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.

项目总结 利普森博士的职业目标是成为一名领先的精神健康差距研究人员，为 青少年和青年人口差异的结构性决定因素，特别是变性人和性别 不合格(TGNC)个人(具有与出生时指定的性别不同的性别身份或不符合 男性-女性二进制)。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 全国约70%的青少年和青壮年。尽管TGNC的学生只占所有本科生的3%-4%，但他们 约占自杀未遂报告的15%。拟议的K01侧重于如何暴露于结构性污名，形式为6 校园政策与TGNC大学生自杀和心理健康服务利用有关。 本K01包括3个具体目标，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(在1号秋季到达之前)对校园政策的接触很少或没有接触到校园政策的实验 本科)。在目标1中，利普森博士将应用她的K01因果推理训练来比较自杀意念的变化 以及在有和没有结构性污名的校园里，TGNC和顺性学生之间的尝试。在《目标2》中，利普森博士将 分析全国咨询中心记录的数据库，以评估结构性污名如何与治疗退出有关 TGNC和顺性学生。在她的K01定性研究培训的支持下，利普森博士将在目标3中进行 与TGNC学生和咨询中心主任的访谈。这项形成性研究将符合 多阶段优化战略(MOST)的准备阶段，这是一个优化/评估的原则框架 干预措施。筹备阶段将为制定和评估未来的干预措施提供信息，以解决结构性污名问题。 及其潜在的机制。凭借她的K01研究和培训，利普森博士将拥有技能、知识和证据来 领导干预评估，并在干预团队中有效协作。在K01结束时，她将准备好 继续进行MOST的后续阶段，她将为此寻求R01资金。作为波士顿大学的助理教授 大学公共卫生学院(BUSPH)，利普森博士处于有利地位，可以完成拟议的研究和 实现她的总体职业目标。她的导师来自北京理工大学、波士顿儿童医院/哈佛大学和罗格斯大学 带来跨学科的专业知识：TGNC健康差异(奥斯汀博士)、因果推理(林博士)、定性研究(Dr (杰尼根)、干预发展和评估(斯坦博士)和自杀流行病学(格拉德斯博士)。 NIH已将TGNC指定为不平等人群，但在知识方面仍存在巨大差距，这破坏了TGNC的发展 公共卫生干预，包括支持实施保护政策的证据。关于TGNC的自杀行为， NIMH特别强调了考虑可能增加风险的过渡期的必要性。开始上大学(重点是 目标1和目标2)是一个重大的人生转变，与许多终生精神障碍的发病年龄不谋而合。建议数 研究将加强NIMH支持的研究对公共健康的影响(战略目标4)，并通过以下方式解决关键障碍 提高关于校园结构污名如何与TGNC自杀有关的知识。这一证据可以用来告知 改变政策，创造更具包容性的服务，以满足全国日益增长的TGNC学生的需求。