{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T08:15:36Z","timestamp":1790842536032,"version":"4.1.0"},"posted":{"date-parts":[[2023,4,17]]},"group-title":"Epidemiology","reference-count":55,"publisher":"openRxiv","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2023,4,17]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                <jats:p>This study examined how race\/ethnicity, sex\/gender, and sexual orientation intersect to socially pattern depression among US adults. We used repeated, cross-sectional data from the 2015-2020 National Survey on Drug Use and Health (NSDUH; n=234,772) to conduct design-weighted multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) for two outcomes: past-year and lifetime major depressive episode (MDE). With 42 intersectional groups constructed from seven race\/ethnicity, two sex\/gender, and three sexual orientation categories, we estimated group-specific prevalence and excess\/reduced prevalence attributable to intersectional effects (i.e., two-way or higher interactions between identity variables). Models revealed heterogeneity between intersectional groups, with prevalence estimates ranging from 3.4\u201331.4% (past-year) and 6.7\u201347.4% (lifetime). Model main effects indicated that people who were Multiracial, White, women, gay\/lesbian, or bisexual had greater odds of MDE. Additive effects of race\/ethnicity, sex\/gender, and sexual orientation explained most between-group variance; however, approximately 3% (past-year) and 12% (lifetime) were attributable to intersectional effects, with some groups experiencing excess\/reduced prevalence. For both outcomes, sexual orientation main effects (42.9\u201354.0%) explained a greater proportion of between-group variance relative to race\/ethnicity (10.0\u201317.1%) and sex\/gender (7.5\u20137.9%). Notably, we extend MAIHDA to calculate nationally representative estimates to open future opportunities to quantify intersectionality with complex sample survey data.<\/jats:p>","DOI":"10.1101\/2023.04.13.23288529","type":"posted-content","created":{"date-parts":[[2023,4,18]],"date-time":"2023-04-18T02:15:32Z","timestamp":1681784132000},"source":"Crossref","is-referenced-by-count":3,"title":["Depression at the intersection of race\/ethnicity, sex\/gender, and sexual orientation in a nationally representative sample of US adults: A design-weighted MAIHDA"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0522-2748","authenticated-orcid":false,"given":"F. 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