Disparities Research Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
Department of Medicine, Harvard Medical School, Boston, MA, USA.
Psychol Med. 2023 Aug;53(11):5099-5108. doi: 10.1017/S0033291722002112. Epub 2022 Jul 29.
Racial/ethnic differences in mental health outcomes after a traumatic event have been reported. Less is known about factors that explain these differences. We examined whether pre-, peri-, and post-trauma risk factors explained racial/ethnic differences in acute and longer-term posttraumatic stress disorder (PTSD), depression, and anxiety symptoms in patients hospitalized following traumatic injury or illness.
PTSD, depression, and anxiety symptoms were assessed during hospitalization and 2 and 6 months later among 1310 adult patients (6.95% Asian, 14.96% Latinx, 23.66% Black, 4.58% multiracial, and 49.85% White). Individual growth curve models examined racial/ethnic differences in PTSD, depression, and anxiety symptoms at each time point and in their rate of change over time, and whether pre-, peri-, and post-trauma risk factors explained these differences.
Latinx, Black, and multiracial patients had higher acute PTSD symptoms than White patients, which remained higher 2 and 6 months post-hospitalization for Black and multiracial patients. PTSD symptoms were also found to improve faster among Latinx than White patients. Risk factors accounted for most racial/ethnic differences, although Latinx patients showed lower 6-month PTSD symptoms and Black patients lower acute and 2-month depression and anxiety symptoms after accounting for risk factors. Everyday discrimination, financial stress, past mental health problems, and social constraints were related to these differences.
Racial/ethnic differences in risk factors explained most differences in acute and longer-term PTSD, depression, and anxiety symptoms. Understanding how these risk factors relate to posttraumatic symptoms could help reduce disparities by facilitating early identification of patients at risk for mental health problems.
创伤后心理健康结果的种族/民族差异已有报道。对于解释这些差异的因素知之甚少。我们研究了创伤前、创伤中和创伤后风险因素是否可以解释创伤后住院患者的急性和长期创伤后应激障碍（PTSD）、抑郁和焦虑症状的种族/民族差异。
在住院期间以及 2 个月和 6 个月后，对 1310 名成年患者（6.95%为亚洲人，14.96%为拉丁裔，23.66%为黑人，4.58%为多种族裔，49.85%为白人）进行了 PTSD、抑郁和焦虑症状评估。个体增长曲线模型分别检查了每个时间点 PTSD、抑郁和焦虑症状的种族/民族差异及其随时间的变化率，以及创伤前、创伤中和创伤后风险因素是否解释了这些差异。
拉丁裔、黑人和多种族裔患者的急性 PTSD 症状高于白人患者，而黑人患者和多种族裔患者在住院后 2 个月和 6 个月时仍保持较高水平。PTSD 症状也显示出拉丁裔患者比白人患者改善得更快。风险因素解释了大多数种族/民族差异，但在考虑风险因素后，拉丁裔患者的 6 个月 PTSD 症状较低，黑人和患者的急性和 2 个月抑郁和焦虑症状较低。日常歧视、经济压力、过去的心理健康问题和社会限制与这些差异有关。
风险因素的种族/民族差异解释了急性和长期 PTSD、抑郁和焦虑症状的大部分差异。了解这些风险因素与创伤后症状的关系可以通过促进对有心理健康问题风险的患者的早期识别来帮助减少差异。
