双性恋患者的大麻使用、大麻使用障碍风险、焦虑和抑郁：大型卫生系统中性别和性别认同差异的比较研究

IF 3.6 2区医学 Q1 PSYCHIATRY

Drug and alcohol dependence Pub Date : 2025-06-20 DOI:10.1016/j.drugalcdep.2025.112762

Naira Setrakian , Lillian Gelberg , Julia Koerber , Un Young Chung , Whitney N. Akabike , Pamina M. Gorbach , Marissa J. Seamans , Steven Shoptaw , Alison Cerezo , Marjan Javanbakht

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引用次数: 0

摘要

本研究使用了9869名18岁及以上的性少数群体患者的电子健康记录（EHR）数据，这些患者在洛杉矶大学卫生系统（2020年6月至2023年5月）进行了初级保健访问。性少数患者，定义为女同性恋、男同性恋或双性恋，在年度健康访问期间进行大麻使用和大麻使用障碍（CUD）风险筛查。从患者的电子病历中提取心理健康诊断。使用多变量回归模型来评估性别认同、性别和大麻相关结果之间的关联，包括大麻使用、CUD风险、报告使用大麻的个人的心理健康诊断，以及大麻用于相应诊断的症状管理。所有模型都控制了年龄和种族/民族。双性恋患者与男同性恋/女同性恋患者相比，大麻使用的调整几率更高(女性AOR: 1.67；男性:1.47)。与男同性恋相比，双性恋男性患CUD （AOR: 1.48）和抑郁症（AOR:1.86）的风险更高。与男同性恋相比，被诊断为抑郁症的双性恋男性使用大麻来治疗抑郁或悲伤症状的几率更高（AOR: 2.44）。与男同性恋/女同性恋相比，双性恋女性被诊断为严重压力的几率更高（AOR: 2.44）。这些发现强调了制定有针对性的初级保健方法的重要性，这些方法可以解决双性恋患者的大麻使用和心理健康问题。目的：虽然性少数群体使用大麻的比例高于异性恋群体，但很少有研究调查性少数群体在不同性别和性身份的人群中使用大麻的差异，特别是在保健方面。本研究探讨了性少数群体初级保健患者的性身份和性别与大麻使用、大麻使用障碍（CUD）风险、大麻使用后的症状管理和心理健康诊断之间的关系。我们使用电子健康记录（EHR）数据进行了一项横断研究，这些数据来自9869名年龄≥18岁的性少数群体，定义为女同性恋、男同性恋或双性恋，并在2020年6月至2023年5月期间在洛杉矶一所大学的卫生系统中进行了初级保健访问。过去3个月大麻使用和CUD风险的常规筛查是基于酒精物质参与筛查试验（ASSIST），并作为所有年度健康检查的一部分进行的。患者被要求报告他们使用大麻的症状，并从患者的电子病历中提取精神健康诊断。根据国际疾病分类第十版（ICD-10）代码确定符合临床阈值标准的诊断，包括焦虑症（icd - 10f41）、抑郁症（icd - 10f33）和严重应激（icd - 10f43）。根据社会人口特征对大麻使用流行率的差异按性别进行分层，并使用卡方检验对分类变量进行比较，使用Wilcoxon秩和检验对连续变量进行比较。使用多变量回归模型来评估性别认同、性别和大麻相关结果之间的关联，包括过去3个月的大麻使用情况、CUD风险、报告使用大麻的个人的心理健康诊断以及使用大麻进行相应诊断的患者的症状管理。所有模型都控制了年龄和种族/民族。结果在9869例患者中，30.7%的患者报告在过去3个月内使用过大麻。双性恋患者与男女同性恋患者相比，使用大麻的调整几率更高(女性调整优势比（AOR）：1.67；95%置信区间（CI） 1.46, 1.92；男性AOR: 1.47；95% ci 1.24, 1.73)。在报告使用大麻的男性中，双性恋者患CUD的几率更高(AOR: 1.48；95% CI: 1.14, 1.93)和抑郁症诊断(AOR: 1.86；95% CI: 1.34, 2.56)。诊断为抑郁症的双性恋男性使用大麻来治疗抑郁症或悲伤症状的几率更高(AOR: 2.44；95% CI: 1.34, 4.52)。在报告使用大麻的女性中，双性恋患者比男同性恋/女同性恋女性有更高的几率被诊断为严重压力(AOR: 2.44；95% ci: 1.45, 4.35)。这些发现强调初级保健提供者需要考虑双性恋患者的独特经历，特别是在精神健康和大麻使用方面。双性恋患者使用大麻的几率增加，再加上他们患精神健康障碍的几率更高，这就加强了将精神健康支助和处理大麻使用问题纳入日常保健的重要性。

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Cannabis use, risk of cannabis use disorder, and anxiety and depression among bisexual patients: A comparative study of sex and sexual identity differences in a large health system

