The Relationship of Stressors in Health Care to Emotional and Physical Symptoms Experienced by Marginalized People

项目摘要 性别少数的人（GM;性别与分配的性别不一致的人） 他们出生时）的残疾，慢性病和精神健康状况不佳的比率也显着较高 死亡率高于顺性别个体（性别与他们的性别一致的人）， 出生时分配）。这些健康差异与慢性压力有关， 他们遇到的压力。定性研究的证据表明，与医疗保健的相互作用 环境可能是影响转基因人寻求护理意愿的主要压力来源。不过小 关于医疗保健中的压力源和情绪困扰症状之间的关系， 或转基因个体经历的身体功能受损，或者一些性别认同群体是否可能 比其他人更容易受到医疗保健方面的压力因素的负面影响。此外，很少有心理上健全的 目前已有开展这类研究的措施。本研究的目的是解决这些差距， 知识2015年美国跨性别调查（USTS）的数据将被分析，以确定因素 这可能是转基因人在医疗保健互动中的压力源的基础， 这些压力源构成了一个有效和可靠的指标，供今后在转基因研究中使用。这些项目没有被 作为一组进行有效性和可靠性测试。此外，这项研究将研究可能存在的关系， 健康护理互动中的压力源与情绪困扰和身体受损的症状之间的关系 在转基因人中发挥作用情绪困扰是衡量与凯斯勒的心理困扰 规模评估身体功能的项目改编自CDC的行为风险因素监测 系统和全国健康访谈调查。症状管理理论将为研究提供信息。 目的1：通过评估USTS压力源，确定可能导致医疗保健互动中压力源的关键因素 因素结构和内部一致性的项目。 目的2：确定在医疗保健互动中暴露于压力源与症状之间的关系 转基因人经历的（情绪困扰和身体功能受损），在控制 社会经济因素（如年龄、收入、教育、种族/民族）。 目标3：评估性别认同作为医疗保健压力源和 情绪困扰和身体功能受损的症状。 评估转基因医疗压力源的潜在措施可以提高该领域研究的质量。 研究结果也可以用来为干预措施和政策指导提供信息，以改善转基因的医疗保健。 人们通过减少症状负担经历。为实现这些目标而获得的培训和经验 研究结果将为本研究者的研究发展计划提供坚实的基础。

Project Summary People who are gender minority (GM; people whose gender is incongruent with the sex that was assigned to them at birth) experience significantly higher rates of disability, chronic disease, and poor mental health as well as higher mortality than cisgender individuals (people whose gender is congruent with the sex they were assigned at birth). These health disparities have been linked to chronic stress associated with multiple stressors they encounter. There is evidence from qualitative studies that interactions with the health care environment may be a major source of stress that affects GM people’s willingness to seek care. However, little is known about the relationship between the stressors in health care and the symptoms of emotional distress or impaired physical functioning experienced by GM individuals or whether some gender identity groups may be more negatively affected by stressors in health care than others. In addition, few psychometrically sound measures are available to conduct such studies. The purpose of this study is to address these gaps in knowledge. Data from the 2015 United States Transgender Survey (USTS) will be analyzed to identify factors that may underlie stressors in health care interactions for GM people and whether survey items related to these stressors constitute a valid and reliable index for future use in GM research. These items have not been tested as a group for validity and reliability. Additionally, this research will examine relationships that may exist between stressors in health care interactions and symptoms of both emotional distress and impaired physical functioning among people who are GM. Emotional distress is measured with Kessler’s Psychological Distress Scale. Items to assess physical functioning are adapted from CDC’s Behavioral Risk Factor Surveillance System and the National Health Interview Survey. Symptom Management Theory will inform the study. Aim 1: Identify key factors that may underlie stressors in health care interactions, by evaluating USTS stressor items for factor structure and internal consistency. Aim 2: Determine the relationship between exposure to stressors in health care interactions and symptoms experienced by GM people (emotional distress and impaired physical functioning), after controlling for socioeconomic factors (e.g. age, income, education, race/ethnicity). Aim 3: Evaluate the potential role of gender identity as a moderator between health care stressors and symptoms of both emotional distress and impaired physical functioning. Evaluating a potential measure of GM health care stressors can enhance the quality of research in the field. Findings can also be used to inform interventions and policy guidelines that will improve health care for GM people by reducing the symptom burden experienced. The training and experience acquired to achieve these outcomes will provide a solid foundation for this investigator’s developing program of research.