The Mental Health Consequences of Life Course-Varying Exposure to Structural Sexual Minority Stigma: Advancing Causal Inference Using Longitudinal Models Moderated by Sexual Orientation

不同生命周期暴露于结构性性少数耻辱的心理健康后果：使用以性取向为调节的纵向模型推进因果推理

• 批准号: 10576079
• 负责人: Arjan van der Star
• 金额: $ 7.53万
• 依托单位: SAN DIEGO STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-12-08 至 2024-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10576079
• 关键词: Address; Adolescent; Adult; Advocacy; Affect; Attitude; Automobile Driving; Climate; Data; Data Set; Development; Disparity; Dose; Education; Elements; Etiology; European; Exposure to; Feeling suicidal; Gender; Health; Heterosexuals; Individual; Inequity; Institutionalization; Laws; Legal; Libido; Life Cycle Stages; Literature; Longitudinal Studies; Maps; Marriage; Mental Depression; Mental Health; Modeling; National Longitudinal Survey of Adolescent to Adult Health; Outcome; Participant; Pattern; Persons; Policies; Population; Public Health; Reporting; Research; Risk Factors; Role; Sex Orientation; Shapes; Specificity; Statutes and Laws; Stretching; Suicide attempt; Time; US State; Violence; depressive symptoms; design; gender diversity; health disparity; health equity; improved; indexing; internalized stigma; lifetime risk; middle age; migration; programs; public health research; residence; response; secondary analysis; sexual minority; sexual minority youth; social stigma; theories; young adult

PROJECT SUMMARY 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 two to seven-fold increased risk for lifetime report of suicide attempts and a near three-fold increased odds for depression. Sexual minority stigma exposure, in its various forms, 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 in cross-sectional designs, no longitudinal studies to date have examined three key elements needed to establish causality, including 1) temporality with the exposure preceding the effect, 2) dose-response gradient comprehensively assessed across the life course, and 3) specificity of results with the exposure explaining an observed disparity in outcomes. With data collected during a transformational period for sexual minorities in the US (from 2001 to 2018 with, e.g., changes in population attitudes and the step-wise introduction of same-gender marriage), the National Longitudinal Study of Adolescent to Adult Health (Add Health) provides a unique and timely opportunity to longitudinally examine the effect of life-course structural stigma exposure on sexual minorities’ mental health and the three missing causality requirements. Therefore, this proposed study will 1) quantify the level of structural sexual minority stigma for each US state between 2001 and 2018 and calculate individuals’ exposure over time, 2) examine the associations between structural sexual minority stigma and suicidal ideation, suicide attempts, and depressive symptoms in longitudinal models, and 3) examine if the associations between structural sexual minority stigma and mental health outcomes in longitudinal models vary by sexual orientation. The proposed study will employ advanced three-level multi-membership longitudinal models to account for lifetime-varying exposure and between-state migration. Findings from the proposed study may have direct theoretical and applied implications as it addresses important causality issues on how structural sexual minority stigma shapes sexual minorities’ mental health. Results may further contribute to health equity by facilitating targeted advocacy to improve structural climates for sexual minorities, not only in the US, but similarly across the globe.

项目概要 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比例为 2 终生报告自杀未遂的风险增加了七倍，自杀的几率增加了近三倍 各种形式的性少数群体耻辱被认为是抑郁症的一个根本原因。 并推动这些基于性取向的心理健康差异，同时推动性的结构形式。 少数群体的耻辱，包括歧视性法律、不公平政策和消极的民众态度， 在横断面设计中与不良性少数心理健康相关，但没有纵向研究 迄今为止，我们已经研究了建立因果关系所需的三个关键要素，包括 1）时间性 效应发生前的暴露，2) 在整个生命过程中全面梯度评估剂量反应， 3) 暴露结果的特异性解释了观察到的结果差异。 收集于美国性少数群体转型时期（2001 年至 2018 年，例如： 人口态度的变化和逐步引入同性婚姻），国家 青少年到成人健康的纵向研究（Add Health）提供了一个独特而及时的机会 纵向研究生命全程结构性耻辱暴露对性少数群体心理健康的影响 以及三个缺失的因果关系要求因此，这项研究将 1) 量化的水平。 2001年至2018年间美国各州的结构性性少数群体耻辱并计算个人的暴露程度 随着时间的推移，2）检查结构性性少数群体耻辱与自杀意念、自杀之间的关联 纵向模型中的尝试和抑郁症状，以及3）检查之间的关联是否 纵向模型中的结构性性少数群体耻辱和心理健康结果因性取向而异。 拟议的研究将采用先进的三级多成员纵向模型来解释 拟议研究的结果可能具有直接影响。 理论和应用意义，因为它解决了关于结构性性行为的重要因果关系问题 少数群体的耻辱影响了性少数群体的心理健康，结果可能会进一步促进健康公平。 促进有针对性的宣传，以改善性少数群体的结构性氛围，不仅在美国，而且 全球范围内也是如此。