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.

项目概要 利普森博士的职业目标是成为一名领先的心理健康差异研究员，提供关于心理健康差异的新证据 青少年和年轻人口差异的结构性决定因素，特别是跨性别者和性别差异 不合格 (TGNC) 个体（性别认同与出生时指定性别不同或不符合性别认同的人） 男女二元）。利普森博士对大学生的心理健康差异特别感兴趣，其中包括 全国约 70% 的青少年和年轻人。尽管 TGNC 学生仅占所有本科生的 3-4%，但他们 约占报告的自杀企图的 15%。拟议的 K01 重点关注如何暴露结构耻辱，其形式为 6 校园政策与 TGNC 大学生的自杀倾向和心理健康服务利用相关。 该 K01 包括 3 个具体目标，每个目标都需要进一步培训和专家指导： 目标 1 和 2 利用自然 实验中，学生在前期（第一年秋季入学之前）很少/没有接触过校园政策 本科年）。在目标 1 中，Lipson 博士将应用她在因果推理方面的 K01 训练来比较自杀意念的变化 以及 TGNC 和顺性别学生在有或没有结构性耻辱的校园里的尝试。在目标 2 中，利普森博士将 分析国家咨询中心记录数据库，以评估结构性耻辱与治疗退出之间的关系 TGNC 和顺性别学生。在定性研究 K01 培训的支持下，在目标 3 中，Lipson 博士将进行 采访 TGNC 学生和咨询中心主任。这项形成性研究将按照 多阶段优化策略 (MOST) 的准备阶段，这是优化/评估的原则框架 干预措施。准备阶段将为未来干预措施的制定和评估提供信息，以解决结构性耻辱 及其基本机制。通过她的 K01 研究和培训，Lipson 博士将拥有技能、知识和证据 领导干预评估并在干预团队中进行有效协作。在 K01 结束时，她将准备好 继续 MOST 的后续阶段，为此她将寻求 R01 资金。作为波士顿大学的助理教授 大学公共卫生学院 (BUSPH) 的 Lipson 博士恰好能够完成拟议的研究和 实现她的总体职业目标。她的导师来自 BUSPH、波士顿儿童医院/哈佛大学和罗格斯大学 带来跨学科专业知识：TGNC 健康差异（奥斯汀博士）、因果推理（林博士）、定性研究（林博士） Jernigan）、干预措施制定和评估（Stein 博士）以及自杀流行病学（Gradus 博士）。 NIH 已将 TGNC 指定为差异人群，但知识方面仍存在巨大差距，阻碍了 TGNC 的发展 公共卫生干预措施，包括支持实施保护政策的证据。关于 TGNC 的自杀倾向， NIMH 特别强调需要考虑可能增加风险的过渡期。开始大学生活（重点 目标 1 和 2）是一个重要的人生转变，与许多终生精神障碍的发病年龄一致。拟议的 研究将加强 NIMH 支持的研究对公共卫生的影响（战略目标 4），并通过以下方式解决关键障碍： 加深对校园结构性耻辱与 TGNC 自杀倾向之间关系的了解。该证据可用于告知 政策变化并创造更具包容性的服务，以满足全国范围内不断增长的 TGNC 学生的需求。