Suicidal and Nonsuicidal Self-Injurious Behavior in Sexual Minority Youth: Examining Modifiable Mechanisms for Treatment Development

项目摘要 女同性恋者，男同性恋者，双性恋者，酷儿和其他性少数青年（SMY）的风险比他们的 异性恋者的自杀想法和行为（STB），非自杀性自伤（NSSI），以及无数 健康问题具体来说，SMY对STB和NSSI的支持率是异性恋的3倍 青年虽然NSSI本身是一个主要的公共卫生问题，但它大大加剧了自杀的风险 行为因此，研究SMY中的自杀和自伤行为是联邦公共卫生的优先事项， 如NIH PA-15-263所承认的。 心理调解框架，改编的少数民族压力（MS）模型，假定MS (i.e.,压力源，从日常的轻视或侮辱到更公开的欺凌和歧视， 边缘化的性取向）导致受损的一般心理过程，如情感 失调，适应不良的认知过程，社会和人际关系的困难，以及性 针对少数群体的进程（例如，因此，这些过程使SMY处于 增加精神病的风险拟议的研究旨在通过审查 可能解释SMY中MS和STB/NSSI之间关系的潜在机制。通知 心理调解框架以及我们自己的试点研究结果，我们试图调查 四个功能领域的机制：情感（情感强度，情感失调，反刍， 注意力偏向负面影响），认知（低自尊），人际（社会支持不足， 人际排斥敏感性）和性少数群体特异性（内化的同性恋恐惧症和性 方向隐藏）。非常重要的是，这些假设的机制中的每一个都被发现是 与自杀风险增加相关，每种都代表了干预的潜在目标。 我们提出了一个创新的探索性研究，管理主观自我报告的措施和客观的 行为任务的高风险SMY（N=60），从各种临床环境中招募。我们将研究MS是否 与特定的情感、认知、人际和群体特定机制相关， 这些是否又与SMY中的STB/NSSI相关联（目标1）。使用每日日记的方法，我们将 检查假设的这些机制在多大程度上解释了MS和 自然环境中的STB/NSSI（目标2）。我们还将进行时间轴后续采访， 参与者在每日日记阶段结束时。为指导未来干预措施的制定，我们还 建议对同一SMY参与者（n=20）的风险子集进行深入访谈，以更好地 了解他们对这些机制、应对和治疗的经历。这项研究的结果将 证明进行更大规模的前瞻性R 01研究以阐明 增加SMY中NSSI/STB的风险和试点数据，以制定有效和文化敏感的干预措施。

PROJECT SUMMARY Lesbian, gay, bisexual, queer and other sexual minority youth (SMY) are at greater risk than their heterosexual counterparts for suicidal thoughts and behaviors (STB), nonsuicidal self-injury (NSSI), and myriad health problems. Specifically, SMY endorse both STB and NSSI at rates 3 times greater than heterosexual youth. NSSI, while a major public health concern in its own right, significantly exacerbates risk for suicidal behavior. Thus, examining suicidal and self-injurious behaviors among SMY is a federal public health priority, as acknowledged by NIH PA-15-263. The psychological mediation framework, an adaptation of the minority stress (MS) model, posits that MS (i.e., stressors ranging from daily slights or insults to more overt forms of bullying and discrimination related to marginalized sexual orientation) leads to impaired general psychological processes, such as emotional dysregulation, maladaptive cognitive processes, and social and interpersonal difficulties, as well as sexual minority group-specific processes (e.g., internalized homophobia).Consequently, these processes put SMY at increased risk for psychopathology. The proposed research seeks to address gaps in the field by examining potential mechanisms that may account for the relationship between MS and STB/NSSI in SMY. Informed by the psychological mediation framework as well as our own pilot research findings, we seek to investigate mechanisms across four areas of functioning: affective (affect intensity, affect dysregulation, rumination, and attention bias to negative affect), cognitive (low self-esteem), interpersonal (insufficient social support and interpersonal rejection sensitivity) and sexual minority-group specific (internalized homophobia and sexual orientation concealment). Very importantly, each of these hypothesized mechanisms have been found to be associated with increased risk for suicidality, and each represent potential targets of intervention. We propose an innovative exploratory study, administering subjective self-report measures and objective behavioral tasks to high risk SMY (N=60), recruited from various clinical settings. We will examine whether MS is associated with specific affective, cognitive, interpersonal, and group-specific mechanisms, and whether these are in turn associated with STB/NSSI in SMY (Aim 1). Using a daily diary approach, we will examine the extent to which hypothesized these mechanisms account for the relationship between MS and STB/NSSI in their natural environment (Aim 2). We will also conduct Timeline Followback interviews with all participants at the end of the daily diary phase. To inform the development of future interventions, we also propose conducting in-depth interviews with an at-risk subset of the same SMY participants (n=20) to better understand their experiences with these mechanisms, coping, and treatment. Findings from this study would demonstrate feasibility for a larger-scale, prospective R01 study to elucidate the mechanisms underlying the increased risk for NSSI/STB in SMY and pilot data to develop effective and culturally-sensitive interventions.