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Prior differences in previous trauma exposure primarily drive the observed racial/ethnic differences in posttrauma depression and anxiety following a recent trauma

Published online by Cambridge University Press:  31 January 2022

N. G. Harnett ,
N. M. Dumornay ,
M. Delity ,
L. D. Sanchez ,
K. Mohiuddin ,
P. I. Musey Jr. ,
M. J. Seamon ,
S. A. McLean Open the ORCID record for S. A. McLean [Opens in a new window] ,
R. C. Kessler  and
K. C. Koenen
...Show all authors
N. G. Harnett*
Affiliation:
Division of Depression and Anxiety, McLean Hospital, Belmont, MA 02478, USA Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
N. M. Dumornay
Affiliation:
Division of Depression and Anxiety, McLean Hospital, Belmont, MA 02478, USA
M. Delity
Affiliation:
Division of Depression and Anxiety, McLean Hospital, Belmont, MA 02478, USA
L. D. Sanchez
Affiliation:
Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA Department of Emergency Medicine, Harvard Medical School, Boston, MA 02115, USA
K. Mohiuddin
Affiliation:
Department of Emergency Medicine, Einstein Medical Center, Philadelphia, PA 19141, USA
P. I. Musey Jr.
Affiliation:
Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
M. J. Seamon
Affiliation:
Department of Surgery, Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Pennsylvania, PA 19104, USA
S. A. McLean
Affiliation:
Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27559, USA Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27559, USA
R. C. Kessler
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, USA
K. C. Koenen
Affiliation:
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA
F. L. Beaudoin
Affiliation:
Department of Emergency Medicine & Department of Health Services, Policy, and Practice, The Alpert Medical School of Brown University, Rhode Island Hospital and The Miriam Hospital, Providence, RI 02930, USA
L. A. M. Lebois
Affiliation:
Division of Depression and Anxiety, McLean Hospital, Belmont, MA 02478, USA Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
S. J. H. van Rooij
Affiliation:
Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30332, USA
N. A. Sampson
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, USA
V. Michopoulos
Affiliation:
Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30332, USA
J. L. Maples-Keller
Affiliation:
Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30332, USA
J. P. Haran
Affiliation:
Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA 01655, USA
A. B. Storrow
Affiliation:
Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, USA
C. Lewandowski
Affiliation:
Department of Emergency Medicine, Henry Ford Health System, Detroit, MI 48202, USA
P. L. Hendry
Affiliation:
Department of Emergency Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, FL 32209, USA
S. Sheikh
Affiliation:
Department of Emergency Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, FL 32209, USA
C. W. Jones
Affiliation:
Department of Emergency Medicine, Cooper Medical School of Rowan University, Camden, NJ 08103, USA
B. E. Punches
Affiliation:
Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA College of Nursing, University of Cincinnati, Cincinnati, OH 45221, USA
M. C. Kurz
Affiliation:
Department of Emergency Medicine, University of Alabama School of Medicine, Birmingham, AL 35294, USA Department of Surgery, Division of Acute Care Surgery, University of Alabama School of Medicine, Birmingham, AL 35294, USA Center for Injury Science, University of Alabama at Birmingham, Birmingham, AL 35294, USA
R. A. Swor
Affiliation:
Department of Emergency Medicine, Oakland University William Beaumont School of Medicine, Rochester, MI 48309, USA
M. E. McGrath
Affiliation:
Department of Emergency Medicine, Boston Medical Center, Boston, MA 02118, USA
L. A. Hudak
Affiliation:
Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA 30329, USA
J. L. Pascual
Affiliation:
Department of Surgery, Department of Neurosurgery, University of Pennsylvania, Pennsylvania, PA 19104, USA Perelman School of Medicine, University of Pennsylvania, Pennsylvania, PA 19104, USA
S. L. House
Affiliation:
Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO 63130, USA
X. An
Affiliation:
Department of Anesthesiology, Institute for Trauma Recovery, University of North Carolina at Chapel Hill, Chapel Hill, NC 27559, USA
J. S. Stevens
Affiliation:
Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30329, USA
T. C. Neylan
Affiliation:
Departments of Psychiatry and Neurology, University of California San Francisco, San Francisco, CA 94143, USA
T. Jovanovic
Affiliation:
Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI 48202, USA
S. D. Linnstaedt
Affiliation:
Department of Anesthesiology, Institute for Trauma Recovery, University of North Carolina at Chapel Hill, Chapel Hill, NC 27559, USA
L. T. Germine
Affiliation:
Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA Institute for Technology in Psychiatry, McLean Hospital, Belmont, MA 02478, USA
E. M. Datner
Affiliation:
Department of Emergency Medicine, Einstein Healthcare Network, Pennsylvania, PA 19141, USA Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Pennsylvania, PA 19107, USA
A. M. Chang
Affiliation:
Department of Emergency Medicine, Jefferson University Hospitals, Pennsylvania, PA 19107, USA
C. Pearson
Affiliation:
Department of Emergency Medicine, Wayne State University, Detroit, MA 48202, USA
D. A. Peak
Affiliation:
Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
R. C. Merchant
Affiliation:
Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA
R. M. Domeier
Affiliation:
Department of Emergency Medicine, Saint Joseph Mercy Hospital, Ypsilanti, MI 48197, USA
N. K. Rathlev
Affiliation:
Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield, MA 01107, USA
B. J. O'Neil
Affiliation:
Department of Emergency Medicine, Wayne State University, Detroit, MA 48202, USA
P. Sergot
Affiliation:
Department of Emergency Medicine, McGovern Medical School, University of Texas Health, Houston, TX 77030, USA
S. E. Bruce
Affiliation:
Department of Psychological Sciences, University of Missouri – St. Louis, St. Louis, MO 63121, USA
M. W. Miller
Affiliation:
National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, Boston, MA 02130, USA Department of Psychiatry, Boston University School of Medicine, Boston, MA 02118, USA
R. H. Pietrzak
Affiliation:
National Center for PTSD, Clinical Neurosciences Division, VA Connecticut Healthcare System, West Haven, CT 06516, USA Department of Psychiatry, Yale School of Medicine, West Haven, CT 06510, USA
J. Joormann
Affiliation:
Department of Psychology, Yale University, West Haven, CT 06520, USA
D. M. Barch
Affiliation:
Department of Psychological & Brain Sciences, Washington University in St. Louis, St. Louis, MO 63130, USA
D. A. Pizzagalli
Affiliation:
Division of Depression and Anxiety, McLean Hospital, Belmont, MA 02478, USA Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
J. F. Sheridan
Affiliation:
Department of Biosciences, OSU Wexner Medical Center, Columbus, OH 43210, USA Institute for Behavioral Medicine Research, OSU Wexner Medical Center, Columbus, OH 43211, USA
J. W. Smoller
Affiliation:
Department of Psychiatry, Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Boston, MA 02114, USA Stanley Center for Psychiatric Research, Broad Institute, Cambridge, MA 02142, USA
B. Luna
Affiliation:
Affiliation Laboratory of Neurocognitive Development, University of Pittsburgh Medical Center – Western Psychiatric Hospital, Pittsburgh, PA 15213, USA
S. E. Harte
Affiliation:
Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI 48109, USA Department of Internal Medicine-Rheumatology, University of Michigan Medical School, Ann Arbor, MI 48109, USA
J. M. Elliott
Affiliation:
The Kolling Institute, University of Sydney, St Leonards, New South Wales 2065, Australia Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales 2006, Australia Physical Therapy & Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL 60208, USA
K. J. Ressler
Affiliation:
Division of Depression and Anxiety, McLean Hospital, Belmont, MA 02478, USA Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
*
Author for correspondence: Nathaniel G. Harnett, E-mail: nharnett@mclean.harvard.edu
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Abstract

