Prior differences in previous trauma exposure primarily drive the observed racial/ethnic differences in posttrauma depression and anxiety following a recent trauma (original) (raw)
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Psychological Medicine
Background The prevalence of mental disorders among Black, Latino, and Asian adults is lower than among Whites. Factors that explain these differences are largely unknown. We examined whether racial/ethnic differences in exposure to traumatic events (TEs) or vulnerability to trauma-related psychopathology explained the lower rates of psychopathology among racial/ethnic minorities. Methods We estimated the prevalence of TE exposure and associations with onset of DSM-IV depression, anxiety and substance disorders and with lifetime post-traumatic stress disorder (PTSD) in the Collaborative Psychiatric Epidemiology Surveys, a national sample (N = 13 775) with substantial proportions of Black (35.9%), Latino (18.9%), and Asian Americans (14.9%). Results TE exposure varied across racial/ethnic groups. Asians were most likely to experience organized violence – particularly being a refugee – but had the lowest exposure to all other TEs. Blacks had the greatest exposure to participation in o...
Journal of Traumatic Stress, 2012
Urban, socially disadvantaged individuals are at high risk for traumatic event exposure and its subsequent psychiatric symptomatology. This study examined the association between race/ ethnicity and symptom severity of posttraumatic stress disorder (PTSD), generalized anxiety disorder (GAD), and depression in an urban clinical sample of 170 trauma-exposed adults. In addition, this study investigated the role of socioeconomic position (SEP) and coping style in the relationship between race/ethnicity and posttrauma psychiatric symptom severity. Hierarchical regression analyses indicated that Blacks had lower depression symptom severity compared to Whites. No significant relationship was found between racial/ethnic group status and indices of SEP, PTSD, or GAD symptom severity. Adjustment for trauma exposure, gender, positive reframe coping, avoidance coping and negative coping accounted for 3%, 3%, 8%, 4%, and 3% of the variance in depression severity, respectively; however, Black race remained significantly associated with decreased depression symptom severity accounting for a statistically significant 5% of the variance in lower depression symptom severity. These preliminary findings and their clinical implications are discussed.
Posttraumatic stress disorder in African Americans: A two year follow-up study
Psychiatry Research, 2014
The present study was a prospective, naturalistic, longitudinal investigation of the two year course of posttraumatic stress disorder (PTSD) in a sample of African Americans with anxiety disorders. The study objectives were to examine the two year course of PTSD and to evaluate differences between African Americans with PTSD and anxiety disorders and African Americans with anxiety disorders but no PTSD with regard to comorbidity, psychosocial impairment, physical and emotional functioning, and treatment participation. The participants were 67 African Americans with PTSD and 98 African Americans without PTSD (mean age 41.5 years, 67.3% female). Individuals with PTSD were more likely to have higher comorbidity, lower functioning, and they were less likely to seek treatment than those with other anxiety disorders but no PTSD. The rate of recovery from PTSD over two years was .10 and recovery from comorbid Major Depressive Disorder was .55. PTSD appears to be persistent over time in this populattion. The rates of recovery were lower than what has been reported in previous longitudinal studies with predominantly non-Latino Whites. It is imperative to examine barriers to treatment and factors related to treatment engagement for this population.
Posttraumatic Stress Disorder Among Ethnoracial Minorities in the United States
Clinical Psychology: Science and Practice, 2008
Because ethnoracial minorities are a growing part of the U.S. population yet are underrepresented in the psychopathology literature, we reviewed the evidence for differences in prevalence and treatment of posttraumatic stress disorder (PTSD) in African Americans, Latino Americans, Asian and Pacific Islander Americans, and American Indians. With respect to prevalence, Latinos were most consistently found to have higher PTSD rates than their European American counterparts. Other groups also showed differences that were mostly explained by differences in trauma exposure. Many prevalence rates were varied by subgroup within the larger ethnoracial group, thereby limiting broad generalizations about group differences. Regarding service utilization, some studies of veterans found lower utilization among some minority groups, but community-based epidemiological studies following a traumatic event found no differences. Finally, in terms of treatment, the literature contained many recommendations for culturally sensitive interventions but little empirical evidence supporting or refuting such treatments. Taken together, the literature hints at many important sources of ethnoracial variation but raises more questions than it has answered. The article ends with recommendations to advance work in this important area.
