Morbiditatea psihiatrica in randul homosexualilor si bisexualilor

8/3/2019 Morbiditatea psihiatrica in randul homosexualilor si bisexualilor

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Morbiditatea psihiatric n rndul homosexualilor ibisexualilor

Traducere i adaptare din limba englez deBogdan Mateciucdupwww.homosexinfo.org

n anii 1960 i la nceputul anilor 1970, unii afirmau c homosexualii sunt la fel de sntoimintal ca heterosexualii. Totui, n faa multor dovezi aprute ncepnd din anii 1990, care aratc homosexualii i bisexualii au de cel puin 2-3 ori mai multe anse s manifeste tulburri dedispoziie, anxietate i abuz de diferite substane, comparativ cu heterosexualii, activitiihomosexuali i homofilii au nceput imediat s dea vina pe stigmatul social, pe prejudeci i pevictimizare, pentru morbiditatea psihiatric crescut n rndul non-heterosexualilor. Analizele

preliminare sugereaz faptul c morbiditatea psihiatric crescut printre non heterosexuali nu sepoate explica att de repede n termeni de stigm, prejudeci i victimizare.

O meta-analiz

Meyer1a realizat o meta-analiz a datelor din mai multe studii pe populaii reprezentative2,3,4,5,6,7plus cteva studii mai vechi bazate pe eantioane nereprezentative.8,9,10,11Statistica RS (IC95%) ponderat non-heterosexuali vs. heterosexuali privind tulburrile de-a lungul vieii a artaturmtoarele (RS = raportul anselor; de cte ori este mai probabil un fapt):

Orice tulburare: 2,07 (1,57-2,74)pentru brbai i 3,31 (2,19-5,06) pentru femei.Tulburri de dispoziie: 2,66 (2,07-3,64)pentru brbai i 2,46 (1,71-3,69) pentru femei.

Tulburri anxioase: 2,43 (1,78-3,30)pentru brbai i 1,63 (1,09-2,47) pentru femei.Abuz de substane: 1,45 (1,10-1,91)pentru brbai i 3,47 (2,22-5,50) pentru femei.

Cifrele pentru tulburrile mintale actuale au fost similare, cu excepia unei tendinenesemnificative ctre un abuz ridicat de substane n rndul brbailor non-heterosexuali (RS =1,37, 95% IC = 0,96-1,95).

Eantioanele nereprezentative i-au artat pe non-heterosexuali ca fiind mai sntoi mintal;statistica RS ponderat (IC 95%) non-heterosexuali vs. heterosexuali, pentru comparareaeantioanelor aleatoriu vs. nealeatoriu privind tulburrile de-a lungul vieii a artat:

Orice tulburare: 2,47 (1,88-3,22) vs. 2,23 (1,44-3,53).Tulburri de dispoziie: 2,68 (2,12-3,34) vs. 1,49 (0,84-2,64).Tulburri anxioase: 1,86 (1,44-2,41) vs. 1,94 (0,93-4,44).Abuz de substane: 2,17 (1,68-2,77) vs. 1,43 (0,72-2,86).

Unele studii pe populaii reprezentative folosite de Meyer au artat o tendin nesemnificativ deinciden ridicat a unui grup specific de tulburri mintale printre brbaii sau femeile non-heterosexuali, n timp ce alte studii au artat o inciden semnificativ a acelui grup. Aceastatranspare imediat ca o consecin a mrimii inadecvate a eantionului, dat fiind c meta -analizaarat clar c abuzul de substane, tulburrile de dispoziie i anxioase sunt mult mai prevalente

printre non-heterosexuali dect printre heterosexuali, n special ca multiple tulburri mintale laaceeai persoan (de 5-6 ori mai prevalente printre non-heterosexuali). Aproape jumtate dintre
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www.homosexualitate.ro 2

homosexuali/bisexuali vor avea o problem mintal de-a lungul vieii i unul din cinci va aveaprobleme mintale multiple.

