Dissertations, Theses, and Capstone Projects

Date of Degree

9-2024

Document Type

Dissertation

Degree Name

Ph.D.

Program

Psychology

Advisor

Danielle Berke

Committee Members

Sarit Golub

Jonathon Rendina

Cheryl Carmichael

Devin English

Subject Categories

Clinical Psychology | Health Psychology | Multicultural Psychology | Other Psychology

Keywords

intersectionality, transgender, non-binary, stigma, resilience, LGBTQ+ health

Abstract

Background: Racially minoritized transgender and gender expansive young adults (RMTGEYA; aged 18-26) experience mental health inequities due to intersectional, multilevel stigma. RMTGEYA communities embody intersectional strength and resilience that can mitigate the impact of stigma. Understanding and capturing strength and stigma factors to address these inequities has significant implications for clinical science research and practice. There is, however, a complete absence of instruments that are validated to do so. Objective: The goal of this study is to conduct a three-phase, mixed methods study that centers intersectional and community engaged methods of psychometric development for a measure that captures daily experiences of intersectional strength and stigma among RMTGEYA. Method: Phase 1 aims to adapt an existing measure of intersectionality (i.e., PRISM) using cognitive interviewing among a sample of 10 RMTGEYA. Phase 2 aims to test the psychometric properties and clinical predictive ability of the refined measure using a 21-day daily diary approach among 66 participants. Phase 3 utilizes semi-structured interviews to further validate the measure and provide human, narrative data on a sample of 16 participants from Phase 2. Results: Cognitive interviews yielded two overarching issues— logical or survey communications and acceptability of content—which guided revisions to survey components. MCFA’s using daily diary data further refined the item pool towards a finalized 21-item measure and yielded a two-factor structure for strength and stigma with good fit at the day-level (𝛘2=2641.93; RMSEA=0.09; pclose=0.10; SRMR=0.54) and acceptable fit at the between-person level (SRMR=0.45). MLM’s showed that the predictive effects of average strength (𝛽= -0.08, pppphigh-low patterns of between-person strength and stigma moderated the association between stigma and distress (see Table 13 for full results). Finally, I observed seven distinct themes that elucidate these patterns: 1) individual-level strength; 2) intersectional strength; 3) macro-level strengths); 4) individual-level stigma; 5) intersectional stigma; 6) individual-level stigma; 7) structural stigma and macro-level supports deficits. These thematic profiles map onto the quantitative patterns to detail clinical profiles of social functioning, mental health, and structural impacts, and provide further support for the validity of the measure. Discussion: Findings highlighted the benefits of an intersectional, community engaged, mixed methods approach to psychometric measure development, as well as the translation implications for clinical intervention. Findings also elucidate a critical need for structural supports for RMTGEYA and implicates systems of interlocking power that significantly drive inequity among this community.

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