Abstract
Introduction
African American men have the highest rates of prostate cancer of any racial group, but very little is known about the psychological functioning of African American men in response to prostate cancer diagnosis and treatment.
Purpose
In this secondary analysis of a national trial testing a psychological intervention for prostate cancer patients, we report on the traumatic stress symptoms of African American and non-African American men.
Methods
This analysis includes 317 men (African American: n = 30, 9%; non-African American: n = 287, 91%) who were enrolled in the intervention trial, which included 12 weeks of group psychotherapy and 24 months of follow-up. Using mixed model analysis, total score on the Impact of Events Scale (IES) and its Intrusion and Avoidance subscales were examined to determine mean differences in traumatic stress across all time points (0, 3, 6, 12, 18, and 24 months). In an additional analysis, relevant psychosocial, demographic, and clinical variables were added to the model.
Results
Results showed significantly higher levels of traumatic stress for African American men compared to non-African American men in all models independently of the intervention arm, demographics, and relevant clinical variables. African Americans also had a consistently higher prevalence of clinically significant traumatic stress symptoms (defined as IES total score ≥27). These elevations remained across all time points over 24 months.
Conclusions
This is the first study to show a racial disparity in traumatic stress specifically as an aspect of overall psychological adjustment to prostate cancer. Recommendations are made for appropriate assessment, referral, and treatment of psychological distress in this vulnerable population.
Similar content being viewed by others
References
Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ (2009) Cancer statistics. CA Cancer J Clin 59:225–249
American Cancer Society (2009) Cancer facts and figures for African Americans 2009-2010. American Cancer Society, Atlanta
Kunkel EJS, Bakker JR, Myers RE, Oyesanmi O, Gomella LG (2000) Biopsychosocial aspects of prostate cancer. Psychosomatics 41:85–94
Eton DT, Lepore SJ, Helgeson VS (2001) Early quality of life in patients with localized prostate carcinoma—an examination of treatment-related, demographic, and psychosocial factors. Cancer 92:1451–1459
Lubeck DP, Kim H, Grossfeld KC, Ray P, Penson DF, Flanders SC, Carroll PR (2001) Health related quality of life differences between black and white men with prostate cancer: data from the cancer of the prostate strategic urologic research endeavor. J Urol 166:2281–2285
Jayadevappa R, Johnson JC, Chhatre S, Wein AJ, Malkowicz SB (2007) Ethnic variation in return to baseline values of patient-reported outcomes in older prostate cancer patients. Cancer 109:2229–2238
American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders. American Psychiatric Association, Washington, DC
Jim HSL, Jacobsen PB (2008) Posttraumatic stress and posttraumatic growth in cancer survivorship: a review. Cancer J 14:414–419
Kangas M, Henry JL, Bryant RA (2002) Posttraumatic stress disorder following cancer—a conceptual and empirical review. Clin Psychol Rev 22:499–524
Kessler RC, Sonnega A, Bromet E, Hughes M, Nelson CB, Breslau N (1999) Epidemiological risk factors for trauma and PTSD. In: Yehuda R (ed) Risk factors for posttraumatic stress disorder. American Psychiatric Press, Washington, DC, pp 23–59
Breslau N (2009) The Epidemiology of trauma, PTSD, and other posttrauma disorders. Trauma Violence Abuse 10:198–210
Palesh O, Mustian K, Heckler C, Purnell J, Peppone L, Weiss M, Atkins JN, Dakhil SR, Spiegel D, Morrow G (2009) A phase III randomized prospective trial of the effect of psychotherapy on distress in 287 prostate cancer patients: a URCC CCOP study. J Clin Oncol 27:9637
Classen C, Butler LD, Koopman C, Miller E, DiMiceli S, Giese-Davis J, Fobair P, Carlson RW, Kraemer HC, Spiegel D (2001) Supportive-expressive group therapy and distress in patients with metastatic breast cancer—a randomized clinical intervention trial. Arch Gen Psychiatry 58:494–501
Zilberg NJ, Weiss DS, Horowitz MJ (1982) Impact of event scale: a cross-validation study and some empirical evidence supporting a conceptual model of stress response syndromes. J Consult Clin Psychol 50:407–414
Andersen BL (2002) Biobehavioral outcomes following psychological interventions for cancer patients. J Consult Clin Psychol 70:590–610
McNair DM, Lorr M, Droppelman LF (1971) Manual: profile of mood states. Educational and Industrial Testing Service.
