Suicidal and Nonsuicidal Self-Injurious Behavior in Sexual Minority Youth: Examining Modifiable Mechanisms for Treatment Development

项目总结 女同性恋者、男同性恋者、双性恋者、同性恋者和其他性少数族裔青年(SMY)比他们的 自杀想法和行为(STB)、非自杀自残(NSSI)和无数的异性恋同龄人 健康问题。具体地说，SMY对STB和NSSI的支持率比异性恋高3倍 青春年华。虽然NSSI本身就是一个主要的公共卫生问题，但它显著加剧了自杀的风险 行为。因此，检查SMY中的自杀和自残行为是联邦公共卫生的优先事项， 正如NIH PA-15-263所承认的。 心理中介框架是少数群体应激(MS)模型的一种改编，它假设MS (即，从日常的轻视或侮辱到更公开的欺凌和歧视形式的压力源 边缘化的性取向)会导致一般心理过程受损，如情绪 失调，不适应的认知过程，社交和人际困难，以及性障碍 少数群体特有的过程(例如，内在化的同性恋恐惧症)。因此，这些过程将SMY置于 增加了患精神病的风险。拟议的研究试图通过审查以下问题来解决该领域的空白 可能解释SMY中MS和STB/NSSI之间关系的潜在机制。通知人 心理调解框架以及我们自己的先导研究结果，我们试图调查 跨越四个功能领域的机制：情感(影响强度、影响调节失调、沉思和 注意偏向负面情绪)、认知(低自尊)、人际关系(社会支持不足和 人际拒绝敏感)和特定的性别少数群体(内在化的同性恋恐惧症和性行为 方向隐藏)。非常重要的是，这些假设的机制中的每一个都被发现是 与自杀风险增加相关，每一种都是潜在的干预目标。 我们提出了一项创新性的探索性研究，管理主观自我报告的测量和目标 高危SMY(N=60)的行为任务，从不同的临床环境招募。我们将检查多发性硬化是否 与特定的情感、认知、人际和群体特定机制有关，以及 这些指标是否依次与SMY的STB/NSSI相关(目标1)。使用每日日记的方法，我们将 检查假设的这些机制在多大程度上解释了MS和 自然环境中的STB/NSSI(目标2)。我们还将进行Timeline Followback采访 参与者在每日日记阶段结束时。为了通报未来干预措施的发展情况，我们还 建议对同一SMY参与者(n=20)的高危部分进行深入访谈，以更好地 了解他们在这些机制、应对和治疗方面的经验。这项研究的发现将 论证进行更大规模的前瞻性R01研究的可行性，以阐明 SMY中NSSI/STB的风险增加，以及开发有效和对文化敏感的干预措施的试点数据。

PROJECT SUMMARY Lesbian, gay, bisexual, queer and other sexual minority youth (SMY) are at greater risk than their heterosexual counterparts for suicidal thoughts and behaviors (STB), nonsuicidal self-injury (NSSI), and myriad health problems. Specifically, SMY endorse both STB and NSSI at rates 3 times greater than heterosexual youth. NSSI, while a major public health concern in its own right, significantly exacerbates risk for suicidal behavior. Thus, examining suicidal and self-injurious behaviors among SMY is a federal public health priority, as acknowledged by NIH PA-15-263. The psychological mediation framework, an adaptation of the minority stress (MS) model, posits that MS (i.e., stressors ranging from daily slights or insults to more overt forms of bullying and discrimination related to marginalized sexual orientation) leads to impaired general psychological processes, such as emotional dysregulation, maladaptive cognitive processes, and social and interpersonal difficulties, as well as sexual minority group-specific processes (e.g., internalized homophobia).Consequently, these processes put SMY at increased risk for psychopathology. The proposed research seeks to address gaps in the field by examining potential mechanisms that may account for the relationship between MS and STB/NSSI in SMY. Informed by the psychological mediation framework as well as our own pilot research findings, we seek to investigate mechanisms across four areas of functioning: affective (affect intensity, affect dysregulation, rumination, and attention bias to negative affect), cognitive (low self-esteem), interpersonal (insufficient social support and interpersonal rejection sensitivity) and sexual minority-group specific (internalized homophobia and sexual orientation concealment). Very importantly, each of these hypothesized mechanisms have been found to be associated with increased risk for suicidality, and each represent potential targets of intervention. We propose an innovative exploratory study, administering subjective self-report measures and objective behavioral tasks to high risk SMY (N=60), recruited from various clinical settings. We will examine whether MS is associated with specific affective, cognitive, interpersonal, and group-specific mechanisms, and whether these are in turn associated with STB/NSSI in SMY (Aim 1). Using a daily diary approach, we will examine the extent to which hypothesized these mechanisms account for the relationship between MS and STB/NSSI in their natural environment (Aim 2). We will also conduct Timeline Followback interviews with all participants at the end of the daily diary phase. To inform the development of future interventions, we also propose conducting in-depth interviews with an at-risk subset of the same SMY participants (n=20) to better understand their experiences with these mechanisms, coping, and treatment. Findings from this study would demonstrate feasibility for a larger-scale, prospective R01 study to elucidate the mechanisms underlying the increased risk for NSSI/STB in SMY and pilot data to develop effective and culturally-sensitive interventions.