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Ralston AL, Holt NR, Andrews AR, Huit TZ, Puckett JA, Woodruff N, Mocarski R, Hope DA. Mental Health and Marginalization Stress in Transgender and Gender Diverse Adults: Differences between Urban and Non-Urban Experiences. Psychol Sex Orientat Gend Divers 2024; 11:165-176. [PMID: 38577413 PMCID: PMC10989840 DOI: 10.1037/sgd0000595] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
Background Transgender and gender diverse (TGD) individuals face high rates of psychological distress, including depression, anxiety, and suicide risk. Further, TGD individuals living outside of urban areas experience additional disparities compared to their urban counterparts. Minority stress theory states that minority stressors (termed marginalization stressors for this paper), such as experiences of discrimination and internalized transphobia, lead to psychological distress. The current study compared marginalization stressors across rural (population less than 2,500), urban cluster (population between 2,500 and 50,000), and urban (population greater than 50,000) samples and tested the degree to which these stressors account for differences across areas of residence. Methods Participants were 225 TGD individuals who completed an online survey that included measures of depression, anxiety, suicidal ideation marginalization stress, and protective factors. Results In the first model, mental health outcomes, marginalization stressors, and protective factors differed between areas. Urban cluster participants reported experiencing higher levels of depression, anxiety, and suicidal ideation and rural participants reported experiencing higher levels of depression suicidal ideation than urban participants. Both rural and urban cluster participants reported more experiences of several marginalization stressors. In the subsequent path model, indirect effects between area and marginalization stress variables were significant, but urban cluster participants still reported higher depression, anxiety, and suicidal ideation symptoms (p-values < .05). Discussion We demonstrate that marginalization stress processes appear to account for some of the differences between TGD individuals living in urban, rural, and urban cluster areas. The differences between areas largely persist, however, after controlling for marginalization stress, especially when comparing urban with urban cluster areas.
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Haws JK, Laifer LM, Acosta LM, Ralston AL, Ruggiero KJ, Davidson TM, Andrews AR. A Distinction Without a Difference? A Multi-Method Approach to Understanding PTSD and Depression Symptom Overlap Among Disaster-Exposed Adolescents. Res Child Adolesc Psychopathol 2023; 51:1021-1035. [PMID: 36881210 DOI: 10.1007/s10802-023-01042-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2023] [Indexed: 03/08/2023]
Abstract
Among adolescents exposed to trauma, posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) commonly co-occur. Despite the prevalence of comorbidity, the question of how PTSD and MDD are related and appropriate conceptual models for understanding their linkage in adolescence remains unclear. This study applies a multi-methodological approach to advance conceptual and theoretical understanding of the overlap between PTSD and MDD diagnoses/symptoms. We tested three methodological approaches with three distinct theoretical underpinnings on the structure of each disorder proposed in the literature: confirmatory factor analysis (CFA) with dimensional constructs, latent class analysis (LCA) with person-based categorical constructs, and network analysis with symptom-to-symptom associations. Across the three different analytical approaches, there was a significant overlap between PTSD and MDD. Overall, there was no compelling evidence for distinct boundaries between disorders among trauma-exposed adolescents. Instead, we found considerable evidence that the typical latent-construct-based conceptualizations, whether categorical or dimensional, may need revision.
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Affiliation(s)
- James Kyle Haws
- Department of Family Medicine, and the Adult and Child Adult & Child Center for Outcomes Research & Delivery Science, University of Colorado School of Medicine, 13199 E. Montview Blvd, Suite 300, Aurora, CO, 80045, USA.
| | - Lauren M Laifer
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Laura M Acosta
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Allura L Ralston
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Kenneth J Ruggiero
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Tatiana M Davidson
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Arthur R Andrews
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE, USA
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Puckett JA, Holt NR, Lash B, Zachary Huit T, Ralston AL, Hope DA, Mocarski R, Zachary DuBois L. Transgender and gender diverse adults' self-reported mental health diagnoses, engagement in mental health services, and perceptions of therapists. Psychother Res 2023; 33:84-95. [PMID: 35767823 DOI: 10.1080/10503307.2022.2091961] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVE Transgender and gender diverse (TGD) people face various challenges when seeking therapy. Given this, we wanted to understand more about TGD people's perceptions of providers and how these compare to researcher ratings of providers on metrics of affirming practice. METHOD The sample included 158 TGD adults (Mage = 33.06); 57.6% were in therapy. Participants completed measures about mental health, resilience, and therapy. We systematically coded provider websites and intake forms. RESULTS Participants in therapy were older, had higher depression, and lower resilience than participants not in therapy. Non-binary/genderqueer participants rated providers as less knowledgeable compared to trans feminine participants. Overall, participants appeared satisfied (71.4% extremely satisfied) and viewed providers as at least moderately knowledgeable (89.1%). Provider coding revealed variation across the markers of affirmation; 66.04% identified a TGD-specialty and only 26.42% shared provider pronouns. Higher frequency of inclusivity (via coding) was related to higher ratings of provider knowledge and more of a focus on gender, however, there was not a significant association with satisfaction. CONCLUSIONS Providers who engaged in more affirming practices were more knowledgeable compared to those who engaged in fewer affirming practices. This may influence the content of therapy and whether clients feel comfortable discussing gender.
