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

项目摘要 性少数群体（即，不认为自己是异性恋的人，或者被异性恋吸引的人， 与同性或不同性别的人发生关系或性接触）在美国的比例为2 终生报告的自杀企图的风险增加了7倍， 萧条各种形式的性少数污名暴露被认为是一个潜在的原因， 并推动了这些基于性取向的心理健康差异。虽然性的结构形式 少数民族的耻辱感，包括歧视性法律、不平等政策和消极的人口态度， 在横断面设计中，与不良的性少数群体心理健康相关，没有纵向研究 到目前为止，我们已经研究了建立因果关系所需的三个关键因素，包括1）与 暴露先于效应，2）在整个生命过程中全面评估的剂量-反应梯度， 和3）结果的特异性，暴露解释了观察到的结果差异。与数据 在美国性少数群体的转型期（从2001年到2018年，例如， 人口态度的变化和逐步实行同性婚姻）， 青少年到成人健康的纵向研究（添加健康）提供了一个独特而及时的机会， 纵向考察生命历程结构性污名暴露对性少数群体心理健康的影响 以及三个缺失的因果关系要求。因此，这项拟议的研究将：1）量化 2001年至2018年期间美国各州性少数群体的结构性耻辱，并计算个人的暴露 随着时间的推移，2）检查结构性性少数污名与自杀意念，自杀， 尝试，和抑郁症状的纵向模型，和3）检查之间的关联 纵向模型中的结构性少数性歧视和心理健康结果因性取向而异。 拟议的研究将采用先进的三级多成员纵向模型，以说明 寿命变化暴露和状态间迁移。这项研究的结果可能会直接影响 理论和应用的影响，因为它解决了重要的因果关系问题，如何结构性的性 少数民族污名化影响性少数群体的心理健康。结果可能会进一步促进健康公平， 促进有针对性的宣传，以改善性少数群体的结构性气候，不仅在美国， 同样地在地球仪上。

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.