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: 10055300
• 负责人: Sarah Ketchen Lipson
• 金额: $ 16.25万
• 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/10055300
• 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.

项目摘要 利普森博士的职业目标是成为主要的心理健康差异研究者，为有关 青少年和年轻人种群差异的结构决定因素，专门针对跨性别和性别 不合格的（TGNC）个体（那些具有性别认同的人与分配的性别不同或不适合 男女二进制）。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〜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 约有15％的自杀未遂。提出的K01的重点是如何以6的形式接触结构污名 校园政策与TGNC大学生的自杀和心理健康服务利用有关。 该K01包括3个特定目标，每个目标都需要进一步的培训和专家指导：目标1和2利用自然 学生在前期的校园政策中有低/无暴露的实验 本科年）。在AIM 1中，Lips博士将在因果推理中应用她的K01培训，以比较自杀念头的变化 以及TGNC和Cisgender学生在校园内有和没有结构性污名的尝试。在AIM 2中，Lips博士将 分析一个国家咨询中心记录的国家数据库，以评估结构性污名与治疗辍学如何相关的 TGNC和Cisgender学生。在AIM 3中的K01定性研究培训的支持下，Lips博士将进行 与TGNC学生和咨询中心董事的访谈。这项形成性研究将符合 多相优化策略的制备阶段（大多数），这是一个优化/评估的原则性框架 干预措施。准备阶段将为未来干预措施的开发和评估提供信息，以解决结构性的污名 及其基本机制。 Lipson博士将拥有K01的研究和培训，将拥有技能，知识和证据 领先的干预评估并有效地在干预团队上合作。在K01结束时，她将准备好 继续进行大多数阶段，为此，她将寻求R01的资金。作为波士顿的助理教授 Lipson博士的公共卫生学院（BUSPH）有利地完成拟议的研究和 实现她的整体职业目标。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（Austin博士），因果关系（Lin博士），定性研究（博士 Jernigan），干预发展和评估（Stein博士）和自杀流行病学（Gradus博士）。 NIH已将TGNC指定为差异人口，但在知识中仍然存在很大的差距，这些差距破坏了 公共卫生干预措施，包括支持实施保护政策的证据。关于TGNC自杀性， NIMH特别强调了需要考虑可能会增加风险的过渡期。开始大学（重点 目标1和2）是一个重要的生活转变，与发病年龄的一生精神障碍相吻合。提议 研究将加强NIMH支持研究的公共卫生影响（战略目标4），并解决 促进了解校园结构污名与TGNC自杀性如何相关的知识。这些证据可用于告知 政策改变并创建更多的包容性服务，以满足全国TGNC学生不断增长的人群的需求。