Within the last 2 decades, research examining psychopathology among lesbians and gay men has moved away from viewing homosexuality as causal to investigating the role of social stress arising from this population's common experiences with discrimination and victimization. Consistent with a psychosocial stress model predicting that higher rates of distress and perhaps mental disorders will result, evidence suggests that lesbians and gay men may be more likely than others to experience depressive disorders, dysfunctional drug/alcohol use, and suicide attempts, though findings are mixed. In addition, research hints that lesbians and gay men may have different mental health care needs and utilization patterns. These issues, though, are largely understudied and, unfortunately, the majority of work has been hampered by critical methodological limitations, primarily a near total reliance on convenience-based sampling designs without similarly sampled heterosexual controls. A recent Institute of Medicine report on lesbian health issued in response to NIH and CDC requests for guidance on research with this population concluded that population-based studies and development of methodological improvements were needed to provide essential information about morbidity risk and protective factors. In response to the IOM recommendations and NIMH RFA PA-99-121, the current application proposes to capitalize on the existence of several population-based datasets that offer a means of examining mental health and related services use by lesbians and gay men as a population. Specifically, we will identify in 6 national surveys individuals likely to be lesbians or gay men using sexual behavior and relationship status indicators. We will then compare these samples to similarly identified heterosexual women and men in order to estimate prevalence of mental health morbidity, quality of life indicators, and treatment utilization. Findings will clarify the nature of excess psychiatric risk, as well as factors that may promote resiliency, among lesbians and gay men. A further goal of the study is to facilitate developments in research methodology with this population. To that end, we will conduct comparisons using data from population-based and previously collected convenience-based surveys (including approximately 1 0,000 lesbians) in order to identify possible demographic and mental health morbidity differences between women in the two source populations sampled. Findings will greatly assist developing more efficient sampling frames in future studies.
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