"Being who I am means everything bad can happen": Chronic structural stressors in trauma focused therapy sessions with marginalized adolescents.

OBJECTIVE: Exposure to chronic structural stressors (e.g., poverty, community violence, and discrimination) exacerbates posttraumatic stress disorder (PTSD) symptoms and reduces how adolescents benefit from trauma-focused interventions. However, current evidence-based PTSD interventions seldom include concrete guidance regarding how to target chronic structural stressors in care. METHOD: This study utilized qualitative thematic analysis of audio-recorded PTSD therapy sessions with 13 racially diverse, low socioeconomic status adolescents to elucidate (a) how often adolescents disclose chronic structural stressors in therapy, (b) the types of chronic structure stressors that are disclosed, and (c) the context in which chronic structural stressors are disclosed and the content of these disclosures. RESULTS: 77% of adolescents disclosed at least one chronic structural stressor and that the presence of stressors exacerbated psychological distress, reduced treatment engagement, and decreased perceptions of intervention effectiveness. CONCLUSIONS: Our findings suggest that there is a missed opportunity to improve the effectiveness of treatment for PTSD by incorporating intervention elements that directly target structural stressors. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Discrimination and Internalizing Symptoms in Rural Latinx Adolescents: The Protective Role of Family Resilience.

OBJECTIVE: There is a well-documented relationship between discrimination and increases in internalizing symptoms among rural Latinx youth. Among numerous assets in these adolescents' lives, family resilience emerges as a culturally relevant and robust protective factor. However, it is still unclear whether family resilience is equally protective across different internalizing symptom clusters and whether this buffering effect is independent of other interconnected resilience sources. METHOD: Latinx adolescents from an underserved rural community (n = 444; Mage = 15.74, SDage = 1.22; 51% male) reported on their internalizing symptoms, experiences of discrimination, and sources of resilience. We examined whether perceived family resilience moderated the association between perceived discrimination and self-reported depressive, somatic, and anxiety symptoms over and above adolescents' sex, self-reported level of acculturation, as well as perceived individual and contextual resilience. RESULTS: Analyses showed that perceived discrimination experiences were robustly associated with higher levels of self-reported internalizing symptoms, while perceived family resilience was related to lower self-reported symptomatology. Closer examination revealed that perceived family resilience buffered the negative effects of perceived discrimination on self-reported depression and somatic symptoms, but not anxiety symptoms. CONCLUSIONS: This study addresses a gap in the literature by identifying differential protective effects of family resilience that might be explained by cultural values and practices in rural Latinx families. Findings suggest that interventions that incorporate family members and promote supportive family environments may benefit rural Latinx youth with a broad range of internalizing symptoms.

Minority Stress Factors Associated With Depression and Anxiety Among Transgender and Gender-Nonconforming Youth.

PURPOSE: Transgender and gender-nonconforming (TGNC) adolescents and young adults experience mental health problems, including anxiety and depression, at an elevated rate as compared to their cisgender counterparts. A growing literature suggests that vulnerability to psychiatric problems in TGNC individuals results from social discrimination and minority stress. METHODS: The sample consisted of adolescent TGNC patients (N = 109) who completed behavior health screening questionnaires as standard of care at their first clinical visit to an interdisciplinary gender program within a pediatric academic medical center in a metropolitan Midwestern city. Binary logistic regressions were used to assess whether the likelihood that participants met clinical diagnostic criteria for Major Depressive Disorder (MDD) and Generalized Anxiety Disorder (GAD) was predicted by gender identity appearance congruence, proximal forms of minority stress (e.g., negative expectations of the future related to gender identity; internalized transphobia) and community connectedness (i.e., resilience) . RESULTS: Overall, 33% (n = 36) of the sample met diagnostic criteria for MDD and 48% (n = 53) met diagnostic criteria for GAD. Those with high levels of internalized transphobia were significantly more likely to meet diagnostic criteria for both MDD and GAD. Those with low levels of gender identity appearance congruence were significantly more likely to meet diagnostic criteria for MDD but not GAD. CONCLUSION: There are several unique factors that may predict mental illness among TGNC youth. Understanding these factors may offer opportunities for targeted clinical and structural interventions.

