Sexual Minority Mental Health During the COVID-19 Pandemic: An Intersectional, Social Epidemiologic Investigation

项目摘要 Ruth L. Kirschstein国家研究服务奖个人博士后奖学金，NOT-MD- 19-001（关于性和性别少数群体（SGM）健康研究的特别兴趣通知）： 2019冠状病毒病（COVID-19）大流行对人口心理产生了深远的负面影响 在美国，特别是对边缘化人群，如性少数群体（SM）。新兴 研究表明这种差异是由少数压力过程（例如，柱头）和结构 脆弱性（例如，体制压迫），系统地使SM面临更多与流行病相关的压力 并加剧其影响。然而，在交叉分布方面， 以及上游（即，社会和结构）的决定因素。到 为了解决这些差距，目前的项目将利用少数民族的压力、交叉性和生态社会框架 研究社会身份/地位和上游流行病相关压力源的多个维度如何影响 共同影响了SM人群在大流行期间的心理健康。杠杆化前所未有 数据来自COVID-19大流行子研究（一项基于人群的纵向队列研究， Nurses' Health Study 2 & 3和Growing Up Today Study（N> 57，000）和新的分析方法 从社会、空间和法律的流行病学角度，该项目的目标是：1）估计 心理健康症状（即，抑郁症，焦虑症和饮食失调症）的第一年， 按性取向、性别和种族/民族共同定义的群体之间的COVID-19大流行; 2）评估 目标1中观察到的流行模式是否与时空分布特征相关 COVID-19发病率和死亡率（例如，县一级死亡率）;和3）评估是否流行 目标1中观察到的模式与更广泛的流行病政策环境有关（例如，封锁/停留- 家庭订单，有或没有伴随的经济救济努力）。这些目标与上述目标一致。 NIH FY 2021-25战略计划中的优先事项，以推进对性和性行为的健康和福祉的研究。 重要的是，性别少数群体与公共卫生具有紧迫的相关性。最终，该项目将 在持续的COVID-19期间，提供对SM心理健康的更细致入微和情境化的理解 大流行病，目的是产生知识，为制定和实施多项 需要心理健康公平的努力。一个量身定制的指导培训计划伴随着这一建议，并概述 推进申请人作为独立调查员的职业生涯所需的步骤， 方法论严谨和理论上知情SM心理健康差异研究。

PROJECT SUMMARY PA-21-048 Ruth L. Kirschstein National Research Service Award Individual Postdoctoral Fellowship, NOT-MD- 19-001 (Notice of Special Interest in Research on the Health of Sexual and Gender Minority (SGM) Populations): The coronavirus disease 2019 (COVID-19) pandemic has had a profound negative impact on population mental health in the United States, especially for marginalized populations such as sexual minorities (SMs). Emerging research suggests that this disparity is driven by minority stress processes (e.g., stigma) and structural vulnerabilities (e.g., institutional oppression) that systematically expose SMs to more pandemic-related stressors and exacerbate their effects. However, critical knowledge gaps remain regarding the intersectional distribution and upstream (i.e., social and structural) determinants of COVID-19-related disparities in mental health. To address these gaps, the current project will draw on minority stress, intersectionality, and ecosocial frameworks to examine how multiple dimensions of social identity/position and upstream pandemic-related stressors have jointly impacted population mental health for SMs over the course of the pandemic. Leveraging unprecedented data from the COVID-19 Pandemic Sub-Study (a population-based longitudinal cohort study embedded within the Nurses’ Health Study 2 & 3 and the Growing Up Today Study with N>57,000) and novel analytic methods from social, spatial, and legal epidemiology, the project aims are to: 1) estimate the time-varying prevalence of mental health symptoms (i.e., depressive, anxiety, and eating disorder symptomology) over the first year of the COVID-19 pandemic across groups jointly defined by sexual orientation, gender, and race/ethnicity; 2) evaluate whether the prevalence patterns observed in Aim 1 are related to the spatiotemporal distribution characteristics of COVID-19 morbidity and mortality (e.g., county-level mortality rate); and 3) evaluate whether the prevalence patterns observed in Aim 1 are related to the broader pandemic policy environment (e.g., lockdowns/stay-at- home orders, with or without concomitant economic relief efforts). These aims are consistent with the stated priorities in the NIH FY 2021–25 Strategic Plan to Advance Research on the Health & Well-Being of Sexual & Gender Minorities, and importantly, are of urgent relevance to public health. Ultimately, the proposed project will provide a more nuanced and contextualized understanding of SM mental health during the ongoing COVID-19 pandemic, with the intent of generating knowledge that can inform the development and implementation of much- needed mental health equity efforts. A tailored mentored training plan accompanies this proposal and outlines the steps required to advance the Applicant’s career as an independent investigator with expertise in conducting methodologically-rigorous and theoretically-informed SM mental health disparities research.