Trauma, psychiatric disorders, and treatment history among pregnant African American women.

Abstract

Objective: Pregnant African American women living in low-income urban communities have high rates of trauma exposure and elevated risk for the development of trauma-related disorders, including posttraumatic stress disorder (PTSD) and depression. Yet, engagement in behavioral health services is lower for African American women than Caucasian women. Limited attention has been given to identifying trauma exposure and PTSD, especially within at-risk communities. The present study examined rates of trauma exposure, PTSD, depression, and behavioral health treatment engagement in an obstetrics/gynecology (OB/GYN) clinic within an urban hospital. Method: The study included 633 pregnant African American women screened within the OB/GYN clinic waiting room; 55 of the women also participated in a subsequent detailed clinical assessment based on eligibility for a separate study of intergenerational risk for trauma and PTSD in African American mother-child dyads. Results: Overall, 98% reported trauma exposure, approximately one third met criteria for probable current PTSD, and one third endorsed moderate-or-severe depression based on self-report measures. Similar levels were found based on clinical assessments in the subsample. While 18% endorsed depression treatment, only 6% received treatment for PTSD. In a subsample of women with whom chart reviews were conducted (n ϭ 358), 15% endorsed a past psychiatric diagnosis but none shared their PTSD diagnosis with their OB/GYN provider. Conclusion: Results of the current study highlight elevated levels of trauma exposure, PTSD, and depression in low-income, African American pregnant women served by this urban clinic, and demonstrate the need for better identification of trauma-related disorders and appropriate linkage to culturally responsive care especially for PTSD. Clinical Impact StatementThe current study highlights the high rates of chronic trauma exposure, PTSD, and depression based on self-report measures among pregnant African American women served in an OB/GYN clinic within a public urban hospital. Identification of PTSD in particular among providers and engagement in care among these women was limited and demonstrates the need for improved screening for trauma and PTSD, more accessible culturally responsive trauma-informed care, and better identification of potential barriers to such care for pregnant women within these at-risk communities.

Racial and ethnic disparities in posttraumatic psychopathology among postpartum women

“…These disparities in trauma and related psychopathology extend to the perinatal period, with pregnant Black women experiencing particularly high rates of trauma and PTSD (e.g., Dailey et al, 2011;Powers et al, 2020;Seng et al, 2011). Furthermore, PTSD during the prenatal period is associated with adverse birth outcomes (Cook et al, 2018;Rogal et al, 2007;Yonkers et al, 2014), which disproportionately afflict women of color (Martin et al, 2019).…”

Engagement in and Benefits of a Short-Term, Brief Psychotherapy Intervention for PTSD During Pregnancy

“…Our sample size is small, without a control group, and limited to a cohort of women who are demographically homogenous. However, given high levels of trauma and poor access to mental health services in low-income, majority Black communities ( 8 , 9 , 90 ) the findings may be generalizable to pregnant women in other similar communities outside of Philadelphia and St. Louis ( 9 ). Given the small sample size, we were unable to investigate the relationship between improvement in PTSD and pPTSD symptoms and preterm birth or other pregnancy or birth outcomes.…”

“…In nationally representative samples of non-pregnant individuals, lifetime prevalence rates of PTSD are estimated to be 6.4% ( 2 ) and those of partial PTSD (pPTSD; describing a subthreshold version of the disorder, where only some criteria are met, but functional impairment is still evident) ( 3 – 5 ) range from 4 to 11% ( 6 , 7 ). PTSD rates are even higher for Black people; non-pregnant Black individuals living in violent communities report rates between 30 and 50% ( 8 ) and Black pregnant women with a history of trauma exposure report rates of 34–40% ( 9 – 12 ). The prevalence of pPTSD during pregnancy is estimated to be even higher, with 28.6% of women with previous pregnancy complications reporting pPTSD in a subsequent pregnancy ( 13 ).…”

“…The prevalence of pPTSD during pregnancy is estimated to be even higher, with 28.6% of women with previous pregnancy complications reporting pPTSD in a subsequent pregnancy ( 13 ). Low-income women of color may be especially at-risk for PTSD during pregnancy and less likely than white women to seek or receive treatment ( 9 , 14 ).…”

The role of prenatal posttraumatic stress symptoms among trauma exposed women in predicting postpartum depression

“…Moreover, women with a history of trauma present with a wide range of symptoms during pregnancy that are not identified through typical depression screeners (Freeman, 2019) and may be missed when relying exclusively on current depressive symptoms to determine risk. Unfortunately, history of trauma and PTSD are challenging to assess in an efficient manner (Guintivano et al., 2018) and are not routinely examined, which limits not only our ability to identify at risk women, but also to provide referrals and treatment to women in need (Powers et al., 2020). Therefore, it is imperative to determine how we can better capture symptom profiles in women at risk for PPD that may be missed with typical depression screenings.…”