Sexual Orientation, Substance Use and Mental Health

为响应PA-06-329《药物滥用流行病学》，本探索性项目建议使用现有的全国代表性数据集来评估美国性取向、感知歧视、药物滥用、心理健康和治疗利用之间的关系。过去的研究普遍发现，女同性恋、男同性恋和双性恋（LGB）个体在药物使用和精神健康障碍方面的风险更高，但这些研究一直受到方法限制的困扰，包括样本小、不具代表性以及缺乏异性恋对照组。迄今为止，没有大规模的具有全国代表性的研究调查了自我认定为LGB的个体中物质使用和精神健康障碍的流行病学，几乎没有关于性少数群体治疗利用的数据。因此，我们建议对2004-2005年全国酒精及相关疾病流行病学调查（NESARC）进行二次分析，这是一个具有全国代表性的样本，包括34,653名18岁及以上的美国成年人。具体目的是：(1)评估基于性取向的物质使用行为、DSM-IV物质使用、情绪和焦虑障碍的患病率和共现率；(2)基于性取向的药物滥用和心理健康治疗利用评估。(3)研究性少数群体的感知歧视与物质使用和心理健康结果之间的关系。拟议的项目将利用2004-2005年国家人口研究中心提供的独特机会：可获得大量的种族多样化的样本，其中包括大量性少数群体妇女和男子；包括性取向的多种测量；以及关于DSM-IV物质使用、情绪和焦虑障碍以及治疗利用的丰富数据。该项目的研究结果将加强对美国异性恋者和性少数群体中物质使用和精神健康障碍的流行病学的了解，并将为改进这些疾病的评估、预防和治疗提供信息。7. 了解基于性取向维度的药物滥用和精神健康障碍在亚群体中的模式和分布，对于设计有效的公共卫生预防、干预和治疗方案至关重要。本项目将研究几个尚未探索的研究问题，这些问题涉及性取向、这些群体的治疗利用以及感知到的歧视对性少数群体的物质使用行为和精神健康的影响等各方面的物质使用和精神健康障碍的流行病学。

DESCRIPTION (provided by applicant): In response to PA-06-329, Epidemiology of Drug Abuse, this exploratory project proposes to use an existing nationally representative dataset to assess the relationships among sexual orientation, perceived discrimination, substance abuse, mental health, and treatment utilization in the United States. Past research has generally found lesbian, gay and bisexual (LGB) individuals are at heightened risk for substance use and mental health disorders but these studies have been plagued by methodological limitations, including small, non-representative samples and lack of heterosexual comparison groups. To date, no large-scale nationally representative studies have examined the epidemiology of substance use and mental health disorders among self-identified LGB individuals and almost no data on treatment utilization among sexual minorities exists. Thus, we propose to conduct a secondary analysis of the 2004-2005 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a nationally representative sample of 34,653 U.S. adults 18 years and older in the United States. The specific aims are to: (1) assess the prevalence and co-occurrence of substance use behaviors, DSM-IV substance use, mood and anxiety disorders based on sexual orientation; (2) estimate substance abuse and mental health treatment utilization based on sexual orientation among respondents with and without DSM-IV diagnoses; and (3) examine the association between perceived discrimination and substance use and mental health outcomes among sexual minorities. The proposed project will take advantage of the unique opportunities afforded by the 2004-2005 NESARC: the availability of an ample and ethnically diverse sample with large numbers of sexual minority women and men; the inclusion of multiple measures of sexual orientation; and the wealth of data on DSM-IV substance use, mood and anxiety disorders, and treatment utilization. Findings from this project will enhance understanding of the epidemiology of substance use and mental health disorders among both heterosexuals and sexual minorities in the United States, and will provide information to improve the assessment, prevention and treatment of these disorders. 7. PROJECT NARRATIVE Understanding patterns and distributions of substance abuse and mental health disorders across sub-groups based on dimensions of sexual orientation is critical for designing effective public health prevention, intervention and treatment programs. This project will examine several unexplored research questions related to the epidemiology of substance use and mental health disorders across dimensions of sexual orientation, treatment utilization among those groups and the impact of perceived discrimination on the substance use behaviors and mental health of sexual minority groups.