethnicity, sexual orientation, or gender and with responses to discrimination experiences. We first examined the prevalence of past-year self-reported discrimination experiences based on race/ethnicity, sexual orientation, or gender in a US national sample. Second, we estimated the associations between discrimination experiences and the prevalence of psychiatric disorders as defined in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition ( DSM-IV ),²² including mood, anxiety, and substance use disorders, thus providing the first such estimates across a range of disorders. Third, we examined the distribution of responses to discrimination across 2 domains (acceptance–nonacceptance and disclosure–nondisclosure). Finally, we estimated the associations between responses to discrimination and psychiatric disorders among individuals exposed to past-year discrimination.