Trajectories of Adaptation to Traumatic Stress in a Vulnerable Population

变性人不成比例地背负着慢性(例如，人际排斥)和急性 (受害)歧视。根据少数群体压力理论，这两种形式的歧视是相关的 有不良的心理健康后果，包括创伤后应激障碍，这是一种可能因暴露而引起的压力敏感型障碍 危及生命的事件、严重伤害或性侵犯。而据估计，美国6.8%的人患有创伤后应激障碍。 在一般人群中，变性人样本中的流行率估计在18%-61%之间。可以说，两种创伤后应激障碍 以日常歧视的形式对一个人的身份构成的长期和持续的威胁产生了类似的 压力反应。暴露在日常歧视中也可能加剧创伤应激反应 已经暴露在创伤应激源中的变性人。然而，它的独特和互动效果 人们对这些压力源知之甚少，特别是在变性人中。了解影响 创伤后急性期创伤后应激障碍的发病、维持和病程的日常辨别 由于依赖横断面和自我报告方法，风险敞口一直受到阻碍。纵向研究是 需要阐明创伤应激、日常歧视和创伤后应激障碍之间的时间路径。此外，给出了 少数族裔健康差距的主要解释理论表明，与 少数群体的地位通过一系列共同的机制导致消极的心理健康结果 个人内部机制，重要的是与性别少数群体进行研究，以了解独特的 造成观察到的差异的过程。而大多数跨性别者都表现出 普遍的社会压迫背景下的复原力，揭示了 对慢性创伤相关痛苦和功能损害的脆弱性和防护代表着 重点研究重点。这个SC3的目标是填补创伤适应科学中的一个重大空白。 通过检查变性人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。私家侦探将招募不同的创伤暴露样本 纽约市的变性人参加一项多方法纵向研究方案。 参加这项研究的参与者将完成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个月评估会议之后的14天内，参与者 还将完成日常日记措施，评估接触日常歧视的程度和类型，以及 创伤应激风险和复原力反应的假定内部和人际机制。发现 这项研究的最终结果将是制定预防和实施指南的研究和实践指南 在那些暴露于持续的性别相关耻辱和压力下的人中治疗创伤后应激障碍。

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.