Gender, Ethnicity, and Mental Health in a Rural State

说明(申请人提供)：在关于少数群体精神健康治疗需求的大量文献中，对女同性恋者、男同性恋者、双性恋者和变性者(LGBT)的关注很少，特别是那些生活在种族多样化的农村地区的人。我们提出了一个为期两年的民族志项目，以检查新墨西哥州LGBT人群心理健康服务的可用性和使用情况。新墨西哥州是美国拉美裔和美国原住民比例最高的州之一。新墨西哥州的人口特征表明，许多LGBT人士拥有多种少数群体身份，因此可能受到不同形式的基于种族和LGBT的偏见和歧视。新墨西哥社区以农村和经济萧条为主的特点可能会加剧LGBT人群经历的社会、经济和心理压力，并加剧这一种族多样化人口的心理健康需求。尽管有如此强大的压力源和护理障碍，我们预计在这些环境中的许多LGBT者已经制定了可行的应对策略，促进积极的心理健康。为了更好地了解农村生活对LGBT人群心理健康需求的影响，我们提出了一项研究，对两个农村县和两个有大都市中心的县的提供者、LGBT社区成员和LGBT患者进行半结构式访谈和参与式观察。我们的三个具体目标是：(1)评估农村和城市地区的精神卫生服务提供者将(A)LGBT患者的诊断、治疗和转诊需求概念化的方式，以及(B)个人偏见和照顾LGBT患者的体制障碍的影响。(2)评估性别认同、性别角色、性取向和不同形式的歧视对非裔美国人、盎格鲁人、西班牙人和美洲原住民LGBT人群精神困扰和疾病经历的影响。(3)审查农村和城市有精神健康问题的LGBT者的求助过程，记录护理障碍和LGBT克服障碍的战略。总体目标是确保为获得心理健康服务的机会或选择有限的LGBT人群提供文化上适当的高质量护理。将通过将同性恋、双性恋和变性者纳入拟议研究的设计和执行来实现这一目标。这项研究的结果将提供有关LGBT心理健康特有的风险和保护因素的迫切需要的信息，这对于设计有效的公共卫生预防、干预和直接护理计划至关重要。该项目还将为针对西南部多个少数群体LGBT人群的全面研究议程奠定基础。

DESCRIPTION (provided by applicant): In the extensive literature on the mental health treatment needs of minority populations, scant attention has been given to lesbian, gay, bisexual, and transgender (LGBT) persons, particularly those living in ethnically-diverse, rural areas. We propose a two year ethnographic project to examine the availability and use of mental health services for LGBT persons in New Mexico. New Mexico is one of the states with the highest percentages of Hispanic and Native American residents in the U.S. The demographic characteristics of New Mexico suggest that many LGBT persons possess multiple minority status and, thus, may be subject to varying forms of ethnic-based as well as LGBT-based prejudice and discrimination. The largely rural and economically depressed character of New Mexican communities may intensify social, financial, and psychological stress experienced by LGBT persons, and exacerbate the mental health needs of this ethnically diverse population. In spite of such powerful stressors and barriers to care, we expect that many LGBT persons in these settings have developed viable coping strategies that promote positive mental health. With the intent of better understanding the effect of rural living on the mental health needs of LGBT persons, we propose a study to conduct semi-structured interviews and participant observation among providers, LGBT community members, and LGBT patients in two rural counties and, as a comparison, two counties with metropolitan centers. Our three specific aims are: (1) To assess the ways that mental health providers serving rural and urban areas conceptualize (a) the diagnostic, treatment, and referral needs of LGBT persons and (b) the effect of personal bias and institutional barriers to care for LGBT persons. (2) To assess the ways that gender identity, gender role, sexual orientation, and varying forms of discrimination affect the experience of mental distress and illness among LGBT persons of African American, Anglo, Hispanic, and Native American descent. (3) To examine the help-seeking processes of rural and urban LGBT persons with mental health problems, documenting both barriers to care and LGBT strategies for overcoming impediments. The overall objective is to ensure the availability of culturally appropriate, quality care for those segments of the LGBT population that have limited access to or choice of mental health services. This objective will be achieved through the inclusion of LGBT persons in the design and execution of the proposed research. The results of this research will provide much needed information on both risk and protective factors specific to LGBT mental health, which is essential to the design of effective public health prevention, intervention, and direct care programs. This project also will lay the groundwork for a comprehensive research agenda targeting multiple minority status LGBT persons in the Southwest.