Trajectories of Adaptation to Traumatic Stress in a Vulnerable Population

弱势群体对创伤应激的适应轨迹

• 批准号: 10701731
• 负责人: Danielle Shea Berke
• 金额: $ 11.7万
• 依托单位: HUNTER COLLEGE
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-01 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10701731
• 关键词: Acute; Address; Affect; Chronic; Clinical; Cognition; Data; Development; Discrimination; Disease; Disparity; Distress; Enrollment; Etiology; Evaluation; Event; Exposure to; Foundations; Gender; General Population; Goals; Health behavior; Hydrocortisone; Individual; Individual Differences; Injury; Intervention; Interview; Lead; Life; Literature; Longitudinal Studies; Maintenance; Measures; Mental Health; Methods; Minority; Modeling; Neurosecretory Systems; New York City; Outcome; Participant; Pathway interactions; Patient Self-Report; Pattern; Persons; Population; Post-Traumatic Stress Disorders; Practice Guidelines; Prevalence; Prevention; Prevention Guidelines; Process; Protocols documentation; Research; Research Priority; Research Project Grants; Risk; Risk Factors; Risk Marker; Salivary; Sampling; Science; Severities; Stress; Subgroup; Survivors; Symptoms; Time; Trauma; Victimization; Vulnerable Populations; biological adaptation to stress; biopsychosocial; coping; design; diaries; emotion regulation; follow up assessment; functional disability; gender minority; gender minority stress; health disparity; high risk; minority health disparity; minority stress; post-trauma exposure; recruit; research and development; resilience; resilience factor; response; salivary immunoassay; sexual assault; social stigma; stressor; theories; transgender; trauma exposure; traumatic stress

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.

跨性别者不成比例地承受着慢性（例如，人际排斥）和急性 歧视（discrimination）。根据少数民族压力理论，这两种形式的歧视是相关的， 有不良心理健康结果，包括创伤后应激障碍，一种可能因暴露而引起的压力敏感性疾病， 危及生命的事件、严重伤害或性侵犯。虽然PTSD影响了估计6.8%的美国人， 在一般人群中，变性人样本的患病率估计为18%-61%。可以说，创伤后应激障碍 以及以日常歧视的形式对一个人身份的长期和持续的威胁， 应激反应暴露于日常歧视也可能加剧创伤性应激反应， 已经暴露在创伤压力源下的变性人然而， 人们对这些压力源知之甚少，特别是在变性人当中。了解影响 在创伤后急性期对PTSD的发作、维持和病程的日常辨别 由于依赖横截面和自我报告的方法，接触受到阻碍。纵向研究 需要阐明创伤性应激、日常歧视和创伤后应激障碍之间的时间通路。此外，鉴于 少数民族健康差异的主要解释理论提出，与少数民族健康差异相关的压力源， 少数群体地位通过一系列共同的机制导致负面的心理健康结果， 自我机制，重要的是与性别少数群体进行研究，以了解独特的 导致观察到的差异的过程。尽管大多数跨性别者表现出 在普遍存在的社会压迫的背景下的韧性，揭示生物心理社会机制， 对慢性创伤相关痛苦和功能障碍的脆弱性和保护是一个 重点研究。本SC 3的目标是填补创伤适应科学中的一个重大空白。 通过检查跨性别者的风险和弹性的轨迹和机制来研究压力 使用多方法纵向方法进行评估。PI将招募各种创伤暴露样本 在纽约市的跨性别者参与多方法纵向研究协议。 参加这项研究的参与者将完成一个黄金标准的临床访谈，以评估创伤后应激障碍症状 并在创伤暴露后1个月内提供唾液皮质醇样本，并在第3、6和12个月时再次提供。 后续评估。在基线、3个月和6个月评估会议后的14天内，参与者 还将完成每日日记测量，评估每日遭受歧视的程度和类型， 假定的内部和人际机制的风险和弹性反应创伤压力。结果 研究的结果将最终导致制定预防和治疗艾滋病的研究和实践指南， 治疗那些暴露于持续的性别相关的耻辱和压力的PTSD。