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

项目总结 PA-21-048 Ruth L.Kirschstein国家研究服务奖个人博士后奖学金，非医学博士 19-001(对性少数和性别少数群体健康研究特别感兴趣的通知)： 冠状病毒病2019年(新冠肺炎)大流行对人群心理产生了深刻的负面影响 在美国，特别是针对边缘人群，如性少数群体(短信)。新兴 研究表明，这种差异是由少数群体的压力过程(例如，耻辱)和结构性的 系统地将短信暴露于更多与流行病相关的应激源的脆弱性(例如，机构压迫) 并加剧了它们的影响。然而，关于横截面分布的关键知识差距仍然存在 以及与新冠肺炎相关的心理健康差距的上游(即社会和结构性)决定因素。至 为了消除这些差距，目前的项目将利用少数群体压力、交叉性和生态社会框架 研究社会认同/地位的多个维度和上游大流行相关的压力来源 在大流行期间，短信对人们的心理健康产生了共同影响。利用史无前例的 来自新冠肺炎大流行分研究的数据(嵌入在 护士健康研究2&3和N&GT；57,000人的今日成长研究)和新的分析方法 从社会、空间和法律流行病学的角度，该项目的目标是：1)估计随时间变化的 第一年的精神健康症状(即抑郁、焦虑和进食障碍症状) 新冠肺炎跨群体流行，由性取向、性别和种族/民族共同定义；2)评估 目标1中观察到的流行模式是否与时空分布特征有关 新冠肺炎的发病率和死亡率(例如，县级死亡率)；以及3)评估 在目标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/停留在- 家庭订单，有或没有伴随的经济救济努力)。这些目标与声明的目标一致 美国国立卫生研究院2021-25财年战略计划中的优先事项，以推进性与性健康和福祉的研究 性别少数群体，而且重要的是，对公共卫生具有迫切的相关性。最终，拟议的项目将 在正在进行的新冠肺炎期间提供对SM心理健康的更细致入微和更有背景的理解 大流行，目的是产生知识，为制定和实施许多-- 需要心理健康公平方面的努力。本建议书附带一份量身定制的指导性培训计划，并概述 推进申请人职业生涯所需的步骤，使其成为一名具有以下专业知识的独立调查员 方法论严谨和理论知情的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.