NNAMDI POLE, JOSEPH P. GONE, AND MADHUR KULKARNI PRESENTED BY: TIFFANY N. PELLETIER Posttraumatic Stress Disorder Among Ethnoracial Minorities in the United States

Quick Overview of PTSD / /

PTSD Prevalence in Ethnoracial Minority Groups African Americans Latino Americans Asian and Pacific Islander Americans (APIA) American Indians

African Americans and PTSD Constitute 12.3% of the US population Similarities:  Religious Orientation, strong work ethic, reliance on extended family networks, maintenance of tight kinship bonds. Lower rates of Mood Disorders and SUDs than European Americans Higher rates of Anxiety disorders (simple phobia and agoraphobia) Mixed Rates of PTSD when compared to European Americans

African Americans and PTSD Trauma Exposure  Studies that have found more PTSD among African Americans have also found more trauma exposure within this group. Studies that have controlled for trauma exposure have almost eliminated difference in the prevalence of PTSD compared to European Americans Reasons for more trauma exposure? Coping Mechanisms for dealing with trauma Trait and Peritraumatic Dissociation

Assessment & Treatment within African Americans African Americans have been found to be:  Less likely to utilize mental health services than European Americans  More likely to drop out of treatment than European Americans African American have been shown to be over- diagnosed with Schizophrenia but under-diagnosed with affective disorders.  How might this effect PTSD diagnosis in African Americans? Recommendations within Psychotherapy  Ethnic matching?

Latino Americans and PTSD Largest minority group in the U.S.: 12.5% Similarities among Latino Americans  Catholicism & Spanish Language  Core values attributed to Latino Americans  familismo, simpatia, respeto, personalismo, fatalismo Lower rates of mood, anxiety, and other mental disorders when compared to non-Latino Caucasians Higher rates of PTSD especially within Latino American combat veterans. Moderators of PTSD within Latino Americans  Geographic Location  Acculturation

Latino Americans and PTSD Trauma Exposure  Unlike African Americans, elevated rates of PTSD in Latino Americans cannot be explained by higher amounts of trauma exposure. Discrimination: Latino Americans who reported ethnic discrimination also reported more severe PTSD symptomology Coping Greater Peritraumatic Dissociation

Assessment & Treatment within Latino Americans Latinos have been found to utilize mental health services less than their European American counterparts.  Trauma exposed Latinos however, appear to utilize mental health services at a similar rate when compared to non-Latino trauma exposed individuals. Assessment & Therapy can be difficult with Latino Americans because of the language barriers, somatic complaints as “idioms of distress,” and also symptoms that are uncommon to PTSD (i.e. auditory hallucinations Recommendations within Psychotherapy:  Spanish Speaking therapist?  Family therapy?  Boundaries of traditional therapy too rigid?

Asian and Pacific Island Americans (APIA) and PTSD Although APIAs only constitute 4.4% of the total U.S. population, it is the fastest growing minority group. Very diverse ethnic group but similarities do exist:  Identity in terms of a larger social unit, value of maintaining harmony with others, greater adherence to social norms, subordinate individual desires to the will of the group. APIAs show lower rates of psychopathology, including PTSD, than their European American counterparts.  Japanese Americans had significantly lower rates of PTSD

Asian and Pacific Island Americans (APIA) and PTSD Trauma Exposure  There hasn’t been much research done on the APIA group. Not surprising, the research shows that the subgroup of APIA that has experienced the most trauma (Cambodian Refugees) also had more severe PTSD. Japanese Americans showed the least amount of PTSD symptomology even when controlling for trauma exposure. Acculturative Stress Ethnic Discrimination Reporting Style

Assessment & Treatment within Asian and Pacific Island Americans (APIA) Utilization of mental health services among APIAs  Research on general mental health service utilization among APIAs show that this ethnic group is less likely to use these services as well as prematurely terminate psychotherapy.  Post-9/11 APIAs were as likely as their European American counterparts to seek mental health services.  APIAs appear to get as much benefit from PTSD therapy as do European Americans. Recommendations for Psychotherapy  Interventions at group level?

American Indians and PTSD American Indians constitute 1.5% of the U.S. population. American Indians appear to have greater levels of alcohol abuse and dependence and suicide rates than European Americans Very few studies of PTSD within American Indians, but one study found that the prevalence of PTSD within Native Americans was almost double that when compared to European Americans.

American Indians and PTSD Trauma Exposure  American Indian veterans (like African American, Latino American, and APIA veterans) reported more exposure to combat than European Americans.  Controlling for exposure to trauma significantly reduced PTSD rates among American Indians. Intergenerational Trauma  Multigenerational Trauma History

Relationship of Parental Trauma Exposure and PTSD to PTSD, Depressive and Anxiety Disorders in Offspring Rachel Yehuda, Sarah Halligan, Linda Bierer A specific association was found between parental PTSD and the occurrence of PTSD in offspring. Additionally, parental trauma exposure, more than parental PTSD, was found to be significantly associated with lifetime depressive disorder. The identification of parental PTSD as a risk factor for PTSD in offspring of Holocaust survivors defines a sample in which the biological and psychological correlates of risk for PTSD can be further examined.

Assessment & Treatment within American Indians Utilization of mental health services among American Indians:  American Indians may be more likely to seek help from traditional healers within their tribe Assessment may be difficult within the American Indian group.  Less distinction between emotional and somatic symptoms  May be confusing due to the generations of discrimination Recommendations for Psychotherapy  Incorporate American Indian tradition into therapy?  Meet with spiritual leaders?  Participate in traditional ceremonies?

PTSD in Ethnoracial Minorities Review revealed mixed data pertaining to prevalence of PTSD among minority groups  Overall there is evidence to support the theory that ethnoracial minority groups may have higher prevalence rates of PTSD (with the exception of Japanese Americans) Small effect size associated with minority and PTSD

Recommendations for Future Research Future research with ethnoracial minority groups should be focused within the framework of pretrauma, index trauma, and posttrauma variables

Pretrauma Variables Variables that occur prior to the trauma exposure:  Ethnic or Racial group Membership  Level of acculteration  Prior exposure to traumatic and non-traumatic stressors  Multigenerational trauma Exposure  Age  Gender  Family history of pscyopathology  Etc.

Index Trauma Variables that influence the likelihood of magnitude of exposure to the trauma:  Peritraumatic dissociation  Exposure  Cultural meaning of trauma  Trauma Severity  Perceived life threat

Postrauma Variables All variables that occur after the trauma and influence the trajectory of trauma recovery:  Coping style  Postrauma life stress  Disclosure of trauma  Expressions of emotions  Social support  Co-morbid psychopathology  Service utilization

Conclusion Ethnoracial variables may be important to consider in the assessment and treatment of PTSD (although you should not use minority status alone to make clinical decisions regarding PTSD).