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Affiliation(s)
- Jae A Puckett
- Department of Psychology, Michigan State University, East Lansing
| | - Natalie R Holt
- Clinical Psychology Fellow, VA Quality Scholars, VA Tennessee Valley Healthcare System, Nashville
| | - Brenna Lash
- Department of Psychology, University of Nebraska-Lincoln, Lincoln
| | - T Zachary Huit
- Department of Psychology, University of Nebraska-Lincoln, Lincoln
| | - Allura L Ralston
- Department of Psychology, University of Nebraska-Lincoln, Lincoln
| | - Debra A Hope
- Department of Psychology, University of Nebraska-Lincoln, Lincoln
| | - Richard Mocarski
- Associate Vice President for Research, San José State University, San José
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Andrews AR, Acosta LM, Acosta Canchila MN, Haws JK, Holland KJ, Holt NR, Ralston AL. Perceived Barriers and Preliminary PTSD Outcomes in an Open Pilot Trial of Written Exposure Therapy With Latinx Immigrants. Cognitive and Behavioral Practice 2022; 29:648-665. [PMID: 36171805 PMCID: PMC9512264 DOI: 10.1016/j.cbpra.2021.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Latinx immigrants experience substantial disparities in mental health treatment access, particularly for posttraumatic stress disorder (PTSD). The availability of brief, flexible interventions in Spanish may assist in reducing these disparities. Written Exposure Therapy (WET) is a five-session PTSD intervention that appears as effective as longer, gold-standard interventions, but has yet to be tested among Latinx immigrants. To test the acceptability and preliminary effectiveness of WET, 20 Spanish-speaking, Latinx immigrants conducted structured interviews at pretreatment, were offered WET, and completed posttreatment structured interviews. Open thematic coding of pre- and posttreatment interview questions examined perceived barriers and benefits of WET. Quantitative components examined symptom change across PTSD (PCL-IV-C) and depression (PHQ-9). Quantitative results indicated clinically meaningful and statistically significant change in PTSD symptoms using intent-to-treat analyses (Mdiff = 17.06, SDdiff = 9.97, range = 0-29, t(15) = 6.84, p < .001). Open thematic coding identified four barrier-related themes and three benefit-related themes at pretreatment. At posttreatment, three barrier-related themes and two benefit-related themes were identified. Qualitative results largely suggested that perceived barriers were common to other PTSD interventions (e.g., exposure components). Only one participant identified barriers specific to WET. Results suggested WET may reduce PTSD symptoms among Latinx immigrants. WET also appeared to be acceptable and primarily viewed as beneficial among this population. WET is a promising intervention with Latinx immigrants and warrants further testing larger trials, including testing implementation strategies that may improve access to care.
