Post-traumatic Stress Disorder Symptoms and Mental Health over Time among Low-Income Women at Increased Risk of HIV in the U.S (original) (raw)
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PTSD symptoms and partner abuse: Low income women at risk
Journal of Traumatic Stress, 2001
Aspects of partner abuse (types, severity, chronicity, treatment of injury, fear, etc.) were addressed with low income community women, half of whom scored above the cutoff on the Crime Related PTSD scale. Using this cutoff, 47% of women who sustained moderate violence were high in CR-PTSD symptoms. If their partner also raped them, the rate (63%) was similar to women who sustained severe violence (65%) or severe violence and rape (71%). No ethnic differences were found for rates or severity of CR-PTSD symptoms. A MANCOVA by ethnicity (African Americans, Euro-Americans, Mexican Americans) and CR-PTSD symptoms (low vs. high) identified ethnic differences only on total sexual aggression and recent threats of violence. The high symptom group reported more abuse on all measures. Results from the CR-PTSD and the general lack of ethnic differences support the notion that SES contributes more to women's vulnerability to abuse and stress symptoms than does ethnicity.
Objective: During the 1994 Rwandan genocide, rape was used as a weapon of war to transmit HIV. This study measures trauma experiences of Rwandan women and identifies predictors associated with posttraumatic stress disorder (PTSD) and depressive symptoms. Methods: The Rwandan Women's Interassociation Study and Assessment (RWISA) is a prospective observational cohort study designed to assess effectiveness and toxicity of antiretroviral therapy in HIV-infected Rwandan women. In 2005, a Rwandan-adapted Harvard Trauma Questionnaire (HTQ) and the Center for Epidemiologic Studies Depression Scale (CES-D) were used to assess genocide trauma events and prevalence of PTSD (HTQ mean >2) and depressive symptoms (CES-D ! 16) for 850 women (658 HIV-positive and 192 HIVnegative). Results: PTSD was common in HIV-positive (58%) and HIV-negative women (66%) ( p ¼ 0.05). Women with HIV had a higher prevalence of depressive symptoms than HIV-negative women (81% vs. 65%, p < 0.0001). Independent predictors for increased PTSD were experiencing more genocide-related trauma events and having more depressive symptoms. Independent predictors for increased depressive symptoms were making <$18 a month, HIV infection (and, among HIV-positive women, having lower CD4 cell counts), a history of genocidal rape, and having more PTSD symptoms. Conclusions: The prevalence of PTSD and depressive symptoms is high in women in the RWISA cohort. Four of five HIV-infected women had depressive symptoms, with highest rates among women with CD4 cell counts <200. In addition to treatment with antiretroviral therapy, economic empowerment and identification and treatment of depression and PTSD may reduce morbidity and mortality among women in postconflict countries.
Psychosomatic Medicine, 2005
In addition to biological markers of human immunodeficiency virus (HIV) disease progression, physical functioning, and utilization of health care may also be important indicators of health status in HIV-infected patients. There is insufficient understanding of the psychosocial predictors of health-related physical functioning and use of health services among those with this chronic disease. Therefore, the current study examines how trauma, severe stressful events, posttraumatic stress disorder (PTSD), and depressive symptoms are related to physical functioning and health utilization in HIV-infected men and women living in rural areas of the South. Methods: We consecutively sampled patients from 8 rural HIV clinics in 5 southern states, obtaining 611 completed interviews. Results: We found that patients with more lifetime trauma, stressful events, and PTSD symptoms reported more bodily pain, and poorer physical, role, and cognitive functioning. Trauma, recent stressful events, and PTSD explained from 12% to 27% of the variance in health-related functioning, over and above that explained by demographic variables. In addition, patients with more trauma, including sexual and physical abuse, and PTSD symptoms were at greater risk for having bed disability, an overnight hospitalization, an emergency room visit, and four or more HIV outpatient clinic visits in the previous 9 months. Patients with a history of abuse had about twice the risk of spending 5 or more days in bed, having an overnight hospital stay, and visiting the emergency room, compared with those without abuse. The effects of trauma and stress were not explained by CD4 lymphocyte count or HIV viral load; however, these effects appear to be largely accounted for by increases in current PTSD symptoms. Conclusion: These findings highlight the importance of addressing past trauma, stress, and current PTSD within clinical HIV care.
