A Structural Approach to Understanding and Addressing Suicidality among Transgender and Gender Nonconforming College Students

理解和解决跨性别和性别不合格大学生自杀行为的结构性方法

• 批准号: 10469474
• 负责人: Sarah Ketchen Lipson
• 金额: $ 14.78万
• 依托单位: BOSTON UNIVERSITY MEDICAL CAMPUS
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-08-20 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10469474
• 关键词: Accounting; Address; Adolescent and Young Adult; Affect; Age; Age of Onset; Birth; Boston; Caring; Cause of Death; Client; Code; Counseling; Data; Databases; Development; Discrimination; Dropout; Enrollment; Epidemiology; Evaluation; Evaluation Research; Exposure to; Feedback; Feeling suicidal; Female; Funding; Future; Gender; Gender Identity; Health Insurance; Hormone replacement therapy; Housing; Individual; Institution; Institutional Policy; Insurance Coverage; Intake; Intervention; Interview; Investigation; Knowledge; Lead; Life; Link; Longitudinal Surveys; Measures; Mediating; Mediation; Mediator of activation protein; Mental Health; Mental Health Services; Mental disorders; Mentors; Mentorship; Methods; Modeling; Names; National Institute of Mental Health; Natural experiment; Outcome; Pediatric Hospitals; Personal Satisfaction; Phase; Policies; Policy Analysis; Population; Positioning Attribute; Preparation; Provider; Public Health; Public Health Schools; Qualitative Research; Recommendation; Recording of previous events; Records; Reporting; Research; Research Design; Research Personnel; Research Support; Research Training; Resources; Risk; Sampling; Schools; Services; Stigmatization; Structure; Students; Suicide; Suicide attempt; Surveys; Symptoms; Time; Training; United States National Institutes of Health; Universities; Variant; austin; base; career; cisgender; college; experience; falls; gender nonconforming; health care settings; health disparity; health service use; higher education; interest; male; multi-component intervention; multiphase optimization strategy; novel; professor; prospective; psychosocial; public health intervention; sensitivity training; sex; skills; social stigma; suicidal; suicidal risk; theories; therapy development; transgender; treatment center; undergraduate student; university student

PROJECT SUMMARY Dr. Lipson's career objective is to become a leading mental health disparities researcher, contributing novel evidence about structural determinants of disparities in adolescent and young adult populations, specifically for transgender and gender nonconforming (TGNC) individuals (those who have a gender identity that differs from assigned sex at birth or does not fit the male-female binary). Dr. Lipson is particularly interested in mental health disparities among college students, which include ~70% of adolescents and young adults nationwide. Though TGNC students represent just 3-4% of all undergraduates, they account for ~15% of reported suicide attempts. The proposed K01 focuses on how exposure to structural stigma, in the form of 6 campus policies, is associated with suicidality and mental health service utilization among TGNC college students. This K01 includes 3 specific aims, each requiring further training and expert mentorship: Aims 1 and 2 leverage the natural experiment in which students have low/no exposure to campus policies in the pre-period (before arriving in fall of the 1st undergraduate year). In Aim 1, Dr. Lipson will apply her K01 training in causal inference to compare changes suicidal ideation and attempts between TGNC and cisgender students on campuses with and without structural stigma. In Aim 2, Dr. Lipson will analyze a national database of counseling center records to assess how structural stigma is associated with treatment dropout by TGNC and cisgender students. Supported by her K01 training in qualitative research, in Aim 3, Dr. Lipson will conduct interviews with TGNC students and counseling center directors. This formative research will be in accordance with the preparation phase of the Multiphase Optimization Strategy (MOST), a principled framework for optimizing/evaluating interventions. The preparation phase will inform development and evaluation of future interventions to address structural stigma and its underlying mechanisms. With her K01 research and training, Dr. Lipson will have the skills, knowledge, and evidence to lead intervention evaluation and effectively collaborate on intervention teams. At the end of the K01, she will be prepared to proceed with subsequent phases of MOST, for which she will seek R01 funding. As an assistant professor at the Boston University School of Public Health (BUSPH), Dr. Lipson is opportunely positioned to accomplish the proposed research and achieve her overall career objectives. Her mentors from BUSPH, Boston Children's Hospital/Harvard, and Rutgers University bring interdisciplinary expertise in: TGNC health disparities (Dr. Austin), causal inference (Dr. Lin), qualitative research (Dr. Jernigan), intervention development and evaluation (Dr. Stein), and suicide epidemiology (Dr. Gradus). NIH has designated TGNC as a disparity population, yet there remain large gaps in knowledge that undermine development of public health interventions, including evidence to support implementation of protective policies. With regard to TGNC suicidality, NIMH has specifically highlighted a need to consider transition periods that may heighten risk. Beginning college (the focus of Aims 1 and 2) is a significant life transition that coincides with age of onset for many lifetime mental disorders. The proposed research will strengthen the public health impact of NIMH-supported research (Strategic Objective 4) and address a critical barrier by advancing knowledge of how campus structural stigma is associated with TGNC suicidality. This evidence can be used to inform policy change and create more inclusive services to meet the needs of a growing population of TGNC students nationwide.

