Innovating Intersectional Methods to Identify Mental Health Disparities from Adolescence to Adulthood

About This Grant

PROJECT SUMMARY/ABSTRACT The goal of the F99/K00 award is to provide Talia Kieu, MSPH, with the training needed to become an independent investigator focused on using advanced methods to identify the risk and protective factors of mental health outcomes among populations with multiple marginalized identities across the life course, as well as provide resources to augment and support researcher diversity. In 2019, the economic burden of major depressive disorder in the United States was estimated at $333.7 billion. Those with multiple marginalized identities (e.g., a low-income Black woman) are more likely to experience severe and persistent depression than those with a single or no marginalized identities. Depressive symptoms may be reflective of experienced life events; therefore, examining social conditions from adolescence and their effect into adulthood is critical to understand. Current literature on depression outcomes primarily sums the effects of social identities (e.g., race, sex) without exploring their multiplicative effects (i.e., how being both Black and a woman may uniquely compound risks for depression compared to each identity alone), often relying on cross-sectional analyses, which may contribute to the mixed findings in the current depression disparities literature. These conflicting findings highlight the need for a more nuanced understanding of how depression manifests longitudinally in marginalized populations. It is equally important to identify protective factors, such as social integration—the degree in which an individual is connected to their social environment. Research in the F99 phase (Aim 1) addresses these gaps by investigating 1) how depression evolves over the life course in those with multiple marginalized identities; 2) how multiple marginalized identities can have compounding, multiplicative effects on depression outcomes; and 3) how social integration manifests as a protective factor. Findings from this study will have implications for practice by identifying vulnerable populations and exploring strengths-based, protective factors for mental health interventions. Mental health interventions should also be well timed. Some marginalized populations, such as sexual/gender minority (SGM) communities, experience off-time sensitive periods due to multiple forms of stigma, which may result in overlooking optimal timing for mental health interventions. There is a need to examine how early-life experiences and off-time sensitive periods shape the mental health of SGM populations. Research in the K00 phase (Aim 2) will address these gaps by collecting mixed-methods data to 1) retrospectively explore the impact of holding multiple marginalized identities on the sensitive periods and mental health trajectories of older, SGM individuals of color; 2) explore the long-term impacts of adolescent experiences; and 3) validate findings through intergenerational member-checking sessions with adolescent and older SGM individuals. Findings from this study will have practical implications for timing mental health interventions effectively, and tailoring interventions to facilitate the protective qualities of SGM communities.