當代美國心理健康不平等的趨勢：性傾向的差異

Mental Health Disparities by Sexual Orientation in the U.S.: Current Patterns and Recent Trends

過去幾十年來，美國社會逐漸接納同志社群（同性戀及雙性戀），並在2015年全面通過同性婚姻法案。然而，自2000年初以來的大規模人口調查研究持續發現，同志與異性戀間仍存有顯著的健康差異，同志的健康狀況普遍較差。性少數壓力理論（minority stress theory）指出，同志群體在社會上面臨的偏見、歧視和暴力，為此健康不平等的主要原因。本研究使用2013-2016全國健康訪查資料（National Health Interview Survey）分析美國當代性傾向與心理健康的關聯和趨勢，以及健康不平等的相關因素。研究發現，同性婚姻法案通過後，同志與異性戀之間的心理健康差異並未顯著下降，且年輕人口中的健康差異反而大於老年人口。此外，社經條件和婚姻狀態無法解釋多數同志群體的健康劣勢（女同性戀除外）。研究結果顯示，婚姻平權並非同志健康的萬靈丹，社會應同時落實其他基本人權保障，才能減低同志與異性戀間的健康不平等。

In the past few decades, U.S. society has gradually become more accepting of gays, lesbians, and bisexuals (LGB). The recent nationwide legalization of same-sex marriage is a monumental example of that acceptance. Despite the progress in civil rights, population-based studies since the early 2000s have noted that LGB populations continue to exhibit poorer health outcomes compared to their heterosexual counterparts. According to minority stress theory, prejudice, discrimination, and violence directed at sexual minorities over the course of their lives accounts for this health inequality. Using representative data from the 2013-2016 National Health Interview Survey, the current study examines recent patterns of, and potential explanations for, mental health disparities by sexual orientation in the U.S. The study investigates whether mental health disparities have narrowed significantly since the introduction of marriage equality and whether younger LGB people experience fewer health disadvantages compared to older ones. Results show that LGB people continue to experience higher levels of mental distress than heterosexuals. Most of the health disadvantages faced by gay men and bisexual men and women cannot be explained fully by access to socioeconomic resources or marital status, whereas disadvantages faced by lesbian women are largely attributable to these factors. Moreover, not only do mental health disparities by sexual orientation persist in the years from 2013-2016, but the disparities are actually larger among younger people. These findings suggest that marriage equality is not a panacea for the mental health of sexual minorities and that much more effort is needed to address fundamental rights for sexual minorities.