Longitudinal Determinants of Posttraumatic Stress in a Population-Based Cohort Study
Epidemiology, 2008
Background: Posttraumatic stress disorder is a prevalent and disabling psychologic pathology. Longitudinal research on the predictors of posttraumatic stress symptomatology is limited. Methods: We recruited 2752 participants to a prospective, population-based cohort study by conducting a telephone survey of adult residents of the New York City metropolitan area in 2002; participants completed 3 follow-up interviews over a 30-month period. Censoring weights were estimated to account for potential bias. We used generalized estimating equation logistic regression models with bootstrapped confidence intervals to assess the predictors of posttraumatic stress over time in multivariable models. Results: Predictors of posttraumatic stress over time included ongoing stressors (odds ratio ͓OR͔ ϭ 1.91 per 1 unit increase in number of stressors, ͓95% confidence interval ϭ 1.55-2.36͔) and traumatic events (OR ϭ 1.92 per 1 unit increase in number of traumatic events ͓CI ϭ 1.71-2.22͔), social support (compared with high levels, OR ϭ 1.71 for medium ͓1.09-2.52͔; OR ϭ 1.57 for low ͓1.08-2.35͔), low income (OR ϭ 0.87 per $10,000 increase ͓0.81-0.92͔), female sex (1.60 ͓1.11-2.23͔), and Latino ethnicity (compared with white, OR ϭ 1.74 ͓1.05-2.97͔). Conclusions: These findings suggest that ongoing stressors play a central role in explaining the trajectory of posttraumatic stress over time, and that factors beyond the experience of stressors and traumas may account for sex and ethnic differences in posttraumatic stress risk. Interventions that focus on reducing ongoing adversity may help mitigate the consequences of traumatic events.
Traumatic Events Associated With Posttraumatic Stress Disorder
Violence Against Women, 2015
This study sought to examine specific types of potentially traumatic experiences as predictors of posttraumatic stress disorder (PTSD) and the moderating effect of race/ethnicity and major depressive disorder (MDD) among non-Hispanic White, non-Hispanic Black, and Hispanic U.S. women. The study sample was drawn from two waves of the National Epidemiologic Surveys of Alcohol and Related Conditions. Sexual assault, intimate partner violence, and childhood trauma were the strongest predictors of PTSD compared to the reference group (indirect/witnessed trauma). Similar patterns were revealed across racial/ethnic groups, although the estimates were most robust among White women. Findings also suggest that MDD moderates the effect of traumatic experiences on PTSD.
Ethnicity and Risk for Symptoms of Posttraumatic Stress Following Intimate Partner Violence
Journal of interpersonal violence, 2009
The present study uses a feminist theoretical framework to explore risk factors for the development of posttraumatic stress symptoms following intimate partner violence, with a community sample of 120 low-income European American and African American women. Hierarchical regression analyses were used to examine demographic, violence, and mental health variables that predict posttraumatic stress symptoms. The data reveal that African American women report lower levels of posttraumatic stress symptoms than do their European American peers. This difference was observed despite the presence of more empirically identified risk factors for African American women. Regression analyses show that symptoms of depression increase risk for posttraumatic stress for both groups. However, a difference was observed such that past victimization increase risk for only European American women, whereas amount of psychological violence in the previous year increases risk for only African American women. Potential explanations for observed ethnic differences are offered.
Journal of Consulting and Clinical Psychology, 2010
The present study investigated the influence of race on posttraumatic stress disorder (PTSD) treatment among 94 African American and 214 Caucasian female victims of interpersonal violence participating in 2 studies of cognitive-behavioral treatment for PTSD that were conducted sequentially and continuously. Method: In each study, participants were randomized into 1of 3 conditions. The first study compared cognitive processing therapy with prolonged exposure and a delayed treatment condition. In the second study, cognitive processing therapy was compared with its constituent components: cognitive therapy only and written accounts. Participants were assessed with the Clinician Administered PTSD Scale and the Structured Clinical Interview for DSM-IV, as well as through self-report measures of PTSD. Results: Analyses revealed that African Americans were significantly less likely to complete treatment compared with Caucasians (45% vs. 73%, respectively, p Ͻ .001) and that the differences held even after controlling for education and income. Despite racial differences in treatment completion status, analyses with the intent-to-treat sample indicated no racial differences in outcomes on PTSD measures. Conclusions: The lack of difference in treatment outcomes despite racial differences in dropout may be explained by greater symptom improvement of African Americans who dropped out compared with Caucasians who dropped out. Implications of these findings and practical approaches to addressing sociocultural barriers to care are explored.