Journal of Urban Health

, 85:693 | Cite as

Experiences of Traumatic Events and Associations with PTSD and Depression Development in Urban Health Care-seeking Women

  • Jessica M. GillEmail author
  • Gayle G. Page
  • Phyllis Sharps
  • Jacquelyn C. Campbell


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.


PTSD Depression Trauma Urban Women 



Funding for this research was provided by the following sources:

Individual National Research Service Award (NRSA) F31 NR009166 funded through the National Institute for Nursing Research (NINR); Institutional Training Grant funded through NINR T32 NR 07968: Health Disparities in Underserved Populations; The Freedom from Fear Sharon Davies Memorial Grant; Sigma Theta Tau, Beta Nu Chapter, Small Grant Award.


  1. 1.
    Kessler RC, Sonnega A, Bromet E, Hughes M, Nelson CB. Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry. 1995;52(12):1048–1060.PubMedGoogle Scholar
  2. 2.
    Breslau N, Kessler RC, Chilcoat HD, Schultz LR, Davis GC, Andreski P. Trauma and posttraumatic stress disorder in the community: the 1996 Detroit area survey of trauma. Arch Gen Psychiatry. 1998;55(7):626–632.PubMedCrossRefGoogle Scholar
  3. 3.
    Breslau N, Davis GC, Peterson EL, Schultz LR. A second look at comorbidity in victims of trauma: the posttraumatic stress disorder-major depression connection. Biol Psychiatry. 2000;48(9):902–909.PubMedCrossRefGoogle Scholar
  4. 4.
    North CS, Pfefferbaum B, Tivis L, Kawasaki A, Reddy C, Spitznagel EL. The course of posttraumatic stress disorder in a follow-up study of survivors of the Oklahoma City bombing. Ann Clin Psychiatry. 2004;16(4):209–215.PubMedGoogle Scholar
  5. 5.
    O’Donnell ML, Creamer M, Pattison P. Posttraumatic stress disorder and depression following trauma: understanding comorbidity. Am J Psychiatry. 2004;161(8):1390–1396.PubMedCrossRefGoogle Scholar
  6. 6.
    Alim TN, Charney DS, Mellman TA. An overview of posttraumatic stress disorder in African Americans. J Clin Psychol. 2006;62(7):801–813.PubMedCrossRefGoogle Scholar
  7. 7.
    Kimerling R. An investigation of sex differences in nonpsychiatric morbidity associated with posttraumatic stress disorder. J Am Med Women’s Assoc. 2004;59(1):43–47.Google Scholar
  8. 8.
    Breslau N, Davis GC, Andreski P, Peterson EL, Schultz LR. Sex differences in posttraumatic stress disorder. Arch Gen Psychiatry. 1997;54(11):1044–1048.PubMedGoogle Scholar
  9. 9.
    Norris FH, Murphy AD, Baker CK, Perilla JL. Postdisaster PTSD over four waves of a panel study of Mexico’s 1999 flood. J Trauma Stress. 2004;17(4):283–292.PubMedCrossRefGoogle Scholar
  10. 10.
    Holbrook TL, Hoyt DB, Stein MB, Sieber WJ. Gender differences in long-term posttraumatic stress disorder outcomes after major trauma: women are at higher risk of adverse outcomes than men. J Trauma. 2002;53(5):882–888.PubMedCrossRefGoogle Scholar
  11. 11.
    Baker CK, Norris FH, Diaz DM, Perilla JL, Murphy AD, Hill EG. Violence and PTSD in Mexico: gender and regional differences. Soc Psychiatry Psychiatr Epidemiol. 2005;40(7):519–528.PubMedCrossRefGoogle Scholar
  12. 12.
    Mezey G, Bacchus L, Bewley S, White S. Domestic violence, lifetime trauma and psychological health of childbearing women. BJOG. 2005;112(2):197–204.PubMedCrossRefGoogle Scholar
  13. 13.
    Breslau N. Epidemiologic studies of trauma, posttraumatic stress disorder, and other psychiatric disorders. Can J Psychiatry. 2002;47(10):923–929.PubMedGoogle Scholar
