Skip to main content
SpringerLink
Log in

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

  • Original Paper
  • Published:
Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

Abstract

Purpose

To determine conditional risk of posttraumatic stress disorder (PTSD) in two culturally distinct American Indian reservation communities.

Method

Data derived from the American Indian Service Utilization, Psychiatric Epidemiology, Risk and Protective Factors Project, a cross-sectional population-based survey that was 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 US 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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Notes

  1. DSM-IV defines a trauma as an event or events that (1) “involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others” AND “the person’s response involved intense fear, helplessness, or horror.” (pp. 427–428 [1]). The literature does not always conform to this full definition (e.g., in non-psychiatric literature or in studies predating DSM-IV). Here, “qualifying trauma” is used when the full DSM-IV definition was applied. This was the case for the AI-SUPERPFP trauma assessments described here.

References

  1. American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders, fourth edition (DSM-IV). American Psychiatric Association, Washington, DC

    Google Scholar 

  2. Breslau N, Kessler RC, Chilcoat HD, Schultz LR, Davis GC, Andreski P (1998) Trauma and posttraumatic stress disorder in the community: the 1996 Detroit Area Survey of Trauma. Arch Gen Psychiatry 55:626–632

    Article  PubMed  CAS  Google Scholar 

  3. Kessler RC, Sonnega A, Bromet E, Hughes M, Nelson CB (1995) Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry 52:1048–1060

    Article  PubMed  CAS  Google Scholar 

  4. Keane TM, Marshall AD, Taft CT (2006) Posttraumatic stress disorder: etiology, epidemiology, and treatment outcome. Annu Rev Clin Psychol 2:161–197

    Article  PubMed  Google Scholar 

  5. McFarlane A (2004) The contribution of epidemiology to the study of traumatic stress. Soc Psychiatry Psychiatr Epidemiol 39:874–882

    Article  PubMed  Google Scholar 

  6. Manson SM, Beals J, Klein S, Croy CD, the AI-SUPERPFP Team (2005) The social epidemiology of trauma in two American Indian reservation populations. Am J Public Health 95:851–859

    Article  PubMed  Google Scholar 

  7. Robin RW, Chester B, Rasmussen JK, Jaranson JM, Goldman D (1997) Prevalence and characteristics of trauma and posttraumatic stress disorder in a southwestern American Indian community. Am J Psychiatry 154:1582–1588

    PubMed  CAS  Google Scholar 

  8. US Department of Health and Human Services (2010) Trends in Indian health: 2002–2003. Department of Health and Human Services, Rockville

    Google Scholar 

  9. Bureau of Justice Statistics (2004) American Indians and crime. US Department of Justice, Washington, DC

    Google Scholar 

  10. Beals J, Manson SM, Mitchell CM, Spicer P, the AI-SUPERPFP Team (2003) Cultural specificity and comparison in psychiatric epidemiology: walking the tightrope in American Indian research. Cult Med Psychiatry 27:259–289

    Article  PubMed  Google Scholar 

  11. Beals J, Manson SM, Whitesell NR, Spicer P, Novins DK, Mitchell CM, for the AI-SUPERPFP Team (2005) Prevalence of DSM-IV disorders and attendant help-seeking in 2 American Indian reservation populations. Arch Gen Psychiatry 62:99–108

    Article  PubMed  Google Scholar 

  12. Kessler RC, Berglund P, Demler O, Jin R, Walters EE (2005) Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey-Replication. Arch Gen Psychiatry 62:593–602

    Article  PubMed  Google Scholar 

  13. Kessler RC, Chiu WT, Demler O, Walters EE (2005) Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 62:617–627

    Article  PubMed  Google Scholar 

  14. Kessler RC, McGonagle KA, Zhao S, Nelson CB, Hughes M, Eshleman S, Wittchen H-U, Kendler KS (1994) Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Arch Gen Psychiatry 51:8–19

    Article  PubMed  CAS  Google Scholar 

  15. Spitzer RL, Williams J, Gibbon M (1987) Structured clinical interview for DSM-III-R, version NP. New York Psychiatric Institute, Biometrics Research Department, New York

    Google Scholar 

  16. Beals J, Novins DK, Whitesell NR, Spicer P, Mitchell CM, Manson SM, the AI-SUPERPFP Team (2005) Prevalence of mental disorders and utilization of mental health services in two American Indian reservation populations: mental health disparities in a national context. Am J Psychiatry 162:1723–1732

