Posttraumatic stress disorder in African Americans: A two year follow-up study

Abstract

The present study was a prospective, naturalistic, longitudinal investigation of the two year course of posttraumatic stress disorder (PTSD) in a sample of African Americans with anxiety disorders. The study objectives were to examine the two year course of PTSD and to evaluate differences between African Americans with PTSD and anxiety disorders and African Americans with anxiety disorders but no PTSD with regard to comorbidity, psychosocial impairment, physical and emotional functioning, and treatment participation. The participants were 67 African Americans with PTSD and 98 African Americans without PTSD (mean age 41.5 years, 67.3% female). Individuals with PTSD were more likely to have higher comorbidity, lower functioning, and they were less likely to seek treatment than those with other anxiety disorders but no PTSD. The rate of recovery from PTSD over two years was .10 and recovery from comorbid Major Depressive Disorder was .55. PTSD appears to be persistent over time in this populattion. The rates of recovery were lower than what has been reported in previous longitudinal studies with predominantly non-Latino Whites. It is imperative to examine barriers to treatment and factors related to treatment engagement for this population.

MDMA-assisted therapy for posttraumatic stress disorder: A pooled analysis of ethnoracial differences in efficacy and safety from two Phase 2 open-label lead-in trials and a Phase 3 randomized, blinded placebo-controlled trial

“…Despite the disproportionate rates of dropout between BIPOC and non-Hispanic White participants in this study, dropout was low overall, and one of the three BIPOC participants in the MDMA-AT group terminated prematurely because they reported “feeling cured” after one dosing session. In fact, the retention rate observed in the present study is in sharp contrast to previous psychotherapy and pharmacotherapy trials that have found significantly lower retention rates among BIPOC participants in clinical research (e.g., completion rate of 45% vs 73% for non-Hispanic Whites; Lester et al, 2010), owing to mistrust and fear of medical misconduct (Alim et al, 2006; Benítez et al, 2014). The current finding perhaps speaks to the intentional emphasis on set and setting in both treatment groups, ranging from thoroughly addressing concerns and dispelling myths about the effects of MDMA, to establishing and cultivating deep trust amongst the participants and co-therapists.…”

“…A closer examination of the efficacy and safety of novel treatments among BIPOC communities is warranted, since BIPOC tend to be at increased risk for PTSD, compared with non-Hispanic Whites (e.g., odds ratio (OR) of 1.33 among African Americans vs non-Hispanic Whites; Alegría et al, 2013;Hall-Clark et al, 2016;Kisely et al, 2017;Roberts et al, 2011;Tortella-Feliu et al, 2019). Recovery from PTSD may also be affected; in a 2-year naturalistic follow-up study of African Americans with symptoms of anxiety-related disorders, Benítez et al (2014) found comparatively lower rates of recovery from PTSD (probability of 0.10) than found with predominantly non-Hispanic White samples (e.g., probability of 0.18; Zlotnick et al, 2004). The researchers attributed this difference to the co-occurrence of ongoing social stressors (e.g., socioeconomic inequities and racial discrimination), which may have perpetuated symptoms in their sample.…”

African American Health and Posttraumatic Slave Syndrome: A Terror Management Theory Account

“…Although African Americans report lower rates of generalized anxiety (Himle, Baser, Taylor, Campbell, & Jackson, 2009), they show more severe symptoms and greater functional impairment when anxiety is suffered. Moreover, African Americans more frequently meet the criterion for posttraumatic stress disorder (PTSD) than White Americans with symptoms persisting for a longer period (Himle et al, 2009; Perez Benitez et al, 2014).…”

Posttraumatic stress disorder in African American and Latinx adults: Clinical course and the role of racial and ethnic discrimination.

“…Additionally, research has also suggested that African American and Latinx individuals may experience more severe PTSD symptoms (e.g., Ortega & Rosenheck, 2000; Roberts et al, 2011). A number of studies have offered evidence to help explain these racial and ethnic group differences in PTSD prevalence and severity, including socioeconomic factors that may limit their resources to cope with traumatic stressors (Roberts et al, 2011; Seng, Kohn-Wood, McPherson, & Sperlich, 2011), increased exposure to assaultive violence (Roberts et al, 2011; Seng et al, 2011); stressors associated with displacement and immigration (Pérez Benítez et al, 2014); cultural differences in emotional expression (Soto, Levenson, & Ebling, 2005); overrepresentation in poorer, disadvantaged, and higher crime communities (Cutrona et al, 2005); pervasive marginalization and “invisibility” (e.g., Franklin & Boyd-Franklin, 2000); and higher rates of victim blaming following an assault (e.g., Dukes & Gaither, 2017), as well as increased rates of incarceration (Carson, 2018), homelessness (U.S. Department of Housing and Urban Development, 2017), intimate partner violence (Catalano, 2012), and sex trafficking (Banks & Kyckelhahn, 2011).…”