RESEARCH WEEKLY: Underdiagnosed PTSD Among African American Individuals with Serious Mental Illness
By Morré Taylor
(September 14, 2022) African Americans, in general, are at a high risk of developing posttraumatic stress disorder (PTSD)— a mental health disorder in which a person struggles to recover from a traumatic event that they witnessed or experienced. A 2019 study found than African Americans have the highest lifetime prevalence of PTSD (8.7%) compared to their white (7.4%), Latino (7%) and Asian (4%) counterparts. This high rate of PTSD among African Americans is likely because this demographic is more likely to experience traumatic events such as childhood neglect and domestic violence.
PTSD among African Americans is an important mental health issue because African Americans are less likely than other racial groups to receive mental health treatment, in part because they disproportionately experience barriers to treatment such as financial challenges, inadequate access to transportation services and/or a lack of knowledge about how to access treatment.
When African Americans have serious mental illness, there is an even greater probability that they also have PTSD, according to a recent study from Rutgers University. People with serious mental illness are uniquely vulnerable to violent victimization, especially considering this population’s high rate of homelessness and time spend in jail, which can significantly increase one’s chances of developing PTSD. As such, individuals who experience victimization due to their race and mental health status are likely to be at a high risk for developing PTSD.
The authors of this study investigated trauma exposure, PTSD symptoms and the rate of PTSD in African American individuals with serious mental illness. Study participants were clients receiving services at Rutgers University Behavioral Health Care who participated in one of five outpatient and partial hospitalization programs.
From 2007 through 2010, potential participants were screened using a 16-item Traumatic Life Events Questionnaire that asked about experiences related to traumatic events and used wording that corresponded with the DSM-IV criterion for PTSD. Participants who indicated “yes” to any of the 16 items underwent a second screening in which a clinician used a checklist, referred to as a PCL, to identify cases of probable PTSD and PTSD symptom severity for the traumatic event(s) identified by the participant in the initial questionnaire.
A total of 404 African American participants who reported experiencing at least one traumatic event, had a PCL score of at least 45, indicating probable PTSD, and were diagnosed with a serious mental illness were included in the final study results.
Although all of the participants in the study were positively screened as having significant indicators of PTSD, only 18.3% of all participants had PTSD documented in their medical records. Participants with schizophrenia had the lowest rate of diagnosed PTSD at 4.3% compared to 26.2% among the participants with major depressive disorder and 7.7% among participants with bipolar disorder. The authors hypothesize that the overall underdiagnosis of PTSD is in part because there is overlap between PTSD symptoms and symptoms of serious mental illness such as delusions, depression and suicidality.
With regards to the severity of PTSD symptoms, the researchers of this study found that participants with schizophrenia displayed less severe symptoms of PTSD compared to those with mood disorders. This trend is likely why the rate of diagnosed PTSD was lowest among participants with schizophrenia.
Participants most commonly identified the sudden death of a loved one, physical abuse, sexual abuse and domestic violence as traumatic events they had experienced. Childhood sexual abuse, more specifically, was identified as being the most distressing traumatic event experienced by participants. Previous research cited in the study found that rates of childhood sexual abuse among people with serious mental illness is approximately 18.5%, which is much lower than the rate of childhood sexual abuse among the studied sample of African Americans (64%).
The findings of this study suggest that PTSD is underdiagnosed among African American individuals with serious mental illness. As a result, the authors suggest that current treatment for this population may fail to address PTSD and stunt treatment progression. As such, there is a need for more a routine assessment of PTSD and traumatic histories in African Americans with serious mental illness who receive community mental health services. According to the authors, culturally sensitive counseling services, particularly as it pertains to childhood sexual abuse and grief, which were major sources of trauma among the studied sample, are needed to adequately address PTSD in African Americans with serious mental illness and should be appropriately incorporated into treatment.
Lu, W., Silverstein, S. M., Mueser, K. T., et al. (July 2022). Undocumented PTSD among African American clients with serious mental illness in a statewide mental health system. Psychological Trauma: Theory, Research, Practice, and Policy.