Trauma and conditional risk of posttraumatic stress disorder in two American Indian reservation communities

Abstract

Purpose To determine conditional risk of posttraumatic stress disorder (PTSD) in two culturally distinct American Indian reservation communities. Method Data from the American Indian Service Utilization, Psychiatric Epidemiology, Risk and Protective Factors Project, a cross-sectional population-based survey completed between 1997 and 2000. This study focused on 1,967 participants meeting the DSM-IV criteria for trauma exposure. Traumas were grouped into interpersonal, non-interpersonal, witnessed, and “trauma to close others” categories. Analyses examined distribution of worst traumas, conditional rates of PTSD following exposure, and distributions of PTSD cases deriving from these events. Bivariate and multivariate logistic regressions estimated associations of lifetime PTSD with trauma type. Results Overall, 15.9% of those exposed to DSM-IV trauma qualified for lifetime PTSD, a rate comparable to similar U.S. studies. Women were more likely to develop PTSD than were men. The majority (60%) of cases of PTSD among women derived from interpersonal trauma exposure (in particular, sexual and physical abuse); among men, cases were more evenly distributed across trauma categories. Conclusions Previous research has demonstrated higher rates of both trauma exposure and PTSD in American Indian samples compared to other Americans. This study shows that conditional rates of PTSD are similar to those reported elsewhere, suggesting that the elevated prevalence of this disorder in American Indian populations is largely due to higher rates of trauma exposure.

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

“…For instance, asking AIAN men questions such as “Do you rarely show much emotion?” and “Do you rarely react to praise or criticism?” may lead to the misinterpretation of traditional cultural higher odds of disorder when compared to NHW women. AIAN women have over twice the odds of being raped, sexually assaulted, or violently attacked than other US women [55, 57, 58, 63, 69]. The degree to which the higher prevalence rates, found here for AIAN women compared to their NHW counterparts, are explained by differential violence exposure is an important avenue of research.…”

“…Physical abuse at these boarding schools included being chained to a bed, incarcerated in cells, and beatings for speaking AIAN languages, torture, and sexual abuse [60]. The cumulative impact of compulsory Indian boarding schools may have negatively influenced the quality of parent-child interactions across generations and contributed to unresolved grief, depression, and increased prevalence of substance abuse [57, 60–62]. The imposition of the reservation system, the loss of sacred lands and decimation of the buffalo, for example, revered and central to identity for many tribes, compounded the pervasive and overwhelming trauma exposure.…”

“…Perceived discrimination is associated with depression, and frequent historical cultural losses are negatively associated with mental health [61, 64–65]. Cumulative adversity, elevated in AIAN communities, may further impact psychological distress [55, 57, 66–68]. …”

Women finding the way: American Indian women leading intervention research in Native communities

“…Although AI/AN women have made significant contributions to AI/AN leadership in modern times as elected officials and have asserted traditional strengths in many ways across generations, currently AI/AN women also have the highest rates of violent and interpersonal trauma risk of any racial or ethnic group. AI/AN women experience higher prevalence of interpersonal violence (Bachman, Zaykowski, Lanier, Poteyeva, & Kallmyer, 2010; Beals et al, 2013; Oetzel & Duran, 2004; Yuan, Belcourt-Dittloff, Schultz, Packard, & Duran, 2015) and are at least twice as likely to be a victim of rape, sexual assault, or other violent crime (Evans-Campbell, Lindhorst, Huang, & Walters, 2006; Oetzel & Duran, 2004). …”

“…Historical trauma is understood as the collective trauma exposure within and across generations, including interpersonal losses and unresolved grief (Brave Heart, 2003; Brave Heart, Chase, Elkins, & Altschul, 2011; Whitbeck, Adams, Hoyt, & Chen, 2004; Whitbeck, Chen, Hoyt, & Adams, 2004); as well, AI/ANs are at high risk for post-traumatic stress disorder (PTSD; Beals et al, 2013; Manson, Beals, Klein, Croy, & the AI-SUPERPFP Team, 2005; Tsosie et al, 2011). Many have emphasized that AI/AN mental health must be understood within the context of AI/AN histories of collective traumas and the damages those and subsequent traumas have caused in terms of culture, identity, and spirituality (Brave Heart, 1998, 1999a, 1999b; Gone & Alcantara, 2007; Walls & Whitbeck, 2012).…”