General Hospital Psychiatry
Volume 31, Issue 6 , Pages 505-514, November 2009

Trauma exposure and stress-related disorders in inner city primary care patients☆

  • Charles F. Gillespie, M.D., Ph.D.

      Affiliations

    • Departments of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30322, USA
    • ,
  • Bekh Bradley, Ph.D.

      Affiliations

    • Departments of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30322, USA
    • Atlanta VA Medical Center, Emory University, Atlanta, GA 30033, USA
    • ,
  • Kristie Mercer, M.P.H.

      Affiliations

    • Department of Human Genetics, Emory University School of Medicine, Atlanta, GA 30322, USA
    • ,
  • Alicia K. Smith, Ph.D.

      Affiliations

    • Departments of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30322, USA
    • Department of Human Genetics, Emory University School of Medicine, Atlanta, GA 30322, USA
    • ,
  • Karen Conneely, Ph.D.

      Affiliations

    • Department of Human Genetics, Emory University School of Medicine, Atlanta, GA 30322, USA
    • ,
  • Mark Gapen, Ph.D.

      Affiliations

    • Departments of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30322, USA
    • ,
  • Tamara Weiss, M.D.

      Affiliations

    • Departments of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30322, USA
    • ,
  • Ann C. Schwartz, M.D.

      Affiliations

    • Departments of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30322, USA
    • ,
  • Joseph F. Cubells, M.D., Ph.D.

      Affiliations

    • Departments of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30322, USA
    • Department of Human Genetics, Emory University School of Medicine, Atlanta, GA 30322, USA
    • ,
  • Kerry J. Ressler, M.D., Ph.D.

      Affiliations

    • Departments of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30322, USA
    • Howard Hughes Medical Institute, Emory University, Atlanta, GA 30322, USA
    • Yerkes National Primate Research Center, Emory University, Atlanta, GA 30329, USA
    • Corresponding Author InformationCorresponding author. Yerkes Research Center, Emory University, Atlanta, GA 30329, USA. Tel.: +1 404 727-7739; fax: +1 404 727 8644.

Received 8 January 2009; accepted 6 May 2009. published online 10 June 2009.

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.

Keywords: Posttraumatic Stress Disorder, Depression, African-American, Minority, Trauma, Child Abuse, Childhood Maltreatment, Psychiatry

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☆ Financial disclosure statement: There were no commercial sponsors or commercial relationships related to the current work. All additional past and present financial ties of the investigators are disclosed herein. Dr. Gillespie has received funding from APIRE/Wyeth, NARSAD, NIDA and NIMH. Dr. Ressler has received awards and/or funding support related to other studies from Lundbeck, Burroughs Wellcome Foundation, Pfizer, NARSAD, NIMH, NIDA and previously had a consulting agreement with Tikvah Therapeutics for NMDA-based therapeutics. Dr. Bradley has received funding from AFSP. Dr. Ressler had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. None of the above funding agencies had any role in the design and conduct of the study; collection, management, analysis and interpretation of the data; and preparation, review, or approval of the manuscript.

PII: S0163-8343(09)00090-5

doi:10.1016/j.genhosppsych.2009.05.003

General Hospital Psychiatry
Volume 31, Issue 6 , Pages 505-514, November 2009

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