A patient-centered model of mental health care for trauma and minority stress in transgender and gender diverse people: A bottom-up network analysis.

Transgender and gender diverse (TGD) individuals are disproportionately exposed to traumatic and high-impact minority stressors which can produce an array of transdiagnostic symptoms. Some clinical presentations align well with established evidence-based treatments, but others may require patient-centered modifications or combined approaches to address treatment needs. In this study, we employed a novel, bottom-up approach to derive insights into preferred intervention strategies for a broad range of trauma- and TGD-minority stress-related expressions of clinical distress. Participants (18 TGD individuals, 16 providers) completed a q-sort task by first sorting cards featuring traumatic experiences and/or minority stressors and transdiagnostic psychiatric symptoms into groups based on perceived similarity. Next, participants sorted interventions they believed to be most relevant for addressing these concerns/symptoms. We overlayed networks of stressors and symptoms with intervention networks to evaluate preferred intervention strategies. TGD networks revealed transdiagnostic clustering of intervention strategies and uniquely positioned the expectancy of future harm as a traumatic stressor. Provider networks were more granular in structure; both groups surprisingly emphasized the role of self-defense as intervention. While both networks had high overlap, their discrepancies highlight patient perspectives that practical, material, and structural changes should occur alongside traditional clinical interventions.

John L. McNulty (1955-2023).

Dr. John L. McNulty, born on January 25, 1955, in Bartlesville, Oklahoma, passed away on October 31, 2023, in Tulsa, Oklahoma, at the age of 68 years. Ever the pragmatist and always bringing a critical mindset to test use, Dr. McNulty coauthored seminal articles demonstrating the absence of predictive bias among African Americans. His commitment to diversity more recently focused on contemporary assessment with transgender and gender-diverse individuals. While Dr. McNulty's empirical work advanced the field of personality and psychopathology, his relationships with colleagues and mentees are his most lasting legacy. Dr. McNulty inspired many while he was here, and his memory will inspire many into the future. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Exploring the Minnesota Multiphasic Personality Inventory (MMPI)-3 in a transgender and gender diverse sample.

Comparisons of transgender and gender diverse (TGD) individuals' mental health functioning with that of cisgender individuals rely almost exclusively on screening measures. The limited research with TGD individuals and omnibus assessment measures has primarily used previous iterations of the Minnesota Multiphasic Personality Inventories (MMPIs). This study sought to examine the psychometric functioning of the MMPI-3 with a TGD community sample (n = 97) and compare mean scores across TGD and cisgender subsamples. We expected MMPI-3 substantive scale reliability to be comparable across all samples and subsamples. Individual MMPI-3 scales were expected to demonstrate appropriate convergent and discriminant validity with relevant criterion measures in the TGD sample. Results generally supported MMPI-3 scale score reliability and validity with TGD individuals. Next, three sets of mean score comparisons were conducted across all MMPI-3 substantive scales: (a) TGD individuals not currently in mental health treatment and the MMPI-3 normative sample, (b) TGD individuals not currently in mental health treatment and TGD individuals currently in mental health treatment, and (c) TGD individuals currently in mental health treatment and an outpatient mental health sample. Fewer differences were found between TGD individuals in our sample who were not currently in mental health treatment and the MMPI-3 normative sample compared to previous work. This initial study indicates that MMPI-3 scales largely have appropriate psychometric properties when administered to a TGD sample and that the test may be helpful in identifying mental health needs of TGD individuals. Needs and directions for further research are discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

A bottom-up approach to developing a unified trauma-minority stress model for transgender and gender diverse people.

OBJECTIVE: Transgender and gender diverse (TGD) people are at heightened risk of both Criterion A trauma exposure and other bias-related minority stressors (e.g., discrimination, rejection). In the absence of a unified trauma-minority stress theory, it remains unclear how to best conceptualize psychopathology for people who experience both trauma and minority stress. METHOD: Using a participant-driven q-sort methodology and network analytic approach, we analyzed card sort data from 18 TGD people and 16 providers with expertise in TGD care to derive thematic networks of trauma and minority stress experiences, as they connected to transdiagnostic symptoms (e.g., hyperarousal, avoidance). RESULTS: The TGD participants' resulting network illustrates conceptualizations of identity- and nonidentity-based Criterion A traumas as similar and only related to psychiatric symptoms via the shared connection through other minority stressors. The provider network was more granular, although the general pattern was consistent with TGD participants, demonstrating similar perceptions of how these experiences are associated. CONCLUSIONS: Evidence of inextricable links between trauma and psychiatric symptoms through the conduit of minority stressors lays the groundwork for novel, integrated models of trauma, minority stress, and their transdiagnostic symptom sequelae. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Real-time associations between discrimination, cannabis use, and mood among sexual and gender minority individuals.

