Improving mortality data through postmortem measurement of sexual orientation and gender identity

项目摘要 健康风险文献表明，性和性别少数（SGM）的人更有可能 死于暴力死亡的人比非SGM同龄人多（例如，SGM的人有超过2-4倍的可能性 尝试自杀的人比非SGM人多），但由于性取向和性别认同（SOGI） 在死亡时没有系统地收集数据，死亡率的差异不能被 进行评估，为预防和干预提供信息。本项目的目的是展示 暴力死亡后收集SOGI的可行性。因为我们与 法医学死亡调查员，验尸官和法医，以开发死亡培训 调查人员收集SOGI数据验尸，我们的团队是独一无二的准备实现拟议的 研究目标，这符合R21机制的探索和发展目的。我们的目标 （1）评估培训死亡调查人员实施死后测量的可行性 （2）检验死亡调查人员测量的准确性 SOGI在最初的SOGI训练之后。为了进行这项研究，我们将与洛杉矶 县法医-验尸官部门和法医办公室 位于犹他州湖城的犹他州卫生部。对于目标1，我们将使用定量和定性 研究在两个地点进行培训的可行性的方法。通过每月的案例总结，我们 假设研究者进行SOGI测量的病例率将显著增加 从培训前一个月到培训后6个月。6个月后开始 培训，我们将与死亡调查人员进行半结构化访谈，以探索促进者， 在调查的动态背景下测量SOGI的障碍，并收集建议，指导， 并从他们的警告，以促进最佳做法SOGI测量死亡调查。 对于目标2，一个4人专家小组将使用文件分析来审查去 从6个类别中确定病例叙述（即，性少数，异性恋，性取向 未确定、跨性别/非二元、顺性别、性别认同未确定），确定主题 不同类别的案件在文件记录方面的异同。我们的建议 符合RFA-MD-20-005的目标，即“研究性能、效用和 新的或现有措施的可接受性”，但它采用了一种不同于典型SOGI的方法 体内测量研究，因为我们解决了阻止SOGI的主要差距 死后测量。由于这种独特的方法，拟议的研究响应 直接向国家心理健康研究所的方案利益“，以改善收集 自杀和/或其他暴力死亡后的SOGI数据。

Project Summary The health risk literature suggests that sexual and gender minority (SGM) people are more likely to die by violent death than their non-SGM peers (e.g., SGM people are over 2-4 times more likely to attempt suicide than non-SGM people), but because sexual orientation and gender identity (SOGI) data are not systematically collected at the time of the death, disparities in mortality cannot be assessed to inform prevention and intervention. The goal of this proposed project is to demonstrate the feasibility of collecting SOGI following a violent death. Because we have worked closely with medicolegal death investigators, coroners, and medical examiners to develop a training for death investigators to gather SOGI data postmortem, our team is uniquely poised to achieve the proposed study goal, which befits the exploratory and developmental purposes of the R21 mechanism. We aim to: (1) assess feasibility of training death investigators to implement postmortem measurement of SOGI among decedents of violent death, and (2) examine death investigators' fidelity of measuring SOGI after the initial SOGI training. To conduct this research, we will partner with the Los Angeles County Department of the Medical Examiner-Coroner and the Office of the Medical Examiner for the Utah Department of Health in Salt Lake City, UT. For Aim 1, we will use quantitative and qualitative methods to examine feasibility of training at both sites. Using monthly case summaries, we hypothesize that the rate of investigators' cases with SOGI measurement will significantly increase over time from one-month prior to training through 6 months after training. Beginning 6-months post training, we will conduct semi-structured interviews with death investigators to explore facilitators and barriers of measuring SOGI in the dynamic contexts of investigations and gather advice, guidance, and caveats from them to contribute to best practices for SOGI measurement in death investigation. For Aim 2, a 4-person expert panel will use document analysis to review random samples of de- identified case narratives from 6 categories (i.e., sexual minority, heterosexual, sexual orientation undetermined, transgender/non-binary, cisgender, gender identity undetermined), identifying themes of similarities and differences in documentation within and between categories of cases. Our proposal aligns with the RFA-MD-20-005 objective for “research that examines the performance, utility, and acceptability of new or existing measures,” but it takes an approach that is unique from typical SOGI measurement studies that are in vivo because we address major gaps preventing SOGI measurement postmortem. Because of this unique approach, the proposed research responds directly to the National Institute of Mental Health's programmatic interest “to improve the collection of SOGI data following a suicide and/or other violent death.”