Introduction to the Special Issue: Disproportionate trauma, stress, and adversities as a pathway to health disparities among disenfranchised groups globally

Abstract

Globally, individuals and communities that are marginalized based on their identities are at heightened risk for exposure to traumatic stress and socioeconomic hardship. Marginalization and disproportionate risk for many types of adversities correspond with disparities in physical health, mental health, and overall well‐being. Together, the 12 empirical studies, one systematic review, and commentary in this special issue of the Journal of Traumatic Stress highlight the impact of discrimination and disproportionate adversity among groups marginalized based on race, ethnicity, nativity, caste, gender identity, sexual orientation, economic status, and medical status. Although most studies in this issue focus on the United States, the articles that focus on disparities and risk factors in India, El Salvador, Uganda, and Burundi provides a multicontinent global perspective. The global perspective, including the impact of the global pandemic, invites further examination of how disproportionate exposure to traumatic stress and adversity are associated with inequitable burden and health disparities worldwide. This special issue further highlights the developmental and multigenerational burden of systemic marginalization by including studies of children, young adults, adults, and parent–child dyads. Pathways for change and intervention are illustrated through a liberatory consciousness perspective, with one study utilizing liberatory media skills (e.g., positive media images and messages) to mitigate the adverse effects of trauma exposure on at‐risk young adults of color. Worldwide, research on the effects of trauma, stress, and adversities must examine contextual factors (e.g., economic hardship), marginalization (e.g., discrimination, identity factors), and the differential impact on health among individuals and communities.

The influence of betrayal trauma on complex posttraumatic stress disorder symptoms.

“…One limitation was that our sample was predominately White and cisgender, which limits the generalizability of study findings. Namely, people with minoritized racial, ethnic, and/or sexual identities experience a wide range of traumas of various kinds (e.g., community violence and hate-based violence; Allwood et al, 2021), and it is not clear what sorts of traumas might be associated with complex PTSD symptoms for them. An additional limitation to this study is that we did not gather information about specific geographic areas within the United States in which participants lived.…”

The Middle‐Out Approach to reconceptualizing, assessing, and analyzing traumatic stress reactions

“…Overall, this article is part of a growing body of literature calling for improved data‐ and theory‐driven conceptualizations of PTSD, traumatic stress, and other psychopathologies that better represent broader and diverse individuals’ and communities’ experiences of health and illness using improved methods (Allwood et al., 2021; Bredström, 2019; Chandler et al., 2020; Maguen et. al, 2023).…”

“…Many current assessment practices also fail to attend to the context in which symptoms occur, reducing external validity and cross‐cultural generalizability (e.g., Bredström, 2019; Shevlin & Elklit, 2012). For some communities, understanding and empirically capturing culturally relevant, context‐based symptoms or indicators may be integral to identifying unique and increasingly precise traumatic stress reactions that address salient mental health needs (Allwood et al., 2021; Carter, 2007). In particular, current practices used to simplify and categorize diagnostic criteria may lose key information that is vital to culturally sensitive and effective clinical practices.…”

“…Issues of heterogeneity, comorbidity, clinical utility, and equitable representation perennially invite criticisms of existing diagnostic classifications of traumatic stress reactions as well as the tools and methods used to identify them (Allwood et al., 2021; Bryant et al., 2023; Flake & Fried, 2020; Herzog & Kaiser, 2022). Traumatic stress is used here to delineate a broader taxonomy of biopsychosocial reactions following exposure to psychological trauma, with posttraumatic stress disorder (PTSD) being the most recognized diagnostic representation (American Psychiatric Association [APA], 2022).…”

Moving forward with a culturally inclusive PTSD Criterion A: Commentary on Marx et al. (2023)

“…In addition, the disproportionate impact of traumatic experiences on marginalized groups (Allwood et al., 2021), especially through traumatic separation and loss (e.g., COVID‐19 deaths, violent deaths, carceral system detainment and imprisonment) must be addressed. Any disorder intended to focus on the consequences of trauma cannot exclude some of the most egregious identity‐based experiences because an individual did not endorse a direct risk of death or the event(s) did not occur in the context of their occupation.…”