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产后女性创伤后精神病理学中的种族和族裔差异。

Racial and ethnic disparities in posttraumatic psychopathology among postpartum women.

作者信息

Thomas Jordan L, Carter Sierra E, Dunkel Schetter Christine, Sumner Jennifer A

机构信息

Department of Psychology, University of California, Los Angeles (UCLA), Los Angeles, CA, USA.

Department of Psychology, Georgia State University, Atlanta, GA, USA; Department of Psychiatry and Behavioral Science, Emory University, Atlanta, GA, USA; Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA.

出版信息

J Psychiatr Res. 2021 May;137:36-40. doi: 10.1016/j.jpsychires.2021.02.030. Epub 2021 Feb 16.

Abstract

People of color in the United States disproportionately bear the burden of trauma and posttraumatic stress disorder (PTSD). Pregnant women of color are at particular risk, as perinatal PTSD is associated with adverse maternal and child health. However, PTSD is a heterogeneous disorder comprising discrete symptom dimensions. Adopting a dimensional understanding of PTSD could aid in identifying women at-risk for the consequences of posttraumatic psychopathology and guide treatment selection. In a large sample of Latina, Black, and non-Hispanic White postpartum women in the United States (N = 1663), we examined racial and ethnic differences in the factors of the dysphoric arousal model-a leading dimensional model of PTSD. This model is characterized by five symptom dimensions: re-experiencing, avoidance, numbing, dysphoric arousal, and anxious arousal. Past-year trauma in this sample was common, afflicting nearly 70% of women. In unadjusted models, women of color exhibited more severe PTSD symptom levels across dimensions except for dysphoric arousal, with Black mothers particularly affected. In models adjusted for age, education, and poverty, Black women continued to report elevated symptoms of avoidance and, relative to Latina mothers, re-experiencing symptoms. In contrast, White women reported more dysphoric arousal symptoms relative to women of color. Illuminating differential patterns of symptom dimensions across racial and ethnic groups is critical to PTSD assessment and treatment and may shed light on disparities. Perinatal healthcare may be an important opportunity for posttraumatic symptom screening, and greater understanding of racial and ethnic variation in posttraumatic symptom dimensions can guide targeted intervention selection for perinatal women.

摘要

美国的有色人种承受着不成比例的创伤和创伤后应激障碍(PTSD)负担。有色人种孕妇面临着特别的风险,因为围产期PTSD与母婴健康不良有关。然而,PTSD是一种异质性疾病,由离散的症状维度组成。采用对PTSD的维度理解有助于识别有创伤后精神病理学后果风险的女性,并指导治疗选择。在美国的一个由拉丁裔、黑人及非西班牙裔白人产后女性组成的大样本(N = 1663)中,我们研究了烦躁不安唤醒模型(一种主要的PTSD维度模型)各因素中的种族和民族差异。该模型的特征在于五个症状维度:重新体验、回避、麻木、烦躁不安唤醒和焦虑唤醒。该样本中过去一年的创伤很常见,近70%的女性受其折磨。在未经调整的模型中,有色人种女性在除烦躁不安唤醒外的各维度上表现出更严重的PTSD症状水平,黑人母亲受影响尤为严重。在针对年龄、教育程度和贫困进行调整的模型中,黑人女性继续报告有更高的回避症状,并且相对于拉丁裔母亲,有更多的重新体验症状。相比之下,白人女性相对于有色人种女性报告了更多的烦躁不安唤醒症状。阐明不同种族和民族群体症状维度的差异模式对于PTSD评估和治疗至关重要,并且可能揭示差异所在。围产期医疗保健可能是进行创伤后症状筛查的重要时机,而对创伤后症状维度中种族和民族差异的更深入理解可以指导为围产期女性选择有针对性的干预措施。

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