  14. 14.
    Noll JG, Horowitz LA, Bonanno GA, Trickett PK, Putnam FW. Revictimization and self-harm in females who experienced childhood sexual abuse: results from a prospective study. J Interpers Violence. 2003;18(12):1452–1471.PubMedCrossRefGoogle Scholar
  15. 15.
    Kaplow JB, Dodge KA, maya-Jackson L, Saxe GN. Pathways to PTSD, part II: sexually abused children. Am J Psychiatry. 2005;162(7):1305–1310.PubMedCrossRefGoogle Scholar
  16. 16.
    Basile KC, Arias I, Desai S, Thompson MP. The differential association of intimate partner physical, sexual, psychological, and stalking violence and posttraumatic stress symptoms in a nationally representative sample of women. J Trauma Stress. 2004;17(5):413–421.PubMedCrossRefGoogle Scholar
  17. 17.
    Campbell DG, Felker BL, Liu CF, et al. Prevalence of depression-PTSD comorbidity: implications for clinical practice guidelines and primary care-based interventions. J Gen Intern Med. 2007;22(6):711–718.PubMedCrossRefGoogle Scholar
  18. 18.
    Gillock KL, Zayfert C, Hegel MT, Ferguson RJ. Posttraumatic stress disorder in primary care: prevalence and relationships with physical symptoms and medical utilization. Gen Hosp Psych. 2005;27(6):392–399.CrossRefGoogle Scholar
  19. 19.
    Alim TN, Graves E, Mellman TA, et al. Trauma exposure, posttraumatic stress disorder and depression in an African-American primary care population. J Natl Med Assoc. 2006;98(10):1630–1636.PubMedGoogle Scholar
  20. 20.
    Frayne SM, Seaver MR, Loveland S, et al. Burden of medical illness in women with depression and posttraumatic stress disorder. Arch Intern Med. 2004;164(12):1306–1312.PubMedCrossRefGoogle Scholar
  21. 21.
    Dobie DJ, Kivlahan DR, Maynard C, Bush KR, Davis TM, Bradley KA. Posttraumatic stress disorder in female veterans: association with self-reported health problems and functional impairment. Arch Intern Med. 2004;164(4):394–400.PubMedCrossRefGoogle Scholar
  22. 22.
    Walker EA, Katon W, Russo J, Ciechanowski P, Newman E, Wagner AW. Health care costs associated with posttraumatic stress disorder symptoms in women. Arch Gen Psychiatry. 2003;60(4):369–374.PubMedCrossRefGoogle Scholar
  23. 23.
    Ciechanowski PS, Walker EA, Russo JE, Newman E, Katon WJ. Adult health status of women HMO members with posttraumatic stress disorder symptoms. Gen Hosp Psych. 2004;26(4):261–268.CrossRefGoogle Scholar
  24. 24.
    Spiro A III, Hankin CS, Mansell D, Kazis LE. Posttraumatic stress disorder and health status: the veterans health study. J Ambul Care Manage. 2006;29(1):71–86.PubMedGoogle Scholar
  25. 25.
    Sareen J, Cox BJ, Stein MB, Afifi TO, Fleet C, Asmundson GJ. Physical and mental comorbidity, disability, and suicidal behavior associated with posttraumatic stress disorder in a large community sample. Psychosom Med. 2007;69(3):242–248.PubMedCrossRefGoogle Scholar
  26. 26.
    Breslau N, Lucia VC, Davis GC. Partial PTSD versus full PTSD: an empirical examination of associated impairment. Psychol Med. 2004;34(7):1205–1214.PubMedCrossRefGoogle Scholar
  27. 27.
    Lipschitz DS, Rasmusson AM, Anyan W, Cromwell P, Southwick SM. Clinical and functional correlates of posttraumatic stress disorder in urban adolescent girls at a primary care clinic. J Am Acad Child Adolesc Psych. 2000;39(9):1104–1111.CrossRefGoogle Scholar
  28. 28.