Studii suplimentare

Alte studii publicate de la sfritul anilor 1990 ncoace au artat o morbiditate psihiatriccrescut (referitor la tulburri de dispoziie, anxietate i abuz de substane) n rndulhomosexualilor i bisexualilor comparativ cu heterosexualii:

O prevalen mai mare a tentativelor/gndurilor de suicid printre brbaii homosexualicomparativ cu fraii gemeni heterosexuali, chiar dup verificarea abuzului de substane ia simptomelor depresive altele dect ideea de sinucidere.12Studiul Naional al Fundaiei MacArthur privind Calitatea Vieii n Statele Unite(MIDUS); eantion reprezentativ de populaie.13O analiz pe 11.876 de femei lesbiene i bisexuale a artat o prevalen mai mare a

abuzului de alcool i tutun n rndul lor comparativ cu femeile heterosexuale.

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ntr-o cercetare pe 4.501 de medici femei, dintre care 115 au fost identificate ca lesbienei 4.177 ca heterosexuale pe baza comportamentului sexual i a auto-identificrii,lesbienele aveau erau mai predispuse s aib depresii.15ntr-un eantion de 93.311 femei din loturile Iniiativei privind Sntatea Femeii, cuvrste ntre 50-79 de ani, 0,6% erau lesbiene ( jumtate s-au identificat ca lesbienedintotdeauna iar restul s-au identificat ca lesbiene dup vrsta de 45 de ani) i 0,8%bisexuale. Femeile lesbiene i bisexuale aveau un statut socio-economic mai bun dectfemeile heterosexuale i un acces mai bun la serviciile de sntate, i totui au raportat unabuz de alcool i fumat mai ridicat, o sntate psihic mai proast (depresie; 11,1% dintrefemeile heterosexuale, 15,4% dintre femeile bisexuale, 16,5% dintre femeile lesbiene) i

ali factori de risc privind cancerul aparatului reproductor i boli cardiovasculare, untipar similar cu cel gsit la femeile lesbiene i bisexuale tinere.16Studiul prin coresponden privind lesbienele din Noua Zeeland (Country Lesbian

Mailing List); lesbienele au indicat o morbiditate psihiatric mai ridicat dect femeiledin Noua Zeeland n general, n ciuda faptului c erau predominant albe, cu educaiesuperioar, din mediul urban i cu vrsta ntre 25 i 50 de ani.17Studiul englez/galez King et al.; eantion tip bulgre de zpad.18Nu exist motive scredem c tehnica de lucru a condus la discrepana dintre homosexuali i heterosexuali,n special avnd n vedere faptul c majoritatea participanilor au fost recrutai fr nici oreferin la sexualitatea lor.

Tulburri de pe axa II (tulburri de personalitate)

Studiile aleatorii pe populaie n general nu au evaluat prevalena tulburrilor de personalitate nrndul homosexualilor i bisexualilor. n parte, aceasta se datoreaz prevalenei reduse att ahomosexualitii/bisexualitii, ct i a majoritii tulburrilor de personalitate n rndul

populaiei generale, iar eantioanele de probabilitate nu vor putea evalua dac exist o legtur ntre o identitate non-heterosexual i tulburrile de personalitate, dect dac mrimeaeantionului este uria.

Totui, se tie prea bine c aproape jumtate dintre persoanele cu tulburri mintale au tulburri

de personalitate (DSM-IV-TR, 2000). De pild, tulburrile de personalitate antisocialecaracterizeaz cam 3% din populaia masculin general i 1% din populaia feminin general
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(s-ar putea s fie o estimare mic), ns ntre 3-30% din eantioanele clinice (incidene mai maripentru eantioanele penale i consumatorii de substane), n timp ce tulburrile de personalitatede limit caracterizeaz 10% dintre pacienii psihiatrici ambulatorii, 20% dintre cei internai i30-60% dintre persoanele cu tulburri de personalitate (DSM-IV-TR, 2000). De aceea, dat fiindfaptul c homosexualii manifest o prevalen mai mare a tulburrilor de pe axa I (abuz de

droguri, tulburri de dispoziie, anxietate, etc.), ar fi foarte surprinztor dac ei nu ar manifesta itulburri de personalitate mai numeroase.

ntr-un eantion reprezentativ de australieni, aproape 6,5% aveau una sau mai multe tulburri depersonalitate (tulburri de pe axa II) de-a lungul vieii.19Prevalena tulburrilor de personalitateeste improbabil s depeasc 10% din populaie. Cteva studii au artat valori mai mari pentru

brbaii homosexuali:

ntr-un eantion de persoane care se testau pentru HIV i ulterior observate la o clinic detratament ambulatoriu, 13% dintre brbaii homosexuali cu HIV aveau tulburri depersonalitate i prezentau acelai profil psihic ca brbaii homosexuali fr infecie

