Discrimination and Symptoms of Post-Traumatic Stress Among Black Transgender Women in the United States: The Moderating Effect of Sleep.

Background: Black transgender women experience high rates of intersectional discrimination contributing to post-traumatic stress disorder (PTSD) symptoms. While sleep typically buffers psychological distress among general populations, these relationships remain underexplored among Black transgender women, and existing protective sleep literature derives primarily from non-Hispanic White, cisgender, socioeconomically advantaged populations. Methods: This exploratory secondary cross-sectional analysis of 155 Black transgender women (aged 18+) examined whether sleep quality (Pittsburgh Sleep Quality Index) moderates associations between discrimination (Intersectional Discrimination Index) and PTSD symptoms (PTSD Symptom Checklist-DSM-5) using moderated multiple linear regression models, controlling for age (n = 139-149). Results: Contrary to expectations, better sleep quality strengthened associations between day-to-day (p = 0.0126) and major discrimination (p = 0.0235) and the PTSD symptom severity. Conclusions: These exploratory findings reveal paradoxical sleep-distress relationships among Black transgender women that contradict patterns documented among general populations, highlighting critical limitations in applying existing psychological frameworks to multiple marginalized communities. Results underscore urgent needs for culturally validated assessment instruments and comprehensive measurement of structural determinants (housing stability, economic security, and neighborhood safety) before concluding psychology in populations experiencing intersectional oppressions.