Gender, Ethnicity, and Mental Health in a Rural State

描述（由申请人提供）：在关于少数民族人群心理健康治疗需求的大量文献中，对女同性恋、男同性恋、双性恋和变性人（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。我们建议开展一个为期两年的人种学项目，以调查新墨西哥州LGBT人群获得和使用心理健康服务的情况。新墨西哥州是美国拉美裔和土著居民比例最高的州之一。新墨西哥州的人口特征表明，许多LGBT人士拥有多重少数民族身份，因此可能受到各种形式的基于种族和基于LGBT的偏见和歧视。新墨西哥社区的大部分农村和经济萧条的特点可能会加剧LGBT人群所经历的社会、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。尽管有这些强大的压力源和护理障碍，我们希望在这些环境中的许多LGBT人士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，对两个农村县的LGBT服务提供者、LGBT社区成员和LGBT患者进行半结构化访谈和参与式观察，并将两个县与大都市中心进行比较。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概念化(a) LGBT人群的诊断、治疗和转诊需求的方式，以及(b)个人偏见和制度障碍对LGBT人群护理的影响。(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、西班牙裔美国人和印第安人后裔的精神痛苦和疾病体验的影响。(3)研究城乡双性恋人群心理健康问题的求助过程，记录治疗障碍和克服障碍的策略。总体目标是确保在文化上适当的、高质量的护理提供给那些获得或选择精神卫生服务有限的LGBT人群。这一目标将通过将LGBT人士纳入拟议研究的设计和执行中来实现。这项研究的结果将为LGBT心理健康的风险和保护因素提供急需的信息，这对设计有效的公共卫生预防、干预和直接护理项目至关重要。该项目还将为一项针对西南地区多个LGBT少数群体的综合研究议程奠定基础。

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.