Probable Posttraumatic Stress Disorder and Psychiatric Co-morbidity among Latino Primary Care Patients in Puerto Rico

The role of resilience and gender: Understanding the relationship between risk for traumatic stress, resilience, and academic outcomes among minoritized youth

OBJECTIVE

Minoritized students experience high trauma rates which can impact academic outcomes, and experiences may differ between males and females. We investigated the relationship between traumatic stress and academic outcomes by gender among predominantly minoritized students, and whether resilience-building assets can mediate the relationship between traumatic stress and academic outcomes.

METHOD

School administrative data were linked to survey data from 9th graders in 2016-2018 across 37 West Coast schools. We examined the association between traumatic stress risk and academic outcomes by gender. Where significant associations were found, mixed effects regression models accounting for school-level variation were fit to assess the role of resilience-building assets as potential mediators of the relationship between traumatic stress risk and academic outcomes.

RESULTS

Among 1,750 female and 2,036 male students, we found no significant association between traumatic stress risk and low attendance (<96% days attended). The odds of low grade point average (GPA <2.0) were significantly higher among female students with traumatic stress risk (OR = 1.46, 95% CI [1.16, 1.84]), with no association among males. In models controlling for resilience-building assets, the magnitude of the association between traumatic stress risk and GPA <2.0 among females was reduced. We identified significant mediation for 3 resilience measures: self-efficacy (21.20%; p < .05), school support (18.97%; p < .05), and total internal assets (27.84%; p < .01).

CONCLUSIONS

Resilience-building assets may partially mediate the effect of traumatic stress on GPA among females. Resilience initiatives, especially among minoritized female students, may protect against the effect of trauma on academics. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Psychological adverse effects of COVID-19 pandemic on health service providers: an online survey

Background

Results

Conclusions

The Association Between Post-Traumatic Stress and Depressive Symptoms Among Older Puerto Ricans in Boston: How Does Loneliness Matter?

OBJECTIVES

To examine the association between post-traumatic stress and depression and whether such an association differs by level of loneliness among older Puerto Ricans.

METHODS

Data were collected from 304 Puerto Ricans aged 60 and above living in the Greater Boston area who responded to questionnaires. We used ordinary least squares regression to examine the association between post-traumatic stress, loneliness, and depressive symptoms.

RESULTS

Post-traumatic stress was significantly associated with higher levels of depression. The association between post-traumatic stress and depression was stronger for those experiencing a higher degree of loneliness.

DISCUSSION

In working with older Puerto Ricans experiencing post-traumatic stress, it is important for mental health professionals to incorporate the assessment of loneliness and to prevent and reduce comorbid depression by addressing loneliness through improving social skills, enhancing social support, and reducing maladaptive social cognition.

Patient Preferences for Discussing Childhood Trauma in Primary Care

CONTEXT

Exposure to traumatic events is common in primary care patients, yet health care professionals may be hesitant to assess and address the impact of childhood trauma in their patients.

OBJECTIVE

To assess patient preferences for discussing traumatic experiences and posttraumatic stress disorder (PTSD) with clinicians in underserved, predominantly Latino primary care patients.

DESIGN

Cross-sectional study.

MAIN OUTCOME MEASURE

We evaluated patients with a questionnaire assessing comfort to discuss trauma exposure and symptoms using the Adverse Childhood Experiences (ACE) Study questionnaire and the Primary Care-PTSD screen. The questionnaire also assessed patients' confidence in their clinicians' ability to help with trauma-related issues. Surveys were collected at an integrated medical and behavioral health care clinic.

RESULTS

Of 178 adult patients asked, 152 (83%) agreed to participate. Among participants, 37% screened positive for PTSD, 42% reported 4 or more ACEs, and 26% had elevated scores on both measures. Primary Care-PTSD and ACE scores were strongly positively correlated (r = 0.57, p < 0.001). Most patients agreed they were comfortable being asked about trauma directly or through screening questionnaires and did not oppose the inclusion of trauma-related information in their medical record. In addition, most patients perceived their clinician as comfortable asking questions about childhood trauma and able to address trauma-related problems.

CONCLUSION

Screening is acceptable to most primary care patients regardless of trauma exposure or positive PTSD screening. Findings may aid primary care clinicians to consider screening regularly for ACEs and PTSD to better serve the health care needs of trauma-exposed patients.

The Prevalence of Posttraumatic Stress Disorder in Primary Care: A Systematic Review

LEARNING OBJECTIVES

After participating in this activity, learners should be better able to:• Determine the prevalence of clinician-diagnosed posttraumatic stress disorder (PTSD) in primary care patients• Identify the prevalence of questionnaire-ascertained PTSD symptoms in primary care patients OBJECTIVE: Determine the prevalence of clinician-diagnosed PTSD and questionnaire-ascertained PTSD symptoms in primary care patients.

METHODS

A systematic review of the literature using the PRISMA method, searching MEDLINE, CINAHL, Cochrane Database, PsycINFO, EMBASE, Google Scholar, and relevant book chapter bibliographies. Studies that reported on the prevalence, including point or lifetime prevalence, of PTSD ascertained using diagnostic interviews or self-report questionnaires, or from administrative data, among patients seen in primary care were deemed eligible for inclusion. We abstracted data on the PTSD assessment tool, the mean questionnaire scores/cutoff scores, the time period of PTSD symptoms, and PTSD prevalence reported.

RESULTS

Of 10,614 titles screened, 41 studies were eligible for inclusion. The included studies assessed PTSD in a total of 7,256,826 primary care patients. The median point prevalence of PTSD across studies was 12.5%. The median point prevalence in the civilian population was 11.1%; in the special-risk population, 12.5%; and in veterans, 24.5%. The point prevalence of diagnostic interview-ascertained PTSD ranged from 2% to 32.5%, and the point prevalence of questionnaire-based substantial PTSD symptoms ranged from 2.9% to 39.1%. Lifetime prevalence of diagnostic interview-ascertained PTSD ranged from 14.5% to 48.8%. The prevalence of PTSD in administrative data-based studies ranged from 3.5% to 29.2%.

CONCLUSIONS

PTSD is common in primary care settings. Additional research on effective and generalizable interventions for PTSD in primary care is needed.