Trauma Exposure and Stress-related Disorders in Inner City Primary Care Patients

Overview

Journal Gen Hosp Psychiatry

Specialties Health Services
Psychiatry

Date 2009 Nov 7

PMID 19892208

Citations 293

Authors

Charles F Gillespie

Bekh Bradley

Kristie Mercer

Alicia K Smith

Karen Conneely

Mark Gapen

Tamara Weiss

Ann C Schwartz

Joseph F Cubells

Kerry J Ressler

Affiliations

Soon will be listed here.

Abstract

Objective: This study was undertaken to increase understanding of environmental risk factors for posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) within an urban, impoverished, population.

Method: This study examined the demographic characteristics, patterns of trauma exposure, prevalence of PTSD and MDD, and predictors of posttraumatic stress and depressive symptomatology using a verbally presented survey and structured clinical interviews administered to low-income, primarily African-American (>93%) women and men seeking care in the primary care and obstetrics-gynecology clinics of an urban public hospital.

Results: Of the sample, 87.8% (n=1256) reported some form of significant trauma in their lifetime. Accidents were the most common form of trauma exposure followed by interpersonal violence and sexual assault. Childhood level of trauma and adult level of trauma separately, and in combination, predicted level of adult PTSD and depressive symptomatology. The lifetime prevalence of PTSD was 46.2% and the lifetime prevalence of MDD was 36.7%.

Conclusions: These data document high levels of childhood and adult trauma exposure, principally interpersonal violence, in a large sample of an inner-city primary care population. Within this group of subjects, PTSD and depression are highly prevalent conditions.

Citing Articles

The contribution of childhood trauma to irritability symptoms.

Grasser L, Yang R, Brotman M, Wiggins J JCPP Adv. 2025; 5(1):e12260.

PMID: 40059990 PMC: 11889654. DOI: 10.1002/jcv2.12260.

Framework for constructing an optimal weighted score based on agreement.

Qiu Z, Amita M, Peng L, Guo Y, Jovanovic T J Appl Stat. 2025; 52(4):894-913.

PMID: 40040675 PMC: 11873963. DOI: 10.1080/02664763.2024.2399586.

A systematic review on the bidirectional relationship between trauma-related psychopathology and reproductive aging.

Arnold A, Prochaska T, Fickenwirth M, Powers A, Smith A, Chahine E J Mood Anxiety Disord. 2025; 8.

PMID: 39803367 PMC: 11721711. DOI: 10.1016/j.xjmad.2024.100082.

The effect of mindfulness-based cognitive therapy on PTSD and depression symptoms in trauma-exposed black adults: Pilot randomized controlled trial results.

Au M, Lipschutz R, Mekawi Y, Lathan E, Dixon H, Carter S J Mood Anxiety Disord. 2025; 8.

PMID: 39749141 PMC: 11694627. DOI: 10.1016/j.xjmad.2024.100092.

Endocannabinoid dysregulation and PTSD in urban adolescents: Associations with anandamide concentrations and FAAH genotype.

Marusak H, Ely S, Zundel C, Gowatch L, Shampine M, Carpenter C Psychopharmacology (Berl). 2024; .

PMID: 39547971 DOI: 10.1007/s00213-024-06717-3.

References

Beck A, Ward C, Mendelson M, Mock J, ERBAUGH J . An inventory for measuring depression. Arch Gen Psychiatry. 1961; 4:561-71. DOI: 10.1001/archpsyc.1961.01710120031004. View

Kessler R, Sonnega A, Bromet E, Hughes M, Nelson C . Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry. 1995; 52(12):1048-60. DOI: 10.1001/archpsyc.1995.03950240066012. View

Goodwin R, Stein M . Association between childhood trauma and physical disorders among adults in the United States. Psychol Med. 2004; 34(3):509-20. DOI: 10.1017/s003329170300134x. View

Hien D, Nunes E, Levin F, Fraser D . Posttraumatic stress disorder and short-term outcome in early methadone treatment. J Subst Abuse Treat. 2000; 19(1):31-7. DOI: 10.1016/s0740-5472(99)00088-4. View

Batten S, Aslan M, Maciejewski P, Mazure C . Childhood maltreatment as a risk factor for adult cardiovascular disease and depression. J Clin Psychiatry. 2004; 65(2):249-54. DOI: 10.4088/jcp.v65n0217. View