This study used electronic health record (EHR) data from 9869 sexual minority patients aged 18 and older who had a primary care visit within a Los Angeles university health system (June 2020–May 2023). Sexual minority patients, defined as lesbian, gay, or bisexual, were screened for cannabis use and risk of cannabis use disorder (CUD) during annual wellness visits. Mental health diagnoses were extracted from patients’ EHR. Multivariable regression models were used to assess associations between sexual identity, sex, and cannabis-related outcomes, including cannabis use, risk of CUD, mental health diagnoses among individuals reporting cannabis use, and cannabis use for symptom management among those with a corresponding diagnosis. All models controlled for age and race/ethnicity. Bisexual patients had higher adjusted odds of cannabis use compared to gay/lesbian patients (AOR females: 1.67; males: 1.47). Bisexual males had greater odds of risk of CUD (AOR: 1.48) and depression diagnosis (AOR:1.86) compared to gay males. Bisexual males with a diagnosis for depression had higher odds of cannabis use for managing depression or sadness symptoms (AOR: 2.44) compared to gay males. Bisexual females had higher odds of a severe stress diagnosis compared to gay/lesbian females (AOR: 2.44). These findings emphasize the importance of developing targeted primary care approaches that address both cannabis use and mental health concerns among bisexual patients.

Purpose

While the prevalence of cannabis use is higher among sexual minorities as compared to their heterosexual counterparts, few studies have examined the differences in cannabis use across sex and sexual identity among sexual minority individuals, especially in the context of health care. This study examines the association of sexual identity and sex with cannabis use, risk of cannabis use disorder (CUD), symptoms managed with cannabis use, and mental health diagnoses among sexual minority primary care patients.

Methods

We conducted a cross-sectional study using electronic health record (EHR) data from 9869 patients ≥ 18 years of age who identified as sexual minority, defined as lesbian, gay, or bisexual, and had a primary care visit between June 2020 and May 2023 within a university-based health system in Los Angeles, CA. Routine screening for past 3-month cannabis use and risk of CUD was based on the Alcohol Substance Involvement Screening Test (ASSIST) and was conducted as part of all annual wellness visits. Patients were asked to report symptoms for which they used cannabis, and mental health diagnoses were extracted from patients’ EHR. Diagnoses meeting clinical threshold criteria were identified based on the International Classification of Diseases, Tenth Revision (ICD-10) codes and included anxiety disorders (ICD-10 F41), depressive disorders (ICD-10 F33), and severe stress (ICD-10 F43).

Differences in the prevalence of cannabis use by sociodemographic characteristics were stratified by sex and compared across sexual identity using chi-squared tests for categorical variables and Wilcoxon rank-sum tests for continuous variables. Multivariable regression models were used to assess associations between sexual identity, sex, and cannabis-related outcomes, including cannabis use in the past 3 months, risk of CUD, mental health diagnoses among individuals reporting cannabis use, and cannabis use for symptom management among those with a corresponding diagnosis. All models controlled for age and race/ethnicity.

Results

Among the 9869 patients included in this study, 30.7 % reported cannabis use in the past 3 months. Bisexual patients had higher adjusted odds of cannabis use in comparison to gay/lesbian patients in both females and males (female adjusted odds ratio (AOR):1.67; 95 % Confidence Interval (CI) 1.46, 1.92; male AOR: 1.47; 95 % CI 1.24, 1.73). Among males reporting cannabis use, bisexual individuals had greater odds of risk of CUD (AOR: 1.48; 95 % CI: 1.14, 1.93) and depression diagnosis (AOR: 1.86; 95 % CI: 1.34, 2.56) compared to gay males. Bisexual males with a diagnosis for depression had higher odds of cannabis use for managing depression or sadness symptoms (AOR: 2.44; 95 % CI: 1.34, 4.52) compared to gay males. Among females reporting cannabis use, bisexual patients had higher odds of a severe stress diagnosis compared to gay/lesbian females (AOR: 2.44; 95 % CI: 1.45, 4.35).

Conclusions

These findings highlight the need for primary care providers to consider the unique experiences of bisexual patients, particularly regarding mental health and cannabis use. Increased odds of cannabis use among bisexual patients, coupled with their higher odds of mental health disorders, reinforces the importance of integrating mental health support and addressing cannabis use in routine healthcare.

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来源期刊

Drug and alcohol dependence 医学-精神病学

CiteScore

7.40

自引率

7.10%

发文量

409

审稿时长

41 days

期刊介绍： Drug and Alcohol Dependence is an international journal devoted to publishing original research, scholarly reviews, commentaries, and policy analyses in the area of drug, alcohol and tobacco use and dependence. Articles range from studies of the chemistry of substances of abuse, their actions at molecular and cellular sites, in vitro and in vivo investigations of their biochemical, pharmacological and behavioural actions, laboratory-based and clinical research in humans, substance abuse treatment and prevention research, and studies employing methods from epidemiology, sociology, and economics.