Abstract
Purpose
To determine conditional risk of posttraumatic stress disorder (PTSD) in two culturally distinct American Indian reservation communities.
Method
Data derived from the American Indian Service Utilization, Psychiatric Epidemiology, Risk and Protective Factors Project, a cross-sectional population-based survey that was completed between 1997 and 2000. This study focused on 1,967 participants meeting the DSM-IV criteria for trauma exposure. Traumas were grouped into interpersonal, non-interpersonal, witnessed, and “trauma to close others” categories. Analyses examined distribution of worst traumas, conditional rates of PTSD following exposure, and distributions of PTSD cases deriving from these events. Bivariate and multivariate logistic regressions estimated associations of lifetime PTSD with trauma type.
Results
Overall, 15.9 % of those exposed to DSM-IV trauma qualified for lifetime PTSD, a rate comparable to similar US studies. Women were more likely to develop PTSD than were men. The majority (60 %) of cases of PTSD among women derived from interpersonal trauma exposure (in particular, sexual and physical abuse); among men, cases were more evenly distributed across trauma categories.
Conclusions
Previous research has demonstrated higher rates of both trauma exposure and PTSD in American Indian samples compared to other Americans. This study shows that conditional rates of PTSD are similar to those reported elsewhere, suggesting that the elevated prevalence of this disorder in American Indian populations is largely due to higher rates of trauma exposure.
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Notes
DSM-IV defines a trauma as an event or events that (1) “involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others” AND “the person’s response involved intense fear, helplessness, or horror.” (pp. 427–428 [1]). The literature does not always conform to this full definition (e.g., in non-psychiatric literature or in studies predating DSM-IV). Here, “qualifying trauma” is used when the full DSM-IV definition was applied. This was the case for the AI-SUPERPFP trauma assessments described here.
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Acknowledgments
AI-SUPERPFP would not have been possible without the significant contributions of many people. The following interviewers, computer/data management and administrative staff supplied energy and enthusiasm for an often difficult job: Anna E. Barόn, Antonita Begay, Amelia T. Begay, Cathy A.E. Bell, Phyllis Brewer, Nelson Chee, Mary Cook, Helen J. Curley, Mary C. Davenport, Rhonda Wiegman Dick, Marvine D. Douville, Pearl Dull Knife, Geneva Emhoolah, Fay Flame, Roslyn Green, Billie K. Greene, Jack Herman, Tamara Holmes, Shelly Hubing, Cameron R. Joe, Louise F. Joe, Cheryl L. Martin, Jeff Miller, Robert H. Moran Jr., Natalie K. Murphy, Melissa Nixon, Ralph L. Roanhorse, Margo Schwab, Jennifer Settlemire, Donna M. Shangreaux, Matilda J. Shorty, Selena S. S. Simmons, Wileen Smith, Tina Standing Soldier, Jennifer Truel, Lori Trullinger, Arnold Tsinajinnie, Jennifer M. Warren, Intriga Wounded Head, Theresa (Dawn) Wright, Jenny J. Yazzie, and Sheila A. Young. We would also like to acknowledge the contributions of the Methods Advisory Group: Margarita Alegria, Evelyn J. Bromet, Dedra Buchwald, Peter Guarnaccia, Steven G. Heeringa, Ronald Kessler, R. Jay Turner, and William A. Vega. Finally, we thank the tribal members who so generously answered all the questions asked of them. Data collection was supported by National Institute of Mental Health grants R01 MH48174 (SM Manson and J Beals, PIs) and P01 MH42473 (SM Manson, PI); data analyses and writing by R01 MH073965 (J Beals, PI), R01 MH075831 (Kaufman, PI), and National Institute of Aging’s Native Elder Research Center/Resource Center for Minority Aging Research Native Investigator Program 2P30 AG 15292-12 (SM Manson, PI).
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The authors declare that they have no conflict of interest.
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The members of the AI-SUPERPFP Team are given in Appendix.
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Appendix
In addition to those named, the AI-SUPERPFP team includes Cecelia K. Big Crow, Dedra Buchwald, Buck Chambers, Michelle L. Christensen, Denise A. Dillard, Karen DuBray, Paula A. Espinoza, Candace M. Fleming, Ann Wilson Frederick, Joseph Gone, Diana Gurley, Shirlene M. Jim, Carol M. Kaufman, Ellen M. Keane, Suzell A. Klein, Denise Lee, Monica C. McNulty, Denise L. Middlebrook, Christina M. Mitchell, Laurie A. Moore, Tilda D. Nez, Ilena M. Norton, Douglas K. Novins, Theresa O’Nell, Heather D. Orton, Carlette J. Randall, Angela Sam, James H. Shore, Sylvia G. Simpson, Paul Spicer, and Lorette Yazzie.
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Beals, J., Belcourt-Dittloff, A., Garroutte, E.M. et al. Trauma and conditional risk of posttraumatic stress disorder in two American Indian reservation communities. Soc Psychiatry Psychiatr Epidemiol 48, 895–905 (2013). https://doi.org/10.1007/s00127-012-0615-5
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DOI: https://doi.org/10.1007/s00127-012-0615-5