PROJECT SUMMARY
PA-21-048 Ruth L. Kirschstein National Research Service Award Individual Postdoctoral Fellowship, NOT-MD-
19-001 (Notice of Special Interest in Research on the Health of Sexual and Gender Minority (SGM) Populations):
The coronavirus disease 2019 (COVID-19) pandemic has had a profound negative impact on population mental
health in the United States, especially for marginalized populations such as sexual minorities (SMs). Emerging
research suggests that this disparity is driven by minority stress processes (e.g., stigma) and structural
vulnerabilities (e.g., institutional oppression) that systematically expose SMs to more pandemic-related stressors
and exacerbate their effects. However, critical knowledge gaps remain regarding the intersectional distribution
and upstream (i.e., social and structural) determinants of COVID-19-related disparities in mental health. To
address these gaps, the current project will draw on minority stress, intersectionality, and ecosocial frameworks
to examine how multiple dimensions of social identity/position and upstream pandemic-related stressors have
jointly impacted population mental health for SMs over the course of the pandemic. Leveraging unprecedented
data from the COVID-19 Pandemic Sub-Study (a population-based longitudinal cohort study embedded within
the Nurses’ Health Study 2 & 3 and the Growing Up Today Study with N>57,000) and novel analytic methods
from social, spatial, and legal epidemiology, the project aims are to: 1) estimate the time-varying prevalence of
mental health symptoms (i.e., depressive, anxiety, and eating disorder symptomology) over the first year of the
COVID-19 pandemic across groups jointly defined by sexual orientation, gender, and race/ethnicity; 2) evaluate
whether the prevalence patterns observed in Aim 1 are related to the spatiotemporal distribution characteristics
of COVID-19 morbidity and mortality (e.g., county-level mortality rate); and 3) evaluate whether the prevalence
patterns observed in Aim 1 are related to the broader pandemic policy environment (e.g., lockdowns/stay-at-
home orders, with or without concomitant economic relief efforts). These aims are consistent with the stated
priorities in the NIH FY 2021–25 Strategic Plan to Advance Research on the Health & Well-Being of Sexual &
Gender Minorities, and importantly, are of urgent relevance to public health. Ultimately, the proposed project will
provide a more nuanced and contextualized understanding of SM mental health during the ongoing COVID-19
pandemic, with the intent of generating knowledge that can inform the development and implementation of much-
needed mental health equity efforts. A tailored mentored training plan accompanies this proposal and outlines
the steps required to advance the Applicant’s career as an independent investigator with expertise in conducting
methodologically-rigorous and theoretically-informed SM mental health disparities research.
