Abstract
BackgroundThe theory of fundamental causes explains why health disparities persist over time, even as risk factors, mechanisms, and diseases change. Using an intersectional framework, we evaluated multifactorial discrimination as a fundamental cause of mental health disparities.MethodsUsing baseline data from the Project STRIDE: Stress, Identity, and Mental Health study, we examined the health effects of discrimination among individuals who self-identified as lesbian, gay, or bisexual. We used logistic and linear regression to assess whether multifactorial discrimination met the four criteria designating a fundamental cause, namely that the cause: 1) influences multiple health outcomes, 2) affects multiple risk factors, 3) involves access to resources that can be leveraged to reduce consequences of disease, and 4) reproduces itself in varied contexts through changing mechanisms.ResultsMultifactorial discrimination predicted high depression scores, psychological well-being, and substance use disorder diagnosis. Discrimination was positively associated with risk factors for high depression scores: chronic strain and total number of stressful life events. Discrimination was associated with significantly lower levels of mastery and self-esteem, protective factors for depressive symptomatology. Even after controlling for risk factors, discrimination remained a significant predictor for high depression scores. Among subjects with low depression scores, multifactorial discrimination also predicted anxiety and aggregate mental health scores.ConclusionsMultifactorial discrimination should be considered a fundamental cause of mental health inequities and may be an important cause of broad health disparities among populations with intersecting social identities.
Highlights
The theory of fundamental causes explains why health disparities persist over time, even as risk factors, mechanisms, and diseases change
Health disparities based on sexual orientation, gender, race, socioeconomic status (SES), and other identity markers may be viewed through the minority stress framework [2], which suggests that unique stressors arising from minority experiences can impact epigenetic processes [3], influence health behaviors [4], and modulate the use of health
These results suggest that multifactorial discrimination is associated with increased exposure to multiple risk factors for poor mental health (Table 3)
Summary
The theory of fundamental causes explains why health disparities persist over time, even as risk factors, mechanisms, and diseases change. Khan et al International Journal for Equity in Health (2017) 16:43 examining the associations between intersecting minority identities, the stress experienced by non-White sexual minorities, and mental health outcomes. Given their dual minority status, non-White sexual minorities may experience stressors that differ from those experienced by non-White heterosexuals or White lesbian, gay, bisexual, and queer individuals (LGBQs). Certain gay bars have been known to provide poor services to African American gay men and in some cases, refuse their entry altogether [11] Within their own cultural communities, non-White sexual minorities may experience heterosexism causing members to conceal their sexual orientation [12]. Such forms of discrimination can have major implications for health, leading to poor mental and physical health outcomes among non-White sexual minorities [13, 14]
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