    Schwartz AC, Bradley RL, Sexton M, Sherry A, Ressler KJ. Posttraumatic stress disorder among African Americans in an inner city mental health clinic. Psychiatr Serv. 2005;56(2):212–215.PubMedCrossRefGoogle Scholar
  29. 29.
    Kuruvilla A, Jacob KS. Poverty, social stress & mental health. Indian J Med Res. 2007;126(4):273–278.PubMedGoogle Scholar
  30. 30.
    Kubany ES, Leisen MB, Kaplan AS, Kelly MP. Validation of a brief measure of posttraumatic stress disorder: the Distressing Event Questionnaire (DEQ). Psychol Assess. 2000;12(2):197–209.PubMedCrossRefGoogle Scholar
  31. 31.
    Zimmerman M, Sheeran T, Young D. The diagnostic inventory for depression: a self-report scale to diagnose DSM-IV major depressive disorder. J Clin Psychol. 2004;60(1):87–110.PubMedCrossRefGoogle Scholar
  32. 32.
    Foa EB, Tolin DF. Comparison of the PTSD symptom scale-interview version and the clinician-administered PTSD scale. J Trauma Stress. 2000;13(2):181–191.PubMedCrossRefGoogle Scholar
  33. 33.
    Weisberg RB, Bruce SE, Machan JT, Kessler RC, Culpepper L, Keller MB. Nonpsychiatric illness among primary care patients with trauma histories and posttraumatic stress disorder. Psychiatr Serv. 2002;53(7):848–854.PubMedCrossRefGoogle Scholar
  34. 34.
    McQuaid JR, Pedrelli P, McCahill ME, Stein MB. Reported trauma, post-traumatic stress disorder and major depression among primary care patients. Psychol Med. 2001;31(7):1249–1257.PubMedCrossRefGoogle Scholar
  35. 35.
    Gomez-Beneyto M, Salazar-Fraile J, Marti-Sanjuan V, Gonzalez-Lujan L. Posttraumatic stress disorder in primary care with special reference to personality disorder comorbidity. Br J Gen Pract. 2006;56(526):349–354.PubMedGoogle Scholar
  36. 36.
    Stein MB, McQuaid JR, Pedrelli P, Lenox R, McCahill ME. Posttraumatic stress disorder in the primary care medical setting. Gen Hosp Psych. 2000;22(4):261–269.CrossRefGoogle Scholar
  37. 37.
    Bruce SE, Weisberg RB, Dolan RT, et al. Trauma and posttraumatic stress disorder in primary care patients. Prim Care Companion J Clin Psychiat. 2001;3(5):211–217.Google Scholar
  38. 38.
    Liebschutz J, Saitz R, Brower V, et al. PTSD in urban primary care: high prevalence and low physician recognition. J Gen Intern Med. 2007;22(6):719–726.PubMedCrossRefGoogle Scholar
  39. 39.
    Frans O, Rimmo PA, Aberg L, Fredrikson M. Trauma exposure and post-traumatic stress disorder in the general population. Acta Psychiatr Scand. 2005;111(4):291–299.PubMedCrossRefGoogle Scholar
  40. 40.
    Bradley R, Schwartz AC, Kaslow NJ. Posttraumatic stress disorder symptoms among low-income, African American women with a history of intimate partner violence and suicidal behaviors: self-esteem, social support, and religious coping. J Trauma Stress. 2005;18(6):685–696.PubMedCrossRefGoogle Scholar
  41. 41.
    Filipas HH, Ullman SE. Child sexual abuse, coping responses, self-blame, posttraumatic stress disorder, and adult sexual revictimization. J Interpers Violence. 2006;21(5):652–672.PubMedCrossRefGoogle Scholar
  42. 42.
    Myers HF, Wyatt GE, Loeb TB, et al. Severity of child sexual abuse, post-traumatic stress and risky sexual behaviors among HIV-positive women. AIDS Behav. 2006;10(2):191–199.PubMedCrossRefGoogle Scholar
  43. 43.
    Banyard VL, Williams LM, Siegel JA. Re-traumatization among adult women sexually abused in childhood: exploratory analyses in a prospective study. J Child Sex Abuse. 2002;11(3):19–48.CrossRefGoogle Scholar
  44. 44.
