OSTTRAUMATIC STRESS DISORder (PTSD) is a debilitating stress-related psychiatric disorder, with prevalence rates of at least 7% to 8% in the US population, and with much higher rates among combat veterans and those living in high-violence areas. 1-3 Initially viewed as a potentially normative response to traumatic exposure, 4 it became clear that not everyone experiencing trauma develops PTSD. Thus, a central question in research on PTSD is why some individuals are more likely than others to develop the disorder in the face of similar levels of trauma exposure. 5-8 Although PTSD is the single disorder within the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) (DSM-IV) 9 that requires a specific environmental insult within its diagnostic criteria, it is becoming increasingly clear that there are critical roles for predisposing genetic and environmental influences in differentially mediating psychological risk to the traumatized individual. 10-13

Objective: This study was undertaken to increase understanding of environmental risk factors for PTSD and MDD within an urban, impoverished, population.Method: This study examined the demographic characteristics, patterns of trauma exposure, prevalence of PTSD and MDD, and predictors of post-traumatic stress and depressive symptomatology using a verbally-presented survey and structured clinical interviews administered to low-income, primarily African-American (>93%), women and men seeking care in the primary care and obstetrics-gynecology clinics of an urban public hospital.Results: 87.8% (N=1256) of the sample reported some form of significant trauma in their lifetime. Accidents were the most common form of trauma exposure followed by interpersonal violence and sexual assault. Childhood level of trauma and adult level of trauma separately, and in combination, predicted level of adult PTSD and depressive symptomatology. The lifetime prevalence of PTSD was 46.2% and the lifetime prevalence of MDD was 36.7%. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.Financial Disclosure Statement: There were no commercial sponsors or commercial relationships related to the current work. All additional past and present financial ties of the investigators are disclosed herein. Dr. Gillespie has received funding from APIRE/Wyeth, NARSAD, NIDA, and NIMH. Dr. Ressler has received awards and/or funding support related to other studies from Lundbeck, Burroughs Wellcome Foundation, Pfizer, NARSAD, NIMH, NIDA, and previously had a consulting agreement with Tikvah Therapeutics for NMDA-based therapeutics. Dr. Bradley has received funding from AFSP. Dr. Ressler had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. None of the above funding agencies had any role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript. Conclusions: These data document high levels of childhood and adult trauma exposure, principally interpersonal violence, in a large sample of an inner-city primary care population. Within this group of subjects, PTSD and depression are highly prevalent conditions. NIH Public Access

These data support the corticotropin-releasing hormone hypothesis of depression and suggest that a gene x environment interaction is important for the expression of depressive symptoms in adults with CRHR1 risk or protective alleles who have a history of child abuse.

This study examined 184 African-American outpatients in a mental health clinic in the inner city to define the rate of occurrence of traumatic experience and posttraumatic stress disorder (PTSD). This population experienced a high rate of severe trauma. Forty-three percent were found to have PTSD, as measured by the PTSD Symptom Scale. Finally, a chart review of 72 participants found that only 11 percent of participants who met DSM-IV criteria for PTSD also had a chart diagnosis of PTSD. PTSD is a common yet underrecognized and undertreated source of psychiatric morbidity in this urban community of African Americans with low socioeconomic status.

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