Material hardship is associated with posttraumatic stress disorder symptoms among low-income Black women

Post-traumatic stress disorder: evolving conceptualization and evidence, and future research directions

The understanding of responses to traumatic events has been greatly influenced by the introduction of the diagnosis of post-traumatic stress disorder (PTSD). In this paper we review the initial versions of the diagnostic criteria for this condition and the associated epidemiological findings, including sociocultural differences. We consider evidence for post-traumatic reactions occurring in multiple contexts not previously defined as traumatic, and the implications that these observations have for the diagnosis. More recent developments such as the DSM-5 dissociative subtype and the ICD-11 diagnosis of complex PTSD are reviewed, adding to evidence that there are several distinct PTSD phenotypes. We describe the psychological foundations of PTSD, involving disturbances to memory as well as to identity. A broader focus on identity may be able to accommodate group and communal influences on the experience of trauma and PTSD, as well as the impact of resource loss. We then summarize current evidence concerning the biological foundations of PTSD, with a particular focus on genetic and neuroimaging studies. Whereas progress in prevention has been disappointing, there is now an extensive evidence supporting the efficacy of a variety of psychological treatments for established PTSD, including trauma-focused interventions - such as trauma-focused cognitive behavior therapy (TF-CBT) and eye movement desensitization and reprocessing (EMDR) - and non-trauma-focused therapies, which also include some emerging identity-based approaches such as present-centered and compassion-focused therapies. Additionally, there are promising interventions that are neither psychological nor pharmacological, or that combine a pharmacological and a psychological approach, such as 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy. We review advances in the priority areas of adapting interventions in resource-limited settings and across cultural contexts, and of community-based approaches. We conclude by identifying future directions for work on trauma and mental health.

Trauma exposure, contextual stressors, and PTSD symptoms: patterns in racially and ethnically diverse, low-income postpartum women

BACKGROUND

Racial, ethnic, and socioeconomic disparities persist in posttraumatic stress disorder (PTSD), which are partly attributed to minoritized women being trauma-exposed, while also contending with harmful contextual stressors. However, few have used analytic strategies that capture the interplay of these experiences and their relation to PTSD. The current study used a person-centered statistical approach to examine heterogeneity in trauma and contextual stress exposure, and their associations with PTSD and underlying symptom dimensions, in a diverse sample of low-income postpartum women.

METHODS

Using a community-based sample of Black, Hispanic/Latina, and White postpartum women recruited from five U.S. regions (n = 1577), a latent class analysis generated profiles of past-year exposure to traumatic events and contextual stress at one month postpartum. Regression analyses then examined associations between class membership and PTSD symptom severity at six months postpartum as a function of race/ethnicity.

RESULTS

A four-class solution best fit the data, yielding High Contextual Stress, Injury/Illness, Violence Exposure, and Low Trauma/Contextual Stress classes. Compared to the Low Trauma/Contextual Stress class, membership in any of the other classes was associated with greater symptom severity across nearly all PTSD symptom dimensions (all ps < 0.05). Additionally, constellations of exposures were differentially linked to total PTSD symptom severity, reexperiencing, and numbing PTSD symptoms across racial/ethnic groups (ps < 0.05).

CONCLUSIONS

A person-centered approach to trauma and contextual stress exposure can capture heterogeneity of experiences in diverse, low-income women. Moreover, racially/ethnically patterned links between traumatic or stressful exposures and PTSD symptom dimensions have implications for screening and intervention in the perinatal period.

Financial strain measures and associations with adult health: A systematic literature review

Despite growing attention to other social needs like food and housing insecurity, financial strain, defined as having difficulty making ends meet or lacking money for basic needs, is under-recognized. Inconsistent labels and measures have made the literature difficult to unify. We used many synonyms for financial strain to systematically identify 199 U.S. studies (316 papers) that used financial strain measures that were operationally consistent with our definition as predictors of health among adults. We thematically coded financial strain measures for content and synthesized evidence based on measure and methods. Financial strain was measured by self-reported lacking money for basic needs (119 studies) and/or difficulty making ends meet (n = 132), and less commonly additionally based on coping strategies (n = 23), satisfaction with finances (n = 14), worry about finances (n = 22), the anticipation of strain (n = 14), and/or lacking money for leisure (n = 29). Regardless of measure, financial strain was associated with poorer mental, physical, biological, and functional health, worse health behaviors and more social needs. Associations were found across diverse and population-based samples and when accounting for other socioeconomic factors and even intermediating health factors. Results demonstrate predictive validity for two different one-item screening tools. Furthermore, the vast evidence linking financial strain to health highlights an urgent need for policy action addressing financial strain to advance health equity.

