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

项目描述：现有的研究表明，女同性恋，男同性恋和双性恋（LGB）的个人是在 物质使用障碍（SUD）的风险增加，以及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， 性少数这项提案，歧视，压力和物质使用障碍的性少数群体 成人：NESAR-III的二次分析解决了缺乏关于性少数群体的研究， PAR-16-234，利用现有数据加快药物滥用研究的步伐。在2015年， NESAR-III数据可用于二次分析，包括全国最大的 LGB个体的代表性样本和SUD的最全面措施，以及异性恋 和LGB性取向NESARC-III包括：a）异性恋和LGB个体的大样本 用于一般和子样本比较; B）一种衡量性取向的方法，可以评估 SUD和性取向的三个维度（吸引力，行为，身份）内的不和谐取向; 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;以及d） 物质使用的措施，符合新的DSM-5标准的SUD和其他精神疾病。的 NESARC-III是唯一一个大规模的全国代表性调查，允许心理社会和 根据DSM-5诊断对LGB和异性恋者以及SUD进行流行病学检查 的搜索.在Meyer的少数民族压力模型的指导下，我们使用NESAR-III数据对我们提出的模型进行了检验， 性少数群体压力模型（SMStM）：目标1：评估以下疾病的患病率：a）物质使用障碍（DSM-5 诊断），包括严重程度（轻度、中度和重度）; B）特定药物使用障碍（例如，DSM-5 c）与物质使用障碍相关的精神共病（DSM-5诊断）; 和d）基于吸引力、行为和身份的物质使用障碍的恢复/缓解。审查 按性别、年龄、出生队列、种族/族裔划分的差异。目标2：评估我们提出的SMStM在多大程度上 在NESARC-III数据中证明：a）我们将确定整体测量模型是否提供了更好的 与异性恋者相比，模型适合性少数群体; B）我们将确定模型适合性是否有所改善， （c）包括针对性少数群体的个人和机构歧视的措施; 我们将评估不同出生队列模型拟合的差异。目标3我们将评估性行为在多大程度上 方向不一致性有助于我们在面向所有人的SMStM背景下理解SUD 被调查者和性少数群体。据推测，性不一致（即， 受访者的性身份与他们的性吸引力，行为，或两者）将与SUD 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.