Trajectories of Adaptation to Traumatic Stress in a Vulnerable Population

弱势群体对创伤应激的适应轨迹

基本信息

批准号：
10701731
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
项目类别：
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/10701731
关键词：
Acute Address Affect Chronic Clinical Cognition Data Development Discrimination Disease Disparity Distress Enrollment Etiology Evaluation Event Exposure to Foundations Gender General Population Goals 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 Prevention Guidelines Process Protocols documentation Research Research Priority Research Project Grants Risk Risk Factors Risk Marker Salivary Sampling Science Severities Stress Subgroup Survivors Symptoms Time Trauma Victimization Vulnerable Populations biological adaptation to stress biopsychosocial coping design diaries 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 resilience factor response salivary immunoassay sexual assault social stigma stressor theories transgender trauma exposure traumatic stress

项目摘要

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.

跨性别者承受着不成比例的慢性（例如人际排斥）和急性的负担（受害）歧视根据少数群体压力理论，这两种形式的歧视都是相关的。具有不良的心理健康后果，包括创伤后应激障碍（PTSD），这是一种可能因暴露而引起的压力敏感障碍估计有 6.8% 的美国人受到 PTSD 的影响。在一般人群中，跨性别样本的患病率估计在 18%-61% 之间，可以说，这两种情况都是 PTSD。以日常歧视的形式对一个人的身份造成长期和持续的威胁也会产生类似的结果暴露于日常歧视也可能加剧创伤性应激反应。跨性别者已经暴露于创伤性压力源，但其独特的互动效应。人们对这些压力源知之甚少，尤其是跨性别者。创伤后应激障碍的发生、维持和病程的日常歧视对横断面和自我报告方法的依赖阻碍了暴露。需要阐明创伤性应激、日常歧视和创伤后应激障碍之间的时间途径。少数族裔健康差异的主要解释理论提出，与少数群体地位通过一系列相互之间的共享机制导致负面的心理健康结果就个人内部机制而言，对性别少数群体进行研究以了解其独特的机制非常重要导致大多数跨性别者之间存在差异的过程表明。在普遍的社会压迫背景下的恢复力，揭示潜在的生物心理社会机制易受慢性创伤相关痛苦和功能损伤的影响和保护是一种 SC3 的关键研究重点是填补创伤适应科学的重大空白。通过检查跨性别者的风险和复原力的轨迹和机制来缓解压力使用多方法纵向方法进行评估，PI 将招募不同的遭受创伤的样本。纽约市的跨性别者参与多方法纵向研究方案。参加该研究的参与者将完成黄金标准临床访谈，以评估 PTSD 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 个月时再次提供唾液皮质醇样本参与者在基线、3 个月和 6 个月的评估会议后的 14 天进行后续评估。还将完成每日日记测量，评估日常歧视的程度和类型，以及对创伤压力的风险和复原力反应的假定的内部和人际机制。该研究的结果将最终形成预防和预防的研究和实践指南对那些持续遭受与性别相关的耻辱和压力的人进行创伤后应激障碍（PTSD）的治疗。