    Article  PubMed  Google Scholar 

  17. Breslau N, Peterson EL, Poisson LM, Schultz LR, Lucia VC (2004) Estimating post-traumatic stress disorder in the community: lifetime perspective and the impact of typical events. Psychol Med 34:889–898

    Article  PubMed  CAS  Google Scholar 

  18. Norton IM, Manson SM (1996) Research in American Indian and Alaska Native communities: navigating the cultural universe of values and process. J Consult Clin Psychol 64:856–860

    Article  PubMed  CAS  Google Scholar 

  19. National Center for Posttraumatic Stress Disorder and the National Center for American Indian and Alaska Native Mental Health Research (1996) Matsunaga Vietnam Veterans Project. National Center for PTSD, White River Junction

    Google Scholar 

  20. Turner RJ, Lloyd DA (2002) Lifetime traumas and mental health: the significance of cumulative adversity. J Health Soc Behav 36:360–376

    Article  Google Scholar 

  21. World Health Organization (1990) Composite international diagnostic interview (CIDI), version 1.0. Work Health Organization, Geneva, Switzerland

  22. Andrews G, Peters L (1998) The psychometric properties of the Composite International Diagnostic Interview. Soc Psychiatry Psychiatr Epidemiol 33:80–88

    Article  PubMed  CAS  Google Scholar 

  23. SAS Institute Inc. (2008) SAS language. 9.2 edn. SAS Institute, Cary

  24. SPSS (2010) IBM SPSS statistics. 19.0 edn. IBM, Somers

  25. Stata (2010) Stata Statistical Software. 10.1 edn. Stata Corporation, College Station, TX

  26. Breslau N (2009) The epidemiology of trauma, PTSD, and other posttrauma disorders. Trauma Violence Abuse 10:198–210

    Article  PubMed  Google Scholar 

  27. Breslau N, Chilcoat HD, Kessler RC, Peterson EL, Lucia VC (1999) Vulnerability to assaultive violence, further specification of the sex difference in post-traumatic stress disorder. Psychol Med 29:813–821

    Article  PubMed  CAS  Google Scholar 

  28. Beals J, Manson SM, Whitesell NR, Mitchell CM, Novins DK, Simpson S, Spicer P, the AI-SUPERPFP Team (2005) Prevalence of Major Depressive Episode in two American Indian reservation populations: unexpected findings with a structured interview. Am J Psychiatry 162:1713–1722

    Article  PubMed  Google Scholar 

  29. Mitchell CM, Beals J, Novins DK, Spicer P, the AI-SUPERPFP Team (2003) Drug use among two American Indian populations: prevalence of lifetime use and DSM-IV substance use disorders. Drug Alcohol Depend 69:29–41

    Article  PubMed  Google Scholar 

  30. Spicer P, Beals J, Mitchell CM, Novins DK, Croy CD, Manson SM, the AI-SUPERPFP Team (2003) The prevalence of DSM-III-R alcohol dependence in two American Indian populations. Alcohol Clin Exp Res 27:1785–1797

    Article  PubMed  Google Scholar 

  31. Manson SM, Beals J, O’Nell TD, Piasecki J, Bechtold DW, Keane E, Jones M (1996) Wounded spirits, ailing hearts: PTSD and related disorders among American Indians. In: Marsella AJ, Friedman MJ, Gerrity ET, Scurfield RM (eds) Ethnocultural aspects of posttraumatic stress disorder: issues, research, and clinical applications. American Psychological Association, Washington, DC, pp 255–284

    Chapter  Google Scholar 

  32. Manson SM (1996) The wounded spirit: a cultural formulation of post-traumatic stress disorder. Cult Med Psychiatry 20:489–498

    Article  PubMed  CAS  Google Scholar 

  33. O’Nell TD (2000) “Coming home” among Northern Plains Vietnam veterans: psychological transformations in pragmatic perspective. Ethos 27:441–465

    Article  Google Scholar 

  34. Sijbrandij M, Olff M, Reitsma JB, Carlier IV, de Vries MH, Gersons BP (2007) Treatment of acute posttraumatic stress disorder with brief cognitive behavioral therapy: a randomized controlled trial. Am J Psychiatry 164:82–90

    Article  PubMed  Google Scholar 

  35. Sijbrandij M, Olff M, Reitsma JB, Carlier IV, Gersons BP (2006) Emotional or educational debriefing after psychological trauma. Randomised controlled trial. Br J Psychiatry J Mental Sci 189:150–155