Experience of Intimate Partner Violence-Related Head Trauma and Its Association With Posttraumatic Stress Disorder and Depression Symptoms Among Community Dwelling Women and Men

Individuals who experience intimate partner violence (IPV) often report posttraumatic stress disorder (PTSD) and depressive symptoms and IPV-related head trauma (IPV-HT), which can also affect mental health. We aimed to estimate rates of IPV-HT and examine the unique associations of IPV, HT, and IPV-HT with PTSD and depression symptom severity in a community-based sample of cohabitating couples. A total of 413 participants (216 women, 1 non-binary) self-reported lifetime history of HT and physical IPV. Chi-square analyses and Fisher's exact tests were used to compare the proportion of women and men who reported IPV-HT. Kruskal-Wallis tests with Dunn's post-hoc testing and Bonferroni correction were used to compare symptom severity across five groups: (a) IPV-HT, (b) non-IPV-related HT (Other HT) with exposure to physical IPV (IPV-Other HT), (c) Other HT without exposure to physical IPV (No IPV-Other HT), (d) no exposure to HT with exposure to physical IPV (IPV-No HT), and (e) no exposure to HT without exposure to physical IPV (No IPV-No HT). A greater proportion of women than men reported IPV-HT from a fight or being strangled (fight: 50.0% vs. 3.6%, p < .001; Strangulation: 74.1% vs. 3.8%, p < .001). The IPV-HT and IPV-Other HT groups endorsed greater PTSD and depression symptom severity compared to all individuals with no history of physical IPV, regardless of HT exposure (IPV-No HT and IPV-Other HT groups). No differences in symptom severity between the IPV-HT and the other IPV groups (No HT and Other HT) were found. These results suggest that PTSD and depression symptom severity may be driven by experiencing physical IPV, with some exacerbation due to experiencing HT of any etiology. Future work seeking to examine the effects of IPV-HT on PTSD and depression symptom severity should consider any history of physical IPV and any additional HT exposures.

COVID-19 impact on post-traumatic stress symptoms in burning mouth syndrome: A multicentric study

OBJECTIVES

This study investigates the psychological impact of COVID-19 on burning mouth syndrome (BMS) patients. It focuses on comparing post-traumatic stress symptoms (PTSS), post-traumatic growth (PTG), and resilience between BMS patients and Controls.

METHODS

A total of 100 BMS patients and 100 Controls from five Italian centers participated in this observational cross-sectional study. They completed several assessments, including the General Health Questionnaire, Depression Anxiety and Stress Scale, Insomnia Severity Index, National Stressful Events Survey Short Scale, Impact of Event Scale-Revised, Post Traumatic Growth Inventory Short Form, and Connor-Davidson Resilience Scale.

RESULTS

BMS patients had significantly higher stress, anxiety, and depression (DASS-21 score) and post-traumatic stress symptoms (IES-R-6 score), particularly in terms of intrusive thoughts. They showed lower post-traumatic growth (PTGI-SF score) compared to Controls. The resilience scale (CDRS-10) was a key predictor of PTG in both groups, explaining a significant variance in PTGI-SF scores.

CONCLUSIONS

BMS patients experienced heightened post-traumatic stress, stress, anxiety, and depression during the COVID-19 pandemic, with reduced post-traumatic growth. This highlights the need to prioritize their psychological well-being, focusing on stress management and fostering post-traumatic growth in challenging times.

Posttraumatic stress disorder and its associated factors among people living in Dabat district, northwest Ethiopia

Background

The conflict between the Ethiopian government and the Tigray People's Liberation Front (TPLF) in the Dabat district of Ethiopia has led to significant civilian casualties, instances of rape, sexual abuse, and property theft. These traumatic events contribute to the development of post-traumatic stress disorder (PTSD) among local residents. However, there is currently no available data on the prevalence of PTSD and its associated factors in this region. This study seeks to fill this gap by assessing PTSD prevalence and identifying related factors among residents of the war-affected Dabat district in northwest Ethiopia.

Method

A community-based correctional study was conducted in the Woken and China kebeles of Dabat district, northwest Ethiopia, spanning from July 13 to September 19, 2023. A total of 410 participants were selected using systematic random sampling, making a 100% response rate. The study utilized an interviewer-administered questionnaire, which included the Post-Traumatic Stress Disorder Checklist (PCL-5) to assess PTSD. The research investigated the association between PTSD and various demographic and psychosocial characteristics using both bivariate and multivariable binary logistic regression analyses. Statistical significance was set at a P-value of 0.05.

Results

The majority of participants in the study were male (62%) with a mean age of 33 ( ± 1.67) years. The overall prevalence of PTSD was 30.7% (95% CI: 26.6-35.10). Multivariable logistic regression analysis identified several factors significantly associated with PTSD: symptoms of depression (AOR=3.5; 95% CI: 1.13-6.89), age between 45 and 67 years (AOR=1.68; 95% CI: 1.04-5.78), experiencing stressful life events (AOR=1.63; 95% CI: 1.05-7.86), experiencing sexual abuse or rape (AOR=1.53; 95% CI: 1.07-6.75), chewing khat (AOR=1.48; 95% CI: 1.08-4.56), being female (AOR=1.43; 95% CI: 1.13-3.67), and having an income of 34.6 USD (AOR=1.28; 95% CI: 1.07-4.67).

