PTSD detection and symptom presentation: Racial/ethnic differences by gender among veterans with PTSD returning from Iraq and Afghanistan.

BACKGROUND: To determine differences in positive PTSD screenings and symptom presentation by race/ethnicity and gender for Iraq and Afghanistan veterans diagnosed with PTSD. METHOD: We conducted a retrospective analysis using existing records from Iraq and Afghanistan veterans who enrolled in VA care, received a post-deployment PTSD diagnosis, initiated mental health outpatient treatment between 10/01/07 and 12/31/11, and had a PTSD screen result at the start of treatment (N=79,938). PTSD outcomes were measured using the PC-PTSD and PCL. RESULTS: At treatment initiation, differences in race/ethnicity and gender were found for PTSD screens and PTSD symptoms. Compared to their white counterparts, Asian/Pacific Islander (A/PI) women and black men were more likely to screen positive for PTSD (adjusted ORs=1.42 and 1.17, ps=.04 and <.0001, respectively) and endorse all measured symptoms (adjusted ORs=1.09 to 1.66, ps≤.000-.04) except avoidance for A/PI women and hyperarousal for black men; A/PI men were less likely to endorse hyperarousal (adjusted OR=.88, p=.04) and did not differ otherwise; and black women did not differ from their white counterparts. Additional differences in PTSD symptom presentation by race/ethnicity and gender were found. LIMITATIONS: The current study utilized administrative data and was cross-sectional. The results may not be generalizable to veterans from other service eras. CONCLUSIONS: PTSD screens differ by race/ethnicity and gender, and further by PTSD symptoms, which can influence initiation and planning of PTSD treatment. Awareness of such differences may aid in detecting PTSD to provide care for diverse veterans.

Relationships between racial/ethnic minority status, therapeutic alliance, and treatment expectancies among veterans with PTSD.

Our objective was to examine the relationships between veterans' racial/ethnic minority status, components of therapeutic alliance (bond, tasks, and goals) with former outpatient providers, and expectancies for Department of Veterans Affairs (VA) posttraumatic stress disorder (PTSD) residential treatment. Veterans (N = 819; 37% minority, 63% White) completed surveys at intake into VA PTSD residential treatment programs. As hypothesized, racial/ethnic minority status was related to weaker overall alliance, therapeutic bond, and goal agreement with former outpatient provider. Alliance with former provider was also associated with expectancies for residential treatment. After controlling for other variables, task agreement (not therapeutic bond) and racial/ethnic minority status were linked to higher expectancies. However, effect sizes were small. Thus, we found little evidence of clinically significant differences by racial/ethnic minority status on expectancies of VA PTSD residential treatment. Future research should investigate these relationships among veterans with PTSD not admitted to VA PTSD residential treatment and in other treatment settings, as well as nonveteran racial/ethnic minorities with PTSD. (PsycINFO Database Record

Minimally adequate mental health care and latent classes of PTSD symptoms in female Iraq and Afghanistan veterans.

Female veterans of Operations Enduring and Iraqi Freedom, and Operation New Dawn (OEF/OIF/OND) represent a growing segment of Department of Veterans Affairs (VA) health care users. A retrospective analysis used national VA medical records to identify factors associated with female OEF/OIF/OND veterans' completion of minimally adequate care (MAC) for PTSD, defined as the completion of at least nine mental health outpatient visits within a 15-week period or at least twelve consecutive weeks of medication use. The sample included female OEF/OIF/OND veterans with PTSD who initiated VA health care between 2007-2013, and were seen in outpatient mental health (N=2183). Multivariable logistic regression models examined factors associated with completing MAC for PTSD, including PTSD symptom expression (represented by latent class analysis), sociodemographic, military, clinical, and VA access factors. Within one year of initiating mental health care, 48.3% of female veterans completed MAC. Race/ethnicity, age, PTSD symptom class, additional psychiatric diagnoses, and VA primary care use were significantly associated with completion of MAC for PTSD. Results suggest that veterans presenting for PTSD treatment should be comprehensively evaluated to identify factors associated with inadequate completion of care. Treatments that are tailored to PTSD symptom class may help to address potential barriers.

Race/ethnicity and gender differences in mental health diagnoses among Iraq and Afghanistan veterans.

Veterans who served in Operation Enduring Freedom (OEF; predominantly in Afghanistan) and Operations Iraqi Freedom and New Dawn (OIF and OND; predominantly in Iraq) and are enrolled in the VA are comprised of a growing cohort of women and higher proportions of racial/ethnic minorities than civilians. To compare rates of mental health disorders by race/ethnicity and gender for this diverse cohort, we conducted a retrospective analysis of existing records from OEF/OIF/OND veterans who were seen at the VA 10/7/01-8/1/2013 (N=792,663). We found that race/ethnicity was related to diagnoses of mental health disorders. Asian/Pacific Islanders (A/PIs) were diagnosed with all disorders at lower rates than whites, and American Indian/Alaska Native (AI/AN) males were diagnosed with most disorders at higher rates than white males. Research is needed to identify contributing factors to differential rates of diagnoses based on race/ethnicity and gender. A/PIs and AI/ANs have unique patterns of mental health diagnoses indicating they should be considered separately to present a comprehensive picture of veteran mental health.

