Grossoehme Daniel H, Teeters Alexis, Jelinek Sue, Dimitriou Sophia M, Conard Lee Ann E
a Division of Pulmonary Medicine , Cincinnati Children's Hospital Medical Center , Cincinnati , Ohio , USA.
b Department of Pastoral Care , Cincinnati Children's Hospital Medical Center , Cincinnati , Ohio , USA.
J Health Care Chaplain. 2016;22(2):54-66. doi: 10.1080/08854726.2015.1123004.
Spiritual struggles are associated with poorer health outcomes, including depression, which has higher prevalence among transgender individuals than the general population. This study's objective was to improve the quality of care in an outpatient transgender clinic by screening patients and caregivers for spiritual struggle and future intervention. The quality improvement questions addressed were whether screening for spiritual struggle was feasible and acceptable; and whether the sensitivity and specificity of the Rush Protocol were acceptable. Revision of the screening was based on cognitive interviews with the 115 adolescents and caregivers who were screened. Prevalence of spiritual struggle was 38-47%. Compared to the Negative R-COPE, the Rush Protocol screener had sensitivities of 44-80% and specificities of 60-74%. The Rush Protocol was acceptable to adolescents seen in a transgender clinic, caregivers, and clinic staff; was feasible to deliver during outpatient clinic visits, and offers a straightforward means of identifying transgender persons and caregivers experiencing spiritual struggle.
精神挣扎与较差的健康结果相关，包括抑郁症，而抑郁症在跨性别者中的患病率高于普通人群。本研究的目的是通过对患者及其照料者进行精神挣扎筛查和未来干预，提高门诊跨性别诊所的护理质量。所解决的质量改进问题包括：对精神挣扎进行筛查是否可行且可接受；以及拉什协议（Rush Protocol）的敏感性和特异性是否可接受。筛查的修订基于对接受筛查的115名青少年及其照料者的认知访谈。精神挣扎的患病率为38%-47%。与消极应对量表（Negative R-COPE）相比，拉什协议筛查工具的敏感性为44%-80%，特异性为60%-74%。拉什协议对于在跨性别诊所就诊的青少年、照料者和诊所工作人员来说是可接受的；在门诊就诊期间实施是可行的，并且提供了一种直接的方法来识别经历精神挣扎的跨性别者及其照料者。
