Miller-Perusse Michael, Horvath Keith J, Kahle Erin, Stephenson Rob
San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA.
The Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, Michigan, USA.
Transgend Health. 2024 Aug 16;9(4):307-316. doi: 10.1089/trgh.2022.0117. eCollection 2024 Aug.
Gender minority (GM) stress, resulting from distal (i.e., external) and proximal (i.e., internal) stigma-based stressors, is thought to drive mental health disparities among transgender and gender diverse (TGD) youth. We tested the gender minority stress and resilience (GMSR) model hypotheses that distal GM stress effects on mental health are partially mediated by proximal GM stress and moderated by GM-specific resilience (i.e., community connectedness, identity pride) among a U.S. national sample of TGD youth.
As part of an HIV prevention study (NCT03185975), 159 TGD youth (ages 15-24) completed an online survey that included the GMSR measure, assessing distal and proximal GM stress and GM resilience, and the 18-item Brief Symptom Inventory, assessing past-7-day psychological distress. Three models linking GMSR constructs to psychological distress were tested using PROCESS v4.0: (1) simple partial mediation, (2) moderated partial mediation, and (3) serial partial mediation.
A direct effect of distal GM stress was observed in all models. An indirect effect through proximal GM stress alone was observed in model 1, but not models 2 or 3. In model 2, resilience did not moderate the effects of distal or proximal GM stress. In model 3, indirect effects were observed through proximal GM stress and GM resilience serially as well as GM resilience alone.
Larger prospective studies are needed to confirm the role of GM resilience as a mediator, rather than moderator, of GM stress effects on mental health and a critical, rather than supplementary, target for mental health intervention among TGD youth.
性别少数群体（GM）压力源于基于远端（即外部）和近端（即内部）耻辱感的应激源，被认为是导致跨性别和性别多样化（TGD）青少年心理健康差异的原因。我们在美国全国范围内的TGD青少年样本中，检验了性别少数群体压力与复原力（GMSR）模型的假设，即远端GM压力对心理健康的影响部分由近端GM压力介导，并由GM特定的复原力（即社区联系、身份自豪感）调节。
作为一项艾滋病预防研究（NCT03185975）的一部分，159名TGD青少年（年龄在15 - 24岁之间）完成了一项在线调查，该调查包括GMSR测量，评估远端和近端GM压力以及GM复原力，以及18项简明症状量表，评估过去7天的心理困扰。使用PROCESS v4.0测试了将GMSR结构与心理困扰联系起来的三个模型：（1）简单部分中介模型，（2）调节部分中介模型，以及（3）序列部分中介模型。
在所有模型中均观察到远端GM压力的直接效应。在模型1中观察到仅通过近端GM压力的间接效应，但在模型2或3中未观察到。在模型2中，复原力并未调节远端或近端GM压力的效应。在模型3中，观察到通过近端GM压力和GM复原力依次产生的间接效应以及仅通过GM复原力产生的间接效应。
需要进行更大规模的前瞻性研究，以确认GM复原力作为GM压力对心理健康影响的中介而非调节因素的作用，以及作为TGD青少年心理健康干预的关键而非补充目标的作用。
