Sexual Orientation, Discrimination, and Health Disparities in DSM-5 Alcohol Use Disorder
In response to PAR-14-338: Secondary Analyses of Existing Alcohol Epidemiology Data, this project Sexual Orientation, Discrimination, and Health Disparities in DSM-5 Alcohol Use Disorder proposes to use existing alcohol epidemiological data to examine relationships among sexual orientation, adverse childhood events, sexual orientation discrimination (individual-level and institutional-level), stress and DSM-5 alcohol use disorders (AUDs). AUDs are one of the most prevalent mental health disorders and contribute substantially to morbidity and mortality worldwide. Over 65 million adults in the U.S. will meet criteria for a DSM-5 AUD, with past research finding that sexual minorities are at increased risk for AUD. To date, no large-scale nationally representative studies have examined the epidemiology of DSM-5 AUD among sexual minorities and there is limited data on DSM-5 AUD severity, comorbidity, and disability among sexual minorities. A significant gap in knowledge remains regarding the underlying reasons why sexual minorities are more likely to meet criteria for DSM-5 AUD. Thus, we propose to build on our prior work and conduct a secondary analysis of the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-III), a nationally representative sample of 36,309 U.S. adults. The NESARC-III study comprises the only nationally representative study that has sufficient measures and sample size to test for potential age, gender, racial/ethnic and sexual orientation differences and to meet the objectives of our study, which aims to: (1) estimate the prevalence of (a) DSM-5 AUD diagnoses including severity level (mild, moderate and severe), (b) potential differences in AUD diagnoses between DSM-IV and DSM-5 criteria, and (c) DSM-5 psychiatric comorbidity associated with DSM-5 AUD based on sexual orientation (attraction, behavior, and identity); (2) assess the disability (social functioning), help seeking (e.g., self-help), and recovery (e.g., abstinence) associated with DSM-5 AUD based on sexual orientation; and (3) examine the risk factors (e.g., individual-level sexual orientation discrimination, institutional-level sexual orientation discrimination, and stressful life events) from multiple developmental domains (i.e., childhood, adolescence, adulthood and past-year) and potential moderators (e.g., age, sex, race/ethnicity, and childhood adversity) associated with DSM-5 AUD severity, psychiatric comorbidity, and disability among sexual minorities. The proposed project will benefit from the unique opportunities afforded by the 2012-2013 NESARC including: a larger nationally representative sample of sexual minority women and men than any other national alcohol study; the inclusion of multiple measures of sexual orientation based on attraction, behavior and identity; and the wealth of data on DSM-5 AUD and other DSM-5 psychiatric disorders. This study will examine the implications of changes from the DSM-IV to DSM-5 for AUDs among sexual minorities. A theory-driven approach will be utilized to assess how childhood adversity, sexual orientation discrimination, and other stressors contribute to alcohol-related health disparities among sexual minorities.
National Institute on Alcohol Abuse and Alcoholism
(1 R01 AA 025684 01)
Funding Period: 2/10/2018 to 1/31/2021