Project Summary Women are approximately twice as likely as men to be diagnosed with depression and anxiety, with rates increasing since the COVID-19 pandemic. Gendered health disparities extend to physical health such that while women live longer than men, women have higher levels of disability and morbidity. Researchers and health practitioners have recently called for a greater understanding of how women's mental and physical health are impacted by structural social inequality and experiences with gender-based discrimination and harassment. The proposed study analyzes the large and purposefully diverse NIH All of Us dataset to understand these gender health disparities, taking into account intersecting identities of race/ethnicity and sexual orientation. The All of Us dataset consists of comprehensive objective and subjective measures of health and social determinants of health. The proposed project has two primary aims. The first aim is to test a novel psychosocial model that describes pathways through which gender-based discrimination is related to women's health. Specifically, we seek to examine whether (a.) women's sense of control and social support moderate the association between experiences with gender-based discrimination and mental health of depression and anxiety, (b.) whether health behaviors (i.e., smoking, alcohol use, substance use) mediate the association between gender-based discrimination and mental health; and (c.) if the proposed model functions similarly for physical health, allowing for a correlation between physical and mental health. The second aim is to explore whether the proposed model accounts for women's mental health taking into account their intersecting identities. The proposed project involves sophisticated data analytic approaches, including a general linear modeling approach and multiple groups moderated mediation analyses with a model comparison approach. Given the differences in societal inequalities faced by women from marginalized groups, we seek to understand if the models' proposed moderators and mediators function similarly for subgroups (i.e., race/ethnicity and sexual identity) in order to achieve greater understanding of how mental health is associated with gender-based discrimination. Results from the proposed study will directly inform prevention and intervention efforts to address physical and mental health among women with intersecting identities. Importantly, explanatory mechanisms examined in the model are all modifiable (social support, sense of control, health behaviors) and represent key points for future interventions. Manuscripts and conference presentations will disseminate the results of the proposed analyses.

Project Narrative The proposed project will test a novel psychosocial model of women's mental health, taking into consideration women's intersecting identities of ethnicity/race and sexual orientation. The model proposes pathways by which interpersonal factors (i.e., gender-based discrimination and social support), intrapersonal factors (i.e., sense of control), and health behaviors (i.e., smoking and alcohol and substance use) are associated with women's physical and mental health outcomes (i.e., anxiety and depression). As the proposed explanatory mechanisms of sense of control, social support and health behaviors are all modifiable, the results of this study can provide insights into points of intervention to improve women's mental health.