# The Relationship of Stressors in Health Care to Emotional and Physical Symptoms Experienced by Marginalized People

> **NIH NIH F31** · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · 2021 · $31,155

## Abstract

Project Summary
People who are gender minority (GM; people whose gender is incongruent with the sex that was assigned to
them at birth) experience significantly higher rates of disability, chronic disease, and poor mental health as well
as higher mortality than cisgender individuals (people whose gender is congruent with the sex they were
assigned at birth). These health disparities have been linked to chronic stress associated with multiple
stressors they encounter. There is evidence from qualitative studies that interactions with the health care
environment may be a major source of stress that affects GM people’s willingness to seek care. However, little
is known about the relationship between the stressors in health care and the symptoms of emotional distress
or impaired physical functioning experienced by GM individuals or whether some gender identity groups may
be more negatively affected by stressors in health care than others. In addition, few psychometrically sound
measures are available to conduct such studies. The purpose of this study is to address these gaps in
knowledge. Data from the 2015 United States Transgender Survey (USTS) will be analyzed to identify factors
that may underlie stressors in health care interactions for GM people and whether survey items related to
these stressors constitute a valid and reliable index for future use in GM research. These items have not been
tested as a group for validity and reliability. Additionally, this research will examine relationships that may exist
between stressors in health care interactions and symptoms of both emotional distress and impaired physical
functioning among people who are GM. Emotional distress is measured with Kessler’s Psychological Distress
Scale. Items to assess physical functioning are adapted from CDC’s Behavioral Risk Factor Surveillance
System and the National Health Interview Survey. Symptom Management Theory will inform the study.
Aim 1: Identify key factors that may underlie stressors in health care interactions, by evaluating USTS stressor
items for factor structure and internal consistency.
Aim 2: Determine the relationship between exposure to stressors in health care interactions and symptoms
experienced by GM people (emotional distress and impaired physical functioning), after controlling for
socioeconomic factors (e.g. age, income, education, race/ethnicity).
Aim 3: Evaluate the potential role of gender identity as a moderator between health care stressors and
symptoms of both emotional distress and impaired physical functioning.
Evaluating a potential measure of GM health care stressors can enhance the quality of research in the field.
Findings can also be used to inform interventions and policy guidelines that will improve health care for GM
people by reducing the symptom burden experienced. The training and experience acquired to achieve these
outcomes will provide a solid foundation for this investigator’s developing program of research.

## Key facts

- **NIH application ID:** 10102125
- **Project number:** 5F31NR019000-02
- **Recipient organization:** UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
- **Principal Investigator:** Kristen Drew Clark
- **Activity code:** F31 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $31,155
- **Award type:** 5
- **Project period:** 2019-12-01 → 2021-09-07

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10102125

## Citation

> US National Institutes of Health, RePORTER application 10102125, The Relationship of Stressors in Health Care to Emotional and Physical Symptoms Experienced by Marginalized People (5F31NR019000-02). Retrieved via AI Analytics 2026-06-11 from https://api.ai-analytics.org/grant/nih/10102125. Licensed CC0.

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