文章基本信息

标题：State-Level Policies and Psychiatric Morbidity In Lesbian, Gay, and Bisexual Populations
本地全文：下载
作者：Mark L. Hatzenbuehler ; Katherine M. Keyes ; Deborah S. Hasin 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2009
卷号：99
期号：12
页码：2275-2281
DOI：10.2105/AJPH.2008.153510
语种：English
出版社：American Public Health Association
摘要：Objectives. We investigated the modifying effect of state-level policies on the association between lesbian, gay, or bisexual status and the prevalence of psychiatric disorders. Methods. Data were from wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a nationally representative study of noninstitutionalized US adults (N = 34 653). States were coded for policies extending protections against hate crimes and employment discrimination based on sexual orientation. Results. Compared with living in states with policies extending protections, living in states without these policies predicted a significantly stronger association between lesbian, gay, or bisexual status and psychiatric disorders in the past 12 months, including generalized anxiety disorder ( F = 3.87; df = 2; P = .02), post-traumatic stress disorder ( F = 3.42; df = 2; P = .04), and dysthymia ( F = 5.20; df = 2; P = .02). Living in states with policies that did not extend protections also predicted a stronger relation between lesbian, gay, or bisexual status and psychiatric comorbidity ( F = 2.47; df = 2; P = .04). Conclusions. State-level protective policies modify the effect of lesbian, gay, or bisexual status on psychiatric disorders. Policies that reduce discrimination against gays and lesbians are urgently needed to protect the health and well-being of this population. A longstanding area of importance in public health research is the determination of how social factors influence the distribution of adverse health outcomes.^{1 – 5} In particular, social policies have received attention because they represent clear targets for intervention that can lead to significant improvement in public health at a population level. For example, legislation restricting access, availability, and opportunities to use tobacco^{6 – 9} and alcohol^{10 – 12} has been shown to greatly affect the rates of use of these substances. In the area of obesity, researchers have also pointed to social policy changes that may reduce the prevalence of obesity and associated morbidities,¹³ such as altering the school food environment.¹⁴ Debates on social policies affecting lesbian, gay, and bisexual individuals have been common in recent years, including the November 2008 California election, in which voters reversed a state Supreme Court decision allowing gays and lesbians to marry. This is but one of several current social policies targeting lesbian, gay, and bisexual individuals. The failure to prohibit employer discrimination on the basis of sexual orientation and the exclusion of sexual orientation as a protected category in federal hate crimes legislation^{15 , 16} are additional examples of policies that do not extend protection to lesbian, gay, and bisexual individuals. Collectively, these policies represent examples of institutional discrimination, which refers to societal-level conditions that constrain individuals' opportunities, resources, and well-being.¹⁷ Despite the high prevalence of institutional discrimination against lesbian, gay, and bisexual individuals, few empirical studies have examined the extent to which this form of discrimination affects the mental health of the lesbian, gay, and bisexual community. Recent research with racial/ethnic minorities has shown that institutional discrimination, typically in the form of housing and neighborhood effects, is associated with various adverse health outcomes, including physical and mental health status, violence, and mortality.^{4 , 18 – 22} This research has provided important insights, but histories and types of discrimination confronted by racial/ethnic and sexual minorities differ. Consequently, research is needed to determine whether institutional discrimination may also have deleterious consequences for the mental health of lesbian, gay, and bisexual populations. To address this research question, we used data from wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; N = 34 653), a general population study with the largest nationally representative sample of lesbian, gay, and bisexual participants to date. The study considered 2 markers of institutional discrimination in the form of state-level policies that do not confer protection to lesbian, gay, and bisexual individuals: (1) hate crimes that exclude sexual orientation as a protected category and (2) failures to ban employment discrimination based on sexual orientation. These 2 policies were chosen in part because of recent attempts at the federal level to address hate crimes protection and employment nondiscrimination specifically related to sexual orientation (e.g., the 2007 Local Law Enforcement Hate Crimes Prevention Act,²³ which was passed by the US House of Representatives). We hypothesized that these markers of institutional discrimination would be associated with psychiatric disorders. In particular, we anticipated that the association between lesbian, gay, and bisexual status and psychiatric disorders would be significantly greater in states without policies that protected lesbian, gay, and bisexual individuals than in states with protective policies. The large sample size, population-based sampling scheme, and detailed measurement of diagnoses according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV)²⁴ all presented an advantageous setting in which to examine effects of institutional discrimination on the association between lesbian, gay, and bisexual status and mental health.