HIV.20,21ntr-un eantion de brbai monitorizai consecutiv n aceeai zi, n fiecare sptmntimp de un an la o clinic pentru probleme genito-urinare, 29% dintre brbai fcuserpredominant sex cu ali brbai. 23/61 (38%) dintre acetia i 16/57 (28%) dintre brbaiiheterosexuali aveau tulburri de personalitate. Mrimea inadecvat a eantionului estecauza probabil pentru care diferena de prevalen a tulburrilor de personalitate estenesemnificativ.22ntr-un eantion debrbai homosexualicare triesc n afara centrelor cu o prevalenridicat a epidemiei SIDA i recrutai din departamente de sntate locale, dinorganizaii ale homosexualilor i prin anunuri n pres, 19/58 (33%) dintre homosexualiicu HIV i 8/53 (15%) dintre homosexualii fr HIV aveau tulburri de personalitate.23Homosexualii cu tulburri de personalitateprezentau mai multe anse s aib tulburri depe axa I.ntr-un eantion debrbai homosexuali voluntari, 19% dintre homosexualii cu HIV (n =110) i dintre homosexualii fr HIV (n = 52) aveau tulburri de personalitate.24Homosexualii cu tulburri de personalitateaveau mai multe anse s aib tulburri de peaxa I.

Studiile de mai sus nu trebuie respinse pe temeiul nereprezentativitii mrimii eantioanelorpentru c, din nou, cu o prevalen mai mare bine-documentat a tulburrilor de pe axa I printrebrbaii homosexuali, acetia pot avea o prevalen mai mare a tulburrilor de personalitate sau

invers (aa cum s-a artat n dou studii citate mai sus). n plus, ntr-un studiu longitudinalprivind controlul strii infeciei cu HIV i istoricul tulburrilor de pe axa I,brbaii homosexualicu tulburri de personalitateaveau de 4 ori mai multe anse s dezvolte o tulburare de pe axa Idect homosexualii fr tulburri de personalitate la momentul de referin.25 A se vedea idovezile pentru o suprareprezentare a homosexualilor i bisexualilor n rndul populaiei cutulburri de personalitate de limit.

Aspecte care dau de gndit

Autorii unui studiu pe brbai cu gemeni de control (Herrell et al., 1999) au artat o prevalensimilar a tentativelor de sinucidere n rndul brbailor homosexuali din diferite generaii dinSUA, indiferent de schimbarea mediului social? De ce nu s-a identificat o scdere odat cucreterea tolerrii homosexualitii de ctre americani?
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n studiul MIDUS, controlul infeciei cu HIV nu a mbuntit starea psihic a non-heterosexualilor (7% dintre brbaii non-heterosexuali i 0,4% dintre cei heterosexuali auraportat un tratament pentru HIV/SIDA). ntr-o evaluare, dei brbaii homosexuali cu HIVaveau anse puin mai mari de depresie i anxietate, comparativ cu brbaii homosexuali frHIV, evoluia strii medicale cauzate de HIV nu a agravat tulburrile de dispoziie ale

homosexualilor cu HIV.26

ntr-o alt evaluare, heterosexualii cu HIV nu aveau o stare psihicmai proast dect heterosexualii fr HIV.27n plus, ntr-un eantion neselectat de 56 de brbaihomosexuali, n anii 1980, care erau n majoritate HIV-pozitivi, prevalena problemelor psihicede-a lungul vieii era ridicat comparativ cu grupul de control al heterosexualilor i cu populaiamasculin general: 39,3% aveau un diagnostic de abuz de alcool sau medicamente, 39,3%aveau Tulburri anxioase generalizat i 30,3% aveau depresie major; ns aceste problemedeseori precedau o boal diagnosticat sau confirmarea statutului HIV.28De aceea, nu se poatespune c o prevalen crescut a infeciei cu HIV ar putea explica nrutirea strii psihice a

brbailorhomosexuali i bisexuali.

