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

性少数耻辱的社会生态学：数据协调以解决混杂偏见并调查跨层面的心理健康影响

• 批准号: 10728261
• 负责人: Arjan van der Star
• 金额: $ 47.19万
• 依托单位: SAN DIEGO STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-06-16 至 2026-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10728261
• 关键词: Address; Advocacy; Age; Attitude; Automobile Driving; Climate; Complex; Country; County; Data; Data Pooling; Data Set; Development; Disparity; District of Columbia; European; Exposure to; Feeling suicidal; Gender; Generations; Geography; Health Surveys; Heterosexuals; Individual; Inequity; Institutionalization; Laws; Legal; Libido; Life Cycle Stages; Link; Marriage; Measures; Mediating; Mental Depression; Mental Health; Modeling; National Longitudinal Survey of Adolescent to Adult Health; Neighborhoods; Outcome; Personal Satisfaction; Persons; Policies; Politics; Population; Prevalence; Public Health; Random Allocation; Reporting; Research; Risk; Sample Size; Schools; Sex Orientation; Sexuality; Shapes; Societies; Stigmatization; Suicide attempt; System; Testing; Therapeutic Intervention; US State; Urbanization; Victimization; combat; data harmonization; data integration; depressive symptoms; evidence base; gender diversity; hate crimes; health disparity; health equity; health inequalities; improved; indexing; internalized stigma; lifetime risk; multilevel analysis; novel; preventive intervention; same-sex marriage; sexual minority; sexual minority group; social stigma; structural determinants; suicidal; suicidal behavior; theories

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.

项目概要/摘要 性少数群体（即不认为自己是异性恋的人，或者被异性恋所吸引的人） 在美国，与相同或不同性别的人发生关系或发生性接触的情况已接近尾声 患抑郁症的几率增加三倍，一生自杀的风险增加两到七倍 与异性恋个体相比，各种结构性性少数群体的耻辱暴露。 水平（例如宏观水平和外泌体水平）被认为是这些性行为的潜在原因和驱动因素 基于取向的心理健康差异。而性少数群体耻辱的结构性形式，包括 歧视性法律、不公平的政策和消极的民众态度与不利的行为有关。 性少数群体心理健康，来自美国研究的证据，取决于单一独立指标 结构性耻辱，受到来自其他 1) 的常见原因造成混杂偏见的风险的阻碍 更高级别和2）同级别的结构性耻辱相关因素，以及3）经常被忽视的结构性因素 在耻辱范式之外，现有的大型美国公共卫生调查不允许独立进行分析。 这可以充分解释这种混杂的偏差。但是跨数据集的数据协调和集成（即， NHIS、Add Health、YRBS 和 ABCD）将通过新开发的综合宏观数据启用复杂模型 （即州）和外层（即县）个人心理层面的结构性性少数群体耻辱预测因素 健康结果、足够的聚类和足够大的平均聚类大小。 美国性少数群体的转型期（2001年至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 共同， 提供一个千载难逢的及时机会来协调和整合这些数据集，以实现 复杂的多层次模型，解释了混杂偏见的风险，并有助于进一步加强因果关系 因此，这项拟议的研究将 1) 协调和汇集来自多达 42,000 名性行为的高质量数据。 少数民族和140万异性恋个体，2）全面量化结构性性水平 2001 年至 2021 年间美国各州和县的少数族裔耻辱暴露情况，以及 3) 检查横截面数据 以及结构性性少数群体耻辱的跨层面（即宏观到外在）影响之间的纵向关联 抑郁症状和自杀结果（即自杀意念和自杀行为）。 拟议的研究可能具有直接的理论和应用意义，因为它解决了重要的问题 目前混淆的问题扭曲了关于宏观和外在层面结构性少数群体耻辱如何影响的研究结果 塑造性少数群体的心理健康，结果可能通过促进有针对性的方式进一步促进健康公平。 倡导和治疗干预措施，以改善性少数群体的结构性气候和系统性打击 影响不仅在美国，而且在全球也同样如此。