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

项目摘要 本研究旨在确定创伤后应激障碍（PTSD）的转诊断机制-物质使用 在创伤暴露的跨性别和性别多样性（TGD）成年人中的疾病（SUD）共病。 意义：TGD人群几乎没有PTSD-SUD研究，尽管令人担忧， 在这一人群中观察到的暴力、创伤后应激障碍和SUD暴露率不成比例地高。现有 理论表明，这些差异是由累积的耻辱感造成的， 少数民族的性别认同（即，性别少数压力）。为综合创伤后应激障碍-南方发展提供信息 针对TGD和其他少数群体的干预措施，需要进行研究以确定跨诊断， 在长期暴露于少数民族压力的背景下，PTSD-SUD风险的文化一致性机制。 目的和方法：Chiral，拟议的研究旨在阐明人群水平的PTSD-SUD 差异在心理社会上表现出来（即，通过日常行为和内部/外部经验）和 生理上（即，体内），以告知循证，综合PTSD-SUD的发展 治疗原则。利用现有母研究的资源和基线数据（SC3 GM 136580; PI：Berke），我将招募70名TGD成年人进行两部分研究。在基线生物心理社会评估之后 (i.e.,临床访谈、唾液应激激素收集、自我报告调查），参与者将完成 为期14天的生态瞬时评估（EMA），以评估每日共同波动的模式和预测因子 在暴露于性别少数压力（例如，歧视），物质使用和PTSD症状。这将是 通过描述以下事件之间的日常共同发生的并发和前瞻性关联来实现 歧视暴露，物质使用和PTSD症状（目标1），并确定转诊断 介体（即，内化的耻辱，情绪失调;目标2）和身体健康风险相关（即， 慢性病患病率、应激激素反应性;目的3）这些关联。创新：这项研究 利用了一种新颖的、统一的生物心理社会框架，该框架解释了相关的生物学（例如，应力 反应失调），心理（例如，情绪失调），和社会环境（例如，耻辱） 影响该人群PTSD-SUD风险的因素。识别跨越创伤后应激障碍的可改变的风险因素， SUD，以及它们共同发生的性别少数压力的条件将直接影响未来 为TGD人群制定跨诊断的综合PTSD-SUD干预框架， 关于TGD人群中PTSD-SUD合并症临床危险因素的丰富生物心理社会学数据。的结果 该项目还将为有益于所有少数民族的研究和干预范例奠定基础 受身份相关暴力影响不成比例的亚群体， 以病人为中心的健康公平干预方法。与NOT-MD-19 - 001相关的提案。

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.