Nimeni nu i ntrece pe olandezi cnd vine vorba de tolerana fa de homosexualitate . Olandezii

sunt un popor foarte tolerant: au legalizat eutanasia, prostitu ia, consumul de marijuana,cstoriile homosexuale i i tolereaz pe pedofili. i totui, de ce studiul NEMESIS (Sandfort etal., 1999) arat c homosexualii/bisexualii olandezi au un profil psihic similar cu omologii loramericani? n studiul NEMESIS, n comparaie cu brbaii heterosexuali, brbaiihomosexuali/bisexuali aveau de 7 ori mai multe anse s aib o tulburare bipolar i de 6 ori maimulte anse s manifeste o tulburare obsesiv-compulsiv de-a lungul vieii; de remarcat c aici evorba de un eantion reprezentativ. Tulburarea bipolar este o tulburare de stare n care subieciialterneaz ntre depresie i o stare maniac sau euforic. Tulburarea obsesiv-compulsiv (TOC)este o tulburare anxioas caracterizat prin obsesii i dependene consumatoare de timp, care pot

produce o afectare vizibil sau o incapacitare semnificativ. De remarcat c att tulburareabipolar29, 30 ct i TOC31, 32, 33 sunt foarte influenate de gene. Cum ar putea deci aa-zisahomofobie s reprezinte o explicaie pentru frecvena ridicat a unor probleme cum ar fi TOC,tulburarea bipolar i tulburrile de personalitate n rndul homosexualilor?

n studiul prin coresponden privind lesbienele din Noua Zeeland (Country Lesbian MailingList, Welch et al., 2000) precum i n studiul naional privind starea de sntate a lesbienelor( National Lesbian Health Care Survey 1.925 lesbiene; 73% fie primeau consiliere, fie

primiser n trecut din partea unui psiholog)34, lesbienele au prezentat o morbiditate psihiatricmai mare dect femeile heterosexuale i, de asemenea, o inciden mai mare a molestrii ntimpul copilriei. Totui, s-a artat c dac se verific dup abuzul sexual, probabilitatea de douori mai mare a femeilor care au depresie sau anxieti, comparativ cu brbaii, este n mare parte

neschimbat.

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n plus, de multe ori molestarea din copilrie se produce n familie. n unelecazuri, genetica asociat cu perturbri nespecifice poate spori ansele unui interes sexual albrbailor fa de fiice i surori sau nepoate mai mici, i aceeai genetic poate spori ansele unorprobleme psihice la rudele de sex feminin ale acelorai brbai, indiferent dac acele femei aufost molestate sau nu. De aceea, molestarea acestor femei de ctre rudele lor de sex masculin

poate fie s exacerbeze unele probleme psihice, fie s nu contribuie suplimentar la problemelelor psihice, ns totui apare ca fiind corelat cu problemele acestor femei. Mai mult, n studiulnaional privind starea de sntate a lesbienelor, numai 12% dintre respondente au indicat csunt preocupate dac oamenii tiu c sunt lesbiene. De aceea, acceptarea social ahomosexualitii feminine nu are cum s fie relevant pentru explicarea problemelor psihice aleacestui grup de lesbiene.
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Nu s-a dovedit c aa-zisa homofobie ar fi responsabil de prevalena crescut a problemelorpsihice din rndul homosexualilor.36 Meyer, a crui meta-analiz este citat la nceputulmaterialului, a ncercat s demonstreze impactul prejudecilor, discriminrii i victimizriihomosexualilor/bisexualilor, nsanaliza detaliata acestor date respinge aceast ipotez.

Referine

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2. ^ Fergusson DM, Horwood LJ, Beautrais AL. Is sexual orientation related to mentalhealth problems and suicidality in young people? Arch Gen Psychiatry 1999;56(10):876-80.

3. ^ Sandfort TG, de Graaf R, Bijl RV, et al. Same-sex sexual behavior and psychiatricdisorders: findings from the Netherlands Mental Health Survey and Incidence Study(NEMESIS). Arch Gen Psychiatry 2001;58(1):85-91.

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^ Cochran SD, Mays VM. Relation between psychiatric syndromes and behaviorallydefined sexual orientation in a sample of the US population. Am J Epidemiol2000;151(5):516-23.

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6. ^ Cochran SD, Mays VM. Lifetime prevalence of suicide symptoms and affectivedisorders among men reporting same-sex sexual partners: results from NHANES III. AmJ Public Health 2000;90(4):573-8.

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Morbiditatea psihiatrica in randul homosexualilor si bisexualilor

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