The March, 2024 Publications of Interest column presents six articles which focus on how minority stress and systemic discrimination can compound traumatic experiences. I hope they will be of some interest.
Ragavan, M. I., Thomas, K. A., Fulambarker, A., Zaricor, J., Goodman, L. A., & Bair-Merritt, M. H. (2020). Exploring the needs and lived experiences of racial and ethnic minority domestic violence survivors through participatory research: A systematic review. Trauma, Violence & Abuse, 21(5), 946-963. https://doi.org/10.1177/1524838018813204
Abstract:
Community-based participatory research (CBPR) is a methodological approach where community–academic teams build equitable relationships throughout the research process. In the domestic violence (DV) field, CBPR may be particularly important when conducting research with racial and ethnic minority DV survivors, as this group faces concurrent oppressions that inform their lived experiences. To our knowledge, no systematic review has synthesized articles using a CBPR approach to explore the needs and lived experiences of racial and ethnic minority DV survivors. Using PRISMA guidelines, we conducted a systematic review of the literature, retrieving articles that used a CBPR approach to understand the needs and/or lived experiences of female racial and ethnic minority DV survivors residing in the United States. Articles were identified from peer-reviewed databases, bibliographies, and experts. Thirteen of the 185 articles assessed for eligibility were included. Articles focused on a variety of racial and ethnic minority groups, the majority identifying as African American or Latina. Collaboration occurred in multiple ways, primarily through equitable decision-making and building team members’ strengths. Several needs and lived experiences emerged including gender identity and patriarchal attitudes, racism and discrimination, the immigrant experience informing DV, poverty, shame and stigma, and the need for social support. This is the first systematic review of articles using a CBPR approach to explore the needs and lived experiences of racial and ethnic minority survivors. Implications include promoting community-based dissemination, conducting quantitative studies with larger sample sizes of DV survivors, and encouraging culturally specific services that address DV survivors’ intersectional needs.
Valentine, S. E., Gell-Levey, I. M., Godfrey, L. B., & Livingston, N. A. (2024). The associations between gender minority stressors and PTSD symptom severity among trauma-exposed transgender and gender diverse adults. Journal of Trauma & Dissociation. Advance online publication. https://doi.org/10.1080/15299732.2024.2323977
Abstract:
This study investigates associations between minority stressors, traumatic stressors, and post-traumatic stress disorder (PTSD) symptom severity in a sample of transgender and gender diverse (TGD) adults. We utilized surveys and clinical interview assessments to assess gender minority stress exposures and responses, and PTSD. Our sample (N = 43) includes adults who identified as a minoritized gender identity (i.e., 39.5% trans woman or woman, 25.6% trans man or man, 23.3% genderqueer or nonbinary, 11.6% other identity). All participants reported at least one traumatic event (i.e., life threat, serious injury, or sexual harm). The most common trauma events reported by the sample were sexual (39.5%) and physical violence (37.2%), with 40.9% of participants anchoring their symptoms to a discrimination-based event. PTSD symptom severity was positively correlated with both distal (r = 0.36, p = .017) and proximal minority stressors (r = 0.40, p < .01). Distal minority stress was a unique predictor of current PTSD symptom severity (b = 0.94, p = .017), however, this association was no longer significant when adjusting for proximal minority stress (b = 0.18, p = 0.046). This study suggests that minority stress, especially proximal minority stress, is associated with higher PTSD symptom severity among TGD adults.
Jeon, M. E., Robison, M., Robertson, L., Udupa, N. S., Potter, M. R., & Joiner, T. E. (2024). From identity-based distress to thinking “I am better off being dead:” Minority stress, posttraumatic cognitions, and suicidal ideation. Journal of Affective Disorders, 354, 143-151. https://doi.org/10.1016/j.jad.2024.03.064
Highlights:
- Discrimination is related to suicidal ideation through minority stress and posttraumatic cognitions.
- This relationship holds across race, ethnicity, sexual orientation, and multiple marginalizations.
- Applying cognitive behavioral therapy for PTSD may help reduce the harms of minority stress.
Abstract:
Background: Suicidal ideation (SI) disproportionately impacts individuals with minoritized race/ethnicity, gender, and sexual orientation. Minority stress – i.e., traumatic, insidious distress that results from acts of discrimination – may lead to the formation of posttraumatic cognitions that may generalize to suicidal ideation, elevating SI risk in minoritized populations. The current study aimed to test this potential relationship by examining whether minority stress and posttraumatic cognitions accounted for the association between discrimination and SI.
Methods: Series of structural equation models, including multigroup confirmatory factor analyses conducted to test invariance of latent constructs, were estimated on cross-sectional data collected from minoritized young adults (n = 337).
Results: Results supported the hypothesized model: experience of discrimination indirectly associated with SI via correlations shared between minority stress and posttraumatic cognitions. Experiences of discrimination lacked a significant correlation with SI while accounting for minority stress and posttraumatic cognition variance. Invariance testing conducted to account for applicability of the model across race, ethnicity, sexual orientation, and plurality of minoritized identities all demonstrated that the model was applicable across these identity dimensions.
Limitations: Granular inspection of identity dimensions was infeasible due to sample size and causal inferences cannot be drawn given cross-sectional nature of the data used.
Conclusions: Posttraumatic cognitions within the context of discrimination may be effective treatment targets for minoritized individuals who present with minority stress and SI. Future studies should aim to replicate such findings longitudinally to infer temporality.
