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: 10466891
• 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/10466891
• 关键词: Acute; Address; Affect; Chronic; Clinical; Cognition; Data; Development; Discrimination; Disease; Distress; Enrollment; Etiology; Evaluation; Event; Exposure to; Foundations; Gender; General Population; Goals; Gold; 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 Guidelines; Process; Protocols documentation; Research; Research Priority; Research Project Grants; Risk; Risk Marker; Salivary; Sampling; Science; Severities; Stress; Subgroup; Survivors; Symptoms; Time; Trauma; Victimization; Vulnerable Populations; biological adaptation to stress; biopsychosocial; coping; design; diaries; disorder prevention; disorder risk; 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; 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.

跨性别者被慢性（例如人际拒绝）和急性烧毁 （受害）歧视。根据少数派压力理论，两种形式的歧视都是相关的 具有不利的心理健康结果，包括PTSD，这是一种因暴露而引起的压力敏感障碍 危及生命的事件，严重伤害或性侵犯。 PTSD估计有6.8％的美国影响 普通人群，跨性别样本的患病率估计范围为18％-61％。可以说，都是PTSD 每天歧视的形式对个人身份的慢性和持续威胁产生了类似 压力反应。暴露于每日歧视也可能加剧创伤性应力反应 变性人已经接触到创伤性压力。但是， 这些压力源知之甚少，尤其是在跨性别者中。了解影响 急性创伤后PTSD的发作，维护和过程的每日歧视 依赖横断面和自我报告方法的依赖使暴露受到阻碍。纵向研究是 需要阐明创伤性应力，每日歧视和PTSD之间的临时途径。此外，给予 针对少数民族健康分布的领先剥夺理论，与与之相关的压力源 少数群体的地位通过许多共同的机制与 人际机制，与性别少数群体进行研究以了解独特的研究很重要 导致观察到的差异的过程。大多数跨性别人士证明 在普遍社会压迫的背景下的韧性，揭示了依据的生物心理社会机制 脆弱性和防止与慢性创伤有关的困扰和功能障碍代表 关键的研究优先级。 SC3的目的是填补适应性创伤科学科学的巨大空白 通过检查跨性别者的轨迹和风险和韧性机制来压力 使用多量化纵向方法进行评估。 PI将招募暴露创伤的潜水员样本 纽约市的跨性别者参加了多方法纵向研究方案。 参加研究的参与者将完成金标准的临床访谈，以评估PTSD符号 并在创伤暴露1个月内提供唾液皮质醇样品，并在3、6和12个月中再次提供 后续评估。在基线，3个和6个月的评估课程之后的14天，参与者 还将完成每日日记措施评估每日歧视的程度和接触类型 假定的风险和弹性反应对创伤压力的人体内部和人际机制。发现 从研究中将最终提高预防预防和实践指南 暴露于持续性别相关的污名和压力的患者中的PTSD治疗。