The Mental Health Consequences of Life Course-Varying Exposure to Structural Sexual Minority Stigma: Advancing Causal Inference Using Longitudinal Models Moderated by Sexual Orientation

不同生命周期暴露于结构性性少数耻辱的心理健康后果：使用以性取向为调节的纵向模型推进因果推理

• 批准号: 10576079
• 负责人: Arjan van der Star
• 金额: $ 7.53万
• 依托单位: SAN DIEGO STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-12-08 至 2024-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10576079
• 关键词: Address; Adolescent; Adult; Advocacy; Affect; Attitude; Automobile Driving; Climate; Data; Data Set; Development; Disparity; Dose; Education; Elements; Etiology; European; Exposure to; Feeling suicidal; Gender; Health; Heterosexuals; Individual; Inequity; Institutionalization; Laws; Legal; Libido; Life Cycle Stages; Literature; Longitudinal Studies; Maps; Marriage; Mental Depression; Mental Health; Modeling; National Longitudinal Survey of Adolescent to Adult Health; Outcome; Participant; Pattern; Persons; Policies; Population; Public Health; Reporting; Research; Risk Factors; Role; Sex Orientation; Shapes; Specificity; Statutes and Laws; Stretching; Suicide attempt; Time; US State; Violence; depressive symptoms; design; gender diversity; health disparity; health equity; improved; indexing; internalized stigma; lifetime risk; middle age; migration; programs; public health research; residence; response; secondary analysis; sexual minority; sexual minority youth; social stigma; theories; young adult

PROJECT SUMMARY Sexual minorities (i.e., individuals who do not identify as heterosexual, or who are attracted to, have romantic relationships with, or have sexual contact with, people of the same or diverse genders) in the US are at a two to seven-fold increased risk for lifetime report of suicide attempts and a near three-fold increased odds for depression. Sexual minority stigma exposure, in its various forms, has been purported as a cause underlying and driving these sexual orientation-based disparities in mental health. While structural forms of sexual minority stigma, including discriminatory laws, inequitable policies, and negative population attitudes, have been associated with adverse sexual minority mental health in cross-sectional designs, no longitudinal studies to date have examined three key elements needed to establish causality, including 1) temporality with the exposure preceding the effect, 2) dose-response gradient comprehensively assessed across the life course, and 3) specificity of results with the exposure explaining an observed disparity in outcomes. With data collected during a transformational period for sexual minorities in the US (from 2001 to 2018 with, e.g., changes in population attitudes and the step-wise introduction of same-gender marriage), the National Longitudinal Study of Adolescent to Adult Health (Add Health) provides a unique and timely opportunity to longitudinally examine the effect of life-course structural stigma exposure on sexual minorities’ mental health and the three missing causality requirements. Therefore, this proposed study will 1) quantify the level of structural sexual minority stigma for each US state between 2001 and 2018 and calculate individuals’ exposure over time, 2) examine the associations between structural sexual minority stigma and suicidal ideation, suicide attempts, and depressive symptoms in longitudinal models, and 3) examine if the associations between structural sexual minority stigma and mental health outcomes in longitudinal models vary by sexual orientation. The proposed study will employ advanced three-level multi-membership longitudinal models to account for lifetime-varying exposure and between-state migration. Findings from the proposed study may have direct theoretical and applied implications as it addresses important causality issues on how structural sexual minority stigma shapes sexual minorities’ mental health. Results may further contribute to health equity by facilitating targeted advocacy to improve structural climates for sexual minorities, not only in the US, but similarly across the globe.

项目摘要 性少数群体（即，没有认同为异性恋或被吸引的个人有浪漫 在美国，与同一或潜水员的人的关系或与潜水员的人有性交 终身自杀未遂报告的风险增加了七倍，几乎增加了三倍的几率 沮丧。以各种形式的性少数族裔污名暴露已被称为根本原因 并推动这些基于性取向的精神健康分布。而性的结构形式 少数民族的污名，包括歧视性法律，不平等政策和负面的人参加者， 与不良性少数民族心理健康有关，没有纵向研究 迄今 效果之前的暴露，2）在整个生命过程中彻底评估的剂量反应梯度， 3）结果的特异性与暴露有关结果的差异。与数据 在美国的性少数群体的变革时期（从2001年到2018年）收集 人口的变化参加以及同性婚姻的逐步引入） 青少年对成人健康的纵向研究（ADD健康）为及时提供了独特的机会 纵向研究生活方式结构性污名对性少数群体心理健康的影响 以及三个缺失的休闲要求。因此，这项拟议的研究将1）量化 2001年至2018年之间每个美国州的结构性少数族裔污名，并计算个人的接触 随着时间的流逝，2）检查结构性性少数族裔污名与自杀思想，自杀之间的关联 尝试和纵向模型中的抑郁症状，以及3）检查是否相关 纵向模型中的结构性少数族裔污名和心理健康成果因性取向而异。 拟议的研究将采用先进的三级多成员纵向模型来解释 终生变化的暴露和状态之间的迁移。拟议研究的发现可能是直接的 理论和应用含义，因为它解决了有关结构性性如何的重要休闲问题 少数民族的污名塑造了性少数群体的心理健康。结果可能会进一步促进健康公平 促进有针对性的倡导改善性少数群体的结构气候，不仅在美国，而且 同样在全球。