Links between social safety and health among sexual and gender minorities

University Of Utah, Salt Lake City UT

Investigators

Abstract

Project Summary/Abstract (30 lines) SGMs individuals (LGBTQ+) face significant mental and physical health disparities, but the biobehavioral mechanisms underlying these disparities are not fully understood. The proposed study tests a new theoretical model (Diamond & Alley, 2022) positing that insufficient social safety worsens SGM health by fostering chronic threat-vigilance. Social safety refers to perceptions of belongingness, inclusion, and protection by other people, which are core human needs at all stages of life. Cues of social safety in public spaces (such as seeing “welcome” signs or the presence of similar people) help us to move through our daily lives without constant threat-vigilance, by reminding us that we belong to a larger protective social fabric. Yet this protective social fabric is often withdrawn from stigmatized individuals once their identities are known, leading them to feel insufficiently safe, protected, and included in public settings. Daily experiences of insufficient safety foster chronic threat-vigilance, which increases SGM’s risks for sleep disruption, substance use, depression, anxiety, suicidal ideation/behavior, and systemic inflammation. The proposed research tests this groundbreaking new approach to SGM health with an innovative research design: We will use a custom-designed smartphone application to collect “crowdsourced” reports on the presence of social safety signals (such as seeing people like yourself or having friendly interactions with strangers) across 15 pre-selected campus settings. Participants will be 300 undergraduates (50% SGM and 30% ethnic-minority). Using these 4500 reports, we will calculate the perceived safety of each setting for (1) white SGMs, (2) ethnic-minority SGMs, (3) white non-SGMs, and (4) ethnic-minority SGMs. A subset of 30 SGM participants (30% ethnic-minority) will complete these reports while also wearing ambulatory wireless biosensing devices for 5 consecutive days (120 hours), to capture real-time changes in physiological indices of threat- vigilance (increased electrodermal activity and reduced heart-rate variability) associated with occupying safe versus unsafe settings. We predict that participants who spend a greater proportion of the 120-hour assessment period in safer settings, and who have reduced levels of concurrent threat-vigilance, will have better sleep quality, less depression and anxiety, less substance use, less self-harm/suicidal ideation, and lower systemic inflammation (an immunological risk factor directly related to chronic social threat). Our study tests an innovative theoretical model of SGM health, uses an innovative methodology (crowdsourcing with a custom-developed smartphone application), and employs innovative technology (our wireless “smartring” is the smallest available device for ambulatory electrodermal assessment). By testing prospective associations among social safety, threat-vigilance, and health outcomes in both white and ethnic-minority SGMs, this study will break new ground in our understanding of social safety as one of the key social determinants of health for marginalized populations.