Skidmore, S. J., Sorrell, S. A., & Tyler Lefevor, G. (2023). Attachment, minority stress, and health outcomes among conservatively religious sexual minorities. Journal of Homosexuality, 70(13), 3171-3191. https://doi.org/10.1080/00918369.2022.2087483
Abstract: Sexual minority (SM) members of the Church of Jesus Christ of Latter-day Saints (LDS) face increased exposure to minority stressors as well as concerns of attachment injuries relative to their heterosexual counterparts. The Integrated Attachment and Sexual Minority Stress Model outlines the mutually reinforcing associations between adult attachment and sexual minority stress, positing that adult attachment is both influenced by experiences of minority stress and simultaneously capable of shaping minority stress experiences in adulthood. The present study explored how adult attachment style directly and indirectly affects minority stressors and health outcomes for LDS SMs. A sample of 602 LDS SMs completed a quantitative survey assessing attachment, minority stress, and health. Results indicated that an insecure attachment style related to increased minority stressors and depression, whereas a secure attachment style related to decreased minority stressors and increased life satisfaction. Further, attachment moderated the relationship between minority stressors and health outcomes, such that experiences of minority stress were related to a decrease in life satisfaction only for securely attached LDS SMs. However, securely attached LDS SMs still reported better health than insecurely attached LDS SMs, even when reporting high degrees of minority stressors. These findings add to the growing body of literature suggesting that attachment style has direct and indirect effects on health outcomes for SMs, including those from conservative religious backgrounds.
McKernan, S., D’Andrea, W., Collier, A., Pyzewski, M. L., Cao, T., Caligiuri, S., Milbert, M., Feldmiller, J., Feingold, M., Min, M., Nieves, N., Herzog, S., Khedari, V., Stafford, E., Freed, S., DePierro, J., Minshew, R., Doukas, A., Polanco-Roman, L., Yates, E. H., & Siegle, G. J. (2024). Sexual and gender minority status predicts additional variance in posttraumatic stress disorder after accounting for conventional trauma exposure. Stigma and Health. Advance online publication.https://doi.org/10.1037/sah0000498
Abstract: Sexual and gender minority (SGM) populations have substantially higher rates of most psychopathologies. Several theoretical models have been proposed, attributing the disparities to either (a) additional stressors related to their minoritized status (i.e., minority stress) or (b) that stressors interact with a pre-existing vulnerability. A parallel body of research posits minority stress as a form of trauma and connects discrimination to posttraumatic stress disorder (PTSD). The present study attempts to bridge these two areas of literature by testing if SGM status—a proxy for minority stress—predicts additional variance in PTSD symptoms after accounting for conventional trauma (i.e., childhood maltreatment, actual or threatened death/bodily harm, sexual violence, and other stressful life events) or if SGM status interacts with conventional trauma to nonlinearly increase PTSD symptoms. First, the validity of using SGM status as a proxy for minority stress was examined in a subsample of participants. Then, to test our primary hypotheses, a post hoc analysis of a study investigating common psychobiological adaptations to trauma was completed. Results supported the use of SGM status as a proxy and the additive, as opposed to interactive, model. After accounting for conventional trauma, SGM status predicted additional variance in PTSD symptoms and diagnosis. Although tentative, these findings suggest that minority stress may be additive to trauma symptomatology in SGM individuals and therefore be an important factor to consider when assessing for and treating PTSD in this population. Future research that directly measures minority stress should be conducted to validate these findings.
Harb, F., Bird, C. M., Webb, K., Torres, L., deRoon-Cassini, T. A., & Larson, C. L. (2023). Experiencing racial discrimination increases vulnerability to PTSD after trauma via peritraumatic dissociation. European Journal of Psychotraumatology, 14(2), Article 2211486. https://doi.org/10.1080/20008066.2023.2211486
Abstract:
Background: Racial discrimination is a traumatic stressor that increases the risk for posttraumatic stress disorder (PTSD), but mechanisms to explain this relationship remain unclear. Peritraumatic dissociation, the complex process of disorientation, depersonalization, and derealization during a trauma, has been a consistent predictor of PTSD. Experiences of frequent racial discrimination may increase the propensity for peritraumatic dissociation in the context of new traumatic experiences and contribute to PTSD symptoms. However, the role of peritraumatic dissociation in the relationship between experiences of discrimination and PTSD has not been specifically explored.
Objective: The current study investigated the role of peritraumatic dissociation in the impact of racial discrimination on PTSD symptoms after a traumatic injury, and the moderating role of gender.
Method: One hundred and thirteen Black/African American individuals were recruited from the Emergency Department at a Level I Trauma Center. Two weeks after the trauma, participants self-reported their experiences with racial discrimination and peritraumatic dissociation. At the six-month follow-up appointment, individuals underwent a clinical assessment of their PTSD symptoms.
Results: Results of longitudinal mediation analyses showed that peritraumatic dissociation significantly mediated the effect of racial discrimination on PTSD symptoms, after controlling for age and lifetime trauma exposure. A secondary analysis was conducted to examine the moderating role of gender. Gender was not a significant moderator in the model.
Conclusions: Findings show that racial discrimination functions as a stressor that impacts how individuals respond to other traumatic events. The novel results suggest a mechanism that explains the relationship between racial discrimination and PTSD symptoms. These findings highlight the need for community spaces where Black Americans can process racial trauma and reduce the propensity to detach from daily, painful realities. Results also show that clinical intervention post-trauma must consider Black Americans’ experiences with racial discrimination.