Latent profiles of PTSD symptoms in women exposed to intimate partner violence.

BACKGROUND: Studies have utilized latent class analysis (LCA) and latent profile analysis (LPA) to examine posttraumatic stress disorder (PTSD) symptom profiles in a range of populations. Further study is needed to explore symptom profiles among women exposed to intimate partner violence (IPV). The current study examined latent symptom profiles in a sample of IPV-exposed women, and explored trauma-related cognitive appraisals associated with these PTSD symptom presentations. METHODS: An LPA was conducted using cross-sectional data from a non-treatment seeking community sample of women recruited following a police-reported incident of IPV by a male perpetrator (N=229). Multinomial regression analyses determined associations between latent profile membership and trauma-related appraisals. RESULTS: The LPA identified five PTSD symptom profiles: Low Symptom (46% of the sample); Low Symptom with High Hypervigilance (17%); Intermediate Symptom (16%); Intermediate Symptom with High Hypervigilance (11%); and High Symptom (10%). Trauma-related appraisals, including fear, alienation, and self-blame, were the strongest independent predictors of PTSD symptom profile membership. LIMITATIONS: The study focused on female victims of IPV by a male partner, and findings may not generalize to other gender configurations (e.g. same-sex couples, male victims, etc.). The LPA is cross-sectional, and the stability of these profiles over time warrants further study. CONCLUSIONS: These findings suggest the need for careful consideration of differences among IPV-exposed women within the larger context of PTSD research and clinical intervention. Identifying latent subgroups may provide an empirical basis for practitioners to design and implement PTSD intervention efforts that are tailored to specific symptom profiles.

Race-ethnicity and gender differences in VA health care service utilization among U.S. veterans of recent conflicts.

OBJECTIVE: The purpose of this study was to compare health care utilization patterns by race-ethnicity and gender among veterans returning from Iraq and Afghanistan. METHODS: A retrospective analysis was conducted with records from U.S. service members and veterans returning from Iraq and Afghanistan who enrolled in health care through the Veterans Health Administration, who received a psychiatric diagnosis, and who had used primary or mental health outpatient care between October 7, 2001, and December 31, 2012 (N=309,050). Racial-ethnic minority groups were first collapsed together and compared with whites and then separated by racial-ethnic group. Gender was also tested as a moderator of utilization. RESULTS: Although rates of mental health outpatient care, primary care, and emergency service utilization were relatively similar for racial-ethnic minority groups and whites, minority groups were admitted to psychiatric inpatient care at lower rates than whites. When veterans were separately categorized by specific racial-ethnic groups, some differences in utilization rates emerged; most notably, only black and Hispanic men were admitted less frequently to psychiatric inpatient care, and male and female Asian/Pacific Islander veterans used emergency services less, than their white counterparts. Gender moderated the association between race-ethnicity and mental health outpatient use, such that American Indian and Hispanic women used mental health outpatient services less than white women, but American Indian and Hispanic men showed the opposite pattern. Furthermore, black men were more likely than white men to use mental health outpatient services, but there was no difference between these women. CONCLUSIONS: Although service utilization rates between minority groups and whites were similar when minority groups were combined, examination of utilization by racial-ethnic groups and by men and women separately yielded more robust findings.

Use of drinking protective behavioral strategies and sexual perceptions and behaviors in U.S. college students.

Alcohol use among college students is linked to an increased likelihood of engaging in risky sexual behaviors, including casual sex and unprotected sex. These behaviors increase college students' risks for negative social and health-related consequences. This study examined the relationship between drinking behaviors and protective behavioral strategies (PBS), expectancies and perceptions of sexual risk, and actual alcohol-related sexual behaviors and consequences. Sexually active college students completed Web-based self-report measures of drinking behaviors and use of PBS, alcohol expectancies and perceptions of risk, and sexual behaviors and related consequences (n = 524; 57.1% women). Findings indicated that PBS were related to lower expectancies of sexual risk and sexual disinhibition, and among lighter drinkers, lower expectancies of sexual enhancement from alcohol. PBS were also related to decreased perceptions of sexual-related risks, some alcohol-related sexual behaviors, including number of drinks before/during sex, and number of sexual consequences, but were not related to abstaining during sex, frequency of alcohol-related sexual behaviors, or general condom use. These findings demonstrate a disconnect between perceived and actual risks among college students, such that decreased perceptions of risk may not be associated with protective behaviors. Prevention and intervention implications are discussed.

The cultural context of nondisclosure of alcohol-involved acquaintance rape among Asian American college women: a qualitative study.