Holbrook T, Hoyt D, Stein M, Sieber W . Gender differences in long-term posttraumatic stress disorder outcomes after major trauma: women are at higher risk of adverse outcomes than men. J Trauma. 2002; 53(5):882-8. DOI: 10.1097/00005373-200211000-00012. View

Danese A, Moffitt T, Pariante C, Ambler A, Poulton R, Caspi A . Elevated inflammation levels in depressed adults with a history of childhood maltreatment. Arch Gen Psychiatry. 2008; 65(4):409-15. PMC: 2923056. DOI: 10.1001/archpsyc.65.4.409. View

Coffey S, Dansky B, Falsetti S, Saladin M, Brady K . Screening for PTSD in a substance abuse sample: psychometric properties of a modified version of the PTSD Symptom Scale Self-Report. Posttraumatic stress disorder. J Trauma Stress. 1998; 11(2):393-9. DOI: 10.1023/A:1024467507565. View

Dietz P, Spitz A, Anda R, Williamson D, McMahon P, Santelli J . Unintended pregnancy among adult women exposed to abuse or household dysfunction during their childhood. JAMA. 1999; 282(14):1359-64. DOI: 10.1001/jama.282.14.1359. View

10.

Southwick S, Morgan 3rd C, Nicolaou A, Charney D . Consistency of memory for combat-related traumatic events in veterans of Operation Desert Storm. Am J Psychiatry. 1997; 154(2):173-7. DOI: 10.1176/ajp.154.2.173. View

11.

Lissau I, Sorensen T . Parental neglect during childhood and increased risk of obesity in young adulthood. Lancet. 1994; 343(8893):324-7. DOI: 10.1016/s0140-6736(94)91163-0. View

12.

Green B, Goodman L, Krupnick J, Corcoran C, Petty R, Stockton P . Outcomes of single versus multiple trauma exposure in a screening sample. J Trauma Stress. 2000; 13(2):271-86. DOI: 10.1023/A:1007758711939. View

13.

Binder E, Bradley R, Liu W, Epstein M, Deveau T, Mercer K . Association of FKBP5 polymorphisms and childhood abuse with risk of posttraumatic stress disorder symptoms in adults. JAMA. 2008; 299(11):1291-305. PMC: 2441757. DOI: 10.1001/jama.299.11.1291. View

14.

King D, King L, Foy D, Gudanowski D . Prewar factors in combat-related posttraumatic stress disorder: structural equation modeling with a national sample of female and male Vietnam veterans. J Consult Clin Psychol. 1996; 64(3):520-31. DOI: 10.1037//0022-006x.64.3.520. View

15.

Delahanty D, Bogart L, Figler J . Posttraumatic stress disorder symptoms, salivary cortisol, medication adherence, and CD4 levels in HIV-positive individuals. AIDS Care. 2003; 16(2):247-60. DOI: 10.1080/09540120410001641084. View

16.

Kendler K . Stressful life events and genetic liability to major depression: genetic control of exposure to the environment?. Psychol Med. 1997; 27(3):539-47. DOI: 10.1017/s0033291797004716. View

17.

Liebschutz J, Saitz R, Brower V, Keane T, Lloyd-Travaglini C, Averbuch T . PTSD in urban primary care: high prevalence and low physician recognition. J Gen Intern Med. 2007; 22(6):719-26. PMC: 2219859. DOI: 10.1007/s11606-007-0161-0. View

18.

Foa E, Tolin D . Comparison of the PTSD Symptom Scale-Interview Version and the Clinician-Administered PTSD scale. J Trauma Stress. 2000; 13(2):181-91. DOI: 10.1023/A:1007781909213. View

19.

Breslau N, Peterson E, Poisson L, Schultz L, Lucia V . Estimating post-traumatic stress disorder in the community: lifetime perspective and the impact of typical traumatic events. Psychol Med. 2004; 34(5):889-98. DOI: 10.1017/s0033291703001612. View

20.

Perkonigg A, Kessler R, Storz S, Wittchen H . Traumatic events and post-traumatic stress disorder in the community: prevalence, risk factors and comorbidity. Acta Psychiatr Scand. 2000; 101(1):46-59. DOI: 10.1034/j.1600-0447.2000.101001046.x. View