Racial/ethnic differences in acute and longer-term posttraumatic symptoms following traumatic injury or illness

Abstract

Background Racial/ethnic differences in mental health outcomes after a traumatic event have been reported. Less is known about factors that explain these differences. We examined whether pre-, peri-, and post-trauma risk factors explained racial/ethnic differences in acute and longer-term posttraumatic stress disorder (PTSD), depression, and anxiety symptoms in patients hospitalized following traumatic injury or illness. Methods PTSD, depression, and anxiety symptoms were assessed during hospitalization and 2 and 6 months later among 1310 adult patients (6.95% Asian, 14.96% Latinx, 23.66% Black, 4.58% multiracial, and 49.85% White). Individual growth curve models examined racial/ethnic differences in PTSD, depression, and anxiety symptoms at each time point and in their rate of change over time, and whether pre-, peri-, and post-trauma risk factors explained these differences. Results Latinx, Black, and multiracial patients had higher acute PTSD symptoms than White patients, which remained higher 2 and 6 months post-hospitalization for Black and multiracial patients. PTSD symptoms were also found to improve faster among Latinx than White patients. Risk factors accounted for most racial/ethnic differences, although Latinx patients showed lower 6-month PTSD symptoms and Black patients lower acute and 2-month depression and anxiety symptoms after accounting for risk factors. Everyday discrimination, financial stress, past mental health problems, and social constraints were related to these differences. Conclusion Racial/ethnic differences in risk factors explained most differences in acute and longer-term PTSD, depression, and anxiety symptoms. Understanding how these risk factors relate to posttraumatic symptoms could help reduce disparities by facilitating early identification of patients at risk for mental health problems.

Mental health symptoms are comparable in patients hospitalized with acute illness and patients hospitalized with injury

“…Higher assault rates may reflect patient environments with higher rates of violent crime. Analyses of the same dataset found that social determinants of health, such as financial stress and discrimination, were worse in Black patients and were associated with mental health disparities [ 51 ]. Given that interpersonal violence is associated with both physical wounds and mental health problems, these patients require medical interventions targeted at both physical and mental health symptoms.…”

Racial discrimination increases the risk for nonremitting posttraumatic stress disorder symptoms in traumatically injured Black individuals living in the United States

“…The estimated lifetime prevalence rate of posttraumatic stress disorder (PTSD) has been reported to be approximately 7% in the United States (Goldstein et al., 2016). Racial differences have been consistently observed, with Black individuals living in the United States (i.e., Black Americans), including those who have been traumatically injured, exhibiting higher rates of PTSD and more severe symptoms compared to other populations (Alegria et al., 2013; Cruz‐Gonzalez et al., 2023; Roberts et al., 2011; Sibrava et al., 2019). Still, these disparities are not well understood.…”

“…Further work has corroborated these racial differences. Within a longitudinal study design, not only were Black Americans found to have higher PTSD scores than White Americans, but these rates remained relatively unchanged over time (Cruz‐Gonzalez et al., 2023). Other longitudinal research has noted the chronicity of PTSD among Black Americans, showing poorer prognosis and higher levels of symptom severity (Sibrava et al., 2019).…”

“…The authors concluded that the ongoing nature of racial discrimination has a negative impact on PTSD recovery among Black Americans. Further, racial discrimination has been thought to add to the cumulative risk that Black Americans experience, potentially explaining elevated and persistent PTSD symptoms (Cruz‐Gonzalez et al., 2023). Overall, the empirical research suggests that racial discrimination is a distinctive contributor to symptoms of traumatic stress.…”

Structural inequities contribute to racial/ethnic differences in neurophysiological tone, but not threat reactivity, after trauma exposure

“…The extant literature thus suggests that racially/ethnically minoritized individuals may show adaptive counter-regulatory amygdala dynamics (e.g., emotional blunting) to compensate for greater life stress. The race-related structural inequities may partially contribute to recently observed race-related differences in posttraumatic symptoms in the early aftermath of trauma [26,27]. However, to the best of our knowledge, no prior work has directly investigated racial/ethnic differences in connectivity of threat neurocircuitry in the early aftermath of trauma and the potential contributions of structural inequities.…”