Identifying Transdiagnostic Intervention Targets for PTSD-SUD Comorbidity in a Vulnerable Population: A Mixed-Method Study

确定弱势群体 PTSD-SUD 合并症的跨诊断干预目标：混合方法研究

• 批准号: 10726507
• 负责人: Madalyn Michele Liautaud
• 金额: $ 5.37万
• 依托单位: HUNTER COLLEGE
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-01 至 2025-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10726507
• 关键词: Adult; Behavior; Biological; Cannabis; Caring; Chronic; Chronic Disease; Client; Clinical; Clinical Sciences; Clinical Treatment; Collection; Criminal Justice; Data; Development; Diagnostic; Discrimination; Disease; Disparity; Drug Addiction; Drug usage; Ecological momentary assessment; Empirical Research; Evaluation; Exposure to; Funding; Future; Gender Identity; Goals; Health; Healthcare; Hormones; Hydrocortisone; Illicit Drugs; Incidence; Individual; Individual Differences; Interpersonal Violence; Intervention; Interview; Life; Link; Measures; Mediating; Mediator; Methods; Minority; Minority Groups; Modeling; Morbidity - disease rate; National Institute of Drug Abuse; Neurosecretory Systems; Nicotine; Parents; Participant; Pathway interactions; Patient Self-Report; Pattern; Persons; Pharmaceutical Preparations; Physiological; Population; Population Heterogeneity; Population Intervention; Post-Traumatic Stress Disorders; Prevalence; Public Health; Quality of life; Recording of previous events; Research; Research Priority; Resources; Risk; Risk Factors; Salivary; Sampling; Severities; Shame; Shapes; Social Environment; Source; Stress; Structure; Substance Use Disorder; Surveys; Symptoms; System; United States National Institutes of Health; Violence; Vulnerable Populations; Work; biological adaptation to stress; biopsychosocial; cisgender; clinical center; clinical decision-making; clinical diagnostics; clinical risk; comorbidity; cost; design; disorder risk; drug use behavior; emotion dysregulation; emotion regulation; epidemiological model; evidence base; experience; falls; gender diversity; gender minority group; gender minority stress; health equity; high risk population; impaired productivity; innovation; internalized stigma; minority stress; modifiable risk; mortality; multiple chronic conditions; novel; patient oriented; physical conditioning; prospective; psychobiologic; psychologic; psychosocial; recruit; salivary immunoassay; social; social health determinants; social stigma; stress reactivity; substance use; syndemic; theories; transgender; trauma exposure; violence exposure; virtual

Project Summary This study aims to identify transdiagnostic mechanisms of posttraumatic stress disorder (PTSD)-substance use disorder (SUD) comorbidity among trauma-exposed transgender and gender diverse (TGD) adults. Significance: TGD populations are virtually absent from PTSD-SUD research despite the alarming and disproportionately high rates of exposure to violence, PTSD, and SUD observed in this population. Existing theory suggests that these disparities are driven by cumulative exposure to stigma associated with having a minoritized gender identity (i.e., gender minority stress). To inform the development of integrated PTSD-SUD interventions for TGD and other minoritized people, research is needed to identify transdiagnostic, culturally-congruent mechanisms of PTSD-SUD risk in the context of chronic exposure to minority stress. Objectives and methods: Chiefly, the proposed study is designed to clarify how population-level PTSD-SUD disparities manifest psychosocially (i.e., via daily behaviors and internal/external experiences) and physiologically (i.e., within the body) to inform the development of evidence-based, integrative PTSD-SUD treatment principles. Leveraging the resources and baseline data of an existing parent study (SC3 GM136580; PI: Berke), I will recruit 70 TGD adults into a two-part study. Following a baseline biopsychosocial assessment (i.e., clinical interview, salivary stress hormone collection, self-report surveys), participants will complete ecological momentary assessment (EMA) for 14 days to assess patterns and predictors of daily co-fluctuation in exposure to gender minority stress (e.g., discrimination), substance use, and PTSD symptoms. This will be achieved by characterizing concurrent and prospective associations of daily co-occurrence among discrimination exposure, substance use, and PTSD symptoms (Aim 1) and identifying transdiagnostic mediators (i.e., internalized stigma, emotion dysregulation; Aim 2) and physical health risk correlates (i.e., chronic disease prevalence, stress hormone reactivity; Aim 3) of these associations. Innovation: This study leverages a novel, unified biopsychosocial framework that accounts for relevant biological (e.g., stress response dysregulation), psychological (e.g., emotion dysregulation), and socio-environmental (e.g., stigma) factors that shape PTSD-SUD risk in this population. Identifying modifiable risk factors that cut across PTSD, SUD, and the conditions of gender minority stress in which they co-occur will directly inform future development of transdiagnostic, integrated PTSD-SUD intervention frameworks for TGD people by yielding rich biopsychosocial data on clinical risk factors for PTSD-SUD comorbidity among TGD people. Findings from the project will also set the stage for research and intervention paradigms that benefit all minoritized subpopulations that are disproportionately impacted by identity-related violence by promoting a shift toward more patient-centered approaches to health equity interventions. Proposal relevant to NOT-MD-19-001.

项目总结