Minority Stress, Caregiving Experiences, and Health of Bi+ Informal Caregivers of People with Alzheimer’s Disease and Related Dementias

IF 13 1区 医学 Q1 CLINICAL NEUROLOGY Alzheimer's & Dementia Pub Date : 2025-01-09 DOI:10.1002/alz.091581
Krystal R. Kittle, Ethan C. Cicero, Jordan Pelkmans, Jason D. Flatt, Joel G Anderson
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Abstract

Background

Bi+ people, those with non-monosexual identities (e.g., bisexual, pansexual, sexually fluid) are more likely to experience poor physical and mental health compared with monosexual minority (i.e., gay[G], lesbian[L]) people. These poor health outcomes stem from minority stress related to their sexual minority status (e.g., discrimination, victimization). Due to minority and caregiver stress, LGB+ people providing care to someone with ADRD are more likely to have worse health than their straight counterparts. Little is known about how minority and caregiver stress affect the health of bi+ ADRD caregivers versus monosexual minority ADRD caregivers.

Method

Cross-sectional survey data from a non-probabilistic sample of sexual minority ADRD caregivers (bi+, n = 125; gay/lesbian, n = 161) were used to examine associations between minority stress (discrimination, victimization, microaggressions, perceived stress), caregiver stress (caring for spouse/partner, respite use, distress from care recipient’s neuropsychiatric symptoms, care recipient’s level of independence) on overall self-rated health and if these associations differed among bi+ and monosexual minority ADRD caregivers. Multivariable regression, adjusting for demographic characteristics, was used to investigate if sexual orientation (bi+ vs. gay/lesbian) moderated the association between minority/caregiver stress variables and health.

Result

All minority stressors and two caregiving stressors (caring for spouse, care recipient’s level of independence) were associated with overall health. In our adjusted model, three variables (lifetime victimization, day-to-day discrimination, caring for spouse/partner) moderated the association between sexual orientation and overall health. As lifetime victimization scores increased, bi+ overall health decreased while monosexual minority overall health increased (B = -0.56; 95% CI = 1.06,0.05; p = 0.03). Caring for a spouse/partner, protective for both groups (B = 5.11; 95%CI = 3.04,7.17; p<0.001), had a greater effect on health for monosexual minorities (B = -4.26; 95% CI = -7.49,-1.03; p<0.001). Higher day-to-day discrimination scores predicted worse health for both groups (B = -0.61; 95% CI = -0.91,-0.32; p<0.001), but the magnitude was greater for monosexual minorities (B = 0.41; 95% CI = 0.01,0.80; p = 0.044).

Conclusion

The effects of lifetime victimization, day-to-day discrimination, and caring for one’s spouse/partner on health differ significantly dependent on being bi+ or gay/lesbian. Qualitative inquiries may help illuminate the underlying mechanisms for this phenomenon, informing interventions and policy development aimed at supporting the health and well-being of bi+ ADRD caregivers.

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阿尔茨海默病及相关痴呆患者Bi+非正式照顾者的少数民族压力、照顾经历与健康
bi +人群,即非单性恋者(如双性恋、泛性恋、性不变性者)与少数单性恋者(如男同性恋[G]、女同性恋[L])相比,更有可能经历较差的身心健康状况。这些不良的健康结果源于与他们的性少数地位有关的少数群体压力(例如,歧视、受害)。由于少数族裔和照顾者的压力,照顾患有ADRD的LGB+人比他们的异性恋同行更有可能有更差的健康状况。对于少数族裔和照顾者压力如何影响双性恋+ ADRD照顾者与单性恋少数族裔ADRD照顾者的健康,我们知之甚少。方法来自性少数ADRD照顾者非概率样本的横断面调查数据(bi+, n = 125;男同性恋/女同性恋,n = 161)被用来研究少数群体压力(歧视、受害、微侵犯、感知压力)、照顾者压力(照顾配偶/伴侣、使用喘息时间、照顾者神经精神症状的痛苦、照顾者的独立水平)与总体自我评估健康之间的关系,以及这些关系在双性恋和单性恋少数ADRD照顾者之间是否存在差异。采用多变量回归,调整人口统计学特征,调查性取向(双性恋vs男同性恋/女同性恋)是否调节了少数民族/照顾者压力变量与健康之间的关系。结果少数压力源和两个照顾压力源(照顾配偶、被照顾者的独立性水平)与整体健康水平相关。在我们调整后的模型中,三个变量(终生受害、日常歧视、对配偶/伴侣的照顾)调节了性取向与整体健康之间的关系。随着终身受害分数的增加,双性恋+整体健康水平下降,而单性恋少数整体健康水平上升(B =‐0.56;95% ci = 1.06,0.05;P = 0.03)。照顾配偶/伴侣,对两组都有保护作用(B = 5.11;95%ci = 3.04,7.17;p<0.001),对单性少数群体的健康有更大的影响(B =‐4.26;95% ci =‐7.49,‐1.03;术中,0.001)。日常歧视得分越高,两组的健康状况越差(B = - 0.61;95% ci =‐0.91,‐0.32;p<0.001),但单性少数群体的幅度更大(B = 0.41;95% ci = 0.01,0.80;P = 0.044)。结论终身受害、日常歧视和照顾配偶/伴侣对健康的影响在双性恋和同性恋之间存在显著差异。定性调查可能有助于阐明这一现象的潜在机制,为旨在支持双性恋+ ADRD照料者健康和福祉的干预措施和政策制定提供信息。
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来源期刊
Alzheimer's & Dementia
Alzheimer's & Dementia 医学-临床神经学
CiteScore
14.50
自引率
5.00%
发文量
299
审稿时长
3 months
期刊介绍: Alzheimer's & Dementia is a peer-reviewed journal that aims to bridge knowledge gaps in dementia research by covering the entire spectrum, from basic science to clinical trials to social and behavioral investigations. It provides a platform for rapid communication of new findings and ideas, optimal translation of research into practical applications, increasing knowledge across diverse disciplines for early detection, diagnosis, and intervention, and identifying promising new research directions. In July 2008, Alzheimer's & Dementia was accepted for indexing by MEDLINE, recognizing its scientific merit and contribution to Alzheimer's research.
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