Trajectories of Adaptation to Traumatic Stress in a Vulnerable Population

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Transgender individuals are disproportionately burdened by chronic (e.g., interpersonal rejection) and acute (victimization) discrimination. According to minority stress theory, both forms of discrimination are associated with adverse mental health outcomes including PTSD, a stress sensitive disorder that may arise from exposure to life-threatening events, serious injury, or sexual assault. While PTSD effects an estimated 6.8% of the U.S. general population, prevalence estimates in transgender samples range from 18%-61%. Arguably, both PTSD and chronic and persistent threats to one’s identity in the form of everyday discrimination produce similar stress responses. Exposure to daily discrimination may also exacerbate traumatic stress responses for transgender people already exposed to traumatic stressors. However, the unique and interactive effects of these stressors are poorly understood, particularly among transgender individuals. Understanding the impact of daily discrimination on the onset, maintenance, and course of PTSD in the acute aftermath of trauma exposure has been stymied by reliance on cross-sectional and self-report methods. Longitudinal studies are needed to elucidate temporal pathways among traumatic stress, daily discrimination, and PTSD. Further, given that the leading explanatory theory for minority health disparities proposes that stressors associated with minority status lead to negative mental health outcomes through a host of shared mechanisms inter- and intrapersonal mechanisms, it is important to conduct research with gender minorities to understand the unique processes that contribute to observed disparities. Whereas the majority of transgender individuals demonstrate resilience in a context of pervasive societal oppression, uncovering biopsychosocial mechanisms underlying vulnerability to and protection against chronic trauma-related distress and functional impairment represents a key research priority. The goal of this SC3 is to fill a substantial gap in the science of adaptation to traumatic stress by examining trajectories and mechanisms of risk and resilience among transgender individuals assessed using a multimethod longitudinal approach. The PI will recruit a diverse sample of trauma-exposed transgender individuals in New York City to participate in a multimethod longitudinal research protocol. Participants who enroll in the study will complete a gold-standard clinical interview to assess PTSD symptoms and provide a salivary cortisol sample within 1-month of trauma exposure, and again at a 3, 6, and 12-month follow-up assessments. For 14-days following the baseline, 3, and 6-month assessment session, participants will also complete daily diary measures assessing degree and type of exposure to daily discrimination and putative intra- and interpersonal mechanisms of risk and resilience responses to traumatic stress. Findings from the study will culminate in the development of research and practice guidelines for the prevention and treatment of PTSD among those exposed to ongoing gender-related stigma and stress.