With high college enrollment and increasing alcohol use, Asian American (AA) college women may be at particular risk for experiencing alcohol-involved acquaintance rape. Although AA women have expressed the weakest intentions to report rape when compared to other ethnic groups, cultural factors influencing these intentions remain unexamined. Guided by grounded theory, 17 self-identified AA college women were interviewed about how the average AA college woman would respond to an alcohol-involved acquaintance rape. Despite awareness of benefits of disclosing rape, participants emphasized that nondisclosure would be the normative response. Three themes emerged from participants: institutional, sociocultural, and psychological contexts of nondisclosure. At an institutional level, nondisclosure referenced mental health and police services, which included Asian stereotypes and mistrust of police. Within a sociocultural context, rape nondisclosure focused on negative consequences on relationships with parents and, to a lesser extent, on friendships. Emotional avoidance and not labeling an acquaintance rape as rape were psychological strategies for rape nondisclosure. Participant's conceptualizations of mental and physical health concerns, specifically post-rape concerns, were framed within sociocultural/macrostructural contexts and may not match that of the more individualistic U.S. mainstream conceptualizations of health. Culturally sensitive rape education may be more effective in increasing rape prevention and support.

Posttraumatic Cognitions, Somatization, and PTSD severity among Asian American and White College Women with Sexual Trauma Histories.

The need for trauma research with monoracial groups such as Asian Americans (AA) has recently been emphasized to better understand trauma experiences and inform interventions across populations. Given AA cultural contexts, posttraumatic cognitions and somatization may be key in understanding trauma experiences for this group. AA and White American (WA) trauma-exposed college women completed a survey on sexual trauma history, posttraumatic cognitions, somatic symptoms, and PTSD severity. For the overall sample, higher negative cognitions were associated with higher somatization. Asian race was associated with higher negative cognitions, which then predicted higher PTSD. Unexpectedly, WAs more strongly endorsed somatization than AAs. These findings indicate that posttraumatic cognitions may be helpful in understanding relationships between somatization and PTSD severity among those of Asian backgrounds and that the relationship between somatization and PTSD symptoms is culturally complex.

Sexual assault, drinking norms, and drinking behavior among a national sample of lesbian and bisexual women.

Childhood sexual abuse (CSA) and adolescent/adult sexual assault (ASA) are strongly associated with women's alcohol use and the rates of both alcohol use and sexual assault history are higher among lesbian and bisexual women than heterosexual women. Although descriptive drinking norms are one of the highest predictors of alcohol use in emerging adults, this is the first study to examine the relationship between sexual assault history, drinking norms, and alcohol use in lesbian and bisexual women. We found that CSA severity was associated with a higher likelihood of experiencing more severe alcohol-involved ASA, more severe physically forced ASA, and was indirectly associated with more drinking behavior and higher drinking norms. Additionally, more severe alcohol-involved ASA was associated with higher drinking norms and more drinking behavior, but physically forced ASA was not. These findings help explain previous contradictory findings and provide information for interventions.

Risky sex: interactions among ethnicity, sexual sensation seeking, sexual inhibition, and sexual excitation.

Rates of sexually transmitted infections, including HIV, vary across ethnic minority groups, yet few studies have evaluated sexual risk behaviors and their psychological correlates to determine if risk and protective factors vary by ethnicity. The purpose of the current study was to assess sexual sensation seeking (SSS), sexual inhibition (SIS1 and SIS2), and sexual excitation (SES) as correlates of risky sexual behaviors in 106 (55 male and 51 female) Asian Americans, African Americans, and Caucasian Americans. Results revealed that higher SSS was associated with more vaginal and anal sex partners. Further, the association between SSS and the number of anal sex partners was positive among Asian Americans and Caucasians, but non-significant among African Americans. SIS1 was positively associated with unprotected sex on the first date among Asian Americans and African Americans. However, the association was not significant for Caucasians. SIS2 was negatively associated with general unprotected sex, and SES was positively associated with the number of vaginal sex partners. Findings suggest that ethnicity plays an important moderating role in the relationship between sexual traits and risky sexual behaviors.

Misogyny, acculturation, and ethnic identity: relation to rape-supportive attitudes in Asian American college men.

Asian Americans have been understudied with respect to sexuality and rape and its contributory factors. Some attitudinal research has shown that Asian American college males tend to hold more rape-supportive beliefs than their White counterparts. Generally, this research treats ethnicity as a proxy for culture rather than examining specific facets of culture per se. The current study incorporated measures of misogynistic beliefs, acculturation, and ethnic identity to investigate these ethnic differences in rape-supportive attitudes. White (n = 222) and Asian American (n = 155) college men read an acquaintance rape vignette and evaluated it on four judgments: how much they blamed the perpetrator and the victim, how credible they viewed the victim's refusal, and to what degree they defined the event as rape. Consistent with previous research, Asian American men made more rape-supportive judgments than Whites. This relationship was partially mediated by misogynistic beliefs for all judgments except the extent to which they defined the vignette as rape. Among Asian Americans, acculturation was negatively associated with all four rape vignette judgments above and beyond generational status, and ethnic identity was positively associated with two of the four judgments above and beyond acculturation and generational status. These findings suggest that cultural constructs are relevant to understanding rape-supportive attitudes among Asian American men, and may be useful for promoting culturally enhanced theoretical models of rape and sexual assault prevention efforts, as well as a deeper understanding of cultural influences on sexuality.