Mental health disorders in a sexual minority population

描述（由申请人提供）：最近的流行病学研究使用现有的基于人群的健康数据集反复发现，在女同性恋、男同性恋或可能是少数性取向的个体中，心理健康发病率和心理健康服务使用的风险较高。特别是，反复观察到压力敏感性障碍（如抑郁、焦虑和物质使用依赖）的患病率高于预期。不幸的是，现有数据集的方法学局限性（主要是统计能力低，性取向的间接测量，以及缺乏对可能的性取向特异性影响调节因素的测量）阻碍了对这一高危人群心理健康服务需求的理解。作为对NIMH PA-01-096的回应，目前的申请建议利用两年一次的加州健康访谈调查（CHIS）提供的信息来检查男女同性恋者的心理健康发病率和心理健康相关服务的使用情况。我们将对2,700名CHIS II参与者进行系统抽样，对少数性取向进行抽样，以评估心理健康、物质使用和性取向特定问题之间的关系。我们将比较不同性取向的个体，以调查精神健康和物质使用发病率、精神健康和物质使用合并症的模式以及精神健康和物质相关服务的使用方面的差异。第二个目标是确定改变男女同性恋者精神健康/物质使用发病率风险的因素，包括艾滋病毒感染状况、歧视经历、社会支持水平和社区特征。进一步的目标是调查在寻求服务的人群中，特定于性取向的障碍和接受护理的障碍、服务质量指标和满意度方面的差异。研究结果将澄清少数性取向者精神健康/物质使用发病率过高风险的性质和基础，并确定促进复原力的因素。结果还将提供有关服务提供问题的关键信息，协助设计有效的干预措施。

DESCRIPTION (provided by applicant): Recent epidemiologic studies using existing population-based health datasets repeatedly find elevated risk for mental health morbidity and mental health services use among lesbians, gay men or individuals likely to be of minority sexual orientation. In particular, greater than expected prevalences of stress sensitive disorders (e.g. depression, anxiety, and substance use dependency) have been repeatedly observed. Unfortunately, current methodological limitations in the existing datasets (primarily low statistical power, indirect measurement of sexual orientation, and lack of measurement of probable sexual orientation-specific effect modifiers) hampers understanding of the mental health services needs in this at risk population. In response to NIMH PA-01-096, the current application proposes to capitalize on information available from the biennial California Health Interview Survey (CHIS) to examine mental health morbidity and mental health-related services use among lesbians and gay men. We will reinterview a systematic sample of 2,700 CHIS II participants, oversampled for minority sexual orientation, to conduct an assessment of the relationships among mental health, substance use, and sexual orientation-specific issues. We will compare individuals varying in sexual orientation in order to investigate differences in prevalence of mental health and substance use morbidity, patterns of mental health and substance use comorbidity, and use of mental health and substance-related services. A second goal is to identify factors that modify mental health/substance use morbidity risk among lesbians and gay men, including HIV infection status, experiences with discrimination, levels of social support, and neighborhood characteristics. A further goal is to investigate, among those seeking services, sexual orientation-specific differences in barriers and obstacles to receiving care, indicators of services quality, and levels of satisfaction. Findings will clarify the nature and basis of excess risk for mental health/substance use morbidity among those of minority sexual orientation, as well as identify factors that promote resiliency. Results will also provide critical information about problems in service delivery, assisting efforts to design effective interventions.