    Article  Google Scholar 

  36. Thoresen S, Tambs K, Hussain A, Heir T, Johansen V, Bisson J (2010) Brief measure of posttraumatic stress reactions: impact of Event Scale-6. Soc Psychiatry Psychiatr Epidemiol 45:405–412

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

AI-SUPERPFP would not have been possible without the significant contributions of many people. The following interviewers, computer/data management and administrative staff supplied energy and enthusiasm for an often difficult job: Anna E. Barόn, Antonita Begay, Amelia T. Begay, Cathy A.E. Bell, Phyllis Brewer, Nelson Chee, Mary Cook, Helen J. Curley, Mary C. Davenport, Rhonda Wiegman Dick, Marvine D. Douville, Pearl Dull Knife, Geneva Emhoolah, Fay Flame, Roslyn Green, Billie K. Greene, Jack Herman, Tamara Holmes, Shelly Hubing, Cameron R. Joe, Louise F. Joe, Cheryl L. Martin, Jeff Miller, Robert H. Moran Jr., Natalie K. Murphy, Melissa Nixon, Ralph L. Roanhorse, Margo Schwab, Jennifer Settlemire, Donna M. Shangreaux, Matilda J. Shorty, Selena S. S. Simmons, Wileen Smith, Tina Standing Soldier, Jennifer Truel, Lori Trullinger, Arnold Tsinajinnie, Jennifer M. Warren, Intriga Wounded Head, Theresa (Dawn) Wright, Jenny J. Yazzie, and Sheila A. Young. We would also like to acknowledge the contributions of the Methods Advisory Group: Margarita Alegria, Evelyn J. Bromet, Dedra Buchwald, Peter Guarnaccia, Steven G. Heeringa, Ronald Kessler, R. Jay Turner, and William A. Vega. Finally, we thank the tribal members who so generously answered all the questions asked of them. Data collection was supported by National Institute of Mental Health grants R01 MH48174 (SM Manson and J Beals, PIs) and P01 MH42473 (SM Manson, PI); data analyses and writing by R01 MH073965 (J Beals, PI), R01 MH075831 (Kaufman, PI), and National Institute of Aging’s Native Elder Research Center/Resource Center for Minority Aging Research Native Investigator Program 2P30 AG 15292-12 (SM Manson, PI).

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Mail Stop F800, Nighthorse Campbell Native Health Building, 13055 E. 17th Avenue, Aurora, CO, 80045, USA

    Janette Beals, Calvin Croy, Nancy Rumbaugh Whitesell, Christina M. Mitchell & Spero M. Manson

  2. Departments of Pharmacy Practice/Community and Public Health Sciences, College of Health Professions and Biomedical Sciences, University of Montana, Missoula, MT, USA

    Annjeanette Belcourt-Dittloff

  3. Department of Sociology, Boston College, Chestnut Hill, MA, USA

    Eva M. Garroutte

  4. Department of Anthropology and Center for Applied Social Research, University of Oklahoma, Norman, OK, USA

    Lori L. Jervis

Authors
  1. Janette Beals
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Annjeanette Belcourt-Dittloff
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Eva M. Garroutte
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Calvin Croy
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Lori L. Jervis
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Nancy Rumbaugh Whitesell
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Christina M. Mitchell
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Spero M. Manson
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

The AI-SUPERPFP Team

Corresponding author

Correspondence to Janette Beals.

Additional information

The members of the AI-SUPERPFP Team are given in Appendix.

Appendix

Appendix

In addition to those named, the AI-SUPERPFP team includes Cecelia K. Big Crow, Dedra Buchwald, Buck Chambers, Michelle L. Christensen, Denise A. Dillard, Karen DuBray, Paula A. Espinoza, Candace M. Fleming, Ann Wilson Frederick, Joseph Gone, Diana Gurley, Shirlene M. Jim, Carol M. Kaufman, Ellen M. Keane, Suzell A. Klein, Denise Lee, Monica C. McNulty, Denise L. Middlebrook, Christina M. Mitchell, Laurie A. Moore, Tilda D. Nez, Ilena M. Norton, Douglas K. Novins, Theresa O’Nell, Heather D. Orton, Carlette J. Randall, Angela Sam, James H. Shore, Sylvia G. Simpson, Paul Spicer, and Lorette Yazzie.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Beals, J., Belcourt-Dittloff, A., Garroutte, E.M. et al. Trauma and conditional risk of posttraumatic stress disorder in two American Indian reservation communities. Soc Psychiatry Psychiatr Epidemiol 48, 895–905 (2013). https://doi.org/10.1007/s00127-012-0615-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00127-012-0615-5

Keywords

Search

Navigation