The Socioecology of Sexual Minority Stigma: Data Harmonization to Address Confounding Bias and Investigate Cross-Level MentalHealth Effects

项目总结/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， 在美国，与同性或不同性别的人发生关系或发生性接触）的人数接近 患抑郁症的几率增加三倍，终生报告自杀的风险增加两到七倍。 与异性恋者相比。各种不同的结构性性少数群体的污名暴露 水平（例如，宏观和外部水平）一直被认为是这些性行为的潜在原因和驱动因素。 心理健康方面的取向差异。虽然性少数群体的结构性耻辱， 歧视性的法律、不公平的政策和消极的人口态度， 性少数心理健康，来自美国研究的证据，取决于单一的独立指标， 结构性耻辱，受到其他共同原因造成的混淆偏见风险的阻碍1） 高层次和2）同层次的结构性污名相关因素，以及3）经常被忽视的结构性因素 在污名模式之外。美国现有的大型公共卫生调查不允许独立分析 可以完全解释这种混淆的偏见。但是数据集之间的数据协调和集成（即， NHIS、Add Health、YRBS和ABCD）将通过新开发的综合宏观模型实现复杂模型， (i.e.,状态）和外能级（即，县）结构性少数性别歧视的个人层面的心理预测 健康结果，足够的集群，以及足够大的平均集群大小。在一次 美国性少数群体的转型期（从2001年到2021年;例如，人口态度的变化 以及逐步引入同性婚姻），NHIS，Add Health，YRBS和ABCD，一起， 为协调和整合这些数据集提供了一代人一次的及时机会， 复杂的多层次模型，解释混杂偏倚的风险，并有助于进一步加强因果关系， 推理。因此，这项拟议的研究将1）协调和汇集来自多达42，000名性行为者的高质量数据， 少数民族和140万异性恋者，2）全面量化结构性性的水平， 2001年至2021年期间美国各州和县的少数民族污名暴露，以及3）检查横截面 以及跨级别之间的纵向关联（即，结构性的性少数污名化的宏观到外部影响 以及抑郁症状和自杀结局（即自杀意念和自杀行为）。结果 从拟议的研究可能有直接的理论和应用的影响，因为它解决了重要的 目前混淆的问题扭曲了关于宏观和外部层面的结构性少数污名如何 塑造性少数群体的心理健康。这些结果可能通过促进有针对性的 宣传和治疗干预措施，以改善性少数群体的结构性气候， 影响，不仅在美国，而且在地球仪也是如此。

PROJECT SUMMARY/ABSTRACT 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 near three-fold increased odds for depression and a two to seven-fold increased risk for lifetime report of suicide attempts, compared with heterosexual individuals. Structural sexual minority stigma exposure across various levels (e.g., macro and exo levels) 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, evidence from US-based studies, depending on single stand-alone indicators of structural stigma, has been hampered by risks for confounding bias through common causes from other 1) higher-level and 2) same-level structural stigma-related factors, as well as 3) often-overlooked structural factors outside of the stigma paradigm. Large existing US public health surveys do not independently allow for analyses that can fully account for such confounding bias. But data harmonization and integration across datasets (i.e., NHIS, Add Health, YRBS, and ABCD) will enable complex models with newly developed comprehensive macro- (i.e., state) and exo-level (i.e., county) structural sexual minority stigma predictors of individual-level mental health outcomes, sufficient clusters, and large-enough mean cluster sizes. With data collected during a transformational period for sexual minorities in the US (from 2001 to 2021; e.g., changes in population attitudes and the step-wise introduction of same-gender marriage), the NHIS, Add Health, YRBS, and ABCD, together, provide a once-in-a-generation and timely opportunity to harmonize and integrate these datasets to enable complex multilevel models that account for the risks of confounding bias and aid to further strengthen causal inferencing. Therefore, this proposed study will 1) harmonize and pool high-quality data from up to 42,000 sexual minority and 1.4 million heterosexual individuals, 2) comprehensively quantify the level of structural sexual minority stigma exposure in US states and counties between 2001 and 2021, and 3) examine the cross-sectional and longitudinal associations between cross-level (i.e., macro to exo) effects of structural sexual minority stigma and depressive symptoms and suicidality outcomes (namely, suicidal ideation and suicidal behaviors). Findings from the proposed study may have direct theoretical and applied implications as it addresses important confounding issues currently distorting findings on how macro- and exo-level structural sexual minority stigma shape sexual minorities’ mental health. Results may further contribute to health equity by facilitating targeted advocacy and therapeutic interventions to improve structural climates for sexual minorities and combat systemic effects, not only in the US, but similarly across the globe.