The Journal of Nutrition, 2019
Background Food insecurity, which disproportionately affects marginalized women in the United States, is associated with depressive symptoms. Few studies have examined relations of food insecurity with other mental health outcomes. Objective The aim of this study was to investigate the associations of food insecurity with symptoms of generalized anxiety disorder (GAD), stress, and posttraumatic stress disorder (PTSD) in the Women's Interagency HIV Study (WIHS), a prospective cohort study of women with or at risk of HIV in the United States. Methods Participants were 2553 women with or at risk of HIV, predominantly African American/black (71.6%). Structured questionnaires were conducted during April 2013–March 2016 every 6 mo. Food security (FS) was the primary predictor, measured using the Household Food Security Survey Module. We measured longitudinal outcomes for GAD (GAD-7 score and a binary GAD-7 screener for moderate-to-severe GAD). Only cross-sectional data were available ...
Women's Health Issues, 2019
Background: Trauma is increasingly recognized as a near-universal experience among women living with HIV (WLHIV) and a key contributor to HIV acquisition, morbidity, and mortality. Methods: We present data from the baseline analysis of a planned intervention trial of the impact of trauma-informed health care on physical, mental, and social health outcomes of WLHIV in one clinic, with particular focus on quality of life and viral suppression. Data were collected through interviewer-administered surveys and electronic health record data abstraction. Results: Among 104 WLHIV, 97.1% of participants reported having experienced lifetime trauma, and participants had experienced on average 4.2 out of 10 Adverse Childhood Experiences (ACEs). WLHIV with more lifetime trauma were significantly more likely to report PTSD, depression, and anxiety symptoms; significantly more likely to report potentially harmful alcohol and drug use; and had significantly poorer quality of life. In addition, women who had experienced more lifetime trauma were significantly less likely to report being on and adhering to HIV medications, although trauma was not significantly associated with having an undetectable HIV viral load.
Journal of Urban Health, 2008
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
AIDS Care, 2004
Many individuals living with HIV have been exposed to some type of traumatic event during their lives and may be living with symptoms of post-traumatic stress disorder (PTSD). A substantial number of these individuals are also likely to show evidence of a co-morbid substance use disorder (SUD). There is reason to believe that the co-occurrence of HIV and PTSD or co-morbid PTSD and SUD (PTSD/SUD) may predict poorer health outcomes. There are several pathways through which PTSD or PTSD/SUD might adversely impact the health of individuals living with HIV, including participation in negative health behaviours, low levels of adherence to antiretroviral medications, and/or a direct, deleterious effect on immune function. Psychological interventions are needed to treat PTSD and PTSD/SUD in HIV-positive individuals, and reduce the negative impact of these conditions on health outcomes.
American Indian and Alaska native mental health research (Online), 2015
We assessed the relationship between post-traumatic stress disorder (PTSD), binge drinking, and HIV sexual risk behavior by examining number of unprotected sex acts and number of sexual partners in the past 6 months among 129 sexually active American Indian women. A total of 51 (39.5%) young women met PTSD criteria. Among women who met the PTSD criteria, binge drinking was associated with a 35% increased rate of unprotected sex (IRR 1.35, p < .05), and there was a stronger association between increased binge drinking and risk of more sexual partners (IRR 1.21, p < .001) than among women who did not meet PTSD criteria (IRR 1.08, p < .01) with a difference of 13% (p < .05). HIV intervention and prevention interventions in this population likely would benefit from the inclusion of efforts to reduce binge drinking and increase treatment of PTSD symptoms.