Ethnic/Racial Diversity and Posttraumatic Distress in the Acute Care Medical Setting

Abstract

Recent commentary has advocated for epidemiological investigation as a foundational science for understanding disparities in the delivery of mental health care and for the development of early trauma-focused interventions. Few acute care investigations have examined the diversity of ethnic/racial heritages or compared variations in early posttraumatic distress in representative samples of injured trauma survivors. Hospitalized injury survivors at two United States level I trauma centers were randomly approached in order to document linguistic and ethnic/racial diversity. Approximately 12% of patients approached were non-English speaking with 16 languages represented. English speaking, inpatients were screened for posttraumatic stress disorder, peritraumatic dissociative, and depressive symptoms. For 269 English speaking study participants, ethnic/racial group status was clearly categorized into one group for 72%, two groups for 25%, and three groups for 3% of participants. Regression analyses that adjusted for relevant clinical and demographic characteristics revealed that relative to whites, patients from American Indian, African American, Hispanic, and Asian heritages demonstrated significant elevations in one or more posttraumatic symptom clusters. A remarkable diversity of heritages was identified, and posttraumatic distress was elevated in ethnic/racial minority patients. Policy-relevant clinical investigations that combine evidence-based treatments, bilingual/bicultural care-management strategies, and support for trauma center organizational capacity building may be required in order to enhance the quality of mental health care for diverse injured trauma survivors.

Prevalence and risk factors for posttraumatic stress disorder: a cross-sectional study among survivors of the Wenchuan 2008 earthquake in China

“…[21] The HTQ has been shown to produce reliable results in different languages [22] and has also been used and validated in many countries, including developing and poor countries. [23] It contains 16 of the 17 DSM-IV PTSD criteria and asks the respondent to endorse them on a scale of 0-4 (none, a little, moderate, quite a bit, extremely). We determined if an individual met symptom criteria for the occurrence of PTSD according to a scoring algorithm proposed by the Harvard Refugee Trauma Group on the basis of DSM-IV diagnostic criteria.…”

Intersection of Stress, Social Disadvantage, and Life Course Processes: Reframing Trauma and Mental Health

“…One recent nationwide prospective cohort study reports that approximately 30% of injured trauma survivors admitted to urban trauma centers have no insurance and approximately 40% report family household incomes of less than $30,000 per year (Zatzick et al, 2007). These patients are also highly racially and ethnically diverse: Previous clinical epidemiological investigations found that approximately 1 in 10 randomly sampled injured trauma survivors were monolingual, non–English speaking, with over 40 languages spoken in the cohort (Santos et al, 2008; Stephens et al, 2010). …”

“Our Culture Is Medicine”: Perspectives of Native Healers on Posttrauma Recovery Among American Indian and Alaska Native Patients

“…5 Similarly, among 269 trauma patients hospitalized at 2 level 1 trauma centers in the Western region of the US, PTSD and related symptoms were significantly more frequent among Native patients than among white patients. 6 In the largest epidemiologic survey available regarding Native health, researchers found that two-thirds of the Native populations reported levels of lifetime trauma exposure that were higher than those in the general US population. 7 Additionally, trauma from unintentional injury, such as motor vehicle accidents, is experienced at higher rates by North American indigenous populations than by other ethnoracial groups (Dedra Buchwald, MD, personal communication; 2012).…”