OBJECTIVE: Sexual and gender minority (SGM) individuals experience high rates of discrimination, which is associated with increased cannabis use. Studies have also linked daily SGM discrimination to event-based mood states, but none have examined the degree to which cannabis buffers or potentially exacerbates mood in response to discrimination in real time. METHOD: Fifty SGM individuals participated in a 2-week ecological momentary assessment study. Participants completed a baseline assessment and then received six daily prompts assessing SGM discrimination, cannabis use, and current mood. We investigated the immediate associations between SGM discrimination and mood, and how cannabis use differentially moderated these associations. RESULTS: SGM discrimination was associated with increased negative mood and decreased positive mood. Among those who experienced discrimination, individuals who used cannabis reported feeling less anxious and depressed, and happier and more relaxed, in the 2 hr following an SGM discrimination experience compared to those that did not use cannabis. CONCLUSIONS: These findings uncover some of the acute within-day effects of both daily SGM discrimination and cannabis use on mood. These findings build on the current understanding of minority stress, in real time, and suggest avenues for prevention, and intervention efforts to offset risk for psychological distress and cannabis use among SGM individuals who experience minority stress. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Hazardous Substance Use Among Sexual and Gender Minority Adults: A Deeper Look into Distal Minority Stressors.

Discrimination and victimization drive health disparities among sexual and gender minority (SGM) individuals, yet little is known about the relative impacts of specific experience types on hazardous substance use. Using data from 704 SGM adults, we examined SGM-related discrimination vs. victimization and specific experiences as predictors of hazardous substance use. SGM-related victimization, not discrimination, predicted hazardous substance use, and SGM-related sexual assault and harassment predicted hazardous alcohol use, although only sexual assault predicted hazardous drug use. These findings implicate lifetime SGM-related victimization, and SGM-related sexual assault and harassment specifically, as key correlates of recent hazardous substance use among SGM adults.

Examining Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) scale scores in a transgender and gender diverse sample.

Transgender and gender diverse (TGD) individuals are at increased risk of various forms of psychopathology. Little research has been conducted with broadband measures of psychopathology and TGD individuals. The present study sought to examine how TGD individuals scored on Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) scales. This included MMPI-2-RF profiles from 85 TGD individuals; 37 were in mental health treatment and 48 of which were not. This study involved three sets of pairwise comparisons on MMPI-2-RF substantive scales via t-tests: (a) TGD individuals not in treatment versus the MMPI-2-RF normative sample, (v) TGD individuals not in treatment versus TGD individuals in treatment, and (c) TGD individuals in treatment versus a large outpatient clinical sample. Compared to the MMPI-2-RF normative sample, TGD individuals not in treatment scored significantly higher on 31 of the MMPI-2-RF substantive scales. Compared to those TGD individuals not in treatment, those in treatment had significantly higher scores on several MMPI-2-RF scales, primarily those of internalizing psychopathology. In the final comparison between TGD individuals in treatment and an outpatient clinical sample, the TGD individuals had some significantly higher and significantly lower scores on MMPI-2-RF substantive scales. Implications regarding minority stress and the current findings are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Which Domain of the PSY-5 Is Most Relevant to Substance Use?

Substance use has generally been related to lower levels of agreeableness and conscientiousness, but has evidenced relationships with other personality trait domains as well, including impulsivity. This study was conducted to determine which trait domain of personality is most related to substance use from the perspective of the Personality Psychopathology Five model (Harkness & McNulty, 1994 ). Archival data were used from 2 clinical settings: 1 outpatient community mental health center and 1 inpatient Veteran's Affairs hospital. The outpatient sample was mostly female (58.9%), White (78.7%), and had a mean age of 33.01 (SD = 10.26). The inpatient sample was entirely male, predominantly White (91.5%), and had a mean age of 48.03 (SD = 13.88). Correlations were conducted to identify the Minnesota Multiphasic Personality Inventory-2-Restructured Form Personality Psychopathology Five scales (Ben-Porath & Tellegen, 2008 ; Harkness et al., 2013 ) that were significantly related to variables measuring substance use. Subsequent regression analyses revealed that Disconstraint was the only significant predictor in the majority (89%) of analyses. In the event Disconstraint was not the only significant predictor, it continued to exhibit the largest unique predictive impact in the regression models. These results suggest that Disconstraint is the Personality Psychopathology-Five dimension most relevant to substance use.