Discrimination, Stress and Substance Use Disorder among Sexual Minority Adults: A Secondary Analysis of NESARC-III

项目描述：现有研究表明，女同性恋者、男同性恋者和双性恋者 物质使用障碍(SUD)风险增加，性别少数歧视和积累 生活压力可能是SUD的病因；然而，很少有研究试图研究这些因素中的 性少数群体。性别少数群体中的建议、歧视、压力和物质使用障碍 成年人：NESARC-III的二次分析解决了关于性少数群体的研究匮乏的问题， 并响应PAR-16-234，加快了利用现有数据进行药物滥用研究的步伐。2015年， NESARC-III数据可用于二次分析，其中包括全国最大的 具有代表性的LGB个体样本和最全面的性功能障碍和异性恋衡量标准 和路易斯安那州立大学的性取向。NESARC-III包括：a)异性恋和LGB个人的大样本 用于一般和次抽样比较；b)一种衡量性取向的方法，可评估 性取向三个维度(吸引力、行为、认同感)中的性取向和不和谐取向；c) 有效和可靠的性别少数歧视措施(远端/机构和近端/个人)， 童年压力、累积压力、生活质量和健康、寻求治疗和康复；和d) 与新的DSM-5标准相一致的物质使用措施，以治疗SUD和其他精神障碍。这个 NESARC-III是唯一一项具有全国代表性的大规模调查，允许进行心理-社会和 基于DSM-5诊断的LGB和异性恋个体和SUD的流行病学检查 标准。在Meyer的少数应激模型的指导下，使用NESARC-III数据对我们提出的模型进行了检验 性少数群体应激模型(SMStM)：目标1：评估：a)物质使用障碍(DSM-5)的患病率 诊断)包括严重程度(轻度、中度和重度)；b)具体药物使用障碍(例如，DSM-5 (C)与药物使用障碍有关的精神共病(DSM-5诊断)； 以及d)根据吸引力、行为和身份从物质使用障碍中恢复/缓解。考查 因性别、年龄、出生队列、种族/民族而异。目标2：评估我们建议的SMSTM的程度 NESARC-III数据证明了这一点：a)我们将确定整体测量模型是否提供了更好的 与异性恋相比，适合少数性别者的模特；b)我们将确定模特适合的程度是否有所提高 包括针对个人和制度性少数群体歧视的措施时的性少数群体；c) 我们将评估出生队列中模型匹配度的差异。目标3我们将评估性行为在多大程度上 取向不协调有助于我们在全民SMSTM的背景下理解SUD 受访者，并按性别少数群体地位。据推测，性不和谐(即 受访者的性认同与他们的性吸引力、性行为或两者兼而有之)将与SUD相关 所有异性恋和LGB受访者的结果。我们将评估出生队列之间的差异。

PROJECT DESCRIPTION: Extant research indicates that lesbian, gay and bisexual (LGB) individuals are at heightened risk for substance use disorders (SUD), and that sexual minority discrimination and accumulated life stresses may be etiologic to SUD; however, few studies have attempted to study these factors among sexual minorities. This proposal, Discrimination, Stress and Substance Use Disorder among Sexual Minority Adults: A Secondary Analysis of NESARC-III addresses the dearth in research regarding sexual minorities, and responds to PAR-16-234, Accelerating the Pace of Drug Abuse Research Using Existing Data. In 2015, the NESARC-III data became available for secondary analysis and includes the largest, nationally representative sample of LGB individuals and the most comprehensive measures of SUD, and heterosexual and LGB sexual orientation. The NESARC-III includes: a) a large sample of heterosexual and LGB individuals for general and subsample comparisons; b) a measure of sexual orientation that allows for an assessment of SUD and discordant orientation within three dimensions of sexual orientation (attraction, behavior, identity); c) valid and reliable measures of sexual minority discrimination (distal/institutional and proximal/individual), childhood stress, accumulated stress, quality of life and health, treatment seeking and recovery; and d) substance use measures that align with the new DSM-5 criteria for SUD and other psychiatric disorders. The NESARC-III is the only large-scale nationally representative survey that allows for a psycho-social and epidemiological examination of LGB and heterosexual individuals, and SUD based on DSM-5 diagnostic criteria. Guided by Meyer's Minority Stress Model and using NESARC-III data, we test our proposed model, the Sexual Minority Stress Model (SMStM): Aim 1: Assess prevalence of: a) substance use disorders (DSM-5 diagnosis) including severity level (mild, moderate and severe); b) specific drug use disorders (e.g., DSM-5 cannabis disorder); c) psychiatric comorbidities associated with substance use disorders (DSM-5 diagnosis); and d) recovery/remission from substance use disorders based on attraction, behavior, and identity. Examine variations by sex, age, birth cohort, race/ethnicity. Aim 2: Evaluate the extent to which our proposed SMStM is evidenced in the NESARC-III data: a) We will determine if the overall measurement model provides a better model fit for sexual minorities when compared to heterosexuals; b) We will determine if model fit improves for sexual minorities when measures for individual and institutional sexual minority discrimination are included; c) We will assess differences in model fit across birth cohorts. Aim 3 We will evaluate the extent to which sexual orientation discordance contributes to our understanding of SUD in the context of the SMStM for all respondents, and by sexual minority status. It is hypothesized that sexual discordance (i.e. mis-alignment of respondents' sexual identity with their sexual attraction, behavior, or both) will be associated with SUD outcomes for all heterosexual and LGB respondents. We will assess differences across birth cohorts.