Experiences of Traumatic Events and Associations with PTSD and Depression Development in Urban Health Care-seeking Women (original) (raw)

2008, Journal of Urban Health

Posttraumatic stress disorder (PTSD) is an anxiety disorder that occurs after a traumatic event and has been linked to psychiatric and physical health declines. Rates of PTSD are far higher in individuals with low incomes and who reside in urban areas compared to the general population. In this study, 250 urban health care-seeking women were interviewed for a diagnosis of PTSD, major depressive disorder, and also the experience of traumatic events. Multivariate logistic regressions were used to determine the associations between traumatic events and PTSD development. Survival analysis was used to determine if PTSD developed from assaultive and nonassaultive events differed in symptom duration. Eighty-six percent of women reported at least one traumatic event, 14.8% of women were diagnosed with current PTSD, and 19.6% with past PTSD. More than half of women with PTSD had comorbid depression. Assaultive traumatic events were most predictive of PTSD development. More than two thirds of the women who developed PTSD developed chronic PTSD. Women who developed PTSD from assaultive events experienced PTSD for at least twice the duration of women who developed PTSD from nonassaultive events. In conclusion, PTSD was very prevalent in urban health care-seeking women. Assaultive violence was most predictive of PTSD development and also nonremittance. 693 mediate MDD development in traumatized individuals. 4,5 Lastly, MDD has been shown to co-occur in almost half of individuals who develop PTSD, compounding psychological and physical health impairments. Women develop PTSD at twice the rate of men, 1-3,8-10 and also experience PTSD symptoms for longer periods than men. 2 Women's vulnerability for PTSD development may be related to the experience of assaultive events. Assaultive traumatic events including rape, sexual assault, physical assault, or being robbed, mugged, shot, or stabbed have been shown to result in substantially higher risk for PTSD development than non-assaultive events. Individuals who experienced one traumatic event were not at any greater risk to develop PTSD compared to nontraumatized controls; however, individuals who reported experiencing two or three traumatic events were two to three times more likely to develop PTSD than nontraumatized controls. 1,3,12 Assaultive events perpetrated by a known assailant and which may take place over time, such as childhood sexual abuse and intimate partner violence (IPV), place women at high risk for PTSD development. Longitudinal and cross-sectional studies have shown the duration and severity of abuse to be related to the risk for PTSD development, particularly in individuals who experienced IPV or childhood physical or sexual abuse. PTSD is more prevalent among individuals seeking health care, with rates more than triple the national rate, resulting in current PTSD rates between 8% and 14%. 2,11,18 Furthermore, in samples of more-urban and less-insured individuals, extremely high rates of PTSD have been reported, including a study in which 30% of health care-seeking urban women were diagnosed with lifetime PTSD. Individuals with PTSD may be more prominent in primary care settings because of greater use of out-patient services 20-23 and the experience of additional medical conditions. African Americans who live in urban economically disadvantaged areas experience higher rates of trauma and PTSD than the general population. 1,3,6,26 In a sample of health care-seeking urban African-American women, rates of current PTSD were as high as 23%. In a large epidemiologic study, rates of PTSD for nonwhites was twice as high as whites (14% versus 7%); however, these higher rates were attributed to socioeconomic status and urban residence, suggesting that these factors may congregate and result in increased risk. The chronic stress of poverty and urban living may contribute to PTSD risk. Low-income urban women are confronted with chronic stressors including economic hardship, which extends to nearly every aspect of ordinary life, from difficulties meeting daily needs to dangers of substandard housing and dangerous neighborhood environments. The cumulative burden of economic hardship, witnessing violent crimes, limited health care resources, and high risk for direct victimization may tax urban women's psychological resources, increasing the risk for psychiatric and physical health declines. Although high rates of trauma and PTSD have been reported in samples of urban African-American women, the nature of PTSD risk has not been wellcharacterized. Therefore, this study was undertaken in a health care-seeking urban sample of predominantly African-American women, and was guided by four specific aims: (1) to determine how many women experienced traumatic events and also the percentage who developed PTSD and MDD, (2) to identify traumatic events that were associated with an increased risk for PTSD development, (3) to determine if assaultive precipitating trauma increased the duration of PTSD, and (4) to describe the association between PTSD and MDD. GILL ET AL. 694 PTSD IN UNINSURED HEALTH CARE-SEEKING WOMEN 695