Conclusion and recommendation

This study reported that the prevalence of PTSD was high. As a result, the study suggested that governments and other stakeholders should be involved in implementing efficient interventions and quick measures to mitigate the effects of war on mental health following the conflict. The government and nongovernmental organizations were also advised by these studies to continue providing humanitarian assistance, which should include access to food, clean water, clothing, shelter, and education. This study also suggested that people living in conflict zones should be legally protected from rape, sexual abuse, arson, detention without cause, and kidnapping.

Worldwide Perinatal Intimate Partner Violence Prevalence and Risk Factors for Post-traumatic Stress Disorder in Women: A Systematic Review and Meta-analysis

Post-traumatic stress disorder (PTSD) in women who have experienced perinatal intimate partner violence (P-IPV) has gradually attracted the attention of psychologists, mental health, and health care professionals. However, a comprehensive understanding of its prevalence and associated risk factors is still lacking. The aim of this systematic review and meta-analysis was to determine the prevalence and explore influencing factors for PTSD in women who have suffered P-IPV. Our study inclusion criteria were: women who experienced IPV in the year before conception, throughout pregnancy, during delivery, and up to 1 year after giving birth for which a quantitative assessment of PTSD was done using validated diagnostic or screening tools. This study searched nine English databases and four Chinese databases. The final analysis included 16 studies, involving 9,098 female subjects. Meta-analysis was performed on the extracted data using the Stata 16.0 software (Stata Corp. LP, College Station, TX, USA).Fixed or random effect models were selected to pool odds ratio (OR) and 95% confidence interval (CI) of PTSD after heterogeneity test. Meta-analysis showed that the pooled prevalence of PTSD in women who suffered P-IPV was 30.0% (95% confidence interval [95% CI] = [22.0%, 37.0%]). Only nine studies described influencing factors for PTSD based on multivariate logistic regression analysis. The five identified influencing factors were: non-immigrants (OR = 2.56; 95% CI [1.29, 5.08]), non-cohabitation (OR = 2.45; [1.35, 4.42]), trauma history (OR = 1.80; [1.18, 2.76]), education below senior high school (OR = 1.32; [0.64, 2.75]), and age 18 to 29 years (OR = 1.06; [0.94, 1.19]). These findings provided a reference value of PTSD prevalence, risk factors, and potential association with P-IPV among women worldwide. However, the geographical coverage of the reviewed studies is limited and epidemiological investigations from more diverse areas are required in the future.

An Exploratory Analysis of Domestic and Intimate Partner Violence Victimization Among Persons Experiencing Eviction

A paucity of research has examined the prevalence of domestic and intimate partner violence (DV/IPV) victimization among persons experiencing eviction. The current study uses administrative records for a random sample of evicted adults in Omaha, Nebraska from 2017 to 2019 (n = 306) to assess the prevalence of DV/IPV victimization among evicted persons and differences among the DV/IPV and no DV/IPV groups. Findings indicated over 20% of evicted persons experienced DV/IPV victimization, and DV/IPV often preceded the first eviction. DV/IPV disproportionately impacted Black women. Implications regarding the compounding consequences of eviction and DV/IPV victimization and recommendations for future research are discussed.

Commentary on the special issue on disproportionate exposure to trauma: Disrupting single stories, broadening the aperture, and embracing the trauma socioexposome in research with minoritized individuals

The theory-driven studies in this special issue of the Journal of Traumatic Stress illustrate the opportunities and inherent methodological complexities that arise in traumatic stress studies when scholars consider the unique social-ecological contexts and exposure histories of minoritized individuals. Moreover, the included articles challenge the field's paradigmatic preoccupation with maladaptive individual trauma responses and invite researchers to shift their attention to the role played by a range of environmental adversities. This commentary is organized around three key recommendations regarding what is needed to enhance future research and treatment among trauma-exposed minoritized populations: (a) disrupt single scientific stories about trauma risk, detection, protection, and resilience; (b) embrace the complexity of the trauma socioexposome; and (c) expand capacity to assess, research, and mitigate syndemic risk. The present commentary describes how these key points are highlighted and underscored in the articles in this special issue, arriving at the conclusion that, more than ever, scholars and clinicians need lenses and methods that can help in assessing and treating the whole person and community from a biopsychosocial perspective when racism contibutes to a complex trauma socioexposome rather than perpetuating scientific and clinical models based only on single stories of isolated individuals confronted by discrete traumatic events.

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

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.