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Bautista CL, Ralston AL, Brock RL, Hope DA. Peer coach support in internet-based cognitive behavioral therapy for college students with social anxiety disorder: efficacy and acceptability. Cogent Psychology 2022. [DOI: 10.1080/23311908.2022.2040160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Chandra L. Bautista
- Mental Health Care Line, Michael E. DeBakey Va Medical Center2002 Holcombe Blvd, Houston, TX 77030, United States
| | - Allura L. Ralston
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE 68588-0308
| | - Rebecca L. Brock
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE 68588-0308
| | - Debra A. Hope
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE 68588-0308
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Puckett JA, Aboussouan AB, Ralston AL, Mustanski B, Newcomb ME. Systems of cissexism and the daily production of stress for transgender and gender diverse people. Int J Transgend Health 2021; 24:113-126. [PMID: 36713141 PMCID: PMC9879165 DOI: 10.1080/26895269.2021.1937437] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
BACKGROUND Transgender and gender diverse (TGD) people encounter a range of minority stressors (e.g., harassment, victimization, misgendering) that impact many areas of life. Much of the empirical literature on gender minority stress has utilized frameworks that were developed with a focus on sexual orientation and were often limited to cisgender sexual minorities (lesbian, gay, bisexual, and other non-heterosexual individuals), leaving questions about how well existing models fit the experiences of TGD people. AIMS To expand understandings of gender minority stress, we conducted a daily diary study where participants detailed the types of stressors they encountered on a daily basis for 56 days. METHODS There were 181 TGD participants recruited into the study (M age = 25.6 years; SD = 5.6), with 167 retained in the daily surveys from which these analyses were conducted. RESULTS The written responses revealed a variety of stressors, some of which are novel to the literature. Many participants reported instances of non-affirmation, such as misgendering, as well as vicarious stress when learning of oppressive experiences impacting other TGD people and seeing negative media portrayals of the lives of TGD individuals. Participants also reported bodily vigilance when being on alert for how others were perceiving their gender. Other stressors included rejection, political oppression, physical violence, uneasiness from others, and the enforcement of gender binarism. DISCUSSION These findings highlight gaps in the existing understandings of marginalization for TGD people that must be addressed to ensure that frameworks include and center the experiences of gender minorities.
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Affiliation(s)
- Jae A. Puckett
- Department of Psychology, Michigan State University, East Lansing, Michigan, USA
| | - Alix B. Aboussouan
- Department of Psychology, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Allura L. Ralston
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, Nebraska, USA
| | - Brian Mustanski
- Department of Medical Social Sciences, Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Michael E. Newcomb
- Department of Medical Social Sciences, Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Holt NR, Ralston AL, Hope DA, Mocarski R, Woodruff N. A Systematic Review of Recommendations for Behavioral Health Services for Transgender and Gender Diverse Adults: The Three-Legged Stool of Evidence-Based Practice is Unbalanced. Clin Psychol (New York) 2021; 28:186-201. [PMID: 34456519 PMCID: PMC8386449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
There is a growing literature of clinical recommendations for transgender and gender diverse (TGD) affirming behavioral health care, yet it is unknown to what extent these recommendations are rooted in evidence-based practice (EBP). This systematic review included 65 articles published between 2009 and 2018 with recommendations for behavioral health services with TGD adults, emphasizing general clinical care. Coded variables included type of article, participant demographics, aspects of EBP, and whether care was informed by objective assessment. Most articles did not equally draw from all components of EBP. Recommendations for specific clinical problems are increasingly available and address diversity within TGD communities. More research, including clinical trials adapting established interventions, is needed to inform state-of-the-art TGD-affirmative behavioral health care.
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Ralston AL, Andrews AR, Hope DA. Fulfilling the promise of mental health technology to reduce public health disparities: Review and research agenda. ACTA ACUST UNITED AC 2019. [DOI: 10.1111/cpsp.12277] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abstract
Zero Balancing (ZB, pronounced Zee Bee) can be defined as the art and skill of balancing body energy with body structure through the use of conscious touch. ZB is unique as a therapeutic tool, as its aim is to work with energy and structure simultaneously. ZB bridges the gap between energetic therapies and structural therapies, maximizing the potential of both and creating a new world of possibilities for health-care professionals.
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Selgrade MK, Daniels MJ, Illing JW, Ralston AL, Grady MA, Charlet E, Graham JA. Increased susceptibility to parathion poisoning following murine cytomegalovirus infection. Toxicol Appl Pharmacol 1984; 76:356-64. [PMID: 6093289 DOI: 10.1016/0041-008x(84)90017-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
In mice treated with ordinarily sublethal doses of parathion 2 to 5 days postinfection with murine cytomegalovirus (MCMV) 50 to 100% mortality was observed. These mortalities appeared to be due to a decrease in the ability of infected mice to detoxify parathion. Pentobarbital-induced sleeping time was also enhanced 3 and 6 days postinfection and cytochrome P-450 concentrations were markedly depressed in mice tested 3 days after infection. MCMV-induced effects on sensitivity to parathion and pentobarbital did not appear to be directly attributable to liver infection since concentrations of virus in the liver persisted at maximum concentrations well beyond the time when sensitivity to these compounds returned to normal. The time frame during which enhanced sensitivity to parathion and pentobarbital was observed suggests that this sensitivity may have been caused by viral-induced interferon-mediated depression of cytochrome P-450.
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