Trauma exposure and stress‐related disorders in African‐American women with diabetes mellitus

Dixon, H. Drew; Michopoulos, Vasiliki; Gluck, Rachel; Mendoza, Hadrian; Munoz, Adam P.; Wilson, Joseph S.; Powers, Abigail; Schwartz, Ann C.; Umpiérrez, Guillermo E.; Gillespie, Charles F.

doi:10.1002/edm2.111

Cited by 13 publications

(7 citation statements)

References 47 publications

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“…Descriptive statistics on trauma exposure, PTSD symptoms, and racial discrimination for this sample of 55 Black women living in the US (mean [SD] age, 37.7 [10.7] years; range, 21-61 years) are provided in Table 1. Participants reported a mean (SD) TEI frequency of 33.0 (18.8) (similar to previous Grady Trauma Project studies [28][29][30] ) and showed moderate levels of current PTSD symptoms (mean [SD] PSS, 15.4 [12.9]). Racial discrimination (EOD) scores ranged from 0 to 9 and were moderately correlated with current PTSD symptoms (PSS total: r = 0.36; P = .009), but not with age (r = 0.20; P = .15) or TEI frequency (r = −0.02; P = .89).…”

Section: Ptsd Symptoms Trauma and Racial Discriminationsupporting

confidence: 75%

Association of Racial Discrimination With Neural Response to Threat in Black Women in the US Exposed to Trauma

et al. 2021

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IMPORTANCE Racial discrimination has a clear impact on health-related outcomes, but little is known about how discriminatory experiences are associated with neural response patterns to emotionally salient cues, which likely mediates these outcomes.OBJECTIVE To examine associations of discriminatory experiences with brainwide response to threat-relevant cues in trauma-exposed US Black women as they engage in an attentionally demanding task. DESIGN, SETTING, AND PARTICIPANTSA cross-sectional study was conducted from May 1, 2014, to July 1, 2019, among 55 trauma-exposed US Black women to examine associations of racial discrimination experiences with patterns of neural response and behavior to trauma-relevant images in an affective attentional control task. Posttraumatic stress disorder (PTSD) symptoms and trauma exposure were entered as covariates to isolate variance associated with experiences of racial discrimination.EXPOSURES Varying levels of trauma, PTSD symptoms, and experiences of racial discrimination.MAIN OUTCOMES AND MEASURES Experiences of Discrimination Questionnaire (EOD) (range, 0-9) for count of the number of situations for which each participant reported having unfair treatment for a racial reason. Experiences of trauma and PTSD symptoms were assessed with the Traumatic Events Inventory (TEI) (number of times the person was exposed to trauma; score range, 0-112) and PTSD Symptom Scale (PSS) (score range, 0-51). Response to trauma-relevant vs neutral distractor cues were assessed via functional magnetic resonance imaging during performance of an affective Stroop (attentional control) task. Statistical analyses were conducted at a whole-brain, voxelwise level with familywise error correction. RESULTSIn this study of 55 Black women in the US (mean [SD] age, 37.7 [10.7] years; range, 21-61 years), participants reported a mean (SD) TEI frequency of 33.0 (18.8) and showed moderate levels of current PTSD symptoms (mean [SD] PSS score, 15.4 [12.9]). Mean (SD) EOD scores were 2.35 (2.44) and were moderately correlated with current PTSD symptoms (PSS total: r = 0.36; P=.009) but not with age (r = 0.20; P = .15) or TEI frequency (r = -0.02; P = .89). During attention to trauma-relevant vs neutral images, more experiences of racial discrimination were associated with significantly greater response in nodes of emotion regulation and fear inhibition (ventromedial prefrontal cortex) and visual attention (middle occipital cortex) networks, even after accounting for trauma and severity of PTSD symptoms (brainwide familywise error corrected; r = 0.33 for ventromedial prefrontal cortex; P = .02). Racial discrimination was also associated with affective Stroop task performance; errors on trials with threat-relevant stimuli were negatively correlated with experiences of racial discrimination (r = −0.41; P = .003).CONCLUSIONS AND RELEVANCE These findings suggest that experiences of racial discrimination associate with disproportionately greater response in brain regions associated with emotion regulation and fear inhibiti...

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Section: Ptsd Symptoms Trauma and Racial Discriminationsupporting

confidence: 75%

Association of Racial Discrimination With Neural Response to Threat in Black Women in the US Exposed to Trauma

et al. 2021

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“…Compared to non-Hispanic Whites, American Indians experience higher rates of post-traumatic stress disorder [29]. The co-occurrence of T2D and post-traumatic stress disorder is associated with worse diabetes-related health outcomes compared to T2D alone [25,26,28]. To date, only one study has examined post-traumatic stress and HRQoL among American Indians with T2D [28].…”