Background

Racial and ethnic groups in the USA differ in the prevalence of posttraumatic stress disorder (PTSD). Recent research however has not observed consistent racial/ethnic differences in posttraumatic stress in the early aftermath of trauma, suggesting that such differences in chronic PTSD rates may be related to differences in recovery over time.

Methods

As part of the multisite, longitudinal AURORA study, we investigated racial/ethnic differences in PTSD and related outcomes within 3 months after trauma. Participants (n = 930) were recruited from emergency departments across the USA and provided periodic (2 weeks, 8 weeks, and 3 months after trauma) self-report assessments of PTSD, depression, dissociation, anxiety, and resilience. Linear models were completed to investigate racial/ethnic differences in posttraumatic dysfunction with subsequent follow-up models assessing potential effects of prior life stressors.

Results

Racial/ethnic groups did not differ in symptoms over time; however, Black participants showed reduced posttraumatic depression and anxiety symptoms overall compared to Hispanic participants and White participants. Racial/ethnic differences were not attenuated after accounting for differences in sociodemographic factors. However, racial/ethnic differences in depression and anxiety were no longer significant after accounting for greater prior trauma exposure and childhood emotional abuse in White participants.

Conclusions

The present findings suggest prior differences in previous trauma exposure partially mediate the observed racial/ethnic differences in posttraumatic depression and anxiety symptoms following a recent trauma. Our findings further demonstrate that racial/ethnic groups show similar rates of symptom recovery over time. Future work utilizing longer time-scale data is needed to elucidate potential racial/ethnic differences in long-term symptom trajectories.

Keywords

Disparitiesethnicityracetraumaanxietydepression
Type
Original Article
Information
Psychological Medicine , Volume 53 , Issue 6 , April 2023 , pp. 2553 - 2562
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Copyright
Copyright © The Author(s), 2022. Published by Cambridge University Press

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