Heiney SP, McWayne J, Ford L, Carter C (2006) Measurement in group interventions for women with breast cancer. J Psychosoc Oncol 24:89–106
Spiegel D, Bloom JR, Yalom I (1981) Group support for patients with metastatic cancer: a randomized outcome study. Arch Gen Psychiatry 38:527–533
Devins GM, Binik YM, Hutchinson TA, Hollowby DJ, Barre PE, Guttmand RD (1984) The emotional impact of end stage renal disease: importance of patients’ perception of intrusiveness and control. Int J Psychiatry Med 13:327–343
Devins GM, Edworthy SM, Seland TP, Klein GM, Paul LC, Mandin H (1993) Differences in illness intrusiveness across rheumatoid-arthritis, end-stage renal disease, and multiple-sclerosis. J Nerv Ment Dis 181:377–381
Kenward MG, Roger JH (1997) Small sample inference for fixed effects from restricted maximum likelihood. Biometrics 53:983–997
Coffey SF, Gudmundsdottir B, Beck JG, Palyo SA, Miller L (2006) Screening for PTSD in motor vehicle accident survivors using the PSS-SR and IES. J Trauma Stress 19:119–128
Himle JA, Baser RE, Taylor RJ, Campbell RD, Jackson JS (2009) Anxiety disorders among African Americans, blacks of Caribbean descent, and non-Hispanic whites in the United States. J Anx Disorders 23:578–590
Alim TN, Charney DS, Mellman TA (2006) An overview of posttraumatic stress disorder in African Americans. J Clin Psychol 62:801–813
Baider L, Peretz T, De-Nour AK (1993) Holocaust cancer patients: a comparative study. Psychiatry 56:349–355
Peretz T, Baider L, Ever-Hadani P, De-Nour AK (1994) Psychological distress in female cancer patients with Holocaust experience. Gen Hosp Psychiatry 16:413–418
Powe BD, Hamilton J, Hancock N, Johnson N, Finnie R, Ko J, Brooks P, Boggan M (2007) Quality of life of African American cancer survivors—a review of the literature. Cancer 109:435–445
Krizek C, Roberts C, Ragan R, Ferrara JJ, Lord B (1999) Gender and cancer support group participation. Cancer Pract 7:86–92
Thaxton L, Emshoff JG, Guessous O (2005) Prostate cancer support groups: a literature review. J Psychosoc Oncol 23:25–40
Weber BA, Sherwill-Navarro P (2005) Psychosocial consequences of prostate cancer: 30 years of research. Geriatr Nurs 26:166–175
Dana R (1992) Multicultural assessment perspectives for professional psychology. Allyn and Bacon, Upper Saddle River, NJ
Coker AL, Sanderson M, Ellison GL, Fadden MK (2006) Stress, coping, social support, and prostate cancer risk among older African American and Caucasian men. Ethn Dis 16:978–987
Krupski TL, Sonn G, Kwan L, Maliski S, Fink A, Litwin MS (2005) Ethnic variation in health-related quality of life among low-income men with prostate cancer. Ethn Dis 15:461–468
Acknowledgments
The authors wish to acknowledge financial support from the National Cancer Institute (CA037420 & R25CA102618).
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Purnell, J.Q., Palesh, O.G., Heckler, C.E. et al. Racial disparities in traumatic stress in prostate cancer patients: secondary analysis of a National URCC CCOP Study of 317 men. Support Care Cancer 19, 899–907 (2011). https://doi.org/10.1007/s00520-010-0880-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00520-010-0880-3