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

确定弱势群体 PTSD-SUD 合并症的跨诊断干预目标：混合方法研究

• 批准号: 10726507
• 负责人: Madalyn Michele Liautaud
• 金额: $ 5.37万
• 依托单位: HUNTER COLLEGE
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-01 至 2025-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10726507
• 关键词: Adult; Behavior; Biological; Cannabis; Caring; Chronic; Chronic Disease; Client; Clinical; Clinical Sciences; Clinical Treatment; Collection; Criminal Justice; Data; Development; Diagnostic; Discrimination; Disease; Disparity; Drug Addiction; Drug usage; Ecological momentary assessment; Empirical Research; Evaluation; Exposure to; Funding; Future; Gender Identity; Goals; Health; Healthcare; Hormones; Hydrocortisone; Illicit Drugs; Incidence; Individual; Individual Differences; Interpersonal Violence; Intervention; Interview; Life; Link; Measures; Mediating; Mediator; Methods; Minority; Minority Groups; Modeling; Morbidity - disease rate; National Institute of Drug Abuse; Neurosecretory Systems; Nicotine; Parents; Participant; Pathway interactions; Patient Self-Report; Pattern; Persons; Pharmaceutical Preparations; Physiological; Population; Population Heterogeneity; Population Intervention; Post-Traumatic Stress Disorders; Prevalence; Public Health; Quality of life; Recording of previous events; Research; Research Priority; Resources; Risk; Risk Factors; Salivary; Sampling; Severities; Shame; Shapes; Social Environment; Source; Stress; Structure; Substance Use Disorder; Surveys; Symptoms; System; United States National Institutes of Health; Violence; Vulnerable Populations; Work; biological adaptation to stress; biopsychosocial; cisgender; clinical center; clinical decision-making; clinical diagnostics; clinical risk; comorbidity; cost; design; disorder risk; drug use behavior; emotion dysregulation; emotion regulation; epidemiological model; evidence base; experience; falls; gender diversity; gender minority group; gender minority stress; health equity; high risk population; impaired productivity; innovation; internalized stigma; minority stress; modifiable risk; mortality; multiple chronic conditions; novel; patient oriented; physical conditioning; prospective; psychobiologic; psychologic; psychosocial; recruit; salivary immunoassay; social; social health determinants; social stigma; stress reactivity; substance use; syndemic; theories; transgender; trauma exposure; violence exposure; virtual

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.

项目摘要 这项研究旨在鉴定创伤后应激障碍（PTSD）的转诊机制 - 固定使用 暴露于创伤的变性者和性别多样性（TGD）成年人之间的疾病（SUD）合并症。 意义：尽管令人震惊和 在该人群中观察到的暴力，PTSD和SUD的暴露率不成比例。现存的 理论表明，这些差异是由与具有污名的累积暴露所驱动的 少数性的性别认同（即性别少数压力）。告知综合PTSD-SUD的开发 需要进行TGD和其他少数少数人的干预措施，需要进行研究以识别转诊， 在长期暴露于少数族裔压力的情况下，PTSD-SUD风险的文化含量机制。 目标和方法：主要是，拟议的研究旨在阐明人口级的PTSD-SUD如何 差异在心理上表现出来（即，通过日常行为和内部/外部经验）和 在生理上（即体内），以告知基于证据的，综合PTSD-SUD的发展 治疗原则。利用现有家长研究的资源和基线数据（SC3 GM136580； PI：Berke），我将招募70个TGD成年人参加两部分研究。遵循基线生物心理社会评估 （即临床访谈，唾液压力激素收集，自我报告调查），参与者将完成 生态瞬时评估（EMA）14天，以评估每日共透视的模式和预测指标 暴露于性别少数族裔压力（例如歧视），药物使用和PTSD症状。这将是 通过表征每日共发生的并发和前瞻性关联来实现 歧视暴露，药物使用和PTSD症状（AIM 1）并识别转诊 介体（即内在的污名，情绪失调；目标2）和身体健康风险相关（即， 慢性疾病患病率，应力激素反应性；目的3）这些关联。创新：这项研究 利用一个新颖的，统一的生物心理社会框架，说明相关的生物学（例如，压力 反应失调），心理（例如，情绪失调）和社会环境（例如，污名） 在该人群中塑造PTSD-SUD风险的因素。识别可修改的危险因素，这些因素削减了PTSD， SUD以及他们同时发生的性别少数压力的条件将直接为未来提供信息 通过产量为TGD人员开发转诊，集成的PTSD-SUD干预框架 TGD人员中PTSD-SUD合并症的临床风险因素的丰富生物心理社会数据。来自 该项目还将为研究和干预范式奠定阶段，使所有少数化 通过促进向身份相关的暴力影响的亚群，通过促进向朝向 以患者为中心的健康公平干预措施。与非MD-19-001相关的建议。