    Sher L. The concept of post-traumatic mood disorder. Med Hypotheses. 2005;65(2):205–210.PubMedCrossRefGoogle Scholar
  45. 45.
    Ouimette P, Cronkite R, Henson BR, Prins A, Gima K, Moos RH. Posttraumatic stress disorder and health status among female and male medical patients. J Trauma Stress. 2004;17(1):1–9.PubMedCrossRefGoogle Scholar
  46. 46.
    Mollica RF, McInnes K, Sarajlic N, Lavelle J, Sarajlic I, Massagli MP. Disability associated with psychiatric comorbidity and health status in Bosnian refugees living in Croatia. JAMA. 1999;282(5):433–439.PubMedCrossRefGoogle Scholar
  47. 47.
    Oquendo MA, Krunic A, Parsey RV, et al. Positron emission tomography of regional brain metabolic responses to a serotonergic challenge in major depressive disorder with and without borderline personality disorder. Neuropsychopharmacology. 2005;30(6):1163–1172.PubMedCrossRefGoogle Scholar
  48. 48.
    Friedman MJ, Schnurr PP, Donagh-Coyle A. Post-traumatic stress disorder in the military veteran. Psychiatr Clin North Am. 1994;17(2):265–277.PubMedGoogle Scholar
  49. 49.
    Gerrity MS, Corson K, Dobscha SK. Screening for posttraumatic stress disorder in VA primary care patients with depression symptoms. J Gen Intern Med. 2007;22(9):1321–1324.PubMedCrossRefGoogle Scholar
  50. 50.
    Breslau N, Peterson EL, Poisson LM, Schultz LR, Lucia VC. Estimating post-traumatic stress disorder in the community: lifetime perspective and the impact of typical traumatic events. Psychol Med. 2004;34(5):889–898.PubMedCrossRefGoogle Scholar
  51. 51.
    Breslau N, Anthony JC. Gender differences in the sensitivity to posttraumatic stress disorder: an epidemiological study of urban young adults. J Abnorm Psychology. 2007;116(3):607–611.CrossRefGoogle Scholar
  52. 52.
    Vieweg WV, Julius DA, Fernandez A, Beatty-Brooks M, Hettema JM, Pandurangi AK. Posttraumatic stress disorder: clinical features, pathophysiology, and treatment. Am J Med. 2006;119(5):383–390.PubMedCrossRefGoogle Scholar
  53. 53.
    Bisson J, Andrew M. Psychological treatment of post-traumatic stress disorder (PTSD). Cochrane Database Syst Rev. 2007;(3):CD003388.PubMedGoogle Scholar
  54. 54.
    Glass N, Perrin N, Campbell JC, Soeken K. The protective role of tangible support on post-traumatic stress disorder symptoms in urban women survivors of violence. Res Nurs Health. 2007;30(5):558–568.PubMedCrossRefGoogle Scholar
  55. 55.
    Arnette NC, Mascaro N, Santana MC, Davis S, Kaslow NJ. Enhancing spiritual well-being among suicidal African American female survivors of intimate partner violence. J Clin Psychol. 2007;63(10):909–924.PubMedCrossRefGoogle Scholar
  56. 56.
    Amaro H, Dai J, Arevalo S, et al. Effects of integrated trauma treatment on outcomes in a racially/ethnically diverse sample of women in urban community-based substance abuse treatment. J Urban Health. 2007;84(4):508–522.PubMedCrossRefGoogle Scholar
  57. 57.
    Cohen LR, Hien DA. Treatment outcomes for women with substance abuse and PTSD who have experienced complex trauma. Psychiatr Serv. 2006;57(1):100–106.PubMedCrossRefGoogle Scholar

Copyright information

© The New York Academy of Medicine 2008

Authors and Affiliations

  • Jessica M. Gill
    • 1
    Email author
  • Gayle G. Page
    • 2
  • Phyllis Sharps
    • 2
  • Jacquelyn C. Campbell
    • 2
  1. 1.National Institute of Nursing ResearchNational Institutes of HealthBethesdaUSA
  2. 2.School of NursingJohns Hopkins UniversityBaltimoreUSA

Personalised recommendations