The Gender Minority Stress and Resilience Measure: Psychometric Validity of an Adolescent Extension.

OBJECTIVE: Minority stress contributes to several physical and psychological problems in sexual and gender minorities but is largely understudied in transgender/gender-nonconforming (TGNC) individuals, particularly TGNC adolescents. The availability of psychometrically sound measures of adolescent minority stress can help improve assessment and treatment planning in this area. This original research study examined whether an existing measure of TGNC-related minority stress and resilience among adults could retain construct and psychometric validity when administered to TGNC adolescents. METHODS: Respondents were 258 TGNC adolescents, aged 12 -17.99 years (M=15.1, SD=1.4), majority white/European American (70.2%) and assigned female at birth (71.7%) seeking care in an interdisciplinary gender-health clinic within a pediatric academic medical center in the Midwestern United States. Respondents completed a battery of clinical measures as standard of care, including the Gender Minority Stress and Resilience Measure, measures of anxiety and depression symptoms, and parental support. RESULTS: Findings indicated that minor adaptation of the existing adult measure resulted in high internal consistency and construct validity across 9 subscales assessing domains of minority stress and resilience in this sample of TGNC adolescents. CONCLUSIONS: This study provides evidence of the factor structure, reliability and validity of an adolescent extension of the Gender Minority Stress and Resilience measure (GMSR-A). These findings demonstrate the clinical utility of the GMSR-A, a tool that can help increase understanding of minority stress and resilience phenomena experienced by TGNC adolescents.

Housing status among single adults following Homelessness Prevention and Rapid Re-housing Program participation in Indianapolis.

The Homelessness Prevention and Rapid Re-housing Program (HPRP) was a federally-funded program in the United States that provided short-term financial and support services to individuals and families who were at-risk or currently experiencing homelessness. There is limited research on factors that predict placement in permanent housing following prevention and rapid rehousing interventions, particularly for single adult populations. The present study examined demographic and program-related predictors of permanent housing upon program exit among two groups of adults enrolled in HPRP in Indianapolis, IN: Homelessness Prevention (HP) recipients (n = 219) and Rapid Re-housing (RRH) recipients (n = 296). Results revealed that 76.3% of HP and 68.8% of RRH recipients were living in permanent housing when they exited HPRP. For HP recipients, completion of HPRP and outreach and engagement services were significant predictors of remaining in permanent housing. For RRH recipients, individuals who were African American, did not have a disabling condition, completed HPRP, received a greater amount of financial assistance, and received case management services had significantly greater odds of permanent housing. Findings have implications for informing short-term housing support programs for precariously housed or homeless single adults and highlight the need for future research on prevention and rehousing interventions.

Applying a Time-Patterned Typology of Homelessness Among Individuals with Mental Illness.

Identification of subgroups of the homeless populations, or typologies, has been an important research priority to guide homelessness services and policies. This study builds on previous typological research conducted in the general homeless population by focusing on individuals with mental illness to further delineate typologies within a more homogenous subset of the homeless population. A time-patterned typology based on episodes of street and shelter homelessness over a four-year period was applied to a sample of 246 individuals identified through mental health administrative records. Four groups were created based upon patterns of homelessness: 26.8% experienced homelessness for 4 years, 13.4% had one episode of homelessness but were no longer homeless at the end of the follow-up, 48.4% had at least two episodes of homelessness, and 11.4% had a single episode of homelessness lasting 3 months or less. Findings from a multinomial logistic regression indicated that gender, presence of a psychotic disorder, substance abuse, and year of study enrollment significantly predicted group membership. Residential trajectories upon exit from homelessness and at the end of the four-year follow-up were examined. Implications for current policy and future research are discussed.