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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There is a dearth of research on risk/protective factors for posttraumatic stress disorder (PTSD) among low-income African American women with a history of intimate partner violence (IPV), presenting for suicidal behavior or routine medical care in a large, urban hospital. We examined self-esteem, social support, and religious coping as mediators between experiences of child maltreatment (CM) and IPV and symptoms of PTSD in a sample (N = 134) of low-income African American women. Instruments used included the Index of Spouse Abuse, the Childhood Trauma Questionnaire, the Taylor Self-Esteem Inventory, the Multidimensional Profile of Social Support, the Brief Religious Coping Activities Scale, and the Davidson Trauma Scale. Both CM and IPV related positively to PTSD symptoms. Risk and resilience individual difference factors accounted for 18% of the variance in PTSD symptoms over and above IPV and CM, with self-esteem and negative religious coping making unique contributions. Both variables mediated the abuse-PTSD symptom link. In addition, we tested an alternate model in which PTSD symptoms mediated the relationship between abuse and both self-esteem and negative religious coping.

Exposure therapy is a well-established treatment for Posttraumatic Stress Disorder (PTSD) that requires the patient to focus on and describe the details of a traumatic experience. Exposure methods include confrontation with frightening, yet realistically safe, stimuli that continues until anxiety is reduced. A review of the literature on exposure therapy indicates strong support from well-controlled studies applied across trauma populations. However, there are many misconceptions about exposure therapy that may interfere with its widespread use. These myths and clinical guidelines are addressed. It is concluded that exposure therapy is a safe and effective treatment for PTSD when applied as directed by experienced therapists.

African Americans in low-income, urban communities are at high risk for exposure to traumatic events as well as for symptoms of posttraumatic stress disorder (PTSD). Approximately 22% of 220 participants recruited from urban hospital medical clinics met survey criteria for PTSD. Among the common traumas were having relatives/friends murdered (47%), being attacked with weapons (64% of men), and being sexually attacked (36% of women). Although desiring mental health services, only 13.3% of those with PTSD had prior trauma-focused treatment. Barriers to treatment included limited transportation and finances, family disapproval, and unfamiliarity with accessing treatment, among others. These data highlight the need for an awareness of the high prevalence of trauma and PTSD in this population.