Section: Discussionmentioning

confidence: 99%

“…A number of studies have examined the association of psychosocial factors, such as support, coping, resilience, and mental health [post-traumatic stress disorder (PTSD)] with HRQoL in non-Native populations [19][20][21][22][23][24][25]. For example, in a sample of older African Americans and Whites with diabetes, findings suggested that diabetes-specific social support was positively associated with HRQoL [20], and in a systematic review examining the relationship between resilience and chronic diseases findings indicated that lower levels of resilience were associated with poor HRQoL [23].…”

Section: Introductionmentioning

confidence: 99%

Diabetes and health-related quality of life among American Indians: the role of psychosocial factors

et al. 2021

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Purpose Little is known about the association of psychosocial factors with health-related quality of life (HRQoL) among American Indians with type 2 diabetes (T2D). This study described functional social support, emotional support, coping, resilience, post-traumatic stress disorder, and HRQoL, among American Indians by diabetes status and, among those with diabetes, examined the association of these factors with HRQoL. Methods Using data from the Cherokee Nation Health Survey collected between 2017 and 2019, we evaluated differences in each measure of interest according to diabetes status, using t-test and Chi-squared tests of association. We used weighted multiple logistic regression to examine associations between multiple psychosocial factors and HRQoL among those with diabetes. Results Compared to individuals without diabetes, participants with diabetes rated their functional social support (4.62 vs. 4.56, respectively) and coping (2.65 vs. 2.61, respectively) slightly lower and were more likely to report ≥ 15 days of poor physical (14% vs. 26%, respectively) and mental health (14% vs. 17%, respectively) in the past month. Odds of reporting poor overall health increased more than sixfold for those who were dissatisfied/very dissatisfied with life (AOR = 6.70). Resilience scores reduced odds of reporting ≥ 15 days with poor physical health, while experiences of post-traumatic stress doubled these odds. Conclusion Our study yielded insights into the risk as well as protective factors associated with diabetes outcomes in a large sample of American Indians with T2D. Researchers should design pragmatic trials that deepen understanding of preventive as well as treatment leverage through greater attention to experiences that compromise HRQoL.

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“…Additionally, biological, psychological, social, and environmental processes linking childhood experiences to adulthood routine diabetes care and self-management should be tested. For example, recent studies have identified adulthood mental health (Dixon et al, 2020), psychological distress (Strenth et al, 2022), and delay discounting (Shain et al, 2022) as potential mechanisms for explaining how childhood trauma relates to diabetes self-management in adulthood.…”

Section: Discussionmentioning

confidence: 99%

Adverse childhood event subtypes and routine diabetes care utilization among U.S. adults with Type 2 diabetes.

Hoadley¹,

Bass²,

Rubin³

2024

Psychological Trauma: Theory, Research, Practice, and Policy

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Objective: Adverse childhood events (ACEs) have significant impacts on adulthood health, including greater risk of Type 2 diabetes (T2D). While there is a known connection to increased use of outpatient and emergency healthcare services, the potential role of ACEs in routine diabetes care utilization remains unclear. This study uses ACE subtypes to explain pathways to routine diabetes care utilization among adults with T2D. Method: Cross-sectional data were obtained from the 2019 Behavioral Risk Factor Surveillance System, a survey of a representative sample of U.S. adults. Eligible participants resided in a state that completed both the Adverse Childhood Experiences (ACEs) and Diabetes modules and were diagnosed with non-gestational diabetes (N = 9,904), of whom the majority were presumed to have T2D. Confirmatory factor analysis was used to test the measurement model for three ACE factors: household dysfunction, physical and emotional abuse, and sexual abuse. Structural equation modeling was used to relate factors to four routine diabetes care utilization outcomes. Results: Factor loadings were strong, and fit indices indicated good measurement model and full structural model fits. In the full structural equation model, household dysfunction was associated with decreased likelihood of meeting frequency recommendations for A1C testing (β = − 0.22, p , .05) and foot exams (β = −0.29, p , .01). Physical and emotional abuse were associated with greater likelihood of meeting A1C testing frequency recommendations (β = 0.21, p , .05). Conclusion: Specific types of ACEs may differentially relate to routine diabetes care utilization in adulthood. Clinical Impact StatementAdverse childhood experience types related differently to whether recommendations for four different types of routine diabetes care were met among U.S. adults with type 2 diabetes (T2D). Specifically, people with a history of childhood household dysfunction were less likely to meet ADA recommendations for A1C testing and foot exams from a medical provider. Findings highlight the potential significance of trauma-informed diabetes care to address disparities in diabetes self-management and engagement with routine diabetes care. However, future studies should discover why and how adverse childhood experiences relate to routine diabetes care use in adulthood to further optimize intervention strategies.

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Trauma exposure and stress‐related disorders in African‐American women with diabetes mellitus

Cited by 13 publications

References 47 publications

Association of Racial Discrimination With Neural Response to Threat in Black Women in the US Exposed to Trauma

Association of Racial Discrimination With Neural Response to Threat in Black Women in the US Exposed to Trauma

Diabetes and health-related quality of life among American Indians: the role of psychosocial factors

Adverse childhood event subtypes and routine diabetes care utilization among U.S. adults with Type 2 diabetes.

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