Posttraumatic stress disorder and symptoms among American Indians and Alaska Natives: a review of the literature

Abstract

Purpose: American Indians and Alaska Natives (AI/ANs) experience high rates of trauma and posttraumatic stress disorder (PTSD). We reviewed existing literature to address three interrelated questions: 1) What is the prevalence of PTSD and PTSD symptoms among AI/ANs? 2) What are the inciting events, risk factors, and comorbidities in AI/ANs, and do they differ from those in the general U.S. population? 3) Are studies available to inform clinicians about the course and treatment of PTSD in this population? Methods: We searched the PubMed and Web of Science databases and a database on AI/AN health, capturing an initial sample of 77 original English-language articles published 1992-2010. After applying exclusion criteria, we retained 37 articles on prevalence of PTSD and related symptoms among AI/AN adults. We abstracted key information and organized it in tabular format. Results: AI/ANs experience a substantially greater burden of PTSD and related symptoms than U.S. Whites. Combat experience and interpersonal violence were consistently cited as leading causes of PTSD and related symptoms. PTSD was associated with bodily pain, lung disorders, general health problems, substance abuse, and pathological gambling. In general, inciting events, risk factors, and comorbidities appear similar to those in the general U.S. population. Conclusions: Substantial research indicates a strikingly high incidence of PTSD in AI/AN populations. However, inciting events, risk factors, and comorbidities in AI/ANs, and how they may differ from those in the general population, are poorly understood. Very few studies are available on the clinical course and treatment of PTSD in this vulnerable population.

Psychiatric disorders and mental health treatment in American Indians and Alaska Natives: results of the National Epidemiologic Survey on Alcohol and Related Conditions

“…Importantly, posttraumatic stress disorder (PTSD) was not assessed in the Wave 1 NESARC data analyzed here. Other studies have shown elevated rates of trauma and ensuing PTSD among AIANs [55, 57, 66, 68, 71] compared to other Americans. Finally, treatment-seeking measures were limited by the non-inclusion of traditional healers, who are frequent sources of care in AIAN communities [26], and the lack of assessment of duration or quality of care.…”

American Indian Boarding Schools: What Went Wrong? What Is Going Right?

“…Students and teachers who published accounts of their boarding school experiences were exceptional. Many of their descriptions recount harsh discipline and students running away from school in freezing weather; their suffering sometimes led to post-traumatic stress syndrome (Bassett, Buchwald, & Manson, 2014;Lajimodiere, 2014). However, some students found boarding schools a refuge from poverty at home and a place to make friends and learn useful skills (Child, 1998;Lomawaima, 1994;McBeth, 1983).…”

Development of a Screening and Brief Intervention Process for Symptoms of Psychological Trauma Among Primary Care Patients of Two American Indian and Alaska Native Health Systems

“…22–24 Since the frequency of traumatic events is significantly elevated, there is an increased likelihood that an AI/AN individual will experience multiple traumas compared to national samples. 21,25–28 …”