项目摘要 博士利普森的职业目标是成为一名领先的心理健康差异研究人员，为以下方面提供新的证据： 青少年和年轻成年人人口差异的结构性决定因素，特别是变性人和 性别认同（TGNC）个体（性别认同与出生时指定的性别不同或不符合性别认同的人） 男性-女性二进制）。利普森博士特别感兴趣的是大学生之间的心理健康差异，其中包括 全国约70%的青少年和年轻人。虽然TGNC学生仅占所有本科生的3-4%，但他们 约占自杀未遂报告的15%。拟议的K 01侧重于如何暴露于结构性耻辱，以6 校园政策，与TGNC大学生的自杀和心理健康服务利用有关。 该K 01包括3个具体目标，每个目标都需要进一步的培训和专家指导：目标1和2利用自然 实验中，学生有低/没有接触到校园政策在前期（在第一个秋天到来之前） 本科一年）。在目标1中，利普森博士将应用她在因果推理中的K 01训练， 以及TGNC和校园里有或没有结构性耻辱的顺性别学生之间的尝试。在目标2中，利普森博士将 分析咨询中心记录的国家数据库，以评估结构性耻辱与治疗退出的关系， TGNC和cisgender学生。在她的K 01定性研究培训的支持下，在目标3中，Lipson博士将进行 与TGNC学生和咨询中心主任的访谈。这一形成性研究将符合 多阶段优化策略（MOST）的准备阶段，一个优化/评估的原则框架 干预措施。准备阶段将为制定和评估未来的干预措施提供信息，以解决结构性成见问题。 及其潜在机制。通过她的K 01研究和培训，Lipson博士将拥有技能，知识和证据， 领导干预评价并有效地与干预小组合作。在K 01结束时，她将准备 她将为社会变革管理计划的后续阶段寻求R 01资金。作为波士顿大学的助理教授 大学公共卫生学院（BUSPH），利普森博士正好能够完成拟议的研究， 实现自己的职业目标。她的导师来自BUSPH、波士顿儿童医院/哈佛和罗格斯大学 带来跨学科的专业知识：TGNC健康差距（奥斯汀博士），因果推理（林博士），定性研究（博士。 Jernigan），干预开发和评估（Stein博士）和自杀流行病学（Gradus博士）。 NIH已将TGNC指定为差异人群，但在知识方面仍存在巨大差距，这破坏了 公共卫生干预措施，包括支持实施保护性政策的证据。关于TGNC的自杀行为， NIMH特别强调需要考虑可能增加风险的过渡期。开始大学（重点是 目的1和2）是一个重要的生活转变，与许多终身精神障碍的发病年龄相吻合。拟议 研究将加强NIMH支持的研究的公共卫生影响（战略目标4），并通过以下方式解决关键障碍： 推进校园结构性耻辱与TGNC自杀行为相关的知识。这些证据可以用来告知 政策变化，创造更具包容性的服务，以满足全国各地不断增长的TGNC学生的需求。